Re: Statins in primary prevention

From: David Rind (drind_at_caregroup.harvard.edu)
Date: 12/21/04 

Date: Mon, 20 Dec 2004 19:50:58 -0500

My news reader still seems to be missing a lot of these posts. My
apologies if this appears oddly "threaded".

Zwalanga wrote:
> These studies are industry studies, with just about everyone weeded out
> who might scew it to industry disadvantage, using relative rather than
> absolute numbers and ending the trials before major side effects show
> up.
>
> I have every confidence that those who so adamantly stand on faith here
> will in the event that any or all statins are proven to be like Vioxx
> will suddenly have known it all along.

If you take the position that all favorable information about
medications published by drug companies is of no value, but that
negative information is true, then you will, of course, conclude that
the only believable "evidence" about medications is that they are
harmful. Not really worth discussing the issue further at that point.

While I believe the drug companies often behave badly, in general I
think it is possible to evaluate most drugs and studies reasonably
objectively. Still, drug companies do seem to come up with deceptive
practices that had not occurred to me (like running three identical
trials and only publishing the one with positive results), so perhaps in
the end they will turn out to be so clever that my interpretations of
trials is wrong. That said, given current evidence, I think the evidence
is overwhelming that statins are beneficial for people with coronary
heart disease. If you want to call this an issue of "faith" we
apparently have different definitions of faith.

As for Vioxx, I can't claim to have known it all along. But since I am
generally skeptical of new medications, I've advised people for years to
stick with the older NSAIDs unless they had a clear indication for a
COX2. This had nothing to do with any suspicion that Vioxx was causing
cardiac events, however. 

-- 
David Rind
drind@caregroup.harvard.edu