The Cholesterol Drug Problems Two Step: Or How the Tail Wags the Dog in Medicine
For years, I’ve been an ardent critic of the Madison avenue message that we all desperately need to lower our serum cholesterol by taking cholesterol drugs (statins). First, we have observed that these drugs tend to hurt adult stem cells. Second, I’ve had to research them for my own use. In that research, I was appalled at the paltry benefits of the drugs versus the hyped benefits out of the Madison avenue pharma machine. Then to add insult to injury, major Cardiology meetings these past few years have consistently revealed that the main cholesterol number that the commercials told you was critical is largely meaningless. Then media events like the Harvard medical school students revolt occurred (they complained when a paid consultant professor for a statin drug company gave them lectures extolling the virtues of the drugs without exposing his commercial interest). Finally, a few academics began a small mutiny, questioning whether the drugs were dangerous.
So when I saw that the cholesterol number myth had finally gone down in flames this past week as two major heart groups adopted guidelines that got rid of the concept, I was ecstatic! Maybe we wouldn’t have any more patients chasing a silly and meaningless number largely created by Madison avenue rather than science. Maybe this would finally result in weaning the populous from a sometimes nasty drug class that some physicians believe should be in the water supply like fluoride? Nope, we’re all not so lucky. Instead, as an excellent NY Times editorial points out, the new guidelines will increase statin prescriptions by a staggering 70%! Another front page article out this morning reports that the on-line risk calculator over-estimates who should take the drugs even based on the inflated guidelines. While the paid university consultants that sit on these panels have finally right sized the cholesterol number messaging, they also still brought home the pharma bacon.
The NY Times editorial is very good, so you should read the whole thing. However, I’ll also summarize the message here:
- The old guidelines based on the silly number only required patients with a 10-20% risk of a heart attack over the next ten years to be on statins. The new ones expand that to patients with a lower 7.5% risk over 10 years. The new guidelines also throw in a new criteria-risk of stroke.
- While all of this sounds like it would be a good thing for patients, that would be the case if statins actually worked well to prevent deaths-they don’t.
- While statins are minimally effective for people with known heart disease, for people who have less than a 20 percent risk of getting heart disease in the next 10 years, statins not only fail to reduce the risk of death, but also fail to reduce the risk of serious illness — as shown in a recent BMJ article co-written by the authors. That article shows that, based on the same data the new guidelines rely on, 140 people in this risk group would need to be treated with the drugs in order to prevent a single heart attack or stroke, without any overall reduction in death or serious illness.
- This NTT number (number to treat to see an effect) is humongous and silly, given the serious possible negative side effects of these drugs. For example, the usual NTT for most effective drugs is in the 1 to 2 range (you would need to treat 1-2 patients to see an effect). These cholesterol drug problems and side effects as I have documented them include an increase in joint pain, spine/ligament pain, muscle damage, nerve damage, fatigue, and cellular problems. There’s also a great discussion in Businessweek on why an NTT this high is nuts.
- The NY Times article states: “At the same time, 18 percent or more of this group would experience side effects, including muscle pain or weakness, decreased cognitive function, increased risk of diabetes (especially for women), cataracts or sexual dysfunction.”
- Statins give many patients a false sense of security, often preventing them from exercising, stopping smoking, or changing their diets. I’ve seen this many times where patients who could be fixing things that would help their heart disease much more (like eating a low carb diet), don’t do these things because they can pop a pill.
- Relying on guidelines created by paid consultants for Pharma companies can be dangerous. For example, the last guidelines that forced us all to chase the silly number recommended statins for women, even though there was no evidence they helped women. In addition, for all patients, the original committee members acknowledged that the drugs were far less effective than just changing lifestyle.
- From the article: “The process by which these latest guidelines were developed gives rise to further skepticism. The group that wrote the recommendations was not sufficiently free of conflicts of interest; several of the experts on the panel have recent or current financial ties to drug makers. In addition, both the American Heart Association and the American College of Cardiology, while nonprofit entities, are heavily supported by drug companies.” You mean “payola” is alive and well in modern medicine? Who knew?
Perhaps the scariest part of the new guidelines is the nexus with Obamacare. Whatever your political bent or support or hate for the new law, Obamacare has a seed change embedded in it that makes these guidelines critically important to all of us. Starting next year, if your local family doctor doesn’t follow them, he will be dinged financially. So what begins as a “guide”- line to “guide” care decisions will soon become set in stone as physician reimbursement policy. And you wondered why the new guidelines just came out now? Follow the money…