Ask the doctor: Our scrooge GP wants me to switch to cheaper statins (2022)

Our scrooge GP wants me to switch to cheaper statins


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My husband, who is 80, has for some years taken atorvastatin. His doctor has asked if he could change to pravastatin sodium, which costs the NHS much less, but does the same thing.

Could you please let me know what the difference is? After all these years I am wondering why the change.

Mrs D.R. Dullard, London

Ask the doctor: Our scrooge GP wants me to switch to cheaper statins (1)

GPs are under pressure to prescribe less expensive options to their patients on long-term medicine

There are five different statins on the market, and the drive to change your husband from atorvastatin to pravastatin is, as your doctor explained, about saving money.

GPs are under pressure to prescribe less expensive options to their patients on long-term medicines, particularly when there’s nothing to choose between products in terms of either effectiveness or side effects.

There are often huge differences in price between similar medicines — this is because when a medicine is discovered by a drug manufacturer, a vast amount of time and expenditure is taken up with trials to confirm effectiveness and exclude any possibility of long-term harm.

The company then has a ten-year period in which to re-coup those development costs.

After this period they lose the exclusive rights to the ‘recipe’, or patent, for the drug and anyone can produce it.

For the statins, that development period was extensive, and involved around 20 years of investment. Atorvastatin (best known to patients under its trade name, Lipitor) is still within patent until this May and a pack of 10mg tablets cost £13.

Statins which are no longer under patent are cheaper — for instance, pravastatin (which used to be sold under the trade name Lipostat), costs £1.58 for a pack, and simvastatin (trade name Zocor) is only 81p.

You can see how switching to these would make significant savings, especially when patients require higher doses to control cholesterol.

But what a GP needs to think about when changing a patient’s drug is the small but significant differences between the various statins, including their side-effects.


To contact Dr Scurr with a health query, write to him at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email - including contact details.

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His replies cannot apply to individual cases and should be taken in a general context.

Always consult your own GP with any health worries.

A vast study (known as the JUPITER study) tested one type of statin, rosuvastatin, on over 17,000 people, half of them on the genuine pill, and half on placebo — a dummy pill.

While there has been some controversy about that trial (including how clear its results were for people who hadn’t had a heart attack), at the very least we did learn that the side-effects of the statin were much lower than popularly thought.

Nevertheless, there are subtle differences in the way that different statins are absorbed into the system and the way they work in the liver to lower cholesterol levels.

This may be the reason why some people tolerate different statins better than others.

However, what we cannot yet predict is who will react in which way to what, as everyone is different. But if your husband tolerated atorvastatin, the likelihood is that he will accept pravastatin without difficulty, as this is the usual experience.

The efficiency and safety of statins in reducing coronary heart disease, strokes, and total mortality is well proven — this is essential medication for your husband. I very much expect that your husband will be able to migrate from atorvastatin to pravastatin smoothly.

For many years I have been treated for acid reflux.

I have now been offered a keyhole operation which takes a part of your stomach and folds it over the damaged part.

Could you explain this procedure, and the risks involved?

Mr P. Kenneally, Liverpool.

After years of taking medicines to suppress acid production in your stomach, the thought of an operation to solve the issue must be welcome.

However, I understand the reluctance anyone might feel at the thought of surgery, even keyhole. But before I answer your question let me explain what’s been behind your troublesome symptoms.

The gullet, or oesophagus, is a muscular tube that runs down from the throat, and enters the stomach. At the lower end is a sphincter, a valve, which opens when you swallow. It also opens to allow swallowed air to be passed back upwards.

Most episodes of reflux — when food or stomach acid spills up into the gullet — occur during these brief periods when the valve is open.

This causes the characteristic pain in the centre of the chest, or heartburn and indigestion. If these brief valve openings become more frequent, this is called gastro-oesophageal reflux disease or GORD, which is what you have.

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Typically, GPs treat the condition with medicines to suppress acid production (you tell me you are taking lansoprazole, a common treatment). Patients should also be advised to lose weight, minimise their intake of tea, coffee, and alcohol, and avoid heavy meals before bedtime.

The risk with long-term, untreated acid reflux is Barrett’s oesophagus, a condition named after a surgeon at St Thomas’ Hospital. This is where the acid has triggered an unhealthy change in the lining of the gullet that can then turn cancerous.

The only way to diagnose the condition is with an endoscopy — where a thin tube with a camera and instruments is passed down the throat.

Anyone found to have the condition has to be re-inspected every two years as the risk of cancerous change is 20 times greater than the risk for the general population.

Once diagnosed, a patient will be offered either medication to prevent further acid reflux, or an operation.

You have been offered the latter, by a keyhole technique. The risks include a small mortality rate, less than one in a thousand. There is also a 5 per cent risk the surgery doesn’t prevent reflux, or causes side-effects such as difficulty in swallowing or upper abdominal discomfort.

There are a few different operations, but all involve wrapping the top of the stomach around the bottom of the gullet. This not only helps to strengthen the valve, but means that when the stomach contracts it also squeezes the base of the gullet, preventing acid from escaping.

However, surgery will not remove the cancer risk; you would need to have the surveillance endoscopies every two years in the future. Your specialist will advise you about this.

I wish you luck, and a healthy symptom-free future.

By the way... The jury's still out on cancer screening

Ask the doctor: Our scrooge GP wants me to switch to cheaper statins (2)

It is worth attempting to screen every middle-aged woman in the country, when there's a risk they could end up undergoing unnecessary and invasive treatment?

Is screening a good idea?

By screening I mean the process of subjecting healthy people to tests to try to detect disease early, on the basis that early diagnosis leads to better chances of cure.

It’s a question very much in the ether at the moment, with the national breast cancer screening programme currently being assessed by the cancer tsar, Professor Sir Mike Richards.

A woman who’s had a microscopic breast cancer discovered during a routine mammogram — and who’s then cured by local surgery — would not argue against screening.

The bigger question is whether it’s worth attempting to screen every middle-aged woman in the country, when there’s a risk they could end up undergoing unnecessary and invasive treatment.

There are those who suggest it’s better to wait until there is a symptom — a lump is found on clinical examination — and reserve mammograms for these cases.

Prostate cancer is another common malignancy where there is a complex debate about screening.

If results of a blood test, the prostate specific antigen blood test (PSA), are outside the normal range this is taken to be suggestive of cancer.

However, there are many problems with this test — the most significant is that many cancer-free men also produce abnormally high results.

Put simply, it is not a very specific test. Yet it can mean many men end up having a prostate biopsy even though they don’t have cancer. The risk is that the procedure can cause blood poisoning and worse.

Furthermore, many men who are found to have a small area of cancer, say as big as a pea (the prostate itself is the size of a golf ball), may live for years without the cancer growing or producing symptoms, and will ultimately die of something else.

Operating on these men, with all the complications of major surgery — or even subjecting them just to radiotherapy — may also be unwise.

We do know that routine PSA blood testing, across a community, does not ultimately save lives.

The problem is that the genie is out of the bottle — people want to be screened, they want to know.

How are we going to resolve this? The research, and the debate, must go on.

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