In October 2013 the ABC aired the first part of its two-part edition of theCatalyst program titled The Heart of the Matter , criticising the use of statins (cholesterol-lowering drugs) in Australia.
Much has been written about this program, which has now been removed from the web.
The program has been the subject of an internal ABC investigation, a Media Watchprogram and numerous articles.
All have concluded that the program was misleading, biased and ignored the overwhelming evidence of benefit of statins, especially in people with established heart disease or those at high cardiovascular risk.
At the time of the airing of the episodes, the Heart Foundation warned that people would stop taking their medications and that, as a result, people could die.
The Heart Foundation urged people to talk to their doctors before stopping their medication.
It is only now that we have become aware of the full negative impact of these programs.
The conclusions presented in the Catalyst program were not supported by the Heart Foundation or the vast majority of the medical and scientific communities across the country and internationally.
It was with interest, then, that I read the report by A. Schaffer and colleagues published in this week’s Medical Journal of Australia, examining the impact of theCatalyst programs.
The authors used Pharmaceutical Benefits Scheme records to measure changes in weekly statin dispensing and to assess if there was a change in statin dispensing following the program.
The study covered 191,833 people, dispensed, on average, nearly 27,000 statins weekly. The authors found there was a temporary increase in discontinuation and a sustained decrease in overall statin dispensing.
Eight months after the program was aired, more than half a million fewer statins were dispensed, affecting more than 60,000 Australians.
The authors conclude that if the individuals affected remained off statins long-term,
it could result in between 1522 and 2900 preventable, and potentially fatal, major cardiovascular events.
it could result in between 1522 and 2900 preventable, and potentially fatal, major cardiovascular events.
They also write: “The subsequent retraction of the program may counteract some of the apparent negative impact, but this remains to be seen”.
Leon Simons, professor of medicine and director of the lipid research department at the University of NSW, says it directly and most effectively in commenting: “It was unfortunate that while the positive results of research showing the cardiovascular benefits of lipid therapy were often not considered newsworthy, the slightest hint that any medical therapy may have adverse effects leads to sensational headlines.”
The professor is right; we are living in a time when people are questioning the accepted wisdom and are taking a more active role in their health. They also have more information available to them than ever before.
But the science and facts can’t be ignored. Statins are the most commonly prescribed medicines in Australia. More than 27 per cent of people aged 50 and over are taking them.
The simplistic claim that this must be because they are “overprescribed” does not consider the fact that heart disease is Australia’s single biggest killer.
It accounts for the highest numbers of deaths in Australia (19,766 a year), while 600,000 Australians are living with ischaemic heart disease.
Large-scale, randomised trials have consistently shown a significant, beneficial effect of statins in reducing death and disability from cardiovascular disease, particularly in those who already have heart disease.
It is also important to realise that cholesterol is not the only risk factor for heart disease. Other risk factors include high blood pressure, smoking, diabetes, physical inactivity, and obesity.
These risk factors are well known and largely controllable, yet more than 60 per cent of Australians are overweight or obese, two out of three (66.9 per cent) Australians aged 15 years and over are either sedentary or have low levels of physical activity, and while smoking rates continue to fall overall, there is a worrying increase in smoking among young women.
There is a common perception among Australians that heart disease has been “fixed”, or can easily be treated by medications such as statins.
That is not true and much more research is required to guide future treatments for heart disease.
In the meantime it is important for individuals to be aware of their own risk of heart disease and to seek well-informed, balanced advice from their doctors.
This week’s research shows the power of the media in influencing public opinion.
It also clearly shows the consequences when the media get it wrong.
Cardiologist Jennifer Johns is national board president of the Heart Foundation.
Does the Heart Foundation still take money from corporates such as McDonalds food chain to hand out their red tick (of approval)?
Dr.ABC
incredible that they havnt been struck off the medical boardfor misleading,mischievous reporting.
stiil,what else would one expect from this organisation.
Dr Johns has provided a highly credible criticism of the ABC's Catalyst program with emotionlessly objective presentation of the facts as well as a balanced understanding for the use and evident misuse of statistical data. The real question here is, if the ABC can get something like this so very wrong where the public’s reactions could pose such a potentially dangerous risk for those who take the implications of the presentation so literally in how many other instances is the ABC misleading its audiences, intentionally or unintentionally where the risks are not so great?
