Tuesday, May 12, 2009

Statins: life-saving wonder-drugs or just life-damaging?

Many readers empathised with Christopher Hudson when he wrote about his experience of taking statins. Here, he renews his call for doctors to take the concerns of patients more seriously

The phone calls began around breakfast time on March 12. Emails also started pouring in, to me, to our friends, to our friends’ friends and to this newspaper, which, that morning, had published my story – “Wonder Drug That Stole My Memory” – about my experience of taking statins.

It seems to have struck a nerve. Over the next fortnight, scores of people up and down the country posted comments on telegraph.co.uk about their own experiences with the same drugs. Their symptoms included forgetfulness, confusion, loss of names and words, numbness in the fingertips. Reading about my predicament seemed to have synthesised a lot of fears and emotions, ranging from bitterness towards the medical profession, to relief that their symptoms might not premise Alzheimer’s after all.

How many more people must there be who think they are alone in their suffering? Last week it was claimed that every third person in England over the age of 45 was taking statins – around seven million people. Worldwide, they are now the most commonly prescribed drug in the history of medicine. Yet, according to the Department of Health, up to 10 per cent of patients may have significant side-effects. That is to say, 700,000 Britons may now be suffering moderate to crippling pain or loss of memory or libido, after taking a drug that is hailed everywhere as the greatest pharmacological find of the 21st century.

Many of my respondents had suffered far worse experiences that anything that the doctors, the warnings on the packets or the promotional literature could have led them to expect. They claim their limbs felt like lead weights; they had lost the power of concentration, and in some cases their sex drive was affected. One man who had severe muscle pains was told by his doctor that tests in the US had revealed that statins could have the effect of “dissolving muscles”.

It sounded like science fiction – but then I spoke to my cousin, a London GP, who rang me while recovering from hip surgery. He believes that his two hip replacements were both largely down to the statins he took, which weakened the musculature of his hips and thighs.

As for forgetfulness, there were writers who could not remember their own phone number. One post read heart-rendingly, “I am 62 and have been taking high-dosage statins for 20 years following a heart attack. My high cholesterol is genetic. I have insomnia, muscle pains and serious memory loss, short and long term. I can’t even remember the events of my wedding day. My life is a closed book.”

Why has the widespread evidence of such side-effects from statin intolerance been ignored by the medical profession for so long? The nonchalance with which some GPs appear to shrug off the problem is extraordinary. As another correspondent states, “If the substance was a sweet, a drink or a foodstuff, the Health and Safety Executive would get it banned immediately”.

I believe there is a reluctance to investigate any statin-related problems properly. Too many people in the scientific and medical professions see them as drugs that can do no wrong. They are also cheap and effective, and according to the Department of Health, they save 10,000 lives a year, significantly reducing strokes and coronary heart disease. The latest evidence suggests that they may also cut the risk of deep-vein thrombosis and pulmonary embolisms.

It is no wonder, then, that having found this “wonder-drug” effective against some of the most common health problems in the industrialised world, scientists are not all that keen to criticise it. For one thing, it would be taking on the pharmaceutical giants that developed the drug; for another, as Telegraph columnist Dr James LeFanu pointed out recently, family doctors get a special payment from the Government for everyone they treat for a raised cholesterol level.

It is left up to each GP as to what constitutes a “raised” level, which may be why I came across so many “cholesterol victims” among my correspondents. I have had relatively high cholesterol for years, probably genetic, and I have always been told the same thing by GPs and Bupa doctors: 7.5 is too high, 6.5 is rather higher than it should be, and if you can bring it down to a level of 5.5 that would be just fine. Yet there are patients here being treated with statins for mildly high blood pressure when their cholesterol level was at 4.3 or lower. These pills are handed out like Smarties.

Despite the mounting evidence of problems, the medical profession seems alarmingly relaxed about the risks. The other day I happened upon a six-year-old transcript of a BBC radio phone-in show on statins. A cardiologist was present in the studio. Everything was going swimmingly until a lady from Powys said she was getting terrible muscle pain in her thighs after taking the drugs. “I couldn’t lift my foot off the ground,” she complained. “I couldn’t get on and off the loo; let’s face it, I couldn’t even put my knickers on.” The cardiologist tried to reassure her. “In less than one person in a thousand, quite literally, less than one person in a thousand, do statins cause a serious inflammation in the muscles,” he said.

Today, the figure has risen to as many as one in 10. But just the other day, on a BBC ask-the-doctor website, a consultant was, to my mind, downplaying the side-effects. “Tummy upsets, aches, muscle aches and liver problems are among the common side effects of statins,” she stated airily. “Most of these settle with time.”

This is not good enough. Statin 'victims’ deserve better. For one thing, they need more answers to crucial questions, such as what alternatives there might be to statin therapy – such as fibrates or diet, for example – and how successful they are. The British Heart Foundation says that tests can be done to identify those patients at greatest risk of side-effects; if so, why are they not widely utilised? The Department of Health refuses to commit itself on alternatives to statins, saying only that there is a range of cholesterol-lowering treatments that can be used in cases of statin intolerance, and patients should consult their doctors about which one is most appropriate.

