Statins are one thing  keep coming back to: we don’t know much about the very long term use – 30, 40 years – that are going to be routine from now on.My concern is that the Yellow Card system may not be accurate or sensitive enough to do pick up infrequent side effects that nevertheless become common because so many people are taking them. Similarly, with the PPIs, drugs that switch off acid production in the stomach and have managed to almost halt the need for stomach ulcer operations, so commonplace a couple of decades ago. Now, people are maintained on these ‘proton pump inhibitors’ commonly in the very long term. Some people, those at high risk for serious stomach problems, are likely to benefit. But we are using them in a far wider group  – and again, this might have advantages, but it may also come with harms. If you d’t actively consider the possibility of harm and then go to look for it, you are likely to miss it. Here’s an example of researchers considering the possibility of harm – an increased rate of bone fracture with PPI use – and finding that harm. This editorial makes the case for stopping lots of the prescriptions (annoyingly, it’s not available in full for free.)