If all doctors followed the latest cholesterol treatment guidelines and all their patients took their prescribed statin medication, there would be 3.5 million more diabetics in America. But wait! There is another pill (or injection, actually) that has been shown to reduce the risk of diabetes. And it's only about $50,000 per year per patient. Let's see: 3.5 million, times $50,000. What does that bring us to?
We are stuck in an absurd cultural habit of thinking that medication will save us from lifestyle and social diseases.
Two separate studies in today's issue of the Journal of the American Medical Association (JAMA) underscore that we have come to the end of an era of being saved by medication. Antibiotics and vaccines were a huge advance in medicine in the 20th century. But the single pill for the single ill just doesn't work for 21st century chronic diseases like heart disease and diabetes.
Statins cause diabetes
The latest cholesterol guidelines (ATP III) increased the number of Americans who should take statin therapy from 13 to 40 million. Those additional 27 million are ones without heart disease, but who have high cholesterol. This type of treatment is called primary prevention. I have extensively reviewed the research on using statins to prevent heart attacks in people who never had them. The data is weak and shows no benefit, except the Jupiter trial, which ONLY showed benefit if patients also had inflammation (high C-reactive protein), not just high cholesterol or LDL. If you just had an elevated cholesterol, statins didn't help.
I have previously written about research that showed that statins increase the risk of diabetes. This latest study examined five major clinical trials on statins that included 32,752 non-diabetics over 4.9 years. During the study period, 2,749 patients (or 8.4 percent) developed diabetes. Those on the highest doses of statins (which are increasingly prescribed by physicians) were at the highest risk of developing diabetes.
While there was a slight overall reduction in risk of heart attacks in the patients treated with statins, the authors found that you have to treat 155 people for one year to prevent just one heart attack or death. If a doctor had to prescribe antibiotics to 155 people to cure just one patient of pneumonia, we would think that antibiotics weren't very good medication. But that is exactly the "number needed to treat" to prevent just one cardiac event. On top of that, for every 498 people treated, one more person would become diabetic. If these drugs were not the top-selling drugs in history, we might accept a small risk, but if we treated everyone who "needed" them, we would have more than 3.5 million more diabetics in America.
Using statins may be an acceptable risk if there was no other treatment for heart disease. And we spend more than $100 billon a year on angioplasties (which don't benefit 95 percent of people receiving them), and cardiac bypasses (which reduce the risk of death in only 3 percent of people who receive them), while ignoring that heart disease is a lifestyle and social disease that requires lifestyle medicine and a social cure that would prevent more than 90 percent of all heart disease.
Immune-suppressing medication prevents diabetes
In another study of nearly 14,000 patients, published in today's issue of JAMA, researchers from Harvard found that those treated with powerful immune-suppressing medications (TNF alpha blockers like Remicade or Enbrel), reduced their risk of getting diabetes.
Sounds great. We have an explosion of diabetes. By 2020, one in two Americans could either have pre-diabetes or diabetes. The authors said "there is evidence suggesting a possible role for ... immunosuppression in diabetes prevention." But the side effects of these drugs are overwhelming infection, increased cancer risk and death. And they cost about $50,000 per year, per patient. Were the authors serious about using these drugs for diabetes, another lifestyle and social disease?
Yes, diabetes is an inflammatory disease. And yes, reducing inflammation can prevent and even reverse diabetes. But it won't be by taking aspirin, Advil, or some high-powered immune suppressing, toxic, expensive medication. The major cause of inflammation is our processed, high-sugar, low-fiber, fast food, junk food, calorie-dense, nutrient-poor industrial diet and our couch-potato lifestyle. A plant-based, whole foods, real-food diet without sugar and flour in pharmacologic doses along with anti-inflammatory omega-3 fats and a good dose of exercise can dramatically reduce the risk of and even reverse heart disease and diabetes. And they cost a lot less.
Last week, a study in JAMA found that the risk of diabetes, heart attacks and death increased significantly with more than two hours of television watching per day. The average American spends seven to nine hours in front of a screen every day. We have a social problem, a host of chronic diseases driven by a food industry and screen-dominated culture and the breakdown of communities. Cooking real food takes a bit more time, but people spend more time watching cooking shows on television than actually cooking.
The answer to our exploding health care costs and burgeoning chronic disease is not going to be found at the bottom of a pill bottle, but at the end of our forks and the soles of our shoes. Please save us from Pharmageddon.
Mark Hyman, M.D. is a practicing physician, founder of The UltraWellness Center, a four-time New York Times bestselling author, and an international leader in the field of Functional Medicine. You can follow him on Twitter, connect with him on LinkedIn, watch his videos on YouTube, become a fan on Facebook, and subscribe to his newsletter.