The term Pharmageddon almost appears to be created specifically for the marketing of statins. Look at the facts.
Forty years ago Ancel Keys sold the concept of cholesterol etiology of cardiovascular disease to the powers that be in Washington and the war was on - the misguided war on cholesterol. Starting in the mid-fifties anyone walking counter-current to this philosophy was considered un-informed and seriously behind the times.
Prior to my retirement from Family Practice I wrote thousands of prescriptions for whatever cholesterol buster was in vogue at the time. I lectured at high schools, men's clubs and to each of my sometime skeptical patients on the evils of eggs, whole milk and butter. I raised my family on no eggs, skim milk and margarine, so convinced I was that for every 1% of cholesterol lowering, we would gain two more years of productive life. Like all of my peers I was riding the anti-cholesterol bandwagon. Who wouldn't? You give cholesterol to rabbits, they get atherosclerosis. You take cholesterol away, the atherosclerosis disappears. What more proof do you need?
None of us was scientist enough to know the difference between natural cholesterol of angelic disposition and its devilish oxy-cholesterol brother that blocked rabbit arteries with such ease. All of us were looking for better ways to lower cholesterol. Well meaning men would spend their lives trying to sort out which of the many lipid components floating about our blood stream was the biggest enemy. We were delighted when drug company scientists discovered the reductase step along the biochemical path to cholesterol synthesis. Suddenly we had a meaningful weapon.
We had been chipping away at cholesterol for 30 years without doing much good. On the other hand we had not done much harm either. We needed that big gun and the billion dollar statin industry was on! None of us even bothered to look in our dusty textbooks to find out just where this reductase step was located and what things other than cholesterol might be involved when we knocked over that one domino. Merck had a few good men then and they even filed for a CoQ10 patent so they could combine their Zocor with CoQ10. That should have aroused our suspicion then but it didn't.
Not only were doctors convinced but they had the whole world convinced that cholesterol was our enemy. We could use the cholesterol word to frighten small children. Within only a few years millions of people were on statins. A few had unusual reactions. Some of those, including myself, started to really research these statins, suspecting the drug company had not done its job adequately or might have tweaked the data just a bit. We were right on both counts but how to tell the world?
It would have been smart to look into the whole statin side effect issue then but we didn't. Only in the past few years has the true legacy of statins emerged and no wonder doctors do not want to look at it.
Then came news about cholesterol's possible irrelevance. Statins worked, it seemd to many, not by cholesterol reduction but by their powerful anti-inflammatory action. Atherosclerosis was an inflammatory process and the proper treatment now was anti-inflammation. Study after study proved this effect of statins. They worked better than anything else available for vascular inflammation and could be used successfully for almost anything having an inflammatory component.
The new cholesterol disease was rapidly disappearing. In its place was rising a new edifice to the role of inflammation. How best to handle this confusing fact from the viewpoint of the drug industry? Pretend it isn't happening! Keep the doctors focused on cholesterol as long as possible, for billions of dollars are at stake, and if we play our cards right we might slide cholesterol out and inflammation in and never miss a statin sale.
Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor