The Lancet Versus BMJ: Dispatch From The Statin Wars

–The editors of the two top UK medical journals are in a bitter fight over statins.

The editors of the two top medical journals in the UK are at war over statins.

The bitter fight has its origins in the 2014 publication in the BMJ of two articles that were highly critical of statins. Rory Collins (Oxford University), a leading statin trialist, demanded that the BMJ retract the article. After a lengthy investigation by an independent committee the BMJ declined to retract the articles, though it did issue corrections.

Last week the Lancet became involved when it published a 30 page review article by Collins and colleagues seeking to demonstrate that the benefits of statins have been underappreciated and the adverse effects of statins have been overstated by both the medical community and the public. In a related comment Lancet editor Richard Horton aligned himself with Collins and supported an effort by Collins and others to seek sanctions against the BMJ from COPE (the committee on publication ethics), decrying what he described as ” COPE’s refusal to investigate the growing concerns of senior UK scientists.”

The latest salvo in the battle comes from the BMJ in response to Horton’s comment. In a statement issued on Thursday the BMJ said Horton’s characterization of COPE’s response was “inaccurate” and it published for the first time COPE documents relating to the controversy.

The documents from COPE, published online by the BMJ, make clear that a COPE panel did investigate the issue but did not agree with Collins and his supporters. The COPE panel “found that neither paper met the COPE criteria for retraction.” COPE also rejected the idea that it was unethical or inappropriate to publish   articles critical of statins: “Without having an opinion on one or other side of the debate on the use of statins and their side effects, it is clear that this is a topic on which there is a considerable range of opinion and no purpose is served by censoring either side of the debate.”

“We hope that publication of the documents relating to the complaint will serve to correct the public record,” said Fiona Godlee, editor-in-chief of BMJ. Godlee announced that she had also written to England’s chief medical officer, Sally Davies, “asking her to set up an inquiry into the statins saga and an independent review of the evidence on statins.”

The supporting documents released by the BMJ also clearly indicate that Collins refused invitations from Godlee to publish his concerns about the disputed papers in BMJ.

BMJ  also published an editorial comment by Harlan Krumholz (Yale University) on the statin controversy. (Krumholz was a member of the independent BMJ committee that investigated whether the BMJ should retract the disputed 2014 articles.) Krumholz, though generally supportive of statins, points out limitations in the trials and calls for independent verification of the data. “In the end,” he writes, “the sharing of these data by the trialists may do more to advance their interpretation of the data and promote consensus than anything else they could do.”

Also appearing on the BMJ website is a blog post by Richard Lehman, who raises questions about the blithe dismissal of statin side effects. “Muscle pain and fatigability are not a figment of misattribution and public misinformation,” he writes. “They are too prevalent and recurrent in people who desperately want to stay on statins. Rather than discount a widely observed phenomenon, we should ask why there is such a mismatch with reporting in the trials.”

Lehman further observes: “The main adverse effect of statins is to induce arrogance in their proponents. The evidence for this class of drugs is massive and the areas of controversy are quite small. Most of the current debate consists of throwing blame at the BMJ for creating public doubt about statins in two short articles. So it has become an argument about communicating evidence to the public and to individuals, and this is something the Lancet authors seem to think should be done by authoritative persuasion…”

I have invited Rory Collins and Richard Horton to respond to the BMJ statement and will update this story as necessary.