
Risk Calculator for Cholesterol Appears Flawed - uladzislau
http://nytimes.com/2013/11/18/health/risk-calculator-for-cholesterol-appears-flawed.html?from=homepage
======
r0h1n
_" But, in a major embarrassment to the health groups, the calculator appears
to greatly overestimate risk, so much so that it could mistakenly suggest that
millions more people are candidates for statin drugs."_

What? In the Mecca of over-medication & healthcare lobbying, a health group is
recommending putting millions of healthy people on lifelong medication?

I'm shocked!!

~~~
astral303
Statin drugs are nearly entirely generic now, with a 3-month supply being $12,
made by competing manufacturers. [1] This is not a profit source for big
pharma like you might think.

Statin drugs have fewer side-effects than OTC painkillers. (Heard this on NPR
the other day).

1 - [http://www.consumerreports.org/health/best-buy-
drugs/statins...](http://www.consumerreports.org/health/best-buy-
drugs/statins.htm)

~~~
tremendo
33 million new americans on the drug[1], $12 every three months, that's about
$1.5 billion dollars a year of new business, by just issuing a new
"guideline". In just one country. Not a profit source? I don't agree. Edited
to add reference to the 33 million new users. [1]
[http://www.washingtonpost.com/national/health-science/new-
gu...](http://www.washingtonpost.com/national/health-science/new-guidelines-
could-have-far-more-americans-taking-statin-drugs-for-
cholesterol/2013/11/12/7f249318-4be4-11e3-be6b-d3d28122e6d4_story.html)

~~~
carbocation
1) Statins save lives.

2) The people making the recommendations are not the people making money off
of the drugs.

3) $1.5 billion is a minuscule slice of the US healthcare market.

4) At $0.13 per pill, it's kind of hard imagining a non-subsidized price
getting much lower. What could be done to assuage your concerns?

~~~
tremendo
1) We could go into a rabbit hole with this, I'm not going to, just will
remark that there are plenty of credible (subjective I know) who believe
statins at best replace one malady with another, they do lower cholesterol
while not caring why it's high in the first place. They help people who have
already have had a cardiac event, and up to 50 years old. Not older men, and
in no case women. 2) No conflicts of interest? 3) I made no claim about slice
size, it's still $1.5 Billion per year for one country, and that's not
insignificant. 4) so, each pill is cheap.

------
pgcudahy
These calculators aren't just pulled from thin air, they use studies of
various populations over time to derive a mathematical model that predicts the
cardiovascular risk of a patient. The article is pretty muddled but it appears
that two authors of a commentary in the Lancet are arguing with which studies
were included in making the models. The big problem is that the commentary
hasn't been published yet so there's no way to evaluate whether their
criticisms are valid or not. So long story short, this is a crummy summary of
an article that we're not able to read yet so not really worth your time.

------
semenko
The co-author of the study (Ridker) and the Brigham have already issued a
Press Release disputing the reporter's spin.

Ridker portrays the calculator issues as minor, and offers strong support for
statins in risk reduction (which is what the data /strongly/ support):

[http://www.brighamandwomens.org/about_bwh/publicaffairs/news...](http://www.brighamandwomens.org/about_bwh/publicaffairs/news/pressreleases/PressRelease.aspx?sub=0&PageID=1613)

~~~
carbocation
> Paul Ridker, MD, a cardiologist at Brigham and Women's Hospital (BWH) in
> Boston, strongly supports the key messages of the new guidelines and
> believes that questions raised about the risk calculator should be
> relatively easy to address. Dr. Ridker is an advocate of expanded statin use
> in primary prevention, a major advance of the new ACC/AHA guidelines.

Good link. Basically we have the person who is cited in the linked article
(Dr. Ridker) on record as supporting the new guidelines and finding the errors
in the model easy to address. This is an important counterpoint to the
sensationalist NYT article from the very person whom they are citing to
further their stance.

At MGH, we have already had two noon conferences on the topic. The only
disagreement that I've heard with regard to the new guidelines is from those
who believe that, on top of the guidelines, there should still be LDL targets
for more people, and the targets should be lower than they ever have been
before.

