In my regular trawl through on-line newspapers this week I came across this story in the Telegraph (UK). Apparently, death rates in the UK are at a record low. This is, on the surface, a good thing. However, such statistics can belie the fact that while individuals may be living longer, the quality of the life may not be so desirable. One reason for this is that modern medicine has the capacity to keep some very sick people alive, and these people may then endure debilitating symptoms, pain, immobility and growing dependence.
When I was a junior doctor I worked for a lovely cardiologist who first made me aware of the downside of ‘keeping people alive’. He told his assembled team on a ward round one day that just a few years before we had relatively limited options for individuals coming in with a heart attack. The management was, in his own words ‘give them some painkillers, stick them in a bed, and keep an eye on them.” However, even in those days (20 years ago) we had more sophisticated treatments including clot-busting drugs and more effective resuscitation techniques. As a result, he lamented, we were now keeping more people from dying, but we were also creating more ‘cardiac cripples’ (again, his own words) – essentially people who had very poor heart function who had limited tolerance for activity, and might be breathless on a semi-permanent basis. In terms of length of life, more is not necessarily better.
The other reason I wanted to write about this piece in the Telegraph concerns its focus on statins. The contention from some ‘experts’ is these cholesterol-reducing drugs have contributed in no small way to our improved survival. Really? Let’s have a cold hard look at some facts.
Statins are given either to people who are essentially healthy but somehow deemed to be at high risk of cardiovascular disease. We call this ‘primary prevention’. Sometimes, however, statins are prescribed to people with already-established cardiovascular disease who may, for example, already had a heart attack or a stroke. We call this ‘secondary prevention’. The great majority of people taking statins are in the primary prevention category. But do statins reduce risk of death in these people. The answer is ‘no’. I wrote about this quite recently here.
The plain and simple fact is that for the vast majority of people taking statins, their lives will not be extended by one single day. This would perhaps lead us to reconsider the ‘expert’ view that statins are some sort of magic elixir.
In the Telegraph piece we have some figures quoted that caught my eye: “It is estimated that about five million people in Britain are on statins, which are credited with saving 7,000 lives a year.” I’m not sure where these figures came from, but let’s run with them for a moment anyway.
If 5 million people are taking statins, and this saves 7,000 lives a year, then over the course of a year ONE life is save for every 714 (seven hundred and fourteen) people taking statins. Even if we extrapolate forward in time (assuming similar benefit over time) this equates to needing to treat 143 people over five years to prevent just one death.
But of course, the longer you treat for, the greater the risk of adverse effects too. I recently wrote about some research published earlier this year in the British Medical Journal which showed statin use can cause serious adverse effects in significant numbers of people who take them. See here for more about this.
I’d like to round off with a real-life story. It concerns my elderly father who has known heart disease. Some years ago he was prescribed statins. A couple of weeks ago he and my mum came for lunch and my father (an avid reader) picked up a copy of Dr Malcolm Kendrick’s The Great Cholesterol Con that was in a pile of books on a table. Later on, my father was telling my mother and I that he had every one of a list of statin side-effects listed in this book. He also told me that it was taking him twice as long to walk to the local shops than it used to.
He asked my advice about this, and I advised him to stop the statins. “That’s good,” he said “because I’ve already done that.” It turns out that a few weeks before he’d intuitively felt that the statins may not be agreeing with him, so he’d started taking them only very occasionally. I suggested an all out ban. But in addition, I suggested we dose my father up with some CoEnzyme Q10. This nutrient is depleted by statins, and low levels of it can cause, among other things, muscle pain and weakness.
My parents were round again yesterday and my father spontaneously reported that he was feeling so much stronger, and that the time it took him to get to the shops had more than halved. Of course this could be an overblown placebo response. I don’t care if it is (and neither does he).
The point is that the likelihood is that my father had become a ‘cardiac cripple’ – created as a result of taking a drug which supposedly was good for his heart.
Not only is it unscientific and highly misleading to pin our enhanced survival on statins, it ignores the fact that these drugs have the potential to mess up peoples’ lives.