Could “negative” news coverage of statins lead to thousands of heart attacks and strokes?

Kevin Lomangino is the managing editor of HealthNewsReview.org. He tweets as @Klomangino. There’s a study published in the BMJ today that will interest journalists, health care professionals, and other health news observers. The authors report that news coverage questioning the risk-benefit balance of statin drugs was linked to a rise in the number of patients who stopped taking those drugs in the UK. The study says:

After the media coverage, there were no changes in statin initiation among those with a recorded new indication but an 11% and 12% increase in the likelihood of existing users stopping their treatment, for primary and secondary prevention, respectively. These effects could result more than 2000 extra cardiovascular events across the UK over a 10 year period.

News stories could cause thousands of deathsBy highlighting the excess cardiovascular events that might result from users stopping their statin treatment, the authors’ clear implication is that the news coverage could have had a detrimental impact on public health. But is that implication justified? Do health news stories that discuss the harms of medical treatments scare people away from lifesaving drugs?

Harms of statins deserve consideration by researchers and patients
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Writing in a linked editorial, HealthNewsReview.org Publisher Gary Schwitzer argues that we know little about what effects the news coverage may or may not have had on patients. He notes, for example, that the authors do not consider the possibility that patients may have experienced fewer adverse effects, including muscle pain, rhabdomyolysis, liver damage, diabetes, and cognitive side effects, as a result of stopping statin treatment. Schwitzer further suggests that the purportedly “negative” media coverage of statins could easily have been (and arguably should have been) framed much differently. He asks,

“…what if news coverage did have an effect, by alerting people to the debate and uncertainty that still exist about the extent of potential benefits and harms of statin use? Is that such a bad thing? As Montori and others have said, “Informed patients may choose not to follow a guideline that does not incorporate their preferences.”

The authors appropriately point out that their observational study “cannot confirm a causal link between the media coverage and the observed changes in the likelihood of stopping taking statins.” But the study elsewhere uses causal language that contradicts this important caveat.  As Schwitzer observes, the authors use words like “impact” and the “the effect of negative media coverage,” all of which suggest that the news stories were responsible for changes in prescription drug use.

Stories that address harms are swimming against the tide

The context for Schwitzer’s comments is the work that he and I and a team of more than 50 contributors do every day on this project. All too often, we see that stories about medical interventions tend to exaggerate benefits, minimize harms, fail to discuss costs, and don’t address limitations of evidence that often leaves much to be desired. As detailed below, in fact, our data show that fewer than 40% of stories we’ve reviewed over 10 years satisfactorily address those four key criteria:

Criterion Percent rated “satisfactory”
Does the story adequately discuss the costs of the intervention? 31%
Does the story adequately quantify the benefits of the treatment/test/product/procedure? 34%
Does the story adequately explain/quantify the harms of the intervention? 36%
Does the story seem to grasp the quality of the evidence? 39%

 

The BMJ authors cite two stories, one in the Guardian and another in the Daily Mail, that discussed the potential for adverse effects of statins to outweigh their benefits in individuals at low risk. A look at the headlines suggests it’s a stretch to characterize either of these stories as “negative” toward statins:

The text of each story does address the potential harms of statin treatment and quotes the views of qualified, skeptical experts. I don’t see that as a problem at all. In fact, I wish there were more such stories that explored the risks and tradeoffs of health interventions and which encouraged critical thinking by readers.

Questioning stories are an antidote to puffy, promotional speculation

Instead, we often see stories that fail to dig into the key controversies that surround recommendations for statin use.  More troubling still are the stories that already assume a net benefit for statins with respect to cardiovascular prevention, and which speculate — usually without enough context — that the drugs are likely beneficial for other uses that aren’t even remotely close to being proven. Here’s a small sampling of such stories that we’ve reviewed over the past few years:

By all means, let’s explore the impact that news stories have on patient decision-making and outcomes. But what we shouldn’t do is to link thorough, questioning journalism to thousands of excess deaths without proof.  Not when so much of what we see out there is puffy, promotional, and speculative. As Schwitzer puts it, “We rarely see journalism about overdiagnosis, overtreatment, or shared decision making. 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.”

Addendum 6/29 We sometimes comment in our reviews how news stories don’t even quote the editorial that appears in the same journal as the study being reported on. Well, that’s what happened in this case with The GuardianThe Daily Mail, The Telegraph and the Mirror – all of whom reported on the BMJ paper claiming UK news coverage drove people to stop taking statins, but all of whom turned to old familiar, British voices to re-ignite the argument. In the US, journalist Larry Husten wrote about both sides of the issue at Cardiobrief.  HealthNewsReview.org was also mentioned in the following stories:

We were also pleased to see the BMJ editorial mentioned on Twitter by Dr. Richard Lehman, one of our favorite evidence and media analysts:

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Comments (5)

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Steven Miles

June 29, 2016 at 8:26 am

It would be lovely if doctors would communicate “number needed to treat for a year” to prevent an adverse events. Instead drug companies prefer that risk reduction is described as relative risk reduction. Thus, if there are 6 bad events per year in 1,000 patients and a drug reduces to 4/1,000 patient years, the drug is promoted as decreasing risk 33%. For the individual patients however, the benefit for taking the drug for four years is small. If 1 000 persons take the drug for a year, there will be 2 fewer bad events. A related problem is shown in the Zetia and Vytorin matter where two drugs got to market because they lowered cholesterol without out having to prove that they lowered heart attack and stroke as had been proven with other cheaper generic drugs. It turned out they did not have a beneficial effect but had the effect of diverting people from disease preventing drugs.. Steve Miles MD

Anna Stern

June 29, 2016 at 11:02 am

This is not unlike the article Gina Kolta recently published in the NY Times about osteoporosis treatment and a soon-to-be published editorial in Joirnal of Bone and Mineral Research. While they don’t broadly cite the media, at least one broadcast is mentioned, having dug into the history of BMD texting and surrogate indicators, it is an interesting parallel to statin issues.

Gary Schwitzer

June 30, 2016 at 7:47 am

Anna,

I agree with your comparison. I saw the NY Times piece, “Fearing Drugs’ Rare Side Effects, Millions Take Their Chances With Osteoporosis,” as I was writing the editorial in question for The BMJ. Guest blogger Alan Cassels analyzed the story on our blog – https://www.healthnewsreview.org/2016/06/objective-news-story-or-giant-platform-for-propaganda-the-times-pushes-pharma-viewpoint-with-one-sided-coverage-of-osteoporosis-drugs/.

Gary Schwitzer
Publisher

Peter Brett

July 5, 2016 at 5:48 am

I ma disappointed the mass media almost never makes reference to familial hyperlipidemia. For whatever reason statins have helped me and my family survive in reasonable health way beyond our use by dates. In four generations, we are the first to make it past 47 years, some dying earlier, all of CVD. It appears FH is an inconvenient bystander.

Sarah J Eber

July 5, 2016 at 12:02 pm

You keep right on doing what you are doing… encouraging objectivity and showing both sides of the story… even if one side goes against mainstream medicine or big Pharma…consumers need to read this to help them advocate for themselves… and health professionals need it to help us maintain our humility and objectivity!