The fat police and the cholesterol fairy [Apr 2001; 86-1]

The fat police and the cholesterol fairy
Close, but no cigar Andrew's mother's hairdresser's friend picks and chooses Bandolier Internet update BioMed Central

Myths that go bump in the night. Those of you who take tablets will know what a pain it is to remember to take them, especially for an asymptomatic condition. Some people use the Barker and Dobson principle - tip all the tablets into a jar, then dole out 'enough' for the day. Every so often comes a quirk, albeit a plausible quirk.

Take your statin at night. Why? Because the cholesterol fairy gets all busy at night, doing her cholesterol shovelling then. Bandolier has been digging too, and can't find the evidence. It might just be that the fairy comes to life at night. But if you take a once a day drug for ever you might expect that the peaks and troughs would be smoothed out. One of the five statins on the market does not mention evening or night, but still can combat the cholesterol fairy. It is much, much, easier to take all your once a day medicines at the same time. Either all should be spooned out at night time, or the statin moves to morning with the others. Perhaps it's all down to boring stuff like pharmacokinetics, but Bandolier has failed to find the fairy.

The cholesterol fairy gets ready for shovelling

Close, but no cigar

Many of you have asked for more on adverse effects, after Bandolier 85 . Why is it so difficult for even professionals to obtain credible incidence data on adverse effects? Patients rightly ask will it work? and will it do me any harm? Our answers to the efficacy question have improved beyond recognition, or at least the evidence has, but our answers about harm fall way short. Bandolier's example for you this month is urticaria with ACE inhibitors. What is the incidence, and is it a class phenomenon?

Andrew's mother's hairdresser's friend picks and chooses

One of life's great sports is rebutting meta-analyses that conflict with your deeply-held beliefs. One method is to say that the patients included in the meta-analysis are different from our patients. The sound of moving goal posts often accompanies this strategy, as disbelievers search desperately for any difference, because, of course, they don't like the evidence and don't want to believe it. In contrast, we may be less than fastidious when we do like the evidence.

So two examples this month from meta-analyses which show how sensitivity analysis can help us over or around our prejudices. One from nicotine replacement therapy shows how robust the evidence is for patch, but not gum. Another comes from the anaesthetists. Using epidurals or spinals as well as a general anaesthetic reduces mortality says a meta-analysis . Yes, but only when a few small trials from decades ago with unreasonably high death rates (over 15%) were included. With patients like our's, death rates below 3%, there's no effect.

Bandolier Internet update

Some major moves this month to increase the electronic resource that Bandolier aims to become.

The migraine site sponsored by the Gwen Bush Foundation and MSD has grown substantially, though we still can't find good evidence on trigger factors
With sponsorship from the BUPA Foundation and in collaboration with the Cochrane PaPaS group we have launched a new Palliative and supportive care site
Healthy Living has over a dozen new stories, with some impressive stuff on the benefits of certain types of alcohol, again backed by the BUPA Foundation
With new sponsorship from AstraZeneca, a new site on Atrial Fibrillation will open soon.

All the specialist subsites are available from the home page , as well as screen, and downloadable facsimile versions, of every issue (2 months in arrears) of Bandolier and ImpAct , and much else. There's Bandolera , our Spanish language version, and the Oxford Pain Internet Site in Spanish.

BioMed Central

This new electronic journal is just the bees' knees for systematic reviews and meta-analysis because there are no restraints on space. Two articles from BioMed are mentioned in this issue of Bandolier . It's great for systematic reviews and meta-analysis because there is lots of detail there in tables, and submission to publication is about three months. Each paper comes in PDF format to print and read over coffee. Try it at www.biomedcentral.com .

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