By Jerome Burne
Regular readers of the “Statin Wars” soap that we’ve been following here for several months will be eager to know the result of the survey sent to members of the British Cardiovascular Society (BCS) last month. It asked them how many of their patients had stopped statins as a result of critical articles in the press.
When news of the survey first came out the consensus among HIUK contributors was that it was a doomed attempt to portray statins’ critics as irresponsible, ignorant and risking patients’ lives. (Newcomers will find this link should bring them up to speed.)
Now I realise we had missed the point. That was before I read a column by the admirable Guardian columnist George Monbiot which puts the whole issue of government policies that are, in theory, driven by scientific evidence, in a new light. These are issues such as climate change, badger culling, pesticide use and, he could have added, statins.
Dissenting scientists are not wanted
I realised I had naively bought into to official line that decisions about drugs are purely evidence based. So if research shows that a drug isn’t as effective as claimed, then the official view should change. What Monbiot’s article makes clear is that dissent from the official line on policies involving science – however securely evidence based – is not considered either useful or even the correct way of following the scientific method.
But first the survey results – just released here. The main question it raises is just how irritated should members of the (BCS) be at this predictable waste of their subscriptions.
The headline conclusion – dutifully reported (only) in the Times – was that 79.69% of cardiologists who replied said that media stories raising doubts about the benefits of statins in the BMJ and in a public letter to NICE, had resulted in “patient confusion” about the role of statins in treating cardiovascular disease.
I originally thought this was typically irrelevant finding. When a scientist finds evidence suggesting that the advice people have been getting from the experts for years is probably wrong, that’s guaranteed to increase confusion. But that is no reason not to do it.
However in the light of the Monbiot article it became clear that this is precisely why the attacks on statin critics had been so aggressive and so persistent. Creating confusion in the public mind over a public policy is not what official science is about. Before I couldn’t understand why Professor Sir Rory Collins and other high ranking statin supporters had been so apparently pig headed when it came to responding to evidence. Now I understand.
Survey asking the wrong questions
But first the multiple inadequacies in the way the survey had been carried out. To begin with it asked cardiologists, who spend their days seeing people with heart disease, if the recent articles critical of statins had caused any of their patients to stop taking the drugs. But the criticism had been directed at the plan to extend the use of statins to healthy people to cut their risk of heart disease. The experience of doctors treating heart disease is not really relevant.
The result was that all the cardiologist could offer were estimates:
59% of respondents stated that they ‘do believe these events resulted in patients discontinuing statins where [they] believe they are indicated’.
- 31.7% of respondents stated that they estimated zero patients/NA had discontinued Statins due to media stories and articles.
- 30.29% stated that they estimated more than 5 patients had discontinued Statins due to media stories and articles.
What’s more the survey was asking cardiologists to report patients’ motives but how on earth can they know for certain why they stopped? Was it because of the particular articles mentioned or some other articles or because they made them feel lousy or because of a book?
The final flaw is that fewer than 10% of members responded. As one statistically literate consultant explained to me, given the relatively small number of people polled, for the survey to tell us anything useful about what is happening with these patients generally the response rate would have to over 80%.
Scientists should avoid questioning official policies
So why was the science-free exercise devised apparently to support a science based policy? The clue lies in a journal article by Professor Ian Boyd, chief scientific advisor to the UK department of the Environment – a department whose policies on climate change, badgers and the rest obviously involves a lot of scientific input.
For anyone who has signed up to the importance of scientific evidence, the raw realpolitik line taken by the chief scientific advisor should come as a shock. This is what Monbiot wrote:
“Boyd argues that if scientists speak freely, they create conflict between themselves and policymakers, leading to a “chronically deep-seated mistrust of scientists that can undermine the delicate foundation upon which science builds relevance”. This, in turn, “could set back the cause of science in government”. So they should avoid “suggesting that policies are either right or wrong”. If they must speak out, they should do so through “embedded advisers (such as myself), and by being the voice of reason, rather than dissent, in the public arena”.
This seems a pretty succinct description the intellectual position that appears to be driving Professor Sir Rory Collins harassment of his critics. His allegations that the articles in the BMJ, subsequently publicised in the open letter to NICE, could make people stop taking statins seemed odd at the time. As did the question about patients’ “confusion” posed in the survey. But it fits perfectly into a mind-set that warns against creating: “chronically deep-seated mistrust”.
We don’t want scientist’s views
While I have huge respect for Monbiot, I wanted to check that he wasn’t exaggerating this unashamed “might is right” view and how it applies in the scientific arena. I found that Boyd’s position was even more authoritarian than Monbiot’s summary suggested. This extract, for instance, is directly relevant to Dr’s Malhotra and Abramson, authors of the papers in the BMJ, and to the editors of the journals as well.
“When scientists start to stray into providing views about whether decisions based upon the evidence are right or wrong they risk being politicised. In general, it is important for scientists to stick to the evidence and its interpretation.”
And in Boyd’s world that “evidence” which scientists think is all that ultimately matters is just one element in the decision making process:
“The grey area in which there is scientific uncertainty is somewhere that scientists need to tread very carefully. On the one hand, those making the decisions—the elected politicians—will benefit from well-formed opinion to guide them through this tricky region at the science-policy interface, but scientists should not be surprised if politicians place considerably more weight upon other factors when key decisions have to be made without the support of a strong evidence base.”
So one mystery solved –Professor Sir Rory Collins and his medical colleagues have one eye on the politicians who are putting “considerably more weight upon other factors (than just evidence) when key decisions have to be made”.