Troubling Drug Developments in the News

ZETIA:  LOWERS CHOLESTEROL BUT DOESN’T LOWER RISK

Ezetemibe (Zetia, Vytorin) remains a favorite cholesterol lowering drug in spite of the fact that research has yet to show it prevents heart attacks and may increase risk of cancer.  Approximately 24 million prescriptions were written out by doctors in 2008.

A month’s worth of this questionable drug (10 mg) costs $130.99 at one of our local pharmacies.  Let’s be conservative and round that down to $100 a month and you have an annual price tag of roughly $2.4 billion for a drug with no proven benefit.  Furthermore, the fact that it lowers cholesterol without improving health is one more reason to question the whole “lower is better” cholesterol hypothesis.

BLOOD PRESSURE DRUGS FOR KIDS?

Apparently high blood pressure is on the rise in kids due to obesity, poor diet and a decrease in physical activity.  An estimated 2 million U.S. kids are estimated to have it.  Most are   Blood pressure checks are now recommended for children 3 years and older!  Pediatricians are also being asked to check blood sugars and cholesterol levels.  Although lip service is being given to the need to emphasize lifestyle first, the whole range of blood pressure drugs is being recommended – ACE inhibitors and ARBS offered as useful in kids.  Calcium channel blockers are a good option for kids with diabetes or metabolic syndrome.  Diuretics, like hydrocholorothiazide are a reasonable choice but watch for low potassium.

Beta-blockers should be saved for back-up because they cause fatigue and exercise intolerance.  This is what doctors are now reading.  The big problem here is not that doctors should now check blood pressure, blood sugar and cholesterol in 3 year olds and treat it if necessary.   What’s troubling is the probability that the first line lifestyle interventions – diet and exercise – are unlikely to work because our health care system simply isn’t set up to allow this to happen.  Doctors have neither the training nor time to deliver this sort of care.  Reimbursement favors short appointments which end up with the doctor whipping out the prescription pad.  This all looks like another Big Pharma bonanza, with the doctors reduced to obedient mechanics and young kids turned into low hanging fruit ripe for the picking.

HOW LONG SHOULD WOMEN TAKE BISPHOSPHANATES?
HOW ABOUT NOT AT ALL.

There’s now controversy about how long women should be on a class of popular bone drugs called bisphosphonates.  Examples go by the trade names of Actonel and Fosomax.  Apparently most post-menopausal women are prescribed them indefinitely.  Mainstream experts now think this many not be safe.  Fosomax has been out for 11 years and went off patent last year.  These drugs stay in the bones for years.  In fact, experts have no idea how long they hang around in your bones and the rest of your body, for that matter. Long term use may be associated with an increased risk of femur (thigh bone) fractures without trauma – that’s where your bone breaks on its own under normal use.  Long term use can interfere with normal bone turnover and delay healing of the usual “micro-cracks” that occur with normal activity.   These drugs – like most drugs — don’t work for the vast majority of people who take them.  For example, one study (which was typical) showed you need to treat over 80 women with osteoporosis for three years to prevent one hip fracture.  Yet I can tell you many doctors, nurse practitioners and physician’s assistants still routinely slap women on these drugs, even if they don’t have osteoporosis.  The current mainstream advice is now to stop these drugs after 5 years in women at LOW RISK for fracture.  Given their poor performance and risk of harm, why not skip them entirely. Look for more information on how to safely support good bone health without resorting to costly, marginally effective drugs with significant side effects in upcoming issues of AMERICAN COUNTRY DOCTOR.

Alan Inglis MD
American Country Doctor

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