Stories from Australia and Britain reveal the dangers of telling the truth about statins
DRUG BUST by Alan Cassels
• The people’s briefing note on prescription drugs
When policy dooms you, start telling stories – stories so fabulous, so gripping, so spellbinding that the king forgets all about a lethal policy.
– Karl Rove (one of George W. Bush’s advisors)
Welcome to Lipid Land, ruled by our old friends Scandal, Deception and Deceit. After last month, it’s time to add Censorship to the list.
If you think this subject doesn’t affect you, think again. With one in five Canadians swallowing a daily cholesterol-lowering drug, or statin – which leaps to 50% of Canadians over 65 – and all of us consuming media about pharmaceuticals, this is a vital issue, even beyond the massive prescribing of drugs like Lipitor, Zocor or Crestor.
Many of my voyages into the absurdities of Lipid Land over the last decade have delivered stories of intrigue and scandal, yet I have to admit things have never been this weird. Statin fanaticism seems to have so clouded medicine’s thinking that now even some of the most cherished tenets of medicine – i.e, “First, let’s try not to kill the patient” – seem quaint and outdated. The motto “He who dies with the lowest cholesterol wins” pretty much captures the immense hubris around using chemicals to tweak a substance essential to our health.
Two stories from the UK and Australia in the last month have confirmed the arguments around statin drugs – their benefits and harms – have become completely unanchored from reality and are threatening to sink in a sea of propaganda.
There are three generally irrefutable points you can summarize from the research on the effectiveness and safety of statins: 1.) statins ‘work’ primarily for a small subset of men who have heart disease; 2.) most people currently prescribed statins are unlikely to see any net health benefit; and 3.) all statin takers expose themselves to risks of harm. When I say ‘work,’ I don’t mean lowering your cholesterol, I mean preventing a heart attack or stroke. The only ones who benefit from the drugs are men who have had heart disease or previously had a heart attack. They may see a 4-5% reduced risk of a heart attack or stroke over five years by swallowing a daily statin. There is a lack of evidence showing women, the elderly and ‘low risk’ men (i.e. most of us) will benefit from statins. What is disputable is the rate at which statin swallowers are harmed. The big manufacturer-funded statin trials show a very small level of adverse effects, yet other case studies or observational studies note perhaps as many as one in five statin users will experience adverse effects.
Last year, one of the most prestigious medical journals in the world, the British Medical Journal (BMJ), weighed into this controversy by publishing a report that said there is no benefit of taking statins for people who have a less than 20% risk of a heart attack over the next 10 years. It also said that, from observational studies of statins, about 18-20% of patients don’t tolerate the drug due to side effects. Those effects can include fatigue, muscle aches and pain, stomach complaints, short-term memory loss and erectile dysfunction, among other things.
A large, influential group in the UK – the Cholesterol Treatment Trialists’ Collaboration (CTT) – soaks in millions of pounds of drug money and emits some of the most egregious pro-statin propaganda on the planet. The head of the CTT, Sir Rory Collins at Oxford, was obviously outraged by the BMJ’s piece and in media interviews, including the UK’s Guardian, accused the BMJ report of killing people. He then went on to brow-beat the BMJ’s editor Fiona Godlee saying the BMJ got it wrong and the side effects weren’t 18-20%; they were less. The BMJ published a correction, indicating the true number might only be “9% of the study population having possibly discontinued statin therapy as a consequence of statin related events, rather than the 18% cited.”
End of story, right? Not quite. Seems the BMJ correction didn’t exactly satisfy the CTT people and Collins next asked the BMJ to retract the article saying patients would be scared off their valuable statins unless the BMJ relented.
This is medical-academic bullying of the finest kind. Some observers say the whole fiasco is a smokescreen put up by statin manufacturers and their agents who are known to hide statin adverse events data while insisting the drugs are safe enough to be added to the drinking water. Godlee has sent the issue to an independent panel, but the whole thing stinks to high heaven. The most awful stench is the rot of censorship where the manufacturers want to protect the image of cholesterol-lowering drugs and do so by attacking the integrity and independence of a medical journal. Stay tuned on this one.
The second tale from Lipid Land concerns an investigative report produced by the Australian Broadcasting Corporation. Journalist Maryanne Demasi’s two-part investigative program, The Heart of the Matter, was part of ABC’s Catalyst program examining the health effects of diets (part 1) and statin drugs (part 2). (Go to www.youtube.com and search for Heart of the Matter, The Cholesterol Myth, Part 2.)
This two-part series was dynamite, probably one of the hardest hitting programs you’re likely to see on statins anywhere. Demasi interviewed a wide range of researchers and physicians, including some desperate defenders of the statin hypotheses and prominent non-conflicted statin researchers Drs. John Abramson, Rita Redberg and Beatrice Golomb. Uffe Ravnskov, a prominent cholesterol scientist from Denmark, has covered the misinterpretations and exaggerations around cholesterol for decades. He said, “As far as I know, this is the first TV program in the western world where critics of the cholesterol campaign have been allowed to present their view in detail.”
Instead of kudos for Demasi and her team, Australia’s National Heart Foundation and the drug companies immediately began their attack, forcing the ABC to convene their “Audience and Consumer Affairs” group to examine the critical comments. The 49-page judgment on the Catalyst program says the program generally did a very balanced job and 10 of 11 critical points were cleared of bias. Apparently, one part offended the sensibilities of the reviewers with the conclusion: “The program could have done a better job of teasing out the mainstream perspective to leave audiences better informed.” What the heck does that mean? We’re not sure.
The Director of Australia’s National Heart Foundation, an organization which lives off the avails of drug companies, came to defend statins by repeating the usual canard: “Statins reduce the risk of death or cardiovascular events in populations without a history of cardiovascular disease, irrespective of age and gender and across a wide range of cholesterol levels.”
Despite the program showing vital evidence of the very minor effects of statins for most people and the lack of any lifesaving benefit in women or in those without established heart disease, as well as an indeterminate number who suffer adverse events from the drug, guess what happened? ABC pulled the Heart of the Matter series off the air. Jaws were heard dropping around the world.
In the end, I’m fearful these kinds of bully tactics don’t just affect the officials at the Australian Broadcasting Corporation or the British Medical Journal; they also affect all journalists worldwide who we expect to expose these sorts of controversies so consumers can make informed healthcare decisions. Will these two episodes usher in a new era of self-censorship as future problems with pharmaceuticals are avoided by serious journalists or obscured or manipulated by the manufacturers and their sycophants?
I have to give the last word to French cardiologist and researcher Michel de Lorgeril. In his book, Cholesterol and Statins: Sham Science and Bad Medicine, he asks, “Why does challenging the cholesterol theory trigger such extreme reactions?” And further, “Why are the media afraid of revealing the greatest medical scandal in modern time?” All I can add is “Why indeed?”
Alan Cassels is a pharmaceutical policy researcher at the University of Victoria and the author of three books, each of which contain chapters on cholesterol-lowering. www.alancassels.com