Editorials

Mass treatment with statins

BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g4745 (Published 23 July 2014) Cite this as: BMJ 2014;349:g4745
  1. Ben Goldacre, research fellow in epidemiology,
  2. Liam Smeeth, professor of clinical epidemiology
  1. 1London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
  1. ben.goldacre{at}lshtm.ac.uk

True informed choice will require wholesale changes to the way we gather and communicate evidence

In broad terms, statins are cheap and more likely to do good than harm. But broad terms may no longer be sufficient. The UK National Institute for Health and Care Excellence (NICE) now recommends offering a statin to anyone with more than a 10% 10 year risk of a cardiovascular event, estimated to be 25% of the population aged 30-85 years.1 When we offer a preventive drug to such large numbers of healthy people, we are a long way from the doctor treating a sick patient. In some respects, we are less like doctors and more like a life insurance sales team: offering occasional, possibly life changing, benefits, many years from now, in exchange for small ongoing inconvenience and cost. This represents a new kind of medicine, and delivering informed choice that reflects differing patient preferences will require wholesale structural improvements in how we gather and communicate research evidence.

The current data on statins have many avoidable shortcomings. Important questions on comparative efficacy, and efficacy in different risk strata, have never been adequately answered.2 3 We still do not know the difference, for example, in mortality benefits and side effects between high and low dose atorvastatin treatment in the …

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