There are, to my mind, two camps of doctors in terms of their attitude to statins. Some maintain these drugs are ‘highly effective’ and very safe (and might even be put in the water supply). Others (who bother to look objectively at the research) tell us that statins only help a small minority of people who take them, and have potential harms that are real but underplayed by statin proponents.
Well, some prominent doctors in the latter camp came out swinging recently in the form of a letter they have written to the National Institute of Health and Clinical Excellence (NICE – a body in the UK that sets healthcare policy and is considering recommending much wider the use of statins in people who are well).
The doctors raise a number of concerns about the planned expansion of statin prescribing and the evidence on which this mooted recommendation is based. The authors raise six major issues:
1. The medicalization of millions of healthy individuals
NICE is suggesting we treat ever more people who are healthy. The problem is, in healthy individuals with no evidence of cardiovascular disease, the benefits of statins are vanishingly small, though the hazards are real and significant.
2. Conflicting levels of adverse events
Many ‘experts’ claim that trials show statins rarely cause problems. Actually, there are many reasons why trials can simple missed harms (like screening out people who are intolerant to statins before the study starts or recognising harms once there is extreme derangement in blood values)
3. Hidden data
The Cholesterol Treatment Trialists’ Collaboration (CTT) regularly makes very pro-statin pronouncements based on the ‘evidence’ from trials given to them by drug companies. The problem is, no one is allowed to take a look at this data to verify it and assess its accuracy.
4. Industry bias
It is well recognised that industry funded studies tend to report more benefits and fewer harms than independently funded studies. The problem is, almost all the statin studies are industry-funded and subject to this bias.
5. Loss of professional confidence
There is opposition to the proposed changes to the guidelines from within the medical profession. Apparently, the British Medical Association General Practitioners Committee, has recently decided that: ‘[it] will request that NICE refrain from recommending a reduction to the current treatment threshold for primary prevention of cardiovascular disease with statin therapy, unless this is supported by evidence derived from complete public disclosure of all clinical trials’ data’.
But I think there’s another crisis of confidence here, concerning the professional standing and trustworthiness of doctors in their patients’ eyes. The public is gradually wising up to the fact that statins are virtually useless for the vast majority of people who take them, and also have significant risks. You can imagine that a doctor making a case for these drugs can quite easily look ill-informed, biased or just plain stupid in the eyes of their patients.
6. Conflicts of interest
These are rife. They exist in those who conduct the statin studies, but even affect the majority of people who sit on the NICE committee due to make a decision about widening statin prescribing.
The letter comes from a group of doctors, some of whom might be regarded as ‘heavy weights’ in the medical arena, including the President of the Royal College of Physicians and a past chair of the Royal College of General Practitioners. Here’s a full list of the signatories:
Sir Richard Thompson, President of the Royal College of Physicians
Professor Clare Gerada, Past Chair of the Royal College of General Practitioners and Chair of NHS Clinical Transformation Board
Professor David Haslam, General Practitioner and Chair of the National Obesity Forum
Dr J S Bamrah, Consultant Psychiatrist and Medical Director of Manchester Mental Health and Social Care Trust
Dr Malcolm Kendrick, General Practitioner
Dr Simon Poole, General Practitioner
David Newman, Director of Clinical Research, Dept of Emergency Medicine, Icahn School of Medicine at Mt Sinai, New York
Here’s a quote from one of the letter’s signatories Dr David Newman, Assistant Professor of Emergency Medicine and Director of clinical research at Mount Sinai School of medicine in New York:
I am always embarrassed when I have to tell patients that our treatment guidelines were written by a panel filled with people who stood to gain financially from their decisions. The UK certainly appears to be no different to that of the United States. The truth is for most people at low risk of cardiovascular disease a statin will give them diabetes as often as it will prevent a non fatal heart attack—and they won’t live any longer taking the pill. That’s not what patients are looking for.
Sums it up nicely, I reckon.