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Mediocrity In Medicine: Why Is It Accepted?

by Dr. Brownstein

About four years ago, I lectured to a group of conventional cardiologists about statin drugs. In that presentation, I presented data that cholesterol-lowering medications including statins and Zetia were poor choices to treat heart disease.

Needless to say, the lecture was not well received. When I presented data about Zetia, the audience voiced their displeasure. I stated at the time that there were no studies that show that Zetia or Vytorin (which contains Zetia and the statin drug Zocor) were effective at treating or preventing heart disease. At that time, I stated that Zetia should be pulled from the market.

Perhaps I was wrong. You can decide.

The headline at today stated, “IMPROVE-IT Meets Endpoint and Demonstrates Real But Modest Clinical Benefit for Ezetimibe.” (1)

Let’s look at the “real but modest” benefit that is touted in the headline. IMPROVE-IT randomized 18,144 high-risk patients (those who already had a cardiac event) to either Vytorin or placebo. Patients were followed for an average of six years. The endpoints included cardiovascular death, heart attack, hospital admission for unstable angina, coronary bypass surgery, or stroke.

The “real but modest benefits” were this: 34.7% of the placebo group versus 32.7% of the Vytorin group suffered a cardiac event. The article stated that represents a 6.4% reduction(32.7/34.7)  in cardiac risk in those that took Vytorin versus placebo. However, the 6.4% reduction is the relative risk reduction.

Relative risk reduction provides little useful information on whether a drug therapy is beneficial or not. A more meaningful number is the absolute risk reduction. The absolute risk reduction from taking Vytorin (when compared to placebo) for six years was 2% (34.7-32.7).

So, how many people need to take Vytorin for six years to prevent one cardiac event? This number is called the number needed to treat. In this study, 50 patients would have to take Vytorin for six years to prevent one cardiac event. That comes out to a cost of $900,000.00 as a quick call to CVS informed me that it costs $250.00/month for Vytorin.

That is not the whole story. This study found no difference in the most important endpoints: overall deaths, cardiovascular deaths, or coronary deaths.

Why should a 2% cardiovascular risk reduction in a drug that has shown nothing before this be considered a success?  And, keep in mind, that this risk reduction did not include the most meaningful risk reduction–death.  In this article, a senior author of the paper stated, “These results are a home-run for patients.”

A “home-run”? Yougottabekiddingme! Another way to look at the study is that this study found that Vytorin failed 98% of those that took it since 49 out of 50 treated subjects receive no benefit. And, the 49 who did not receive a benefit were exposed to adverse effects and pad $250 per month for naught.  The only home-run here is for Big Pharma who gets to promote another mediocre drug.

Why does my profession accept this mediocrity? Not only do they accept it, they embrace it. It is pathetic.

Folks, we spend too much money on drugs that provide little, if any, benefit. In fact, we spend more on drugs than any country on the face of the earth and we lag behind every major Western country on every important health and disease indicator.

This study should be the last nail in the coffin for Vytorin. It is a failed drug that has little usefulness. We would be better served to remove it from the marketplace.

Read the full article at and comment there.

More information about cholesterol-lowering drugs can be found in my book, Drugs That Don’t Work and Natural Therapies That Do.