An old man told me how the two boys be sat beside at school died in a Diphtheria out break in the 1920s. But Diphtheria, Tetanus , Epiglotitis , measles and hopefully soon bacterial meningitis are illnesses of the past. Today Infectious disease consultants are left playing table tennis in the Doctors mess. Vaccination is medicines miracle , protecting individual and the public health . The anti-vaccination lobby is illogical. Today’s courageous public health policy is the suggestion of offering statins to all the middle aged to prevent vascular disease. For a recent Cochrane review states that that statins are safe and effective in primary prevention  , with another meta-analysis reporting statins effective even in low risk groups.[ 2 ] There is no longer a ”normal” cholesterol level. Is treating everyone over a certain age good medicine ?
The cardiovascular disease model is a paradigm based on risk factors , all now morphed into “diseases” . Cholesterol , Glucose, and the elasticity of arteries based assessed by a Victorian hearing aid ! Yet you can fly a jumbo-jet between the confidence intervals that support this model [ 3,4 ] A simplistic model is riven many paradoxes. Like the declined in vascular disease predating modern medications by decades.[5 ] Also we are told vascular disease is a product of modern lifestyle but a study irrefutably demonstrates IHD was common in prehistory. [ 6] .And why has vascular disease not increased with the increase in diabetes and obesity ?  But medicine believes in this model , worshipping at the educational cathedrals of the pharmaceutical industry.
Also, the effects of statins need quantified. In those low risk over 60 on standard statin treatments, the NNT per year to prevent cardiovascular events is 450 and to prevent vascular death 1250 [ 2] So unlike vaccination , virtually none of these patients will actually benefit directly despite taking statin for the rest of their lives. For any benefits are seen only at a population level, this the treatment paradox. And with much of statin research now twenty years old , since then background incidence has halved, these NNTs could have doubled. Finally , already we prescribe 60 million statins yearly  , so why can’t we categorically prove that statins work in the real world? What happens if there is some unforeseen long term side effect ?
But skeptism is futile. Guidelines will be issued expanding statin use , and these orders dutifully followed. Patients trust Doctors, will go along with this advice , eroding societies wellbeing and fanning health anxiety. Soon the natural extension of this logic will see a clammer for statins ever younger age groups and for more aggressive treatment. Is statins-for-all bad medicine ? Time will tell.
[ 1] Taylor, F Statins for the primary prevention of cardiovascular disease The Cochrane Library Published Online: 31 JAN 2013
 Cholesterol Treatment Trialists' (CTT) Collaborators. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 2012; 380: 581-590
[ 3] Piotr Bandosz Decline in mortality from coronary heart disease in Poland after socioeconomic transformation: modelling studyBMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.d8136 (Published 25 January 2012)
[ 4 ] Belgin Unal Modelling the decline in coronary heart disease deaths in England and Wales , 1981-2000: comparing contributions from primary prevention and secondary prevention BMJ 2005; 331 doi: http://dx.doi.org/10.1136/bmj.38561.633345.8) http://www.bmj.com/content/331/7517/614
[ 5] CDC Achievements in Public Health, 1900-1999: Decline in Deaths from Heart Disease and Stroke -- United States, 1900-1999 August6, 1999 / 48(30);649-656 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4830a1.htm
[ 6] Thompson R Atherosclerosis across 4000 years of human history: the Horus study of four ancient populations The Lancet, Volume 381, Issue 9873, Pages 1211 - 1222, 6 April 2013http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60598-X/abstract
[ 7] Wang C Health and economic burden of the projected obesity trends in the USA and the UK The Lancet Volume 378, Issue 9793, 27 August–2 September 2011, Pages 815–825
[8 ] Health and Social Care Information Centre. Prescription Cost Analysis— England , 2012. April 2013.