15 November 2011
What’s wrong with saving lives?
Generating large profits and using sometimes dubious ethics, the pharmaceutical company are an easy target for writers. However, a recent book by James le Fanu “The Rise and Fall of Modern Medicine” (see this article in the Daily Telegraph, in which le Fanu writes a regular column) makes the mistake of putting too much icing on the cake by criticising good as well as harmful developments within the medical profession.
He claims that there are serious flaws in both the medical profession and the pharmaceutical industry.
He makes veiled criticism of the medical profession for first inventing and then carrying out coronary angioplasty. He comments that, presumably because the operation is so simple and effective, the number benefitting from the procedure has increased twelvefold.
I doubt whether a patient with angina, whose life has been saved and enhanced, would agree that too many of these procedures are carried out.
He then moves on to take on the might of the pharmaceutical industry. He argues against multiple drug prescriptions in general and statins in particular.
First of all let’s look at a few figures:
- A rise of 1mmol/l of cholesterol increases the risk of a severe cardiovascular event by 72%.
- A reduction of 1mmol/l of LDL reduces the risk of a severe cardiovascular event by 23%.
- The life expectancy of a female has risen from 73 to 82 since 1970.
- A month’s course of simvastatin 20mg daily costs less than £1.
- A person with Type 2 Diabetes is at high risk of premature death due to hypertension and dyslipidæmia.
Mr le Fanu starts off on the pharmaceutical industry by criticising polypharmacy. The majority of patients who are on half a dozen or more prescriptions daily – a figure which Mr le Fanu finds particularly shocking – are those with Type 2 Diabetes.
These people, who have hyperglycæmia, are at high risk of developing hypertension and dyslipidæmia, from where it is a short journey to cardiovascular disease and premature death. However, if hypertension is managed effectively (which virtually always requires three different medications), if hyperglycæmia is managed (which often requires two different medications) and if dyslipidæmia is managed (which may require more than one medication) then the life expectancy can be increased to normal.
This result is not caused by pharmaceutical companies ramming medications down patients’ throats. It has been proven time and again by repeated research projects to be a highly effective way of managing this life-long disease.
The onslaught on statins is particularly unfortunate. He mentions (unspecified) side effects of statins despite the British Heart Foundation commenting that statins are among the safest of drugs with a large amount of research evidence supporting their use. The only severe side effect is rhabdomyolysis. The incidence of this is about 1 in 100,000 patients. Hardly common. The remainder are reversible and probably dose related. He does not mention the beneficial effect on reducing cholesterol by a figure of approximately 25%. That’s a big saving of lives.
So where’s the problem?
It is no accident that the life expectancy in the United Kingdom has risen by 10 years in the last 45 years. Would the many people who are living 10 years longer as a result of the developments within the medical and pharmaceutical profession agree with Mr le Fanu’s criticism? Perhaps not.
One final thought. I wonder if Mr le Fanu is any relation of Sheridan le Fanu, one of the most famous writer of ghost stories in the 19th century.