Talk:Statin/Archive 3

Archive 1

Archive 2

Archive 3

Suggested expansion of the article to merge or include the history of cerivastatin

It appears that the relative potency of one statin head to head against another is about to become profoundly relevant. I think this article would benefit from a minor expansion that includes the rise and fall of cerivastatin. Cerivastatin was engineered (and succeeded) to be the most potent statin yet devised and was trotted out in daily doses of just 0.4 and 0.8 mgs. One could still soundly reason that what happened to cerivastatin is a class effect and can still be extrapolated to all the others within it. Well documented encyclopedic illumination of this dark corner in the history of statins may help balance the anticipated explosion of information forthcoming. Those favoring the "megastatins" do this at their peril. Wikipedia is well poised to document this as it unfolds. --lbeben 00:08, 14 November 2013 (UTC) — Preceding unsigned comment added by Lbeben (talk • contribs) 00:08, 14 November 2013 (UTC)

origin of the name?

i am surprised not to see an etymology of the name of this group Feroshki (talk) 23:49, 11 November 2013 (UTC)

Have a source? JFW | T@lk 16:15, 11 February 2014 (UTC)

Combination therapy

doi:10.7326/M13-2526 Systematic review discussing whether combination therapy is better than increasing doses of statins. No long-term endpoints, but some data supporting combination with ezetimibe or bile acid sequestrants. JFW | T@lk 16:15, 11 February 2014 (UTC)

Blogs

I have removed the blog / popular press in this edit [1]. If Ben Goldacre wishes to update his paper he must do so the usual way. We cannot use an "update" published in the Guardian. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:20, 15 March 2014 (UTC)

CTT results

The CTT has reported again, this time for 174,000 individual patient data sets. doi:10.1016/S0140-6736(14)61368-4.

• Lowering LDL-C by 1 mmol/l reduces vascular event rate by 16% in women and 22% in men.
• All-cause mortality is reduced by 9% in women and 10% in men, both with a wide-ish confidence interval.

We ought to present this data in the article, perhaps through replacing other references that are older & outdated. JFW | T@lk 12:07, 9 January 2015 (UTC)

Yes agree. Doc James (talk · contribs · email) 16:29, 9 January 2015 (UTC)

Bias in studies related to particular drugs, no bias in general efficacy

In an editorial in the BMJ Bero found a bias favoring the drug from the sponsoring company in studies of statins. This was in response to a study by Naci that found "the findings obtained from industry sponsored statin trials seem similar in magnitude as those in non-industry sources."

I'm not sure how (if) this should be included.

References

- - MrBill3 (talk) 04:06, 4 October 2014 (UTC)

I'd argue for leaving it out. Editorials are not the greatest of sources (probably not peer reviewed, for example). Even if the source were ideal, it seems like an issue that is more about the industry or about specific drugs than about statins as a class, and the article is about the class. Formerly 98 (talk) 04:16, 4 October 2014 (UTC)

It is a commissioned editorial in the BMJ so although not peer reviewed it carries some weight. I tend to agree as the article doesn't delve too deeply into particular brand name drugs. Also the study it comments on and the editorial itself seem to clearly indicate that studies into statins are not biased in terms of the cholesterol lowering effects of statins as a class. Just wanted to make the info I have access to through the WP Library available. Thanks for the input. - - MrBill3 (talk) 04:31, 4 October 2014 (UTC)

Editorials are peer review. WP:MEDMOS says that reliable sources are articles published in peer-reviewed journals. It doesn't say that the only reliable sources are peer-reviewed articles. --Nbauman (talk) 13:05, 17 February 2015 (UTC)

MEDRS calls us to use secondary sources (reviews and statements by major scientific & medical bodies) and makes a clear distinction between editorials and reviews. please see the first paragraph of Wikipedia:Identifying_reliable_sources_(medicine)#Biomedical_journals which says "Peer-reviewed medical journals are a natural choice as a source for up-to-date medical information in Wikipedia articles. They contain a mixture of primary and secondary sources. Journal articles come in many types, including original research ranging from vast studies to individual case reports, reviews, editorials and op-ed pieces, advocacy pieces, speculation, book reviews, letters to the editor and other forms of commentary or correspondence, biographies, and eulogies. It is usually best to use reviews and meta-analyses where possible. Reviews in particular give a balanced and general perspective of a topic, and are usually easier to understand." Editorials are very much PRIMARY sources, and the policies WP:OR and WP:NPOV along with RS and MEDRS call us to use secondary sources. Jytdog (talk) 14:21, 17 February 2015 (UTC)

Dosage

If there is a general consensus as to what constitutes "low","high" and "intensive" dosage levels, it would be nice if the dosage-equivalency chart could be enhanced to indicate these ranges, since they are used when describing benefits and side-effects.(71.233.167.118 (talk) 06:06, 20 April 2015 (UTC))

This page smells of astro-turfing

No mention of any of the studies that show "all cause mortality". No mention of the flaws of the end points - cholesterol No mention of oxLDL - — Preceding unsigned comment added by 108.243.106.82 (talk) 19:52, 19 January 2016 (UTC)

I think the accusation of "astro-turfing" is completely unfounded, but if you could provide some references (compliant with WP:MEDRS) that support the content you are suggesting is missing from the article, I'm sure editors here will have a look. ChemNerd (talk) 20:14, 19 January 2016 (UTC)

Decreasing of specific protein prenylation

I added a subsection under Mechanism of Action related to inhibition of isoprenoids / protein prenylation, which recent research increasingly suggests plays a significant role in the efficacy of statins.

