Genius Foods

look at car seat belts. If they are worn as a preventative
tactic with widespread use, their efficacy is substantial, and
the risk of serious side effects is close to zero. Many people
have to wear seat belts in order to save one life—a massive
NNT. But this is not much of a problem, as wearing a seat
belt confers no side effects. This is not the case for statins,
which regularly cause muscle pain, memory problems, and
metabolic dysfunction, greatly increasing the risk of
diabetes and even parkinsonism in otherwise healthy
people.
So what’s the NNT for statins in at-risk adults with no
known cardiac disease? Studies range from 100 to 150 to
prevent one cardiac event (heart attack or stroke), with no
effect on death rate. In other words, ninety-nine of one
hundred subjects would have no benefit from the statin. If
this were something with minimal cost and zero side effects
like a seat belt, we might be able to justify giving those
ninety-nine people this extra medication. But this is where
the inverse of NNT comes in—NNH, or “number needed to
harm.” For statins, the NNH to develop muscle damage
(myopathy) is nine, or about one in ten patients, and the
NNH for diabetes is 250. There is no right or wrong answer
to “Should I be on a statin?” That said, you and your
physician should be able to have this informed conversation
and come to a decision about what you put into your body
and why. Unfortunately, most physicians are too pressed for
time in the current insurance climate to have such a nuanced
conversation with every patient, which means they are
forced to take shortcuts and generally end up overtreating or
using cookie-cutter guidelines.