My earlier blog commentary on the recent Lancet meta-analysis on outcomes of primary prevention trials in patients designated as "low risk"was done hastily and driven largely by my basic skepticism regarding meta-analyses and betting the farm on a single such study. A much more thoughtful and important analysis can be found here.
It was written by Dr. David Newman,an ER physician who authored the book entitled
Hippocrates Shadow:Secrets from the House of Medicine.
What apparently made the results of the recent Lance Meta-analysis different from a number of meta-analyses which found contradicting results was that the current study looked at the mortality data on those low risk patients who experienced a 40 mg or more decrement in the LDL following the institution of statin therapy.So the measure of interest was not the outcome of all low risk subjects treated with statins just those who had a favorable response to statins.
in Dr. Newman's words:
"Perhaps never has a statistical deception been so cleverly buried, in plain sight. The study answers this question: how much did the people who responded well to the drug benefit? This is, by definition, a circular and retrospective question: revisiting old data and re-tailoring the question to arrive at a conclusion. And to be fair they may have answered an interesting, and in some ways contributory, question. However the authors’ conclusions imply that they answered a different, much bigger question. And that is not a true story."
h/t to the tireless Dr. Roy Poses whose comments on my earlier posting alerted me to this line of thinking.
addendum: added 5/31/2012. I should have known Dr. Newman's comments were not go unchallenged and all such challenges not from hired guns at Pharma. Here are some arguments raised by Newman's critique.Thanks to the always informative and up to date web site ,Cardiobrief.