Many of those who responded to my article recommended a range of alternatives. My favourite came from Father Ignatius Brown: “Red wine, dark chocolate, porridge, fresh air, long walks, small amounts of cheese made from unpasteurised milk, plenty of leafy greens, wild salmon, berries – and laughter”.

For my part, I believe that I haven’t fully shaken off the effects of my encounter with statins, and I don’t know whether I will. What I do know is that there is a dark and growing underside to the “wonder drug” that needs to be exposed and more fully researched.

• A doctor writes...

A year ago I wrote an article in the Telegraph advocating the greater use of statins. Therefore, I feel obliged to respond to Christopher Hudson's concerns. Statins were first developed in Japan in the late Seventies. Today they are taken by tens of millions of middle-aged and elderly people worldwide. In the last 20 years, the use of statins has increased exponentially. So what impact have they had at the frontline of the NHS, in the emergency rooms of our District General Hospitals?

In the last 10 years death rates from coronary heart disease (CHD) have fallen by 46 per cent in people under 65. The decrease in mortality is greatest in the over 55's, and is due to a reduction in the major risk factors such as smoking, improved treatment in the immediate aftermath of a heart attack (eg clot-busting drugs), and widespread secondary prevention, including statins.

The figures are conclusive: we are winning the battle for our arteries, and statins are one of our most powerful allies against heart attacks, strokes, and other vascular diseases. We have enormous amounts of data on statins now, confirming that they are safe to take [How can this guy utter such obvious lies??], and that their benefits far outweigh the well-documented risks.

All drugs have side-effects, and with every prescription he or she writes, a doctor is making a risk-benefit analysis. The most significant side-effect of statins is a reversible inflammation of muscle which is seen in less than 0.01 per cent of recipients. As with every drug, extreme side-effects are occasionally reported: in the case of statins there have been fatalities due to renal failure with an incidence of 0.15 cases per million prescriptions. Abnormalities in liver function are also recognised but rarely significant, and almost always reversible on cessation of medication.

Memory problems are a rare but serious side effect of statins. Patients who are concerned about this aspect of statin medication, should consult their GP and consider a "drug holiday". The vast majority of side-effects would be expected to resolve within the course of a month and if symptoms persisted then other causes should be considered. In those at risk from vascular disease, memory problems are common after middle-age and often a result of damage to small blood vessels in the brain by high blood pressure and atheroma. In this case, it would be an error to attribute a poor memory to a side-effect when, in the majority of cases, the drug is protecting against further damage to our brains.

Let us return to the statistics: CHD is the most common cause of death (and premature death) in Britain; 1 in 5 men and 1 in 6 women die from CHD, and it causes 101,000 deaths here annually. Each year, 130,000 people succumb to strokes, and it is the biggest single cause of serious disability in Britain. In my view, and that of most doctors, the risk-benefit analysis for statins is favourable.


What the ignoramus doctor above omits to mention is that there is much evidence to show that high cholesterol does NOT elevate the risk of heart disease. Statins cure an imaginary problem. Heart disease is a big problem but statins are not the answer. The cholesterol/heart disease connection is a tenacious theory, nothing more

Obesity 'causes 19,000 cancer cases every year'

Another wild "estimate" from the publicity hungry and thoroughly disreputable World Cancer Research Fund. No mention that moderately overweight people live longest, of course. Background on the WCRF here and here.

Almost 19,000 Britons a year develop cancer because they are overweight, researchers say. The toll is 50 per cent higher than any previous estimate, reflecting the current epidemic of obesity. Adults are being warned to stay as slim as possible, without being underweight, to minimise their cancer risk.

The new analysis, by the World Cancer Research Fund, found excess fat was linked to around 17 per cent of cases of seven main cancers - breast, bowel, oesophagus, kidney, pancreas, endometrium (womb lining) and gallbladder.

Professor Martin Wiseman, WCRF medical and scientific adviser, said: 'The stark fact is that every year in this country, many thousands of people are diagnosed with cancer that could have been prevented if they had maintained a healthy weight. 'This is a real cause for concern and the problem is only going to get worse if the number of people who are overweight continues to rise.'

The new estimate is nearly 50 per cent higher than the 13,000 cases a year linked to obesity by the charity Cancer Research UK. WCRF, a charity that promotes ways of preventing the disease, says the evidence is now much stronger than even ten years ago. Body fat promotes the production of hormones and growth factors such as oestrogen and insulin which can increase the risk of cancer. Obese people are also less likely to eat healthy amounts of fruit and vegetables that can protect against cancer.

Professor Wiseman said: 'After not smoking, maintaining a healthy weight is the most important thing you can do. 'But a recent survey showed almost 40 per cent of people still do not know excess fat is a cause of cancer. We need to do more to spread the message.'

Overall, scientists estimate that about a third of the most common cancers could be prevented if people improved their lifestyles - eating more healthily, taking more physical activity and maintaining a healthy weight.

The WCRF says people should aim for a Body Mass Index - calculated by dividing weight in kilograms by height in metres squared - towards the lower end of the recommended healthy range of 18.5 to 24.9.


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