Scary news but editors close their eyes

July 2011

Half a year ago I told you about the new Cochrane report the authors of which concluded that the benefit from statin treatment of people without heart disease is questionable. What I didn´t tell about was the results from a report by Hippisley-Cox and Coupland published last spring in British Medical Journal. The reason was that I hadn´t observed it myself at that time.

In the QResearch database 368 general practices in England and Wales had supplied data from more than 2 million patients of whom 225,922 were new statin users. By analysing these data Hippisley-Cox and Coupland concluded that whereas the total number of prevented coronary events, almost all of which were non-fatal, was less than 3 per cent, the total number of adverse effects was more than 4 per cent. The adversities were not harmless either, but consisted of acute renal failure, cataract, and serious liver and muscle damage.

You may probably ask yourself if statin treatment of healthy people has been stopped after the publication of this scary report. The answer is no. Neither the practicing doctors nor common people know about these figures, possibly because the British report is difficult to understand for people without thorough knowledge about epidemiology and statistics. But what about the experts? Why haven’t they reacted? Are they anxious to loose their research money and their other financial benefits from the drug industry?

Together with two highly qualified members of THINCS (Professors Paul J Rosch and Morley C Sutter; see our list of members) I sent a paper to British Medical Journal about this issue. In the paper we showed in many details that the number of adverse effects must have been even higher because liver disease was recorded only if the substance that reflects liver damage was three times higher than the upper limit of normal, and muscle disease was recorded only if the substance that reflects muscle damage was four times higher. In accordance independent researchers have reported that 20-25% of statin-treated people experience muscle pain or weakness. We also pointed out that several types of adversities were not recorded at all. It is well known for instance that diabetes occur in about 0.5% of statin-treated people and that 20% of the male patients become more or less impotent after a few months treatment. Reviews taking all cholesterol-lowering trials together have also shown a significant increase in death from accidents, suicide, or violence, and there are numerous reports about memory loss and other cerebral disturbances.

Worst of all is that the risk of cancer has been ignored by all experts although there is much scientific evidence that cholesterol lowering may result in cancer (you can read much more about that in my recent book Ignore the Awkward!).

A few days later I received the following message from the editor:

Thank you for sending us your paper. We read it with interest but I regret to say that we have decided not to publish it in the BMJ. Although we are sympathetic to the general point that the downsides of statins are underappreciated, we think that we have covered the point enough. Indeed, we published the Hippesley Cox article that you draw heavily upon.

But neither the editor nor the authors have drawn the relevant conclusion that healthy people should stop taking statins. We therefore send our paper to The Lancet instead, but got an immediate answer from the editor:

Dear Dr. Ravnskov, Many thanks for submitting your manuscript to The Lancet. We have considered your manuscript, but our decision is that it would be better placed elsewhere

We tried Archives of Internal Medicine, but with the same result:

Dear Dr. Ravnskov, Your manuscript has been reviewed by the senior editors of Archives of Internal Medicine. I regret to inform you that its priority rating is not sufficiently high to warrant our considering it further for publication. Based on our initial review, we will not be sending the paper for additional outside editorial review

Today millions of healthy people are on statin treatment without knowing about the imbalance between benefits and risks. How should we inform them when the experts and the medical journals don´t? We haven´t given up and we shall try other journals. The problem is however, that few medical journals are able to survive without their income from the drug industry, and editors are therefore reluctant to publish papers like ours.

In Sweden we have succeeded in informing the public by publishing an article in Dagens Nyheter, the largest and most influential Swedish newspaper. An English version is available on the web. Click also on the text in the upper. right hand corner: Svenska Dagbladet: Debate on reignited.