In last week’s post, I introduced the discussion about preventive drug therapy and the critical need to partner with your doctor on these decisions. I used cholesterol lowering statin drugs as an example. In considering statin therapy, it’s wise to start with three questions:
1. What is the benefit on healthy patients with risk for heart disease?
2. What adverse effects are associated with statin treatment in heathy persons?
3. Do the potential benefits outweigh the potential risks and side effects?
Let’s start with the first question. What’s the benefit of statin therapy to prevent heart disease and save lives? How I communicate the answer to that question could have a profound effect on your decision to take one of these drugs. I could say, “these drugs decrease your chance of having a heart attack or stroke by 20%” which is the approach almost always used by statin advocates or I could say “140 people would have to take a statin for 5 years to prevent a single heart attack or stroke without any significant reduction in overall mortality.” The second statement, while accurate, conveys much less benefit and should have you very interested in the risks of these drugs.
Statistics are very tricky, even for the “experts”, many of whom do not engage in direct patient care and have no training in statistical analysis. Also, many of them receive money from drug companies for promotional efforts which is bound to cause some bias even if subconscious. Finally, most of the studies on which they base their conclusions about statins are drug industry sponsored and therefore notoriously biased. An example which you can easily look up is the so called “Jupiter” trial which was dismantled in the Archives of Internal Medicine and elsewhere for being discontinued prematurely and for commercial bias. This trial continues to be used in setting guidelines.
Is there some vast conspiracy out there to get you to take a drug that has inadequate benefit to offset it’s risks? No! Humans simply want easy solutions to their problems – “isn’t there a pill for that, Doc?” Doctors want to make their patients happy and definitely don’t want to spend the time to coach someone through behavior change. Drug companies, like all companies, want to make money. Do you see how that triumvirate would lead to lots of people taking statins when they should stick to the basics:
Exercise, eat healthy food, get plenty of sleep and don’t smoke, get some rest and recreation!
Sound hard? All worthwhile life changes are difficult but once habits change it is not nearly so hard to maintain and I’ve never heard a successful changer say it wasn’t worth it. The doctors and trainers at Trinity Medical/Vitalsigns would love to help you set and reach goals in 2014 and keep you off unnecessary medications!