The Cholesterol "Pill" & Health Policy

Over the past few days, the media has meted out criticisms of Big Pharma and their cholesterol medications. Certainly, some of it is well deserved. Some, however, confuses the issues and does not consider some fundamental issues related to health policy.

A Bit of Background

Statins and other cholesterol medications represent a critical piece of Pharma's profits. Worldwide, cholesterol meds represent the single largest class of drugs sold--exceeding $25 billion per year.

Why so much?

These medications do work to reduce LDL (bad) cholesterol, and the relationship between LDL cholesterol, heart disease and stroke has been well study and confirmed.

Then there is the magnitude of the issue. Combined, cardiovascular diseases are the primary causes of death and morbidity in the United States.

But, these medication do not "heal". Stop taking these medications, and your LDL cholesterol will rise--all other things being equal. Users of cholesterol medications thus may find themselves on these drugs for decades.

Overall, couple the huge population at risk of cardiovascular disease with the length of time that these medications are potential used, and a huge market is created.

An Oversold Solution?

Cholesterol medications have been oversold and hyped in their ability to remedy heart issues.

Managing cholesterol can improve the cardiovascular system, but it is not and cannot be a guarantee of heart health. Cholesterol also can be managed by means other than medications--nutrition, weight control and exercise. Nutritional approaches that combine nutrients that actively and positively influence blood lipids ---Omega-3 & monounsaturated fatty acids in lieu of saturated fats, plant sterols, soluble fiber, niacin---can achieve results equivalent to many of medications, particularly for the borderline line high cholesterol types like me. This view is widely endorsed in the medical community including the American Heart Association and the American College of Cardiologists.

Certainly, this does not mean that these drugs are without value. For many, the lifestyle and nutritional approaches are not adequate. Medications is required, and for those at high short term risk, they may be essential. Yet, theses meds should complement the therapeutic lifestyles. The approaches should be integrated and the medications should not be the first line of therapeuty.

Moreover, these medications are most effective in affecting only a component of cholesterol---lowering LDL cholesterol. There are other aspects of blood lipids that are important for heart health---the level of HDLs, the ratio of total cholesterol to HDLs, the size of the LDL particle--to name just a few.

Even in regard to LDL cholesterol, a single medication may not achieve heart risk adjusted targets (to calculate your risk-adjusted ldl targets, go to http://www.kardeanutrition.com/cholesterol/ldl_calculator.aspx ). The pharmaceutical solution is to identify other drugs to be taken with the existing medications.

No doubt, new drugs are coming to market or are in development that work with existing medications to favorably affect blood lipid levels. So, you can look forward to taking more medications! Today, we find ourselves with many people taking many drugs, and overall, we are only dimly aware of their interactions and long term afffects on health.

Drivers of a Healthcare Imbalance

From a health policy perspective, we need to give careful thought to what is going.

One issue is that we allow Big Pharma to spend hundreds of millions dollars per year promoting these medications. At whose expense? Well for one, the consumer advertising campaigns dwarf the public health education campaigns that advance nutritional and lifestyle alternatives. We all would be well served if the consumer received more balance input.

A few policy alternatives could be considered. We could require the pharmaceutical companies to contribute an equivalent amount of advertising money to lifestyle and nutrition public health education. This would not be unlike the tobacco companies funding of smoking cessation programs. Alternatively, we could require those media outlets that air these promotion to donate airtime to publilc health education.

Consumer behavior and incentives also are at issue. The advertising ---this unnecessary hype- works in large part because many consumers want to believe that a single pill will eliminate the risk of heart disease--regardless of what they eat, how much they weigh or how much exercise they get. Intellectually, not many of us would ever concede that we believe in the power of the single pill. Practically, the single pill gives us comfort when we fail to live heart healthy lifestyles.

At least for the well-insured consumer, it also may be cheaper, both in terms of time and money, to pursue the pharmaceutical approach than to embrace the alternatives.

Presidential candidates from both parties are discussing fundamental changes in our health care system. Special interest, including Big Pharma, can be expected to mold this system to their benefit. As citizen, we will be best served by making sure that real public health is advanced. Make your voice heard in this debate!