Eezetimibe should be banned, Is Spun as Breakthrough by Drug Company

They managed to get the New York Time to go along with it, sort of…. “…a large study has found that another type of cholesterol-lowering drug can protect people from heart attacks and strokes. The finding can help millions at high risk of heart attacks who cannot tolerate statins or do not respond…” [emphasis ours]

The study was sponsored by Merck. Remember always to be on the lookout for this telltale sign. Did a drug company sponsor the study? They were kicking what I thought was a dead horse, ezetimibe. We don’t know who came up with the ‘help for millions’ part of the headline, but the study compared statin users to statin+ezetimibe users. The combo drug reduced heart ‘events’ 6% over the statin only group. The groups were very high risk, having already had a heart ‘event’. By the way, even if this part of the study is correct, the combination did not decrease heart death.

For the past 25 years, LDL cholesterol has been considered a disease, and attempts made at all costs to lower it. However, it has been shown repeatedly that indiscriminate lowering of LDL with statin has no overall mortality benefit for almost all groups, and further, that low LDL is implicated in dementias.

Medical guidelines seemed to have finally shifted away from LDL lowering. This study hopes to change that.

These results were quite a surprise, or maybe the lesson is that if you test enough, you will eventually get a result you like. Earlier tests, in 2006, had such disastrous results that I thought no one would ever again use this drug. Somehow the FDA approved it anyway.

If fact, earlier results for ezetimibe were so bad, it made it all the more astounding that the drug could suddenly start working. The New York Times apparently decided to seek a second opinion. From Dr. Steven Nissen:

“This [was] as bad a result for the drug as anybody could have feared,” said Dr. Steven Nissen, the chairman of cardiovascular medicine at the Cleveland Clinic, when the 2006 ezetimibe results came out. The results, he said, were “shocking.”

The drug, Dr. Nissen noted in a telephone call Friday, had reached 17 percent of market share for cholesterol-lowering drugs with no evidence of benefit.

“Now we have the result,” Dr. Nissen said. “They were successful, and that’s great. But at this point, it really doesn’t matter. They made their $30 billion.” The drug will be available as a generic in 2016, Merck says.”

Another cardiologist, Dr. Krumholz of Yale had this to say:

“That the drug was promoted and sold for so many years without evidence that it helped was inexcusable, Dr. Krumholz said.

“The fact that the trial exists says there was uncertainty,” he said. “The company and the investigators and the scientific community were uncertain about it. This is a cautionary tale.”

These are the sorts of things that make me tear my hair out. Perhaps that is why there is so little left. It is appalling that 17% of statin users are being prescribed ezetimibe as well, in spite of clear evidence that it offered no benefit. It is even more appalling that 25 million Americans are taking stains when we have result after result looking like this.

“The use of statins in this high-risk primary prevention setting was not associated with a statistically significant reduction …”

So what does the medical/pharmaceutical complex advocate? They add another drug to the useless statins, spend years testing it in spite of having reached the conclusion early on that it made things worse and what is the result? 17% are taking that one as well.

Why are we doing this to our patients? Public skepticism about medicine is probably well placed. At least Merck made their $30 billion.