There is no acceptable excuse for the ABC’s complete lack of regard. I recall when some years ago when Channel Nine’s marketing for the new season of their Nine News shows made the statement "I know everything I need to know because Nine told me so." Making this kind of statement is dangerously arrogant but seems to be the mantra of our rather out of control ABC.
It is unacceptable when the ABC is unable or unwilling to ensure balance in reporting as required by their Charter but it’s downright dangerous when they are unable to ensure balance between facts and an appropriate approach to questioning of those facts, especially when it involves the lives of individuals.
All of this simply adds to the body of evidence indicating that it is time to rein in the ABC and hold it and those responsible to account for the ABC's actions. The Minister can no longer hide behind the claim of editorial independence. This has nothing to do with editorial content or independence and the Minister should take action given by both his portfolio and the Australian Broadcasting Corporation Act 1983 and issue a 'please explain' to the Board and Mr Scott immediately; either that or the Minister should consider the tenability his own position in the Ministry.
When I watched the programme my reaction was that it could be right in its predominant thesis, but the way it was presented left much to be desired.
Mind you, the food ticks given by a well-know heart organisation for foods high in unnecessary sugar don't give me much confidence either.
Disclaimer- I have been on statins for about nine years and I'm still al_________
There is compelling research that dietary changes including the exclusion of meat, chicken and dairy reduces "bad" cholesterol levels far more effectively and safely than statins but too many people would rather take a pill than think carefully about what they are ingesting.
After stopping my statin prescription owing to muscle shrinkage and permanent cramps I wanted to know what excess risk of a heart attack I was running. Based on data from the largest and longest-running study in the world, at age 76 I have 6% LESS risk and at age 86 I will have 19% LESS risk of a heart attack by NOT using statins.
The website is by the US Dept of Health & Human Services and is based on the Framingham Mass study over 65 years of 5,209 people. There have been over 2,000 peer-reviewed papers based on this study.
Bob
What large scale, randomized trials have been done, where and by whom
Many of my clients are telling me they have now been told to take the statins , as a precaution, even when their tests are normal. These drugs are the pot of gold for the medical profession and the pharmaceutical companies
A collation of Medicares patients, their test results and prescribing details for statins would be beneficial to ensure drugs are being prescribed correctly
If all of the scientific experts are convinced that something is good, then it is wrong headed to question that wisdom? This is exactly the same argument used by their ABC to promote its pet concerns around climate change and the elevation of lawyers into positions of absolute power over the community. Whatever the merits or otherwise of the statins argument it cannot be argued by any side of the debate that because all of the scientific experts are in accord, we must accept their view as truth. This philosophical position only serves to entrench what might have been a leading idea in its day as an orthodoxy not to be challenged and this just leads to stagnation, corruption and decay.
One point not addressed is that M.Demasi interviewed a lot of alternate "health" experts who were pushing products they had an interest in marketing,also Prf. D. Sullivan's moderate comments on the benefits of statins were heavily edited.
I distrust their abc utterly but I also question reports such as this. The writer makes no mention of the fact the US health authorities have changed their minds about cholesterol (as reported in the Times and reprinted here, may 25, "More eggs please: cholesterol 'is OK now'". The Australian medical authorities accused the catalyst report of ignoring recent research, and this writer appears to be doing the same thing.
Regarding the claim that discontinuing statins could result in between 1522 and 2900 fatal heart attacks: if statins are so necessary to people's lives, how many have passed away in the last 8 months? Is that number significantly above average for cardiac patients on statins?
This essay does raise one important point, though: the public's loss of faith in medicine (and science). While many medical writers such as this person condemn the public for not accepting medicine's "authority", I see none that wonder how this situation has come about, or what medicine might do to restore the public's confidence in their discipline.
Most things in medicine have a cost and a benefit. Statins can have serious and significant side effects in some people, and are overprescribed. For some people, with established heart disease, they can be extremely useful. I'm a doctor, and I say trust your doctor but also take responsibility for your health. History is replete with examples of the medical profession not questioning the harm that some medicines cause, in taking on faith the next "miracle" drug, and for pharmaceutical companies being less than honest in how they market their wares. Statins are good, if you need them.
@Rachel If Doctor's practice medicine according to current evidence based guidelines then their patient will have best outcomes based on latest information. Doctor's who don't keep up to date are as much risk to a patient as any ABC program with a slant. It is not about faith when Drs prescribe , if patients want faith they should go to their spiritual leader who also can make a difference for that person if they have a belief .
