About Medical Misleading

There is much evidence that the cholesterol campaign may be the main cause of the crises in the health care system in many countries; not only because of the obesity and diabetes epidemics that started shortly after American authorities without any scientific support had introduced the high-carb low-fat diet at the early eighties, but also because millions of patients and healthy people all over the world have been prescribed a drug with minimal benefit, if any at all, and with many serious side effects.

As you know from my November newsletter, we have recently published a review of all the falsifications of the cholesterol hypothesis in the journal Expert Review of Clinical Pharmacology. According to Taylor & Francis who publish more than a hundred scientific journals, more than 10,000 open access papers were published during the year 2018. Our paper is placed on the top of their list of the ten most downloaded papers.

Hitherto our paper has not been commented in any of the major medical journals. Instead, editors of Circulation wrote that they together with the editors of 16 other cardiology journals have published an article in which they claim that the benefit of statin treatment have been proved by “robust scientific advances, published in the pages of our journals” and that it has “fostered significant improvements that benefit individuals and society.” 

But the authors are dissatisfied because their “prodigious tool chest” has been questioned by “medical misinformation hyped through the internet, television, chat rooms, and social media. In many instances, celebrities, activists, and politicians convey false information”.

We consider it highly unlikely that the editors of seventeen major cardiologic journals shouldn´t have observed a paper, which today has been downloaded by more than 70,000 readers. 

“By coincidence”, the Cholesterol Treatment Trialists Collaboration (CTT) have published an article in the current issue of Lancet entitled “Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials“. Here they suggest that up to 8,000 lives can be saved annually in the U.K. if everyone over the age of 75 receives statin therapy. CTT has previously published a 2010 Lancetpaper touting the “Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials”, so the present article is largely a rehash of old data that is not available to anyone else for verification. 

As many cardiovascular events may heal with minimal sequels or none at all, mortality is a more important outcome. In the recent CCT paper the authors claim that the result was a 12% reduction of coronary mortality. However, according to webfigure 6 in the appendix(a section that very few read), the reduction of coronary and all-cause mortality was only 0.2% per year. In webfigure 6 the total number of death per year among the oldest was 850 (4.1%) in the statin groups and 869 (4.3%) in the control/less groups. This means that the number of participants in each group must have been 19,767 and 20,209, respectively, and the total number 49,834. Thus, as the difference between the two groups was only 19 deaths, it means that you have to treat 1040 patients for a year to prevent one death.

How many of these patients may suffer from serious side effects is debatable. According to the statin reports it is less than 0.1%, but this is highly incredible, because in most statin trials the authors have excluded those who suffered from side effects in a short run-in period before the trial started. Many independent authors have documented much higher numbers, and in the IDEAL trial, where a low statin dose was compared with a high dose and where no run-in period was included, almost 50% in each group suffered from serious side effects. This is not mentioned in the abstract or in the text; only in a table (table 4). Furthermore, when you download this paper, the tables are not included.

 More comments to the Lancet paper have been published by Zoë Harcombe, and Malcolm Kendrick,two of our THINCS members.

A relevant question: Who are misinforming?

Uffe Ravnskov

PS This letter has been sent to more than 1500 scientists, colleagues and wise laypeople