Thursday, April 01, 2010

The Latest Approach To Cure An All Too Common Disease. Fat Wallet Syndrome.

Do you get out of bed in the morning and go about your normal business? Work a certain number of hours, perhaps followed by a bit of recreational activity and then return to bed? Do you seem trapped in an endless cycle of waking and sleeping, eating, inhaling and exhaling, with nothing at all interfering with these basic life functions?

If so, you may be perfectly healthy. And you should talk to your doctor about Crestor.

Crestor is a medicine used to treat high cholesterol, but even if your cholesterol is within the normal range, the people at AstraZeneca think you might want to take it anyway. To treat inflammation. Specifically, Crestor is about to be marketed to people with an abnormal C-reactive protein test, which measures the level of inflammation in the body and is on the verge of being declared a risk factor for heart disease.

According to a story in yesterday's New York Times, the inventor of the C-reactive protein test, Dr. Paul M. Ridker, originally went to the National Institutes of Health with a proposal to study how C-reactive protein ties into risk for heart attacks and strokes. And was turned down. Pfizer and Bayer also rejected his ideas. But like Christopher Columbus, that maverick explorer who persisted because he knew he was right, Dr. Ridker persisted and was vindicated. He eventually found a patron to sponsor a study, led by him, that showed that yes, there was a significantly significant link between an abnormal C-reactive protein test and cardiovascular events.

"Significantly significant" however, does not mean "large." There is a statistically significant correlation between living in California and getting bitten by a rattlesnake, but would you spend $1500 a year to lower your lifetime risk of a rattlesnake bite from 0.37% to 0.17%? Or would you just take precautions to avoid surprising a rattlesnake when you're outside?

AstraZeneca would probably tell you it would be ridiculous to cough up $1500 bucks every year for some high-tech rattlesnake repellent. Because the money isn't going to them. When you and your insurance company are writing checks to cover your daily Crestor when you are not sick however, I'm sure AstraZeneca would tell you you are being proactive and smart about your health. At a cost of $638,000 for every heart attack prevented.

Until you get that weird muscle pain, and your urine gets really dark. Then maybe you weren't being so smart about your health. Not to mention there's also some indication statins may increase your risk for type II diabetes. I'd be really pissed if I spent $1500 a year on some rattlesnake repellent that made me more attractive to mountain lions.

Oh, and Dr. Ridker receives "undisclosed amounts" of royalties from the C-reactive protein test he invented. Which totally made him the best person to lead the study that found the link betwen C-reactive protein and heart disease. You always get the best science when the lead researcher can make a shitload of money by proving a specific conclusion.

Remember this when you see the upcoming ad blitz for Crestor, and the commercials for my new rattlesnake repellent.

I think I'll call it Rattenov™


Anonymous said...

I am so glad we have price controls over here, the prices you guys pay for medication is absolutely ridiculous. How much crestor do you use, I barely use a pack a month in my pharmacy, its all about the simvas/atorvastatin

Pharmd Biker said...

Gone are the days of leaving your doctors office empty handed, because all you really needed was rest and chicken noodle soup. Today, the reward for going to the MD, paying a co-pay, waiting in line, is that tiny euphoric piece of paper for a drug that you probably do not need.

I find it offensive that drug reps can no longer come into the pharmacy or MD office to drop off a study or two, give a 5-10 min talk about their drug (which is sometimes helpful), and leave those coveted pens. the government has ended it. why?? Why not put some sort of limit on direct to consumer advertising?? My opinion on what to recommend to a MD or a patient is not going to be based off a stupid pen. I have had people demand their MD write a Rx for certain drugs just because they saw them on the TV.

Sophia said...

That particular study was the paper topic for my journal club in class this semester. We're just 8 2nd year pharm students, but we saw through it pretty quickly. I have to give kudos to whoever picked the paper for us to read and critique, because they clearly want us to get a sense for the BS pharmaceutical companies come up with early on.

DKLA said...

It's just another way to tack on a new indication to extend the patent (we seen it with Plavix...).

Don't they ever consider that an inflammatory condition requires, oh I don't anti-inflammatory agent. Just tell people to stick with their baby aspirin or NSAID's.

Anonymous said...

What will you do if your C-reactive protein is high besides take a drug for it? Are they going to have some genetic testing available soon, so you don't marry into it?

Keith said...

You forgot to add that Crestor should be bought by local municipalites and placed in the drinking water. For folks that live in the country, there should be Crest-a-Cola for them to drink every day. Babies get an ounce, children 4 ounces, and adults get a pint. You also forgot to mention that it should be bottled as a tonic and cure all for everything that ails you and you could call it Rattlesnake Tonic. Add a little alcohol to the bottle and that will soothe everyones nerves so that they will not worry about any side effects from the drug. :)

Elliott said...

I know that this is controversial, but the 638000 number is based on Crestor and the result is generalizable to any statin so lovastatin at about 1/3 the cost is going to be less. Also, the JUPITER study's inclusion criteria included people with no risk factors so including the need for one additional risk factor also decreases the cost/MI avoided. Other endpoints also showed declines. All in all the cost per MI or stroke avoided is probably closer to 200k and that just might meet cost utility analysis threshold of 50k/QALY.

Anonymous said...

Thank you for the rattlesnake/mountain lion analogy. I can't wait to use that when I teach students about studies and stats. Awesome!