Health News Review

I’d like to see a public survey of comprehension of the recent splash of news about new guidelines for heart disease prevention and statin drug use.  Heads must be spinning.

Here are some of the pieces that I found noteworthy:

“The chairman and one of two additional co-chairs of the working panel that wrote the controversial cholesterol guidelines on reducing cardiovascular risk, released last week, had ties to the drug industry at the time they were asked to lead the panel. And, in all, eight of the 15 panelists had industry ties.”

“The process by which these latest guidelines were developed gives rise to further skepticism. The group that wrote the recommendations was not sufficiently free of conflicts of interest; several of the experts on the panel have recent or current financial ties to drug makers. In addition, both the American Heart Association and the American College of Cardiology, while nonprofit entities, are heavily supported by drug companies.

The American people deserve to have important medical guidelines developed by doctors and scientists on whom they can confidently rely to make judgments free from influence, conscious or unconscious, by the industries that stand to gain or lose.

We believe that the new guidelines are not adequately supported by objective data, and that statins should not be recommended for this vastly expanded class of healthy Americans. Instead of converting millions of people into statin customers, we should be focusing on the real factors that undeniably reduce the risk of heart disease: healthy diets, exercise and avoiding smoking. Patients should be skeptical about the guidelines, and have a meaningful dialogue with their doctors about statins, including what the evidence does and does not show, before deciding what is best for them.”

“even if these guidelines were not written by people in the pay of the drug industry, they could just as well have been. And somehow, while important new evidence against the routine use of statins, and suggesting that we really don’t know much about the true mechanism by which these drugs work in the cases where they do, crept into the guidelines for the first time, the bottom line is largely unaffected by such enlightened thoughts. We’re back to putting statins in the water supply.”

by Brian McFadden for Daily Kos

 

  • Finally, with a broader look at conflicts of interest in cardiovascular medicine, See Dr. James Colbert’s piece on MedPage Today, “What I didn’t hear in Dallas,” referring to the recent American Heart Association (AHA) scientific sessions in Dallas. Excerpts:

“…amidst all the late-breaking clinical trial presentations and ask-the-expert sessions, what I didn’t hear were the speakers’ financial conflicts of interest….

Don’t get me wrong — the AHA mandates that all speakers present a disclosure slide at the beginning of every talk, and this rule was reliably followed by all presenters … in the following manner: “Here are my disclosures” — PowerPoint slide flashes on screen with a list of pharmaceutical/device companies. Yet, by the time the speaker finishes speaking those four words, the slide deck has already advanced to the next slide. I, and my fellow audience members, didn’t even have enough time to read the disclosures, let alone process them.

Now, I have no problem with pharmaceutical sponsorship of biomedical research. Nor do I wish to criticize physicians for accepting industry funds. However, I do feel strongly that all such financial relationships must be completely transparent.

Personally, I feel that transparency is not achieved by quickly flashing a slide in front of an audience. No, transparency requires not only that each speaker’s financial relationships be read out loud, but that any connection between these relationships and the subject matter being discussed should be EXPLICITLY stated. We as audience members should not have to connect the dots and look up which pharmaceutical companies manufacture which drugs; rather, we should expect that these connections will be made for us.”

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Comments

Maria (BearMountainBooks) posted on November 24, 2013 at 11:19 am

Here’s the most important line of all:

…we should be focusing on the real factors that undeniably reduce the risk of heart disease: healthy diets, exercise and avoiding smoking.

We gotta own it.

Alexander Exum posted on November 24, 2013 at 11:55 am

As an African-American man who came close to a major heart attack with 95% blockage in heart artery, I went through all of the statins, suffering horrible side effects, until I decided to hell with it since I eat healthy, exercise, and keep mentally active. Nevertheless, I delved deeply into the statin thing, and so only began to smell the stinky figures of Big Farm. I think it’s batshit crazy naive or even criminal to think that profit founded industry like Big Farm is giving away money without expecting a return.”He who pays the piper calls the tune.” When more than half of a panel has, or at some time, had ties to Big Farm, shouldn’t any thing they do be looked at with clinical skepticism. Yeah my bad cholesterol is a bit high, but at 81, I prefer my daily oatmeal, extra virgin olive, fish fresh from the sea three or four times a week, fresh fruit snacks throughout the day, crunchy cooked veggies every day, to aching and crampy legs and other muscles, sleep deprivation. A kid on a street corner can get five years for selling five rocks of crack. Doctors write prescriptions based on dubious and suspect recommendations by vested interest for drugs that have controversial side effects. Who’s the drug pusher here?

