In the previous post regarding the topic of high cholesterol, I presented the idea that cholesterol is not dangerous or might not even be a cause of heart disease. Several research studies and reports have shown this. How then, did the idea that cholesterol must be lowered through low-saturated fat diets and statin drug use get started if there was not enough evidence to support it?
Apparently it started when butter became more expensive than margarine after WWII. At the same time it was discovered that oil could be expressed from cotton seed, a useless by product of the cotton industry, and became profitable, with the company Norton Simon becoming the biggest cotton seed oil producer & supplier to the margarine industry. The milk industry at that time was diverse and powerful, and thus began the marketing campaign by Norton Simon to convince the public that margarine was better than butter and divert profits to their product. This campaign was started by a small group of businessmen around 1946 involved in vegetable oil firms. These men formed a front group, called the American Health Foundation about 1970. The chairman happened to be David Mahoney, the President of Norton Simon. Associations were quickly formed between this Foundation and other tax-supported organizations like the National Cancer Institute and the National Heart, Lung and Blood Institute (NHLBL), including the FDA. With the help of these prominent organizations the Foundation went on to disseminate information on how saturated fat from foods like butter were dangerous.
To continue their promotion of their claim they needed to show that cholesterol in the diet (from butter) lead to heart disease. They latched on to a Russian study done in 1913 that fed large amounts of cholesterol to rabbits who then died of heart disease. They completely ignored the fact that rabbits are vegetarians and are not designed to handle large amounts of animal fats. Despite this omission, and the existence of evidence to the contrary, the study has been repeatedly used to promote the connection between cholesterol and heart disease and used to establish historic precedence.
Not only did the vegetable oil companies develop the myth to benefit profits, soon the pharmaceutical companies realized that they could get a share of the pie too by developing a drug that would lower blood cholesterol levels. This proved to be a very successful money making campaign for the pharmaceutical companies. But they didn’t stop there. They needed to make sure enough people had high enough cholesterol levels to justify a prescription and therefore have a stake in influencing the guidelines . As you probably know these guidelines have been revised several times, despite the fact that 50% of people with heart disease have “normal” cholesterol levels. The more people they could get into the “high” category, the bigger their profits. And it’s no coincidence that the doctors that made the recommendations have financial ties to the drug companies and much of the research that these guidelines are based on is also funded by the drug companies.
Lead Discovery, a UK company that helps companies optimize drug discovery and product pipelines, stated in a report that:
“…Those drugs (cholesterol lowering statin drugs) are one of the most widely-prescribed and most lucrative sectors of the pharmaceutical industry, with total revenues exceeding $26 billion in 2008. Importantly, the world statins market is poised to undergo a period of rapid and dynamic change, with the generic statin sector growing particularly strongly in the years ahead.”
Next it reveals its advice to companies to best reach the profit goal:
“Importantly, there are opportunities for companies to raise sales by maximizing patient compliance and accessing new patient groups. Statins: The World Market, 2009-2024 examines strategies for increasing patient compliance there. The report has detailed interviews with key-opinion leaders in this important field. Full interview transcripts are provided – you will not find this information anywhere else.”
This market research is taken seriously by statin drug producers such as Pfizer and Merck who would have to pay £6999 to get the full report and details on how to increase profits. And no wonder, considering Pfizer’s Lipitor is the biggest statin seller, at $11 billion. Merck’s Zocor, about to lose U.S. patent protection, is No. 2 at $4.2 billion.
The report goes on to outline steps to take regarding patient compliance including prescribing more tests, increase in patient contact and the use of information technology. For obvious reasons, I was not able to find out the details of their recommendations, so I can only infer as to what the above steps may entail. It seems that companies would profit most by focusing their resources on those that disseminate medical information to patients; doctors and media. And the reason they need to focus on patient compliance is that patients prescribed statin drugs stop taking them after about 3 months, many claiming undesirable side-effects such as muscle pain, memory loss, and symptoms of Alzheimer’s . But instead of improving the drug to reduce side effects, drug companies have realized it would be more cost effective to spend more money on tactics to convince patients they are safe and necessary. One way they do this is by perpetuating the myth that cholesterol is highly dangerous.
So how do they get this message across to patients? How would a company make sure that the patient feels like the consequences of not taking their drugs are worse than the potential dangers of the drug? The obvious route would be increase the frequency that the patient receives their message and by creating new tests as outlined in the report. This is done through the media and through a patient’s doctor. Where do the media get its medical information? Many report on research they find in medical journals, even though few medical journalists are trained to interpret them accurately. Because of this, they often rely on the interpretations of research that is published in position statements or articles made by major health organizations like the American Heart Association or the American College of Cardiology. I have pointed out in previous posts that this avenue of information is actually full of conflict of interests, with corporations often influencing the information. This route would be an obvious one for major statin producers like Pfizer to use in order to increase patient compliance by the dissemination of misinformation about the dangers of high-cholesterol. Consider this: Pfizer is a big donor to the American College of Cardiology and in 2002 was a member of its “Diamond Heart Award by donating $750,000 or above. Pfizer was the leading sponsor at its 2001 meeting in Orlando, FL, forking over $822,000 for the meeting.” (Wall Street Journal, 6/15/01).
Although physicians also use these organizations as their source of industry-biased information, it turns out that peer-reviewed research is not their main source of information as one would think. A report in the journal Family Practice concluded that for new drugs “The most important sources (of information) were the pharmaceutical industry [49 percent], in particular the company representative, non-peer-reviewed literature, the mass media, and, to a lesser extent, hospital colleagues. Peer-reviewed literature or independent drug information sources were rarely significant at this stage.” Some companies spend $10,000 a year marketing to just one doctor.
So it seems clear that the flawed information you ultimately receive regarding high-cholesterol is delivered to you in calculated ways with the aid of a myriad of organizations including your physician, to ultimately boost profits received by the pharmaceutical companies.