With great power comes great responsibility

To the Editor: In October 2013, the Australian Broadcasting Corporation television program Catalyst featured a two-part documentary series entitled Heart of the matter. The first episode questioned the role of dietary saturated fat in the development of heart disease, and the second debated the use of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) as a suitable treatment for hypercholesterolaemia.1

Justin Coleman, a general practitioner and senior lecturer in medicine at Griffith University, provided an excellent summary of the two episodes, highlighting the bias of several of the medical experts featured in the program.2 Coleman drew particular attention to their undisclosed conflicts of interest, describing one expert as having his own commercial line of alternative treatments for heart disease. The views portrayed in the program could not have been published in any reputable medical journal without adequate disclosure of the experts’ conflicts of interest. So why should this be allowed on television, when the audience is potentially so much larger and more impressionable?

Perhaps the worst of the views aired was from an expert who suggested that starting statins means weighing up the risk of getting diabetes as a trade-off for preventing a cardiovascular event. Such an opinion shows ignorance of international standards for scientific evidence — pitting the weak observational data suggesting a slight increase in risk of diabetes among statin users3 against the overwhelmingly strong evidence from multiple randomised controlled trials demonstrating the benefits of statins when used for secondary prevention after an acute coronary syndrome.4 Why are television stations allowed to broadcast material on so-called scientific programs that includes such misleading statements?

This program significantly hinders progress in tackling problems such as non-adherence with evidence-based medicines after acute coronary syndromes. It has been demonstrated that patients who stop taking their medications after myocardial infarction have a 10% higher chance of dying within 1 year.5 Resolving this problem requires patient education and empowerment, and a strong doctor–patient relationship — a relationship that is, unfortunately, often tested by skewed views from the media.