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Friday, January 26, 2007

Statins over-prescribed, Harvard doctor says

Dr. John Abramson argued in his 2004 book "Overdosed America" that pharmaceutical companies are distorting medical knowledge. Now he writes in a medical journal that too many people -- healthy women of any age and men over 65 -- are taking statins without proof they need them.

A clinical instructor at Harvard Medical School and former chair of family practice at Lahey Clinic, he questions National Cholesterol Education Program guidelines recommending the blockbuster drugs for people who may have high cholesterol but don't have clogged arteries.

Commenting with Dr. Jim Wright of the University of British Columbia in the Jan. 20 Lancet, he says there's no proof that statins prevent heart attacks or strokes in healthy people, yet high cholesterol numbers are enough to prompt a prescription. We called him, and here's some of what he said:

Q. Where did the NCEP recommendations come from?

A: The full report is 284 pages. Near the back, talking about women, it says "the rationale for therapy is based on extrapolation of benefit from men of similar risk." We know you cannot extrapolate from men to women. ... And there are no gold-standard clinical trials that show benefit for older men without a history of heart disease.

Q. What about people who do have heart disease?

A. There is good evidence that statins are beneficial for secondary prevention but there's even better evidence that living a healthy lifestyle is even more effective than taking a statin, though they are not mutually exclusive. Don't think that by taking your statin you are doing everything you can do to reduce your risk of heart disease.

Everyone is focused on cholesterol, not on real epidemiological facts of what the risks are.

Q. Why?

A. The guidelines that create the clinical imperative for physicians are done by experts who have financial ties to drug companies that make the drugs being considered in the process. Fifty-nine percent of the experts who formulate the guidelines have financial ties.

In a meta-analysis of statins in the October Lancet, 13 out of 14 studies were commercially sponsored. The one that was not commercially sponsored showed distinctly less benefit from statins.

Q. What about you? The Lancet says you are an expert consultant to plaintiff's attorneys on litigation involving the drug industry, including Pfizer for its marketing of atorvastatin.

A. That's right.

Posted by Elizabeth Cooney at 10:06 PM
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