When I first read in the British press last week about a London cardiologist’s proposal that statins — drugs used to lower the risk of heart disease — be freely offered along with ketchup and other condiments at McDonald’s and other fast-food restaurants I thought, “This must be a story from The Onion that somebody in the press just didn’t recognize as a joke.”
But it wasn’t. Dr. Darrel Francis and his colleagues at the National Heart and Lung Institute of the Imperial College in London, are apparently quite serious. As they outline in their editorial in the current issue of the American Journal of Cardiology, they’ve done the math modeling and have concluded it would be a good idea if consumers of Quarter Pounders were given the opportunity to counter the fat-laden food’s known bad effects on the cardiovascular system with a free statin pill.
“Statins do not cut out all of the unhealthy effects of burgers and fries,” said Francis in the Guardian newspaper. “It’s better to avoid fatty food altogether. But in terms of your likelihood of having a heart attack, taking a statin can reduce your risk to more or less the same degree as a fast food meal increases it.”
Francis has dubbed this fast-food/statin combo “The MacStatin.” And, no, he isn’t funded by a drug company — or a fast-food franchise. When asked by a New Scientist reporter if he had any financial conflicts of interest, Francis quipped, “No, the only conflict of interest would be that I quite like hamburgers.”
(By the way, the idea of offering free statins doesn’t sound as far-fetched in Britain as it does here in the U.S. The Brits can apparently already purchase a low-dose generic statin, simvastin, over the counter from their local chemist, or pharmacist.)
Naturally, other heart experts immediately jumped all over Francis’ proposal. Sometimes quite vehemently. Here’s a Guardian quote from Steve Field, the current chairman of Britain’s Royal College of General Practitioners: “This paper just amazes me. Let’s get real; we should be encouraging healthy lifestyles, to pill popping. This is an unwelcome addition to the ‘pill for every ill’ attitude that’s already much too common. The danger of this research is that some people will become even more complacent about eating fatty food and high calorie food, and might even increase their intake of them.”
There’s also the problem, Field added, of potential side effects from the statins, including, in rare cases, cataracts, muscle weakness, liver problems and even kidney failure.
Francis anticipated these arguments in his editorial:
[T]he documented safety record of statins is substantially better than that of fast foods, which carry not only direct cardiovascular risks but other risks due to obesity. It cannot therefore be reasonably argued on safety grounds that individuals should be free to choose to eat lipid-rich food but not be free to supplement it with a statin. It would be no more sensible than allowing individuals to drive without training or a license but at the same time restricting access to seatbelts and airbags.
But there’s another major underlying problem to Francis’ proposal that, to me at least, makes his whole proposal moot. He takes it as a given that statins are effective in reducing cardiovascular risk in people with no previous history of heart attack or stroke. But that’s now a highly controversial assumption. Recent research, including a major study published earlier this summer, has found little evidence that statins reduce the risk of premature death in anybody other than those who have already experienced a heart attack or stroke.
Ah, but you’ve got to smile at Francis’ utopian vision of the fast-food restaurant of the future:
We envisage a future in which fast food restaurants encourage a holistic approach to healthy living. On ordering an unhealthy meal, the food will arrive labeled with a warning message similar to those found on cigarette packets (“This meal increase your risk for heart disease and death”), and on the tray, next to the ketchup, will be a new and protective packet, “MacStatin,” which could be sprinkled onto a Quarter Pounder or into a milkshake. This could easily be provided at no extra charge, just as sugar and salt currently are (despite being harmful). To prevent individuals from believing that the packet is a “cure-all,” it should be accompanied by a leaflet stating, “No table can counteract the full spectrum of harm that comes from [eating] unhealthily. Better ways to reduce your risk for death from heart attack include eating healthily, exercising, maintaining a healthy weight, and not smoking.”
And what is the fast-food industry’s response to all this focus on its unhealthful foods? “We are not pleased,” as the Queen herself might say. Here’s a McDonald’s spokesperson’s no-smiling, no-nonsense response to Francis’ editorial:
We provide a good range of meal options which include porridge, bagels and salads, as well as providing the nutritional information to ensure people can make dietary choices that are right for them. It would not be appropriate or safe for any restaurant chain to offer medication of any kind to its customers.