Money Drugs and Cholesterol

We all know that drug companies are very profitable, and often will use anything to promote their products; even if ineffective.

Many physicians obtain their information about new drugs from drug reps (most often very attractive and flirtatious) rather than academic sources.

About 10 years ago researchers began to question how cholesterol lowering drugs actually work. There is very good evidence that the statins (Lipitor, etc) can lower the risk of heart attacks. But they began to discover that other drugs, such as Zetia, Tricor and Niacin may lower your cholesterol, but not affect the risk heart disease. It seems that the statins work in different ways (the current thinking is an anti inflammatory effect)

So why are these essentially useless, and sometimes dangerous drugs, still on the market? In my opinion it comes down to profit for drug companies and doctors keeping up with their reading.

In a recent study, JAMA Cardiol 2016 Dec 28, researchers again confirmed that fenofibrate does not prevent heart disease, but also has an unacceptable side effect profile - higher risk of heart attacks and strokes! Yet it is still used! The FDA should have really taken it off the market! I still see patients on it; and sometimes their primary care doctors or cardiologists get defensive about it!

And, when a new drug is effective, the drug companies have been pricing them as high as possible; to make them not cost effective! There is a new category of cholesterol lowering medication, the PCSK9 inhibitors which lower LDL cholesterol as well as lowering the risk of heart attacks. However, at the wholesale cost of $15,000 per year, the cost of preventing one death is about $500,000. This is considered not cost effective. (JAMA. 2016;316(7):743-753)

One promise President Trump has espoused is negotiating with drug companies. Based on his top heavy big business cabinet this does seem unlikely.