The Greek philosopher Socrates developed the technique of challenging accepted wisdom through rigorous questioning, with the aim of establishing a better understanding of a subject through a logical assessment of the facts, rather than the pressures of convention. In the Socratic dialogue on the future management of hyperlipidaemia, Professor John Betteridge was joined by six multidisciplinary experts to discuss the strengths and weaknesses of current treatment pathways in cholesterol management, the opportunities, and the barriers to best practice.
Professor Betteridge challenged the group with the statement that current cholesterol management often fails the patient: treatments do ‘marvellously well’ in clinical trials yet clinicians fail their patients by not effectively explaining the benefits of cholesterol management to them. In addition, he asked the group to consider why patients receiving treatment are often not achieving the cholesterol-lowering goals currently set by the National Service Framework for Coronary Heart Disease (NSF for CHD). These are: total cholesterol (TC) < 5 mmol/L and low-density lipoprotein (LDL) cholesterol < 3 mmol/L or reduced by 30% (whichever is greater).1 Professor Betteridge emphasised the importance of addressing the clinical and organisational reasons for this, in order to ensure that patients are properly and adequately treated on the basis of the best available scientific data.