One reason these findings are of such consequence from a research perspective is that statin-induced cholesterol reduction simultaneously serves as a marker for inhibited protein prenylation while patients are under statin therapy (given the HMG-CoA reductase pathway) -- and this shared inhibition has potentially large implications when (re-)interpreting much of the research to date with statins. In addition, the inhibition of protein prenylation may, at least in part, explain: (1) the considerable efficacy of statins in preventing cardiovascular disease where a number of other cholesterol-lowering modalities/medicines have failed to produce such dramatic benefits and (2) the surprising dose-dependent reduction by statins in cardiovascular events when cholesterol is already low (or driven low). The overall finding as to the relevancy of protein prenylation as part of the mechanism of action of statins is more than worthy of mention in the article, and I kept the addition succinct. Bdmwiki (talk) 07:01, 20 November 2013 (UTC)

[Jmh649, would you please explain why you keep removing this subsection, so we can arrive at a better understanding? Per Wikipedia: "The question of whether source material is secondary or primary should not, however, become a focal point for edit warring...It is therefore important to remember that, according to policy, primary, secondary, and tertiary sources may all be acceptable if used appropriately."] — Preceding unsigned comment added by Bdmwiki (talk • contribs) 17:09, 8 November 2013 (UTC) (modifed — Preceding unsigned comment added by Bdmwiki (talk • contribs) 07:36, 17 June 2015 (UTC) )

note, i removed "cataracts" as there are no reviews on this - see here Jytdog (talk) 12:36, 17 June 2015 (UTC)

Here is a later 2002 second study re cataracts, statins, and prenylation- "Geranylgeranyl pyrophosphate counteracts the cataractogenic effect of lovastatin on cultured rat lenses."(pmid 12457872) And of course, cataracts are a well established concern for statins (e.g., http://www.webmd.com/cholesterol-management/news/20141205/daily-statin-might-raise-your-risk-for-cataracts-study), so the potential causative role re prenylation seems significant. I'm not sure why a review is a prerequisite for inclusion in Wikipedia with two good studies and am hoping you could explain. I won't go to war over this one edit, but it seems noteworthy that there is a basis in reduced prenylation for the primary side effects of statins, including cataracts.Bdmwiki (talk) 18:48, 17 June 2015 (UTC)

I found 3 primary sources and associated hype about of each of them like the webMD source you found. Again, not a single review discusses this. Jytdog (talk) 18:54, 17 June 2015 (UTC)

Weird review

I've removed this from the article:

One review propose that statin treatment guidelines must be critically reevaluated because the statins may cause coronary artery calcification.

Okuyama, H; Langsjoen, PH; Hamazaki, T; Ogushi, Y; Hama, R; Kobayashi, T; Uchino, H (March 2015). "Statins stimulate atherosclerosis and heart failure: pharmacological mechanisms". Expert review of clinical pharmacology. 8 (2): 189–99. PMID 25655639.

I am fairly certain that this is a very minor opinion based mostly on small studies and pathophysiological considerations rather than real trial data. Langsjoen has been writing about statins and Q10 for 25 years, and I've previously seen attempts to add this view to the article about statins. I am unaware of decent sources that confirm the acceptance of these perspectives. Even secondary sources can fail WP:WEIGHT and I think this is a good example. JFW | T@lk 17:29, 7 January 2016 (UTC)

Perhaps Dmitry Dzhagarov could comment. JFW | T@lk 12:40, 8 January 2016 (UTC)

Jfdwolff I must agree with you, especially considering other recent literary sources However, it revealed that statin therapy induced a significant increase in coronary fibrous cap thickness (FCT) as assessed by optical coherence tomography (OCT). This increase in FCT was independent of traditional coronary risk factors including the lipid profile. Dmitry Dzhagarov (talk) 13:57, 12 January 2016 (UTC)

So the FCT protects against plaque rupture? Sounds good to me. JFW | T@lk 15:09, 12 January 2016 (UTC)

References

does Ciclosporin increase exposure to Pravastatin?

Wikipedia says: "studies have not shown that these statins increase exposure to ciclosporin". OK, but does ciclosporin=cyclosporin increase exposure to Pravastatin? If yes, how much the dose of Pravastatin is usually to be safe? 20mg per day?

91.214.167.2 (talk) 14:53, 18 February 2016 (UTC)

Statins do not inhibit HmG CoA reductase, instead increase synthesis

See reference:

References

Redtails (talk) 14:48, 31 August 2016 (UTC)

Statin drug use, post menopausal women, diabetes increase

Unsure why this edit was removed the adverse reactions to statin drug use. This was a large scale study including over a hundred thousand post-menopausal womenTaps2386 (talk) 13:23, 18 May 2017 (UTC) Culver, Annie L., et al. "Statin use and risk of diabetes mellitus in postmenopausal women in the Women's Health Initiative." Archives of internal medicine 172.2 (2012): 144-152.