Larry Fritzlan posted on November 24, 2013 at 12:13 pm

Statens seriously destroyed muscle tissue in my body. Any doctor who received money from the pharmaceutical industry or belongs to an organization that received money from the pharmaceutical industry should be banned from prescribing this drug. These drugs will be illegal someday.

naksuthin posted on November 24, 2013 at 12:15 pm

The solution to decreasing bad cholesterol is
1. plenty of physical activity
2. a good diet of fresh fruits , vegetables , nuts, grains.
That’s why humans have been doing for millions of years before the recent invention of statins.

For the medical community to recommend drugs over health lifestyle is a testament to how much they have sold their souls for a few pieces of silver.

virginia benjamin posted on November 24, 2013 at 12:20 pm

My blood sugar has always been perfect until I started taking a statin, now I am not only taking a statin but I am also taking a blood sugar lowering medicine.I have decided to stop the statin, eat better, lose some weight and on an exercise regime.

Lynne Fox posted on November 24, 2013 at 12:47 pm

When I pulled up Google News this morning this article was the top health category news item! Great exposure for Health News Review!

Donald Weller posted on November 24, 2013 at 12:55 pm

I agree these new guidelines are a paid attempt to change the rationale and sell lots more drugs. But I didn’t need these articles to realize that. I’m just a patient but I knew as soon as those headlines came out that it was another blatant example of an AHA bought and paid for by the drug industry. If my doctor suggests I get on statins I will be looking for a new doctor. I quit smoking long ago, eat a very healthy diet and get plenty of exercise, both endurance and cardio. And I am also aware that recent studies have failed to support the cholesterol myth. Bah!

ridgebac posted on November 24, 2013 at 12:56 pm

Medicalization of the entire population driven by drug company profits are leading to these kinds of absurdities. Not too long ago it was suggested Prozac (fluoxetine) be put in the water supply to treat universal depression. We’ve confused living with symptoms and diseases. No wonder the health car system is so expensive. Even disappointment is a medical disorder. One wonders what would happen if the doctors, hospital, drug companies and medical device manufacturers had their profits slashed and much more money was put into good food, exercise facilities and relaxation classes offering a wide variety of techniques including self-hypnosis, mindfulness and meditation instead of pushing pharmaceutical agents on a hapless and gullible public.

    Syd45 posted on December 5, 2013 at 1:25 pm

    Your comments make the most sense I’ve read and certainly put this article in it’s proper perspective. All the money spent on drugs could be better spent on more wholesome habits for people to follow and more ads for living a healthier lifestyle. Unfortunately, the old adage is true…money is at the root of all evil.

Karl Davis posted on November 24, 2013 at 1:00 pm

I don’t have enough biochemistry background to weigh in on whether statins are helpful. I’ve taken them for about 10 years, but after increased exercise and reduced food cut my weight into the ideal range, the amount I take has dropped. I know about 1% of the population can’t tolerate statins, so they simply should not take them and this is for the other 99%.

After the patent on Lipitor expired, I switched to it. I get the 20 mg size in a 90 day supply and pill split them to 10 mg for 180 days. The people who say the pharmaceutical industry is getting rich off this try to gloss over the fact that statins are almost free now that there’s no patent protection. They cost about $4 per month and my insurance covered it 100%. That’s less than $50 per year… so how much does it cost to treat a debilitating stroke? Is that cheaper?

My biggest concern with the guidelines is that they put almost everybody on statins in their 60′s and almost nobody in their 30′s. I needed them most when I was in my 30′s and overweight. Aren’t they preventive? Doesn’t that mean you should take them when you’re 35 to prevent a heart attack when you’re 65? My triglycerides were over 500 when I was 37, now they’re under 75, but this said I had less than a 1% chance of having a heart attack or stroke between the ages of 35 and 45. That’s probably true, but does that mean it’s OK to ignore the huge problem and die at age 50?

Richard Cline posted on November 24, 2013 at 1:48 pm

The statins caused some irreversible muscle damage to me. An alternative drug (Niaspan) provided similar cholesterol control. The government has declaired Niaspan a vitamine and therefor not covered by insurance. It appears that colesterol control is only important if you use preferred drugs.

Jeanne Lenzer posted on November 24, 2013 at 2:47 pm

Nicely done, Gary. Regarding the last point about disclosure: unfortunately, transparency is not only not enough – it has been demonstrated to have perverse effects at times, including the perception by listeners that experts who disclose their conflicts are more honest and trustworthy because they disclosed and it led speakers to exaggerate their findings to an even greater degree to compensate for their disclosure.1-3

The real cure for biased research is independent/publicly funded research.

