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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

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    Sunday, July 18, 2004

    While I Was Away: So much happened. Obesity is no longer a risk factor for disease, but an official disease, which is a bad move for all of these reasons and more. Having named it a disease the onus is now on the medical profession to cure it, or at least that will be the way it will be perceived.

    And then, there were the new cholesterol guidelines which have already come under much-needed scrutiny:

    The new guidelines issued Monday by the American Heart Association and the federal government were aimed at preventing heart attacks. They were written by nine of the country's top cholesterol experts. At least six have received consulting or speaking fees, research money or other support from makers of the most widely used anti-cholesterol drugs.

    ...The heart institute posted information on industry ties of the new guidelines' authors on its Web site Friday. Cleeman said all the authors except him "have some connection with industry.

    ...Newsday first reported on the conflicts in Thursday's editions. They said six authors had earned money specifically from cholesterol drug makers, including Pfizer Inc., Merck & Co., Bristol-Myers Squibb and AstraZeneca LP.

    They estimate that the new guidelines will add 7 million new choleseterol drug users to the market, but the market share increase will be much larger than that. For there will be a whole subsegment of patients who get placed on second and third drugs or whose doses get pushed to the max to try to meet the ideal cholesterol level. It's a coup for the drug companies, that's for sure. Good to see the media and consumer groups on the ball on this one.

    The guidelines are widely reported to be based on good science, but what the reports don't tell you is that the benefits of aggressively treating cholesterol are marginal. Here are the results on which the new guidelines are based:

    The Heart Protection Study, which used Pravachol: (587 [5.7%] deaths due to cardiovascular disease in Pravachol users vs 707 [6.9%] in non-users.

    PROSPER, which also used Pravachol: 408 (14%) cardiovascular events in Pravachol users vs. 473 (16%) in non-users.

    ALLHAT-LLT, another Pravachol study: Coronary heart disease (CHD) rates "were not significantly different between the groups.., with 6-year CHD event rates of 9.3% for pravastatin and 10.4% for usual care."

    ASCOT - LLA, a Lipitor study: 2% of those taking Lipitor had a heart attack, fatal or non-fatal, vs. 3% of those not taking the drug.

    PROVE IT-TIMI 22,a comparison of Pravachol and Lipitor: Death from heart disease, 1.1% over two years in the Pravachol group vs. 1.4% in the Lipitor group. (figures are available here with a subscription)

    Hardly breath taking results, any of them. And certainly hard to argue that the benefits would be worth the cost of the drugs to a patient who had to pay for them. But of course, that's the beauty of it, the people who use them aren't the ones who pay for them.

    Also of note, the American Heart Association has a letter writing campaign to urge politicians to combat heart disease and stroke:

    Stroke affects 700,000 Americans per year and kills 160,000 annually, leaving many more victims severely disabled. Research and public education about the signs and symptoms of stroke are necessary to lower death and disability rates from this condition. Would you support programs that will help ensure that stroke is more widely recognized by the public and treated more effectively by health care providers?

    Would one of those programs include government funding for cholesterol-lowering medication, I wonder?

    posted by Sydney on 7/18/2004 11:21:00 PM 0 comments


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