A Dangerous Doctor

Frank Lipman MD recently posted this to his Twitter feed.

'100% of statin takers have a serious adverse effect - their body is impaired from producing cholesterol'

This was a retweet from a lady called Zoe Harcombe, who appears to be a 'nutritionist'. To steal a Dara O'Briain line, if a dietician is a dentist, then a nutritionist is a toothologist. Judging the nature of Ms Harcombe's tweets, I'll probably be looking at her in more detail in the future.

Dr Lipman is, of course, wrong. The Cochrane Collaboration found statins 'reduced all cause mortality, major vascular events and revascularisation' with 'no excess of adverse events'. For those interested in the systematic review, here it is in its entirety.

For those who don't want to, I'll talk about the stats on adverse effects in more detail. The trials that were pooled in the systematic review looked at 56, 934 patients, of which 19% had an adverse effect. Now adverse effects are never great, but some such as aching joints, mild fever and occasional headaches are tolerable. Not ideal, but if its a one-off headache for protection against heart attack then its probably worth it. Others, such as cancer and liver failure, are less tolerable.

Specifically mentioned in the Cochrane Review are cancer, rhabdomyolosis, myalgia, type 2 diabetes and haemorrhagic stroke. Here's a breakdown below:

Cancer - Eleven trials looked at this. 5.8% of patients developed cancer. There was no increased risk in those taking statins.

Rhabdomyolosis - Six trials looked at this, with three cases seen in over 19,000 patients. There was no increased risk in those taking statins

Myalgia - Just under 10% of patients developed this in the seven trials that noted it. There was no increased risk in those taking statins

Type 2 diabetes (T2DM) - Only two trials recorded this. 2.4% of those in control groups developed T2DM. 2.8% of those taking statins developed T2DM. This represents a relative risk in those taking statins. However, this risk was only seen in those taking part in the second study, which used higher doses. At lower doses, no increase in risk was seen.

Haemorrhagic stroke - only two trials reported this. 0.2% of those in the studies had this type of stroke. This is higher than expected, but as ischaemic strokes were lowered by the statins, overall stroke numbers were down.

Out of the five specific adverse events the review looked, three showed no increased risk when taking statins. A fourth (haemorrhagic strokes) showed a net benefit when looked at in the context of total strokes. Only T2DM showed an increased and the risk was only seen in those taking a higher dosage of statins.

The review also reports in less detail that there is weak evidence suggesting that statins cause elevated liver enzymes, renal dysfunction and arthritis.I can't say why there is less detail or why the evidence is weak but there we go.

Dr Lipman is conclusively wrong in his tweet. Yes, I know it isn't his tweet originally but he must take the blame for it. He is a doctor. He should know better than to shout nonsense from the rooftops. And sometimes it does. Here's two consecutive tweets he sent out. Try and spot the difference.

'Did you know that the US makes up only 5% of the world's population, yet it consumes over 50% of all the world's pharmaceutical drugs?'

'The cellphone industry doesn't want to admit it, but the science is now clearer: Sustained EMF exposure is dangerous http://ow.ly/AKQ9k' 

The first actually talks about a pretty serious problem. Polypharmacy is a huge problem, and especially so in America. I'm not sure I quite buy his figures but the point remains sensible.

The second is essentially something a hobo at a bus stop might say to you.

Dr Lipman, you have a privileged position. You are seen to be an authoritative voice. You should hold yourself to higher standards than this. When doctors say silly things, people can die in droves. Andrew Wakefield sparked the anti-vaccine movement we see today, which has resulted in over 6000 vaccine preventable deaths since 2007 in the US only.  You should know better.