Malhotra takes aim at heart of media statin support

By Marika Sboros

The Guardian newspaper in the UK has been haemorrhaging readers for years.

The newspaper’s recent uncritical support for medical orthodoxy and dogma around diet, nutrition, drugs and cardiovascular disease hasn’t helped. Its treatment of ongoing controversy around cholesterol-lowering drugs known as statins is raising red ethical flags.

Britain’s leading cardiologists, Dr Aseem Malhotra, is demanding that The Guardian retract its online article by health editor Sarah Boseley. Under the headline Butter nonsense: rise of the cholesterol deniers, it aims right at the heart of Malhotra’s credibility and professional integrity.

Malhotra has lodged a written complaint with The Guardian’s editor in chief, Katharine Viner. He has included the UK’s Independent Press Standards Organisation’s Board and Complaints Committee.

‘Hatchet jobs’

He says that Boseley’s article is misleading, inaccurate, distorted and defamatory. He calls it a “hatchet job”. If The Guardian does not retract the article,  it will “continue to cause significant damage to public health with a negative effect on millions of people”.

The Guardian has a “duty to monitor independence”, Malhotra writes. “Never more so than when reporting on issues when lives are at stake”.

Top medical doctors agree with him. Malhotra’s letter of complaint includes comment by BMJ (British Medical Journal) editor in chief Dr Fiona Godlee.

Godlee says Boseley’s article “seemed to be a blatant attempt to suppress that debate by attempting to discredit those who question the merits of statins in people at low risk of heart disease”.

It was “misleading and fell well short of the standards for accuracy or impartiality expected of a credible and trusted publication”, Godlee says. It warrants “at least very substantial correction”.

Sir Richard Thompson, past president of the Royal College of Physicians and former personal physician to Britain’s Queen Elizabeth, agrees. He says that there is currently scientific debate on whether cardiovascular disease is closely related to blood cholesterol levels. There is also debate on the frequency of statins side-effects. And whether benefits are large enough to justify widespread prescription.

Big Pharma’s ‘criminal acts’

“Attacking doctors who genuinely hold opposite views, such as labelling them ‘cholesterol or statin deniers’, should be no part of this healthy debate,” Thompson writes. “Rather, we must all try to move towards a scientific consensus for the benefit of patients.”

Last year, Malhotra spoke alongside Sir Richard in the European Parliament on over prescription of medications, including statins. Sir Richard has criticised the drug industry for “criminal acts” and called for an independent inquiry into how drugs are approved. He has also called statins “a total fraud”.

BMA (British Medical Association) Board of Science Dr JS Bamrah has also tweeted support for Malhotra. He said: “@sarahboseley is changing the face of medical journalism by such biased, crude, one sided reporting. I just wonder what her incentive is to attack you (referencing myself) in this way. Might she be too cosy with the other side? Can’t think of any other motive.”

Even Boseley’s colleagues have been critical of her article. Unusually, two well-known, respected female Guardian columnists on food and health sent Malhotra unsolicited messages of support.

One called the article “shockingly bad”. Another said she had “never seen a character assassination that long minus a quote from the subject under attack”. She added: “I certainly would never get away with that.”

Of course, The Guardian is not alone in what many critics see as “gutter journalism”. The Mail On Sunday did something similar in an article by health editor Barney Calman. Calman targeted Malhotra as well as Scottish GP Dr Malcolm Kendrick and public health researcher Dr Zoë Harcombe.

Statin ‘deniers’?

He called them statin “deniers”, despite their well-documented, evidence-based views on statins. Calman’s reporting has also dragged Britain’s Health Secretary, Matt Hancock, into the statins debate.

However, Malhotra, Kendrick and Harcombe don’t deny that statins have benefits. And as Malhotra told iNews recently, the key point is whether benefits outweigh side effects of the drugs for the patient?

“In many cases, they don’t,” he said.

Thus, the most important issue is ensuring that patients are fully aware of absolute benefits and risks. That, therefore, allows them to make an informed decision on whether to take or stop the drug.

“This is the ethical practice of true evidence-based medicine,” Malhotra said.

(Click here to read a full version of Malhotra’s letter. You can also find it on Facebook.)

Malhotra says that his letter of complaint comes from a background as a once “proud Guardian contributor”. Since 2008, he has written 19 opinion editorials for the newspaper group.

His contributions include three front-commentaries in The Observer on the topics of hospitals selling junk food. Topics covered include dangers of “too much medicine and the threat posed to population health of excess sugar consumption.

Ruffling feathers …

In so doing, Malhotra has clearly ruffled many feathers among medical doctors and professors. It’s probably no coincidence that many are heavily conflicted with close links with food and drug industries.

