25 Oct The Angelina Effect
The Angelina Effect
We don’t always do what we should, the reasons why are often complex. A good example is the recent report from a group in Birmingham looking at statin prescriptions at GP practices. Despite the NICE guidelines in suggesting that adults aged 40 upwards should have their heart disease risk calculated and offered statins if it was above a certain threshold they found that only one in 10 patients had their heart risk calculated and the majority of statins were started without knowing the heart disease risk. A disconnect between guidance and delivery is evident
It may be that a lot of patients are working out their own risks and asking for statins and the GPs do not have the time to screen patients and have nuanced evidence-based individualised conversations in five minutes. Or there is “suboptimal” buy in from the patients or the medics.
There is a lot of work to do to improve the packaging presentation and explanation of information to the public and medics in an unbiased way to improve engagement. Fuzzy thinking theory supports a tailored approach to trigger what is known as a “gist” as a cue to remembering what the health message was. These triggers are delivered in public health messages or using on-line decision making tools.
There is considerable cynicism in the press and among some in the medical community about the safety of statins and the effectiveness of the risk models. If there were better ways of predicting cardiac risk to help truly identify very likely heart disease candidates then prevention with statins could be more targeted. Genetic tests are emerging, cholesterol tests and blood tests for inflammation are already here. Scans can be used to look at the heart carotid and femoral arteries to see if they are starting to fur up. None of these techniques have been scientifically proven to reduce heart attacks and improve survival, not because they are unlikely to work but the experiments have not been done.
Breast cancer is a different disease, screening using x-rays is routine. Genetic testing and the prediction of developing breast cancer is accepted. When a high-profile celebrity chooses to have a double mastectomy following genetic testing it makes the news, it doubled the amount of genetic tests undertaken and was called the “Angelina Jolie” effect. This is a good example narrative or a story which people can follow, empathise with and influences attitudes.
In women there are actually more deaths from heart disease than breast cancer. If a similarly famous actress were taking a statin would we care? It is hard to think of a similarly compelling narrative out there, hopefully it will come along soon.