@Taps2386: Because it's still a primary study and the conclusions are of little value compared to the results from these: pmid:20167359 and pmid:21693744 meta-analyses. I suppose a case can be made that it is relevant to a particular population and it doesn't contradict the secondary sources, so I haven't reverted it again. If you're not sure about how evidence quality is judged on Wikipedia, please read WP:MEDRS. --RexxS (talk) 20:33, 6 June 2017 (UTC)

Thank you for the reply. The study is newer than the previous meta-analyses and higher population base. I will look into the judgement on evidence quality and thank you for the source. — Preceding unsigned comment added by Taps2386 (talk • contribs) 21:03, 6 June 2017 (UTC)

Indeed the study is newer; but that is marginal in this case (2012 vs 2011 and 2010), and the secondary sources used are not out-dated. We would only use a newer secondary source to amend the conclusions of a currently used secondary source, per WP:MEDPRI. If there is little time difference between secondaries that disagreed, we would normally attribute and report both conclusions per WP:YESPOV.

Statin Damage

what about Duane Graveline: Statin Damage Crisis (2010)? i guess an addied controversy section would be beneficial to the article. 80.98.79.37 (talk) 23:48, 21 July 2017 (UTC).

See: Husten, Larry (24 July 2017). "Nissen Calls Statin Denialism A Deadly Internet-Driven Cult". CardioBrief. -- Jytdog (talk) 05:06, 6 August 2017 (UTC)

@Jytdog: What about this article in Expert Review of Clinical Pharmacology? The title is "How statistical deception created the appearance that statins are safe and effective in primary and secondary prevention of cardiovascular disease" and the abstract says:

We have provided a critical assessment of research on the reduction of cholesterol levels by statin treatment to reduce cardiovascular disease. Our opinion is that although statins are effective at reducing cholesterol levels, they have failed to substantially improve cardiovascular outcomes. We have described the deceptive approach statin advocates have deployed to create the appearance that cholesterol reduction results in an impressive reduction in cardiovascular disease outcomes through their use of a statistical tool called relative risk reduction (RRR), a method which amplifies the trivial beneficial effects of statins. We have also described how the directors of the clinical trials have succeeded in minimizing the significance of the numerous adverse effects of statin treatment.

Eric Kvaalen (talk) 10:02, 28 September 2017 (UTC)

I’d say that is compelling, Eric. Jusdafax 04:22, 5 December 2017 (UTC)

Ravnskov cannot be considered unbiased in this debate. JFW | T@lk 17:14, 5 December 2017 (UTC)

Jfdwolff, I'm unfamiliar with the particular author you're referencing (though I see they're involved in the above proposed article). Can you elaborate a bit on why Ravnskov's perspective cannot be viewed as unbiased in this debate? TylerDurden8823 (talk) 03:11, 6 December 2017 (UTC)

I think it depends a lot on how you regard denialists. The benefits of statins on specific endpoints is widely accepted, and I would set very high standards before basing any content based on anything written by this particular author on grounds of WP:WEIGHT. JFW | T@lk 12:18, 8 February 2018 (UTC)

Effectiveness, relative risk, etc

User:Paddybutler in these edits:

• diff 19:22, 1 November 2018
• diff 12:47, 3 November 2018
• diff 14:07, 7 November 2018 (from an IP)
• diff 14:11, 8 November 2018

You have added unsourced content that is WP:OR and content that is based on sources that are not OK per WP:MEDRS. I left you some welcome messages at your talk page (User talk:Paddybutler) describing how we edit about health in Wikipedia. Please be sure to use high quality sources per WP:MEDRS and be sure to summarize what they say. High quality sources drive Wikipedia content. Jytdog (talk) 15:32, 8 November 2018 (UTC)

Primary source removal

The publication of a report entitled "Cholesterol confusion and statin controversy" by Robert DuBroff (a research cardiologist, University Of New Mexico) and Michel de Lorgeril (a medical researcher at the French Centre National de Recherche Scientifique specialized in cardiology and nutrition – and a member of the European Society of Cardiology) presented to the World Congress of Cardiology merely suggested that an association with cholesterol levels does not necessarily indicate a cause of Coronary Heart Disease, but may be also simply a coincidence or an incidental consequence.

References

@Jytdog: I'm curious why this section was removed. Per WP:PRIMARYNOTBAD, it doesn't appear that using primary sources is a problem, by itself. Was there another issue you had with this content? WestWorld42018 (talk) 18:08, 11 November 2018 (UTC)

See WP:MEDRS. Additionally the World Journal of Cardiology is a) not MEDLINE indexed and b) published by a predatory publisher, Baishideng Publishing Group. Not acceptable in Wikipedia. The content is also unacceptable - we don't puff up authors that way. Jytdog (talk) 18:15, 11 November 2018 (UTC)

Thanks for the explanation. WestWorld42018 (talk) 18:23, 11 November 2018 (UTC)

Statin side-effect on gut archaea

"... in highly competitive niches, such as the colon, even partial growth inhibition may cause extinction. In developed countries, such as the United States, statin use is on the rise, and over a third of people over 65 use these drugs for their cholesterol-lowering effects, unaware that at the same time they are taking a broad-spectrum anti-archaeal agent" (from https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1004833). --SCIdude (talk) 07:20, 16 March 2019 (UTC)

Contradictions

To be less confusing for readers, the article could use some work to present various views on statins as a range of research results, rather than what it is now: a serious of statements that contradict each other.

