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Columnist: Canadians spend $2B/yr on statins – much of it wasted

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My friend Alan Cassels – who publishes the Media Doctor Canada site that does basically the same thing our HealthNewsReview.org site does – had a biting column in the Vancouver Sun this week. Excerpts:

“…is there convincing proof that statins will help people with high cholesterol yet without established heart disease live longer?

The answer to this $2-billion question is a resounding “no.”

Low-risk Canadians, like the patients in this study, spend about $2 billion on statins every year.

While doctors have known for some time that statins can help people with established heart disease ward off a second heart attack, and prevent death, the alleged life-saving benefits of cholesterol drugs to healthy people has been in dispute for many years.

Let me put all of this in simple terms: At least $2 billion per year is spent in Canada on a class of drugs that have no proven life-saving benefit in the people who swallow them and which can cause considerable side effects. Against this backdrop is a strong desire for physicians and patients in Canada to obsess about their cholesterol levels.

In 2009, there were 4.7 million physician visits related to cholesterol in Canada and given that each visit involves a physicians’ fee and laboratory costs means hundreds more millions is spent managing what is not a disease, but a “risk factor” for a disease.

Cholesterol-lowering criticism used to be relegated to a smallish band of cholesterol skeptics. But no longer. Cholesterol questioning has gone mainstream. I have said this before and this recent research begs me to say this again: Someday we will look back on society’s zeal for checking and chemically altering our blood cholesterol in the same way we now regard blood letting and purging: A medical barbarity that good science cannot support.”

The Sun apparently doesn’t post online user comments – which is not altogether a bad thing. But, darn, this is one case in which I would have loved to have seen the reactions of statin-pushers. And I’d love to see more of a discussion of these issues in the US as well.

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Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.

as

July 28, 2010 at 5:16 pm

Statins may not directly improve all-cause mortality, but they clearly are effective at primary prevention of heart attacks.(A few cites below). If stopping heart attacks isn’t enough for treatment, we’re using a pretty high standard.
I deeply appreciate this site’s focus on over-treatment and medical fads, but I hope that doesn’t turn into knee-jerk retaliation against everything.
-as
Mills et al, JACC 2008: Primary prevention of cardiovascular mortality and events with statin treatments: a network meta-analysis involving more than 65,000 patients. – Reduction in all-cause and cardiovascular mortality, larger reduction in CV events.
Thavendiranathan et al Arch Intern Med. 2006.
Primary prevention of cardiovascular diseases with statin therapy: a meta-analysis of randomized controlled trials. “In patients without CV disease, statin therapy decreases the incidence of major coronary and cerebrovascular events and revascularizations but not coronary heart disease or overall mortality.”
The British NHS official Health Technology Assessment: Not only effective, but quite cost-effective in high-risk primary prevention populations.

c3

July 28, 2010 at 5:23 pm

“this is one case in which I would have loved to have seen the reactions of statin-pushers”
Hmmm, I would have been interested in the reactions of the statin-takers. I’m recalling the “women under 50 mammogram” controversy of last year. It seems the most exciting were those women who (?)unnecessarily get their breast squeezed on an annual basis. And they were upset at the prospect of NOT getting their breasts squeezed regularly.
I guess when something’s free ( or nearly so) we get upset when it taken away (or even suggested that it could be taken away).
“It not be worth much but I’m entitled to it!”

Chris Johnson

July 28, 2010 at 6:45 pm

Perhaps we should put statins in the same class as many other alternative medical treatments — proven expense, no proven benefit.

Ken Leebow

July 29, 2010 at 9:32 am

Gary,
Thank you for all the incredible information and resources that you provide.
As it relates to meds, if you watch the evening news, I find that all the pharma commercials lead to depression. Thus, I have stopped watching the evening news…except when I want a good laugh at all the sided effects they mention from the drugs they are pushing. It’s very sad, indeed.
I have learned a tremendous amount from all your reporting.
Ken Leebow

Gary Schwitzer

July 29, 2010 at 10:14 am

AS:
Thanks for your note.
I believe in the marketplace of ideas – yours and anyone’s.
So my posting of someone else’s writings should hardly be construed as my “knee-jerk retaliation against everything.”
This one little blog post has already fostered discussion – which is a good thing.

Alan Cassels

July 29, 2010 at 10:38 am

I would assert, in relation to comments made by as, that just measuring the effects of statins on heart attacks (where there is some margin of benefit in high risk patients) without regarding overall mortality, can be an exercise in self-delusion. What if the reduction in heart attacks, is matched by an increase in other types of deaths (cancers, for example) by taking statins, would that be considered an overall medical advance? I would call that disease substitution, not disease avoidance. That’s why it is important to look at overall mortality when considering the benefits of any drug you take over the long term. The NHS’s statement that statins are effective and cost-effective in “high risk populations” refers to those people who have established heart disease. My research is that about 80% of the people who daily take statins are not in this category, but are, as I wrote, in the category of people who see no overall lifesaving benefit. Can we think of a more egregious example in the history of medicine where so much money has delivered so little health?
Alan Cassels

as

July 29, 2010 at 4:58 pm

I’m sorry if my post came off as overly-snarky.
Mr Cassels – ‘Primary prevention’ means people who have not had events. ‘High risk’ means people with risk factors (high cholesterol, diabetes, etc) but no events. Every study that I cited was high risk primary prevention. W/r/t “so much money, so little health” – the NHS called statins for high-risk primary prevention cost-effective. We’ve done worse.
‘All-cause mortality’ is an extremely high bar for chronic illness, especially when it does prevent quite serious events (strokes and heart attacks) and we might improve survival, also. Statins for secondary prevention do improve all-cause mortality (Lancet, Baigent 2005), many think they improve it in high-risk primary prevention (NHS, Mills JACC) and even the study that you referenced (Ray Archives 2010) sure was close (CI 0.83-1.01). Nothing anywhere has hinted they increase mortality.
Mr Schwitzer – Normally when you disagree with a post you say so quite clearly. If I was over-reading by assuming you were agreeing with the article, I apologize.

Paul Scott

July 31, 2010 at 9:10 am

Statins lower LDL, which is is essentially a catch all for at least seven different LDL subtypes, only the smallest of which are related to heart disease. (See Krauss, Ronald.) I have also seen the data that they produce no mortality benefit. The small benefit they produce — Gary has cited the data before on the high numbers of users that must take them for the 5 years to prevent one heart attack — is likely related to their anti-inflammatory properties, as opposed to their manipulation of LDL, the majority of which, being large fluffly LDL, is benign. The fact that one of the most widely consumed medications in the world produces no mortality benefit at great cost for reasons unrelated to their purported mechanism — and that calls are continually made to expand their user pool to children and new markets — make them exhibit A for what is wrong with our health care system.