In making the case for retraction, Malhotra says that Boseley’s intention in writing her article was not just to undermine his credibility. She sought to “undermine other respected doctors, scientists and courageous medical journal editors whose primary purpose is”to advance legitimate scientific debate and improve population health”.

He says that the Guardian would benefit from an internal investigation into Boseley’s article. This would prevent a recurrence and maintain its credibility as one of the most trusted newspapers in the UK.

In her article, Boseley calls Malhotra a “young telegenic cardiologist working in private practice”.

Yet, as he points out, the vast majority (>95%) of his clinical work is seeing patients in the NHS. He sees only a small number of private patients in Harley Street on an ad hoc basis.

Boseley also made inquiries, several days before publication of her article, to the head of communications of the respected independent health think-tank, The King’s Fund. She asked whether Malhotra was still a Fund trustee and why he was appointed ahead of other candidates.

The head of communications emailed an extensive reply explaining that Malhotra is a practising clinician and a public health campaigner, and both roles are relevant to his appointment.

Malhotra’s profile is on the King’s Fund website. It includes a reference to his Honorary Consultant Cardiologist role in the NHS. Boseley omits any mention in her article.

Malhotra’s Pioppi Diet

Boseley also focuses on Malhotra’s book, The Pioppi Diet, citing comment from the heavily conflicted British Dietetic Association (BDA). The BDA called it one of their “ five worst celeb diet books in Britain”.

Malhotra points out that this is the same BDA that openly declares itself “delighted to work with the sugar bureau”. The BDA also has corporate sponsors from the ultra-processed food and drink industries.

Boseley fails to mention the many independent, respected doctors, scientists and dietitians who endorsed Malhotra’s book. They include the Chair of the Academy of Medical Royal Colleges, Professor Dame Sue Bailey. Bailey called The Pioppi Diet a “must have for every household and a must read for every medical student and doctor”.

The former chair of the Royal College of General Practitioners Dr Clare Gerada also reviewed it favourably in the British Journal of General Practice. Gerada said that the book is “not just a guide for individuals to rapidly improve their health from making simple lifestyle changes”.

It also “explains why policy changes to improve the food environment and our dependence on medicines also needs to happen. In addition, a revision of dietary guidelines is required to reverse the UK’s obesity epidemic and sustain the NHS.”

Malhotra also finds it “odd” that Boseley finds space and time to mention Andy Burnham and Keith Vaz MP as “trying the (Pioppi) diet”. She fails to mention the most high-profile politician who endorsed the diet: deputy Labour Party leader Tom Watson. Watson lost almost 100lbs in less than a year following the plan. He also sparked media headlines for using the diet.

Statins debate

And Boseley omits to mention that Malhotra has declared that he is giving all personal royalties for book sales to charity.

She also quotes one of the UK’s major statin supporters, Professor Sir Rory Collins, of Oxford University. She repeats Collins’ concerns that media scaremongering on statin side effects is endangering lives.

Malhotra points out that unlike Collins, an academic who does not see patients, he has prescribed and managed thousands of patients taking statins for close to two decades.

“It is doctors on the front line that have gained the greatest insight into the side effects that interfere with the quality of life for many patients,” Malhotra writes.

Boseley implies that those questioning the conventional cholesterol hypothesis and the value of mass prescribing of statin drugs are a small vocal minority. And that this small minority lacks credibility, in comparison to the “unbiased” experts she has chosen, Malhotra writes.

That is clearly not the case.

And it’s clear, as Malhotra describes it, that the controversy around statins hA become “a complete mess”.

Statins are the world’s most prescribed drug and the pharmaceutical industry’s most lucrative billion-dollar, blockbuster drug ever. And in the UK alone, more than 6-million people take statins. The drugs have a well-documented role in secondary prevention of heart attack and stroke. However, robust evidence suggests that in many cases, risks outweigh benefits.

‘Legitimate questions’

Malhotra stresses that there are now “legitimate questions over whether there are any benefits in high risk/secondary prevention”. And critics include French cardiologist Dr Michel De-Lorgeril, who is “convinced there are none at all!”

De-Loregil is author of Cholesterol and Statins: Sham Science and Bad Medicine.

The Guardian does appear to be in need of extensive reputation rehabilitation, say its critics.

Recent revelations that an animal activist group paid the newspaper a whopping US$886,600 to publish a series of articles haven’t helped its image. The series paints animal farming as inhumane, unhealthy and environmentally dangerous.

  • To read Malhotra’s complaints letter in full, click here. Or visit him on Facebook.
  • Attempts to reach Viner and Boseley for comment via phone and email yesterday were unsuccessful. The company’s spokespeople said both were unavailable. An automated email from Boseley said she was on leave and would not be accessing emails. If that situation changes, will report.
  • EDITOR’S UPDATE: The Guardian has responded via email today to say: ‘A complaint has been passed to our independent readers’ editor.’
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