-"The evidence is strong that statins are not effective for treating cardiovascular disease in the early stages of the disease (secondary prevention) and in those at elevated risk but without cardiovascular disease (primary prevention)." -"Most evidence suggests that statins are effective in preventing heart disease in those with high cholesterol, but no history of heart disease. [primary prevention]" -"Statins are effective in decreasing mortality in people with pre-existing cardiovascular disease [secondary prevention]" — Preceding unsigned comment added by 134.41.142.255 (talk) 22:23, 9 January 2019 (UTC)

Can we be clearer about "most evidence", much of which is generated by Pharmaceutical Co'y research, and often skewed. A growing body of independent professionals have dismissed statins as junk science, and worse. See my other post. Thx. Mike Galvin (talk) 22:56, 15 April 2019 (UTC)

The Downside.

There is a growing school of thought that statins are little more than a fearmongering, pharms racket with few, if any, positive effects. On the contrary, they are proven to damage cell mitochondria, which can have devastating, long term health consequences. My concern is that much "research" on statins is funded by pharmaceutical companies who have a vested interest in selling what many now regard as a thalidomide for the age. The article does not reflect the mounting tide of impartial research which shows the often deadly effects of this drug. Dr Aseem Malhotra's presentation to an EU parliament-funded event is a useful starting point here (available to watch on Youtube). Title = "Stents and statins - Do they work? A top cardiologist's view". The issue is too important to not consider all angles; particularly one that is undervoiced because it is underfunded. Mike Galvin (talk) 20:00, 15 April 2019 (UTC)

Statins may not be perfect or without risks, but a mountain of credible research has shown that they undeniably save lives. Comparing them to thalidomide is laughable. Being skeptical of Big Pharma is reasonable, but that doesn't mean you should buy into conspiracy theories. If you can find a source per WP:MEDRS, then we can talk. ―Biochemistry🙴❤ 04:06, 16 April 2019 (UTC)

A mountain, undeniably. "Credible" is rather more questionable. Pfizer refused to publish the first round of results in clinical trials for Atorvastatin. A second trial was arranged (the product was chemically identical) and the results of that trial published, citing very favourable statistics. This, by itself, should raise alarm bells. Most critics of statins do not dispute the drug's ability to lower LDL cholesterol. What they dispute are the underlying statistics, which have been intentionally corrupted to exaggerate positive effects. Just today in the BBC, there is an article stating that one in two patients who take statins are suffering serious side effects, many catastrophic. The Guardian, today, ran a similar story. Eminent British surgeons have publicly dismissed statins as junk science, with a downside that far outweighs any "benefits", many of those dubious in themselves. This is all in the public domain, though I do not consider myself qualified enough to make the source selections. As far as "conspiracy theories" go, there has never been one surrounding statins, that I'm aware of. If by "conspiracy theory", you mean the rather mundane matter of multinationals turning profit at the expense of the public, then yeah; it's a "conspiracy theory" (.....??). But it's hardly JFK or the moon-landing hoax, now is it? Just daily life. As far as doctors facing the truth, many in the UK are now refusing to prescribe statins of any sort, despite NHS directives to the contrary. To me, this suggests a growing, professional realisation that the downside is worse than first thought; possibly far worse. Quite a few still sing the company song, but to paraphrase Upton Sinclair, "Never argue with a man whose income depends on not understanding the argument". Mike Galvin (talk) 18:24, 18 April 2019 (UTC)

"Dr Malcolm Kendrick. How much longer will you live if you take a statin" and "Study links statins to 300+ adverse health effects. Kelly Brogan MD" are both useful starting points. They at least put into some sensible context the epistemic black-hole that are statins. I'd be interested in your view on those two articles. Both short-ish. Mike Galvin (talk) 19:14, 18 April 2019 (UTC)

"Statin Denialism"

The very name (of this non-existent) phenomenon is pejorative whilst seeking to align itself with the term "denialism" in far more serious and insidious forms (Holocaust Denialism, for example). The phrase thus seeks to presuppose statins as a near-faultless solution whilst seeking to label those who question this assumption as irrational "unbelievers". This is sophistry. The inclusion (creation?) of this term is undoubtedly the work of a Pharma Blogger, who goes on to quote Harriet Hall, herself a Pharma Blogger, who has forged a second career propping up the Pharma establishment and deriding alternative medicines. Consider the following, utterly ridiculous statement: that those engaged in 'Statin Denialism' resort to an "overstatement of side-effects, all of which is contrary to scientific evidence". I'm not certain to which "scientific evidence" Ms. Hall is referring. If she wanders through Google for ten minutes, she will find literally hundreds of GP's, surgeons and even pharmacists - many eminent - who have risked careers to tell the truth about this drug, its unvarnished statistics, and highly dubious genesis. Can I suggest that this phrase, manufactured and calculated as it is, be replaced with something more balanced. 'Public Cynicism', 'Mistrust of Statins', whatever. Mike Galvin (talk) 13:18, 19 April 2019 (UTC)

