Cholesterol Levels: More Underhand Dealings By The Drug Giants

I was fuming after reading a report recently on some new guidelines for the treatment of high-risk heart patients.

The updated guidelines come from the US National Cholesterol Education Programme (NCEP), so without even reading the first word you already know what they're going to say: Low LDL cholesterol levels have to be pushed even lower.

NCEP is part of the National Heart, Lung and Blood Institute, which is part of the National Institutes of Health. And the guidelines have been endorsed by the American College of Cardiology and the American Heart Association. (The guidelines were published in a recent issue of Circulation - an AHA publication.)

In other words: We're talking DEEP medical mainstream here. How deep? Way down deep where the drug money flows.

How low can you go?
In 2001 the NCEP panel of experts said that heart patients who are at very high risk should do whatever it takes (that is: take statin drugs) to get their LDL cholesterol levels down to 100. Now, after reviewing five studies conducted since 2001, the panel has revised the ideal target for LDL cholesterol levels. Now it needs to be 70! At this rate, by the year 2010 they'll be recommending LDL cholesterol levels of 10.

Think I'm joking? Just wait six years.

The new recommendations suggest that statin drugs should be used in nearly all high-risk patients whose LDL cholesterol level is over 100. The lead author of the guidelines - Dr. Scott Grundy - told the Associated Press that three years ago there were about 36 million people 'who could benefit from drugs to lower their cholesterol level.' Dr. Grundy guesses that the new guidelines might increase that number by 'a few million.'

So if you happen to be the executive of a large drug company that manufactures statin drugs... well! These new recommendations are like Christmas in August! But pharmaceutical execs know that there's no Santa Claus. And they know that big, beautiful gifts don't just magically appear under the tree. Someone has to put them there.

Visions of sugarplums
The release of the NCEP guidelines was not accompanied by a financial disclosure statement for the panellists. But just days after the release, Newsday (a Long Island, New York, newspaper) reported that some of the panellists had ties to drug companies. In response to a call for disclosure, NCEP officials posted a statement on their web site. And the details are eye-opening, to say the least.

Pfizer is the maker of the commonly prescribed statin drug Lipitor. Seven of the nine NCEP panellists have financial connections to Pfizer. And five of them have served as consultants to Pfizer. Nice, huh? But if you think that smells fishy, it's just the tip of the day-old fish bin.

Merck is the maker of Zocor, another very popular statin. Seven of the nine panellists have financial connections to Merck. Four of them have served as consultants to Merck.

Only one of the panellists had no financial connections to any drug company. The other eight have received research grants or honoraria for speaking engagements from Bayer, Glaxo Smith Kline, Johnson & Johnson, AstraZeneca, Novartis, and more than half a dozen other drug companies. And most of these companies manufacture statin drugs.

Hear that ranting in the distance? That's me.

No quarrels
The acting director of the National Heart, Lung and Blood Institute, Dr. Barbara Alving, defended the panellists' drug company connections, telling Newsday that the top experts would naturally have contact with companies that develop drugs within their fields of expertise. She said that individuals who don't have ties to drug companies, 'are probably not the experts in the field.'

Hmm. I wonder how Dr. James Cleeman felt when he read that?

Dr. Cleeman - coordinator of the NCEP - is the only panellist with no financial ties to any drug companies. So in Dr. Alving's estimation, Dr. C. apparently doesn't qualify as an expert.

Addressing the initial lack of financial disclosure, Dr. Cleeman dismissed it as procedural blip, a simple oversight that doesn't compromise the recommendations of the panel. Dr. Cleeman told WebMD that the public shouldn't be diverted from the importance of lowering LDL cholesterol, adding that, 'Nobody is quarrelling with the substance of the message.'

Nobody!? Does he mean nobody on the panel? Or nobody at the NCEP? Or nobody at Pfizer? He certainly can't mean that nobody AT ALL quarrels with the message. Because there are many who quarrel long and loud with the basic concept that low cholesterol is the primary key to heart health. Because it isn't. It's not even close. In fact, there is a lot of evidence that the real danger is letting your cholesterol get too low.

This you won't believe
In a coming e-alert, I'll take a look at the 'substance of the message,' of the recommendations - and we'll get some dissenting views.

We'll also hear again from Dr. Cleeman who made a comment about cholesterol that's nothing less than flabbergasting, especially coming from the coordinator of the US National Cholesterol Education Programme. And we'll ask HSI Panellist Dr Allan Spreen, for some tips on ways to address high-risk heart problems naturally.

Stay tuned.