13. The Most Profitable Drug Ever Marketed

13. The Most Profitable Drug Ever Marketed

One area in which there is much deliberate confusion is the efficacy of statins, the most profitable class of drugs in history. Statins work by suppressing the liver’s ability to make cholesterol. Recall that cholesterol is needed for cellular repair, so this is a deliberate interference with a necessary body function.

There is no question at all that statins will reduce your blood cholesterol, specifically Low-Density Lipoproteins, the “bad” cholesterol (and the Apo B plaque-forming particle count in the LDL). But so will exercising 10 minutes a day. The real question is, does this reduction in LDL lead to any actual benefit in terms of risk to health, as proven in clinical studies? The simple answer is: almost none, or so little that most people who can do arithmetic wouldn’t make a decision based on the numbers in those studies.

Critical qualifier: for persons who have already had a heart attack, stroke, bypass surgery, heart failure, etc., the clinical proof for statins is stronger. If you are in this category, obey your doctor. But if all you have is “high cholesterol”, keep reading.

Most statin studies (that aren’t focused on persons who’ve already had a major cardiac event) yield a result that looks like this: Your risk of dying from any cause in 10 years if you take a statin is 2%. If you don’t take a statin, your risk is 3%. Pharmaceutical companies present this as “33% less risk of dying with statins”, and many doctors will just repeat that number or may not even know the number but will just tell you “I’m the doctor, do what I say.” Put that way, of course you would feel safer taking statins.

But the other way to put it is: “Take a statin for 10 years and you can reduce your mortality risk by 1%.” That’s a Number Needed to Treat of 100 (worse than the Cochrane Systematic Review we discussed in the previous article). These are the real-life figures, representative of the real outcome of numerous studies. Now how urgent is it to take statins, just because you supposedly have “high blood cholesterol”?

Even this 1% reduction has to be taken with some skepticism, because there are lots of ways to rig a study or fudge the reporting of its outcome. Many clinical researchers do this consciously or unconsciously in order to give results pleasing to Big Pharma and the Medical Establishment, which have a long reach in terms of future research grants and professorial tenure.

Consider the Swedish Västra Götaland (2010-2016) Study, Tobias Andersson et. al., https://academic.oup.com/eurjpc/article/30/17/1883/7208766, which at least admitted it was an observational study. Andersson identified exactly 13,193 persons who had hypertension and who had filled at least one prescription for statins. Then, to “assure a fair comparison”, his team found exactly 13,193 other persons who in aggregate matched the first group almost perfectly in terms of age, education, income, Body Mass Index, etc., except that they had never filled a statin prescription. (In Sweden, all medical care is free, so whether a prescription is filled or not is entirely a question of volition on the patient’s part.)

The publicized result? 17% lower mortality over 8 years for the statin-taking group, which had 395 deaths (3.0%) vs. 475 (3.6%). Absolute risk reduction? 0.6%. To the average person in moderate health, this is hardly worth fussing about. We routinely accept 10%, 20%, or 500% differences in mortality risk by our choice of car, profession, color of clothing to wear at night, or hotel (whether it provides nonslip shower mats; affirmative for Plantation Bay).

The plot thickens further when we look more closely at the composition of the two Andersson groups. They weren’t perfectly matched after all. The non-statin group had 10% more smokers, 200 more persons. And the non-statin group didn’t just not take statins. It also had hundreds more people who had been told to take blood pressure medication but never even bothered to get their free BP medicines. Obviously the non-statin persons were on average more cavalier about health (more smoking, more lazy refusals to take even the BP medicines), easily accounting for the 0.6% death-risk difference without needing to attribute any weight to statins.

Nice try, Dr. Andersson, but no cigar from me.

The most insidious danger of prescribing statins is that people rely on the medicine to (they believe) protect against cardiac problems, instead of doing much more useful things that would REALLY lessen their mortality risk, like losing weight, exercising, lessening stress, sleeping more, avoiding carbs, practicing gratitude, being helpful to strangers, cutting social media and phone use, and having purpose in life. If you need some help on these, Plantation Bay has several Wellness retreats you might want to consider.