Statins. Photo: Getty
Show Hide image

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

Photo: Getty
Show Hide image

The science and technology committee debacle shows how we're failing women in tech

It would be funny if it wasn’t so depressing.

Five days after Theresa May announced, in her first Prime Minister’s Questions after the summer recess, that she was "particularly keen to address the stereotype about women in engineering", an all-male parliamentary science and technology committee was announced. You would laugh if it wasn’t all so depressing.

It was only later, after a fierce backlash against the selection, that Conservative MP Vicky Ford was also appointed to the committee. I don’t need to say that having only one female voice represents more than an oversight: it’s simply unacceptable. And as if to rub salt into the wound, at the time of writing, Ford has still not been added to the committee list on parliament's website.

To the credit of Norman Lamb, the Liberal Democrat MP who was elected chair of the committee in July, he said that he didn't "see how we can proceed without women". "It sends out a dreadful message at a time when we need to convince far more girls to pursue Stem [Science, Technology, Engineering and Mathematics] subjects," he added. But as many people have pointed out already, it’s the parties who nominate members, and that’s partly why this scenario is worrying. The nominations are a representation of those who represent us.

Government policy has so far completely failed to tap into the huge pool of talented women we have in this country – and there are still not enough women in parliament overall.

Women cannot be considered an afterthought, and in the case of the science and technology committee they have quite clearly been treated as such. While Ford will be a loud and clear voice on the committee, one person alone can’t address the major failings of government policy in improving conditions for women in science and technology.

Study after study has shown why it is essential for the UK economy that women participate in the labour force. And in Stem, where there is undeniably a strong anti-female bias and yet a high demand for people with specialist skills, it is even more pressing.

According to data from the Women’s Engineering Society, 16 per cent of UK Stem undergraduates are female. That statistic illustrates two things. First, that there is clearly a huge problem that begins early in the lives of British women, and that this leads to woefully low female representation on Stem university courses. Secondly, unless our society dramatically changes the way it thinks about women and Stem, and thereby encourages girls to pursue these subjects and careers, we have no hope of addressing the massive shortage in graduates with technical skills.

It’s quite ironic that the Commons science and technology committee recently published a report stating that the digital skills gap was costing the UK economy £63bn a year in lost GDP.

Read more: Why does the science and technology committee have no women – and a climate sceptic?

Female representation in Stem industries wasn’t addressed at all in the government’s Brexit position paper on science, nor was it dealt with in any real depth in the digital strategy paper released in April. In fact, in the 16-page Brexit position paper, the words "women", "female" and "diversity" did not appear once. And now, with the appointment of the nearly all-male committee, it isn't hard to see why.

Many social issues still affect women, not only in Stem industries but in the workplace more broadly. From the difficulties facing mothers returning to work after having children, to the systemic pay inequality that women face across most sectors, it is clear that there is still a vast amount of work to be done by this government.

The committee does not represent the scientific community in the UK, and is fundamentally lacking in the diversity of thought and experience necessary to effectively scrutinise government policy. It leads you to wonder which century we’re living in. Quite simply, this represents a total failure of democracy.

Pip Wilson is a tech entrepreneur, angel investor and CEO of amicable