Paint by Numbers Medicine

Monday, April 7

Remember those popular "Paint by Numbers" hobby kits we used to get as kids? Perhaps I'm dating myself, but they were popular when I was growing up. The pitch was that anybody could create a great painting, even if you lacked artistic talent, merely by scrupulously following numerical paint color guidelines. Great works of Western Art were rolled out with number-coded schematic outlines, and you just painted in the spaces. Easy.

Well, the first time I did one of those, the results were pretty scary. You got a rough approximation of a painting, but an art work it was not.

Unfortunately, the same thing is happening in the field of medicine today. We doctors are given "Paint by Numbers" guidelines, which supposedly make medical practice fool-proof. But a too-literal adherence to sometimes arbitrary guidelines results in botched results. And the disturbing part is the canvases doctors work on: People.

This came to mind the other day when I was fielding questions on my Weekend Edition of Health Talk program. A woman called for a second opinion after her doctor reviewed her cholesterol blood test and unceremoniously sent her a prescription for Tricor, a potent triglyceride-lowering medication.

The facts were these: She was 44, with no history of heart disease, diabetes or high blood pressure. She exercises heavily--four to seven times per week--and follows a good diet. There was a family history of heart disease, but hey, many parents of healthy Baby Boomers have heart problems as they get older. She wasn't overweight, but she said she could lose, maybe, ten pounds.

Now here's the clincher: Her cholesterol was 230, her HDL was 110, and her triglycerides were 116! Entirely normal numbers (although I generally like to see triglycerides 80 or less). While cholesterol was a tad high, her extraordinarily high HDL conferred major protection.

The prescription for Tricor was sent to the patient by mail, with no explanation other than highlighted "abnormal" results on her blood test. No doctor-patient dialogue had occurred. Strange that this patient, like many of my callers on Health Talk, found it easier to access ME for discussion than her own doctor!

I was astounded. What could possess a doctor, rigorously schooled for years in the nuances of physiology and therapeutics, to prescribe a potent drug to a young, healthy woman with NO risk for cardiovascular disease? The answer is: Paint by Numbers Medicine.

Don't get me wrong. The vast majority of doctors are technically adept, conscientious, and dedicated. I am in awe of what doctors do every day. I was the beneficiary of extraordinary technical expertise in the successful repair of my shattered hip a couple of years ago. Before modern orthopedics, this injury would've left me permanently hobbled.

But doctors have succumbed to misleading brainwashing when it comes to cardiovascular prevention. Scribbling the name of a drug on a prescription pad has become a short-hand for comprehensive action to prevent disease.

Lowering cholesterol has become an obsession among many of my medical colleagues. And while drugs are sometimes necessary, no data exists that confirms their benefits in healthy people--especially young women--with minimally elevated cholesterol. Tricor may occasionally be a useful option for patients who can't or won't exercise or stick to a low-carb diet like "Salad and Salmon", or won't avail themselves of natural triglyceride quenchers like fish oil and niacin. It's a drug that I have literally NEVER used, because all of my high-triglyceride patients respond beautiful to our natural approach.

And the data for Tricor is mixed: while it appears to lower cardiovascular events, most studies don't prove it helps patients live longer--which is the point, isn't it? To avoid one health problem only to succumb to another is not my idea of a successful medical intervention.

Why aren't doctors learning from the debacle of Zetia and Vitorin, two cholesterol-lowering drugs recently found to be ineffective at slowing arterial blockage?

They dramatically lower cholesterol, but that's not the point: As an editorial in the New England Journal of Medicine recently put it, "It's not how low you go, it's how you get there."

Don't settle for Paint by Numbers Medicine!