Tuesday, September 16, 2008

Drug companies still promoting medication of the healthy

I had to change doctors due to staff turnover at the clinic, so just had another argument about statins.

Because diabetics have a higher risk factor for heart attacks, doctors take a more aggressive approach to treatment, and prescribe statins earlier than they would for the general population. All very well, but as far as I'm concerned, diabetics have a higher risk because so many of us are morbidly obese, often with failing kidneys and other organs to boot. Given that I'm not even overweight, let alone obese, I find this supposed increased risk factor less than persuasive in my individual case. It's a blunt sociological statistic, not a precise diagnostic tool.

The argument was settled when the doc fed my latest blood test results into the computer, ticked the Diabetes box for additional risk factors, and came up with a "Number Needed to Treat" of 116! He had to agree this wasn't a high risk.

For the layman, this NNT of 116 means that if I and 115 others like me took statins for 10 years, 1 of us could expect to avoid a heart attack we'd otherwise have suffered. So, what's up with me? Don't I want to avoid a heart attack? Well, look at it this way:

1. I'd be permanently taking medication that had only a 1-in-116 chance of actually doing anything for me.

2. How much would it cost Pharmac (ie you, the taxpayer) to subsidise 116 men taking this expensive medication for 10 years? I don't know, but I'm happy enough to approximate it to "a shitload of hard-earned cash."

3. How much would it cost those 116 to pay the unsubsidised portion of the cost? Let's call it "a somewhat-smaller shitload of hard-earned cash."

4. The benefit of medicating 116 healthy men is one heart attack that doesn't happen. In other words, one of us would probably get to die a slow, painful death from cancer rather than a quick death from a heart attack. Who knows how many additional years of life that would take? Might be decades, sure - but it might just as easily be a couple of years.

5. I have a distinct philosophical objection to permanently medicating healthy members of the population based on odds that don't even make it to 1%. If you're healthy, you don't need to be popping expensive pills every day, no matter what the companies who stand to profit try and tell you.

6 comments:

Adolf Fiinkensein said...

Milt, I expect you will rush off and cancel your house insurance today because the odds of it burning down are a hell of a lot more than 1 in 116 - in fact closer to 1 in 1500 if my memory serves me but I'm not sure.

Psycho Milt said...

I'm sure that if insuring my house required me to take pills every day and came with a 10% chance of significant and unpleasant side effects, I might well cancel it Adolf!

In any case, the taxpayer isn't being asked to pay for my house insurance. I'm sure that this business of medicating healthy people is using up health funding that could be spent on people who actually have something wrong with them.

Sus said...

Wrong analogy today, AF. You miss the pertinent point of throwing drugs (ie poisons - we often forget that) down the throats of people who don't need them.

I have a distinct philosophical objection to permanently medicating healthy members of the population, period.

And when it's being pushed by a socialist health system that routinely cries poor, we ought to wonder why.

MacDoctor said...

Sus said: And when it's being pushed by a socialist health system that routinely cries poor, we ought to wonder why.

I can tell you why. It is being driven by doctors who are pill-happy. These are the same clowns who think that the poly-pill is a good idea because it will reduce the frequency of heart attacks. Never mind that it would be massively expensive and 90% of the population would be taking medication they don't need. As PM points out, these things have serious side effect - a fact that is NOT taken into account when you are calculating numbers needed to treat.

Here is the data sheet on Lipex, the commonest statin. For those who find medical terms too incomprehensible, the major side effects are liver damage (sometimes irreversible) and muscle damage, including heart muscle wasting. There have also been reports of depression and cataracts.

Not a very user-friendly drug.

Clunking Fist said...

Would a better analogy be: "like having a constant running sprinkler system, helping prevent fires...but making it difficult to cure the mold in the bathroom ceiling."

Sus said...

Exactly, Fist. Well put.

Mac: you're preaching to the converted with me. I don't disagree with you, but there's loads more to it than that. Prevention being a thousand times cheaper and preferable than the cure is just a start. And did anybody mention being personally responsible? Nah. Didn't think so. Why bother?

I work in the health sector. You could throw twice as much money into "public" health & it wouldn't make a blind bit of difference; never mind that it's never had so many taxdollars thrown at it. The same problems would continue.

It's socialism, silly. Doesn't work for supermarkets and yet we expect it to work for hospitals.

Pathetic, really. But you guys will vote for it!