Letter from a physician

I loved your book. In 1964, I edited The Bulletin of Drug Reactions in Neurology and Psychiatry. The American Psychiatric Association would not accept a paid ad by us, looking for subscribers. I called Walter Barton, MD, medical director of the APA. He told me: "The drug companies pay us a lot of money to advertise. They won't like your publication. We will not accept your ad." Forty years ago, my own APA was a whore for the drug industry.

Thomas P. Lowry, MD
Dr. Lowry, Thanks for you wonderful letter. What do you think it will take to get people to understand that our system of generating and disseminating medical knowledge is not designed to improve Americans' health most effectively, but to generate the greatest profits? My personal approach was to write Overdosed America, and to continue to try to spread the word in language that non-medical people can understand. If you have any ideas about how to spread the word please let me know. And please don't be shy about recommending to the book to friends--I am sure that your opinion is well respected. Is it OK with you if I post your comments on my website?

Sincerely, John Abramson

I'm delighted to hear your response; I expected some sort of mass electronic reply. Of course you can use my comments. I am 72, walk vigorously 30 minutes a day. I had a slight elevation in my LDL. My internist suggested going on Lipitor. Now that I'ved read your book I have some grave doubts anout the wisdom of that. My two best friends in their mid-seventies have both had coronary bypass surgery, with visible loss of cognitive power. Maybe I'll try Christian Science! In brief: a great book and I enjoyed your response.

Thomas P. Lowry, MD

Tom,
I just sent the following message to a large city public health director. The latter part is relevant to your situation. Onward Christian Scientists (mostly):

Statins in women. First of all, there is no evidence from randomized controlled studies to date of a significant benefit of statins in primary prevention for women. Is this just because the studies have not yet been large enough? There is evidence on both sides, but the two most relevant studies that I know of are:

A study published in JAMA a couple of weeks ago reporting on 7300 health women who had been followed for the past 31 years and found that elevated cholesterol contributed absolutely nothing to women's risk of death. [JAMA, 2004; 292:1588-1592] The ASCOT study randomized 2000 high risk women without heart disease to recieve Lipitor or placebo. Those who took Lipitor developed 10% more heart attacks than the women who took placebos. A large randomized controlled study is necessary to answer the question. But the evidence to date does not appear adequate to me to recommend that women take statins for primary prevention. (One would have thought that "First Do No Harm" would still be on experts' minds after the HRT debacle.) And also, the evidence is quite clear that about 80% of the risk of heart disease for women has to do with health and lifestyle habits--the premature and exaggerated attention on cholesterol has distracted doctors' and patients' attention away from the interventions that we know are far more effective at preventing heart disease (as well as osteoporosis, breast cancer, chronic lung disease, stroke, diabetes...) Given the relative benefits and even potential benefits, the nearly singular focus on cholesterol-lowering with statin drugs, in my opinion, undermines the effectiveness of preventive health care being provided to American women.

Similarly another study published a couple of weeks ago in JAMA shows that elderly folks who exercise regularly, eat a Mediterranean style diet, don't smoke, and drink in moderation have only 1/3 the death rate of those who don't do those things. And similarly, the PROSPER study shows that statins don't help elderly women (70-82) with and without heart disease, nor elderly men and women for primary prevention. But in this study statins did significantly increase the risk of getting cancer, and the risk increased in each of the four years of the study lending credence to the finding.

Hope this is helpful,
John