All Drugs Have Side Effects
The question is, does the benefit or potential benefit of the drug outweigh the potential risks? That's a vital question to ask in respect to statins -- drugs that doctors seem to prescribe like they're Tic Tacs.
From the Telegraph/UK, a story by Stephen Adams on how millions are taking statins needlessly:
But a wide-ranging review of previous studies, published today in the journal The Cochrane Library, urges "caution" among GPs who prescribe them. It concludes that there is no "strong evidence" to suggest that statins reduce coronary heart disease deaths among those who have not suffered a heart attack or other cardiovascular event in the past.
Some of the potential side effects?
..."There are some small trials that show evidence of cognitive lapses and depression," he said.Previous studies have also indicated statins could increase the chance of liver problems, acute kidney failure and a type of muscle damage in some people, and can increase the chance of haemorrhagic stroke - bleeding on the brain - in people who have already had one.
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Amy Alkon at January 20, 2011 7:04 AM
Drug trials measure a drugs effectiveness via a statistic called Number Needed to Treat (NNT.) The NNT is the number of patients who need to be treated to prevent one additional bad outcome (i.e. the number of patients that need to be treated for one to benefit compared with a control in a clinical trial).
Obviously an NNT of 1 is ideal (where every person treated with the drug has a positive outcome as a direct result of taking the drug.) Probably the best drugs on the market are the antibiotics used to treat stomach ulcers with an NNT of 1.1 (meaning that 10 out of 11 people taking the drug will be cured of their stomach ulcers.)
Most drugs on the market today that are considered effective have NNT's in the 20's range. As you approach an NNT of 50, a drug is considered to be mostly ineffective. The NNT of Statin drugs is 100!
AllenS at January 20, 2011 8:00 AM
Amy Alkon
http://www.advicegoddess.com/archives/2011/01/20/all_drugs_have.html#comment-1826062">comment from AllenSThanks, AllenS, for explaining that.
Amy Alkon at January 20, 2011 8:11 AM
Over the last several years I have grown increasingly more suspicious of a whole raft of drugs that are generally used to treat symptoms of aging such as cholesterol lowering drugs, blood pressure drugs, and type two diabetic drugs. The number needed to treat studies and number needed to harm seem to indicate that it is basically a crap shoot as to whether most of these drugs will do you any good at all. Since they are mostly being prescribed for elderly people, there may be a whole bunch of side effects that are undetected and unreported because they are being masked by the expected decline of octogenarians.
I think doctors suffer from the same mission creep as government. They have to be seen as doing "something" to justify their existence. Insurance will pay for for almost any drug reasonably linked to treating what I call lifestyle diseases (obesity, smoking, poor diet, alcoholism) Doctors don't get paid much for telling you to stop smoking, moderate your drinking, lose weight and get off your ass. Once you get on one of these drugs you will more than likely need another and another and another to deal with the side effects caused by the first one. I don't think most doctors are deliberating doing this to line their pockets but it is a vicious merry go round that they can't get off of either.
On a side note, I am not one of those kooks that thinks that better hygiene will prevent diseases like small pox, measles and polio. I know that vaccines work. The science is there and the evidence is overwhelming.
Isabel1130 at January 20, 2011 8:14 AM
Actually, it seems likely that WORSE hygiene is protective against diseases:
http://www.advicegoddess.com/archives/2006/06/10/worming_your_wa.html
Amy Alkon at January 20, 2011 8:53 AM
I am always shocked at how many people take statins without asking their doctors any questions about the possible costs and evidence for the benefits...not to mention all the drugs prescribed to adolescents, I swaer 1/2 our undergrads are on some sort of med.
Catherine at January 20, 2011 9:12 AM
Last year my cholesterol numbers came back a bit high, only a bit mind you, about five points above "normal". My doctor wanted to put me on statins. Having heard about the side-effects I said "Thanks but no thanks." He told me that he thinks statins should be in the drinking water.
Personally, if I'm going to wreck my liver, I'll do it with beer and Irish whiskey.
Mark D at January 20, 2011 9:22 AM
Amy Alkon
http://www.advicegoddess.com/archives/2011/01/20/all_drugs_have.html#comment-1826162">comment from Mark DWhy would high cholesterol be a problem? I want mine to be high -- it seems to be healthier.
"Elevated cholesterol is actually protective against stroke" -- Dr. Michael Eades
http://www.proteinpower.com/drmike/statins/jane-brody-and-her-elevated-cholesterol/
Amy Alkon at January 20, 2011 9:52 AM
Get a better doctor.
brian at January 20, 2011 9:53 AM
AllenS: I am surprised to hear those numbers. Do you know what is considered affect there? Is it Heart Attack prevented or cholesterol values lowered? A know a number of people who have taken statins and all have had their cholesterol numbers lowered. In the case of my family, most on my mom's family have taken them, all have had reduced numbers, all but one have been taken off them because all have had severe side effects. The one still on them has had multiple heart blockages in the past and his numbers are way high.
