The Great Medication Lottery

A lady in her 60s recently consulted me. She was extremely concerned because she was facing a dilemma and she did not know what to do. Basically she had been to see her GP and because her cholesterol was found to be a little on the higher side, she was being strongly advised by her GP to take a Statin. My patient did not want to take Statins. Her argument was that she had never had a problem with her heart, did not have a family history of heart disease and therefore did not want to take medications that could cause side effects. Her GP told her that by not taking a Statin, she was being irresponsible because her risk of a heart attack or a stroke was going to be much higher on account of her having a higher cholesterol and the statin would reduce this risk. My patient was left very troubled. She wanted to do the right thing but her GP did not really have the time or patience to discuss her concerns with her. As far as he was concerned, it was either his way or the highway. So she came to me and said Dr Gupta, could you please help me make sense of this. What should I do? Am I being irresponsible and should I go on Statins?

Today, I am i going to tell you what I told her. This video is entitled ‘The Great Medication Lottery’.

All health conditions have to either impact your quality of life adversely or predispose you to some kind of future risk I.e impact your length of life adversely - otherwise they aren’t medical conditions at all. High Cholesterol is not really a condition unless it impacts on the patient’s quality of life or length of life.

Therefore all treatments that are offered have to either improve quality of life or reduce future risk and improve prognosis.

One important difference between quality of life and quantity of life is that your quality of life can be measured and only measured by your yardstick. No-one else can measure your quality of life like you can. Quantity of life on the other hand can’t be measured by you - only other people can measure your quantity of life because to measure something, it has to come to have an end.

Deciding on taking medications that improve quality of life is easy because you can measure your quality of life and therefore if you take a medication that is given to you to improve your quality of life and it does then you know its worth taking. If it doesn’t, then there is absolutely no need to take it.

Deciding on medications that are supposed to improve your length of life is far more difficult because you will never know whether the medication has made you live longer. You could take it all your life and may think it has but you will never know for sure because you don’t know for sure as to what would have happened if you did not take the medication.

So how do you make the decision to take something for the rest of your life when you will never know if it will help or not?