Skepticism of Pharmaceuticals Healthy

By John W. Porter editorial page editor

I see the ads every day, a reminder of the choices I make as a diabetic.

Up until recently, I’d see Dr. Robert Jarvik – lest we forget, inventor of the Jarvik artificial heart – touting the cholesterol- lowering benefits of Lipitor, one of a class of drugs known as statins. Jarvik’s role as a direct-to-consumer spokesperson for the drug has become controversial, leading the maker of Lipitor, Pfizer, to rethink his job pitching the drug.

Still, the ads are out there for other statins, stressing the importance of the drugs for those at a higher risk for heart attack. I’m sure, as an insulin-using diabetic who has had the disease for 19 years, if I asked a pharmaceutical rep if I should take a statin, he or she would say I absolutely should.

But I don’t take Lipitor or any other statin.

It’s not that I have an aversion to medicine. I take blood- pressure medication, for instance, because I have borderline high blood pressure and it’s better to treat that condition than not with a diabetic. But my cholesterol readings are in the normal range, I have no signs of heart disease and my diabetes is well-controlled.

But what about those studies that show people at higher risk for heart attack – and as a diabetic I’m one of them, no matter how well I take care of myself – can greatly benefit from taking a statin?

DOES IT ADD UP?

As a story in the Jan. 28 BusinessWeek pointed out, it’s all in how you do the math.

For instance, the story says that Pfizer’s claim that taking Lipitor will reduce heart attack risk by 36 percent – based on its own study – is accurate from a particular point of view. What that figure means is that, in a large study, 2 percent of the people taking Lipitor had heart attacks, as compared to 3 percent who took a sugar pill.

So, it’s true that about a third fewer people had a heart attack when taking Lipitor. But it’s also true that, for every 100 people who took the medicine for three years, only one realized a benefit. The other 99 risked the side effects of Lipitor and saw no reduction in heart attack risk.

I’m not suggesting that if your doctor has put you on a statin that you stop taking it without discussing the situation with him or her. And I’ve no doubt that for some people, these medicines are the right therapeutic choice.

But people should do exactly that: Talk to their doctors about the risks and benefits of the drugs they take. Patients should not insist on taking a medication based on the direct-to-consumer advertising done by the drug makers. That is because, in case you haven’t noticed, the drug companies have a financial interest in people taking their drugs.

The BusinessWeek story also took on another drug, Avandia, which is used to lower blood-sugar levels in diabetics. The drug is effective at bringing blood sugar down, and that is the most important task in diabetes management. But the story also pointed out that trials have yet to link Avandia in a statistically significant way to lowering the incidence of diabetic complications.

To be fair to GlaxoSmithKline, Avandia’s makers, it often takes many years of higher-than-normal blood sugar to ruin a body, and the long-term benefits of bringing blood sugar to acceptable ranges are well-documented. But in a response to BusinessWeek, Avandia’s maker also cited the fact that the drug could at least delay the onset of having to depend on insulin shots.

To that, I would say, in the strongest terms possible: Fellow diabetics, don’t fear the needle. It’s a little needle. It doesn’t hurt. It’s not hard to do. And insulin is a very effective and proven treatment. Indeed, there are new formulas of insulin that make using it more convenient and easier to manage than before.

There’s also a new insulin product out that you inhale rather than inject, and Pfizer’s marketing for it reinforces the fear of the "shot." This is harmful. A 2005 Canadian study found that, for people who have diabetes but don’t take insulin shots, nearly half are as concerned or more concerned with avoiding the shots than maintaining their blood-sugar control.

When I went on insulin, I went off two different oral drugs. I felt my head was more clear. I had energy. I had more dietary choices. Yes, the first time I had to inject myself was weird and scary and nerve-wracking, but it’s inconsequential now. I find the injections much less painful than pricking my finger to check my blood sugar.

BE A HEALTHY SKEPTIC

A healthy skepticism of drug company claims is not just a good idea when it comes to treatments for diabetes and heart attack, either.

Last week, a British study found that the class of drugs known as selective serotonin reuptake inhibitors, or SSRIs, didn’t help people with mild-to-moderate depression as much as expected. Only severely depressed people benefited from the drugs, according to a study done at the University of Hull in Great Britain.

SSRIs include Prozac, Zoloft, Lexapro and Paxil, among others, and are widely advertised and prescribed for depression.

Here again, these drugs may be right for some, even many, people. They’re frequently used to treat anxiety as well as depression and, no doubt, lots of people have benefited from them.

But the key here is that, as consumers, we should be skeptical. We should sit with our doctors and really talk in detail about what drugs do – what the side effects are and whether the benefits outweigh the risks. And if you’re not comfortable with the advice of your doctor, get a second opinion.

Someday, if my cholesterol creeps up or my arteries start to narrow or new information about statins becomes available, I may end up taking one.

But for now, my doctor and I have decided that treating my diabetes does not require that I take this medication. I’m sure the folks at Pfizer would disagree, but it’s not their body, now, is it?

(c) 2008 Portland Press Herald. Provided by ProQuest Information and Learning. All rights Reserved.