Ding ding! End of another round in the war over statins. These are one of the most commonly prescribed drugs in the UK, and two leading medical journals are at loggerheads over them.
The Lancet this week as well as an editorial attacking the BMJ, claiming its coverage of potential side effects has discouraged people from taking them.
that 鈥渋n the face of an unjustified claim that could harm public health, the scientific community, including journals, should respond quickly and robustly to counter that claim鈥�.
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I prescribe statins frequently, as most GPs do. I鈥檓 neither 鈥渇or鈥� them or 鈥渁gainst鈥� them as drugs. I do, however, firmly believe that people should decide whether they wish to take them, based on high quality evidence. What complicates matters is that 听鈥� where people who aren鈥檛 ill are being recommended to take these pills for life.
Who鈥檚 at risk?
To rewind: statins were originally given to people who already had cardiovascular disease. This use has remained fairly uncontentious. Then statins were found to offer some benefits for people merely 鈥渁t risk鈥� of cardiovascular disease.
To start with, the NHS funded statins for people calculated as having a 20 per cent risk of cardiovascular disease in the next 10 years. In 2014, because the tablets had become cheaper, .
This is the contentious bit: the lower your risk of developing cardiovascular disease, the less likely you are to benefit from statins. In the meantime, larger trials revealed unexpected side effects, such as a small increased risk of type 2 diabetes (around 3 in 100 people taking them for five years). The touch paper was lit when two criticising statins .
These got the risk of side effects wrong (and were subsequently corrected). But the media storm they stirred up prompted and claims public health was harmed.
Ending the war
So is the war over? Is The Lancet paper the last word? Critics question its independence, being written by a large group, including researchers from the , which draws on trials including those funded by the pharmaceutical industry. And related data about side effects is not available . Many side effects experienced with statins will be a result of the nocebo effect 鈥� feeling ill because you expect to, rather than because of the drug; however there are because of the way they are often reported in clinical trials.
But it is the claim of The Lancet authors, that this paper will 鈥渉elp doctors, patients and public make informed decisions about the use of statins鈥� after a period of controversy that is most obviously questionable.
The not journal papers are the best way of achieving this. They set out the pros and cons of medical interventions. These generally help people to make better decisions, and can and should be tested. For statins, we have and the website 鈥� both of which are helpful but also unsuitable for many people with complicating factors.
It鈥檚 better information we need, using independent and conflict-free adjudicators. We must communicate risk, uncertainties and potential outcomes clearly to disparate populations using the meagre resources available.
In the meantime, I wonder if we need a randomised controlled trial of something else: press releases from medical journals. Do we need them at all, or do they ultimately do more harm than good?
is a family doctor in Glasgow. She writes a weekly column for the BMJ and is author of The Patient Paradox (Pinter & Martin), partly about the problems of screening and overmedicalisation
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