Commentary on medical news by a practicing physician.

  • Epocrates MedSearch Drug Lookup


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

    ''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.''
    -Robert Ehrlich, drug advertising executive.

    "Opinions are like sphincters, everyone has one." - Chris Rangel

    email: medpundit-at-ameritech.net

    or if that doesn't work try:


    Medpundit RSS

    Quirky Museums and Fun Stuff

    Who is medpundit?

    Tech Central Station Columns

    Book Reviews:
    Read the Review

    Read the Review

    Read the Review

    More Reviews

    Second Hand Book Reviews


    Medical Blogs


    DB's Medical Rants

    Family Medicine Notes

    Grunt Doc




    Code Blog: Tales of a Nurse

    Feet First

    Tales of Hoffman

    The Eyes Have It


    SOAP Notes


    Cut-to -Cure

    Black Triangle



    Kevin, M.D

    The Lingual Nerve

    Galen's Log



    Doctor Mental



    Finestkind Clinic and Fish Market

    The Examining Room of Dr. Charles

    Chronicles of a Medical Mad House



    Health Facts and Fears

    Health Policy Blogs

    The Health Care Blog

    HealthLawProf Blog

    Facts & Fears

    Personal Favorites

    The Glittering Eye

    Day by Day


    The Business Word Inc.

    Point of Law

    In the Pipeline


    Tim Blair

    Jane Galt

    The Truth Laid Bear

    Jim Miller

    No Watermelons Allowed

    Winds of Change

    Science Blog

    A Chequer-Board of Night and Days

    Arts & Letters Daily

    Tech Central Station





    The Skeptic's Dictionary

    Recommended Reading

    The Doctor Stories by William Carlos Williams

    Pox Americana: The Great Smallpox Epidemic of 1775-82 by Elizabeth Fenn

    Intoxicated by My Illness by Anatole Broyard

    Raising the Dead by Richard Selzer

    Autobiography of a Face by Lucy Grealy

    The Man Who Mistook His Wife for a Hat by Oliver Sacks

    The Sea and Poison by Shusaku Endo

    A Midwife's Tale by Laurel Thatcher Ulrich



    American Academy of Pediatrics

    General Health Info

    Travel Advice from the CDC

    NIH Medical Library Info



    Sunday, November 20, 2005

    The Savorless Bread Which a Poor Alchemy had Made from Ideals: Pfizer has recently come under fire (justly or not) for advertising its cholesterol-lowering drug, Lipitor, to little old ladies. Give the company credit, then, for funding and, more important, publishing a study (called IDEAL*) that does not cast the drug in the best light:

    High doses of the cholesterol-lowering drug Lipitor were no better at preventing recurrent heart attacks and heart-related deaths than regular doses of the competing drug Zocor, according to the latest study on efforts to aggressively treat heart conditions.

    The study, funded and conducted by Lipitor's maker Pfizer Inc., was prepared for presentation Tuesday at an American Heart Association meeting in Dallas. It also appears in Wednesday's Journal of the American Medical Association.

    ...The latest study involved 8,888 mostly male Scandinavian patients aged 61 on average who had previous heart attacks and were given either a high dose of Lipitor or a standard dose of Merck's Zocor.
    The researchers didn't find the main difference they were looking for - fewer "major coronary events" in the Lipitor group during an average follow-up of almost five years. That category lumped together cardiovascular deaths, nonfatal heart attacks and nonfatal cardiac arrest. These events totaled 463 in the Zocor patients and 411 in the Lipitor patients, a difference that was not statistically significant.

    For the past year, the cholesterol mantra has been to push the LDL cholesterol below 70 for patients who are known to have diseased coronary arteries. The recommendations were somewhat controversial - having been made by a panel of doctors who had ties to the statin industry - but they were widely adopted, anyways. The LDL cholesterol is the form of cholesterol that is most closely associated with heart disease, though its relationship with heart disease is probably more nuanced than we currently admit.

    The study does seem to call the mantra into question. Even though the high dose Lipitor did lower the LDL more than the Zocor, the final results were about the same:

    There were 178 coronary deaths (4.0%) in the simvastatin [Zocor - ed.] group vs 175 (3.9%) in the atorvastatin [Lipitor-ed.] group.... Nonfatal myocardial infarction occurred in 321 patients (7.2%) in the simvastatin group and in 267 (6.0%) in the atorvastatin group.

    Lipitor did have an advantage when it came to preventing strokes, but for some reason, neurologists don't promote statins with the same enthusiasm as cardiologists. Maybe that will change, though.

    Interestingly, people were less tolerant of Lipitor. They were more likely to experience muscle aches and liver enzyme elevations. And they were more likely to stop taking it:

    Overall adherence, defined as total study medication exposure as a percentage of total follow-up time, was 89% in the atorvastatin group and 95% in the simvastatin group. By the end of the study, 14% of the atorvastatin-allocated and 7% of the simvastatin-allocated patients had permanently discontinued study medication.

    Maybe we need to rethink those guidelines. Now, will anyone sing Pfizer's praises for paying for - and publishing a study that cast its competitor in a better light?

    *Incremental Decrease in End Points Through Aggressive Lipid Lowering

    posted by Sydney on 11/20/2005 07:31:00 AM 0 comments


    Post a Comment

    This page is powered by Blogger, the easy way to update your web site.

    Main Page


    Home   |   Archives

    Copyright 2006