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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Amazon's unlikely role in the Calais relief efforts

Campaigners are using Amazon's wishlist feature - more commonly used for weddings and birthdays - to rally supplies for the thousands camped at Calais. 

Today and yesterday, relief efforts have sprung up across the web and IRL following the publication of shocking photos of a drowned refugee child. People are collecting second hand clothes and food, telling David Cameron to offer refuge, and generally funneling support and supplies to the thousands in Calais and across Europe who have been forced from their homes by conflict in Syria and elsewhere. 

One campaign, however, stuck out in its use of technology to crowdsource supplies for the Calais camp. An Amazon wishlist page - more familiar as a way to circulate birthday lists or extravagant wedding registries - has been set up as part of the  #KentforCalais and #HelpCalais campaigns, and is collecting donations of clothes, food, toiletries, tents and sleeping supplies. 

Judging by the Twitter feed of writer and presenter Dawn O'Porter, one of the list's organisers, shoppers have come thick and fast. Earlier today, another user tweeted that there were only six items left on the list - because items had sold out, or the requested number had already been purchased - and O'Porter tweeted shortly after that another list had been made. Items ordered through the list will be delivered to organisers and than transported to Calais in a truck on 17 September. 

This, of course, is only one campaign among many, but the repurposing of an Amazon feature designed to satiate first world materialism as a method of crisis relief seems to symbolise the spirit of the efforts as a whole. Elsewhere, Change.org petitions, clothes drives organised via Facebook, and Twitter momentum (which, in this case, seems to stretch beyond the standard media echo chamber) have allowed internet users to pool their anger, funds and second-hand clothes in the space of 24 hours. It's worth noting that Amazon will profit from any purchases made through the wishlist, but that doesn't totally undermine its usefulness as a way to quickly and easily donate supplies. 

Last year, I spoke to US writer and urbanist Adam Greenfield, who was involved New York's Occupy Sandy movement (which offered relief after after hurricane Sandy hit New York in 2011) and he emphasised the centrality of technology to the relief effort in New York:

Occupy Sandy relied completely on a Googledocs spreadsheet and an Amazon wishlist.  There was a social desire that catalysed uses of technology through it and around it. And if that technology didn't exist it might not have worked the way it did. 

So it's worth remembering, even as Amazon suffers what may be the worst PR disaster in its history and Silicon Valley's working culture is revealed to be even worse than we thought, that technology, in the right hands, can help us make the world a better place. 

You can buy items on the Amazon wishlist here or see our list of other ways to help here

Barbara Speed is a technology and digital culture writer at the New Statesman and a staff writer at CityMetric.