December 7

An imaginary war

8  comments

The long-awaited Baker report came out today describing the situation in Iraq as “grave and deteriorating,” and recommending withdrawal. Given the circumstances, withdrawal over some defined timetable is probably the only reasonable option. I suppose that there may be other legitimate options, it’s just that no one seems to know what they are. One wag has jokingly suggested that we give Saddam Hussein back the keys to his palace, tell him we’re sorry about his kids, and let him re-establish his dictatorship. We now know that we don’t have to worry about WMD. Strangely, this solution would probably result in less Iraqi bloodshed after we’re gone than the civil war that will erupt for sure. But, I’m sure we will stick around until the Iraqis hang him.
As I read over the Baker report I couldn’t help but wonder about all the young men and women who have given their lives for this doomed effort and those who will continue to do so. As the saying goes, who wants to be the last person to die for a lost cause?
Bad as dying for a lost cause is, there is probably something even worse: dying in a war against an imaginary foe.
American citizens are dying in just such a war right now. It’s called the war on cholesterol.
As you’ve probably read, the pharmaceutical giant Pfizer (the world’s largest drug manufacturer) has halted development of its newest anti-cholesterol drug torcetrapib because so many patients taking the drug in clinical studies were dying. As all the media reported, this failure is sure to be a financial blow to Pfizer because it was hoping for a major hit. Torcetrapib wasn’t just another statin drug, it was the first of a whole new class of drugs called CETP inhibitors.
What are CETP inhibitors?
Cholesterol ester transfer protein (CETP) is a protein that moves cholesterol from the ‘good’ HDL to the ‘bad LDL causing levels of the former to fall and levels of the latter to rise. The thinking was that if the CETP could be somehow inhibited HDL levels would go up and LDL levels would go down, which, to believers in the lipid hypothesis, would be nirvana. Problem is, CETP is also involved in reverse cholesterol transport, which is the process whereby cholesterol deposited in the walls of arteries is transported out and back to the liver. Many people, myself included, thought that it might not be such a good thing to inhibit this protein. But preliminary studies seemed to indicate that the HDL did indeed go up while the LDL went down, so it was full speed ahead with the development and more extensive testing.
Any pharmaceutical company that can come up with not just a me-too drug, but an entire other class of drugs has a license to print money until the other drug companies can figure out how to weasel in with their own versions. Think Merck & Co. and Mevacor, the first statin drug. Since I’m sure that Pfizer would enjoy printing money, it came as a crushing financial blow to learn that their new drug was killing people and had to be deep sixed. As the New York Times put it in an editorial:

Alas, in the late stages of clinical testing, an independent monitoring panel found that patients receiving torcetrapib were dying at a higher rate and had more heart problems than patients who did not receive the drug. The panel recommended terminating the trial, and Pfizer promptly did so. It was striking evidence of the importance of independent monitors, who can render a judgment based solely on patient safety without worrying about the financial implications for the manufacturer.

The tragedy of all this as far as I’m concerned is that a large number of people signed up for this study because the medical profession has scared them silly about their cholesterol levels. I’m sure that few, if any, realized that the idea that cholesterol has anything to do with heart disease is only an hypothesis, and a tenuous one at that. Many of these folks died in a battle against an imaginary foe. And their deaths, like those of our troops in Iraq, were for naught.
The newspapers and websites reporting on the collapse of a new class of drugs simply shrug off these deaths as bad statistics that forced the early termination of a drug thought by many to have such promise. But these victims were real people with real lives. They were husbands and wives, fathers and mothers and grandfathers and grandmothers–and they are just as dead as if they had been gunned down by Iraqi insurgents. Their premature deaths inflicted countless families with the infinite sadness that comes with the loss of a loved one. The total quantity of grieving and heartache unleashed by this study is incalculable.
The saddest part is that it was unnecessary. Had these people not feared the bogeyman of cholesterol they would be alive today. Their deaths were for naught.
The Times editorial, which was most sympathetic to the plight of Pfizer, unwittingly blew the cover on the entire charade in the very last sentence. After going on about some of the problems discovered earlier with torcetrapib and how those problems might be solved with other drugs, the piece goes onto to say that maybe there could be something intrinsically dangerous about this whole approach to raising HDL levels, which it says would be a shame. Then:

The drugs that reduce bad cholesterol have revolutionized cardiology but have still left heart disease the nation’s No. 1 killer.

