An analogy in medicine
A calculator which "determines" if you should be on a statin or not is just codifying the recommendations arrived at by the organizations that make such recommendations, of course. Leaving aside whether these organizations have a bias toward higher usage, these recommendations are based on "established thinking". Again, leaving aside whether this thinking is biased toward higher effectiveness and/or reduced negative consequences, they are not based on the latest thinking, simply because it takes time for data, whether gathered in a research or clinical settings, to become integrated into the recommendations.
I believe there is a role for participants (doctors and patients) to explore beyond the established recommendations. Not all doctors and not all patients are candidates for this path, and one of the reasons why threads like this get so much attention.
As an illustration for this exploration beyond the established recommendations, the history of diabetes (type 2) might be examined. For a long time, doctors were advised to give ever increasing doses of insulin to push sugar out of the blood and into the cells. Decades ago, maybe because they noticed that diabetic gastric bypass patients suddenly became non-diabetic, a few clinicians risked their license by having their patients undergo various levels of fasting. There were no studies at the time "proving" this worked, but some clinicians trusted what they saw, and moved in a direction not prescribed by the current, at the time, official recommendations. More recently, the idea of draining glucose from cells of the body through fasting has taken an official role in the recommendations for diabetes treatment. Doctors who, years ago, were on the leading edge, realized that by not trying to force glucose out of the blood into cells that couldn't take any more glucose, probably saved a lot of lives (and suffering and amputations). But on the other side, there are doctors who suffer the cognitive dissonance of knowing that it turns out that what they were doing all those years wasn't the best thing for patients. And you will almost certainly find clinicians that have never prescribed a fast; people are often very slow to change their ways.
So coming back to the statin situation with the history of the diabetes situation in mind, I wonder how the statin thing will turn out. I'm sure there are people that will think that treating diabetes and preventing CVD are apples and oranges. I agree that many aspects are hugely different. The point is to illustrate how the wheels of the health industrial complex have progressed through one big revenue disease to see if any knowledge gleaned there can be applied to another big revenue thing, in this case, a CVD prevention effort using statins. One could argue a survivor bias, where the suggested non-accepted diabetes treatments that didn't work are not getting any press?
More differences abound. When you look at diabetes treatment, the up-side potential was huge (i.e. if it works, you won't cut off my foot). The upside potential for a statin might be maybe I might put-off a CVD event that may or may not happen anyway. Then there's the down-side. I can choose to not eat for a few days and see what happens. That's not exactly stopping to pick up a penny in front of a Mack truck barreling down on you...more like stopping to pick up $10 in front of a kid on a trike. I'll leave it up to the reader to come up with an analogy like that for starting on a statin, and continuing on a statin if you tolerate it well.
