I had a patient in my practice this week who was seeking advice about the prevention of heart disease. He’d been on a statin for several years, and then started to get what he felt might be side-effects.
He stopped the statin and the side-effects went away. As he rightly pointed out, the relief from his symptoms might have been entirely coincidental and nothing to do with the fact that he stopped his statin medication. However, he was disinclined to restart. My patient told me that he expects his doctor to be up in arms about this. He has, apparently, an unbridled enthusiasm for statins and believes ‘everyone should be taking them’.
As I pointed out to my patient, the reality is the vast majority of people who take statins are destined not to benefit from them. And then we have the problem, of course, of toxicity and side effects.
Not to mention the cost. What is it then, that causes doctors to be so enthusiastic about drugs that, on balance, have limited benefits and can cause serious harm?
Well, some of this has to do with the fact that doctors make money from cholesterol reduction. In private medicine, the cholesterol concept suddenly makes ‘patients’ out of essentially healthy people.
Here in the UK, national health general practitioners are remunerated for their cholesterol-reducing efforts with patients.
But a major part of the problem too, I think, has to do with how the ‘benefits’ of statins and other drugs are communicated to doctors by drug companies. As I’ve pointed out before, the emphasis is usually on reductions in the ‘relative risk’ of, say, heart disease. But if the overall risk is small, the real reduction in risk (known as the ‘absolute risk’ reduction) becomes vanishingly small.
Another problem is that data can be presented to doctors that gives a misleading account of a drug’s effects for the unwary. I spotted a prime example of this recently in the on-line version of the GP magazine Pulse here.
One problem: the study that purportedly shows that ezetimibe saves lives actually does nothing of the sort. The study is ‘epidemiological’ in nature, and can only tell us that ezetimibe is associated with a reduced risk of death. You see, individuals who take ezetimibe may have a reduced risk of death that has nothing to do with ezetimibe. Maybe, for example, they’re particularly health conscious and in addition to pressing their doctors for more and stronger medication, they’re also active and eat good diets.
The fact that the study in question here is epidemiological means that the statement that ‘A cholesterol-lowering drug…has been shown to reduce mortality…’ is simply wrong and misleading.
To know if ezetimibe really does save lives, we need clinical ‘intervention’ studies. We now have several of these. And here’s what you and your doctor need to know: Not one of them has shown that ezetimibe benefits health or health markers. Some of the studies actually suggest the ezetimibe does more harm than good.
The Pulse piece ends with the following paragraph: ‘Dr Peter Fellowes, a GP in Lydney, Gloucestershire and a member of the GPC clinical and prescribing subcommittee, said: ‘I don't think it should be blacklisted. It is very useful in patients who are statin intolerant. The arguments against ezetimibe and the more potent statins are entirely cost based as I see it, and that is a sorry state of affairs.'’
I’ll tell you what’s a ‘sorry state of affairs’: When a doctor is advocating the use of an expensive and potentially toxic drug that has no proven benefits on health. And it doesn’t help that a magazine for GPs presents information on cholesterol-reducing drugs in a misleading and utterly imbalanced way, either.
To your good health,
Dr. John Briffa
for The Cholesterol truth
Read the full article here.