Say what?
Think about that sentence. Drugs that reduce bad cholesterol, i.e. statin drugs, have ‘revolutionized’ cardiology. How have they ‘revolutionized’ cardiology if they haven’t decreased the incidence of heart disease (which they haven’t), the very thing cardiologists treat.
And you thought debate on the Iraq war was convoluted.


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  1. If a few hundred deaths hear and there was the only consequence of the cholesterol war it would be unfortunate but in comparison to the tragedy that is actually taking place it is insignificant. Diabetes is destroying the lives of hundreds of thousands every year. Blindness, amputations, kidney failure. At least half of them easily preventable, more than 90% preventable with some real effort. Unfortunately the lipid hypothesis prevents the whole system from addressing the real problem.
    Fat causes heart disease;
    diabetics have elevated risk of heart disease;
    Therefore: diabetics must avoid fat.
    Were it not for this; “W” could afford a couple more little wars. Maybe the world is actually better off WITH the cholesterol war?
    Pharma is running a commercial boasting about having 77 new diabetes drugs under development. It is tantamount to blasphemy to address any health problem without a patentable molecule.
    Hi George–
    You’ve summed it up.  The idea that fat is bad is so entrenched that no one can get past it.  I’m convinced that if someone came up with a therapy that would save hundreds of thousands of lives but in the process would raise the amount of fat in the diet, such a therapy would be rejected out of hand.  Wait.  There is something like that.  It’s called the low-carb diet.  Has it been rejected out of hand by the mainstream?  You make the call.
    I can tell you this.  If any pharmaceutical company could put the power of the low-carb diet to reduce disease in a pill it would make more money than the government.  The sad thing is, that it’s all there for free, but has few takers.  Why?  Because of the propaganda of the mainstream.  Sad.
    Best–
    MRE

  2. Hi Mike,
    Interesting analogy. I guess the major difference is that long before the current disaster in Iraq there were many, many people who could simply join the dots and foresee the pointless and inexcusable catastrophe that was to come. “Another Vietnam” was frequently predicted, although the reality is (and was always going to be) a great deal worse, given the long term consequences … and not just for Iraqis.
    I guess it is also hard to think of anyone less suited to the job at hand (devising a politically palatable exit strategy) than the so called “foreign policy realist” Baker given he was one of the chief architects of the post Gulf War plan to foment a Shiite and Kurd uprising against Saddam, and then to abandon those who did so to genocide. Strangely, the ‘he’s done the job before’ line doesn’t cut much ice with me.
    Coming back to cholesterol!!
    The difference is that despite what a handful of people such as yourself say, the drug company propaganda is all most people hear, and it is assumed that the “experts’ either know what they are talking about, or at the very least, have public health as their first priority. Hence the sympathetic reporting of Pfizer’s ‘troubles’, and the scant regard for the terrible human cost of their misguided trials. We are led to believe, if we consider the implications of drug trial death rates at all, that sacrifices (by others) are sometimes necessary on the path to the nirvana of a drug ‘cure’.
    I have a business partner in his early sixties and my father (83) – both diabetics, both on so many pills they would probably rattle if shaken … both, of course, on statins (and ‘heart healthy’ ‘cholesterol lowering’ margarine). Much as I would like to, there is very little I can say. Both have had recent health scares – a blockage requiring a stent and a thankfully minor stroke respectively, so they both feel they are getting the best of care from their various doctors. Neither is likely to read anything which seriously challenges the orthodox ‘artery clogging’ lipid hypothesis … even though I stand ready to supply a mountain of books and research papers at the slightest sign of weakness!
    Thankfully(?), at least when it comes to foreign policy, the cost of pursuing strategies which inflame rather than heal are in plain view, and there is no shortage of independent analysis of where things went wrong. Yes we still have to (finally) learn the lessons, but it is open to anyone to do just that. With drug company dominated medical research and reporting, most people will never even know what the real question was.
    Cheers,
    Malcolm
    Hi Malcolm–
    Thanks for the insightful comment.  I agree with you about Baker.  It would be like hiring Dean Ornish to tell us where the low-fat diet has gone wrong.
    Sorry about your dad.  I know a lot of people in the same boat.  They have problems that could be easily solved with a dietary change, but hang in there instead with the advice (always to reduce fat and take statins) from their docs who have bought the Big Pharma approach hook line and sinker.
    Best–
    MRE

