Highlights
- American Cardiac Societies lower age for statins: UHO recommends Indian studies.
- Secret UK-USA drug deal: Lack of transparency may be due to pharma lobbying.
- Lack of transparency on doctor-industry interactions in the UK
By Dr. Amitav Banerjee, Chairperson of the Universal Health Organisation (UHO)
American Cardiac Societies lower age for statins: UHO recommends Indian studies.
A paper in the Journal of American Medical Association (JAMA), recommends doctors to consider prescribing statins based on patient’s future risk starting at age 30 instead of the previous recommendation of 40 years. Key aspects of the recommendations are as follows:
Extended Age Range: Risk evaluation now begins at age 30 instead of 40.
Long-Term Horizon: Doctors assess multi-decade and 30-year risk rather than just a 10-year outlook.
Selective Medication: Only about 11% of adults in their 30s qualify for statins, primarily those with high LDL (160 mg/dL or higher), a strong family history of early heart disease, or specific conditions like chronic kidney disease.
According to a report in the ETHealthworld, the new guidelines mean more statins for more people. The recommendations have been issued jointly by The American Heart Association, The American College of Cardiology and other professional societies. Most of these societies receive sponsorships from the pharmaceutical industry.
The literature review undertaken by UHO reveals controversy around over-prescriptions of statins. A peer reviewed paper in World Journal of Cardiology has emphasized that the true effect of cholesterol lowering statin drugs are debatable. In particular, whether statins actually decrease cardiac mortality and increase life expectancy is controversial. Concurrently, lifestyle changes including dietary modifications, has been shown to prolong life and reduce the risk of diabetes, cancer, and CHD.
The paper concluded that the expectation that CHD could be prevented or eliminated by simply reducing cholesterol appears unfounded. On the contrary, the paper emphasized that we should acknowledge the inconsistencies of the cholesterol theory and recognize the proven benefits of a healthy lifestyle incorporating a Mediterranean diet to prevent CHD.
UHO concurs with the recommendations of the paper advocating lifestyle changes over statin use for lowering cholesterol. We would further like to recommend caution instead of blindly adopting the American guidelines of starting statins for lowering cholesterol from age 30 onwards. We have a young population and lowering the age for statin therapy will offer huge market for the pharmaceutical industry. Another concern is that Indians are prone to metabolic disorders including Type 2 Diabetes a decade earlier than the Western populations. Statins are known to. predispose to Type 2 Diabetes.
Given these uncertainties, UHO recommends studies among Indian populations before adopting the Western guidelines which are based on Caucasian populations.
Secret UK-USA drug deal: Lack of transparency may be due to pharma lobbying.
According to a report published in the British Medical Journal (BMJ), the UK agreed a drug trade deal with the US in December last year to soften the impact of tariffs put in place by US president Donald Trump. Under the agreement, the UK became the only country in the world to have a 0% tariff on pharmaceuticals exported to the US and secured preferential terms for the UK’s medical technology exports.
Critics believe that this deal will raise medical care costs in the UK and adversely impact the functioning of the UK’s National Health Service (NHS) and estimated to lead to 229000 excess deaths. This is because the NHS will be forced to cut existing services to pay for the increased drug costs—estimated to be an extra £45bn cumulatively by the end of 2036 for England alone.
A challenge to the government’s refusal to release an impact assessment of a controversial pharmaceutical trade deal with the US has been denied.
The UK’s transparency regulator, the Information Commissioner’s Office (ICO), released a response to a complaint made by health think tank the Nuffield Trust, saying that the government’s decision not to make it public was acceptable as the deal has not been finalized.
UHO speculates that this move is part of an overall strategy influence by pharma lobbying of sabotaging public health care infrastructures like the NHS so that dependency on private players is facilitated. The concept of the pharmaceutical industry systematically working to “sabotage” the UK National Health Service (NHS) is a frequent subject of political debate, investigative journalism, and public policy analysis. Rather than a literal, covert operation to destroy the health system, critics and researchers usually describe “sabotage” in terms of aggressive commercial strategies, lobbying, and structural pressures that strain NHS resources.
Lack of transparency on doctor-industry interactions in the UK
Lack of transparency is not limited to government secret deals but also extends to drug industry payments to doctors according to a report in the British Medical Journal (BMJ). Efforts to improve transparency around the payments that drug companies make to doctors, which could influence their practice, have been hit by an “appalling” lack of progress, experts warn.
The 2020 Cumberledge review was commissioned after a series of drug and medical device scandals, including hormone pregnancy tests such as Primodos, the drug sodium valproate, and pelvic mesh implants.
The review recommended the mandatory reporting of drug industry payments to teaching hospitals, research institutions, and individual clinicians.
But the review’s lead researcher has now told The BMJ that, five years on, the current lack of commitment to action from government was “appalling.”
One prominent critic even went so far as to accuse the government of “prioritising industry’s wishes” over patient safety.
Drug and medical device companies often make financial payments or payments in kind to doctors and nurses, researchers, journalists, members of the public, and social media influencers, among others.
Figures indicate that the industry typically spends hundreds of millions of pounds on such payments in the UK every year.
Concerns about these payments and how they may influence doctors and their treatment of patients have been voiced for years.
Despite the Cumberledge review specifically recommending the mandatory reporting of such payments, no such commitment seemed likely at the Department of Health and Social Care workshops.
Sonia Macleod, lead researcher on the Cumberledge review and a visiting fellow at the University of Oxford, said the absence of such a commitment, and the long wait for the implementation of a searchable database of payments, was bitterly disappointing.
“It’s particularly appalling given there’s primary legislation in place that would enable a mandatory database to be set up and run—and yet nothing has happened for years,” she said.
She and others have campaigned for a central, government run database of drug and medical device industry payments to help avoid similar scandals in the future.
The undeclared conflicts of interests and pharma influence on doctors seem to be an universal phenomenon.
It will be recalled that a couple of years back about 30 Indian doctors went on a pharma sponsored foreign jaunt to Paris. Action is yet to be taken by the National Medical Commission against the erring doctors. The trip cost roughly ₹1.91 crore and violated medical marketing code rules.
Action has been delayed or stalled in most cases, with only partial state-level moves that have since faced legal hurdles. While the National Medical Commission forwarded names to state medical councils, most councils have failed to conclude inquiries or report action taken.
Some consolation that we have not raised the ethical bar among doctors while UK has fallen to our level!
दिल बहल तो जाएगा इस ख्याल से, हाल मिल गया तुम्हारा अपने हाल से।
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