Statin-related side effects: the recent Lancet publication is biased toward false-negatives

This is a lot of words. I was with you for the first two paragraphs. But then I just started to get angry. Your writing betrays a strong ideological overtone that goes way beyond the statistical point you’re trying to make.

“Such a methodological and infodemiological problem has consequences as serious as those associated with statin denialism.”

No, in this particular case, it doesn’t- not even remotely close. Are you a clinician who has to grapple, day in and day out, with the consequences of statin denialism for real patients with lives on the line?

“…or because they are influenced by ideological, political, social, or economic pressures…”

You are implicitly accusing clinicians of somehow profiting from the promotion/sale of generic medications that have been on the market for decades and cost patients pennies per day. You’re implying that being forced to “admit” that these drugs might have risks would somehow cut into those profits or force us to acknowledge some embarrassing “truth” about statins that could have wide-reaching clinical consequences. Hogwash. How, exactly , in this day and age, do you propose that clinicians benefit from prescribing statins to their patients?..The answer is that we don’t.

There’s a trope - perpetuated for many years by drug safety researchers whose egos have been bruised by run-ins with defensive pharmaceutical companies, either in print or in court- that paints physicians as either stupid or corrupt or both. The (extremely insulting) insinuation is that we are zombie-like prescribing machines who are incapable of independently assessing the strength of the evidence behind our practices. As though medicine isn’t actually a profession, like any other. As though we don’t care enough to ensure that what we do every day at work makes sense. As though statins are some type of sacred cow that we “ritualistically” defend, with glazed eyes, from any criticism, no matter how well-founded. Newsflash- none of these things are true. Believe it or not, we actually just like keeping our patients alive as long as possible and out of congestive heart failure. There’s no other medication class on the market (aside, perhaps, from contraceptive pills) that has been studied as widely as this one, with benefits demonstrated over and over…and over again. These pills save lives- full stop. Are they perfect? No. Can they have side effects, like every other medication? Yes. Should doctors talk about them? Yes.

Do I think the Oxford team should have said that statins “don’t cause” certain AEs? The answer is “no”- statistically speaking, it’s impossible to “prove” a complete absence of risk. I happen to agree with you that this was a poor choice of wording. And I don’t fault you for calling them out on it. In my opinion, the wording I suggested above would have been more accurate and appropriate and would have put reasonable bounds on the residual uncertainty around statin-related AEs, after all these years. But if you are suggesting (as you seem to be) that there are multiple clinically important risks for this very old class of drugs and that the Oxford researchers are actively trying to bury them with their analysis (in order to “save face” after promoting them heavily or because they are somehow in bed with pharmaceutical companies), any credibility you might have been afforded for your “absence of evidence” point is going to go out the window.

Could your group’s crusade to make your statistical point cost lives given our current clinical climate? Maybe. So I’d suggest that you think very hard about the tone and wording of your rebuttals. In spite of your protests to the contrary, I detect a very strong “anti-pharma”/conspiratorial overtone in your response. I’m not sure how you acquired it, but it’s something you should probably curb - at least when discussing an issue of such massive public health importance.