Tags: cholesterol | prescriptions | stroke | heart attack | complications

Hall Pass or Lottery Ticket?

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Tuesday, 17 Mar 2015 04:21 PM Current | Bio | Archive

As much as I love learning, I did not always love school. We moved a lot, and I was too shy to do well as the new kid.

At a new high school during my freshmen year, I discovered the joys of the hall pass. Being handed one gave me a feeling of freedom. With it, I was able to evade the pressures of the classroom and wander the halls aimlessly.

If a teacher stopped me to see if I should be in class, all I had to do was show my hall pass, and I’d be on my way. I think of a hall pass as something that is assured to protect you. Let’s say a hall pass works about 8 out of 10 times.

There are hall passes, and then there are lottery tickets. I’ve heard it said that lotteries are secret taxes for those with poor math skills.

If you have a few dollars to spare, it may be fun to buy a lottery ticket and imagine striking it rich. On the other hand, if you are hungry, your last few dollars are better spent on a meal than on an infinitesimally small chance at fortune.

You cannot rely on a lottery ticket when it really needs to count.  For the sake of discussion, let’s say that your chance at winning a certain lottery is only 1 in 100.

Last week, a new patient told me she wanted to stop taking her cholesterol pills but was afraid to do so. Her previous doctors had given her the medicine with the implication that it would keep her safe. To her, the medicine felt like a hall pass that was protecting her from heart disease.

But how well do these medicines really work?

Remember we said hall passes worked 8 out of 10 times, and lottery tickets worked maybe 1 in 100 times? Are cholesterol pills hall passes or lottery tickets?

In the case of my patient, she had never had a heart attack. She was in her mid-50s, had high LDL cholesterol and a family history of heart disease. Based on studies involving 65,229 participants, here are the odds of that medication helping or hurting her:

• Chance of preventing a heart attack — 1 in 104

• Chance of preventing a stroke — 1 in 154

• Chance of making her diabetic — 1 in 50

• Chance of causing muscle damage — 1 in 10


The odds of the cholesterol medication doing anything helpful are 1 in 104. That means if 208 people, like my patient, were divided into two groups, and one group took cholesterol pills and the other did not, the group on medicine would see one less heart attack.

Interestingly, even though they would have one less heart attack, they would have no fewer deaths. Any reduction in death from heart disease would be outweighed by deaths from other causes. The odds of muscle damage were 10 times higher than the odds of preventing a heart attack.

That medication is not a hall pass. At best, it’s a lottery ticket.

What about pills for blood sugar? In a study of more than 35,000 people on medications to aggressively control blood sugar there was zero chance of preventing death, stroke, heart attack, or kidney failure. The chance that the blood sugar pill would prevent limb amputation was just 1 in 250.

Yet the chance of being hospitalized because of low blood sugar: 1 in 6.

Here are the numbers for blood pressure medications from more than 8,900 people with blood pressure as high as 159/99: odds of preventing death, stroke, heart attack, or other cardiovascular event, 0; odds of causing severe side effects, 1 in 12.

What do these outcomes prove? Medications do not work well for chronic diseases. Even when they do lower the marker of illness — like high cholesterol, high blood sugar, or high blood pressure — they do nothing to prevent what matters: the complications.

Worse yet, the dangers of these medications are even greater than it may seem because of the false sense of security they provide. What kind of people try harder to improve their health — those who feel they need to, or those who believe that a pill will protect them?

Many patients believe that radical, lifestyle change might be a nice idea, but pills are more powerful.

After looking at these numbers, do you believe that pills are hall passes, protecting us from chronic diseases?

No, pills are lottery tickets.

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AlanChristianson
Last week, a new patient told me she wanted to stop taking her cholesterol pills but was afraid to do so.
cholesterol, prescriptions, stroke, heart attack, complications
748
2015-21-17
Tuesday, 17 Mar 2015 04:21 PM
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