Page 59 - Fall2012

All Thumbs Book Reviews

How Statin Drugs Really Lower Cholesterol so good if you’re taking it. Brown and Goldstein,
and Kill You One Cell at a Time two of the main researchers for Merck, wrote a
by James B. Yoseph and Hannah Yoseph, MD treatise explaining how statins lower cholesterol
Published by James B. Yoseph and won a Nobel prize. They probably thought
and Hannah Yoseph, MD that was great, too. I suppose one might be
impressed with the slick way they avoided any
As you may gather from this book’s title, discussion of the disastrous side effects of statins.
Yoseph and Yoseph are not advocates of statin By the time Yoseph and Yoseph finish
drugs. They give their readers a detailed his- explaining the history and mechanism of statin
tory of the development of statins along with an drugs, we are left with limited options. Either
explanation of precisely what statins do to cell doctors who prescribe them don’t really under-
biology. This information is clearly referenced stand how they work, don’t understand basic cell
and displayed in boxes interleaved in the text at biology, or don’t care about that as much as they
the appropriate places. If you don’t want to read care about their salaries. The authors point out the
all the details in the references you can skip the fundamental conflict of interest in our medical
boxes and read on. If you want to investigate the system.
references immediately, they are right before you. Some of our readers may remember that
I like it. Clearly, the authors know this subject Merck was forced to recall the painkiller Vioxx
is controversial so they back up everything they when the number of people having heart attacks
say as sturdily as possible. became too large to hide. You may also remember
Because one of the authors is an MD and the embarrassing fact that Merck happened to
they are covering all the details, there is a certain know about that problem before it ever released
amount of technicalese in the book but it is all the drug onto the market. The authors of this
adequately explained and therefore understand- book remind us of that debacle and go on to docu-
able if you pay attention. ment the same pattern of behavior in the case Since
Early statin research was carried out by of lovastatin (Merck’s bestselling statin drug). modern
Sankyo in Japan and Merck in the United States Conflict of interest has motivated Merck and
and came to a screeching halt when all the lab other pharmaceutical companies to misbehave medicine
animals developed cancer. The research also in a number of cases that are a matter of public has been so
clearly showed that statins work by disrupting the record. effective at
mevalonate pathway. What essentially happens The NIH-backed National Cholesterol Edu-
when you shut down the mevalonate pathway is cation Program (NCEP) set national policy for convincing
that cellular DNA can no longer replicate itself. lowering cholesterol with statins. All doctors who everyone that
As an added bonus, the cell dies. established NCEP guidelines had financial ties cholesterol is
The American researchers in particular to pharmaceutical companies who make more
overcame this serious obstacle by jettisoning money if recommended cholesterol levels are to be feared
any inconvenient morals they might have had lower. above all else,
and forging ahead with development of the drug. Continuing the conflict-of-interest theme, there was
There is no question that statin drugs reduce we come to the FDA. In an advisory committee
cholesterol in the bloodstream. Since modern meeting held to review guidelines for lovastatin, much money
medicine has been so effective at convincing the meeting was not chaired by an FDA employee to be made
everyone that cholesterol is to be feared above but by a Merck consultant. The advisory com- from statin
all else, there was much money to be made with mittee included two Merck consultants and seven
such a drug. That’s great if you’re selling it, not Merck employees. Half of the audience was made drugs.
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