Cholesterol drug benefits overstated and risks understated
Better odds of winning the lottery and less costly
April 2, 2008
CBS News reported Monday that trials of Vytorin, a cholesterol lowering drug, did what it was supposed to but failed in trials. The drug did not improve heart disease even though it worked as intended to lower three key risk factors. In a January Business Week cover story the magazine reported that cholesterol drugs, including statins like Lipitor, has modest benefits for patients who already have suffered heart attacks but none for those who hadn’t.
Business Week quoted Dr. James M. Wright saying he was surprised to find that for the majority of patients there was no benefit in people over the age of 65, no matter how much their cholesterol declines, and no benefit in women of any age. He did see a small reduction in the number of heart attacks for middle-aged men taking statins in clinical trials. But even for these men, there was no overall reduction in total deaths or illnesses requiring hospitalization—despite big reductions in “bad” cholesterol. Still it’s important to the drug companies and pharmacies that we don’t stop now.
“We’ve made serious strides toward getting statins put in the U.S. water supply like fluoride and it’s important for our industry and my 401k in particular that we don’t slip backward now,” said pharmaceutical salesman Bobby “Big” Bias, an important kind of guy who knows better than we do. “It’s taken a long time and a lot of work to generate the kind of supportive data necessary to get the kind of buy-in from the FDA and medical establishment to mainstream these cholesterol products, and no one can afford the embarrassment of admitting that for most people it’s a waste of money. I don’t take them myself because of the side affects, but you should because they’re good for you.”
Not everyone is so sure that daily ingestion of a chemical substance with known side effects like constant muscle pain and diarrhea, and with unclear if any benefits, should be consumed with reckless abandon. “In the fine print of a newspaper ad for Lipitor there’s an asterisk and the small type says that in a large clinical study, 3% of patients taking a sugar pill or placebo had a heart attack compared to 2% of patients taking Lipitor. They spin their percentages to make them look higher, but Tic Tac Breath Mints are doing as well as cholesterol medications, except they give you minty breath and no muscle aches,” said a Lipitor salesman who refused to divulge his name for fear of being beaten in an alley. “Read the January 17, 2008 online article in Business Week. But do it before the pharmaceutical companies buy the rights and bury it.”
CBS News reported that use of Vytorin and a related drug, Zetia, seemed sure to fall after the findings reported Sunday and fresh questions about why drugmakers took nearly two years after the study ended to give results. Doctors have focused on lowering LDL or bad cholesterol as a way to prevent heart disease. Statins like Merck & Co.’s Zocor, which recently became available in generic form, do this, as do niacin, fibrates and other medicines. American College of Cardiology published research in the New England Journal of Medicine showing that Vytorin and Zetia’s use soared in the United States amid a $200 million-marketing blitz. Now experts aren’t so sure they help health at all, but prefer to keep quiet about it.
Business Week’s January cover story asked whether cholesterol drugs did any good and in the article answered, “Not for those who haven’t already had a heart attack.” According to research, except among high-risk heart patients, the benefits of statins such as Lipitor are overstated and the odds of the drugs benefiting you are worse than the odds of you winning the lottery. The article quoted Dr. Jerome R. Hoffman, professor of clinical medicine at the University of California at Los Angeles: “What if you put 250 people in a room and told them they would each pay $1,000 a year for a drug they would have to take every day, that many would get diarrhea and muscle pain, and that 249 would have no benefit? And that they could do just as well by exercising? How many would take that?” Pharmaceutical companies say everyone should. Especially if you buy lottery tickets, because you just never know.
Some doctors disagree with the results of these non-pharma controlled studies because they seemed biased in favor of free thought and open debate. “You can’t take a study from a non-pharma company as being truthful because they don’t have anything to gain from it, so they’re not trustworthy,” said Sparse Thinkr, a man who looks a lot like a lemming. “I’ve made up my mind and refuse to be confused by any facts. Besides, if we all believe that taking drugs everyday is a good thing to do, then that makes it so. I put a lot of stock in believing stuff. The guys in Area 51 will bear this all out some day.”
In related news, use of leeches and bleedings is making a comeback in medicine, having gone out of practice during the Middle Ages when people kept bleeding to death and dying from it. Said one new practitioner: “All kinds of things can cure people of disease and blood letting is one of them. Of course we don’t do it everyday like taking cholesterol medication. We’d bleed people to death or at the least, drain all their finances. Still, modern medicine does a pretty good job of helping you if it doesn’t kill you and bleed out your savings first. In some ways I guess some things never change.”
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