Evidence
Let’s say you have high cholesterol, but you don’t have atherosclerosis. Your doctor recommends you pop a pill, probably a statin, likely Lipitor. Will that be beneficial for you?
Probably not. On top of that, it represents an enormous expense for you and your insurance company.
Wait… what? Yes, it turns out that taking a statin is unlikely to prevent you from having a stroke or heart attack. The advertisements say as much, albeit in small print, but that hasn’t stopped numerous doctors from prescribing them to people whose cholesterol numbers are “too high.” In fact, according to a survey of statin clinical trials undertaken by the Therapeutics Initiative at the University of British Columbia,
“If cardiovascular serious adverse events are viewed in isolation, 71 primary prevention patients with cardiovascular risk factors have to be treated with a statin for 3 to 5 years to prevent one myocardial infarction or stroke.”
Doesn’t seem like a very good return on investment to me. What’s more, it seems that many of the people in these studies have poor diets and get little exercise; to my knowledge, a proper study comparing statins to improved diet and exercise has not been undertaken.
One other evidence-based pearl: treatment with stimulants (e.g., Ritalin) of children diagnosed with ADHD appears to do little except make the children shorter and weigh less.
Of course, people continue to demand antibiotics to treat viral infections, so maybe they just don’t care about actual science. (Ironic that I’d finish with an apocryphal statement, eh?)
Like many “diet” studies, there are so many factors in health that aren’t controlled. If a person is taking a pill to lower their cholesterol, why should they change their diet or activity level? The magic pill should make them healthy! Oh, and then you can’t eat grapefruit.
Exactly. It’s a conspiracy to put the grapefruit growers out of business!
On a similar note, i picked up some brussels sprouts from the farmer’s market a few days ago and roasted them for dinner. That might have been the first time that I had ever eaten them, and they were great! How did our culture become so averse to eating produce?
Mm. I had Brussels sprouts at Angela’s the other week. I think too many people don’t cook anymore, and boiled, mushy vegetables don’t sound/look/smell/taste good. Roasting is fabulous, though! The Hubby won’t eat broccoli normally, but he liked it roasted.
it is disappointing how pills have become the status quo for health care. instead of having doctors teach people how to take care of themselves, we now have doctors using checklists of symptoms and corresponding medications (or worse – people asking for certain medications based on commercials!). it makes perfect sense when you think of how our world works (profit before well-being) – but i find it disturbing how many people truly believe in the “miraculous” curing capabilities of pills – especially over just plain common sense. we as an american society, composed of individuals and groups, have become much weaker than we were a century ago – and for a number of valid reasons. it scares me a bit – but maybe it’s been like this for a while and i’m just starting to notice it…
I won’t argure that statins aren’t being over-prescribed or that they are more beneficial than a healthy diet and exercise – I don’t believe for one second that they are. But the reality of science and medical product development is that products are created much slower than patients demand them. It is my opinion that as a result the medical system and drug manufacturers take advantage of demand spikes on products that may are marketed as wonderdrugs. Then when the results aren’t “wonderous” they point the finger at science. In reality, the scientist in the lab wasn’t given the research funds or resources to compare their drugs to the myriad of lifestyle changes you mentioned, nor is he/she in the business of media-marketing their research and results. It’s a very flawed system…
but I guess for now it’s this or a return to snake oil salesmen
This isn’t to say that statins are ineffective; in fact, they are slightly beneficial for secondary prevention (albeit with NTT of around 20-50, which while better than 71, still seems high). The issue I take with therapy like Lipitor for primary prevention is that it based on evidence. I don’t want a return to snake oil salesmen; I want a halt to snake oil in the exam room.
On a similar note, it troubles me that many powerful drugs have been pulled from the market because of potentially dangerous side effects. Vioxx is one such example. It’s unfortunate that a few people got hurt, but were they expecting reward without risk? Things sometimes go wrong. Now, millions of people who were helped by Vioxx will need to look elsewhere for relief.
Yeah, I don’t think I was arguing with you, as much as I was adding my own commentary to your discussion point. Didn’t want it to seem that way, but ofter when writing on a topic of which I have a distinct and passionate opinion, I can find myself with a hostile tone.
It seems to me (and I fully admit a strong bias) that often the finger is pointed at science and the development lab when things go wrong (you mention Vioxx) or when wonder drugs aren’t as wonderous as marketed (you mention Lipitor). The people developing these compounds often know the dangers and the limitations, but when it leaves the lab, it’s up to the drug company to make the product “viable.” I’ve heard on multiple occassions from industry men that the biggest obstacle to making a viable product is getting the scientist out of the market. Perhaps they view us scientists as too greedy, having too much personally invested, or perhaps it is that we are unwilling to “spin” our research to mean something that it doesn’t. Probably a little bit of each, and most scientists (or at least most of the good ones) are horribly overly cautious folks. It’s unfortunate, but the doctor in the exam room, the drug company marketing the product, and the laboratory developing the drug are often seen as the same entity by the patient population and sometimes by the media. The reality is they are three very different entities with three grossly different objectives. And it is at these junctures were the flaws exist and are often exposed.
So it’s not that I disagree with your short essay, but I ask you who’s at fault for the failures of statins? The lab that didn’t run controls against diet and exercise? The drug company that commercialized a product as a wonder drug? The doctor who is over prescribing? Who’s at fault for the failures of Vioxx? The lab that didn’t insure safety against a background of cardiac issues? The drug company that didn’t discourage or block the drug for use in non-approved therapies? Or, the doctor who prescribed the compound for high-risk patients and off label usage?