|March 2007 - Column:||
Medicine — Science, art or marketing?
My friend Don asked me a few weeks back what I thought of “statins”, the miracle drug for cholesterol. He said his numbers were a “little high” but his HDL or good cholesterol was 70 mg/dl—a value to “live” for! Now Don is a gym rat, sort of like Bob TerHaar, who works out six or seven days a week; he played competitive full court basketball till age 55 when his knees gave out. Though Italian by ancestry, he watches his diet religiously. Does he need medication for the rest of his life, or are the costs and risks of adverse reactions greater than the benefit?
Another friend, I will call him Jim (believe it or not, I have more than one friend), asked about the “cash” cost of his and his wife’s medications as they near retirement and have to make health insurance decisions. The monthly cost was over $400 per month, though both are relatively healthy and work out at the Fitness Center on a regular basis. One of Jim’s more costly medications was Celebrex. Jim needed this medication for osteoarthritis in his knees and was convinced that this drug was “easier on the stomach” than less costly generic anti-inflammatory drugs. Truth or fiction?
Another friend Gary (I am getting close to the end of my list), is considering back surgery using a relatively new experimental procedure. The advantage is a shorter rehab time thus a quicker return to the golf course (whether his game improves is doubtful!). The procedure is very expensive with no guarantees, and his insurance will probably not cover much of the cost. What is the cost benefit of this surgery compare with “standard” back surgery? Hey, I am just a pharmacist, don’t ask me!
New Research Results
An article in the prestigious New England Journal of Medicine compared the more costly drug-coated stents with bare metal stents in patients undergoing angioplasty (or PTCA). It has been widely believed that the “new and improved” drug-coated stents would reduce the chances for restenosis (or reclosing) of the arteries.
The results of their analysis of almost 5000 patients: no increase in survival, no decreased risk of heart attack and increased risk of thrombosis (or blood clots) with the more expensive drug stents! This requires even more expensive drug therapy such as Plavix to prevent the blood clots!
Two articles appeared in the AJC recently. One reported on the results of a large Danish study of over 250,000 patients. Their conclusion was that there was no medical evidence that Vitamin E or other antioxidants provided any health benefit, and in fact, may increase the risk of death.
Previous studies demonstrated that high doses of Vitamin E (> 400 IU) increase the risk of cardiovascular death. Yet one in four Americans take one or more of these supplements every day (I am one of them, though in low doses)!
The second study reported that contrary to previous preliminary reports garlic in its raw or supplement form taken for six months does not decrease your cholesterol though it may have other health benefits. It appears that oatmeal will lower your cholesterol more than garlic, and you will have more close friends!
USA Not #1 In Health!
Why are Americans whose health is at the bottom of nearly all developed nations, paying more for that distinction? Did you know that we spend $2 trillion dollars on health care, or 16% of our total gross domestic product? And that is prior to the impact of the “baby boomers”! It is no wonder that Medicare is projected to go broke by 2018. What is causing this crisis in medicine?
The answers to some of these questions can be found in a book I recently read by Dr. John Abramson called “Overdosed America: The Broken Promise of America Medicine”. He is a family doctor with a strong research credentials. He discusses statins, hormones, Celebrex/Vioxx, hypertension and other areas of medicine and surgery. As a health care professional, I had to agree with most of his observations and assessments.
The basic premise of the book is that prevention is more cost-effective than intervention. Which “treatment” can best reduce your risk of stroke and heart attack—diet and exercise, eating salmon twice a week or taking a statin (or Zetia) every day? That study has not been done, but results from individual studies would suggest that the benefits would be comparable though the costs vary considerably.
Dr. Abramson makes a plea for more unbiased “evidence-based” medicine that relies more on science and not subtle marketing and influence from pharmaceutical companies. There are miracle drugs and many of my close friends and colleagues are in the industry, but there is no substitute for a well-designed research study comparing a new drug (or procedure) to the gold standard before widespread implementation.
The book is a “good read” if you are interested in health, and some book clubs may want to consider it as it will generate a lot of discussion. It will teach you to stay in good health as long as you can, don’t jump on the bandwagon too soon, and get a second opinion from an “expert” prior to making a major health decision.
Dr. Anderson is a retired Professor from Mercer University, a sometime pharmacist at Walgreens Pharmacy and full-time resident of Big Canoe.
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