04 March 2008

(LDL + HDL) X Big Pharma = BS

First, a necessary disclaimer: I am not a medical professional. You should not take anything in this post to be accurate medical advice, and you should not act upon anything you read herein without consulting a competent medical professional.

OK, now that that’s out of the way, let me issue another warning: This long-winded post is neither particularly spiritual nor particularly political, although it may wind up containing some elements of each realm therein. Rather, this is my rant against what I’ve come to believe is a bunch of bogus assertions regarding one of our most vital health issues, coronary heart disease (CHD) and/or cardiovascular disease (CVD) and its supposed link to cholesterol levels. I will omit most of the minutiae herein, but will provide some links at the end of this post to articles that discuss this topic in much more mind-numbing detail than I really care to repeat here.

Here’s my bottom-line conclusion, again remembering that I am not a medical professional and you shouldn’t believe anything I say. High levels of LDL (“bad”) cholesterol don’t cause CHD (heart disease). There, I’ve said it, and by doing so I’ve contradicted most accepted medical wisdom of the past several decades. What makes me think I know something that all that accepted medical wisdom doesn’t? Let me back up a couple of steps to try to illustrate with some vastly oversimplified (and occasionally truncated) science.

The biggest selling class of drugs in the country is statins, drugs like Lipitor and Zocor that claim to reduce the risk of CHD by reducing LDL levels. Big pharmaceutical companies (“Big Pharma”) generate billions of dollars annually from the sale of statins. In laypersons’ terms, statins reduce the amount of LDL, or “bad”, cholesterol in your blood. Supposedly, LDLs contribute to CHD by causing plaque (fatty deposits) to build up in the lining of your blood vessels. Thus, by reducing LDLs, statins are supposed to reduce the risk of CHD by reducing that plaque. Raising HDLs (“good” cholesterol) tends to reduce those same fatty deposits, thus also reducing the risk of CHD.

Sounds simple so far, right? But here’s a wrinkle. A recent study of a new drug that combined two types of drugs, one statin and one with another LDL-lowering mechanism, had some mind-boggling results. The new drug actually did lower LDLs more than either single drug on its own. However, the drug brought no actual health benefits. That is, even though it significantly lowered LDLs, it didn’t lower the risk of CHD. But if you accept the premise that lower LDLs cause a lower CHD risk, it’s impossible to lower LDLs without lowering CHD risk.

Also, many studies have shown that contrary to accepted wisdom, lower LDL levels don’t actually correlate with lower CHD. In many populations in this country and in many other cultures worldwide, groups with very similar LDL levels have vastly differing rates of CHD.

So what’s happening here? Well, if you’re a genuine scientist, and you find results that contradict your premises, you start questioning your premises and try to establish a better hypothesis that fits the actual results. Some statins have been shown to reduce rates of CHD. Scientists have assumed that this was happening because the statins reduced LDLs, and lowering LDLs reduced CHD. X causes Y, and Y causes Z, therefore X causes Z. But what if Y doesn’t cause Z? Then we have to look for what else X might be causing, which in turn causes Z, for a full explanation of X’s effects on Z. In the case of statins and CHD, we don’t yet know what this missing factor is, but one potential explanation is that statins reduce inflammation in the body, and this reduction of inflammation is what actually is acting to lower CHD.

So why not just keep taking statins, regardless of how they work? Several reasons come to mind. First, they’re bad for you in a lot of other ways, including being somewhat toxic for your liver. Many patients report numerous side effects, including but not limited to memory loss and cognitive impairment, muscle pain, weight gain, skin rashes, and sexual dysfunction. Oh, and if it’s reducing inflammation you want, you can choose instead to take omega-3 fatty acids (such as fish oil) that have no side effects, plenty of other good effects, and cost a whole lot less than name-brand prescription statins. And let’s not forget the basic preventive tips of exercise and weight loss.

But if LDL cholesterol isn’t the big evil it’s been made out to be, why hasn’t someone figured this out previously? Well, some would argue that many researchers have figured this out, but these researchers been drowned out by Big Pharma that has a multi-billion-dollar per year interest in the LDL hypothesis.

Here’s one take on why we have the situation we do. As of a few decades ago, it became easy to test for cholesterol levels, and then for LDL and HDL levels. Then there came drugs that were able to change an easily testable number, so it’s easy to show the immediate impact of these drugs. Tying those numbers to a widely prevalent category of disease made the final linkage an incredibly profitable one for Big Pharma. What could be more persuasive than “Take our little pill and you won’t die?

Not cynical enough to believe that profit motives are behind such a solid tenet of our accepted medical wisdom? Then consider just how many major studies, federal agencies, and supposedly independent bodies recommending statins are comprised of doctors and researchers who receive substantial payments from pharmaceutical companies. Whether it’s consulting fees paid to cardiologists, or funding for research institutions or other supposedly independent groups, Big Pharma has thoroughly funded the research supporting the widespread use of statins. You can read all about this in the various articles I’ve linked at the bottom of this post. Oh, and those nifty TV ads by Lipitor featuring Dr. Robert Jarvik rowing across a lake? Turns out he’s not licensed to practice medicine, he only started taking Lipitor after receiving a $1.3 million endorsement contract, and he isn’t even the guy in the boat (it’s a body double).

Let me make one further point, in order to make this at least quasi-spiritual. Why are we so ready to believe the LDL hypothesis? Is it because we want to trust authorities that tell us to do so? Then we should learn to question authority a little more often. Is it because we actually don’t feel in control of our bodies (and by extension, our lives), and think that a magic pill will give us back that control? Then we should meditate on how we’ve moved away from being able to control our own selves, and strive to reclaim at least some responsibility for our own destinies. Can you apply these options to other areas of your life? Do you want to find some external, higher authority to trust without question? Do you find it easier to assign control over your life to outside forces? If so, consider how you might change that orientation and begin to look within yourself for solutions. It’s sort of Zen-like, but I think it’s also a Christian concept – the Kingdom of God is within you. As Jesus said (albeit in the Gospel of Thomas), "If you bring forth what is within you, what you bring forth will save you. If you do not bring forth what is within you, what you do not bring forth will destroy you."


New York Times, January 16, 2008, "Cholesterol Drug Bombs"

BusinessWeek Magazine, January 17, 2008 cover story, “Do Cholesterol Drugs Do Any Good?”

Wall Street Journal, February 12, 2008, “Can a Drug That Helps Hearts Be Harmful to the Brain?”

New York Times, February 26, 2008, “Pfizer to End Lipitor Ads by Jarvik”
Related Op-Ed Column here

University of California - San Diego Statin Effects Study

Health Beat Blog – “The Cholesterol Con – Where Were the Doctors?”

1 comment:

Cecilia Dominic said...

But the drug reps bring such good lunches!

Sorry, couldn't resist. ;)

You'd probably find the research on the sleep drugs to be similar. There's sometimes a big difference between statistical significance and clinical significance.

All said, your post made me feel better about all the good food I had in Savannah this past weekend. :)