Of the two stories we reviewed that reported the findings of a study showing an association between statin use and lower rates of rheumatoid arthritis, this one does the better job highlighting the preliminary nature of the research. Comments from a researcher about the need for further study before suggesting statins as a preventive measure to fight rheumatoid arthritis appear near the top of the story. The story also includes a comment from an independent source saying this type of study cannot tell us if there is a causal relationship. Like the other story we reviewed, this one fails to make any mention of side effects or any other downside to statin use. As with the other story reviewed, a significant shortcoming of this story was the failure to put the observed difference in rheumatoid arthritis rates into perspective. The story reports those who took statins faithfully for several years had a 40 percent lower rate of developing rheumatoid arthritis. But this was 40 percent lower than what? Neither story answers that question. The American College of Rheumatology estimates that rheumatoid arthritis affects between 2 and 10.7 people per 1,000. That means you would need to treat up to 998 people with statins to eliminate one case of RA. That statistic puts the finding in a different light and should have been included.
A small reduction in a common risk can affect more people than a big reduction in an uncommon risk; that is why stories must include some information about the absolute rates, not merely relative reductions or increases. Without this background information it is impossible to know how important a reduction in the risk really is.
The story does not mention the costs of statin therapy, which include not only the drug itself but also ongoing testing and other monitoring. For some patients, statins are part of a lifelong treatment regimen. In those cases in particular, the costs can really add up.
The story does not clearly explain what a 40 percent reduction in the risk of developing rheumatoid arthritis really means. How many fewer cases developed than were expected? The story doesn’t say. It reports that the researchers reviewed medical records of almost 2 million health plan members in Israel and that about 2,500 new cases of rheumatoid arthritis were diagnosed during the study period. But readers can’t tell from this information what the typical risk of rheumatoid arthritis might be, so they are left to ask: 40 percent of what?
Even though the authors of the research study commented on the risks of statin use in order to place this potential additional use into context, this story failed to include any mention of the potential harms.
Although the story headline and lead suggest the study evaluated whether statins could prevent rheumatoid arthritis, overall the story was clear that the study was observational and that all it can offer is an indication of an association between statin use and arthritis rates. Indeed, the story clearly pointed out that the results of this study merely suggest experimental trials and other research should evaluate the potential benefits of statin use in regard to rheumatoid arthritis. This is not the kind of evidence that can reveal whether statins were responsible for the lower risk seen among participants who took the drugs over an extended period.
This story does not engage in disease-mongering. At the same time, it fails to mention the prevalence or seriousness of rheumatoid arthritis. The American College of Rheumatology estimates the prevalence of RA between 2 and 10.7 per 1000 adults. While relatively uncommon, RA can be a devastating chronic illness. It would have been helpful to provide some information on prevalence in the story.
The story includes comments from an independent source. Although the story does not mention any potential conflicts of interest, none were disclosed by the study authors.
The story does not mention any alternative approaches to reducing the risk of rheumatoid arthritis. There are a number of risks factors associated with the development of rheumatoid arthritis. Of the four, only smoking is modifiable. The others are female gender (women get RA about twice as often as men), family history and age (most people with RA develop it between 40 and 50 years of age). A complete story would have provided a bit more background for the reader.
The story notes that statins are the most commonly prescribed class of drugs in the world, which is an even better description than the one used in the HealthDay story.
The story says there have been other studies that have looked into whether statin use may have any effect on rheumatoid arthritis.
The story does not appear to be based on a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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