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Tuesday 27 October 2015

Truth is sometimes a bitter pill

When ABC television show Catalyst questioned the effectiveness of cholesterol-cutting statins medications in a two-part series two years ago, the repercussions were fast and furious.

Statins affect many people because they are Australia’s most widely prescribed pharmaceutical and billions of dollars hang on their makers’ claims of lowering the risk of heart attack.

In October 2013, some pro-statins doctors claimed the airing of views contesting that belief could lead to thousands of deaths and demanded the Catalyst show be pulled after the first part was broadcast.

The presenter, Maryanne Demasi, came under heavy attack by health groups including the National Heart Foundation and even some of her high-profile colleagues at the ABC, notably Media Watch host Paul Barry and medical expert Norman Swan.

After an internal review was critical of some of Demasi’s reporting, the offending shows were expunged from the ABC’s website and the supporters of widespread statins use appeared to have won the day.

So it was surprising to see Demasi pop up on social media last week promoting a new British Medical Journal study she notes “strongly suggests the benefits of statins have been grossly exaggerated”.

Which is what she was trying to demonstrate on Catalyst two years ago. And it appears she thinks she’s been vindicated.

Much like another recent study on the side effects of hormone replacement therapy, this BMJ report has seen little news coverage in Australia.

The media seems somewhat gun-shy after being burnt in previous controversies.

The BMJ study is important because it proclaims to be the first “to systematically evaluate statin trials using average postponement of death as the primary outcome”. In a nutshell, it found statins increased life expectancy by just three days for people who did not already have a diagnosis of existing heart disease or associated symptoms.

This is highly pertinent to Catalyst’s assertion that many people were being prescribed statins — which have a high proportion of nasty side effects — when they didn’t need them.

For those who had already had a heart attack or stroke, the BMJ study says statins increased their longevity by just four days.

And that’s pertinent because this is the core group who doctors were worried might go off their medication because of the Catalyst report.

A University of Sydney Faculty of Pharmacy study released in June this year reported about 61,000 Australians changed their statins use after the Catalyst program.

It made the extraordinary assertion that up to 2900 “preventable and potentially fatal major vascular events” could result.

That is completely confounded by the BMJ study, which focused particularly on “survival gain” through statin use.

The BMJ study stressed that its findings were over the life of the 11 trials it assessed, which included patients at lower and high risk of heart disease who were followed for up to six years, comparing those who took statins with those put on a placebo.

“Statin treatment results in a surprisingly small average gain in overall survival within the trials’ running time,” the BMJ study concluded.

So was Demasi right when she blew the whistle on statins and got shouted down?

It is a measure of the defensiveness invoked by any questioning of overprescription — as happened with the outrageous levels of ADD medications here in WA — that the ABC’s internal review found little wrong with the first part of Demasi’s report which had provoked the hostile initial reaction.

“The factual information in the program was accurately presented and the reporter has demonstrated that she diligently sought and considered a variety of views on the subject,” it found.

“No material inaccuracy has been demonstrated by any complainant.

“In our view, notwithstanding this conclusion that the program did not infringe standards for accuracy and impartiality, the program highlights the risks of reporting unorthodox and controversial perspectives, particularly where there is a tendency to assume that the mainstream view is well known and well understood and does not require the same level of explanation as the unorthodox position.” That sounds a lot like “don’t rock the boat” — at least on medical issues.

There were obvious problems in reporting style with the second Catalyst program titled “Cholesterol drug war” which led to a finding that editorial standards were breached.

But that doesn’t mean Demasi’s conclusions or the evidence and opinions she adduced were wrong.

“By omitting a principal relevant view — held by the National Heart Foundation and other experts — that statins are useful in primary prevention if carefully targeted, the program had the effect of unduly favouring the perspective that statins are ineffective in primary prevention,” the internal review said.

But the overriding problem here is that statins are not “carefully targeted”.

If you put aside the journalistic principle that “balance” is always needed — even if one side’s argument is palpably wrong — the big issue left hanging is the substance of the position taken by the NHF.

The BMJ report undermines the strident campaign by the foundation in its support of the prevailing statins-prescribing regime in Australia, particularly for so-called “primary prevention”.

What is unseen by the public in these arguments is the pressure brought to bear by massive pharmaceutical corporations on public health groups — indeed on individual doctors — to fall in line with research on their medications that they often control both financially and scientifically.

In America’s much more open society, a lot is known about the funding of public health lobby groups and high profile medical spokesmen by what is known as Big Pharma.

There is no similar level of disclosure in Australia, even though the global nature of these pharmaceutical corporations would suggest they operate in a similar way here.

The BMJ authors recommended the prescribing guidelines for statins in Britain be reviewed in the light of the findings on their lifesaving efficacy.

The silence here is deafening.



Gail said...

This is very scary, Graham. These people spout to us the benefits of this or that drug and I, personally, seem to always suffer the side effects instead of enjoying any benefit. I think my grandmother, who was a midwife and used many herbal remedies, would be more successful with good effects. We are fortunate more have not died from the many of the "miracle" drugs.

Thanks, Jan. Uncle Bill was quite the character. We loved him anyway.

Have a blessed evening.

Gingi said...

How do you stay up on all this news?? You must be a news HAWK! -

Galina L. said...

Thank you for the bringing attention again to the statines problem. It is ironic - on the top the rise of metabolic problems in out society, we also have prescription drugs which contribute negatively to public health.