Do statins reduce the risk of infection?BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d7134 (Published 29 November 2011) Cite this as: BMJ 2011;343:d7134
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Professor Golomb  presents a conventional analysis of the evidence for and against the link between statins and a reduction in the risk of infection. In the editorial, she discusses the weaknesses of observational studies, followed by those of randomised controlled trials. Then, without further ado, the evidence from the recent meta-analysis of RCTs  is accepted and Professor Golomb, contrary to the data from observational studies, concludes that statins do not reduce the risk of infection.
The missing premise in this argument is that RCTs and their meta-analyses are superior to observational studies. This, of course, is written in stone. But once the potential flaws of each method are acknowledged – as some of them are in this case – how are we to gauge which is the better? In any particular instance, how do we know which of the biases listed in the editorial are in play and which are of greater importance?
And there is a curious aspect to this editorial. The meta-analysis by Hoek et al.  showed a relative risk of 1.0 (95% CIs 0.96-1.05) in eleven RCTs involving almost 31,000 participants. To those who believe in this methodology, such results should be convincing. Yet, Professor Golomb ends with the remark that there is more to learn. But what does this mean? Is she encouraging further studies? What would be gained by such endless research? Is she offering solace to the pharmaceutical industry in the face of this unwelcome finding? Or is it rather that she is not so sure about this matter as her editorial would lead us to believe?
The on-going debate about the relative merits of observational studies and RCTs drags on. This is only to be expected. All statistics-based research – whether epidemiological studies or large-scale RCTs – is flawed  and nothing of clarity or of value will ever come of it.
1. Golomb BA. Do statins reduce the risk of infection? BMJ 2011;343;d7134
2. Van den Hoek HL, Bos WJW, De Boer A, van de Garde EMW. Statins and prevention of infections: systematic review and meta-analysis of data from large randomised placebo controlled trials. BMJ 2011;343;d7281.
3. Penston J. Stats.con – How we’ve been fooled by statistics-based research in medicine. The London Press. London, November 2010
Competing interests: No competing interests