Thursday, November 13, 2008

Snake Oil and Hair Tonic

I'm all about prevention, personally and professionally. Prevention keeps bad things from happening. It's the fence that keeps the wolf from the door. It's the observant freind that picks the banana peel up off the floor before disaster strikes. It's seatbelts, vitamin C, and condoms. An ounce of it equals a pound of cure. But that depends on who pays for the study proving that the cure works.

Its all over the news today that giving Crestor, a statin drug that decreases low density lipids (bad cholesterol), to patients with no cardiovascular risk factors (in other words, no discernible reason why they should have a heart attack or stroke) in order to prevent heart attack or stroke. At first glance, this looks like great news. Think of all the lives we can save with just one little pill taken daily. Another great discovery brought to us by the pharmaceutical industry. Better living through chemistry.

What they don't tell you is that the study was funded by AstraZeneca pharmaceuticals. These are the kind folks that make Crestor, as well as drugs to treat high blood pressure, cancer, gastric reflux, pain, schizophrenia, asthma, and allergies. I prescribe their products every day to keep the wolf from my patients' doors. For the most part I think these are good and useful chemicals that help people function at a higher level than they would without these medications.

The NPR piece on Crestor today interviewed residents of Framingham, MA, the site of the longest running study on cardiovascular health ever. The good citizens of Framingham have been giving up their corpuscles to scientists for over 30 years for to help us all prevent early demise from heart disease. Through this epic bit of science we've learned that eating right and exercise can help us tremendously. We've learned that an aspirin a day keeps the cardio-thoracic surgeon away. And today we learned that Crestor will keep us from the monsters lurking under the stairs, waiting to snatch us in the light of day when we aren't looking.

Another missing detail in the NPR story was that the study was funded by AstraZeneca. They didn't let us know that the retail price of Crestor is $320.00 (costco pharmacy online) for 100 tabs (a three month supply). For a mere $32 dollars a day, lives are saved. Of course, crestor is approved by most insurance plan formularies, lists of drugs that insurance companies will cover.

I'm not saying that this isn't valuable information. We should be doing everything we can to prevent disease and disability. I want my family members, my freinds, and my patients to be vital and healthy for as long as possible. If this medication could really do the trick, I'd be handing it like a snoopy pez dispencer.

I'm a little tired of health care being run by Gordon Gecko. Maybe I'm a little bitter that the pharmaceutical industry no longer allows the sales staff to bring us free pens or take us out to lunch. I don't have a problem with the free market, but I have a problem with the free market practicing medicine.

Primun non nocere.

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