27 October 2010


I went to see my "doctor" (Jay the nurse) the other day to get a prescription renewed (sleeping pills). He has long been hassling me for a copy of my lipid profiles. I get them done every couple years through my job. So I brought them in. My total cholesterol was a bit high at 237. The Mayo Clinic rates 240 as too high; other groups say 200; but in any case, it's not exactly freakout high. But he tut-tutted. "Let's see, you're 42? Well, it's time to get you started on statins." As if it's just what you do at 42.

Jay the nurse is an idiot, always has been, but I go to him because he just gives me my damn prescriptions without major hassles. This, however, really irked me. I'm 42 and in otherwise good health, and he wants to put me on a liver-altering drug with ambiguous benefits, numerous side-effects, and unguessable long-term negative consequences, for the rest of my life.

"No, thanks. I'll lose some more weight." "Won't do any good," he says absently, not looking up. Jay really is an idiot. "No," I say flatly, "I won't take statins." Now he looks up. Awkward pause. "Ok," he says. "Uh, can I listen to your heart?"

He says I have a murmur, previously unnoticed by anyone, oddly enough. Maybe he didn't factor in the anger-fueled adrenaline pumping into it. I'm trying to be worried about that murmur, but I've never noticed it on thirty-mile bike rides or pressing 80-pound dumbbells. I don't feel like I'm about to drop dead. And I'm not taking statins.

Statins lower "bad cholesterol" (LDL), produced in the liver, by altering liver function. They are also anti-inflammatory and do many other things, intended and unintended. There is a string of theories going back to the 50s that high cholesterol causes arteriosclerosis, or heart disease. The theory, which has gone through several incarnations, is clearly not based entirely on science. It's always been a facile answer to a complex question. There is a society of researchers that oppose it entirely [1], and the ever-lucid Gary Taubes explains the basic grounds for skepticism. [2]

But this "lipid hypothesis" gained so much traction that Big Pharma saw enormous profit potential. Statins lower LDL cholesterol, indisputably, and are now the second most commonly prescribed medicine behind psychiatric meds. As a bazillion-dollar profit center, they have been marketed to doctors with unparalleled vigor. And clearly this marketing has been successful. They were first approved for the treatment of heart attack victims with advanced heart disease. Now they are prescribed to healthy 40-somethings. It's been seriously proposed that they be sold with hamburgers, as a sort of antidote to fast food. [3] They'll start putting them in our drinking water any day now.

I'm not giving medical advice here, but am advocating self-education. Google around and you'll see that, whatever Big Pharma may say, statins carry serous risks that are gradually being exposed, including an increased risk of diabetes [4, 4a], testosterone suppression [5], and long-known problems like muscle myopathy, memory loss and other neural issues, liver toxicity (of course), and various bowel and flu-like symptoms. I like this real-world perspective from an Amazon commentator:

    While doctors will tell you they've rarely seen anyone with side effects from statins, among my own circle of middle-aged friends, I know 3 who've had serious problems with their livers, one who had some muscles permanently destroyed, one--a usually energetic tennis player-- who felt, for the few months he took statins, as though he had the flu, and could barely go to work-- and one who was left with ringing in the ears and a facial tic. All of these are listed as side effects of statins, as Kendrick points out. [6]

Compounded with the downsides, the actual benefits are ambiguous. Studies of benefits have been tainted by money, and surveys of studies reveal that while statins may help elderly patients with advanced coronary heart disease (CHD), there is no evidence that all the statins being given to the rest of us, even to people at high risk for CHD, actually reduce mortality at all. [7, 8, 9] And even when helpful, it may be due to statins' anti-inflammatory benefits (like aspirin) rather than its impact on lipids. [10]

Statins are big money for Big Pharma, which spends billions on "physician education" (marketing); in fact, twice as much as it does on research, "US$61,000 in promotion per physician during 2004" ($57.5 billion total). [11] Remember who is educating your physician and make an informed choice for yourself. Heart disease rates are still insanely high, in spite of us gobbling up statins. I think I'll take my chances with an old-school remedy: diet and exercise.


Mister Fweem said...

I had a heart murmur when I was a kid, and later on in life it just "went away." Last time I was checked, my LDL was at 220. My family has a history of heart disease -- that is if the cancer didn't get them first. So I don't eat a lot of meat, but I don't exercise as much as I should.

But I also see the cavalcade of meds my mom takes for her various ailments, and the pigheadedness she's witnessed among her various doctors, wanting to do things to cross purposes. She finally put her foot down a month ago and got them to sort things out.

I've generally been unimpressed with doctors -- our pediatrician isn't up to much, and the last time I went to the doctor outside of work was to get an allergy prescription renewed. He checked my heart, asked "do the pills work for you," then charged me $55. I haven't been back since.

carl g said...

Doctors are in the sickness, not the wellness, business. When you're sick with something obvious, they seem to get it right about half the time. But it's like every other profession. Competence varies enormously. If I was ever really sick, I'd only trust a family friend, a pediatrician.