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The latest all-purpose product

MagazineFebruary 2002 (Vol. 12 Issue 11)The latest all-purpose product

Doctors are enthusiasts, who often seize upon an all-purpose product - the type of gadget that claims to hoover your livingroom, cut your grass, wash your dog and put out the rubbish

Doctors are enthusiasts, who often seize upon an all-purpose product - the type of gadget that claims to hoover your livingroom, cut your grass, wash your dog and put out the rubbish.

Nothing illustrates this better than statins. At the moment, statins are the most popular girl at the prom. Statins are being used to lower cholesterol, prevent osteoporosis and senile dementia. Statins are already making drug companies a fortune. But today's profits are about to pale into insignificance. Get set to witness as statins get crowned undisputed prom queen.

Professor Rory Collins, co-director of Oxford University's Clinical Trial Service Unit and lead investigator of the Heart Protection Study (HPS) in Oxford, recently waxed lyrical, declaring that statins were the 'new aspirin'.

Speaking before the American Heart Association's Scientific Sessions 2001 in late November, Collins announced the results of the study he led of more than 20,000 people at high risk of coronary heart disease who were given statins over five years.

The HPS study supposedly demonstrates that routine use of cholesterol-lowering drugs in patients at high risk of vascular disease can reduce the incidence of heart attack and strokes by a third.

According to Collins' evidence, five years of statin treatment can prevent heart attacks, strokes or other major vascular events in one in 10 people who have had a heart attack, eight in 100 people with angina or some other sign of coronary heart disease, seven in 100 people who have ever had a stroke, and seven in 100 people with diabetes.

Collins says his evidence moves statins outside the sideshow arena of cholesterol-lowering, placing it firmly into the centre ring of preventative heart and vascular disease.

If an extra 20 million high-risk people around the world had statin treatment, he estimates, it would save about 50,000 lives each year. That translates into about 1000 lives saved a week.

Statins were even compared with an antioxidant mix, which was found to have no protective effect and nothing like the effect of this wondrous drug.

I've seen these kinds of studies before. In the case of the comparison with the antioxidant mix, for instance, the levels of the supplements (250 mg of vitamin C per day and 20 mg of beta-carotene) were so low, they might only help to prevent deficiency diseases like scurvy. The patients were also not following any holistic lifestyle changes, such as a change in diet or exercise. This is what is usually referred to as a stacked deck.

What is worrying is the utter disregard for all the latest evidence about the dangers of statin drugs. It may turn out that statins have a place for certain patients with diabetes, narrowed arteries in the legs or a previous history of stroke. But, undoubtedly, the study will act as a rationale for doctors to hand out statins to all sorts of people who have normal cholesterol levels - indeed, have nothing whatever wrong with them - in the name of preventative medicine.

Collins points out that his data provide the first evidence that statins work for women and the over-70s - a fact that hasn't prevented doctors up until this time from prescribing these drugs to both these classes of patients.

Collins doesn't simply stop at saving lives. This drug could avoid the need for arterial surgery, angioplasty and amputations in many patients. This is a drug, he says, that could 'change medical practice'.

This, in other words, is another magic bullet - that will mow your lawn, feed your bird, and halve your housework time - only, in this case, it's supposed to replace the need for exercise, the right food and supplements and, in general, clean up your messy and unhealthy lifestyle.

I don't like to dampen anybody's enthusiasms. But one of these days, I feel I ought to have a word in a few ears about not believing everything you hear from door-to-door salesmen.


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