May 16, 2019
Gary Schwitzer is the founder and publisher of HealthNewsReview.org. He longs for a day when he doesn’t feel compelled to write about miscommunicated observational research any more.
Let me count the ways in which I am moved to write about another unwell piece in the New York Times Well section – “Statins May Cut Glaucoma Risk.” Let’s begin with the first line: “More good news about cholesterol-lowering statin drugs.” No, it’s not good news. There’s no “take it to the bank” definitive news-you-can-use here. In fact, the story ends with a statement from one of the researchers:
…glaucoma treatment or prevention is not by itself a reason to start statins. “Our study doesn’t address whether statins stop the progress of the disease,” she said. “That would require a clinical trial.”
The journal article upon which the story is based is headlined, “Association of Statin Use and High Serum Cholesterol Levels With Risk of Primary Open-Angle Glaucoma.”
It said association, not causation.
And so, all of the following phrases in the story, using causal language, are inaccurate and misleading:
- “may reduce the risk for glaucoma” – Feel free to substitute “may not” whenever you see “may” in a news story about biomedical research.
- “using statins had a beneficial effect” – The study didn’t prove cause-and-effect.
- “five or more years of statin use led to a 21 percent reduction in risk” – The words matter. The researchers used the word association and the story should have, too. But “led to reduction in risk” is a causal statement unsupported by the research. We offer loads of help in how to write about such studies in this primer.
As is often the case, the journal article had a substantial section on acknowledged limitations (below), none of which was mentioned in the Times story. But he/she who lives by the journal article du jour often cares little about limitations, but, rather, about meeting one’s story quota. I don’t expect consumer-readers to understand everything in the authors’ limitations section, but I present it here just so you can see how willfully some of this is ignored in mainstream news coverage of research:
Although our study was large, with a long follow-up, repeated assessment of statin use and hyperlipidemia, and the availability of key covariates, our study had several limitations. We likely had misclassification of statin use and cholesterol levels, as we did not measure participants’ recall errors. This misclassification would have biased associations toward the null. Our case ascertainment method had low sensitivity; however, methodologically, RR estimates are still valid if the case definition is highly specific and the case ascertainment is unassociated with exposure. Also, as participants were mostly white health care professionals all free of cancer, our results may not be generalizable to other community-dwelling older populations with different underlying risks for POAG (eg, in predominantly African American populations). Despite our adjusting for many potential confounders, there may still have been some residual confounding. Also, to comprehensively evaluate the association between hyperlipidemia, cholesterol-lowering treatment, and POAG, we performed many secondary analyses; many of these results showed weak associations. Any notable findings (eg, possible interaction with age for statin duration) may have been owing to chance; thus, they must be interpreted with caution and confirmed in other studies. Finally, our study was observational, but a definitive means of assessing the association between statin use and POAG would be to conduct a randomized clinical trial (although more observational studies are warranted to determine ideal dosage, statin type, and target population).
Wisdom of the crowds
It is noteworthy how many smart reader comments were left on the New York Times website. Clearly, readers are fed up with this repeated Well pablum. Examples of reader comments:
- Many articles about statins, like this one, tend to accentuate the positive. The downsides of statins are well-documented and should be presented alongside any supposed benefits of those drugs.
- “More good news about cholesterol-lowering statin drugs”?…Really? The second to last sentence says statins should not be started to treat glaucoma…wise.
- Really tired of medical articles that “may” help a condition. Isn’t this laudatory article a little premature?
- I can’t help wondering if this publication gets some sort of remuneration from articles like this – an ad for statins. It is ironic that in the same days publication the horrors of generic drugs are exposed rightfully while the risks of statins are glossed over in a facile puff piece. Perhaps I expect too much.
- This is the second article by Nicholas Bakalar in two weeks promoting statins.
- When will you cover the patients who take statins and develop muscle pain that does not always go away once stopping the drug? Polymyalgia is hard to treat, especially in seniors, and being unable to lift one’s arms or bend one’s knees is quite a valid reason for discontinuing. This keeps getting glossed over in the breathless coverage of these drugs. Stating that these effects are “rare” does nothing for the people who experience it. And if that side effect is so rare, I must have won a strange lottery because I know 4 people who went through this – some never got fully recovery.
I honestly believe it is better for the New York Times to stop reporting 226-word stories in the Well column. Use that paltry allotment of words in the Style section or the crossword puzzle instead, where no harm will be done. Increasingly, today’s news and health care consumers demand more context and analysis in health care journalism. They’re not getting it from this kind of shovelware – shoveled direct from journal to news story – without much or any independent vetting.