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Why Falling Cholesterol Trumps Cancer Rising – The Galileo Factor and Pharma Marketing

Today, we take it for granted that high cholesterol is a risk factor for coronary heart disease. This medical wisdom is so pervasive that USA statin sales were $14.5 billion in 2008, according to IMS.

I don’t plan to use this blog to debate cholesterol risks or statin benefits. However, based on my experience, the pharmaceutical industry was a contributing factor to the worldview that believes high (LDL) cholesterol is bad regardless of age, sex, race, and/or personal or family medical history.

Copernicus feared expressing his view that the sun, not earth, was the center of the universe. Galileo published a book about it, but recanted his position to spare being burned at the stake (although he did spend the last 8 years of his life under house arrest!). While today’s clinicians and researchers are unlikely to face such harsh punishment for questioning the status quo, there’s a lot more visibility for medical experts whose opinions align with the drug industry’s vs. those who oppose it. If a medical thought leader’s point of view of therapy can be leveraged to sell a drug or disease, it is likely to see a drug company providing funds to help this physician speak out. The opinions of those with opposing views are less likely to be heard.

Lovastatin, the first statin, was approved by the FDA in 1987. Pharmaceutical companies  now were challenged to create a demand for these agents. The problem, however, was that many doctors did not consider high cholesterol a major health issue.

A survey of 1,610 physicians conducted by the National Heart, Lung and Blood Institute in 1983 showed that 91% of doctors said quitting cigarette smoking would lower the risk of heart disease, 86% stated that treating high blood pressure could help lower heart disease rate, but only 40% of physicians surveyed said that lowering high cholesterol lowered risk of heart disease. Just three years later, the updated survey revealed a considerably higher number of physicians – 64% – now believed that reducing high cholesterol levels would reduce heart disease.

Although publication of the LRC-CPPT study in 1984 and the formation of the Adult Treatment Panel (ATP) to develop cholesterol guidelines contributed to our health system’s focus on high cholesterol, the pharmaceutical industry contributed heavily to this ‘re-education’ effort. Drug companies aggressively publicized findings from studies like Framingham Heart Study and MR FIT (Multiple Risk Factor Intervention Trial) that support the benefits of lowering cholesterol, and I myself was involved with creating cholesterol slide decks for thought leader speaker programs  when I worked in medical advertising. However, while we continue to hear about statin benefits, we tend not to hear from highly acclaimed researchers with less favorable opinions.

For example, consider a study on cholesterol reduction and life expectancy published in Annals of Internal Medicine in 1987 stating that a lifelong program of cholesterol reduction in low-risk persons aged 20 to 60 years would provide a gain in life expectancy of 3 days to 3 months. The authors calculated gains ranging from 18 days to 12 months for high-risk patients.

While MR FIT was touted for demonstrating that lowering serum cholesterol reduced cardiac risk, doctors were less likely to hear about an analysis of MR FIT published in 1992 by Neaton et al in Arch Intern Med showing increased cancer rates in adults with cholesterol levels less than 160 mg/dL.

We have known about this relationship between cholesterol and cancer for over three decades. In an article entitled Cholesterol, Coronary Disease, and Cancer published in 1981 in JAMA, the renowned cardiologist (now deceased) Richard J. Jones reported that any reductions in coronary deaths due to cholesterol lowering were accompanied by an equally large increase in fatal cancers.More recent concerns about the link between low cholesterol and cancer risk were reported in the SEAs study (Simvastatin and Ezetimibe in Aortic Stenosis), while an article published on August 26, 2008 in the Canadian Medical Association Journal showed increased cancer risk in patients with type 2 diabetes mellitus with LDL cholesterol (less than 108 /dL) or high LDL (147 mg/dL or above).

Some day in the future our views about drugs and diseases will be very different from what they are today. However, that will require a radical change in the ways that healthcare information is developed and disseminated. American healthcare is driven largely by the dictates of industry.  As long as this is the case, let us be grateful for researchers and public health specialists who like Galileo are not afraid to speak out, whatever the consequences, whatever the cost.

5 Comments

  • SurveyTool on Oct 15, 2012 Reply

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  • Bobby Reduces His Cholesterol on Aug 05, 2010 Reply

    High cholesterol level is considered to be a risk factor for the development of heart diseases. It contributes to the process of atherosclerosis or plaque formation within the wall of the arteries. This leads to serious consequences when the blood supply to an organ is restricted, due to the blockage by the plaque. Cholesterol is transported by lipoproteins in the blood stream. There are different kinds of lipoproteins with distinct functions. Supplementation with mangosteen, coupled with regular exercise and healthy diet, are found to help lower the levels of total cholesterol, triglycerides and bad cholesterol LDL (low-density lipoprotein), while raising the good cholesterol. Thank you for sharing your information.

    Cheers,
    Bobby

  • Joe on Aug 09, 2009 Reply

    Interesting food for thought, Lydia. And very well written, too.

  • Guzzo on Jul 27, 2009 Reply

    I was just thinking about this topic the other day and couldn’t help thinking how analagous it is to what we thought about HRT before we discovered the risks associated with the blanket use of Premarin(TM) in preventing heart disease and osteoporosis in women.

  • Diana on Jul 23, 2009 Reply

    Lydia, thank you so much for getting out the balancing information needed by all to make an informed decision about lowering cholesterol. I myself resisted the urging of my IM to take statins for my moderately high cholesterol for ten years.

    Too long has the American medical community given into the pressure from the pharmaceutical industry to allow for only one pov on a given treatment – theirs. I’m happy to hear another voice speaking out for a fairer, more balanced view.

    Thank you.
    Diana Devlin

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