I had to change doctors due to staff turnover at the clinic, so just had another argument about statins.
Because diabetics have a higher risk factor for heart attacks, doctors take a more aggressive approach to treatment, and prescribe statins earlier than they would for the general population. All very well, but as far as I'm concerned, diabetics have a higher risk because so many of us are morbidly obese, often with failing kidneys and other organs to boot. Given that I'm not even overweight, let alone obese, I find this supposed increased risk factor less than persuasive in my individual case. It's a blunt sociological statistic, not a precise diagnostic tool.
The argument was settled when the doc fed my latest blood test results into the computer, ticked the Diabetes box for additional risk factors, and came up with a "Number Needed to Treat" of 116! He had to agree this wasn't a high risk.
For the layman, this NNT of 116 means that if I and 115 others like me took statins for 10 years, 1 of us could expect to avoid a heart attack we'd otherwise have suffered. So, what's up with me? Don't I want to avoid a heart attack? Well, look at it this way:
1. I'd be permanently taking medication that had only a 1-in-116 chance of actually doing anything for me.
2. How much would it cost Pharmac (ie you, the taxpayer) to subsidise 116 men taking this expensive medication for 10 years? I don't know, but I'm happy enough to approximate it to "a shitload of hard-earned cash."
3. How much would it cost those 116 to pay the unsubsidised portion of the cost? Let's call it "a somewhat-smaller shitload of hard-earned cash."
4. The benefit of medicating 116 healthy men is one heart attack that doesn't happen. In other words, one of us would probably get to die a slow, painful death from cancer rather than a quick death from a heart attack. Who knows how many additional years of life that would take? Might be decades, sure - but it might just as easily be a couple of years.
5. I have a distinct philosophical objection to permanently medicating healthy members of the population based on odds that don't even make it to 1%. If you're healthy, you don't need to be popping expensive pills every day, no matter what the companies who stand to profit try and tell you.
‘The Usual Suspect’
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