Instead of ranting, why don’t you bring reliable sources that support your contention. That way, you’ll have no problem changing our article.Roxy, the dog. wooF 15:15, 19 April 2019 (UTC)

"Ranting"? Mmmm. "OUR article". Who could "we" be, I wonder. I literally wouldn't know where to start. Substantial portions of this advertisement would need to be rewritten or deleted outright. I would have thought the Pharm Heads who penned it in the first place might have noticed one or two....you know....'anomalies' in their own work. At the very least, I wouldn't expect a pile of nonsense like "Statin Denialism" to appear anywhere in a serious evaluation. As for "reliable sources", I'm spoiled for choice. Give me a couple of weeks. Mike Galvin (talk) 15:44, 19 April 2019 (UTC)

We would be you and me and any other editors who have contributed. You can see the list of each contribution to the page, and the name of the contributor by clicking the “history” tab. Pig Farmer membership is not disclosed on the history of the article. I myself have been waiting for my payment from Pig Farmer for at least twenty years. It’s very frustrating. Roxy, the dog. wooF 15:53, 19 April 2019 (UTC)

Fair enough. But you'll understand those trotters have a long reach, hence skepticism. Or "denialism", if you prefer. Mike Galvin (talk) 16:13, 19 April 2019 (UTC)

• I also oppose the existence of this section. It contradicts the well-sourced statement in the lede that the role of cholesterol in heart disease is "controversial". In recognition of these sources and the two against one consensus against the section, I have decided to delete the section. --Wikiman2718 (talk) 18:22, 25 May 2019 (UTC)

Thanks Wikiman2718 for taking this discussion forward. I don't think the blanking of the section was justified, and I have reverted it. Please now act in accordance of WP:BRD and do not delete the content again until further discussion has taken place on this talk page.

The word "denialism" is used increasingly in public debates about medical treatments. HIV/AIDS denialism is a recognised concept and some use "vaccine denialism" for vaccine hesitancy. If the term has been introduced into public debate it is reasonable to report on this.

As for the contradiction with the claims in the intro, this content was actually extremely weak and the sources for this content mostly failed WP:MEDRS. I do not deny that there is a school of thought that contradicts the lipid hypothesis, but the way it was written simply lends too much weight to this. There are probably better sources than a blog called "Manhattan Contrarian" and a press release on ScienceDaily. The only source that comes close is doi:10.1080/17512433.2018.1519391 which needs to be moved into the body of the article but has no place in the introduction. JFW | T@lk 16:20, 26 May 2019 (UTC)

@Jfdwolff:: Thanks for your concern. I think we will be able to work together to improve this article. This source also recognizes the existence of a controversy. I'll run a search to find out how many legitimate sources recognize this controversy. I think that a section called "statin denialism" may be unmerited in the presence of a legitimate scientific controvert on the subject. Maybe a section on the controversy (which might mention the Mediterranean diet and other alternatives) would be better. --Wikiman2718 (talk) 16:33, 26 May 2019 (UTC)

References

To be fair, the term "statin denialism" seems to be the coinage of one commentator. We must be careful about sections called "Criticism" or "Controversy" as they tend to become one-sided. JFW | T@lk 16:40, 26 May 2019 (UTC)

I do think it is clear that there are alternatives to statin treatment. The Mediterranean diet, for instance, is more effective. This gives some credibility to the anti-statin group. It is also the norm in medicine that very few side effects are recognized when a drug first hits the market and the true risks of a drug are only recognized with time. Statins are relatively new, so I tend to agree with the critics who argue that the side effects of statins are more severe than is commonly recognized. While a section on controversy may risk being one-sided, I think that this article is also at risk of being one-sided. For instance, it makes that claim that statins have been shown in some cases to prevent dementia. If I remember correctly, the study linking statins to lower rates of dementia

1) Showed only correlation. There is realy no good argument that statins prevent dementia without a plausible mechanism of action.

2) Was pharmaceutically sponsored and published in response to studies showing that statins may cause dementia.

I think that this article might benefit from showing a bit more controversy. --Wikiman2718 (talk) 16:51, 26 May 2019 (UTC)

• Came here from mention at WT:MED. Without getting into the detail yet I note immediately that PMID 30653537 is being referred to above as a "review" when this is in fact a comment in PloS ONE. This source needs to be taken off the table immediately. Alexbrn (talk) 16:53, 26 May 2019 (UTC)

• @Alexbrn:: At least two well-sourced reviews one well-sourced review finds evidence of an academic controversy surrounding statins. One of them finds that the current censorious in favor of statins is build around flawed and misrepresented data. Surely this information is worth some discussion. I would appreciate if you participated in the talk section before making and reverting controversial edits. --Wikiman2718 (talk) 18:16, 26 May 2019 (UTC)

This 2017 Lancet article argues that there is a statin controversy and calls out the guy who made the "statin denialism" quote: "So despite Horton and Collins and colleagues wanting to shut down the discussion and award themselves the final word, the debate about statins in primary prevention is alive and kicking." There is a controversy, and this should be reflected in the article.--Wikiman2718 (talk) 18:22, 26 May 2019 (UTC)

References

• • If there are decent sources, fine. But nobody should be trying to use weak sources (and misrepresent what they are) when we have ample good ones. As to reversion, nobody WP:OWNs the article and if we can cut the crap, that would be good. Alexbrn (talk) 18:23, 26 May 2019 (UTC)

