Updating the Biases by Pat Conrad MD


Last week Doug shared a piece called “Number Needed to Treat”, in which he noted that as many patients were harmed as were helped by statin therapy.  Now MSN ‘Healthy Living’ has this headline:  “US doctors urge wider use of cholesterol drugs.”

The lead-off grabber:  “(AP) The nation’s first new guidelines in a decade for preventing heart attacks and strokes call for twice as many Americans — one-third of all adults — to consider taking cholesterol-lowering statin drugs.”  Whose guidelines?  Why, the American Heart Association and American College of Cardiology, veritable Walter Cronkites of U.S. medicine, unimpeachable in their credibility.  Now instead of focusing on set lipid levels, they are focusing on four at-risk patient groups:

—Preexisting heart disease.

—Those with LDL of 190 or higher.

—People ages 40 to 75 with Type 2 diabetes.

— People ages 40 to 75 who have an estimated 10-year risk of heart disease of                                                                                                             7.5 percent or higher.

The heart gang is also pro-exercise, pro-aspirin, and pro-healthy diet.

As a former med student and resident, I know this would be my cue to memorize the new guidelines for morning rounds, and start beating my clinic patients into these newly shaped molds  – for their own good.

“The government’s National Heart, Lung and Blood Institute appointed expert panels to write the new guidelines in 2008, but in June said it would leave drafting them to the Heart Association and College of Cardiology.”  (Is there anything the government doesn’t have an [expletive] panel on?)

The story shares that “under the new advice, 33 million Americans — 44 percent of men and 22 percent of women — would meet the threshold to consider taking a statin. Only 15 percent of adults do now.”  Admittedly I stink at math so check me, but that seems to be an increase of over 100%.  Seriously?!

I was also had to chew a little harder than some of my classmates in medical statistics class, but I do remember one lesson very well:  the most important fact or feature in any study is who paid for it.  Credit is due to the article for pointing out that “Roughly half the cholesterol panel members have financial ties to makers of heart drugs, but panel leaders said no one with industry connections could vote on the recommendations.”

Understand, I am not bashing these guidelines.  They purport to advance statins as an agent to treat patients, as opposed to correcting patient lab values.  This may indeed be sincere and based on good science, and if so, laudable.  Or can such guidelines, which arose from government and industry funding, be convincingly free of bias when a third of a population (admittedly often the chubby, out of shape, hyperglycemic third) is deemed in need of intervention?  Are we seeing mass confirmation bias?  Am I guilty of, I don’t know, “bias” bias if I still refuse to take the damn stuff?

44610cookie-checkUpdating the Biases by Pat Conrad MD