  3. The drugs that reduce bad cholesterol have revolutionized cardiology but have still left heart disease the nation’s No. 1 killer.
    All while the prevalence of smoking has declined significantly too!
    Hi Regina–
    Great insight!  We know that smoking causes heart disease, and we know that smoking has been on the wane for years.  We should expect to see a major drop in the incidence of heart disease as a consequence.  But we haven’t; it’s stayed about the same.  A revolution in cardiology indeed!
    Cheers–
    MRE

  4. Sir Hola..reading this afore i head out for Squamish
    Please go to google video and watch the uber brill
    the power of nightmares the rise of the politics of fear
    Not shown in the US. Its a BBC 3-parter, i think you’d really like it.
    As always gasho for your time and effort
    Hi Simon–
    Watched the video. Can’t wait to watch the next two parts when I’ve got a couple of hours to spare.
    If you haven’t yet, you should read Andrew Sullivan’s book The Conservative Soul. It describes how to get out of this mess.
    Cheers–
    MRE

  5. This is why I gave up on corporate media, and only go read people who analyze their fields with disinterest and without corporate connections, whether medical,political, etc. One cannot get accurate information from institutions in bed with Big Agra, Big Pharma, and Eisenhower’s favorite, the Military-Industrial Complex! …Halliburton anyone?
    Speaking of which, one of the political analysts I like reading said that once we leave Iraq to its civil war, a Saddam-like ruler will develop during and after the civil war. This will be necessary to do what Saddam did, which was to keep an uneasy peace among all the factions. So the wag’s joke is actually not one.
    Hi LCforevah–
    Why come up with a new Saddam when we’ve already got one whose resume we’re familiar with?  Why take a chance on a unknown entity?
    Out of curiosity, who are some of the political analysts you enjoy reading?  I wonder if any of them are on my list.
    Cheers–
    MRE

  6. A few years ago, I had a cat that had a heart murmur. The vet prescribed a pill for her, but getting her to take it was an ordeal each and every day. She fought me, she hated the taste of it, she foamed at the mouth and tried as hard as she could not to swallow–it was a horrible battle with her day after day. She got to the point where she would run from me every time she saw me in case I had that nasty pill. After a couple of months, I stopped giving her the pill to reestablish our loving relationship. On her next vet visit I told him I had stopped giving her the pill, and he protested my decision, arguing “But her heart is better.” And I replied, “Her heart may be better, but the cat got worse.” It surprises me how people who seem so smart can be so stupid–drug researchers insist on believing they can create a drug that will fix just one problem in so intricate a creation as the human body without affecting the entire organism. So many of these “wonder” drugs have such serious side effects (and death is a pretty serious one) that the cure often is worse than the disease.
    Hi Ethyl–
    Thanks for the story of your cat’s problem.  You are right.  Most doctors consider their efforts a huge triumph when they successfully treat their patient’s lab values.  If they get their patient’s cholesterol levels to fall, they are delighted, irrespective of how the patient’s themselves are actually doing.  In not just a few cases, their achieving the ultimate end point–cholesterol lowering–brings on the ultimate serious side effect–death–in their patients.  Sad, when you consider that it’s never been shown that cholesterol lowering does squat.
    Best–
    MRE

  7. Dr. Mike, we can’t put back in power someone who’s been through a show trail and is now condemned to death. The rest of the world might think we don’t believe in the rule of law!
    Hi LC–
    You’re right.  How could I have forgotten?  As I’m sure you realize, our leaders are constantly striving to burnish our reputation throughout the world.
    Cheers–
    MRE

  8. Main Entry: rev·o·lu·tion
    Function: noun
    (1) : [b]a progressive motion of a body around an axis so that any line of the body parallel to the axis returns to its initial position [/b] while remaining parallel to the axis in transit and usually at a constant distance from it
    Hi Max–
    I guess I was wrong.  According to this definition statins have indeed brought about a ‘revolution’ in cardiology.
    Cheers–
    MRE

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