Cholesterol Backlash Goes Mainstream!

Sunday, February 3

What a week it's been (no, I'm NOT talking about the count-down to the Super Bowl or Super Tuesday)! On Health Talk, we had a great conversation with Gary Taubes, author of Good Calories, Bad Calories. He's a credible science writer, the only print journalist to have won three Science in Society Journalism awards, so you know he's not just an eccentric wack-job.

Other distinguished science reporters joined Taubes this week in finally reporting the truth about cholesterol-lowering drugs. Tara Parker Pope of the NY Times wrote a story on January 29 entitled "Great Drug, but Does it Prolong Life?" In it, she accurately took on statin drugs, which admittedly have limited benefits that sometimes justify their use in patients who've had heart attacks, angina, stents, or bypass surgery, or those with familial hyperlipidemia with cholesterol levels of three or four hundred. But for the majority of Americans with fair to middling cholesterol she writes: "The surprising answer appears to be no."

Whoa! What a stark admission in the pages of the august NY Times! Doctors routinely snow patients into believing that statin drugs like Lipitor, Pravachol, Zocor , and Crestor are veritable lifesavers. True story: Last week I talked to an 87 year old woman with NO evidence of heart disease with a cholesterol of 260 and an HDL over one hundred who was told by her doctor to take Lipitor OR SHE WOULD DIE!

Same week: I tried to talk sense into a man of 49 who had an LDL cholesterol of 159 whose cardiologist friends told him (erroneously) to take Pravachol because "Even if you're healthy, it'll make you live longer." Despite demonstrating to him that his risk was minimal by performing an EBT heart scan that showed his plaque score to be ZERO, this otherwise intelligent guy was afraid not to take the drug!

Here are the facts, as laid out in the Times article:

"A 2005 study in the Archives of Internal Medicine looked at seven trials of statin use in nearly 43,000 patients, mostly middle-aged men without heart disease. In that review, statins didn't lower mortality."

Pope continues: "Nor did they in a study called Prosper, published in the Lancet in 2002, which studied statin use in people 70 and older. Nor did they in a 2004 review in the Journal of the American Medical Association, which looked at 13 studies of nearly 20,000 women, both healthy and with established heart disease."

To top it off, this week the January 28 cover story of Business Week (a magazine not inhospitable to the pharmaceutical industry!) was entitled "Do Cholesterol Drugs Do Any Good?" In it they conclude that "Research suggests that, except among high-risk heart patients, the benefits of statins such as Lipitor are overstated."

The article goes on to explain that, in healthy patients, 100 to 300 patients would have to be treated for decades to prevent just one heart attack. Which might be wastefully expensive but fine, except for the high incidence of side effects such as muscle pain and weakness, insomnia, cognitive impairment, and impotence.

And who is this guy Jarvik who so sincerely intones the benefits of Lipitor in those ubiquitous TV ads? There is now a call for a Congressional investigation of Pfizer's use of Robert Jarvik as its spokesperson because, incredibly, Jarvik HAS NEVER PRACTICED MEDICINE WITH PATIENTS.

His original degree is in engineering, and he is the inventer of the Jarvik artificial heart which enabled him to show-boat in green surgical scrubs beside South African dentist Barney Clark in the 1980's (REMEMBER?). While the cumbersome device extended the lives of a few patients for months, it was soon relegated to the scrap heap of medical history when supplanted by heart transplants and more finessed approaches like the left ventricular assist device.

It turns out that Jarvik, unable to go medical school in the US, was a graduate of the University of Bologna in Italy, and never even performed an internship or residency. How he is then held up as an authority on prevention of heart disease is unclear--hence the uproar. Imagine the clamor if I were opinionated while similarly non-credentialed--critics would pounce because I was rendering medical recommendations with NO real-world background or experience in clinical practice! Yet I've been treating patients for twenty-five years now, and the facts about unnecessary and harmful drugs are inescapable.

Stay tuned for more developments on the heated cholesterol controversy, because, as with many elements of faith of the modern medical canon, lowering cholesterol with drugs can't withstand the scrutiny of evidence-based research.