Intended for healthcare professionals

Letters The treatment paradox

Not treating, delaying

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39465.479988.3A (Published 24 January 2008) Cite this as: BMJ 2008;336:174
  1. Malcolm Kendrick, salaried general practitioner
  1. 1Brownley Green Health Centre, Wythenshaw M22 4GL
  1. malcolmken{at}doctors.org.uk

    The true benefit of statins is actually much less than Spence outlines.1 This is mainly because the use of the term NNT (number needed to treat) is inappropriate, as the T implies treatment and cure. Statins do not treat or cure death; they only delay it.

    For how long is that death delayed? There is not enough room in a rapid response to do the maths. However, if you model the Kaplan-Meier survival curves, it is considerably less than one year. However, for the sake of argument, let us assume that you do gain one entire extra year of life for every 700 years of taking a statin. Then, clearly, if you treat for 700 years you will create one added life year.

    Using this (overoptimistic) figure means that if you treated someone for 30 years you can expect to provide them with 30/700 added years of life. This is 15.64 days, or, a shade over two weeks.

    In short, if a 50 year old man asked you how much longer he could expect to live if he took a statin for 30 years you can inform him “just over two weeks—max.”

    Footnotes

    • Competing interests: MK wrote the book The Great Cholesterol Con.

    References

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