There is no evidence that the media "got it wrong". Certainly Catalyst took a provocative angle, but it sought balance by presenting comments from both sides of the discussion. The concerns it raised were well-founded and deserve to be discussed. It would have been absurd to raise them in the context of a presentation that was fundamentally pro-statin and Catalyst has been crucified simply for daring to question the conventional wisdom.
What is really concerning is the implicit assumption in articles like this that critics do not have the right to do that. Jennifer Johns starts the article asserting Catalyst was wrong because Media Watch, an internal investigation and "numerous articles" said so: basically appealing to authority rather than evidence. Why has she done this? The answer is that the "evidence" itself is subject to interpretation, as the program showed.
At the end of the article John softens her attack by conceding that a mythology had developed around statins that they were a "cure-all". The medical establishment as a whole (excluding many prudent doctors) is responsible for perpetuating this myth, just as it was in the use of antibiotics, with disastrous results. Doctors should have been providing the "well-informed, balanced advice" about statins all along, whether or not their patients were seeking it.
The ABC is consistently irresponsible in its airing of a large number of its programmes which show intransigence and deliberate bias. However, most of the time it doesn't really matter.
In this case they took it upon themselves to demonstrate their ignorance in a very dangerous manner which will apparently have long lasting and serious consequences for a large number of Australians. We have yet to hear an apology or correction from CEO Scott or anyone else, let alone a full programme covering the subject of their folly. Without drawing attention to their mistake, they do now post a disclaimer to accuracy before some of their Catalyst claims.
Dr Karl and other so-called "science" experts are not immune from error either and speak with all the authority of a research scientist on a wide range of matters on which they have no expertise at all. This is very noticeable when they try to explain something from physics, which is a difficult discipline and where their errors are quite clear to those of us who are familiar with the subject matter being "explained".
John Nicol
'misleading, biased and ignored the overwhelming evidence of benefits'
That pretty much sums up the Left's ABC. Four Corner's anti-coal campaign is the latest example, but this description fits much of what spews out of both the Left's ABC and SBS.
The evidence for statins is not as straightforward as Dr. Johns claims.
Most doctors would accept that statins are effective for "secondary prevention" of heart disease, i.e. people who have known heart disease.
But the story is much murkier for people who do not yet have heart disease, but have been placed on statins anyway -- i.e., "primary prevention". In these patients the cost-benefit ratio is suspect, to say the least.
It's beyond the scope of a short comment to go through all the evidence, but allow me to quote from the relevant Cochrane systematic review on statins for primary prevention:
"Although reductions in all-cause mortality, composite endpoints and revascularisations were found with no excess of adverse events, there was evidence of selective reporting of outcomes, failure to report adverse eventsand inclusion of people with cardiovascular disease. Only limited evidenceshowed that primary prevention with statins may be cost effective and improve patient quality of life. Caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk." (my emphasis)
Millions of patients have been prescribed statins for primary prevention, which is a matter of genuine controversy. It is disappointing that Dr. Johns has ignored this part of the issue.
@Joseph At what point is it a good idea to begin taking statins?? What cholesterol level? 5,6,7,8?? Is cholesterol in the 6's high enough to start the drug to bring it down? I have just had a mini-stroke and my GP has placed my onto a course of statins. I am very concerned now, and not sure what to do.
@Joseph Thanks for making this point, Joseph. I noticed that Dr Johns stresses the benefit of statins in "people with established heart disease or those at high cardiovascular risk". My memory of the ABC program is that it was directed towards the over-prescription for those simply with high cholesterol levels, which is not the same thing. It would have been easy enough to separate the two groups out in the stats, and also to see whether the reduction in dispensing led to any increased deaths in either group. Of course, she also doesn't mention any adverse health outcomes due to statins, either. So this article is really just the Heart Foundation throwing up (yet another) cloud of misleading information. I'm sure they do some good work, but in the end they are like any other bureaucracy.
We have this problem with the ABC because of the proliferation of journalists educated in the arts and socialist attitudes, but with little statistical or mathematical knowledge, and virtually no science background. The same argument explains the extraordinary stance of the ABC on climate alarmism.
