3/17/2010

3863-inter-teas1Now most of you know that I practice in a small town. But, even here it never ceases to amaze me that I have so many patient’s taking statin drugs like Lipitor, Crestor and Zocor to name a few. Now the reason this raises a red flag is that when you work with people suffering from physical pain, you can never discount the effects of these medications when you have a complaint of pain in the back or legs.

Even here in my practice I am presented for my consideration the new patient on a weekly basis that is taking a statin. I am left to evaluate whether the patient is suffering from true back pain or is this a side effect of their medication. When the patient started taking the medication last week and the muscular based pain has come on for no apparent reason it’s a pretty clear clue to look at the statin.

Unfortunately the hurdle here is the disbelief of prescribing physician and sometimes the patient that the medication can truly cause this effect. Or the patient is afraid of stopping the medication because of the fear that an imminent heart attack is lurking around the next corner. The truth is that for over 40 million people on these expensive medications for the rest of their lives, they do absolutely nothing. According to Dr. Julian Whitaker in a recent article “Are you over age 65? Not a single study suggests you’ll receive any benefits, even if your cholesterol goes down substantially. A woman of any age? Same story. A man younger than 65 who has never had a heart attack? Ditto, no help at all. For middle-aged men who have had a heart attack, statins may lower risk of a repeat heart attack, but that’s the extent of it”.

Dr. Whitaker continues “an easy-to-understand measure that you’ll never hear about in drug ads. It’s called “number needed to treat,” or NNT, and it describes the number of patients who would need to be treated with a medical therapy in order to prevent one bad outcome. Experts consider an NNT over 50 to be “worse than a lottery ticket.”

Lipitor ads claim that it reduces risk of heart attack by 36 percent. Sounds pretty good until you look at the fine print, do the math (which John Carey did in a great article in Business Week), and figure out that the drug’s NNT is 100. This means that 100 people must be treated with Lipitor in order for just one heart attack to be prevented. The other 99 people taking the drug receive no benefit.

To put this into perspective, the NNT of antibiotics for treating H. pylori, the underlying cause of stomach ulcers, is 1.1. These drugs knock out the bacteria in 10 out of 11 people who take it, making them a reliable, cost-effective therapy. At the other end of the spectrum are statins, which as a class have an NNT of 250, 500, or higher depending on the study you look at. What a deal for drugs that can cost more than a thousand bucks a year and are almost guaranteed to cause problems ”

So there you have it 40 million people taking an essentially unnecessary medication with serious side effects. Not only are the medications unnecessary but the effect can be duplicated by naturally occurring substances like niacin at a fraction of the cost without side effects