Do you like to take pills? I don’t. I bet most family physicians would say they have some patients who should be better at taking pills and some who love taking pills too much.
For people who don’t like taking pills, what would a trade-off look like? If you were given the option of living X months fewer, but in return you wouldn’t have you doctor twisting your arm to take pills every day for 30 to 40 years, how long would X be?
Recently researchers in London asked this question of 360 members of the general public. The economic theory at play here is a concept called disutility, the opposite of utility. In this case the utility is longer life, the disutility is the inconvenience, cost, and psychological impact of being labelled as having a disease and taking a daily pill. In this case, study subjects were told that the pill was a statin and the disease was cardiovascular.
The patterns of the answers for men and women were remarkably similar. About 45 percent were only willing to forego 0 to 6 months of life to justify taking a statin to delay the onset of heart disease. The other 55 percent were willing to forego 7+ months. 10 to 15 percent were willing to forego 10+ years of life to avoid the pills.
What is the actual increase in life expectancy for asymptomatic average-risk adults who take statins? According to the tables in the article, most middle-aged adults will have an increased life expectancy of about 4 to 12 months, a little longer for smokers with high blood pressure. I’ve read other articles that estimate a lower life expectancy than this range, but even if we use this higher estimate, it means that roughly 40 to 50 percent of people would have the overall summation of their life’s well-being lessened by statins. The harm of taking the pills is greater than the small increase in life expectancy.
This is but one more example of how meaningless measures like the CMS meaningless use metrics really are. The complexity of family medicine is so much greater than their simplistic algorithms can begin to fathom. For the shared decision-making supporter community, here is one more issue beyond knee replacements and cardiac procedures that should be added to their lists of treatments that are over prescribed and should be individually decided by patients.
Richard Young is a family physician who blogs at American Health Scare.