Almost three thousand years ago, the Greek fabulist Aesop told the story of the mountain in labor. The mountain shook, and rumbled, and emitted ominous-looking clouds of black smoke, and as the local villagers looked on in horror, the earth opened up and out of the fissure jumped… a mouse.
It’s uncanny. It’s almost as if Aesop foresaw the rise of the statin industry.
Statins are a $29-billion-dollar-a-year business. One statin, Lipitor, is the best-selling drug of all time, with a whopping $140 billion in cumulative sales. And just what are we getting for this outlay?
Some Danish researchers wanted to find the answer to that question. They conducted a meta-analysis, or a study of studies, of all large placebo-controlled statin trials of at least two years in duration which charted all-cause mortality. The study, published last month in BMJ Open, showed that for secondary prevention (i.e. patients who already had suffered a heart attack or stroke or other major cardiovascular event), statins extended lifespan… by a whopping four days. For primary prevention (patients who had not suffered a major cardiovascular event), the increase in lifespan was an even punier three days.
At this point, it is probably overkill to mention that the 95% confidence intervals for both primary and secondary prevention extended well into the negative digits – in other words, statins may actually be shortening the lives of patients in these trials.
Astonishingly, the authors of the BMJ Open study concluded “We believe that statins should be prescribed according to the prevailing guidelines. Statins are usually inexpensive and safe…” As evidence, they cite a 2005 meta-analysis of statin trials — but almost all of these were funded by the drugmakers. These companies manufacture and control the evidence for the safety and effectiveness of their wares, and they decide which data on toxic effects to release and which to hide. As a result, we don’t know the full extent of the toxic effects produced by these drugs, although we do know that the USAGE survey found that 62% of patients stopped taking their statins within one year of their being prescribed, specifically because of side effects. This study was funded by Kowa Pharmaceuticals, makers of Livalo, and by the National Lipid Association, whose foundation receives funding from a variety of pharmaceutical companies. These companies have a fiduciary duty to do everything within the limits of the law (at least) to present their products in the best light possible, so we have to assume that whatever this and other industry-funded studies report is the best-case scenario.
Moreover, the patients in these trials are in no way representative of the folks who will actually be taking these drugs in actual clinical practice. Patients with substantial co-morbidities are excluded from these trials, which means that the patients in these trials are usually taking only one drug. How many people take just one drug these days? Polypharmacy is rapidly becoming the rule rather than the exception, especially for folks over sixty years of age.
As a result of all this, hundreds of millions of people worldwide are taking powerful drugs that affect the metabolism of every cell in their bodies, in combinations that have never been tested, for years and years beyond the duration of any clinical trial, for conditions that have no symptoms, justified by a data set that has been hopelessly distorted by selective publication.
“Preventive medicine,” they call it (or “preventative medicine,” for the grammatically challenged). But what is it they are preventing? Death? Death cannot be prevented, only delayed. (I guess “delayative medicine” doesn’t have quite the same ring to it.) And it’s an open question how much of that they are doing. Are we doing violence to the English language by calling this “medicine” at all? Is all this just a denial of death?
Some might say that religion performs the same function. But even the atheist must admit that religion has given us beautiful cathedrals, beautiful music. What has “preventative medicine” given us?
We’ve all seen those idiotic commercials for Crestor – which we’re all made to pay for – with War’s “Lowrider” (the worst song ever recorded) blasting in the background while a woman dances with joy after learning her cholesterol level has dropped. Somehow I doubt she represents the average real-life patient getting her cholesterol checked. Nobody actually enjoys this process, any more than they enjoy getting a prostate biopsy or engaging in any of the other dreary rituals our culture has concocted to help us avoid facing the inevitability of our demise – but people really hate the alternative, which is to face the scary reality that the “experts” do not necessarily have our best interests at heart, the scarier reality that for the most part we ourselves are the ones most responsible for our health or lack of same, and the really scary reality of our mortality.
Sooner or later Death comes for us all. When he comes for me, I hope he finds me doing something more interesting than worrying about my lipid levels.