And here’s why that’s important: There was no discussion of costs or harms, insufficient information about limitations, and no independent perspectives.
Best known for lowering cholesterol, statin drugs may also have other effects that could be helpful in the prevention or treatment of a variety of diseases. In addition to pneumonia, researchers have reported preliminary evidence of potential beneficial effects of statins against cancer, osteoporosis, and dementia. But before we go ahead and start pumping statins into the water supply (as some have half-jokingly suggested we should), we need to be sure whether it is the statins themselves or some other factor associated with statin drug use that is responsible for the benefits seen in these studies. There is plenty of reason to be skeptical about the quality of the current evidence.
Notwithstanding one researcher’s comment that statins are “cheap” (which might not be the case if we’re talking about drugs that are still on patent), there was no specific mention of the cost of treatment with statin drugs. These include the costs of the drug itself as well as ongoing monitoring.
To its credit, the story presents the benefits in appropriate statistical terms when it says, “13 percent (109 out of 847) of statin users died compared with 20 percent (578 out of 2,927) of non-statin users.” This is better than saying statin users had a 35% lower risk of dying from pneumonia, which is how many stories would have put it. Nevertheless, many readers will probably come away from this story with an exaggerated sense of the benefits, as the story never provided the absolute death rate due to pneumonia among all statin users compared with non-statin users. Since pneumonia is not very common, any benefit according to this measure would have been much smaller than the 7% reduction mentioned in the story. Even if this statistic was not available, the story could have provided some data about the likelihood of developing pneumonia, which would have put the findings in perspective. It’s important for people to understand that statins won’t reduce their chances of dying by 7% compared to people who don’t take statins.
The story glosses over potential harms when it unquestioningly accepts one of the researcher’s claims that statins are “safe, cheap, and an easy intervention in terms of delivery.” Even if we accept that this is true for patients who take statins to prevent heart disease, it might not be true for patients who start taking the drug once they contract pneumonia. The story should have mentioned this, as well as the other common adverse effects of statin medication, which include muscle pain and gastrointestinal upset.
It wasn’t clearly explained that this was an observational study that couldn’t show whether statins were responsible for the reduced death rate. The published paper about the study makes this abundantly clear when it states: “As with all observational studies, we cannot be certain
that the effects we observed are causally related to the use of statins.” Although the story does, at the end, note that randomized clinical trials are needed to prove any benefit from statins against pneumonia, it really should have explored some of the limitations of the study being covered in more detail than was provided. Importantly, the story could have noted that individuals who are prescribed statins may be more attentive to their health (they may “ask their doctors” about the drug, resulting in a prescription) and be in better overall health than those who aren’t prescribed statins. Even the press release from which this story cribbed much of its content found the space to mention a brief caveat along these lines. These limitations are especially important to convey since the headline suggested that statins “reduce pneumonia deaths.” It would have been better had the headline read: “People who use statins die less frequently from pneumonia that people who don’t use statins.” This way they would have avoided the cause-effect inference.
There was no overt disease-mongering in this story.
The only perspective provided comes from the study’s lead researcher, via a press release.
The story doesn’t really give us much context on pneumonia or why statins might be beneficial. It says that lower cholesterol levels might help the immune system fight infections, but most researchers ascribe the potential benefits of statins to other effects, such as reduced inflammation. There’s no word on any other approaches that might be helpful for reducing pneumonia deaths, such as increasing flu vaccination rates. And it would have required only a few more words to address this.
Statin drugs are commercially available in brand name and generic formulations as indicated.
We do think it’s a bit odd – and unnecessary – to mention the manufacturer and the brand name. Early in our journalism training, we were discouraged from doing so unless absolutely necessary in the story – which is not the case herein.
The story notes that a possible protective effect of statins against infections has been reported previously. It could have also noted that studies haven’t always supported such a relationship. Once again, the story seemed bent on framing only positive outcomes. Nonetheless, we’ll give the story the benefit of the doubt since – with this criterion in mind – it at least established that this isn’t the first research on this topic.
The story seems to have taken several quotes and passages almost directly from this news release put out by the London School of Hygiene and Tropical Medicine without stating this was the case.
Story: “Patients with a record of pneumonia were followed for six months to see if they died, and the researchers found that 13 percent (109 out of 847) of statin users died compared with 20 percent (578 out of 2,927) of non-statin users.”
Press release: “Patients with a record of pneumonia were followed for six months to see if they died and the scientists found that 13% (109 out of 847) of statin users died compared with 20% (578 out of 2927) of non-statin users”.
This is simply not good journalistic practice.
In addition, the story says the research was published in the British Medical Journal, but our reviewers could find no evidence that the study had been posted on the BMJ website at the time of their writing. This increases our concern that the story is simply republishing a press release without ever actually examining the study.
[Update: the article is now available on BMJ with a publication data of Wednesday April 6, whereas the story stated that it was published on Tuesday April 5.]