Communicating the risk reduction achieved by cholesterol reducing drugs

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Abstract
“When the facts change, I change my mind. What do you do?” asked Professor Michael Oliver at a presentation held in Stockholm on 6 June 1996. This is what readers of the New England Journal of Medicine were told in an advertisement for the cholesterol lowering drug simvastatin during the winter of 1996-7. Oliver's statement is accompanied in the advertisement by the following facts: “In post MI and angina patients with cholesterol levels in the range of 5.5 to 8.0 mmol/l (212-309 mg/dl). Proven to reduce the risk of total mortality by 30% (P=0.0003),1 coronary mortality by 42% (P=0.00001).2 “These facts are followed by another statement from Oliver et al: “Lower patients' cholesterol now.”3 This second statement represents Oliver's change of mind since he, in 1992, stated his “Doubts about preventing coronary heart disease: multiple interventions in middle aged men may do more harm than good,”4 which contributed to the controversy over the importance of lowering serum cholesterol concentrations.5 In a similar advertisement, readers of the Lancet have been informed of the same facts, but unaccompanied by Professor Oliver's statements. Instead, these readers are provided with more facts: “Projected 6-year benefits in 1000 patients with coronary heart disease (CHD). 35 lives saved, 67 MIs prevented, 59 procedures avoided.” At first sight, a negative response to Oliver's rhetorical question may seem perverse or prejudiced. On second thoughts, given its rhetorical nature and considering that it is being used in a commercial presentation, you might suspect that there is something more to it. Indeed there is, and the aim of this article is to shed some light on the presentation of facts from clinical trials like the Scandinavian simvastatin survival study (4S) and the West of Scotland coronary prevention study (WOSCOPS).6 Facts from WOSCOPS were presented …