At the end of the article the authors say that it is not good enough only to say that statins are more likely to do good than harm. To suggest one can do better is to set an unachievable target. This is because like is not set against like, for example, in another context it is ingenious to ask whether the ready availability of good music is more important than the absence of bad architecture.
One can say that in the narrow terms of their use statins prevent far more catastrophes than they cause and therefore are for all intents and purposes are safe. One can and should endeavour to iterate towards a narrow estimate of their relative and absolute benefit in naïve low risk populations, accepting that this will always remain an approximation more likely to over-estimate the effect than the contrary. The insuperable problem is that harms are not the immediate antitheses of the benefits. The further the harm is from a clear-cut side effect in the target system, and from being consistent in incidence and impact, the truer this is. For example, muscle pains are not in the same system and their incidence and impact are inconsistent. The potential hazards of investigating the fit and the perceived harm of medicalisation of the population are even more distant difficult to assess. It will therefore never be possible to provide the evidence for, let alone, achieve a consensus on a threshold for intervention.
It may appear to be a public health conundrum but for the reasons above a universally applicable medical solution can never be found. Furthermore as the benefit of a herd approach, akin to universal immunisation, has to be set against the implications of mass medicalisation it is as much a philosophical as a medical question.
A radical change in approach is indeed needed accepting the above. Individuals must be free to make the decision for themselves, unencumbered as much as possible by the views and interests of medical and public health lobbies.
The solution is to make statins freely available without prescription or investigations at cost price for primary prevention in otherwise low risk subjects. As statins are known to be safe, the information given should concentrate on the benefits and the individuals left to find out for themselves the relevance of side effects to their own lives. If their own cost benefit analysis is positive or they are philosophically sympathetic to the herd approach, they might decide to continue treatment. As the initiative is theirs, they are saved any adverse effects of resentment of perceiving medication was being pressed upon them.
Competing interests:
No competing interests
29 July 2014
C Kevin Connolly
Retired Physician
Aldbrough St John Richmond North Yorkshire DL11 7UJ
Rapid Response:
At the end of the article the authors say that it is not good enough only to say that statins are more likely to do good than harm. To suggest one can do better is to set an unachievable target. This is because like is not set against like, for example, in another context it is ingenious to ask whether the ready availability of good music is more important than the absence of bad architecture.
One can say that in the narrow terms of their use statins prevent far more catastrophes than they cause and therefore are for all intents and purposes are safe. One can and should endeavour to iterate towards a narrow estimate of their relative and absolute benefit in naïve low risk populations, accepting that this will always remain an approximation more likely to over-estimate the effect than the contrary. The insuperable problem is that harms are not the immediate antitheses of the benefits. The further the harm is from a clear-cut side effect in the target system, and from being consistent in incidence and impact, the truer this is. For example, muscle pains are not in the same system and their incidence and impact are inconsistent. The potential hazards of investigating the fit and the perceived harm of medicalisation of the population are even more distant difficult to assess. It will therefore never be possible to provide the evidence for, let alone, achieve a consensus on a threshold for intervention.
It may appear to be a public health conundrum but for the reasons above a universally applicable medical solution can never be found. Furthermore as the benefit of a herd approach, akin to universal immunisation, has to be set against the implications of mass medicalisation it is as much a philosophical as a medical question.
A radical change in approach is indeed needed accepting the above. Individuals must be free to make the decision for themselves, unencumbered as much as possible by the views and interests of medical and public health lobbies.
The solution is to make statins freely available without prescription or investigations at cost price for primary prevention in otherwise low risk subjects. As statins are known to be safe, the information given should concentrate on the benefits and the individuals left to find out for themselves the relevance of side effects to their own lives. If their own cost benefit analysis is positive or they are philosophically sympathetic to the herd approach, they might decide to continue treatment. As the initiative is theirs, they are saved any adverse effects of resentment of perceiving medication was being pressed upon them.
Competing interests: No competing interests