Step Right Up and Play the Statin Lottery

An article published on Medscape yesterday caught my eye. The article, Should Clinicians Change How They Talk Statins with Patients? New Study Says Yes, reports on a new statin study and in doing so, echoes the argument put forth in the study that patients would be more responsive to statin usage if the gains were presented “in the language of lotteries,” and patients were enticed by “the possibility of a bigger payoff.”

The Medscape article discusses a study in the medical journal Open Heart, which argues that even though research show a trivial “mean lifespan gain,” on average, among groups of people taking statins, there are some patients who benefit greatly from statin usage. To reach this conclusion, the researchers looked at a large population of statin users and divided the participants into two groups:

  • Group 1: the 93% of statin users who have the worst gain in lifespan (7.4 months on average)
  • Group 2: the remaining 7%, who show an average of 99 months extended lifespan.

By dividing the group of statin users in this way, researchers argue that practitioners can present statins in a more exciting and appealing way.

Quoting the lead researcher of the study, Dr. Darrell Francis of the National Heart and Lung Institute in London,

“Many patients want to know ‘What’s the size of the jackpot?’ So when talking to patients, maybe we really should use the language of lotteries.”

Yes, lotteries! You know, that game where most everyone spends their money and gains nothing and some statistically insignificant few win big? Yeah, that’s what medicine is becoming, all in the name of selling statins. Only in this “lottery,” the losers suffer more than the loss of a few dollars: statin users lose their memory funding a multi-billion dollar industry, increase their risk of cancer and diabetes, and suffer a host of other complications that are readily downplayed by the statin-fueled medical establishment that’s hell bent on selling more statins.

And, of course, as is common when the medical establishment discusses statins, this “lottery” approach comes complete with a way to obfuscate reality. According to the researchers, practitioners should consider saying only that there is a “chance of a 10-year* life-expectancy extension” from taking a statin but physicians should not reveal the actual chance of seeing any benefit unless the patient asks, because “…most people are very interested in the size of the payoff and not the probabilities,” Dr. Francis observes.

Psychology researchers describe lottery gambling as “paradoxical behavior” because those who buy lottery tickets are compelled to “go for the win” even though it’s obvious that the odds overwhelmingly favor the house. Many others aren’t so kind when describing the growing practice of state sponsored gambling, calling it “predatory” because it plays upon the public’s desire to win big, no matter the odds. Psychologists have coined the term “lottery mindset,” to describe the average person’s common propensity for ignoring the odds while focusing only on the payoff.

I find it deplorable that these predatory tactics are now being advocated to sell more statins. It appears that this is the new practice of medicine: If the science doesn’t hold water, resort to deplorable, predatory psychological manipulation.

When I weigh the statin risks and side effects against the statistically insignificant benefits that statins offer (benefits that are easily duplicated by lifestyle changes to control inflammation, glycation, and oxidation), I think equating taking statins to playing the lottery is not the ideal analogy. Russian Roulette seems more accurate to me.





* The study cited a 99 month average life extension for those select few who were “winners,” not 10 years. In typical statin numerical manipulation, the pro-statin crowd immediately rounded 99 months (8.25 years) to 10 years, giving themselves an instant 21% false gain.

4 thoughts on “Step Right Up and Play the Statin Lottery

  1. Our current medical model is appalling. All doctors offer anymore is drugs, and patients have been trained to want and expect drugs. I’m glad to have gotten rid of most of the meds I used to take. Thanks for your book, I recommend it to people. Everyone needs to know the info you shared in it!

  2. Economists traditionally described buying lottery tickets as irrational because the expected payoff – jackpot X probability of winning – was less than the price of the ticket. The breakthrough came with the development of the concept of Utility – how much is something worth to the individual. If I spend $10 or $20 a week on lottery tickets the amount of difference that makes to my lifestyle is trivial, I won’t even miss it. However, if I win a multi-million dollar jackpot that will change my life completely. Seen in this terms a small bet on the lottery is entirely rational – you are exchanging the low utility cost of the ticket price for a small probability of a huge utility benefit.

    Of course, none of that applies to the”statin lottery”. There you would be incurring a high risk of negative side effects (high utility cost) for a low probability of a low payoff (low utility benefit). Everything I’ve read suggests a far lower average extended longevity than 99 weeks – did you see how they came up with that figure? In any case, my understanding is that although statins showed some slight benefit of reducing death by heart attack in middle aged males who’d already had a heart attack, there was no improvement in overall mortality. They may not have died from a heart attack but died instead of increased cancer, suicide and accidents. Consequently the payoff of statins is possibly zero or actually negative, making buying a ticket in the statin lottery REALLY irrational.

    • You’re absolutely right. There is no improvement in absolute mortality. That’s one of statin’s dirty little secrets. Another being that their very very slight anti-inflammatory effect is easily duplicated with a trivial change in diet.

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