The BMJ Today: Statins and uncertainty

And so the debate about the adverse effects of statins rumbles on. Nigel Hawkes reported from yesterday’s press briefing at the Science Media Centre saying that the ‘Statins War’ shows ‘no signs of a ceasefire’. Six leading professors of cardiology and epidemiology present at the meeting backed the NICE guidance on extending the use of statins, expressing conviction that benefits of statins outweigh the risks.

But how, argues Ben Goldacre in a recent rapid response do patients (and doctors for that matter) weigh up the risks and benefits of preventative treatments such as statins when each patient is different and each has different needs?

Professor Peter Weissberg, Medical Director of the British Heart Foundation (ref Hawkes- link above) has stated that ‘objective evidence from RCTs is particularly important with a drug such as a statin where we have to strike a balance between visible harm and invisible benefit’. With these ‘invisible benefits’ in mind, Ben Goldacre highlights that with this new type of preventative treatment medicine we may find ourselves becoming less like doctors and more like being a life insurance sales team ‘offering occasional benefits, many years from now, in exchange for small ongoing costs’.

The theme of uncertainty continues with a recent clinical review on allergic rhinitis in children. The authors provide clarity on the management of this important condition with its potential to have major impact on children’s quality of life, as well as being a risk factor for a child developing asthma in later life. They set out the evidence for use of nasal irrigation, second generation H1 antihistamines as well as modern intranasal glucocorticoids and immunotherapy.

And Margaret McCartney highlights the difficulties faced in primary care in making appropriate cancer referrals. She says that UK’s health secretary’s suggestion to ‘name and shame’ surgeries with low referral rates represents ‘a failure to understand what GPs do’.

Whether discussing the risks and benefits of statins, or spending time making a diagnosis of cancer, the ultimate outcome for patient care is that we present our patients with sufficient information in order to support them to be able to make ‘their own truly informed decisions’. (ref Goldacre -see link above).

Cath McDermott is education editor, The BMJ