The fight over statins

Depending on who you read statins like simvastatin and Lipitor are either the "greatest things evah!" or an out-and-out fraud.

Steve MartinDepending on who you read statins like simvastatin and Lipitor are either the "greatest things evah!" or an out-and-out fraud.

There are two reasons for this.

  1. Studies of long-term statin use are giving results which sometimes appear unclear; and
  2. Statins are an enormous contributor to business' medical bill.

All this was on display in last week's Business Week cover story, which claimed the NNT, the number of people you need to treat in order to prevent a specific event, is actually pretty high for statins and heart attacks.

This was a political "gotcha," perfect for this political season.

What is in fact happening is we're seeing more nuanced work being done by clinicians, and more demands from business that specific benefits be tied to specific compounds before they'll pay for them.

That's what happens with drug compounds. We're constantly re-evaluating them.

The real news is that LDL cholesterol levels, by themselves, are not accurate predictors of heart attacks. Lowering LDL will not, by itself, effect a specific cure.

But it can't hurt.

We're also looking at what other benefits a lower LDL level might have, in terms of stroke, of Alzheimer's Disease, and of other things.  

The work hasn't yet reached a place where we can pinpoint a specific, sure benefit from statin use, but many of the results are promising.

Are statin producers supporting these studies? Yes. Does that make them illegitimate? No, not if peer-reviewed journals are doing their job. And whether they are or not is a separate issue.

I happen to have something of a dog in this fight, as they say down here.

Dr. David Blankenhorn, who died in 1999 of cancer, did a lot of the early work linking cholesterol and plaque to heart problems. (I have no known relation to him, but there aren't that many Blankenhorns about.)

He measured the diameter of coronary heart arteries in heart patients, even reversed heart problems by combining a statin with a low-fat diet.

But how much was the diet and how much the drug? Can we ever quantify and separate the two? The work continues.

What seems clear is that statins lower cholesterol, and that lowering cholesterol seems to benefit many people in many different ways. There's no clear line from take this drug to prevent this heart attack, or that stroke, or that Alzheimer's diagnosis.

Business Week readers, looking for a silver bullet to cut their insurance bills, are being told they were sold a lot of bull, because science does not deliver the precise answers in precisely the way we would like to have them.

Well ex-cuu-u-u-u-s-e-e meeeee-e-e-e-e!