Why have Americans turned against this lifesaving medication?

Statins are one of modern medicine’s miracles. For every 10,000 people who take these cholesterol-lowering drugs, 1,000 will avoid major cardiovascular events. When you consider that cardiovascular disease is America’s top killer, and 92 million Americans are currently taking a statin, thousands of lives every year are being saved. There are essentially no other prescription drugs that offer such tremendous, obvious value.

So, why is the internet doing its best to convince you otherwise?

The idea that statins are just a profit-pushing venture for Big Pharma, a conspiracy made infamous by the 2012 film Statin Nation, is everywhere on YouTube and social media feeds today. In the United Kingdom, an estimated 200,000 people went off statins amid all the negative press coverage in the wake of the film’s release. And the backlash has only grown in the years since.

In the past decade, a growing number of terminally online doctors, non-credentialed influencers, and patients have blamed statins for a litany of health problems: depression, kidney failure, and — perhaps most perversely for a drug developed to prevent heart attacks — weight gain. US Health Secretary Robert F. Kennedy Jr. has added fuel to that fire, citing statins as another example of America’s health care system overmedicating its people with vaguely dangerous consequences.

These days, you don’t have to look far to find patients reporting they gained weight after starting one of these cholesterol-lowering drugs. Doctors with large TikTok followings will tell you that you should hate statins. Even when some social media clinicians encourage their followers to ignore the myths and take them if they would personally benefit, many of the commenters will parrot conspiracy-laden talking points. We live in the era of GLP-1s, and weight is the wellness influencer’s No. 1 enemy.

For the past decade or more, people’s sentiments about statins on social media have grown significantly more skeptical, with the percentage of posts expressing doubts increasing from 26 percent to 40 percent. A person exposed to doubts about statins on Instagram or TikTok is less likely to take the drugs. Less than half of Americans who are eligible for a statin are actually taking one; the high costs of US health care certainly play a role in the low uptake, but it is fair to assume the statin backlash is an important factor, too. Researchers have compared the anti-statin influence to vaccine skepticism — two effective medical interventions undermined by misinformation.

But no, statins are not making you fat. Or depressed. Or hurting your kidneys.

A recent paper provided the strongest evidence yet in statins’ favor. Most of the claims about negative side effects have been anecdotal or based on observational studies that cannot show causation. An international group of researchers examined randomized clinical trial data and found that statins were not actually associated with most of the side effects for which they are blamed.

But even those findings were met by skepticism from the social media doctor crowd. The statin backlash is a microcosm of how dangerous health care myths take root and become so deeply embedded that they are difficult, if not impossible, to eradicate.

The new study, published in The Lancet, was massive.

The authors collected data from more than 120,000 patients participating in 19 different trials, following people for four-plus years, on average, after they began taking statin drugs. Crucially, this allowed them to properly randomize people, as they were in the trials, to isolate the health effects of both being on a statin and not.

And as this kaleidoscope of a graphic shows, almost none of the side effects they tracked meaningfully increased for people who took a statin compared to those who did not. (Here’s a tip if you want to check out the dozens of side effects they studied: Only the dots on the outer ring are statistically significant.)

That’s not to say there were no side effects.

The research noted there were notable increases in abnormal liver readings and changes in urine among statin-taking patients. But the actual health implications of those events are not well understood, though more research is warranted. The liver findings in particular were not that surprising; many prescription drugs put at least some strain on your liver, whose job it is to process the medication.

Here’s what you need to understand about the study: Whatever side effects statins do cause, they are still worth taking for their enormous lifesaving potential. Even if you do put on a little weight while on a statin, your chances of having a heart attack are still greatly reduced.

“Unreliable information about adverse effects of statin therapy hampers patients’ and clinicians’ ability to make properly informed decisions…with potentially life-threatening health consequences,” the authors wrote. “These findings reinforce previous conclusions that any risks associated with statin therapy are greatly outweighed by their cardiovascular benefits.”

Case closed, right? Well, hold on.

Despite providing the most persuasive evidence yet that statins don’t have this long list of undesirable effects, The Lancet study was met with skepticism by several high-profile health influencers. One of them, a “metabolic health enthusiast,” argued that the analysis did show a small increase in weight gain, even if it didn’t rise to the level of statistical significance according to the study’s authors. So, the claim still holds.

It was in reading these responses that I realized how difficult it would be to dislodge the old tropes about statins and gaining weight. Usually, scientists worry about their peers contorting their analysis to make small changes seem larger than they are. Now, we’re worrying about a paper not imbuing importance on a statistically insignificant change across such a large sample size?

And that brought me back to the original 2014 study that has provided the empirical basis for the claims about statins and weight gain.

The 2014 paper was an observational study, not a randomized one. The authors looked at national survey data and tracked the caloric intake and body-mass indices of people who were on statins around 2000 and people who were on them around 2010. And they did find that, in 2010, people taking statins were eating more and weighed more than people in 2000. They weren’t all the same people, which is what you would need to confidently claim that statins were causing the weight gain.

Those findings have been so consistently misinterpreted for years that even this new countervailing research may struggle to overcome the misinformation.

The authors themselves didn’t postulate that statins are causing weight gain. Their theories instead suggested people taking statins may be less diligent about their diets, or their doctors may even focus more on making sure patients take their medicine instead of emphasizing the importance of pairing a good diet with the medication.

It was an argument for refining how doctors advise their patients on statins to make sure they continue eating a heart-healthy diet even after they starts taking a statin. It was not smoking-gun evidence that statins are causing people to put on pounds.

But when combined with the conspiracy-laden Statin Nation narrative, that nuance was lost.

A story of greedy pharmaceutical companies pushing unnecessary treatment while causing their patients to gain weight instead of lose it has proven seductive in a health information ecosystem where more and more Americans distrust traditional medical authorities and increasingly fixate on their weight.

And now, we have Kennedy pushing Americans to eat more foods like red meat that are associated with cardiovascular disease while discouraging them from taking statins. These drugs are now caught in a uniquely American health care paradox, much like vaccines and antidepressants: They’re both highly effective and highly distrusted.