Essays by Malcolm Kendrick, MD
(originally published in RedFlagsDaily)


Jan 11, 2006
Statins And Cancer

By Malcolm Kendrick, MD

For a few years now, studies have been concluding that statins not only protect against heart disease, they also protect against a whole host of other diseases, including — naturally — cancer.

This was always rubbish. It is far more likely that statins promote cancer than protect against it. The only reason people taking statins seemed to have lower rates of cancer is due to the following:

A:            People with higher cholesterol levels have lower rates of cancer.
B:            People with higher cholesterol levels get put on statins.
C:            Ergo, people taking statins will automatically have lower rates of cancer.

It is important to note that the apparent cancer-protecting effect of statins was found in a number of uncontrolled studies. Basically, people taking statins were found to have lower rates of cancer than people not on statins. And rather than the lower rate of cancer being put down — correctly — to the fact that the people on statins were already less likely to get cancer in the first place, the authors of these studies decided, “It was the statins wot done it….” Trigger a series of headlines hailing statins as “wonder drugs.”

Did someone shout “marketing hype?” Surely not. For example, from May last year.

The cholesterol-lowering drugs called statins, used by many to protect against heart disease, may also guard against several kinds of cancers.

“Already shown to shield against prostate cancer, two new studies suggest statins also provide a greater than 50 percent reduction in risk with pancreatic and esophageal cancer, the researchers said.

"To my knowledge, statins are one of the best cancer prevention agents I have come across," said lead researcher Dr. Vikas Khurana, associate program director of the Gastroenterology and Hepatology Training Program and an assistant professor of medicine at Louisiana State University Health Sciences Center.” http://www.medicinenet.com/script/main/art.asp?articlekey=47194

Now, someone has decided to look at the results from the controlled, randomized statin trials. The important word here is not necessarily “controlled.” The important word is randomized; i.e., the people taking the statins, and not taking the statins, were as similar as possible. No different starting cholesterol levels here.

And guess what they found?

Cholesterol drugs don't protect against cancer

Statins do not reduce the risk of cancer, finds a review of several long-term studies published today.

The findings contradict previous studies, which suggested that the cholesterol-lowering drugs reduce cancer risk. They are based on 26 randomized controlled trials of statins and cancer incidence, or cancer death, including a total of 86,936 participants.

Dr C. Michael White and colleagues at the University of Connecticut and Hartford Hospital, Hartford, USA, report the findings in today's issue of the Journal of the American Medical Association.

They write: "In the trials, statins reduced the risk of a first myocardial infarction [heart attack] and overall mortality. With long-term follow-up and collection of cancer data in a majority of studies, insight into the risk of cancer among statin-naive persons and statin users can be derived.*

"In our current meta-analysis, statins did not reduce the incidence of cancer or cancer death." JAMA. 2006; 295: 74-80.

What a surprise … not.

Of course, the pharmaceutical companies don’t care. They’ve got the message out into the public consciousness that statins protect against cancer. And they are now relying on the Datsun/Nissan effect.

As some of you might know, Nissan is a Japanese car manufacturer. For some reason, it marketed its cars in the U.S. and Europe as Datsun. Perhaps it thought that Nissan sounded too Japanese, whereas, of course, Datsun is a good old Anglo-Saxon word.

Anyhoo, the manufacturer then decided that it would call its cars Nissan, not Datsun. Some 17 years later, after spending a few billion dollars on marketing, Datsun still had three times the name recognition of Nissan in the U.S.

Which proves yet again, if proof was needed, that once you put a thought into the mind of the average human being, it becomes almost impossible to shift.

So, well done to the pharmaceutical companies. In about 20 years time, people may finally recognize that statins don’t protect against cancer. By which time it will be somewhat too bleeding late. And well done to the opinion leaders who did the studies and wrote the articles stating that statins protect against cancer. Nice work if you can get it — swimming pools all round. Pass the Cuban cigars, and swallow hard.


*A prize to all who noticed the importance of this sentence.



June 11, 2006
How To Bury $400M

Once again, I get to tell you, “I told you so.” This time about the Women’s Health Initiative’s heart intervention study. Many will probably be familiar with this study by now. For those who are not, I have summarized it below.

  • 48,835 women aged 50 to 79 included
  • Study lasted 8.1 years
  • Major intervention in diet (This was not a passive observational trial. This was a randomized, interventional, controlled clinical study involving almost 50,000 women. The gold standard.)

Those randomized to the intervention group were intensively counseled to reduce their daily fat intake to 20 percent of calories, to increase their intake of fruits and vegetables to at least five servings daily, and to increase grain consumption to at least six servings daily. By year six, the intervention group was consuming, on average, 29 percent of calories as fat, compared to 37 percent in the control group. The corresponding figures for saturated fat were 9.5 percent and 12.4 percent, respectively.


Among the study population as a whole, there were no significant differences in coronary heart disease (CHD) or stroke incidence, CHD or stroke mortality, or total mortality. In addition, the low-fat diet produced no reduction in the incidence or mortality rates of breast cancer, colorectal cancer, or total cancer either.

And what was the response?

“The results of this study do not change established recommendations on disease prevention. Women should continue to get regular mammograms and screenings for colorectal cancer, and work with their doctors to reduce their risks for heart disease including following a diet low in saturated fat, trans fat and cholesterol,” said National Heart, Lung, and Blood Institute Director Elizabeth G. Nabel, MD. 

“This study shows that just reducing total fat intake does not go far enough to have an impact on heart disease risk. While the participants’ overall change in LDL “bad” cholesterol was small, we saw trends towards greater reductions in cholesterol and heart disease risk in women eating less saturated and trans fat,” said Jacques Rossouw, MD, WHI project officer. (We saw trends?)

Judy O'Sullivan, a cardiac nurse at the British Heart Foundation, said: "Numerous studies have confirmed there are huge heart benefits from maintaining a healthy lifestyle, which involves a balanced diet and regular physical activity. It is easy to identify a number of important reasons why this study did not agree with previous research.”

Now for my favorite quote: “There may have been some ‘disappointment’ that the studies didn't always give clear answers,” acknowledged Nabel, who is heart chief at the National Institutes of Health. "The findings are what they are…. Now we're in a second wave of putting the findings into perspective."

Putting the findings into perspective.” I think we know what that means. That means completely ignoring them. Perhaps the findings merely represent a “paradox.” If not, I am sure that you can find plenty of other reasons to sweep this $400 million trial into the dustbin.

But you know, such findings hardly come as a surprise. My tardiness at responding to this study is primarily due to another project I am working on. As part of this project, I was looking through the statistics, produced by the World Health Organization, on saturated fat consumption and heart disease rates in 46 countries across Europe.

Below I have created two graphs. Graph one looks at countries with the lowest consumption of saturated fat, and compares this to their rate of heart disease. Graph two looks at the countries with the highest consumption of saturated fat, and compares this to the rate of heart disease. (All figures are from the MONICA study, all figures from 1998, or within two years of that date, when figures from 1998 were missing.)


I know that such graphs can be a little difficult to follow, and may lack impact. Here is a little summary:

  • The French consumed three times as much saturated fat as was consumed in Azerbaijan, and had one-eighth the rate of heart disease.
  • Every single country in the top eight of saturated fat consumption had a lower rate of heart disease than every single country in the bottom eight of saturated fat consumption.

And still we are told that a high saturated fat diet causes heart disease.

Thank you and goodnight.


  More essays by Malcolm Kendrick