LAUSR

TO THE EDITOR: Nissen argues that not continuing a statin after an adverse event is unreasonable behavior, equivalent to membership in a statin denial cult (1). This analysis fails to take into account some implications of what we might call the public health paradox. From an aggregate perspective, Nissen is right: Statins are effective at decreasing the risk for cardiovascular events in certain populations. However, from the perspective of the individual health care consumer, things look very different. Taking any medication involves a certain amount of inconvenience and expense. Now add an adverse event, which the consumer attributes (rightly or wrongly) to the statin. The rational person might well ask, How likely is it that this drug is benefiting me? The answer, according to Nissen, is 59:1that is, 60 persons in this high-risk cohort will have to use this drug to avoid 1 coronary event. This discovery will probably startle the consumer, who may conclude, Out of every 60 persons who take this pill, 59 are getting nothing out of it. Therefore, the chances that I am benefiting from this drug are pretty low. Given these odds, it no longer seems unreasonable for the individual health care consumer to stop taking this drug.