January 14, 2016
Journalists need to scrutinize the USPSTF’s draft recommendations on statins … and so do patients
The recent United States Preventive Services Task Force (USPSTF) draft recommendations on cholesterol-lowering drugs known as statins generated some news coverage, but not much and not much of high quality. That’s a shame because these recommendations could affect literally tens of millions of otherwise healthy Americans who are at risk of being medicated for their cholesterol for almost no benefit. Here are the recommendations in a nutshell: People between 40 and 75, with one or more risk factors for cardiovascular disease (CVD) such as high cholesterol, diabetes, high blood pressure or smoking and with a 10-year risk of a CVD “event” of 10% or more should take a low-to moderate-dose statin.
My admittedly unsystematic assessment of the reporting is based on stories from several outlets including US News and World Report , Time Magazine, Reuters and UPI. I found that they committed some of the usual sins we complain about: Not properly quantifying benefits or harms, failing to note conflicts of interest and generally ignoring key controversies that surround this issue. When the benefits were quantified, as in the Reuters story, relative values were used, which tend to exaggerate the extent to which these drugs might help. The bigger context, which people need when you are talking about preventive medicine, was missed. Essentially there are a myriad of other ways a person might want to reduce their cardiovascular risk instead of swallowing a drug.
To their credit, Stat News, Time, and UPI did feature some critical commentary from Dr. Steven Nissen at the Cleveland Clinic that was quite useful. Nissen said that “these recommendations leave as many questions as they give answers.” He added: “It doesn’t clarify for prescribers and for patients what they should do. I find that exasperating.”
I would add that I find it exasperating that many journalists didn’t dig much below commentator soundbites on an issue that affects so many of their readers. Maybe they should’ve tried a listicle. A “listicle” you say? A listicle is an obvious smashup of ‘list’ and ‘article’, pure popsicle journalism: just a few licks, followed by a mild sugar-high, then it’s gone. Listicles are the answer to our Twitter-fueled, pay-per-click culture. Instead of developing a thesis, raising arguments for and against, and ending with a well-reasoned conclusion, listicles require mere seconds of attention span. And did I say resistance is futile? While lacking in clickability compared, say, to the “50 cutest things that ever happened,” I’d like to think my “9 reasons to ignore the USPSTF’s draft recommendations on statins” brings some gravitas to the listicle genre. Here they are:
- These recommendations, thankfully, are “draft,” sort of like a test dirigible easily brought down with random shrapnel. We shouldn’t get excited yet because the USPSTF may soon agree how silly they are and discard them.
- We’re talking HEALTHY people here! The best research so far shows that the likelihood statins will benefit people without heart disease is nonexistent. The picture is different if you are higher risk, and have established heart disease. Taking a statin for five years can delay death for about one in 83 high risk people. And the listed ‘risk factors’? Nearly everyone on the planet has one of those, so let the shareholders rejoice.
- The recommendation tiptoes around the known and under-reported dangers of statins which include muscle pain, liver injury, memory loss and diabetes. In trials, statin users experience almost 20% more adverse effects than placebo patients. Frankly the depth of our collective ignorance about the whole range of statins adverse effects is bottomless, according to one pundit.
- This recommendation lines up nicely with the American College of Cardiology/American Heart Association CVD risk calculator, but does that matter? It does, because there’s pretty good evidence that calculator is flawed and overestimates risk.
- Speaking of the ACC and the AHA, let’s remind ourselves that their thoughts on statins can hardly be seen as unbiased seeing as they recruit experts riven with conflicts of interest. Do we really expect the drug companies to put their own people on statin guideline committees if they weren’t satisfying shareholders? Not in this universe. It’s hard to say why the good folks at the USPSTF would want to sully their brand by lining up with these guys.
- Even though USPSTF experts do very careful assessments of data, it’s surprising that they didn’t seem to account for the highly problematic evidence behind statin therapy. The big problem is that the drug companies have funded most of the trials, and industry-funded trials are 20 times more likely to give results favoring the test drug.
- The folks at the USPSTF forgot that real people in the real world are affected by this stuff so recommendations that add more murk to the current swamp of statin ignorance, where ‘informed consent’ is rare, are very unhelpful. If people were required to pass a set of skill testing questions before they got their statin, most would fail.
- The financial consequences of getting more and more healthy people on statins is ginormous, considering that US citizens currently swallow 264 million statin prescriptions every year, worth about $10 billion. Since statins are almost all off patent, the only real way to buoy profits is by expanding the market and the USPSTF guidelines will increase that market. Just see how excited the investors are.
- This flawed recommendation besmirches the USPSTF’s brand, a benchmark of objectivity, in a landscape sullied by conflicts of interest. When the USPSTF speaks, people listen. Why? Because usually they deliver reliable, evidence-based recommendations that nourish and uplift. Yet their statin blather is like they’ve removed all the fiber and nutrients to leave us with a high fructose corn syrupy sugar high. This is just icky and sticky.
Alan Cassels is a drug policy researcher in Victoria, British Columbia and a reviewer with HealthNewsReview.org. The opinions he expresses are his own. Follow his writings on twitter @akecassels.