Just wonderin', is all

I have an aversion to taking medication, largely because of an inherent distrust of prescription drugs and the profit motive behind them. I recognize that there are drugs that work wonders for those who need them, but I also think that the rise in direct-to-consumer advertising has created a boom market for pharmaceuticals that may or may not be necessary.

As a person over 50 who battles blood cholesterol levels that are sometimes borderline-high (although the same doctor that used to have canniptions about my levels -- the one who tried to put me on the accupressure bead crash diet -- never once did a fasting lipids profile, just a blood draw at the end of a day at work), I'm probably supposed to be on statin drugs. The cardiologist son of a co-worker puts all his patients over 40 on statins.

The original statin drugs were derived from lovastatin, which is a compound found in red yeast rice. Oh, you can still get red yeast rice at the health food store -- it runs around 15 bucks a bottle, but it won't have the same cholesterol-lowering effect that studies showed it did prior to 1999 -- because the FDA was looking out for capitalism:

Red yeast rice in the past reduced cholesterol levels because it contained (among many other chemicals), one of the statin drugs, namely lovastatin. (The statin drugs are the most effective cholesterol-lowering agents used in medicine today. They were originally derived from yeast products.)

Studies using the "original" form of red yeast rice accordingly confirmed significant reductions in cholesterol levels.

However, the story does not stop there. In fact, the story became pretty confusing right after the clinicals studies confirming the efficacy of red yeast rice were published in 1999. First, because red yeast rice was found to contain lovastatin, the FDA made an administrative decision that this dietary supplement (often sold as Cholestin in earlier times) was a regulable drug, and thus removed it from the unregulated shelves of the health food store.

Then, in 1999, the FDA ruling on red rice yeast was overturned by the court of the District of Utah. But finally, in 2000, the 10th U.S. Circuit Court of Appeals ruled that red yeast rice IS subject to FDA regulation. Since then, the FDA has aggressively gone after companies selling red rice yeast containing lovastatin. While red rice yeast is still available on the grocer's shelf, the stuff that is out there now is apparently fermented using a different process, and apparently (I say "apparently" because it is in fact extraordinarily difficult to find out what dietary supplements do and do not contain) does NOT contain lovastatin. Therefore, (the active ingredient having been removed) its ability to lower cholesterol levels is probably nil. (This explains why the otherwise colorful labels no longer tout the cholesterol-lowering properties of the product.)

I saw a television ad for one of these statin drugs last week, and the small print at the bottom of the screen caught my attention: "Not shown to prevent heart or coronary artery disease."

Uh....well, gee whiz, then, what's the point of taking it?

It's conventional wisdom that high cholesterol --> heart disease, so therefore lowering cholesterol lowers the risk of heart disease. But that doesn't necessarily seem to be so. The medical profession loves to dump responsibility solely into the lap of individuals. Go on a diet. Exercise. If you avoid fast foods and get regular exercise and eat lots of fruits and vegetables and your cholesterol is still high, or you still get heart disease, it isn't because there's "something else" operative, but because you're cheating and lying to your doctor and stuffing your face with donuts on the side. Never mind the fact that there appears to be a genetic component to metabolic syndrome which seems to be a risk factor for heart disease -- let's not talk about that, because it's so much easier to just berate Teh Fat People and tell them they just have to spend more of their lives chasing an impossible goal. It's sort of the way the Christofascist Zombie Brigade is likely to tell gay men that even though the evidence is increasing that sexual orientation is determined in the womb, they have to "try harder" to be straight.

But then along comes Tim Russert, who dies suddenly while at work. Russert appeared to be doing everything the way he was supposed to given his health issues. He was under a doctor's care. He took prescribed medication for hypertension. He took the damn statin drugs for cholesterol. He exercised. He was trying to lose weight -- something that for many of us, isn't just a question of laying off the Big Macs because we don't even eat Big Macs in the first place. Russert's death is a complete confounding of the conventional wisdom given us by the medical profession:

It is not clear whether Mr. Russert’s death could have been prevented. He was doing nearly all he could to lower his risk. He took blood pressure pills and a statin drug to control his cholesterol, he worked out every day on an exercise bike, and he was trying to lose weight, his doctors said on Monday. And still it was not enough.

If there is any lesson in his death, his doctors said, it is a reminder that heart disease can be silent, and that people, especially those with known risk factors, should pay attention to diet, blood pressure, weight and exercise — even if they are feeling fine.

“If there’s one number that’s a predictor of mortality, it’s waist circumference,” said Dr. Michael A. Newman, Mr. Russert’s internist.

But, Dr. Newman added, most people would rather focus on their LDL cholesterol, instead of taking measures to reduce their waist size. Studies have found a waist of over 40 inches in men and 35 inches in women is a risk factor for heart disease.

Mr. Russert’s cholesterol was not high, and medicine controlled his high blood pressure pretty well, Dr. Newman said. But, he added, Mr. Russert was “significantly overweight.” He also had a dangerous combination of other risk factors: high triglycerides, a type of fat in the blood, and a low level of HDL, the “good cholesterol” that can help the body get rid of the bad cholesterol that can damage arteries.

Even so, Dr. Newman said, “the autopsy findings were a surprise.”

My father-in-law passed away in 2001 at the age of 79. He smoked, he was about 100 pounds overweight, he never, ever ate a vegetable. He liked his meat and he liked his potatoes. And he made it to 79, with all the risk factors. Tim Russert only made it to 58.

This is why all these admonitions we get from the medical profession don't guarantee a damn thing. Some of us yo-yo diet our whole lives and are never able to keep weight off. A woman I know at work has lost about 40 pounds and now can't eat more than 1000 calories a day without gaining. People spend hundreds of dollars a month on prescription statin drugs and still get coronary artery disease. Clearly there's something else going on here other than simply a question of what we put into our mouths and how much we move. One aspect to American life that gets little play in the medical press is stress.

It's interesting that American-style diseases such as heart disease are starting to crop up in countries like India, where high-stress call center jobs are increasing. But you don't see the American medical profession call for a societal effort to reduce stress in a country whose citizens are watching their standard of living diminish and the prospects for their children grow increasingly dim. After all, that would require that corporations have to acknowledge their role in fostering that stress. And it's just so much easier to call Tim Russert a fatty and say he died because of his own excesses, when there's very little sign that his premature death could have been prevented.