1. Sah S. Conflicts of interest and your physician: psychological processes that cause unexpected changes in behavior. J Law Med Ethics. 2012;40(3):482-7. doi: 10.1111/j.748-720X.2012.00680.x.
2. Sah S, Loewenstein G, Cain DM. The burden of disclosure: increased compliance with distrusted advice. J Pers Soc Psychol. 2013;104(2):289-304. doi: 10.1037/a0030527. Epub 2012 Oct 22.
3. Cain DL, G; Moore, DA. The Dirt on Coming Clean: Perverse Effects of Disclosing Conflicts of Interest. Journal of Legal Studies 2005;34.

Larry Husten posted on November 25, 2013 at 10:40 am

I think many of these stories on the statins and guidelines last week got it wrong. (In particular, the editorial cartoon in the NY Times was an smarmy abomination.) There’s lots about the guidelines that’s worth questioning– in particular, the medicalization of one-third of the population– but the questions about statins are misplaced. First, the commercial interests do NOT appear to have played a role here. Except for one all the statins are generic and can be had for pennies a day. And all the branded, non-generic non-statins have pretty much been relegated to a side role, and the companies are NOT happy about this. So much for serving the interest of pharma.

Further, as some of your comments demonstrate, these attacks on statins have served as a launching pad for the rabid anti-statin crowd. Now it is perfectly reasonable to argue that statins should not be widely used for primary prevention or that 1/3 of the population should not be statin eligible, but this should not be based on widely inflated and non-evidence based claims of widespread statin complications. All drugs can cause problems, of course, but statins are about as safe as it gets, so these concerns should not be overplayed in this discussion.

Justin Coleman posted on November 25, 2013 at 5:23 pm

Interestingly, the very week before the new US guidelines, discussion of statins in Australia was at an all-time peak, due to an ABC (our national TV broadcaster) expose of, among other things, the financial conflicts of interest of US panel guidelines. Of course, these US recommendations have flow-on effects around the world.

This TV program, ‘Catalyst’, unfortunately had its own substantial journalistic faults which I analyse in Schwitzeresque fashion at https://theconversation.com/viewing-catalysts-cholesterol-programs-through-the-sceptometer-19817

However, it did bring the over-prescription of statins to our nation’s attention.
[Dr Justin Coleman is President of the Australasian Medical Writers Association]

Membre du FORMINDEP posted on November 30, 2013 at 10:05 am

Hello, in France, there is one association named FORMINDEP (INDEPendant inFORMation) who try to show to the public that conflits of interests are deleterious.

The french law ask any health profesionnal to give his links of interests when he talk about any health products.
But NOBODY in France, whatever the medias, obeyed this law until now (except some members of some independant associations, a drop in an ocean)

Most doctors think that this is a useless shame to lose time with this disclore of links of interests. They prefer to talk from the shadow, asking people to trust them on their big prestigious tittles.

Membre du FORMINDEP posted on November 30, 2013 at 10:20 am

People who said ” there is NO commercial interest in the story of statins dont live on the same planet than me.

Statins are one of the 3 most profitable drugs in all time of drug industry.
Just the LIPITOR earned 120 billions dollars in 14 years.
And it is just ONE of the many “me too” statins, that all want their share of the market.

The adverse effects were hidden from the view of people and doctors before 2008.
In 2012, the FDA added some new adverse effects than the industry had denied for 20 years.

The statins ARE NOT safe. This is a plain lie, when you are aware of the medical litterature.

Of course, some meta-analysis payed by the statins industry said exactly the countrary.
But their is still a lot of independant searchers who try to tell the truth about statins since 1990, and about cholesterol long before that time.

The cholesterol myth is full of vested interests and is one of the most successuf commercial disease mongering.

http://www.bmj.com/content/347/bmj.f7110?tab=responses

Cholesterol Lowering, Cardiovascular Diseases, and the Rosuvastatin-JUPITER Controversy. A Critical Reappraisal. http://archinte.jamanetwork.com/article.aspx?articleid=416101

Mikkel BORCH-JACOBSEN, “Big Pharma”, Les arènes, 2013
Ben GOLDACRE, “Bad Pharma”, Fourth Estate, 2013
David HEALY, « Pharmageddon », University of California Press, 2012
David MICHAELS, « Doubt is their product », Oxford University Press, 2008
Jeremy GREENE, “Prescribing by numbers”, John Hopkins University Press, 2007
John ABRAMSON, “Overdo$ed America”, First Harper Perennial Editions, 2005
Ray MOYNIHAN, “Selling sickness”, Allen&Unwin, 2005
Marcia ANGELL, « The truth about the drug Companies », Random House, 2004
Jay S. COHEN, « Over Dose, the case against the drug companies », Tarcher/Penguin, 2001
Lynn PAYER, “Disease-Mongers”, John Wiley&sons, 1992