Doing less and less for more and more

4 mins read

By Steve Bien, M.D.

According to last week’s New York Times article, the latest findings from the Astra Zeneca School of Medicine are that all of us should have our C-reactive proteins tested and then go onto the drug, crestor.

In case you missed the news splash, a researcher presented data at the recent American Heart Association’s New Orleans meeting that showed a 50 percent reduction in heart attack and stroke risk for “seemingly healthy people” who took the cholesterol lowering drug, crestor. Crestor, made by Astra Zeneca, is one of a class of drugs called ‘statins’ and it has been known for a while that statins are anti-inflammatory among their many actions. In fact, this has led to the tantalizing notion that statins may do their work as anti-inflammatory rather than anti-cholesterol drugs.

The C-reactive protein test is a test for inflammation, hence the idea of having your CRP checked. Inflammation is the latest risk factor to catch medical attention. This originally came from work showing that among hospitalized patients, C-RP measurements helped show which heart attack patients were at greatest risk. It has never been shown that the average person on the street benefits from either having her C-RP measured or that taking anti-inflammatory medicine is a good, general health policy for the rest of us.

Before you call your doctor for your prescription, I recommend considering the fine print. To know how much you will benefit you need to know your current risk. A 50 percent reduction in risk sounds great, but the absolute reduction in risk was less than 2 percent, from 1.8 to 0.9 percent in the study. One hundred twenty patients would need to take the drug for two years in order to prevent one event (heart attack or stroke) for one person.

Since crestor and its ilk cost roughly $1,200 plus per year, this is not chump change. And the magnitude of benefit is less than what is seen from regular exercise and a good diet.

Of course, it is excellent business. Expanding cholesterol drugs to otherwise healthy people means a $200 billion market, and the CRP tests would add $200 million to the annual health care budget. Conflict of interest is written all over this since the study was jointly run by the makers of crestor and an office-based CRP test that is on the market.

Medicine has entered the odd place where risk factors, in this case high cholesterol, are considered a disease to treat. Millions of people are turned into “patients” taking expensive prescription drugs because they have risk factors. While the idea of thinking of risk factors should help us make healthier life style choices, we should be careful about the manipulations of the pharmaceutical industry. Having risk factors for osteoporosis is not the same as having the disease of osteoporosis and should not trigger the same treatment. There are lots of examples are out there.

We all know $700 billion is the cost of the fiscal bail out package  and that is a lot of money. $700 billion is also the amount wasted annually on unnecessary medical and surgical treatments. As I have written before, American health care statistics are stuck in the mediocre range, as measured by World Health Organization data, in large part because we throw money indiscriminately at problems when there is little return. And this ‘statin for everybody’ idea is another example of that. Meanwhile, we cannot afford the public health measures that really work.

Steve Bien is a family physician in Farmington.

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