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Statin Drugs, Profits, Politics, and Compassion

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The latest guidelines for statin drugs, issued by the makers of those drugs, would have us believe that pretty much everyone should be taking them. The argument in favor of such widespread use is that both cholesterol and inflammation contribute to cardiovascular disease, and the statin drugs lower both. Cardiologists and other health gurus have responded loudly to these new recommendations, calling them based on incorrectly assessed data, and biased interpretations. The makers of the drugs, of course, are sticking to their guns.

Is this just a case of Big Pharma trying for another coup? Perhaps yes, but that may not be the whole story. Even if it is, there are more interesting points to take away from the discussion. As a one-time executive (and long-term consultant) in the pharmaceutical industry, I am equally disposed to decry the marketing maneuver and avoid jumping to the obvious conclusion that this is a blatant case of corporate/industry self-interest at work.

The truth is that if there is someone or something to blame for a population that is so chronically ill that it requires expensive, universally prescribed pharmaceuticals to keep it healthy, it is likely the members of that population themselves--specifically the way we consider lifestyle, health, and disease. Is it the fault of the companies who make medicines that we make ourselves sick? Is it the fault of those companies that they will take a profit when one is not justified? Is it the fault of doctors who write the prescriptions in question when their very livelihood requires they do so in order to remain in business? Yes, yes, and yes, but that's not the end of it. Rather, it is a lamentable fact that other than in the case of intractable diseases or trauma, most of us unnecessarily abdicate responsibility for our own health, and healthcare, to others rather than taking control of it ourselves.

One can make an argument that at least since Neolithic times, human society has had witch doctors, shamans, energy healers, and the like to whom individuals turned when illness occurred. Those specialists--perhaps much less effective than those who fulfill that role today, perhaps not--were there to help and no doubt millions of people were as grateful for the resource then as now. What has changed, of course, is that medicine has become such big business (perhaps in the old days a good healing was paid for with an eagle feather or a hug) that the morbid lifestyle that keeps it booming has become, forgive me, a sacred cow. Such an environment makes it easy for us to shun exercise, to embrace virtual worlds on a glass screen, and easier too for the sugar industry to addict us (there is sugar in hot dogs, for goodness sake), for the dairy industry to convince us that the relatively toxic secretion of another species (more and more evidence links dairy products to dire diseases) "does a body good", and, of course have us believe that we should relinquish responsibility for our health to the healthcare business and its minions, and swallow whatever they say to swallow.

While it is certainly true that we can run afoul of our own heredity, results from the burgeoning field of epigenetics show us that lifestyle and emotional components affect how those genes are expressed. In short, to a higher degree than we had previously believed, we can control our health with our attitudes and choices. Does this mean we can't simply have bad luck, get hit by a bus, or live long enough to have our body degrade in inevitable ways? Of course it doesn't. It simply means that we must put being healthy above supersizing our sweet treats, walking over riding, eschew sedentary routines and recreation (especially for our children) and make whatever other choices we can within the framework of our reality, while voting, lobbying, and working to change that reality to a more equitable and fair social and healthcare model.

Population growth has resulted in a plethora of specialists. We have a great choice of plumbers, exercise videos, roofer, lawyers, accountants, and others in a wide range of service industries. So too, we now have a wider range of the service we call medicine than has any other society in history. We have ancient treatment methods like acupuncture, healing dietary choices (even on a very constrained budget), the power of antibiotic and steroid therapies, and, of course, the miracles of high-tech allopathic medicine that can replace our organs, rebuild our skeletons, and treat devastating heritable conditions with gene therapies. We have also to choose between a few uncaring profiteers, and the well-intended manufacturers and of compassionate, devoted, caring, selfless doctors, nurses, and therapists of all stripes. It is the very existence of all these options (and their high potential for abuse from all angles, including patients, healthcare providers, and insurers alike) that makes it all the more important for us to work toward a new healthcare paradigm.

The big question we must all be asking ourselves right now is not whether we need a statin drug when we're not sick. My father, a world-famous cardiologist, taught me early that in every pill there is a little poison. The big question is actually whether health is important as money--whether it can or should be the first job of society and government to care for its infirm and aged, or whether it is more important to protect the and increasingly complex and troubled concept of a free market. We must ask whether money has any business in healthcare, whether healthcare is a right or a privilege, and whether individuals and companies should be profiting from the ills of others. Most importantly, we must ask whether a society that puts national security and imperialism ahead of the welfare of its members is the kind of society we want.

Such questions are often lost in a free-for-all of special interests and a specious flurry of rhetoric about socialism, capitalism, libertarianism, and even the national identity of America. That's a shame. Human life and suffering is what's at stake here, not the confusion between insurance and healthcare, and not whether we all out to be taking some particular pill. Compassion and our core values are at the root of this conversation, no matter how covered those roots may be by political dirt and the detritus of greed. Rather than asking, once again, the same, tired question about who is going to pay for a more compassionate, equable model (the answer is all of us, every day, as job #1), let's get back to talking about what really matters, namely what we value, how we can live longer, healthier lives, and how we can better take care of each other.

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