Intense media coverage of a heated controversy regarding statins was associated with a short-lived period during which an increased number of people in the United Kingdom stopped taking the cholesterol-lowering drugs, reports a study published earlier this week in the BMJ.
As a result, thousands of Britons may experience heart attacks or strokes during the next decade that could have been avoided, the study also suggests.
The message from the study’s authors is clear: The media did the public a serious disservice by airing the statins controversy.
Not everyone agrees, however, including Gary Schwitzer, a longtime health-care journalist and media critic who publishes the Minnesota-based HealthNewsReview website. In an editorial accompanying the study, Schwitzer offers a very different perspective.
“This episode is far less about journalism than about how science and medicine deal with uncertainty,” he writes.
A heated debate
Statins are widely prescribed to people who have existing heart disease (a practice known as secondary prevention), as well as to people who are considered to be at high risk of developing the disease (known as primary prevention).
In October 2013, the BMJ published two controversial articles about statins that were critical of extending the use of the drugs for primary prevention in people at low and intermediate risk for heart disease. For that group of people, the articles suggested, the risk of harm from statins’ side effects, particularly muscle pain and weakness, outweighed any potential benefits.
Critics immediately pounced on problems with the studies’ design and found fault with the analyses, particularly the reliance on lower-rated observational evidence. A major correction was issued. Some critics remain unsatisfied, and have demanded that the studies be retracted.
But other experts — including the editors of BMJ — have stood by the studies. They say there remains a legitimate and ongoing debate about the risks and benefits of statins for people at lower risk of heart disease.
The media has covered the back-and-forth of the controversy quite extensively.
In the new study, Anthony Matthews of the London School of Hygiene and Tropical Medicine and his colleagues analyzed primary-care data in the U.K. to determine the number of people aged 40 and older who started and stopped taking statins each month from January 2011 to March 2015.
They found that during the first six months of media coverage of the controversy (October 2013 through March 2014) there was an increased likelihood that existing users of statins would stop taking the drugs — an 11 percent increase among those taking the medication for primary prevention and a 12 percent increase among those taking it for secondary prevention.
Interestingly, however, the proportion of people who began taking statins for the first time did not change.
Matthew and colleagues estimate that more than 218,000 Britons stopped taking statins during the six months that were the focus of their study. They also calculate that because of that decrease in use among existing users, 2,000 to 6,000 extra cardiovascular events, such as heart attacks and stroke, could occur in the U.K. during the ensuing 10 years.
The media are most likely responsible for those dire numbers, they conclude.
“Our findings suggest that widespread coverage of health stories in the mainstream media can have an important, real world impact on the behavior of patients and doctors. This may have significant consequences for people’s health,” said study co-author Liam Smeeth, also of the London School of Hygiene & Tropical Medicine, in a released statement.
“It’s undoubtedly important that these debates are reflected in the media, who play a key role in communicating public health advice,” he added, “but there is a concern that in the case of statins, widespread reporting of the debate may have given disproportionate weight to a minority view about possible side effects, denting public confidence in a drug which most scientists and health professionals believe to be a safe and effective option against heart disease for the vast majority of patients.”
In his editorial, Schwitzer points out that Matthews and Smeeth’s study is itself an observational study and therefore doesn’t prove that the media caused Britons to discontinue their use of statins.
“The news in question was not all negative,” he points out. “Stories swung between extremes. One newspaper headline claimed that ‘statins do not have major side effects’ just days after another newspaper headlined ‘millions face terrible side effects as [statin] prescription escalates.’ Those two stories might have had very different effects on current or potential statin users.”
But even if the media coverage did raise the public’s awareness about the debate and uncertainty regarding the potential benefits and risk of statins, “[I]s that such a bad thing?” asks Schwitzer. “As [Dr. Victor] Montori and others have said, ‘Informed patients may choose not to follow a guideline that does not incorporate their preferences.’”
“What do we know about patients’ preferences in this case?” he adds. “Perhaps news stories inspired patients to question trade-offs in ways they never did when they started taking statins because they had not been fully informed. We know nothing about the quality of the clinical decision making encounters before the start of treatment. We know nothing about why these patients stopped. Matthews and colleagues acknowledge that they did not engage patients in the development of the study protocol. It might have helped if they had done so.”
A broader problem
Schwitzer raises an even larger point: the uncritical acceptance by much of the media of medical studies and the medical status quo.
“We rarely see journalism about overdiagnosis, overtreatment, or shared decision making,” he writes. “Few stories clearly communicate the trade-offs involved in medical decisions. Far more stories fawningly promote more use of more interventions, evidence be damned. Journalism that exposes the public to ongoing controversies in science should be nurtured, not branded as negative.”
“The debate over the harms and benefits of statins is not over,” Schwitzer adds. “Journals, journalists, clinicians, and researchers could help people to grasp the uncertainty that still exists and to attack it by asking more questions. But they must avoid suggesting absolute certainty exists where it does not.”
FMI: Both the study and Schwitzer’s editorial can be read in full on the BMJ’s website.