On Discovering A Highly Controversial Drug Company Document Revealing A Very Different Perspective On The Development Of Heart Disease - One Contrary To The Same Company's Aggressive Promotion Of Its Drugs To Treat High Blood Pressure And Lower Cholesterol
By RFD Columnist Dr. Malcolm Kendrick
(email - malcolm~llp.org.uk)
They say you should never explain a joke, because then it just isn’t funny any more. I quite agree, but something made me laugh over the weekend, and there is no way that I can get anyone to understand why without explaining it.
I shall attempt to set the scene.
There is a company which makes billions of dollars each year selling drugs that lower the blood pressure and the cholesterol levels of millions of people. This company now promotes the doctrine that there is no such thing as a cholesterol level, or a blood pressure level, that can be too low. Whatever the level, lower it. For these two risk factors are major killers and they must be hunted down and beaten with a big club.
As anyone who reads my words of wisdom by now will know, I don’t think that lowering cholesterol levels or the blood pressure has any effect on heart disease. I believe, instead, that heart disease is primarily due to damaging the lining of the blood vessel wall (endothelial dysfunction), followed by the development of a blood clot over the area of damage (thrombus formation).
Repeated episodes of endothelial dysfunction, and clotting, lead to the build up of a ‘layered’ plaque that can eventually rupture, creating a massive clot, or thrombus, which completely blocks the artery causing a myocardial infarction, or heart attack. Therefore, in order to prevent heart disease, you need to enhance the ‘health’ of the lining of the blood vessel wall and reduce factors in the blood that stimulate blood clotting.
So my views and the views of this company would appear to be dissonant – to put it politely.
Instead of promoting the massive benefits of blood pressure lowering I would say things like ‘The identification and management of patients with hypertension has not had as large and impact on the incidence of coronary heart disease as might be expected.’
Or ‘To date, most of our attempts to prevent atherosclerosis have centered on the control of hypertension and hyperlipidaemia, as well as lifestyle risk factors. However, recent insights into the pathology of coronary heart disease have sharpened our focus on the natural history of atheroma…’
I would add that ‘Several features of mature plaques, such as their multilayered pattern, suggest that platelet aggregation and thrombus formation are key elements in the progression of atherosclerosis…. Given the insidious nature of atherosclerosis, it is vital to consider the role of platelets and thrombosis in this process…’
Furthermore ‘Rupture of these plaques and the cascade of events that leads to thrombosis can occur rapidly and is now recognized as a common and major precipitant of unstable angina, myocardial infarction and sudden cardiac death. Studies suggest that thrombotic events may account for up to 90% of myocardial infarctions.’
As you have probably guessed by now, I am quoting from a document. A document produced twelve years ago by a major pharmaceutical company in the year of our Lord nineteen ninety two. This document was written at a time when this company did not have a cholesterol lowering agent, nor at that time (although this was about to change), a major antihypertensive drug.
What they did have was a product which lowered blood pressure, a bit. But more importantly, this product also had strong, additional, anti-coagulant properties. Thus, in nineteen ninety two, the message of the company was clear. Blood pressure and cholesterol lowering is really not that important. What you must do, if you want to protect against heart disease, is to prevent blood clots.
In order to promote this message they produced a short document called ‘Pathologic triggers - New insights into cardiovascular risk’. Someone I know discovered this whilst clearing out their desk. They thought I would find it funny, and I did. However, it was also a bit weird to find myself looking at my own thoughts on heart disease written down by someone else.
What amused me most was the fact that this company now completely disowns such arrant nonsense. ‘Heart disease is caused by endothelial dysfunction and thrombus formation! Whoever heard of such rubbish? It is blood pressure and cholesterol, BLOOD PRESSURE AND CHOLESTEROL! – you dolt.’
However, I must admit that the amusement faded rather rapidly. I now just feel somewhat empty and depressed to note that, when a major pharmaceutical company changes its mind, otherwise known as ‘now having to market a statin and a blood pressure lowering drug,’ they can change the mind of the entire medical research community. ‘Forget blood clots guys, it’s all due to cholesterol and blood pressure. Got that!’
‘Duh, yeh sure boss. We got it.’ (In the voice of Bennie, from Top Cat.)
For those who have read Animal Farm by George Orwell, this is frighteningly close to satire springing directly to life. For those who have not read this book, it starts with the pigs on the farm leading a revolt to get rid of the farmer. Naturally using the other animals to take all the risks.
Once the farmer has gone the pigs take over the farm and use as their party slogan, ‘Four legs good, two legs bad.’ Some time later, the pigs start smoking cigars and walking on their hind legs. At which point the slogan is changed to: ‘Four legs good, two legs better.’ A one hundred and eighty degree shift that is swallowed, without question, by the other animals.
You probably want to know the name of the company that has now declared four legs good, two legs better. Well, I suspect that you can probably guess. As for getting hold of a copy of this booklet. I rather think that I now own the only copy left in existence. It could be a collector’s item. Perhaps I could sell it back to …..