June 29, 2016

statins wars – a debate worth having?

This week the SMC ran a press briefing to publish two new pieces of research reporting that media coverage of the ‘statins wars’ was associated with some patients stopping taking their tablets. On one level this was a ‘no shit, Sherlock’ story. ‘Mass Media Has Impact’ is hardly news in this of all weeks. But research of this sort is actually quite rare and raises lots of great questions for debate.

The SMC likes to think we are doing a pretty decent job of helping to encourage more measured, accurate coverage of science in the media, but we don’t really have a way of knowing for sure whether that changes public attitudes or behaviour. I remember feeling triumphant when MPs rejected a ban on research using human-animal hybrid embryos after a year of great media coverage only to be told by a politician that the media was irrelevant and the vote was all down to successful lobbying in Westminster. I’m still sure the media coverage made a difference but how can I actually know? The papers published this week don’t prove anything either; one paper, from the London School of Hygiene & Tropical Medicine (LSHTM), is an observational study with all the limitations of that kind of research. They observe a correlation between the media controversy and some people going off their drugs, but cannot prove that one caused the other.

But I still hope it kicks off a discussion. That debate has already started with an interesting editorial in the BMJ (the journal publishing the study) by Gary Schwitzer, the editor of Health News Review, a much loved US website. Gary argues that “Journalism that exposes the public to ongoing controversies in science should be nurtured, not branded as negative”. I could not agree more. The SMC prides ourselves on encouraging scientists to embrace media debate on scientific controversies and I am least comfortable when sitting in rooms with people trying to close down debate. I’ve previously voiced my disagreement with those who want sceptics and mavericks purged from our airwaves – as long as the evidence gets a fair look in and the audience is sign-posted to where the weight of evidence lies I don’t think we should stifle these debates. But there is a difference between branding the media coverage of a controversy as negative (unhelpful, I agree) and reflecting on whether a media row is misleading the public in a potentially harmful way. The scientists involved in these studies were at pains to emphasise that the media was reflecting the row within medical science rather than fermenting it. However they remain concerned that patients may well have come off life-saving drugs based on inaccurate claims about harmful side effects which loomed large in the midst of the frenzy. As study author Professor Liam Smeeth from LSHTM said: “Our findings suggest that widespread coverage of health stories in the mainstream media can have an important, real world impact on the behaviour of patients and doctors. This may have significant consequences for people’s health.”

Schwitzer questions why we should care if news coverage did have an effect. Arguing that it probably had an effect by alerting people to the uncertainties about the potential harms and benefits, he asks: “is that such a bad thing?” Of course it’s not a bad thing for media coverage to alert the wider public to risk of harms. I’ve never worked it out but I would hazard a guess that science journalists and press officers spend a large proportion of our time doing exactly that – communicating/reporting risk/benefit to the wider public. But if the debate results in patients being given an exaggerated impression of risks of side effects, such that they stop taking lifesaving drugs, then my answer to Gary is: ‘Yes I think it might be a bad thing. Or at least I think we might reflect on how we have these debates without misleading patients’. I suspect Schwitzer would baulk at the implication that we should ever gloss over uncertainties, and I agree. I emphasised this point to MPs recently arguing against those in science who have urged climate researchers to stop dwelling on uncertainties for fear they will be seized on by sceptics. However the point here surely is that those uncertainties must be accurate and based on best evidence. Much of the media coverage before the period studied by researchers repeated seriously exaggerated claims about side effects that had been published and were later retracted from a leading medical journal. So is it such a bad thing for patients to understand where uncertainties lie? No. But the studies published this week should remind all of us  to try a lot harder to make sure those uncertainties are accurate and based on best evidence.

Nor I am convinced that patients had to wait for ‘statins wars’ to understand that statins, like any effective drug, will cause side effects in some people. This has been reported in many good quality studies, is reflected in NICE guidelines and is part of the conversation every good doctor has with his or her patients. Interestingly, the LSHTM study also reported a drop in numbers of GPs reporting patients’ heart disease risk scores following the period of intense media debate, suggesting that it may have had the opposite effect, putting doctors off having hard conversations with their patients.

Another point made by Schwitzer in his thought provoking piece is that journalism about over-treatment is rare and hard to find in the sea of excitable coverage about new wonder drugs that will cure all our ills. He is not right, though interestingly the period studied by the researchers was marked by how much media coverage focused on doctors’ fears about over-medicalisation. He and I agree that this is refreshing. The decision of NICE to extend the offer of statins to healthy people at low risk of heart disease was understandably a contentious move. To have up to an extra two million otherwise healthy people taking a drug for the rest of their lives is not trivial. But a perfectly valid and important debate about over-medicalisation should not be an excuse to play fast and loose with the facts and bandy around inaccurate claims about side effects. The media reflected this row, but also amplified it, giving further prominence to the inaccurate claims. As Liam Smeeth said: “In the case of statins, we are concerned that widespread reporting of the debate has given disproportionate weight to a minority view about possible side effects. This has dented public confidence in a drug which most scientists and health professionals believe to be a safe and effective option against heart disease for the vast majority of patients.”

I agree with Schwitzer that we must resist any temptation to conclude that the media should not cover public health controversies in future. Our job at the SMC is to make sure that the media has access to the best evidence and that mainstream scientists engage. As the Guardian’s Sarah Boseley said at the SMC press conference it was not always easy to find mainstream scientists to challenge the mavericks in the midst of this crisis, so experts who rely on the media to report accurately need to make themselves available to help journalists do that.

I really hope we use this new research to prompt some sober reflection within both science and journalism. I have always argued that one of the most damming aspects of MMR for me was a public opinion poll showing that the public believed that medical science was evenly divided over whether MMR caused autism. Media coverage made it seem as if they were.  That was not the case.

Similarly with statins. My suspicion is that some people became worried about statins because a row amongst doctors reported widely in the media gave the incorrect impression that medical science is divided on the safety of the drugs. As Peter Weissberg said emphatically at the SMC briefing: “There is no debate that patients who have suffered a heart attack or stroke should be taking statins to reduce their risk of another cardiovascular event.”

The SMC believes in scientists engaging more often and more effectively in science controversies being played out in the media. We embrace these debates and see them as an opportunity to get the best evidence to the wider public when they care the most. But it’s critical that the public don’t come out of the other end of debates on vaccines, statins or climate change still unclear as to where the best evidence lies, or believing that scientific opinion is split down the middle where it is not. If they do, we are not getting this right.

This blog contains the thoughts of the author rather than representing the work or policy of the Science Media Centre.