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.
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.