Late at night, when things get quiet and just the sounds of crickets
waft through the open windows, if you ever hear an exasperated
howling in the distance, that’s probably me as I browse through
some of the day’s latest health news.
My most recent howling was prompted by a report on some new
guidelines for the treatment of high-risk heart patients.
The updated guidelines come from the National Cholesterol
Education Program (NCEP), so without even reading the first word
you already know what they’re going to say: Low LDL cholesterol
has 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
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 down to 100. Now, after
reviewing five studies conducted since 2001, the panel has revised
the ideal target for LDL. Now it needs to be 70! At this rate, by the
year 2010 they’ll be recommending an LDL 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 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.” Dr. Grundy
guesses that the new guidelines might increase that number by “a
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 July! 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 panelists. But just days after
the release, Newsday (a Long Island, NY, newspaper) reported that
some of the panelists 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 statin Lipitor, the world’s best selling
drug. Seven of the nine NCEP panelists 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 panelists have financial connections to Merck. Four of
them have served as consultants to Merck.
Only one of the panelists 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 howling in the distance? That’s me.
The acting director of the National Heart, Lung and Blood
Institute, Dr. Barbara Alving, defended the panelists’ 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 panelist with
no financial ties to any drug companies. So in Dr. Alving’s
estimation, Dr. C. apparently doesn’t qualify as an expert. But in
my opinion he’s a stand-up guy for resisting an all-expense-paid
first-class ticket on the drug company gravy train.
But that doesn’t mean that Dr. Cleeman is on the right track.
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 quarreling
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 an e-Alert next week, I’ll take a look at the “substance of the
message,” of the recommendations – and we’ll get some dissenting
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 National Cholesterol Education
Program. And we’ll check in with HSI Panelist Allan Spreen,
M.D., for some tips on ways to address high-risk heart problems
To Your Good Health,
Health Sciences Institute
“Implications of Recent Clinical Trials for the National Cholesterol
Education Program Adult Treatment Panel III Guidelines”
Circulation, Vol. 110, No. 2, 7/13/04, circ.ahajournals.org
“New Guidelines for Heart Disease Patients” The Associated
Press, 7/12/04, msnbc.com
“Statin Recommenders’ Drugmaker Ties” Delthia Ricks, Newsday,
“Development of the Adult Treatment Panel III Update” National
Cholesterol Education Program, nhlbi.nih.gov
“Government Group’s Drug Ties Not Disclosed” Salynn Boyles,