Cherchez la pharm

There’s a old sexist saying in France that if you want to discover the cause of a problem, cherchez la femme – find the woman. But, if the problem is medical, I say cherchez la pharm – find the drug.

Take the recent epidemic of heart failure, both in America and the UK. Medical experts have been falling over themselves attempting to work out why this one type of heart disease is spiralling out of control when other varieties of heart conditions are falling off in numbers. So overwhelming is the epidemic, affecting five million people in the US and half a million in the UK, that it tends to dwarf any of medicine’s other cardiovascular successes. We seem to have simply traded death by heart attack for death by heart failure.

And this is where statins come in. As you probably know by now, statins – the biggest medical moneyspinner of all time – are medicine’s preventative drugs du jour, and their uses are extending every day.

Oxford’s Heart Protection Study Collaborative Group recently concluded that statins can help prevent ischaemic stroke among patients over 70 or those with some sort of cardiovascular disease (heart, diabetes or stroke) (Lancet, 2004; 363: 757-67). No doubt doctors will forget to read the fine print – that among patients with cerebrovascular disease, there was no reduction in stroke rate, only a reduction in any ‘major vascular event’ (such as transient ischaemic attacks) as well as no difference in stroke caused by haemorrhage. Any kind of reversal, no matter how particular, is enough to warrant wholesale widening of a drug’s brief.

Yet another study, the REVERSAL (Reversal of Atherosclerosis with Aggressive Lipid Lowering) trial, concluded that intensive statin therapy (that is, doubling the daily dose to 80 mg per day) worked even better at halting the progression of atherosclerosis in patients with coronary heart disease (JAMA, 2004; 291: 1071).

These are the kind of studies that drug companies pray for. In the Oxford trial, the reduction in stroke didn’t show up until year two, which means that its findings will serve to justify putting patients on these drugs for years, even when they patently aren’t working. The REVERSAL trial is a licence for drug companies to sell more of these expensive drugs at double the dose.

However, locked in the attic away from this ever-more dazzling profile – like some deformed relation – is a growing epidemic of puzzling and seemingly unrelated adverse effects of the drug: muscle weakness, liver and kidney failure, fatal muscle wasting and, now, heart failure.

Only a few in medicine have the temerity to open that particular door and let the ugly cousin out. The work of Christian Behl of the Department of Pathobiochemistry at Johannes Gutenberg University in Germany and of Texas cardiologist Dr Peter Langsjoen, when looked at together, provide a clue to the relationship between statins and heart failure. Statins appear to block the synthesis of selenoproteins, which work to synthesise myocytes, or muscle cells. Interfering with this process will cause muscle weakness and, eventually, weakness of the most important muscle of all: the heart. Behl has discovered the link with selenoproteins; Langsjoen uncovered the fact that statins appear to block the production of CoQ10, also vital to heart health.

This is an object lesson to us all. If you have any health problem, before you look to any other causes, first cherchez la pharm.

Lynne McTaggart

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Written by What Doctors Don't Tell You

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