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Burger and a statin to go? Or hold that, please?


5 Star

Burger and a statin to go? Or hold that, please?

Our Review Summary

The journal published the piece under the banner of "editorial." The story perhaps should have indicated that this puts it pretty far down in the hierarchy of evidence. There are clear dissenting views in the story, but how you end a story is often how you frame the takeaway message for readers and, in this case, because of story structure, that takehome may be that using a statin as a condiment would mitigate the effects of a fast food diet. To its credit Reuters Health did its homework and quotes two recognized experts in the field who provided a nice counterbalance to the comments of the study senior author. 


Why This Matters

Cardiovascular disease (heart attack and stroke) is a leading cause of death and disability in the United States and elsewhere in the world. So, efforts to reduce its impact are certainly newsworthy. A good deal of attention has been given in recent years to lifestyle changes as a primary way to reduce risk of heart attack and stroke. Less certain is the role of cholesterol lowering drugs, especially in people with average risk factors. A suggestion that cholesterol lowering drugs, such as the statins, might be considered as condiments for a high fat, high sodium, high calorie meal deserves some attention. This is especially true when the suggestion comes from a well respected research center and is published in a peer reviewed medical journal.


Does the story adequately discuss the costs of the intervention?


In this context, the cost discussion works, even though it is only a passing reference. The authors are trying to argue that statins would not cost much for fast food restaurants. "It would cost less than 5 pence ($0.07) per customer — not much different to a sachet of ketchup," says one of the authors. It would have been nice to have some clarity on whether that is a wholesale cost, retail cost or a British government cost. For this sort of plan to work in the U.S., assuming it even makes sense, the cost likely would be much higher.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?


A balance was struck between the claims of the study author and those of several unaffiliated experts.  While the study centered on the cholesterol lowering effects of a statin condiment, the negative effects of a high fat, high sodium, high calorie diet were highlighted providing a balance to the story. 

The story mentions that "A study in June in the Archives of Internal Medicine suggested, in fact, that statins do not save lives in patients without heart disease, although they may prevent some non-fatal heart attacks." But this wasn’t the only study to come to that conclusion, and, in fact, the drug company’s own research backs this claim up, as has been well documented in previous news stories.

We wish the story had clarified whether the research team was suggesting popping a single statin pill in response to a single cheeseburger, or whether they were suggesting a regular regimen of statin use.  This is a key point, and is relevant to any discussion about the quality (or lack) of evidence, and about potential harms and benefits. 

Does the story adequately explain/quantify the harms of the intervention?


It’s hard to ding the story for not actually calculating the potential harms, given that the piece is based on an editorial. In all, we think the story did a fair job pointing out the problems with using statins as a subsitute for exercise and a healthy diet. It could have at least mentioned some of the side effects of long-term statin use.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The journal piece is an editorial. It does present some research findings, but it is framed as a piece of persuasion, even going to far as to include a fake ad for a McStatin burger. The article about it misses – or at least doesn’t emphasize –  this point and, instead, discusses the findings the same way a reporter would discuss the findings of a study that took in 10,000 people over a seven year period. Those types of numbers are completely missing from the story. As the journal editorial points out, "No interventional study has examined the ability of statins to neutralize the excess cardiovascular risk arising from consuming fast foods, nor is there ever likely to be such a study." That should have been in the first paragraph of the news story. The researchers did not do any original research on patients or fast food consumers. They did a literature search, basically, and crunched some numbers.

Does the story commit disease-mongering?


There is no disease mongering in this story.

Does the story use independent sources and identify conflicts of interest?


The use of independent voices here is key, and the reporting team did a lot of reading to give readers a fuller picture of the debate about statins. If people could hear more doctors saying that a particular drug is "not a magic bullet" in news stories, we probably would pay far less for the drugs that do work well.

Does the story compare the new approach with existing alternatives?


The first quote in the story says "It’s better to avoid fatty foods altogether." And the story goes on to make that point in several ways. The story quotes directly from the editorial, too, saying that there is "no substitute for systematic lifestyle improvements, including healthy diet, regular exercise, weight loss, and smoking cessation".

Does the story establish the availability of the treatment/test/product/procedure?


The story makes it clear that statins are widely available and only by prescription in the U.S.

Does the story establish the true novelty of the approach?


This would definitely be novel, and the story makes that clear. What it does not do, unfortunately, is to emphasize that this wasn’t a study based on people eating fast food and then taking statins. There was only one line very late in the story explaining that the researchers "used data from a previous large study" and that they did a comparison "using data from seven previously published trials." 

Total Score: 9 of 10 Satisfactory


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