Statin study: "Everybody's talking at me; I don't hear a word they're saying."

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OK, turn it over to some journalists and we’ll have statins coming out of the kitchen faucet tomorrow.

On HealthNewsReview.org, we reviewed a story on the Jupiter-Crestor-CRP study done by the once-venerable Los Angeles Times. Excerpt of our review:

This news report about a significant clinical trial on statins and heart disease fails to look skeptically at the claims of the self-interested researchers. Rather than pushing back against the exaggerated claims of efficacy, safety, and imminent transformation of treatment protocols, the report magnifies them.

The report’s failures are largely due to emphasis rather than omission. The caveats are noted, but buried or otherwise minimized. For example:

* The report states that the study and its lead author are funded by the drug maker. But these facts are added as asides, and follow dramatic claims of benefits high in the story.
* Halfway into the story, the reporter cites unnamed “critics” who “charged” that wide adoption of the treatment protocols would be too expensive to justify. But this is followed immediately by a dismissal and a prediction that the changes will come anyway.
* The report eventually states how many people would need to be treated with statins in order to prevent one event–but this comes long after several enthusiastic declarations and statistical formulations supporting statins’ power to prevent heart events and save lives.
* The report mentions a small risk of side effects–but ignores previous reports, including one by the same journalist, that the statin in question has a worse side effect profile than most statins.

In all, 16 paragraphs make positive statements about the results. Four paragraphs call the findings into question.

The story also fails to parse facts about CRP. The study looked at people with presumably safe cholesterol levels but high CRP levels. Because the drugs reduced both cholesterol and CRP, the results are silent on whether the benefits are related to a reduction in CRP. Yet the reporter allows the lead author–who holds a patent on the CRP test used in the study–to make this assertion.

Given the obvious financial interests of the researchers and their sponsors, and the extravagant predictions of population-wide benefits, the reporter should have made an extra effort to find disinterested sources who could put the news in context.

This would not have been difficult. The article cites an editorial in the same issue of the journal urging cautious interpretation of the results. The reporter could have at least used that editorial or an interview with the writer to inject a balance that was missing from this overly enthusiastic report.

NBC’s Robert Bazell didn’t have one skeptical comment in his network news report that – thankfully – reaches fewer people these days because of a decline in network news viewing. He never mentioned the appropriately skeptical, cautious comments in an editorial accompanying the New England Journal of Medicine article – something that is low-hanging fruit for any reporter covering the story.

Viewers of the CBS Early Show got one of the most one-sided reports of all. Anchor Harry Smith asked the doc-of-the day:

“So if I’m one of those people of a certain age who might have high certain other markers, should I be running to my cardiologist today, saying ‘Give me the test for this inflammation so I know that maybe I ought to be on this stuff’?”

And she responded:

(Dr. Suzanne Steinbaum:) Absolutely. If you have any risk factors—high blood pressure, high cholesterol, diabetes—but all of these things are sort of borderline and you’re not taking a statin, really this inflammatory marker, the CRP, might tip the doctor over the edge to give you a statin like Crestor.

Let’s all rush in tomorrow. We’re healthy but we don’t know we’re dying. Let’s find out what bad shape we’re in so that we can all be statin-ized ASAP. Wow. What a job journalism is doing in selling sickness and drugs.

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Comments (8)

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Dr. Wes

November 11, 2008 at 10:20 pm

It’s also concerning that people aren’t asking what an elevated C reactive protein will do to your insurance premiums, now that you’ve been identified as “high risk” for heart disease. With the remarkably high false positive rate of CRP (ANY inflamation or renal disease will elevate it), the insurance companies are licking their chops as we make healthy people look “sick” in the eyes of the insurers.

john goley

November 12, 2008 at 6:55 am

I have been on statins for in excess of 14 years, two heart attacks and three angioplasties within a 7 month period some 21 years ago, then a triple bypass 20 years ago. When I first asked cardiologist about cholesterol lowering drugs about 15 years ago or so he said they were not for me they were for people with numbers in excess of 250, so much has changed now. My hdl and ldl 20 years ago was 178 and 28, my number now range about 78-96 and 44-52. I first started with mevocor which lowered some but then leveled out, I next went to 10mg lipitor and numbers improved significantly, mostly the bad cholesterol no, then I went to 20 Lipitor and bad lowered even more, but good still not high enough, a couple years ago I went to 500-1000 mg of slow release niacin, alas, significant increase in my good cholesterol. I tried Zocor for about a year 40 then up to 80 and it did not control like lipitor in the least, I did this due to cost, have been back on lipitor and under good control, I buy 90 40mg lipitor from uk through canadian pharmacy for about the same price that 30 20mg tablets cost at local pharmacy. Stuff if working for me for sure! John

Marilyn Mann

November 13, 2008 at 2:24 pm

Interesting comment from Dr. Steinbaum, in view of the fact that diabetes is a “coronary risk equivalent” under the NCEP guidelines and thus is already an indication for statin therapy.
There may be a few people who are on the fence about taking a statin who could reasonably be tested for other markers of risk, such as CRP, lipoprotein(a), homocysteine. Say someone’s 10-year risk is 10% and taking a statin could lower it to, say 7%. Is that risk reduction worthwhile? I don’t know, you tell me. People could reasonably differ on that. Testing these other markers could be a tie-breaker. Bear in mind that these tests can reclassify risk either up or down.
A good friend of mine who knows a lot about statistics and clinical trials told me he thinks that stopping the trial early could have exaggerated the treatment effect, which was larger than would have been expected based on previous statin trials. This was also mentioned in the editorial.
Marilyn

InteractMD.com

November 25, 2008 at 11:15 pm

That kind of gushing compliment on national TV is worth billions to a drug company. The Crestor people must be going gaga over Dr. Steinbaum.