Map of life expectancy at birth from Global Education Project.

Friday, December 01, 2006

I'm not exactly sure why this bothers me . . .

Statins would be a drug company exec's dream, if there weren't already perfectly good generic ones available, cheap. The official recommendation is that a large portion of the population take them, every day, for the rest of their lives. That sounds like it means big bucks for somebody but actually, generic statins are now cheaper than the daily paper.

Until recently it wasn't proved that statins really improved life expectancy for people who didn't already have heart disease -- it was just surmised from their effect on the blood lipid profile, i.e. they lower your low density lipoprotein ("bad cholesterol") and raise the HDL ("good cholesterol"). But this large, randomized trial in the UK, along with other evidence, is starting to make it pretty clear that taking cheap, generic statins is well worth it even for people who aren't at particularly high risk for heart attacks. (Please ignore those ads you see on TV for expensive products that are still under patent protection -- they aren't in fact worth it for most people. The companies are just trying to convince you not to take the cheap stuff.)

In fact, I take lovastatin every day. I don't have heart disease, I'm in good physical condition, and I have a pretty good diet. But I still had a fairly high LDL count (it's familial), my father has had a stroke, and my father's father had heart disease, so my doctor felt I should do it. (By the way, it is increasingly the opinion that statins don't only work through their effect on cholesterol. They apparently have other benefits as well, probably through anti-inflammatory properties. Inflammation is now thought to be an important risk factor for vascular disease.)

So, what's wrong with that? Of course, for very poor people, even 25 cents a day is out of reach, but the world is already unjust. Taking a pill might make some people think, okay, that's taken care of, now I don't have to worry about what I eat or getting enough exercise or quitting smoking, and that wouldn't be true. But that doesn't mean that the pill isn't still beneficial for those of us who also do other things right, because according to this British study, it is.

There's still something about the idea of giving everybody a magic pill, even when they aren't sick, that feels a little bit off. But then I thought, why is it different from vaccination? Or nutritional supplementation of the food supply? (As I assume you know, by law milk in the U.S. is fortified with Vitamin D, and wheat flour is fortified with B vitamins. Folic acid was recently added to the requirement, which should have large payoffs for public health.)

Statins do present a risk of a rare but pretty serious side effect called rhabdomyolysis, but that is far outweighed by their beneficial effects. And if you recognize it early, the ill effects should be reversible. Vitamin supplementation does not present such risks, but still, I'd rather have a low risk of suffering rhabdomyolysis than a more substantial risk of heart disease.

This is a new world -- routinely giving powerful medications to large numbers of healthy people -- but apparently it's one we'll have to get used to. I can't really think of any valid objection to it. How about you?

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