@Richard well said. And for real confusion try letting your average journalist try to explain something on a graph. Words after words touting progressive ideas (particularly Fairfax/ABC)- they are good at bombarding us with those - but as for trying to explain something scientific or of a mathematical or statistical nature ....... well, just give the figures and I'll do it myself thanks.
@Lunchalittle @Richard Of course. I go directly to The Australian for all my scientifically rigorous reporting. On climate issue, for example, no rhetorical, ignore the evidence dog whistling there!
It never ceases to amaze me ."I saw it on TV it must be true" It makes more sense if your doctor is prescribing you medication simply ask about the side effects and then weight up the risks .
As an admirer of Catalyst I am grateful for this discussion which challenges all of us to carefully consider the power of the media for the power both ways.
@John don't JUST trust your doctor without question. I had to do my own research to find out if statins were in all likelihood the cause of some symptoms that impeded my quality of life. That included playing with dosages, periods of stopping medication to prove to myself (and after all, only WE know our own bodies) statins were the cause.
I presented my documented/diarized evidence to the cardiologist who agreed with my findings, and then my GP who did likewise after reading the cardio's report.
Anyone who simply does what he/she is told without question because a doctor told them to is as silly as the person who grabs catalysts's story and just runs with it.
I think the persons responsible for the Catalyst programme were irresponsible and reckless in airing opinion rather then factual information about the pros and cons of Statins. Media persons are very aware of the power they have in influencing public opinion. That the ABC did so on this occasion in such a cavalier and irresponsible manner with potential loss of life by those who followed the programme is a reprehensible reflection on the organization.
The Catalyst program was well balanced and made it clear that statins have a role in "secondary prevention" (i.e. those with known IHD), its focus was on the fact that the preventive role is not established in primary prevention and yet millions of people are prescribed them for this purpose. Please acknowledge this fact. As a doctor, myself and many colleagues are dismayed by how the medical profession frequently fails to stand up to Big Pharma. Statins are expensive and cause muscle weakness and ache in many patients. Eat a healthy diet instead. I am disappointed by the standard of debate in this article.
Spot on. The article is the usual pro-pharma propaganda. The rate of prescribing statins makes no sense.
@Paul Well said Johan. The whole basis of lowering cholesterol by the use of Statins is founded on science that is now known as being wrong. Ansel Keys cherry picked his data to get the answer he wanted. Big Pharma picked it up and then developed statins to solve a problem that doesn't exist. No too much money is at stake to admit this and go back to the root cause. Too many people just want a pill and any pill will do.
Thank you. My husband was diagnosed with Alzheimer's about three years ago. He had been on statins, as a preventative measure only and as part treatment for cardiomyopathy, for two years prior to diagnosis. He has been a brilliant man with a formidable memory and successful in his career but I became most concerned about his withdrawal from communicating at all and the excruciating muscular pain he was experiencing. He was totally confused and did not know where he was most of the time. He presented as a late stage Alzheimer's patient. Upon asking his chemist if this could be related to his medication, I was horrified to learn that statins can cause these side effects, although not in everyone. I stress that point. My research revealed alarming "anecdotal" evidence and I demanded he be taken off this medication immediately. Within three days his communication was 100 percent improved and his pain almost gone. He continued to improve over time. This shocked his various physicians, some of whom apologized for not picking up the connection. I will never know if the statins caused his Alzheimer's and he still has the disease but I can tell you he turned from an almost catatonic state into a person who enjoyed life again. I know he is not cured but don't know whether he would be with us now if it weren't for the discovery.
@Johan Agreed.There is no mention of side effects such as muscle pain and energy loss or that there are other factors other than high cholesterol implicated in IHD. Lack of discussion of the positive side of statins in the Catalyst program is criticised in this article which in turn does not comment on the negative side of statins. IanL
@Ian @Johan Yes, Ian, I've been a victim of statins. I had heart attack-like symptoms and continue to suffer muscle pain after having been on a statin drug. My kidneys were damaged and the hospital where I was admitted were super-quick to take me off the drug. They were in no doubt whatsoever as to the cause of my issues. I've now read enough to know that the people who benefit most from statin drugs are the management and shareholders of pharmaceutical companies. In countries like Sweden, where mass trials of this class of drug have been conducted, it has been shown that statins serve no purpose whatsoever in lowering the rate of death by heart attack. Save your kidneys - don't take statins.