In the last fortnight or so, there has been a lot of talk about the two part Catalyst special on cholesterol and statin medications. The Heart of the Matter aired on the 24th and 31st October on ABC TV and received widespread publicity in both the mainstream and medical press. Despite currently being on leave from clinical work, I’ve been approached my numerous concerned friends and non-medical colleagues asking for my opinion on the issues raised. In my role as a medical educator, I’ve had an enquiry or two from somewhat confused registrars wanting to know what to say to their worried patients.
Now this is not a bad thing in itself. Increasing public awareness of important health issues, transparency and rigorous independent scrutiny of established scientific “facts” are vitally important. Like many others, I abhor the tendency to over-medicalise, and the increasing pressure from many sources to over-diagnose and to over-treat. Having said all that, I was disappointed in Catalyst’s treatment of the issues raised. I thought it was sensationalised and unbalanced, and therefore irresponsible to air. Using emotive terms such as “toxic”, “organised crime” and “conspiracy” is not helpful to anyone.
Although the Catalyst shows came with a token disclaimer, I worry that such scaremongering will result in fear-based rejection of statin medications. I’m not saying that statin medications are beneficial to everyone, far from it, but there are certain subsets of patients for whom statin therapy may well be lifesaving and I worry that these some of these patients may be adversely affected.
On the positive side, it has brought the topic of heart health to the public’s attention, and provided a good opportunity for doctors to reassess their patients’ absolute cardiovascular risks, review their need for medication, and to provide education and advice on all lifestyle risk factors. The shows also emphasised the importance of regular exercise and a diet low in refined sugars. All good things.
And I was inspired to create my first ever YouTube mash up/ musical parody. I’m not sure if this was a good thing or not, I’ll let you be the judge…
It was created on a whim while travelling. I had no recording equipment other than my laptop’s cheap and nasty internal microphone (I apologise about the audio quality!) and was overtired. I know fatigue is not a legitimate medico-legal defence regarding duty of care to patients, but I wonder if it is a reasonable excuse for questionable creative content? Perhaps, like shopping when hungry, it is merely ill advisable. All just a bit of fun really, and a chance to try out my Camtasia software for the first time.
Feel free to comment below if you so wish.
If you missed the Catalyst shows and want to see what the fuss is about they are available on YouTube.
Episode one link
Episode two link
For an excellent summary served with lashings of evidence and a sprinkling of humour, check out Dr Robin Park’s blog post.
For some great advice to junior (and senior!) doctors, check out Broome Docs “Letter to my registrars:on statins and stuff” in which a great comparison is made between the current media storm on statins with the uproar over HRT in 2002. Like Casey, I was a bright-eyed bushy-tailed registrar when the WHI results were first released and remember all too clearly the widespread patient (and doctor) panic over HRT. It taught me some valuable lessons. Firstly, I learned to not take medical information imparted to me from on high as the gospel truth, but to always question and to keep questioning “truths” over time. As I’ve become more experienced, I have discovered that nothing in medicine is absolutely right. The more I know, the less certain I’ve become. Secondly, it introduced me to the swinging pendulum: HRT was all good, then all bad, and now rests somewhere in the midline – sometimes good, sometimes bad, depending on the clinical situation. Thirdly, it got me in the habit of using sentences such as “based on current guidelines / what we know at the moment, I would suggest ‘X’ but this may change as further evidence comes to light,” rather than sentences like “Evidence shows that ‘X’ is the best treatment for you.”
For some “fat facts” from the ever-reputable Rosemary Stanton, you can find her article in the MJA here. She points out that Catalyst “relied on the opinion of a journalist and four US experts — a nutritionist, two cardiologists and a physician — but failed to note that three of the experts market a range of “alternative” products via their websites (www.jonnybowden.com, www.drsinatra.com, www.proteinpower.com), including diet “aids” (with “slimming” claims), anti-ageing, “brain power” and detox supplements, plus a variety of bars, shakes, drinks and powders. One product even claims its citrus bergamot content will lower triglycerides, blood sugar and inflammatory LDL (low-density lipoprotein) cholesterol and raise HDL (high-density lipoprotein) cholesterol.”
And finally, a must read: the ever-witty Dr Justin Coleman weighs in with his sceptometer blowing a fuse in the process.