KEY POINTS FROM DAN MURPHY
1. Because statin drug therapy is likely to continue for many years, or for a lifetime, the official written position of the National Cholesterol Education Program of the National Institutes of Health state, “the decision to add drug therapy to the regimen should be made only after vigorous efforts at dietary treatment have not proven sufficient.” “Vigorous” dietary efforts are defined as a minimum of six months of intensive dietary counseling before starting statin drug therapy.
2. Statin drug trials are not preceded by vigorous dietary efforts because to do so would help people and render statin drug therapy less effective in reducing deaths from coronary heart disease (CHD) and other causes of mortality.
3. In performing a clinical trial of a drug, “all-cause mortality” is the only endpoint measure not prone to diagnostic variance and is, therefore, not popular with the drug company studies. Most statin drug trials do not even look at all-cause mortality because of the probability that taking the drugs does not alter all-cause mortality.
4. Drug company study designers search for endpoints that are most apt to yield a positive result. “This would not be the scientific approach but would make sense if the aim was to make the study appear highly successful.”
5. “If a drug or other intervention neither extends life nor improves its overall quality, then it is of no value.”
6. “There is no rigorous reporting of all-cause morbidity, nor of measurement of changes in overall quality of life, in any of the [statin drug] studies.”
7. Statin drug trials show absolute differences of less than 1 percent to a maximum of 3.3 percent in all-cause mortality between the control and treatment groups. “These are not impressive results.”
8. However, drug companies make statin drug results look impressive “by expressing the results as relative difference rather than as absolute difference.” In a statin drug trial of patients with existing CHD, the difference in deaths between the statin group and the placebo group was 3.1 percent (14.1 percent of the placebo group died and 11 percent of the statin group). The benefit of such results can appear to be magnified by expressing them as relative differences, which would be 11/14.1 = 22 percent: “The statin drug lowered the risk of death by 22 percent (11 is 22 percent lower than 14.1).”
9. The small differences favoring statin drugs in published studies “have been magnified by the manner of presentation of results, most notably by the use of relative differences between statins and placebo groups rather than absolute differences.”
10. Another serious problem is that the study does not state the number needed to treat (NNT) for one patient to benefit, which is over 100 in primary prevention trials. This means that more than 100 patients would have to take the drugs for one patient to actually receive any benefit.
11. In a study where 100 patients take statins drugs, two will have a fatal heart attack. In 100 patients taking a placebo, three will have a fatal heart attack. The absolute risk reduction of a fatal heart attach is 1 percent. Yet the drug company spins the pathetic results by dividing 2/3 and publish the relative risk, which is a 33 percent reduction of a fatal heart attack. This is dishonest. These authors claim an honest disclosure would be to state “if you take statins then, in seven years’ time, there is a one chance in about 120 that your death will have been prevented.”
12. Using current available number needed to treat (NNT) data and assuming the cost of a year of statin drugs is $500, the cost of postponing one death by using statin drugs is $85,500 for patients with the highest risk, to more than $300,000 for those with the lowest risk.
13. “It is arguable that statins are cost-effective for the small minority of people at especially high risk of CHD.”
14. “Lowering the threshold to make much larger numbers of people eligible for drug therapy has the effect of making statins an extremely expensive means of preventing heart disease. The case for statin drugs, especially for primary prevention, has not been made.”
Dr. Dan Murphy graduated magna cum laude from Western States Chiropractic College in 1978. He received Diplomat status in Chiropractic Orthopedics in 1986. Since 1982, Dr. Murphy has served part-time as undergraduate faculty at Life Chiropractic College West, currently teaching classes to seniors in the management of spinal disorders. He has taught more than 2000 postgraduate continuing education seminars. Dr. Murphy is a contributing author to both editions of the book Motor Vehicle Collision Injuries and to the book Pediatric Chiropractic. Hundreds of detailed Article Reviews, pertinent to chiropractors and their patients, are available at Dr. Murphy’s web page, www.danmurphydc.com