22 May 2010

Dr Crippen would have loved it

The now-retired top medical blogger, Dr Crippen, should take a break from his lobster fishing and read the latest on statins. He was a great one for making predictions. Although his words of wisdom have been archived for posterity they are now difficult to find. Dr Grumble cannot prove it but he is willing to bet that Crippen would have questioned the wisdom of the government feeding statins to millions according to a set formula. He surely would have pointed out that the long-term effects were unknown and that in some populations the known benefits were very tiny. Any doctor of experience permitted to think would be very cautious about prescribing a medicine with a tiny benefit and unknown long-term effects. To do this to whole populations on a grand scale would seem foolhardy. But, unsurprisingly in the world of New Labour, this seems to be exactly what has happened.

A good few years have now passed since statins have been liberally prescribed to meet targets and earn the likes of Crippen a nest egg for his well-earned retirement. Millions of patients have taken them. Lives will have been saved. What could be wrong with that?

If Dr Grumble were to tell you that out of every 10,000 high risk women given statins, there are 271 fewer cases of cardiovascular disease, what would you conclude? You might conclude that 271 people are better off. You could also conclude that 9,729 people have wasted their time and money popping pills. That is OK, you might think. But how many of these guinea pigs - for that is what they effectively have been - had adverse effects? How many had a myopathy or liver dysfunction or maybe some side effect you didn't even guess might be caused by statins? Some time has passed since this great experiment on our hapless population. It might just be possible to find out.

And somebody has. The figures show that for those 10,000 high-risk women given a statin there were 271 fewer cases of cardiovascular disease and 8 fewer oesophageal cancers but there were also adverse effects. There were:

23 extra patients with acute renal failure

39 extra patients with myopathy

74 extra patients with liver dysfunction

307 extra patients with cataracts

You can only conclude that 279 patients benefited from the treatment and 443 were made worse. And these were high risk patients. For low risk patients the benefit would surely be much less and the risk much the same. None of this would surprise Crippen. Nor the Jobbing Doctor. But nobody listens to jobbing doctors any more.

It doesn't look good to Dr Grumble. But not everyone comes to the same conclusion. Now why could that be?


Fuddled Medic said...

Heya, have you got the number to treat data available for statins? If memory serves its incredibly low

Doctor Zorro said...

I looked at the Pulse article to see that they looked at patients newly put on statins aged 30 to 84. Who in his right mind is starting an 84 yr old on statin?
There is a book on the downsides of statins by Malcolm Kendrick which I would recommend

Jobbing Doctor said...

I do worry about this population medicine, and have a pretty low threshold for stopping treatment.

I saw a 96 year old who was started on a statin.

We stopped it.

Dr Grumble said...

You are fuddled, Fuddled Medic. A low number needed to treat is not much good if the number needed to harm is even lower.

You can find the details here.

Fuddled Medic said...

I should check my comments, before banging them out, meant to write high, not low. Thanks for the links

Nikita said...
This comment has been removed by the author.
Nikita said...

Oops! Will write it again!

I wonder how these revelations will impact on the outcomes of the trials of the much heralded new panacea for the people - the polypill! 20mg statin content.

English Pensioner said...

I won't take any medicines unless my GP can convince me that my health is going to deteriorate quite rapidly without them.
My blood pressure is apparently marginally higher than the recommended figure and he wants me to take some pills; I'm reluctant as my blood pressure hasn't changed - the recommended has been reduced within the last couple of years!

Garth Marenghi said...

Dr G,

I think the same will come true with the government's push for DVT chemoprophylaxis for all.

A lot more harm than good.