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Altered Reality – Are Declining Cardiac Death Rates Attributable to Drugs?

Sometimes I feel like I live in an alternative reality. This seems particularly true when promoting certain drugs for asthma, hypertension or high cholesterol. What do these chronic conditions have in common?  For all, there is ‘big buck’ value to providing medications to people who are sick.

Reality depends on which side of the fence you stand on.  If a pharmaceutical client markets an ACE inhibitor, the medical writer’s reality is that ACE inhibitors are ‘knights in shining armor’ that protect people with hypertension from heart disease, kidney failure and death. However, if my client markets an ARB,  I am waving the flag that calls for the’death’ of ACE inhibitors, suggesting to providers that their patient’s chance of survival will increase if they take an angiotensin receptor blocker. And of course, telling doctors over and over again about the “high incidence” of cough reported in patients taking ACE inhibitors.

If it turned out that exercise and diet were more effective than prescription medications at prolonging life, medical advertising writers would quickly be out of a job. Instead, I am part of an industry that uses inference and speculation to persuade physicians, policymakers and consumers that the discomforts of life, aging and disease are easily avoidable if one takes the right pill.

Even academic researchers are prone to drawing conclusions that are not completely supported by the facts. A Canadian study published in June 2009 analyzed mortality data from Canada’s Canadian Mortality Database and Hospital Morbidity Database from 1994-2004. The death rate from cardiovascular disease in Canada declined 30.0% during this 10 year period. In trying to determine the reason, the study author speculated that the drop in death rate was due to declines in smoking rates, and “increases in the use of medications to lower cholesterol”.  An article published in 2007 in New England Journal of Medicine attributed the drop in cardiac death rates that occurred among U.S. adults 25 to 84 years old between 1980 and 2000 to “specific cardiac treatments” and on changes in risk factors. Like the Canadian article, the authors relied largely on statistical models to support their conclusions.

However, the reality is that mortality rates due to coronary heart disease and sudden cardiac death have been falling in the United States for over fifty years. While we hear repeatedly in the news that heart disease is the leading cause of death in the United States (652,091 people died of heart disease in 2005), we rarely hear about the decline in death rates that have occurred since the 1960s. This decline in cardiac mortality, reported in Circulation, started long before the introduction of statins, ACEs or ARBS.

I am not advocating you rise up and throw away your Lipitor and Diovan. I only advocate for a health care information system where information flows freely, that gives all sides of the story, and where we are not so quick to assume that there’s a pill for every ill. The ‘dumbing down’ of medical communications has serious consequences. While prescription medications can be life saving, there are times where they are not the panacea they appear to be.

One Comment

  • Rational Vs Irrational on Jul 21, 2009 Reply

    hey lydia

    its alwayz sumthng new on ur platform but u really seems to be a little prone to dislike pharmaceutical industry..havnt read all ur blogs …but isnt it tht we hav less infant deaths, now we dont c ppl dying of simple infections, etc

    btw…i m a pharmacy student (conflict of interest as u may say ..hahah)

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