Friday, July 9, 2010

One Look At Statin Cost Benefit, Part 2

"So, why should we as a society spend over $100,000 per year to prevent one self inflicted death from heart disease? And remember, that figure is only good if we prevent every single death from heart disease. What if we only prevent half? Then the price goes up to $200,000 per year per death prevented. What if we only prevent 25% of deaths, then the price goes to $400,000. It would be nice to know how many deaths we prevent if we give a third of the population statins. Let’s take a look.
We can look in a couple of places. First we can look in the executive summary of the full 2001 report. This 12 page summary, published in the May 16, 2001 issue of Journal of the American Medical Association (JAMA), gets right to the point. The recommendations of the full report
expands the indications for intensive cholesterol-lowering therapy in clinical practice.
In other words, the recommendations increase the number of people and conditions that need statin-driven cholesterol-lowering therapy. As you go through this executive summary it becomes clear that the authorities believe that cholesterol-lowering is extremely important in both the primary and secondary prevention of CHD and that statins are the way to lower cholesterol.
Who wrote this executive summary? A long list of esteemed experts in the field of cholesterol study. Do they have any conflicts of interest? Let’s take a look. Here is the list of members on the panel that produced the summary:
Scott M. Grundy, MD, PhD (Chair of the panel), Diane Becker, RN, MPH, ScD, Luther T. Clark, MD, Richard S. Cooper, MD, Margo A. Denke, MD, Wm. James Howard, MD, Donald B. Hunninghake, MD, D. Roger Illingworth, MD, PhD, Russell V. Luepker, MD, MS, Patrick McBride, MD, MPH, James M. McKenney, PharmD, Richard C. Pasternak, MD, Neil J. Stone, MD, Linda Van Horn, PhD, RD
Here is the financial disclosure:
Dr Grundy has received honoraria from Merck, Pfizer, Sankyo, Bayer, and Bristol-Myers Squibb. Dr Hunninghake has current grants from Merck, Pfizer, Kos Pharmaceuticals, Schering Plough, Wyeth Ayerst, Sankyo, Bayer, AstraZeneca, Bristol-Myers Squibb, and G. D. Searle; he has also received consulting honoraria from Merck, Pfizer, Kos Pharmaceuticals, Sankyo, AstraZeneca, and Bayer. Dr McBride has received grants and/or research support from Pfizer, Merck, Parke-Davis, and AstraZeneca; has served as a consultant for Kos Pharmaceuticals, Abbott, and Merck; and has received honoraria from Abbott, Bristol-Myers Squibb, Novartis, Merck, Kos Pharmaceuticals, Parke-Davis, Pfizer, and DuPont. Dr Pasternak has served as a consultant for and received honoraria from Merck, Pfizer, and Kos Pharmaceuticals, and has received grants from Merck and Pfizer. Dr Stone has served as a consultant and/or received honoraria for lectures from Abbott, Bayer, Bristol-Myers Squibb, Kos Pharmaceuticals, Merck, Novartis, Parke-Davis/Pfizer, and Sankyo.Dr Schwartz has served as a consultant for and/or conducted research funded by Bristol-Myers Squibb, AstraZeneca, Merck, Johnson & Johnson-Merck, and Pfizer. [My bold type]
So, you’ve got about half the panel – including the Chair – who are, like so much lint, buried deep in the pockets of the pharmaceutical companies that make statin drugs. Do you think these folks might have a motivation to promote the products of the companies that are paying them a lot of money?
But, you say, these people are only summarizing the contents of the real report as an executive summary. They don’t have any say in the data that the report contains. True, but this is where the plot thickens."

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