This is the title of the cover story by John Carey in the January 17, 2008 issue of BusinessWeek.
Mr. Carey has done a thorough job of chipping away at the edifice of the conventional wisdom of cholesterol drugs. Upon seeing this article I was reminded of a quotation from William James, the late 19th century psychologist and philosopher. He said,
“A new idea is first condemned as ridiculous and then dismissed as trivial, until finally, it becomes what everybody knows.”
(I must interject here that the idea of the value of high-dose vitamin C is, by my experience, still in the “condemned as ridiculous” stage. But I digress.) It would seem that the obverse of this quote is also true that “what everybody knows” (e.g. that high cholesterol causes heart attacks) will stick around for a long time despite mounting evidence to the contrary. So first, what does Carey tell us?
The first major point is that taking statin drugs (Lipitor, Zocor, Crestor and the like) helps very few people. The Lipitor ad says "Lipitor reduces the risk of heart attack by 36%...in patients with multiple risk factors for heart disease." This statement reminds me of another favorite quote “numbers, tortured sufficiently will admit to anything”. Here’s how the statistical wizards at Pfizer came up with these impressive results for Lipitor. As Carey says “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.
Now do some simple math. The numbers in that sentence mean that for every 100 people in the trial, which lasted 3 1/3 years, three people on placebos and two people on Lipitor had heart attacks. The difference credited to the drug? One fewer heart attack per 100 people. So to spare one person a heart attack, 100 people had to take Lipitor for more than three years. The other 99 got no measurable benefit. Or to put it in terms of a little-known but useful statistic, the number needed to treat (or NNT) for one person to benefit is 100.”
Not so terrific anymore, is it. And later Carey gets to the real point, that maybe LDL cholesterol isn’t the culprit to heart attacks after all.
In discussing the pathetic NNT of statins we see that these drugs do seem to help one person in 100 treated. Well, what about this guy? In fact statins do appear to help prevent heart attacks in those with existing heart disease. But why? Carey explains this too “In his laboratory at the Vascular Medicine unit of Brigham & Women's Hospital in Cambridge, Mass., Dr. James K. Liao began pondering this question more than a decade ago. The answer, he suspected, was that statins have other biological effects.
Since then, Liao and his team have proved this theory.” He discusses this more fully in the article. This leaves us with the 800-pound gorilla that statin drugs lower cholesterol and THAT IS OF NO VALUE. And what does that imply about cholesterol and heart disease? Occam’s razor states that, “if there are a number of explanations for observed phenomena, the simplest explanation is preferred.” And the simplest explanation for why cholesterol-lowering drugs have no effect on heart attacks would be that higher cholesterol does not cause heart attacks.
For the ten-plus years that I have been publishing Cforyourself, I have been telling people that the “diet-heart” idea is incorrect. My page Saturated Facts discusses that consumption of saturated fats has declined in the same period that heart attacks have sky-rocketed. On my page about the Atkins Diet I quote the director of the Framingham Study, Dr. William Castelli:
"At Framingham, we found that the people who ate the most saturated fat, the most cholesterol and the most calories weighed the least, were more physically active and had the lowest serum cholesterol levels."
There have been a huge number of studies concerning cholesterol, saturated fat and heart disease. The data from these studies supporting the link between heart disease, dietary fat and serum cholesterol are weak at best. I refer you to two books that take a detailed and extensive look at these data. The first is The Cholesterol Myths by Dr. Uffe Ravnskov. From the back cover:
Dr. Ravnskov has done a magnificent service with a scholarly book that gathers a vsst body of impressive evidence and will surprise many with the true facts from research studies. The book is a must reading for all interested persons and certainly should be required reading for nutritionists and all physicians that treat patients
- Ray H. Rosenman, MD
Former Director of Cardiovascular Research in the Health Sciences program at SRI International; former Associate Chief of Medicine, Mt Zion Hospital, San Francisco, Ca
The second book is The Great Cholesterol Con by Anthony Colpo. In this large volume Colpo tells a much more comprehensive story than in The Cholesterol Myths. From the forward by Uffe Ravnskov:
In this timely and urgently needed book, Colpo starts by pointing out the many contradictions inherent in the lipid hypothesis. Meticulously, he dissects the numerous fallacies of the anti-cholesterol campaigners and highlights their blatant misuse of statistics. Colpo presents the reader with numerous examples of how these campaigners have misleadingly presented insignificant findings as ‘strong evidence’ and kept quiet or explained away any finding that runs counter to their pet hypothesis.
Before I leave you, I must talk about one area of Carey’s article where I take exception. When discussing the NNT of drugs he says “[i]f we knew for sure that a medicine was completely safe and inexpensive, then its widespread use would be a no-brainer, even with a high NNT of 100.” This statement shows that even Mr. Carey can be naive. Vitamin C is completely safe and inexpensive and, if looked at its total impact to state of health, it has an NNT of 1.
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