Heroes Not Zombies

The BMJ published a study today which has been reported across at ScienceDaily. This is an incredibly thoughtful article which questions the prescribing of lipid-lowering drugs (statins) to the elderly. Whilst there is good evidence that lowering lipid levels in younger patients reduces their risk of suffering from cardiovascular diseases, there is not good evidence that the same benefits can be achieved with the elderly. However, doctors are being encouraged to treat the elderly with the same assumptions as they make when treating younger patients. Worryingly, one of the studies conducted in the over-70s who take statins shows that while there did seem to be a reduction in death from cardiovascular diseases, the overall mortality remained the same. In other words they died from something else. In this particular study there was an increase in deaths from cancer. The authors of this paper ask a question which I’m astonished has not been asked before.

Is it possible, they ask, that by introducing preventive treatments in the elderly aimed at reducing the risk of a particular cause of death, we are simply changing the cause of death without the patient’s informed consent?

Too often drugs are presented to the public and the medical profession in terms of “saving lives”. Drugs don’t save lives. However, they do alter the experience of dying, and, of course, therefore, the experience of living. But when coerced into taking medication to “prevent” future diseases, patients are not being told exactly what not dying from this particular disease might mean for them. What are they more likely to die from if they don’t die from heart disease for example? This is not a question that should only be asked when treating the elderly. It’s time we had some decent research on how medication changes the experience of living and dying, not just research which only focusses on single diseases. Only then can doctors and their patients make truly informed decisions.

However, the issue of treating the elderly as if you can expect they will receive the same benefit from a treatment as a younger person is also something we need to think about. It doesn’t make sense. People are different and “evidence” from drug trials conducted on younger people may well not be at all useful “evidence” when making a prescribing decision for an elderly person. To be useful, evidence has to be relevant to the individual patient who is being persuaded to take medication.