Drugging Ourselves to Death (Cholesterol Drugs)

[theredhead]

Drugging Ourselves to Death
Carole Jackson
Bottom Line's Daily Health News
The other day, my friend came home from the doctor with a cholesterol reading of 220 and a prescription for Lipitor. Deborah is 36, exercises like a demon, is in great shape, eats a healthful Mediterranean diet, has no heart disease in her family and doesn't smoke. But her doctor read her the riot act -- she left his office convinced that the only thing standing between her and an imminent heart attack was this little pill.

What's wrong with this picture? Why does it seem that so many people (doctors and patients alike) believe that drugs are the answer to all our health problems? The statistics after all are dismal -- health-care spending has gone up by 73% over the past five years. We're now spending more than twice as much per person as the 21 other industrialized countries, but we are last in healthy life expectancy.

What gives? To find out more, I interviewed Harvard professor of medicine John Abramson, MD, author of Overdosed America: The Broken Promise of American Medicine (Harper Perennial). Dr. Abramson believes that health care in America is going in the wrong direction, and that much of the reason has to do with the drug companies.

"FREE" EDUCATION

"The first thing people can do to improve their health and protect themselves from distorted health care is to understand that information about drugs and health is being brought to them and to the doctors by the drug companies, because of its commercial value," Dr. Abramson told me. "The fundamental purpose of that information is to improve corporate profits, not to improve our health."

Dr. Abramson is hardly saying that all drugs are useless. He simply believes that many are way overprescribed and that the focus on specific measures, such as high cholesterol, deprives doctors of a real opportunity to dialogue with their patients about practices that have been repeatedly shown in research to improve health and reduce risk for heart disease and other killers. In many cases, such practices are far better and cheaper than drugs.

THE ODD CASE OF STATINS

"Look," Dr. Abramson told me, "there's not a single randomized controlled study that shows that statin drugs (i.e., Lipitor and Zocor) decrease the risk for heart disease or improve the health of women that don't already have heart disease. But consider this -- there are five behaviors that produce an astonishing 83% reduction in the incidence of cardiovascular disease in women, yet only 3% of American women do these five basic things. I think that concentrating on cholesterol reduction is very misplaced, and is largely fueled by drug company marketing."

The five behaviors that reduce the risk for cardiovascular disease by 83% are...

• 1. Eat a healthy Mediterranean diet (olive oil, fish, fruits, vegetables, whole grains). For more on the Mediterranean diet, see Daily Health News, January 13, 2005.

• 2. Exercise regularly.

• 3. Don't smoke.

• 4. Consume alcohol only in moderation.

• 5. Maintain a healthy body weight.

Dr. Abramson continued, "The impression we get from the media is that we need to depend on expensive new technologies to be healthy when in fact most of our health is determined by how we live our lives. And that is a tremendously liberating concept. There are things we can control right now that will dwarf the health benefits of most of the drugs we're being sold left and right."

To beat the drums on cholesterol and heart disease a little longer... a recent article in the Journal of the American Medical Association on a study that followed 7,300 women for 31 years showed that the overall contribution of high cholesterol to mortality is zero. "It had zero effect on mortality and it did not make a significant contribution to heart disease," Dr. Abramson told me.

RESEARCH COMPARISONS

Then why are statin drugs pushed so relentlessly? "Let's take a study like WOSCOP (a famous study used to support the use of statin drugs). They used high-risk men -- almost half of these men smoked and 8% already had vascular disease. Using a statin drug, they got a 31% reduction in heart disease, which translates to one death prevented for every 100 men treated over five-and-a-half years. Fair enough. But look at what happened in the LYON Diet Heart Study, which studied people who had already had a heart attack. Instead of giving any drugs, they just gave diet advice: One half was counseled to eat a Mediterranean diet, the other half to eat a prudent post-heart attack diet -- one that is low in fat and cholesterol. The Mediterranean diet was three times more effective than the prudent diet at reducing heart disease, and two times as effective in reducing death. And that happened even though cholesterol levels stayed the same!" Dietary modification worked far better than the statins.

Dr. Abramson also said that the women in the Nurses Health Study showed the very same 31% reduction in heart disease just by eating fish once a week that the high-risk men in the WOSCOP study got by going on drugs.

The point isn't that drugs are "bad." The point is that focusing exclusively on cholesterol numbers squanders an important opportunity for doctors to help their patients by giving them lifestyle advice that makes far more of a difference to their health with no side effects than bringing down cholesterol with medications.

IT'S NOT JUST CHOLESTEROL

Dr. Abramson and I talked a lot about the use of cholesterol-lowering medication since it is such a prominent example of excessive drug use. However, according to Dr. Abramson, stroke, heart disease, diabetes, osteoporosis, depression, lung disease and breast cancer all respond powerfully to lifestyle interventions, yet the cost and frequency of drug usage to treat these issues is also skyrocketing.

"We know how to prevent about 70% of illness," Dr. Abramson concluded. "We ought to be focusing on the things we can do right now in our lives to accomplish that rather than focusing on what expensive drug we've been told we need to take. Those drugs don't work nearly as well as the lifestyle choices."


Plus, the lifestyle choices are free and carry no side effects. Oh, there's one possible side effect: Reduced profits at the drug companies. Oh well.