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Statins, news, and nuance

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i3379 (Published 28 June 2016) Cite this as: BMJ 2016;353:i3379

Rapid Response:

Influence of media, existence of professional associations with commercial intent, lack of trustworthy specialists to assist in taking medical decisions,

Dr Gary Schwitzer has rightly suggested that the Journalism that exposes the public to ongoing controversies in science should be nurtured. But many of these issues are very complex. We have to consider the influence of media, existence of professional associations with commercial intent, lack of trustworthy specialists to assist in taking medical decisions among others.

Regular readers of medical journals who also read popular medical news stories may face a dilemma. Such readers with discerning capability may not be carried away by sensational reporting. But when journals themselves carry diverse views on medical matters, the most ideal way for the serious reader is to wait until the conclusions in such peer reviewed papers are considered by scholarly bodies of professional associations, Royal Societies, etc, and they in turn arrive at appropriate guidelines.

This is a slow process. The concerned individual can approach his physician and take a decision on the way forward. Conclusions in one paper may not be enough for the physician to offer you his considered opinion. He will fall back on the prevalent guidelines. The individual patient has no choice in the matter. More often, your physician may not be keeping abreast with the latest papers. In practice, the patient will continue to follow the instructions received during the first visit.

The most serious dilemma faced by a reader who keeps abreast with new developments is when he finds that the clinical guidelines are being challenged by influential groups of physicians whose judgment may or may not be influenced by personal interest. They form their own guidelines which may be different from those of the mainstream professional associations. In some instances, it is very difficult to identify their true intentions.

A typical example is the existence of guidelines recommended by SHAPE which is not endorsed by the mainstream professional associations. SHAPE is the Society for Heart Attack Prevention and Eradication. The Evolution of the SHAPE guidelines may be seen at the following link:

http://www.medscape.com/viewcollection/32912

An important development is that SHAPE could prevail on the political leadership of Texas State to pass a legislation supporting insurance payments for the tests they were suggesting. It was a very controversial legislation. That way, issues which should be settled by professional associations or their Royal Societies were dragged into the political arena. To many, it was an inappropriate way. Some physicians have no qualms in popularizing tests based on anecdotal evidence. Some specialists enlisted the support of TV doctors or TV talk show anchors to promote CT scans of symptom-less patients. Physicians with an eye to make money promoted anti-radiation pill which allegedly reduces (no credible proof) the cancer risk from medical x-ray procedures. Everyone is happy. Physicians can carry out CT scans without worrying about radiation dose; the patient need not worry as he has consumed anti-radiation pill! Main stream medical journals may have too soft an underbelly; they may not be willing to expose such practices because of the fear of litigation.

Often commercial interests influence decision making. A stage has come where a patient has an enormous choice because of the internet. He can now read professional journals, journals published to support commercial interests, trade journals, blogs by various professionals, etc.

Ethical deficits may be bedeviling any profession. But for the medical profession, the implications are wider.

Sensationalism in medical reporting has a devastating impact. I regularly read several medical journals and associated publications. I developed a habit of forwarding medical information of societal importance (associated with BP, Cholesterol, CT scan, life style etc) to friends and relatives. If the receiver of such information is a hypochondriac, I realized that I am doing infinite damage. Issues related to statin use, coronary calcium screening, treatment of hypertension are the latest examples.

Proliferation of medical news stories may not do damage if wise, trustworthy GPs are available for giving advice. Regrettably, they are very rare. I have not included the impact of predatory journals. I do not have quantitative data. We cannot ignore them. In conclusion Medical news stories have other nuances as well.

Competing interests: No competing interests

01 July 2016
Parthasarathy Dr KS
Retired Scientific Officer
AERB
302, Mangal Prabha