Should statin ‘key opinion leaders’ be allowed to just make stuff up?

Just 2 weeks ago, one of my blog posts was dedicated to assessing the call from certain ‘experts’ that more  younger women should be medicated with statins. What a shame these experts simply don’t have the data to support their position.

This week, I came across an interesting piece in the New York Times. The article questions the wisdom of women taking statins. It details some of the ‘under-whelming’ results of research demonstrating that statins don’t work as well for women as for men. In fact, statins have not been found to save women’s lives – even women deemed to be at high risk of cardiovascular issues such as heart attack and stroke.

One thing that caught my eye in this piece concerned comments made by Dr C. Noel Bairey Merz, director of the Barbra Streisand Women’s Heart Center in Los Angeles. According to Dr Bairey Merz,

We haven’t shown that we can prevent deaths, because we just haven’t enrolled enough women, and that’s a crime,

going on to add,

But the absence of data is not the same as negative data.

She’s right on the second point, but is she right on the first?

Well, she is completely correct when she concedes that statins have not been shown to reduce the risk of death in women. In a review of secondary prevention studies (studies of people who have had a previous heart attack or stroke who are generally at high risk of further problems), statin therapy was found not to reduce the risk of death in women [1].

Now, a potential reason for finding no benefit here is that the total number of women involved in these studies was not large enough to detect a difference, as Dr Bairey Merz alludes to. However, in this review, a total of more than 4,500 women were involved in the studies in which mortality was reported. If no mortality benefit was found in this quite large group, then this does suggest that if any mortality benefit exists, it’s going to be quite tiny.

So, what about Dr Bairey Merz’s, though, that “We haven’t shown that we can prevent deaths, because we just haven’t enrolled enough women…”?  She’s not entitled to claim this, I think, for the simple reason she cannot possibly know that. This is not science, it is speculation. She may as well start her claim with the words “When I look into my crystal ball…”

The New York Times piece notes Dr Bairey Merz’s funding from several drug companies, and I suppose her speculation stated as fact may have something to do with these conflicts of interest.

Perhaps like many observers here, I am growing slightly weary of conflicted ‘opinion leaders’ making unfounded claims about statins or some other treatment. I’m half-considering devoting a section on this blog to such instances, and am inclined to call it ‘Experts who make shit up’.

References:

1. Gutierrez J, et al. Statin Therapy in the Prevention of Recurrent Cardiovascular Events: A Sex-Based Meta-analysis. Arch Intern Med. 2012;172(12):909-919

12 Responses to Should statin ‘key opinion leaders’ be allowed to just make stuff up?

  1. Cordier 8 May 2014 at 11:29 am #

    Why physicians are so focused on statin ? A kind ofobsessive compulsive disorder? The musicality of the word? The underlined mechanism by which statins spectacularly seem to cure nearly all cardiovascular diseases? It is indeed very easy for physicians to explain the process to their patients supposed to be totally ignorant about medical science. I imagine an attending physician telling his patient: “take an old weighing scale, put on the left side a high amount of cholesterol and on the right side, the same weight of cholesterol + statin. The result after one month? the right side is lower than the left side: as “simple”as that!” Patients easily understand and of course are very impressed! They say: “It is magic! Bravo doctor! You are great! But now will I be cured?
    - Of course you will! Look at the scale twice!”
    Unfortunately, we all know the process of our body is not so obvious, not so basic (What a shame!). Authentic science demonstrates this fact everyday. And patients are not so ingenuous any longer, as in the nineteenth century for instance… Fortunately.

  2. Cordier 8 May 2014 at 11:37 am #

    Sorry. “…The left side is lower than the right side…”.

  3. O 8 May 2014 at 12:44 pm #

    Please add a section on experts who make things up.

    I’m fed up of medical practitioners making up things when there is no scientific basis for their assertions and ignoring symptoms in patients that would give a different diagnosis because it doesn’t suit the “expert” view.

  4. PhilT 8 May 2014 at 3:49 pm #

    Isn’t “Experts who make shit up” trademarked by The British Dietetic Association ?

    Sorry. I’ll get my coat.

  5. David 8 May 2014 at 4:12 pm #

    ‘Experts who make shit up’

    Could be a very large section.

  6. Dan 8 May 2014 at 6:07 pm #

    I tuned out Dr Merz when I read that she had ties to big pharma.

  7. Mark John 8 May 2014 at 8:27 pm #

    “Appeal to Authority” should not apply in the field of medicine but sadly this form of flawed logic has become all too pervasive and insidious. Doctors and their opinion leaders should follow the science, wherever it should lead them.

    The way to do this is simple:

    Totally divorce all research from big pharma. They can fund it but the data should be blinded and both it and the results under the ownership of the researchers who aren’t in any way associated or paid by the pharma company. The raw data must, in its entirety, be publicly available. Properly qualified statisticians should independently interpret the results / figures. These results should be presented as not just relative benefit (if there is any) but as absolute benefit and numbers needed to treat over timescale.

    Probably not an exhaustive list of requirements but I think most of the way there!

  8. Paul 9 May 2014 at 7:44 am #

    Excellent idea; there is an absolute need for a credible resource dedicate to debunking the industry sponsored misinformation for such a on statin therapy peddaled by so called experts. I cannot think of a better place for such a resource than here.

  9. Jennifer 9 May 2014 at 10:52 am #

    “experts who make shit up”….ah…well…..as Dr Robert Lustig expressed very well…..even shit can be made palatable by adding sugar!!
    So there we are….us poor diabetics have been fed shit (information ) from so-called experts for years now, but so long as we eat the (unnecessary) carbs, the pill pushers can make a bob or two by convincing the medics to prescribe hypoglycaemics…..then statins….then anti hypertensives…then drugs to combat peripheral vascular disease…then stuff to alleviate leg cramps…then pain killers for debilitating joint problems….indigestion mixtures…..oh, the luctrative merry-go-round just goes on and on, bringing our wonderful NHS to its knees.
    Call me cynical?? Couldn’t possibly!
    I have NEVER been a user of bad language….but in this context i reckon it is warranted….although being an old wrinkly now, perhaps the Olde-English SHITE, might sound more polite?

    • Sonia Lancaster 10 May 2014 at 9:57 am #

      Well said

  10. Brian 9 May 2014 at 9:52 pm #

    We should have evidence (science) based decision (prescribing /advising) making.
    Instead we have decision (prescribing /advising) based evidence (so called science) making.

  11. Matt 17 May 2014 at 7:15 am #

    Did you hear that cardiac surgeon who appeared unchallenged this morning on Radiio 4?

    He said taking statins to reduce our cholesterol (he was focused solely on cholesterol) will make us happier, and look younger in old age.

    Statins should be sold over the counter and all men and women over 40 should be taking them!

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