A study by a group led by one Dr. Darrell Francis of Britain’s National Heart and Lung Institute recently made headlines with its recommendation that fast-food joints hand out cholesterol-lowering drugs known as statins to any patron who wants them, free of charge. Popping a statin with one’s Whopper and shake, the study’s authors claim, would help to neutralize their heart-unhealthy effects. Apparently, this is not meant to be a joke.
The call to fortify fast-food meals with statins—a class of medications that includes Crestor, Advicor, Lipotor, Zocor, and other brands—is merely the latest absurd proposal to inappropriately medicate wide sections of the population with these drugs. In 2004, a physician called Dr. John Reckless lived up to his name by suggesting that the water supply should be spiked with statins. When questioned by the BBC about the risks this might pose to children, he allowed, “You might well have statin-free baby water so that babies and others not at risk don’t take their statin.” Is he being too conservative? Perhaps the American Academy of Pediatrics thinks so—they have issued guidelines recommending the use of statins in children as young as 8 and blood-cholesterol testing for 2-year-olds.
But surely, the foundation of evidence for statins’ safety and efficacy must be rock solid if all these prestigious researchers and cardiologists are advocating feeding them to the old, the young, fast-food-eaters, the at-risk, the not-so-at-risk, and surely soon, infants, dogs, and your car’s gas tank, right?
In fact, serious questions have been raised over statins’ purported benefits.
While statins’ benefits are most firmly established for patients with already-existing heart disease, more and more healthy patients with various levels of risk for heart disease are being prescribed these drugs as a preventive measure, and their widespread use is considered by many to be a breakthrough in heart disease prevention.
The drive to medicate the wider public with statins was turbocharged with the widely-reported publication in 2008 of a large clinical trial called Jupiter. Hailed as a landmark study, Jupiter purported to show that statins conferred significant benefits even for those not considered to be at a high risk of developing heart disease.
But the conclusions of that study were called into question by four papers critical of Jupiter appearing a recent issue of the Annals of Internal Medicine. One of these papers, authored by a group led by Dr. Michel de Lorgeril, questions the way the trial was constructed and suggests that bias affected its conduct and the interpretation of its results. (The Jupiter trial was funded by AstraZeneca, which manufactures Crestor.) Another article analyzes previous trials and found no evidence that statins are useful as a preventive measure in those who have not yet developed heart disease. (See this post in the excellent blog Junkfood Science for an in-depth critique of the Jupiter trial.)
Statins’ safety has also been called into question. Their most well-known side effects are muscle pain and cognitive symptoms sometimes described “brain fog”. Uncommon but more serious side effects include liver and kidney damage. While statins’ adovcates insist that these symptoms are rare, some have suggested that incidents of side effects are under-reported because physicians tend to dismiss their patients’ complaints rather than report them to the FDA. Indeed, Senator Charles Grassley, after conducting his own investigation, has called on the FDA to reconsider its assessment of statins’ safety.
Consider another media-hyped class of blockbuster drugs, the antidepressants known as SSRIs, a group that encompasses Zoloft, Paxil, Effexor, and most famously, Prozac. Drug companies aggressively promoted them to physicians and the public, leading to millions of SSRI prescriptions and stratospheric revenues. Yet some observers have questioned the value of these drugs. In 2008, a group of researchers analyzed 47 clinical trials of SSRIs and concluded that they are only marginally effective for the severely depressed and yield no benefit whatsoever for those with mild to moderate depression, who are the vast majority of those prescribed SSRIs. But don’t expect Pfizer to hand out refunds anytime soon.
It’s possible that at some point in the future, statins will be viewed in a similar light—modestly beneficial for those with heart disease or at the highest risk of developing it, but well-nigh useless, and perhaps dangerous, for everyone else. It’s also possible that the claims of statins’ boosters will be vindicated as their safety and benefits become better established.
But until the controversies over statins’ safety and usefulness are cleared up, it’s probably best to hold off on dosing the entire world population with these drugs.
Better yet, instead of letting Big Pharma and Big Food continue to ensnare the public in a toxic but highly profitable cycle of disease and medication, it might be better to work towards eliminating the entire perverse system of government subsidies that makes unnatural, disease-promoting manufactured foods so cheap and keeps natural, whole foods out of reach of people with moderate to low incomes.
In the meantime, hold the statins, please.