Placebos and Nocebos
If a doctor gives you a big red pill and tells you it will help the symptoms that you are suffering from there is a significant chance that these symptoms will improve. This is known as the Placebo effect; it is well established but not fully understood. What we are less aware of is the Nocebo effect. This is when a widely used medication has adverse publicity about possible side effects. This results in patients being more likely to suffer these side effects than would be expected from the blinded trials where they do not know what medication they are taking.
The Nocebo effect has been clearly demonstrated for statins. These are the drugs we use to reduce your chance of a heart attack or stroke by lowering cholesterol levels. Large numbers of patients decline to take them due to worries about side effects that have been nurtured in the media. However, a recent very large trial has now proved these concerns regarding side effects are unfounded.
Statins are one of the most prescribed medications in the world. Nearly eight million people in the UK take them to lower their cholesterol and in turn reduce the risk of heart attacks and stroke. However, currently up to a fifth of people stop taking them due to side-effects such as muscle aches, fatigue, feeling sick and joint pain. We now have two large trials showing that the Nocebo effect may account for almost all the associated symptoms, as statins only cause significant medical problems in less than 1% of patients.
Cardiovascular disease causes a quarter of all deaths in the UK; controlling blood pressure and lowering cholesterol with statins are the most significant tools we have to reduce risks. The higher your risk, the greater the benefit of taking a statin. Getting older increases your risk of heart disease and stroke. The trials are extremely reassuring for patients to whom we offer statins as they move into the higher risk group; over 70 years old with raised blood pressure.
Both the Placebo and Nocebo effects are real. It is wonderful that patients can feel better after being given a pill which has nothing in it. However, suffering symptoms when taking a pill that has been shown not to cause them is a disadvantage. We can now counter this by explaining to patients that any initial statin related symptoms are very unlikely to be directly related to the biochemical effects of the statin and will almost certainly resolve given time. There is no harm in stopping and then restarting statins a couple of times as this will often speed up the resolution of the symptoms.
If you are a patient who has previously been prescribed a statin but stopped taking it due to side effects then this research strongly suggests it would be worthwhile trying a statin again. It is now very clear that the benefits of this group of drugs far outweigh any risks. Trusting the scientific proof over the media speculation will make an enormous difference to many patients by preventing a very large number of heart attacks and strokes.
Anthony O’Brien, Wyndham House Surgery