The Former Banker at January 20, 2011 1:53 PM
TFB - the confounding factor is the utter lack of a general causal relationship between serum cholesterol and heart disease.
Just like there's no general causal link between sodium and hypertension. You have to have a genetic proclivity to be sodium sensitive for that link to exist.
brian at January 20, 2011 1:56 PM
Amy Alkon
http://www.advicegoddess.com/archives/2011/01/20/all_drugs_have.html#comment-1826304">comment from The Former Banker? A know a number of people who have taken statins and all have had their cholesterol numbers lowered.
Whoopsy, problem, as Brian points out: The lipid hypothesis, the notion that cholesterol in blood leads to heart disease, has never been proved.
I could take a drug to raise or lower my platelet count -- but why would I if there's no proven positive effect on my health?
People need to understand that if your doctor is prescribing you drugs based on unproven hypotheses -- as if they are backed up by evidence -- you have a shitty doctor and should find a new one.
Amy Alkon at January 20, 2011 2:51 PM
While we're on the subject, what's the NNT for marijuana? Cocaine?
Radwaste at January 20, 2011 3:43 PM
This is very interesting to me. I will have to research it. After my last two strokes, I was put on statin drugs even though my total cholesterol was 195 and my HDL (yes, the "ggod stuff")was unusually high.
I was told that I need to keep my total cholesterol very low (below 150) because of my health history.
Jen at January 20, 2011 5:00 PM
Actually, your point plays into what I was asking. The studies on statins I have seen all claim that the statins lower cholesterol and use that as a proxy for reducing heart problems. I was guessing the NNT indicated above would be similarly based on the cholesterol numbers rather than heart attacks -- that is why I asked.
That is actually a common problem with papers. They present a problem and the results are some metric that does not really show anything related to the problem.
P.S.: I am not the former banker who gave a bunch of documents to wikileaks.
The Former Banker at January 20, 2011 6:47 PM
My grandma was on a regimen of blood pressure pills and statins as well as a proton pump inhibitor for "acid reflux." She started complaining that every time she went to the doctor he was trying to get her to take a new pill. Two years ago, at the age of 87, she decided that meds weren't for her anymore and hasn't looked back. She claims to feel "like 60 again!" I think patients need to be their own advocates when it comes to taking medicine, but I don't think we could ever do enough research on drugs to uncover all possible negative effects. After all, how long has Darvocet and Darvon been on the market? I know for 20 years at least (I remember asking my mom why she was walking all wobbly after a dental appt when I was a kid and she said it was darvocet), and it's just now being pulled off the market due to possible cardiac risks. Researching your own meds can often deliver conflicting information, also, and I think this keeps a lot of people that are laymen in the healthcare setting from doing just that.
Jessica at January 20, 2011 10:02 PM
Well, the thing is, *everything* you put in your mouth has side effects, including food and drink. There are an awful lot of foods on the market that, if they were drugs, would not pass the safety standards. And I'm not just talking about processed foods either. If eggs were a new food just now being submitted to the FDA, there's no way in hell they would be approved.
Having said that... taking a drug that has no discernible benefits seems like the one valid application of the precautionary principle.
Cousin Dave at January 21, 2011 4:06 PM
So, I must have missed the response to the question about the NNT for marijuana and cocaine.
They're drugs. There must be a benefit, right?
Even though "cognitive lapses and depression" seem to happen to people around the user, too.
Radwaste at January 22, 2011 1:54 PM
thanks for posting, Amy. My mother has been on statins and had a serious muscle tear after killing a garden snake that snuck into the kitchen (I told her that the poor thing was as harmless as an earthworm but she is snake phobic). I've told her that she should read this article and question her doctor since she only has high cholesterol and no cardiovascular disease or other risk factors for cardiovascular disease but unfortunately she is not keen on reading articles or questioning her doctor's authority.
Diana at January 22, 2011 3:12 PM
Amy Alkon
http://www.advicegoddess.com/archives/2011/01/20/all_drugs_have.html#comment-1827726">comment from DianaThanks so much for your comment, Diana. What makes this particularly odious is the trust most people tend to place in doctors, and the fact that most people are not going to read the studies or know how to assess them to begin with. A really good source is Dr. Michael Eades. If you follow him on twitter, he'll also link to a lot of good stuff. @DrEades
His site: http://www.proteinpower.com/drmike/
Amy Alkon at January 22, 2011 3:23 PM
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