That's what I'm trying to do. Please provide ample recognition aforementioned sources, and comment in talk section before making and reverting controversial edits. This issue is two sided: It is not a matter a statin denialists vs science. --Wikiman2718 (talk) 18:27, 26 May 2019 (UTC)

In light of the Lancet article, I recommend that all comments by Horton be removed from this page. --Wikiman2718 (talk) 18:37, 26 May 2019 (UTC)

• I note PMID 26225201 is in a non-MEDLINE indexed journal. This needs to come off the table - we have good sources so no need to be using iffy ones. Alexbrn (talk) 19:33, 26 May 2019 (UTC)

Ok. I'll try to gather together all the sources I can find on the issue that look reputable. I should be able to do that sometime today. Afterwords you can vet them and then we can decide on a plan of action. --Wikiman2718 (talk) 19:44, 26 May 2019 (UTC)

We probably need to steer clear of the Ravnskov piece too, in a low-impact journal and promoting a fringe view that raised a huge WP:REDFLAG with COI concerns. As The Guardian put it: "His [Ravnskov's] most recent review, with 15 others who are mostly members of Thincs, was published last month in the Expert Review of Clinical Pharmacology – an obscure source for newspaper stories that has been brought to the attention of media in the US and the UK".[2] Looking over the article I agree with Jfdwolff that too much credence is given to the anti-lipid hypothesis camp. It savours of coat-racking. While there is some limited legitimate disagreement in this field there is also a grassroots loony "statins are the great Satan; fat is good for you" crowd (the so-called denialists) which we need to describe too, per suitable sourcing (per WP:PARITY). Alexbrn (talk) 21:11, 26 May 2019 (UTC)

I am keen for NPOV reasons that we do explain that there is a dissenting group (THINCS and LCHF continue to get coverage both publicly and in academic fora) but that does not dictate that we should use their own sources; as such we are not obliged to cite the Exp Rev Clin Pharmacol even outside the article introduction. I am sorry I missed the ghastly POV fragment in the introduction that suggested that the lipid hypothesis was "said by some" etc. JFW | T@lk 10:03, 27 May 2019 (UTC)

I agree, but this needs to be handled as the WP:FRINGE position it is. So far as I can see, the lipid hypothesis is long-settled consensus supported by myriad high-quality WP:MEDRS. The opposition make a lot of noise but generally in low-quality publications and with some daft claims. There is a good recent round-up at SBM here. Alexbrn (talk) 10:39, 27 May 2019 (UTC)

Sorry I didn't get those sources in yesterday. Still doing research. Very few high quality papers suggest that statins don't work at all. However, this is significant debate about the expanding prescription recommendations. Many scientists are hesitant to recommend prescriptions to healthy people based largely on opaque industry data which shows signs of bias, and there have been calls for more independent evaluation of the evidence. In particular, there are concerns that statins may not improve all-cause mortality in healthy people. Some researchers argue that muscle pain is more common in clinical settings than is reported in trials, and the origin of this discrepancy is unknown. This article sums up most of these points quite nicely, but doesn't include a discussion of muscle pain. --Wikiman2718 (talk) 14:17, 27 May 2019 (UTC)

References

That source is not WP:MEDRS. Alexbrn (talk) 14:20, 27 May 2019 (UTC)

This one covers many of the same points and is citable. It also discusses the possibility of muscle damage. --Wikiman2718 (talk) 14:58, 27 May 2019 (UTC)

References

Not sure how this is relevant to denialism? The potential adverse muscle effects of statins are well-known and part of the risk/benefit question when prescribing - this is covered in our article. What is at issue for "denial" is the incorrect/pseudoscientific arguments put forward in opposition, which are quite different things. Alexbrn (talk) 15:04, 27 May 2019 (UTC)

See my previous comment. As stated there, the mainstream arguement against statins in the medical community is that the newest prescription guidelines may expand prescriptions to groups in which they have little or no benefit. This review supports that viewpoint. On the subject of statin denialism, only one person ever made that comment and he received lashback in The Lancet. I don't see how we can include that quote. --Wikiman2718 (talk) 15:12, 27 May 2019 (UTC)

Well, it's a fairly skimpy review by one guy (who incidentally has a book to sell about overprescribing) - and this is in America no? What has this got to do with denialism, which is the topic of this section? Alexbrn (talk) 15:27, 27 May 2019 (UTC)

On the issue of muscle damage, the problem is not that it occurs, but that it is reported more frequently in clinical practice than in clinical trials. Here is one of many sources that support this viewpoint. This is all part of the statin controversy that the statin denialist guy was trying to shut down. --Wikiman2718 (talk) 15:26, 27 May 2019 (UTC)

References

That source is too old to be useful. Alexbrn (talk) 15:28, 27 May 2019 (UTC)

It was published in 2011. However, if you're going to pull out the strict five year rule, feel free to find a newer source yourself. And if we're going to go there, we can just as well remove all references to statin denialism on the basis that they don't come from scientific journals. --Wikiman2718 (talk) 15:32, 27 May 2019 (UTC)

