Ethics in Medicine

Some sanity, at last, on Statins

Kristen Sparrow • December 11, 2010

I just attended the annual UCSF conference on Controversies in Women’s Health. This conference is well done, in that it alerts practitioners to issues that are being discussed at the “Task Force” level. For example when I was at the conference 2 years ago I first heard about the mammography controversy, that the science was showing that there was no added benefit to mammography in younger women and that there were increased harms. Of course this caused a huge uproar in the subsequent two years. I won’t go into the particulars of either side. But this was one of the first times I had actually been aware of the medical community admitting that there might be a downside to too much intervention.
This year, Professor Rita F. Redberg gave a thoughtful and informative talk on cardiovascular disease entitled “Prevention and Treatment of Cardiovascular Disease in Women:When is Less More?” Any readers of this blog know that this is an approach that I take seriously; to evaluate interventions carefully to make sure there is no harm being done, and to be highly suspicious of new, lucrative, and highly touted treatments. Dr. Redberg has a column in the Annals of Internal Medicine entitled “Less is More” and solicited contributions to the column via Deborah Grady, MD, section editor, Less is More, Annals of Internal Medicine. She asked specifically for cases, commentary, original investigation. What a great concept!
So as to the topic of Statins, I’ve been suspicious of them since the beginning because of the triad I just mentioned, new, lucrative and highly touted. My patients were coming in saying that their physicians were extremely enthusiastic about these medications, many even saying that they wished that they were in the water supply (!) (No worries, they probably are in our creeks and rivers by now, just like Prozac and antibiotics.) I also heard from patients that since they started taking them they had muscle problems and backaches. They were sure that they were from the statins, but their doctors insisted that they were fine. From Dr. Redberg’s presentation, statins do cause muscle aches and pains, weakness, and memory loss. Her unequivocal position was that there is no data that statins reduce cardiac events or chronic heart disease mortality in women. Furthermore, there is no data that statins reduce all cause mortality in men or women.
She has a quote from one of her patients saying,

“Since stopping the Welchol, my leg muscle weakness has stoppend and I am able to walk down the stairs normally. I am also not experiencing memory loss. My thinking feels sharper.”

First do no harm. Hopefully, with this latest consensus, people will feel more comfortable taking themselves off the statins, and physicians will not be so gung ho prescribing them. Dr. Redberg also said that cholesterol levels are clearly related to diet and physical activity, and it is unclear if the same benefits accrue via cholesterol lowering by medications.

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