December 19, 1997

Advertising Prescription Drugs II

Those of us who have survived the folly of our youth and middle age are destined to die of cancer, heart disease, stroke, or of a myriad of conditions, collectively called "old age."

Newsweek magazine has a two page advertisement with a banner heading that says, "At your age, with your high cholesterol, what is your risk of a first heart attack?" Beneath the headline is a quiz in which you score points for a number of things such as age, lifestyle, cholesterol level etc. On the lower right is the shield of The American Heart Association which, I assume, represents a stamp of approval. Below the quiz is a statement that says "If you score 4 points or more, you could be at above average risk of a first heart attack compared to the general adult population. The more points you score, the greater your risk." I scored 7 points.

Does that mean that I can expect to be struck down by a fatal heart attack at any moment? No, it does not, but that is exactly what Bristol Meyers Squibb drug company would like me to think so that I will go to my doctor and ask her "Why aren't you prescribing pravastatin for me so that I can live longer?"

Being a male over 54 years of age scores you 4 points. As everyone knows, the older that you get, the greater your risk of heart attack. Instead of helping you to accept the fact of life that the older you get the greater your chance of dying of heart disease, cancer and stroke, that ad is trying to frighten you to death. If you are frightened, you are more likely to buy their pitch, that their product can prevent your death from a first heart attack, which kills one third of its victims. It taps into the greatest asset that every snake oil salesman has had, back to antiquity: the fear of death.

How about their product? What is it and what can it do? It is one of several drugs which go by the collective name of "statins." Most have been isolated from a fungus and one is synthetic. They act to inhibit a very powerful enzyme abbreviated "HMG-CoA reductase." Among other things, this enzyme is involved in the manufacture of cholesterol. Cholesterol, as we should all know, is a normal, essential substance that is made by our body and without which we couldn't survive. It is not the evil thing that we have been led to believe. If you want to know more about this, check out Dr.Uffe Ravnskov's web site, called The Cholesterol Myths. Ravnskov is a physician-scientist in Sweden who has done a good deal of investigating of the subject. He has documented the fact that if you eliminate from consideration those people who have familial hypercholesterolemia(high blood cholesterol) and early death from heart disease, blood cholesterol levels are meaningless. If you do not have that hereditary condition and have survived past about 55, a high blood cholesterol level does not put you at increased risk of a heart attack.

A six year, well controlled, Scandinavian study of the effect of simvastatin on people with coronary heart disease showed that the drug clearly reduced the death rate by 34%. The results were clear enough, and have been confirmed in other similar studies. If I had coronary heart disease, I would expect my doctor to consider prescribing one of those statin drugs.

What does a 34% reduction mean? Out of every 100 people in that study, after 6 years, of those who got the placebo(sugar pills) 12 died and 88 were alive. Of those who got the drug, 8 died and 92 were alive. To prolong 4 lives for 6 years, 100 people would have to be given the drug. This will cost approximately $700 per person per year. Those 100 people will have spent a total of $70,000 to prolong 4 lives for 6 years. Compare this to the cost of a years supply of aspirin, taken one pill per day, which is about $5. Aspirin is also beneficial to people with heart disease. If, as several drug companies are suggesting, a healthy man starts taking a statin drug at age 55, and he lives to the age of 85, he will have spent $21,000 on a drug which probably did him no good at all.

An additional problem is that the statin drugs are carcinogenic in laboratory rodents. The statin drugs have produces liver cancer plus several other kinds of tumors. If they turn out to be carcinogenic in people, it can be a major problem. So much so, that an article in a major medical journal suggests that the drug not be used in people with a life expectancy of more than 10 years. Some drug companies are suggesting that the statin drugs should be used on all older men. That could be a disaster waiting to happen, since liver cancer in man is a very malignant condition which is almost always fatal. We will know for sure whether the statin drugs cause cancer in man in about 20 to 30 years.

Well, what will be, will be. We can be sure that much money will pass from the consumer to the drug companies and that medical insurance premiums will go up to pay for it. We can also be sure that those drugs will be thoroughly tested for their ability to produce cancer on one very important experimental animal: MAN.

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