No because "denialism" is largely a social phenomenon like chemtrails etc. For WP:FRINGE topics like that, WP:PARITY applies. Note that denialism is not the same as measured debate about risk/benefit ratios - it hinges on the pseudoscientific proposition that cholesterol is actually good for you so ipso facto statins can be only be harmful. Alexbrn (talk) 15:42, 27 May 2019 (UTC)

Here is another good source about the statin controvery. It is quite real. --Wikiman2718 (talk) 15:38, 27 May 2019 (UTC)

We use that source already to make the point that the evils of statins have been over-amped in the media. It not so much supports the notion of "controversy" so much that a lot of lay people are just wrong/misinformed. Alexbrn (talk) 15:46, 27 May 2019 (UTC)

References

My understanding of the issue is this: While the risks of statins may be small, the benefitsfor people with only mildly elevated cholesterol may be equally small, and legitimate concerns as to overperscribing exist. On the subject of statin denialism, one guy made a quote and one guy responded in the Lancet. If the statin denialism quote referred only to rejection of the lipid hypotheses it may have been fully valid, but he instead referred to

"a spectrum of "statin denialism" ranging from pseudoscientific claims to the understatement of benefits and overstatement of side effects, all of which is contrary to the scientific evidence."

This quote is somewhat problematic, because it risks calling those who don't think statins should be used in healthy people "denialists". Rather than add all this to the article, I would be happy to compromise with no discussion of statin denialism and no discussion of the overperscribing controversy. --Wikiman2718 (talk) 01:01, 28 May 2019 (UTC)

We need to cover denialism per RS. I'm not sure there is RS to support the existence of a specific statin overprescribing controversy (maybe in America?). Those "who don't think statins should be used in healthy people" are denialists, since they're following an absolute belief, not science. Alexbrn (talk) 05:47, 28 May 2019 (UTC)

RS does not compel us to include every claim we find in a reliable source. There is little or no compelling evidence for benefits in people of low risk, and they may be overperscribed in this population. Those with only mildly elevated cholesterol will see less than a one percent decrease in mortality per five years. For reference, stains cause diabetes at a similar rate. While some medical organisations may recommend the use of statins for this group, I have found no compelling evidence for benefit. It is completely absurd to call this objection denialism, as it is evidence-based. --Wikiman2718 (talk) 13:42, 28 May 2019 (UTC)

None of those sources "don't think statins should be used in healthy people" (i.e. make an absolute prohibition). Like every sane source seems to say, they urge a risk/benefit assement where there is risk. That is not statin denialism. Denialism is denying the science (typically, denying the potential benefit from statins and/or denying the risk from high cholesterol). We have enough sources on cholesterol and statin denialism that we should cover it - especially since Wikipedia aspires to be a reputable reflection of accepted knowledge and we know from the sources there is a load of loony denialism "out there" on the web. We're not going to be playing along with it. It may even merit a breakout article - I'm still reading sources ... Alexbrn (talk) 14:30, 28 May 2019 (UTC)

By "healthy people" I mean people at low risk of heart disease, and they do support that claim. The term "statin denialism" revieves 68 hits in a google search, most of which quote that one guy who was called out in The Lancet. If you want to make a breakout article on statin denialism, go ahead. But do remember that NPOV requires you to cite The Lancet. --Wikiman2718 (talk) 14:47, 28 May 2019 (UTC)

References

I don't find Google the best way to find good sources. What in The Lancet are you referring to? Alexbrn (talk) 15:02, 28 May 2019 (UTC)

This commentary in The Lancet calls out the guy who made the "statin denialism" quote: "So despite Horton and Collins and colleagues wanting to shut down the discussion and award themselves the final word, the debate about statins in primary prevention is alive and kicking." --Wikiman2718 (talk) 15:15, 28 May 2019 (UTC)

References

A letter, so not WP:MEDRS. Interesting maybe for insight into the good old BMJ/Lancet rivalry though (may even be some secondary sourcing on that!) Alexbrn (talk) 15:23, 28 May 2019 (UTC)

It most certainly is a letter. You will find no studies on statin denialism. A pubmed search returns five hits for "statin denialism", four of which are the same article (a letter) and the last has little if anything to do with statin denialism. This is not vaccine denialism. According to at least one author, it is being pushed by people who would like to shut down all debate on the risk/benefit ratio of statins. --Wikiman2718 (talk) 15:35, 28 May 2019 (UTC)

References

As I said above, it's a social phenomenon so I'd not expect it to be discussed in the biomedical literature. What is the source for it "being pushed by people who would like to shut down all debate"? I'm thinking this could all be better covered in a wider article on Cholesterol conspiracy theories, maybe. Alexbrn (talk) 15:40, 28 May 2019 (UTC)

The source is the letter in the Lancet. The guy called out by name in that letter is the origin of the statin denialism quote in the sceptical inquirer, which seems to be the source of all this. And for reference, vaccine denialism is discussed in scientific literature.--Wikiman2718 (talk) 15:43, 28 May 2019 (UTC)

This is all very hard to follow. What is the name of the guy being "called out" ? Alexbrn (talk) 15:57, 28 May 2019 (UTC)

Here is a quote from the letter in The Lancet:

"So despite Horton and Collins and colleagues wanting to shut down the discussion and award themselves the final word, the debate about statins in primary prevention is alive and kicking."

