http://www.businessweek.com/magazine/content/08_04/b4068052092994_page_2.htm

Do Cholesterol Drugs Do Any Good?

DOING THE MATH

The second crucial point is hiding in plain sight in Pfizer's own Lipitor newspaper ad. The dramatic 36% figure has an asterisk. Read the smaller type. It says: "That means in a large clinical study, 3% of patients taking a sugar pill or placebo had a heart attack compared to 2% of patients taking Lipitor."

Critics reply that this rosier picture requires several leaps of faith. A 30% reduction in heart attacks "is the best-case scenario and not found in many of the studies," says Wright. What's more, statins have been in use now for 20 years, and there's little evidence yet that the NNT decreases the longer people take the drug.Most important, the statin trials of people without existing heart disease showed no reduction in deaths or serious health events, despite the small drop in heart attacks. "We should tell patients that the reduced cardiovascular risk will be replaced by other serious illnesses," says Dr. John Abramson, clinical instructor at Harvard Medical School and author of Overdosed America.

Why the mismatch? Some of the blame goes to the way results are presented. A 36% decline in heart attacks sounds more dramatic and important than an NNT of 100. "It comes as a shock to see the NNT," says Dr. Barnett S. Kramer, director of the office of medical applications of research at the National Institutes of Health. Drug companies take full advantage of this; they advertise the big percentage drops in, say, heart attacks, while obscuring the NNT. But when it comes to side effects, they flip-flop the message, dismissing concerns by saying only 1 in 100 people suffers a side effect, even if that represents a 50% increase.

http://discovermagazine.com/2005/jun/discover-dialogue

For three decades Nortin Hadler, a professor of medicine at the University of North Carolina at Chapel Hill, has been rigorously examining statistics generated by his medical colleagues’ practices and arriving at startling conclusions about their effectiveness.

You’re 62—do you get your cholesterol checked?

H: I don’t want to know. We have data that tell me if you stigmatize me by labeling me somehow, it will change my sense of well-being. I have nothing to gain from that in this case. I would be infuriated if any doctor checked my cholesterol without my asking and told me if it was up or down. I would think that would be an abuse of science that offered me a chance of feeling less well for no good reason.

If the data are not prompting so much interventional cardiology, what is?

H: Money. Interventional cardiology is what supports almost every hospital in America—it’s an enormous part of our gross domestic product. Every year in this country we do about half a million bypass grafts and 650,000 coronary angioplasties, with the mean cost of the procedures ranging from $28,000 to $60,000. There are a lot of people involved in this transfer of wealth. But no Western European nation has such a high rate of those procedures—and their longevity is higher than ours.

Statins have been shown time and time again to reduce cv mortality in patients with existing heart disease. They have been shown to have only negligibly benefit in reducing mortality in primary prevention, that is prevention in patients with no existing heart disease. Our current practice of prescribing statins as if they are lifesaver candies (no pun intented) is very good for one party in particular- the pharma industry.

I wonder why physicians and patients dont focus on good basic health i.e. exercise, good varied diet, weight loss, smoking cessation, stress reduction? I wonder how much health care spending could be decrease if they did?