Statins: More On The Over-The-Counter Drug Controversy

Last week I received an e-mail from a colleague of mine in the US that read, Did you know the US Food and Drug Administration just voted against over the counter sales of cholesterol drugs?

At first glance it might seem that someone at the FDA was on the right track for once. And in a way that's true. But there's more to it than that. Much more. And before this story finally runs its course, the health of many thousands of people could be put at risk.

As they say, the pursuit of giant drug corporation profits is in the details.

Terrible synonyms

Here's what happened last week: An FDA advisory panel voted to recommend that the agency should not allow over the counter (OTC) sales of Mevacor, a cholesterol-lowering statin drug.

The proposal to make Mevacor available without a doctors prescription was put forward as a joint effort of Johnson & Johnson and Merck, who well call JJM for todays purposes. Executives at JJM may have felt both confident and uneasy at the same time about their proposal.

On one hand, health officials here in the UK approved OTC sales for the statin drug Zocor last year. But on the other hand, the FDA has been under fire lately for letting certain popular drugs sell like hot cakes for years until - oops! - finding out that the drug companies werent entirely forthcoming about dangerous adverse side effects.

Then again, maybe neither of these aspects came into play. Maybe the panel looked over the evidence and simply refused to ignore the obvious: OTC sales of statins drugs is a terrible idea. Feel free to replace the word terrible in that last sentence with disastrous, or reckless - anything along those lines will do.

Counting the ways

The primary problem with making statins available over the counter like in the UK, is that it takes doctors completely out of the loop for a drug thats designed to be used indefinitely. And this is one drug that needs to be monitored by a health professional for these four key reasons:

1) In some patients, statins increase enzyme activity in the liver. Liver damage can occur if this increase is pronounced, but symptoms dont occur until the damage is underway. When a doctor monitors liver function, damage can be avoided. (This may have been a sticking point for the OTC proposal for Mevacor: According to a CBS news report in the US, JJM didnt want the FDA to require patient screening for liver function.)

2) One of the most common side effects of statin use is muscle pain. In some patients statins actually cause muscle cells to break down. When this happens, a protein called myoglobin is released into the bloodstream, which can trigger the third problem...

3) Myoglobin impairs kidney function and can even lead to kidney failure.

4) Statin use depletes antioxidants in general and Coenzyme Q10 (CoQ10) in particular. CoQ10 fuels cellular energy production and repairs free radical damage to the heart muscle. When CoQ10 is deficient, heart health is put at a disadvantage. This is why many doctors recommend a CoQ10 supplement when they prescribe statin drugs.

With a list of drawbacks like these it makes you wonder just how statins ever became approved in the first place as over the counter drugs in the UK!

.. and another thing

Heres some important information for anyone with sun-damaged skin.

The two types of skin cancer known as basal cell and squamous cell carcinomas (or non-melanoma) are highly treatable and rarely fatal. But a report from the US Womens Health Initiative offers a vital warning about other risks involved with these cancers.

In an examination of medical records of more than 93,000 postmenopausal women between the ages of 50 and 79, almost 25 percent of the women who had non-melanoma skin cancers later developed other types of cancers. This statistic is in sharp contrast to women who never had skin cancer; in that group less than 12 percent developed other cancers.

Even more sobering was the breakdown of the statistics into categories such as race. Caucasian women with skin cancer were about two and a half times more likely to develop other cancers compared to women with no skin cancer history, while black women with skin cancer were found to have 7.5 times higher risk of developing other cancers.

The Womens Health Initiative doesnt include men, of course, but the authors of the study note that some research indicates that this higher risk of other cancers is just as much of a concern with men who have skin cancer.

In the past, most doctors have assured their patients that non-melanoma skin cancers are of relatively minor concern. Obviously its time to revise that thinking. Basal and squamous cancers are apparently not terribly dangerous in and of themselves, but now it seems that non melanoma cancers should be considered a red flag signalling the need to be on guard for the warning signs of other cancers.