Theoretically, as we and others have shown it in the number of papers, treatment can be justified when benefit of Rx exceeds its harms by the magnitude appropriate for the disease risk. For example, if the risk of cardiovascular disease is 10% over n years, then benefit should be greater (than total sum of) harms 10 times over the same period. If preferences are taken into account then the ratio needs to be adjusted ( e,g,, if one would prefer avoiding cardiovascular event to statins' harms by 5 times, then benefit of statins needs to exceed its harms by 2 times only and vice verse). 

This, of course, should not to be construed as a medical advice or to minimize Juan's important message regarding shared decision -making. However, if some rational guidance is sought, this can be a starting point for discussion.

Ben Djulbegovic

Sent from my iPad

( please excuse typos & brevity)

On May 30, 2014, at 1:56 AM, "Juan Gérvas" <[log in to unmask]> wrote:

-to decide in your situation, Ian, you need a general practitioners who knows you well (you as human being, biology, psychology and social) more than an evidence researcher
-i am not in a campaign against statins but with great concern about its correct use
-there is enough evidence to recommend in general the use of statins for secondary prevention
-there is enough evidence to recommend in general against the use of statins for primary prevention
-please think when we are commenting and working about antibiotic resistence, we are not in a campaing against antibiotics
-un saludo
-juan gérvas

El 30/05/2014 0:12, Johnson, Ian (MAN-CTY) escribió:

Juan - you seem to have taken up a campaign against statins. I, as an evidence researcher, am unsure how to respond. I had an ischaemic thalamic stroke 3 years ago, leaving me with unilateral peripheral neuropathy and central pain syndrome. I am, of course on atorvastatin 20mg. I have muscular 'pain' but only one sided, so I know it is neuropathic and not metabolic. I have no obvious statin-related AEs, other than, possibly, hair loss. My question is, what evidence of benefit:risk is there for secondary prevention, other than theoretical, or anecdotal? Obviously, I would be happier to be without a statin, but as a stroke victim, one always feels vulnerable. 

Ian

Sent from my iPhone 5

On 29 May 2014, at 18:57, "Juan Gérvas" <[log in to unmask]> wrote:

Therapeutics Initiative.
Estatinas, efectos adversos. Como era esperable, las estatinas tienen efectos adversos. Revisión.
Statins: proven and associated harms. Be aware, statins have adverse effects. Review.
http://ti.ubc.ca/letter89

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