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Letters to the Editor
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Statins
Pharmacists need to see through the spin
From Mr C. F. Brewer, MRPharmS
Although I welcome Jim
Smith’s contribution to the debate on primary
prevention with statins (PJ, 1 April, p382), I am left feeling that he
did not actually acknowledge any of the issues raised by my Broad
spectrum piece (PJ, 11 March, p290).
Pharmacists are aware of the benefits of statins; we cannot open a newspaper
without learning about the latest breakthrough. What we do not need is
spin. I was disappointed with the way in which Professor Smith quoted
some impressive statistics while omitting to mention any of the less
favourable findings from the same study.
The meta-analysis commissioned by the National Institute of Health and
Clinical Excellence did produce myocardial-infarction reduction figures
that were of (borderline) statistical significance.1 However, the same
analysis found that there was no significant decrease in total mortality,
cardiovascular mortality, coronary heart disease mortality, stroke mortality,
non-fatal stroke, unstable angina and revascularisation. These were surely
equally important findings and may indicate that we need to do more research
before we start expecting 3.3 million healthy people to change their
lifestyle.
The Canadian analysis cited by Professor Smith uses the simple expedient
of extrapolating a small treatment benefit to a large population, making
the number of lives saved look positively heroic.2 Had the analysis been
performed in China, the figures would look even better. These types of
headline statistics are of no relevance to those of us who treat one
patient at a time.
Professor Smith unwittingly reinforces my message that a gulf exists
between the objectives of the health establishment and the health care
needs of real people. Our patients are capable of making informed choices,
provided they are given relevant information in a form they can understand.
Chris Brewer
Medicines Information Pharmacist
North Cumbria Acute Hospitals NHS Trust
References
1. National Institute of Health and Clinical Excellence. Cardiovascular
disease — statins. Technology Appraisal 94. London: NICE; 2006.
2. Manuel DG, Lim J, Tanuseputro P. Revisiting rose: strategies for
reducing coronary heart disease. BMJ 2006;332:659–62. |
The
Pharmaceutical Journal