Wednesday, February 29, 2012

Statin Drugs, and the Congestive Failure of Pharma-centric Medicine

Disclaimer: Don't take medical advice from engineers.

The New York Times has an article out today about the side effects of statin drugs: http://www.nytimes.com/2012/02/29/health/fda-warns-of-cholesterol-drugs-side-effects.html. Seems that the more time that goes by, the less clear it is that statins are actually worth taking. I'm not going to claim that statins don't help - if you're interested in that line of thought, read this, for example. But I do think the massive over-prescription of statins endemic in Western medicine is illustrative of the problem of treating symptoms rather than causes.

The line of thinking goes something like this: People with heart disease have been found to have elevated levels of bad cholesterol (LDLs - which incidentally aren't even cholesterol, but instead transport cholesterol). Statins lower LDLs. Thus people should take statins in order to reduce risk of heart disease. The goal, of course, is to go from this logically fallacious argument to then testing whether lowering bad cholesterol via statins actually decreases risk of heart disease. That is, do taking statins make you less likely to get heart disease, and one step further, less likely to die from heart disease? And it's here where the evidence is actually somewhat mixed. The best I've seen is that statins lower risk of cardiac events in people who already have heart disease, but do nothing to lower those risks for people without heart disease. Even more curiously, some scientists think that lower cholesterol levels have nothing to do with the benefit, and it's actually the anti-inflammatory properties of statins that convey their benefit to people already suffering from heart disease. So then why are tens of millions of people in this country alone on a daily regimen of statins?

I'm not writing this as a complete outsider. For some reason, my cholesterol seems to live in the borderline-high range, and when I was 21, my family doctor recommended that I start taking statins. I Googled it, and found that there are some potentially really bad side effects such as muscle degeneration.  At the time I was a competitive gymnast, and the potential for muscle degeneration in my twenties was actually quite horrifying to me. Not only that, but chronic diarrhea, cognitive impairment, and sexual dysfunction. Seriously? I mentioned it to my doctor, and he was basically of the opinion, "Well, statins lower your cholesterol, thus they are good". Having no other risk factors for heart disease, I politely declined. But how many millions of times did that conversation go the other way? Patient blindly trusts doctor, and ends up on a lifelong medication with potentially deleterious side effects and arguable benefits? At what point does prescribing these drugs cross the line from ignorance to negligence to criminal?

Anyway, the real answer to all this, as always, is to follow the money. Statins are a ginormous industry. Pfizer alone made over $12 billion from Lipitor in 2008. And there's nothing that big pharma likes more than finding a lifelong customer for an expensive drug. Once you're on a statin, you're on it for life. Cause the point isn't to actually cure anything (for their part, no drug company claims that statins cure heart disease, because they don't, and that was never the goal). Doctors don't make money prescribing exercise and dietary changes. And we, as healthcare consumers, like to focus on simple things like a number, because it's easier to view our health woes as the direct result of an aberrant metric than as extremely complex diseases with systemic causes and implications.

So, what to do? Exercise more. Eat more vegetables. Find ways to lower your stress. In other words, take responsibility for your health, because there's no miracle drug to do it for you.

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