The reference to statin denialism in article quotes Horton, and appears to be the first use of the phrase in a reputable source. Collins has also used the phrase, and I can't tell who these "colleagues" are and whether or not they account for the rest of the usage. But according to the letter in The Lancet, these guys are trying to shut down debate about risk/benefit ratios. Apparently, Collins wants to give statins to everyone over 50. This is all very new, and I'd give it a few more years to pan out before making judgement and labeling the opposition as anti-science. --Wikiman2718 (talk) 16:17, 28 May 2019 (UTC)

References

But that doesn't mention "denialism". And it isn't that. The legitimate debate about risk/benefit ratios is not the same as the "fat is good for you! statins cause birth defects! etc" stuff from the denialism crowd. Anyway, by following the sources I think this is all fairly clear. The important things from Wikipedia's perspective is that we:

• make sure we have adequate coverage of the statin/cholesterol conspiracy theories with an appropriate WP:FRINGE treatment, either in current articles or with a new one.
• ensure WP:PROFRINGE content expounding these conspiracy theories is absent from our text (already done in this article to some degree).

So far as I can see the respectable "debate" about risk/benefit ratios is a distinct topic. Alexbrn (talk) 16:22, 28 May 2019 (UTC)

In a perfect world these topics would be completely distinct, but in practice they are not. According to this article, statin denialism is "a spectrum... ranging from pseudoscientific claims to the understatement of benefits and overstatement of side effects, all of which is contrary to the scientific evidence." These kind of quotes very much risk infringing upon the risk/benefit debate. At least one major voice (and possibly several) in the statin denialist debate is pushing his own unscientific claim that statins should be taken be people who are not at risk of heart disease. There are quacks people who hold fringe viewpoints on both sides of this issue. While quacks people who hold fringe viewpoints like Mercola may be statin denialists, people like him are in denial of all western medicine. I don't see anything special about statins.--Wikiman2718 (talk) 16:47, 28 May 2019 (UTC)

I don't think so. By that definition, things which are "contrary to the scientific evidence" are denialism. Legitimate debate rooted in scientific evidence is, by definition, not. The sources aren't confused and so there is no need for us to be. As to "there are quacks on both sides of this issue" - that is an idiotic thing to say. Alexbrn (talk) 17:15, 28 May 2019 (UTC)

Surely you don't think that there is scientific evidence for the benefits of statins in people not at risk for heart disease? --Wikiman2718 (talk) 17:21, 28 May 2019 (UTC)

Not my question to answer. But I'm not labeling people "quacks" like you are absent of sourcing. Alexbrn (talk) 17:26, 28 May 2019 (UTC)

There is no scientific evidence in favor of statin use in healthy people. --Wikiman2718 (talk) 17:35, 28 May 2019 (UTC)

Per the sources, there obviously is when - despite their health - there is a high risk of CVD. For lower risks there is more debate. No source that I have seen is describing prescription in the face of such judgements "quackery". Wikipedia is guided by sources, not the POV of editors. Anyway, since WP:NOTFORUM applies I shall indulge this debate no longer, and work on improving the article(s). Alexbrn (talk) 17:50, 28 May 2019 (UTC)

WP:NOTFORUM does not give you the right to make changes to the article against consensus. I did call Collins a quack person who holds fringe viewpoints, but that was just my opinion. I never suggested that we should call him a quack in the article. I support the creation of a section called "fringe views" where we can include the views of Collins, the denialists like Marcola, and this article (doi:10.1080/17512433.2018.1519391) which is medline indexed. --Wikiman2718 (talk) 18:05, 28 May 2019 (UTC)

@Alexbrn: I have removed the allegation that Collins is a quack. Upon further research, he is not a quack, just a person who holds a fringe viewpoint on this issue. It is notable that pure opinions can never be considered libel. I certainly hope that this was a polite attempt to familiarize me with the rules, and not a case of Wikilawiering. If I do remember correctly, you did call me an idiot earlier. So what do you think of my suggestion about fringe viewpoints? --Wikiman2718 (talk) 18:53, 28 May 2019 (UTC)

Per WP:BLP "Material about living persons added to any Wikipedia page must be written with the greatest care and attention to verifiability, neutrality, and avoidance of original research". It is untrue that I called you "an idiot". For anything to be discussed as a fringe view, we would need sourcing that frames it as such. I came here is response to a query about statin denialism, and we have good sourcing on that at least. Alexbrn (talk) 19:00, 28 May 2019 (UTC)

In running a search to see if "statins for everyone over 50" was a fringe viewpoint, I found (quite shockingly) that it is being seriously considered by some members of the medical community. Surely this must validate concerns about overperscribing. The people at the BMJ agree with me. They are running an ongoing campaign for transparency in statin trials. The BMJ (and others) are concerned because the raw data in these trials is not available for viewing. It appears that some people are not comfortable taking recommendations from groups with financial conflicts of interest who tell us the everyone should be on their drugs, but refuse to show their data. --Wikiman2718 (talk) 19:46, 28 May 2019 (UTC)

A relevant article on statin denial. --Wikiman2718 (talk) 20:53, 28 May 2019 (UTC)

References

A small note of thanks to the smarter heads who got on to this. Mike Galvin (talk) 23:53, 6 June 2019 (UTC)