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Should media take the blame for drop in statin use?

REUTERS/Jeff Zelevansky
Statin drugs, like Zocor, are taken by one in four Americans over the age of 45.

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.

Study details

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.”

Another view

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.

Gary Schwitzer
Health News Review
Gary Schwitzer

“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.

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Comments (3)

  1. Submitted by Bradley Bolin on 06/30/2016 - 12:15 pm.

    Statins no slam dunk

    I would change headline from “blame” to “credit”. Statins seem to help those who already have heart disease. For those who don’t it is much murkier. I would try diet and exercise changes long before risking the memory loss and pains reported as side effects of statins. All to improve your risk MAYBE from 3% to 4%.

  2. Submitted by Connie Sullivan on 06/30/2016 - 12:49 pm.

    More solid information is always better for the consuming medical public than less information. Leave it to the Brits to say that open debate, publicized by the press, is at fault for less use of statins.

    Statins are kind of routinely used by the medical profession as a fall-back option whenever there is anything cardiovascular going on with a patient, even when blood cholesterol levels are splendid and don’t call for statins. It has become lazy medical prescribing, which is echoed here in the unproven “it’s the lack of statins that caused the heart attacks–observationally.”

    The reason there seems to be no drop in the number who begin using statins is that the doctors keep prescribing them. The drop in users, though, is because of side effects (the hateful muscle pain and fatigue; medical science’s refusal to look at what statins do to, and for, women, etc.).

  3. Submitted by Brian Berggren on 07/01/2016 - 10:30 pm.

    Toxic statins

    After starting simvastatin, I experienced occasional cold toes and fingers and loss of feeling in two or three of them, along with joint and muscle discomfort. My gerontologist changed my prescription to atorvastatin and, sure enough, things got worse.

    My knees constantly ached to the point of interfering with sleep and I had no spring in my step. I used to run, bike, and ski (ex instructor); with the drug, walking on irregular surfaces was a challenge. I frequently felt I was losing my balance, reached for chairs or walls for help, and lurched and bumped into the doorframe when I got up in the night to use the bathroom.

    Next was the elevated blood sugar and the diagnosis of type II diabetes. Consultant magazine reported two studies linking statins to incidence of type II diabetes development (7% and 11% of those prescribed statins).

    After stopping the atorvastatin, my knees that had been aching and stiff when getting out of bed were free of that discomfort. This alone was reason enough to quit the medicine. Next, my balance improved significantly. Now I can put on pants and socks while standing on one foot. Also, probably unrelated, I often get up to go to the bathroom only once a night, and then between 4 and 5.

    For me the drug’s side-effects made me feel old and achy, while it’s benefit was limited and marginal. I was feeling almost disabled for essentially trying to reduce an almost non-existent cardiac risk. (In a conversation with my ophthalmologist, he also said he cannot tolerate statins.)

    The young doctor I saw after my gerontologist retired also wanted to get me back on a statin even though my blood pressure was well regulated with lisinopril and my blood sugar well controlled with diet and metformin (I have not used any blood sugar tests). This time the statin refusal was less polite.

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