Sunday, November 9, 2008

Defining "Risk": Statins and Heart Disease

The front page of today read "Study: Cholesterol drugs can help low-risk patients." This is a perfect example of the medicalization of health. Rather than advocating high-risk prevention strategies for those at higher risk of developing disease, we now have "medical creep"  -- where even moderate risk of heart disease makes someone a good candidate for medical intervention. 

Dr. W. Douglas Weaver, president of the American College of Cardiology was quoted as saying, "This takes prevention to a whole new level, because it applies to patients who we now wouldn't have any evidence to treat." 

This is great news for Big Pharma -- not mainstream America. Note: cholesterol lowering drugs like AstraZeneca's Crestor (used in the study cited and funder of the research) or Lipitor by Pfizer are laden with awful side effects: headache, diarrhea, muscle pain and even depression, insomnia, and ulcers. Who needs that?

What is the alternative to pharmaceutical intervention? Hmmm...let me think...a healthier diet, regular exercise, and quitting smoking. And the side effects of such a drastic lifestyle change?  Side effects may include lowered risk of diabetes, stroke, cancer, and depression. 

While the choice of pill or persistence may seem obvious to me, the barriers to sustainable lifestyle change are great. Choosing persistence may seem more expensive or too restrictive (who is to say I can't eat another slice of mom's apple pie?). But the truth is we all have the power to make change in our life that will improve our health. The result may be 10 more years of healthy life or 10 more days. How do you measure the worth of your days and years?

My choice: a healthier lifestyle.  I will leave the statins for those who truly need them.


jessica said...

ah, lifestyle change. that's going to be big in coming years [especially if insurance companies think they can use it to save money] but HOW to successfully do it is a different model. after health coaching for a year i still haven't found a good model to get others to make lifestyle changes that is effective, efficient, tailored but standardized.

nice blog :-).

Kate M said...

I agree. I have started thinking that too much talk about "lifestyle change" has been about weight loss. Our parents, grandparents have done the diet thing, over and over again and have often little to show for it. I don't think healthful eating and healthful activity is always about weight loss. While weight loss may be a nice externality of changing what kinds of foods, quantities of foods, risky health behaviors, and physical activity -- that change needs to be about something much greater than just "weight loss" or some very abstract "better health". How can the message be reframed to really get at what people care about -- friends, family, death (avoiding it!), faith, generosity, etc?

Thanks for the comments, Jessica!