USA: Is That Cholesterol-Lowering Drug Needed, asks Harvard Doc

BOSTON (BOSTON HERALD), JUNE 19, 2005:

Doctors are overprescribing cholesterol-lowering drugs and millions of Americans - particularly women and seniors - are needlessly taking the so-called statins, fueling a $16 billion industry, according to a Harvard doctor. "The real problem is that all these people who are taking statins who are going to get little or no benefit are being misled into thinking that they are doing the right thing to prevent heart disease," said Dr. John Abramson, a Harvard Medical School clinical professor and author of "Overdosed America," which criticizes the drug industry. Statins are the biggest-selling class of drugs in the world and the most commonly prescribed drugs for lowering cholesterol. Lipitor is the bestseller In 2000, 13 million Americans were on statins. But a year later, the National Cholesterol Education Program and the federal government's National Heart Lung and Blood Institute issued new guidelines on cholesterol with the goal of tripling that number to 36 million. And they increased that target population by millions more in 2004. It was later learned that eight of the nine experts who helped write those 2004 recommendations had financial ties to companies that make statins, Abramson said. "American health care may not be the best at improving health most effectively and efficiently but it is certainly the best in the world at generating profits for the drug industry," Abramson said. In his research, Abramson found that statins benefit "very high-risk men and people who already have heart disease or diabetes. But he found not even a shred of evidence from randomized controlled studies that women or people over 65 who don't have heart disease or diabetes benefit from statins. Experts have estimated about a third of the Americans taking statins fall into that category. That's because there is money to be made by "pushing drugs," Abramson said. Medical journals and research depend on drug company money, he says. "There's very little money to be made by the medical industry by pushing a healthy lifestyle," Abramson said. Abramson points to a 2000 New England Journal of Medicine article that said there was a 19 percent reduction in stroke risk in people who had taken the statin Pravachol compared to those given a placebo. But when he examined the numbers, he found that if 1,000 "post-heart attack" patients took Pravachol for a year, there would be about one less stroke. A representative from Pfizer, the company that makes Lipitor, did not return calls. But NEJM Editor Jeffrey Drazen responded in an e-mail: "The articles reported that pravastin has a moderate effect in reducing the risk of stroke in patients with coronary heart disease . ... This finding remains valid." Dr. Marcia Angell, a senior lecturer at Harvard Medical School and former NEJM editor, supports Abramson's argument. "I think these drugs have been oversold and that many of the people who are doing the selling have conflicts of interest," Angell said. Angell said when she was at NEJM, companies that advertise in the journal never affected editorial decisions. "But these studies themselves, I believe, are often biased in their design by the sponsors," she said.

By Jessica Heslam