Statins. Photo: Getty
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Why the stats about statins don't tell the whole story

For those without the relevant risk factors, statins aren't the wonder-pill they've been sold as by the media.

Maggie came hot-foot from a “health check” where she’d had her cholesterol measured. “Six point two!” she told me. “The nurse said that’s high.” She sounded rather spooked. “I’d like you to give me a statin.”

I’ve known Maggie for years. She’s a sensible academic in her early fifties. She’d done enough googling to learn that a “high” cholesterol means you are “at risk” of cardiovascular disease (CVD) – heart attacks and strokes – and that statins lower cholesterol and reduce CVD risk by 25 per cent. Her request for treatment made perfect sense to her . . . except she had fallen for the same myth that leads to several million people in the UK swallowing a statin every day for no good reason at all.

Focus for a moment on that 25 per cent risk reduction. If you’re at high risk of something nasty, then lopping off a quarter of that risk makes sense. The people at greatest risk of heart attacks and strokes are those who have previously suffered one. Giving statins to these patients (secondary prevention) does convey modest benefits. If you take 100 heart attack survivors and get them to take a statin for five years, you’ll save one life, prevent two or three non-fatal heart attacks, and avert one stroke. That is worthwhile, even if the statins will fail to prevent at least 15 other heart attacks/strokes, and will cause two patients to develop diabetes, and provoke muscle weakness in ten others. Notice, though: 95 per cent of these highest-risk patients will derive absolutely no benefit from their five years of statin consumption.

Come back to Maggie. Using a statin on someone without existing CVD is termed primary prevention. Maggie has no other risk factors (high blood pressure, smoking, diabetes, and so on) and so her chance of developing heart disease is very low. In Maggie’s case, because her risk is so small to start with, a 25 per cent reduction is minuscule and meaningless. You’d have to treat hundreds of Maggies for years on end to hope to make a jot of positive difference to one of them, and the side effects from statins (we’re still discovering what these are) will far outweigh any putative benefit.

There are large numbers of people just like Maggie who are taking statins and who should come off the tablets. But what about individuals at greater risk – people with high blood pressure or obesity, or smokers? Is there a level of risk at which primary prevention is worthwhile? For some time the UK’s National Institute for Health and Clinical Excellence (NICE) has suggested a threshold of 20 per cent risk over ten years.

At first glance, the trial data does suggest a marginal impact at this sort of level: roughly two heart attacks/strokes are averted among 100 people treated for five years. But, crucially, death rates are not altered; no lives are saved by using statins. This probably reflects the harm also caused by statins, and how any small reduction in CVD is negated by disability and death from other causes.

Taking up regular exercise, or adopting a Mediterranean diet, reduces CVD risk by degrees comparable with statins – in the case of diet, substantially more so. If someone smokes, quitting is similarly helpful. What’s more, once one has adopted these lifestyle changes, statins become virtually redundant. Lifestyle modification is also cheap; there are very few harms besides. And, unlike with statins, these measures protect against other causes of death and disability, such as cancer and the frailties of advancing age. Oh, and they’re good for mental health, too.

This February, NICE initiated a consultation on halving its primary prevention threshold to 10 per cent risk. If achieved, this would add hugely to the six million people in the UK who take statins on prescription. Rather than exacerbate our statin fetish, NICE could design simple decision aids that would help doctors understand the more effective improvements that lifestyle changes can bring to health and well-being – and which would illustrate these benefits to patients.

Once we’d talked things through, Maggie resolved to start attending the university gym a few times a week. She decided to forget the statin prescription, too. As a nation, we’d do well to try the same. 

This article first appeared in the 26 February 2014 issue of the New Statesman, Scotland: a special issue

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The second coming of Gordon Ramsay

A star is reborn. 

It would be a lie to say that Gordon Ramsay ever disappeared. The celebrity chef made his television debut in 1997 and went on to star in shows in 1998, 2001, 2004, 2005, 2006, 2007, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, and 2017. There hasn’t been a lull in Ramsay’s career, which has arguably gone from strength to strength. In 2000, he was cooking for Vladimir Putin and Tony Blair – in 2008, he ate the raw heart of a dead puffin.

Left: Gordon Ramsay shaking hands with Vladimir Putin. Right: Gordon Ramsay hugging a puffin (different from the one he ate).

Yet we are, undeniably, in the middle of a Ramsay renaissance. How? How could a man that conquered the last twenty years of cookery-based television have an upsurge in popularity? There are only so many television channels – so many amateur donkey chefs. Wrong. The internet has enabled a Ramsay resurgence, the second act of a play overflowing with blood, sweat, and French onion soup.

Wow.

We all, of course, know about Gordon’s Twitter account. Although started in 2010, the social media profile hit the headlines in February this year when Ramsay began rating food cooked by the world’s amateur-amateur chefs. But other elements of Ramsay’s internet celebrity are more miraculous and mysterious.

His official YouTube channel uploads, on average, three videos a week. Decades old clips from Kitchen Nightmares accumulate over three million views in as many days. A 15,000 follower-strong Facebook fan page for the show – which premiered in 2007 and ended in 2014 – was set up on 19 June 2017.

Wow, wow, wow, wow. Wow.       

A Google Trends graph showing an April 2017 surge in Ramsay's popularity, after a decline in 2014.                                      

What makes a meme dank? Academics don’t know. What is apparent is that a meme parodying Gordon Ramsay’s fury over missing lamb sauce (first aired on Hell’s Kitchen in 2006) had a dramatic upsurge in popularity in December 2016. This is far from Gordon’s only meme. Image macros featuring the star are captioned with fictitious tirades from the chef, for example: “This fish is so raw… it’s still trying to find Nemo”. A parody clip from The Late Late Show with James Cordon in which Ramsay calls a woman an “idiot sandwich” has been watched nearly five million times on YouTube.

And it is on YouTube where Ramsay memes most thrive. The commenters happily parrot the chef’s most memable moments, from “IT’S RAW” to the more forlorn “fuck me” after the news something is frozen. “HELLO MY NAME IS NINOOOOO!” is an astonishingly popular comment, copied from a clip in which a Kitchen Nightmares participant mocks his brother. If you have not seen it – you should.

But what does all this mean for Ramsay’s career? His YouTube channel and Facebook page are clearly meticulously managed by his team – who respond to popular memes by clipping and cutting new videos of classic Ramsay shows. Although this undoubtedly earns a fortune in ad revenue, Ramsay’s brand has capitalised on his internet fame in more concrete ways. The chef recently voiced Gordon Ramsay Dash, a mobile game by Glu Games Inc in which you can cook with the star and he will berate or praise you for your efforts. Ten bars of gold – which are required to get upgrades and advance in the game – cost 99p.

Can other celebrity chefs learn from Ramsay? A generation will never forgive that twisted, golden piece of meat, Jamie Oliver, for robbing them of their lunch time Turkey Twizzlers. But beyond this, the internet’s love is impossible to game. Any celebrity who tried to generate an online following similar to Ramsay’s would instantly fail. Ramsay’s second coming is so prolific and powerful because it is completely organic. In many ways, the chef is not resposible for it. 

In truth, the Ramsay renaissance only worked because it was - though the chef himself would not want to admit it - completely raw.

Amelia Tait is a technology and digital culture writer at the New Statesman.