Counting the cost?

In recent years, in the UK at least, there has been a growing trend for medicines to be available for purchase from a pharmacist rather than requiring a doctor's prescription.

To the list - which already includes aciclovir cream for cold sores, ranitidine for heartburn and indigestion and domperidone for stomach bloating - is now to be added cholesterol-lowering statins.

These are prescribed at present only to the 1.8m patients in the UK at high risk of the disease but are estimated to save 7,000 lives a year. But experts believe that many more lives could be saved if pharmacies were allowed to sell statins over the counter - perhaps as early as next month - to those at risk of moderate as well as high risk of heart disease.

Certainly the Proprietary Association of Great Britain (PAGB) and the British Heart Foundation (BHF) are in favour of the change, based on evidence that taking 10mg of simvastatin each night can reduce by 27% the danger of heart attack and stroke in those at risk. However, even Professor Sir Charles George, medical director of the BHF, acknowledges that statins should not be used in isolation - rather they should be taken in conjunction with reliable cholesterol checks, stopping smoking, controlling weight, eating a balanced diet and taking more exercise.

But given that statins are the most widely prescribed class of drug in the UK and the most expensive item on the National Health Service drugs bill, costing more than £700m a year, would it be terribly cynical to suggest that cost rather than clinical considerations is behind the decision?

The UK Government has indicated that it wants more medicines to be available from pharmacists 'to increase patient choice'. But a price of around £5 a week has been suggested for the drug, compared with £6.40 - the current cost of a prescription for a month's supply.

The reason many medicines are available only on prescription is because they have the potential to cause serious side effects or to interact with other medicines. But I can't help wondering if a few questions in a busy shop can be as satisfactory in this respect as a private consultation in a GP's surgery where the patient's entire medical history is available together with that of his or her immediate family.

Although statins have a good safety record, they have the potential to cause side effects, including muscle pains and liver disease. Buying another pack of medication over the counter from the pharmacist rather than getting a repeat prescription from the doctor may circumvent the pharmacovigilance system currently in place.

This may be the first time in the UK that a significant patient population has been asked to pay for its own preventative treatment, but it probably won't be the last.