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

Lifestage
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Everything that is wrong with the app Facebook doesn't want over 21s to download

Facebook's new teen-only offering, Lifestage, is just like your mum: it's trying too hard to relate and it doesn't care for your privacy.

Do you know the exact moment Facebook became uncool? Designed as a site to connect college students in 2004, the social network enjoyed nearly a decade of rapid, unrivalled growth before one day your mum – yes, your mum – using the same AOL email address she’s had since her dial-up days, logged on. And then she posted a Minion meme about drinking wine.

Facebook knows it’s uncool. It had a decline in active users in 2014, and in 2015 a survey of 4,485 teens discovered it came seventh in a ranking of ten social apps in terms of coolness. In fact, only 8 per cent of its users are aged between 13 and 19. This is the main reason the corporation have now created Lifestage, an app specifically for under-21s to “share a visual profile of who [they] are with [their] school network”.

Here’s how it works. After signing up and selecting their school, users are prompted to create a series of short videos – of their facial expressions, things they like, and things they dislike – that make up their profile. Once 20 people from any school sign up, that school is unlocked, meaning everyone within it can access one another’s profiles as well as those from nearby schools. Unlike Snapchat (and truly, this is the only thing that is unlike Snapchat) there is no chat function, but teens can put in their phone number and Instagram handles in order to talk. Don’t worry, though, there are still vomit-rainbows.

But with this new development, rather than hosting your mum, Facebook has become her. Lifestage is not only an embarrassing attempt to be Down With The Kids via the medium of poop emoji, it is also an invasive attempt to pry into their personal lives. Who’s your best friend? What do you like? What’s not cool? These are all questions the app wants teens to answer, in its madcap attempt to both appeal to children and analyse them.

“Post what you are into right now – and replace the video in that field whenever you want,” reads the app description on the iTunes store. “It's not just about the happy moments – build a video profile of the things you like, but also things you don’t like.” They might as well have written: “Tell us what’s cool. Please.”

Yet this is more than an innocent endeavour to hashtag relate, and is a very real attempt, like Facebook’s many others, to collect as much data on users as possible. Teens – no matter how many hot pink splashes and cartoon toilet rolls are used to infantilise them – are smart enough to have figured this out, with one of the 16 reviews of the app on the iTunes store titled “Kinda Sorta Creepy”, and another, by a user called Lolzeka, reading:

“I don't like how much information you have to give out. I don't want my phone number to be known nor do I want everyone to know my Instagram and Snapchat. I could not figure out how to take a picture or why my school was needed. Like I said, I don't want all my information out there.”

But Facebook already knows everything about everyone ever, and it’s not this data-mining that is the most concerning element of the app. It is the fact that – on an app specifically designed for children as young as 13 to share videos of themselves – there is no user verification process. “We can't confirm that people who claim to go to a certain school actually go to that school,” Facebook readily admits.

Although the USP of this app is that those over the age of 21 can only create a profile and aren’t allowed to view others, there isn’t a failsafe way to determine a user’s age. There is nothing to stop anyone faking both their age and the school they go to in order to view videos of, and connect with, teens.

Yet even without anyone suspicious lurking in the shadows, the app’s privacy settings have already come under scrutiny. The disclaimer says all videos uploaded to Lifestage are “fully public content” and “there is no way to limit the audience of your videos”. Despite the fact it is designed to connect users within schools, videos can be seen anyone, regardless of their school, and are “viewable by everyone”.

Of course none of this matters if teens don’t actually bother to use the app, which is currently only available in the US. Lifestage’s creator, 19-year-old Michael Sayman, designed it as a “way to take Facebook from 2004 and bring it to 2016”. Although he has the successful app 4Snaps under his belt, there is no guarantee Lifestage will succeed where Facebook’s other app attempts (Notify, Facebook Gifts, Poke) have not.

There are a few tricks Facebook has put in place to prompt the app to succeed, including the fact that users are ranked by how active they are, and those who don’t post enough updates will be labelled with a frowning or (here we go again) poop emoji. Still, this hardly seems enough for an app whose distinguishing feature is “Privacy? Nah.” 

Only time will tell whether the app will appeal to teens, but one thing is certain: if it does, your mum is totally downloading it.

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