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Editorials

Is this muscle pain caused by my statin?

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j3030 (Published 23 June 2017) Cite this as: BMJ 2017;357:j3030
  1. Matthew J Shun-Shin, cardiology registrar,
  2. Darrel P Francis, professor
  1. International Centre for Circulatory Health, Imperial College London, UK
  1. Correspondence to Darrel Francis darrel{at}drfrancis.org

Use n of 1 trials to get the right kind of individual patient data

Prevention is better than cure, or so the saying goes. In reality, however, swift treatment for a heart attack is more gratefully received than recommendation of a statin to prevent one. Why don’t people want the prevention we offer?

One problem is that no one can ever announce that “statins saved me from a heart attack.” No clinical trial, nor sophisticated observational study, can provide this information, because each person lives their life only once. Therefore, the case for statins relies entirely on trust in statistics (and the people who produce them), which patients might reasonably doubt when their accuracy and implications are debated.1

Moreover, traditional statistics describe only group averages, rarely indicating how much an individual could gain or lose from preventive treatment. For example, if nine out of 10 people who take a statin get no benefit, what does that mean for the one person who does?2 Gain from …

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