Tuesday, 1 May 2007

Scare tactics

William came in to see me today and told me that he stopped taking his statin tablet three weeks ago. He is a rather anxious Welshman in his mid-sixties whom I have known for years, and he was started on atorvastatin by the hospital when he was admitted with a heart attack five years ago. This was a good move as there is clear evidence that taking a statin to lower cholesterol following a heart attack considerably reduces the risk of having another. But atorvastatin is expensive and simvastatin is known to have similar protective properties. Following local and national advice we changed William from atorvastatin 10mg to simvastatin 40mg last year. He had no side effects and his cholesterol level was at a similar low level. All seemed well - so why has he stopped taking the simvastatin?

He showed me a full-page article from The Mail on Sunday, published three weeks ago. This reported that you are three times more likely to die if taking simvastatin than atorvastatin, so naturally William had stopped it. Oh dear! What the newspaper was reporting was a small study in one hospital which showed that the death rate among patients taking simvastatin in one three month period was three times the death rate among those taking atorvastatin in a different three month period.

I explained carefully that this was only one extremely small piece of research that doesn't contradict the large amount of research which shows that simvastatin and atorvastatin are both beneficial. I also explained that it was more dangerous not to take a statin at all. William listened courteously, but replied “it's no use doctor, I can't take them again. Even if I told you that I would, I couldn't bring myself to swallow them”.

So there you have it, the advice of the longstanding family GP counts for nothing against the facts, printed in black and white (and with a colour photograph too) in The Mail on Sunday. This is just a little vexing. I have no problem with journalists reporting facts, but evidence based medicine is a complex beastie and requires careful explanation to the general public. The MoS simply reported that simvastatin patients were more likely to die, and said that the doctors who did the research wanted NICE to reconsider their recommendations. True as far as it went, but extremely misleading out of context. In the case of my patient it has caused a lot of anxiety, and put him at extra risk of a heart attack because he stopped his statin three weeks ago. How many other patients have been similarly affected?

I have asked William to get his cholesterol level checked again and to see me shortly afterwards. We can then look at the figures and I will try to persuade him to restart his simvastatin. But I could end up in the awkward position where I have to offer William the expensive statin he doesn't need because he is too scared to take the cheap statin which would do him just as much good. Which is what The Mail on Sunday wants.
You cannot hope to bribe or twist
(thank God) the British journalist.
But seeing what the man will do
Unbribed, there's no occasion to.


The Little Medic said...

We don't need doctors in the UK anymore. The Daily Mail can take care of everyone.

Your Mother said...

*sigh* I remember all the annoying questions I asked my doctor when I was pregnant, all sparked by some hoopla I had read. She was so patient, but I didn't realize that til later. For instance: "Doctor, I just ate some fancy cheese on my Mexican food plate. The book says it's unpasteurized! My baby's going to die!" Only to learn later that all cheese in the US, including that which we accept for import, is pasteurized.

My favorite, however, was mercury. I so craved fish in the latter half of my second trimester, but was afraid to eat it. So I ate a little. I tried to hold back, but eventually I couldn't and I ate a couple servings of salmon for several weeks. I made an effort to avoid "mercury" fish, but I was worried. Then, a year after my baby is born, the newspaper articles come out with: oops! we were (sorta) wrong. The omega-whatever's in fish are really, really beneficial for baby. People who avoid all fish in the name of mercury may be doing their baby harm!


The information overload effect of our modern age is fascinating.

Dr Andrew Brown said...

Little Medic: it is quite surprising that all those doctors who studied so hard and slogged so long to get that experience should still know less than a journalist on the Daily Mail. It's a scandal - somebody ought to write to the papers about it.

A Mom WTTM: thanks for the anecdotes. But it can't be helped - as parents we "can't do right for doing wrong". I think the sheer volume of information means we need experts whom we can trust, like a doctor or a (good) journalist.

Ms-Ellisa said...

I agree with little medic.. I'm preparing a post on how you can persuade patients to do what is good for them. What is worse there are some papers which publish medical stuff under the title "medicine" or sth like it, and NONE of the writers is a doctor, or anything close to that, but readers think it is written by doctors.

Dr Andrew Brown said...

You can try to persuade people but you can't force them. Your tactics will need to vary depending on the type of patient, and the reason they are refusing. And during your career you will come across a few patients whom you will be unable to persuade and who will come to harm as a result. Life is complex, messy and sometimes uncomfortable.