My health has suddenly deteriorated, after reading the latest claim in the debate about statins.
Professor Rory Collins, criticising some articles in the British Medical Journal, claims that the only side-effects of statins are muscle weakness in 1 in 10,000 people and a small increase in diabetes. Otherwise:
We have really good data from over 100,000 people that show that the statins are very well tolerated. There are only one or two well-documented side effects.
The nocebo effect
Another recent study, in the European Journal of Preventive Cardiology, concluded that while some people reported side effects of statin, just as many reported side effects of placebos. Ben Goldacre calls this the ‘nocebo’ effect: people hear about side effects and convince themselves that they have them.
My ‘nocebo’ effect happened like this. A few years ago one of the GPs in my practice persuaded me to try the famous Simvastatin. In the negotiations I knocked her down from the usual 40mg to just 20mg. For a couple of months I felt no side-effects. Then came the hay fever season. I was visiting the surgery for something else, and said I was feeling constantly dopy. ‘Yes’, said the doctor, ‘it’s a bad year for hay fever’. The dopiness continued for over a year. At each doctor’s appointment I mentioned it, and none of the doctors accepted that the statins might be the cause. I believed them. A year and a half later I was advised to go onto the normal dose. Since the statins didn’t seem to have affected me, I agreed. Within a few weeks on the higher dose I was in an awful mess. I went again, and this time the appointment was with a retired locum. ‘Oh yes, it’ll be the statins’, he said. ‘I can’t take them either.’ I stopped taking them, and soon began to feel better.
That’s my story. If my 18-month dopiness was all in the mind, you might as well say the feeling of not being hungry after a big meal is the placebo effect of the food. I am left asking myself whether the surgery would have been more honest with me about the potential side-effects, were it not for the financial inducements to get lots of people taking statins.
In a later visit I was shown a book with lots of graphs. The graph relevant to me, as a man over 60, basically said all men over 60 should be taking statins. The doctor didn’t find this an absurd claim to make. ‘By today’s standards you are young’, she said.
Why isn’t it absurd? The financial pressure wouldn’t work unless it was socially acceptable to think all males over 60 should take a tablet to make them live longer. Something crazy is going on.
We live with two contrasting models of health. According to one, human bodies have been designed to function in particular ways through the evolutionary process. We have evolved to eat the kinds of foods and perform the kinds of actions which our hunter-gatherer ancestors did for hundreds of thousands of years. This is why a stone age diet is healthy and plenty of exercise is good for us.
According to the other model, progress is all about getting away from nature. New technologies can eradicate disesases that plagued our ancestors, new tablets can make us live longer.
Within the first model, recommending a particular tablet to everybody in a particular age group is absurd. Good health comes from accepting what kind of animal, with what kind of body, each of us is, and respecting our limitations. It is the second model that finds it sensible: by nature you might die at 75, but with the right tablets you may artificially add an extra 10 or 20 years to your life. Around the time when I was born that belief in artificial progress was telling everyone to have their teeth out because false teeth were better, to bottle feed babies because breast milk was inferior.
Accept who you are
The driving force behind statins is of course profit; but the idea of universal statin-taking seems credible because of the continuing influence of the artificial model of health.
Accepting who you are by nature, with your body, your needs and your lifespan, may perhaps be harder for atheists who think the way we are is completely accidental. If automatic, unthinking laws of physics and evolutionary processes generated the bodies we have got, perhaps we can improve on them. It’s a big ‘perhaps’ – the more we learn about our bodies, the more complex they turn out to be – but there is no reason to suppose our bodies are designed to be good for us if they weren’t designed at all.