Forget the Science; Docs Already Know the Answers

Thanks to a faithful follower, I was clued into the program on Minnesota Public Radio last week:
http://minnesota.publicradio.org/display/web/2010/04/08/midmorning2
The Midmorning program addressed the recent decision of the FDA to allow a relabeling of rosuvistatin (Crestor) based on the JUPITER trial, about which I blogged several times, such as:
http://brodyhooked.blogspot.com/2008/11/by-jupiter-slick-drug-marketing-great.html
Midmorning had two guests familiar to regular readers of this blog: cardiologist Dr. Steve Nissen of Cleveland Clinic, and family physician Dr. John Abramson. Both are usually known as critics of the pharmaceutical industry. In this instance they took mostly opposing views, Nissen defending the JUPITER results while Abransom took a more skeptical view (with which the bulk of the opinions I blogged about would agree; see http://brodyhooked.blogspot.com/2008/11/by-jupiter-part-ii-more-skeptical-view.html).

Two comments on the program. While the listeners heard pro and con views regarding the reliability of JUPITER, they did not hear much about what I consider the major news from that trial, which is to knock a further hole in the lipid hypothesis for heart disease, that claims that statins prevent heart disease primarily by lowering cholesterol and that regular cholesterol testing is a critical part of good preventive medicine.

The second comment is perhaps the more important, and includes the only mention that I heard of the challenge to the lipid hypothesis (though neither Abramson nor Nissen picked upon it). During the call-in part of the program, a family physician from Marshall, MN, "Vince," offered a different perspective which he presented as representative of all of the family docs he knew. He said that all of them, on reaching age 50, if they had the slightest hint of a risk factor for heart disease, immediately put themselves on cheap generic simvastatin. Vince agreed with those who believe that the lipid hypothesis has been largely disproved, and was quite willing to say that 1) statins probably work more due to their anti-inflammatory effects and not due to cholesterol lowering effects; and 2) therefore, checking cholesterol levels with repeated lab tests is pointless. But Vince also said that he and all his colleagues were completely convinced that statins were effective for primary prevention of heart disease, they hardly ever saw any serious side efects with statins, and now with generic prices they were dirt-cheap, so why not take one?

My own point of view is that "Vince" represents a fascinating partial victory of pharmaceutical marketing over science. (Both Nissen and Abramson agreed to disagree with Vince.) He's right, I think, in debunking the lipid hypothesis. But I think his confidence that statins are so wonderful for primary prevention reflects the huge success of Pharma brainwashing (see my last post on JUPITER-related stuff, http://brodyhooked.blogspot.com/2009/07/more-on-statins-new-bmj-meta-analysis.html.) It's one of those many features of today's medicine that future medical historians will look back on and shake their heads over.