Dr. Sekula on weight loss, fitness and nutrition

We interrupt our regularly scheduled programming (Top 10 non-generic and generic prescription drugs) to bring you this, what appears to be a concerted effort on the part of Big Pharma to keep their precious statins high on the list of prescribed drugs. (can you blame them? Between Lipitor and Simvistatin you’re looking at 109.2 million prescriptions and $7.4 billion in sales per year!).

In case you haven’t heard, statins and big pharma took it on the chin in a new study from the Journal of the American College of Cardiology. The results showed niacin was significantly more effective at reducing carotid artery plaque than statins alone. In fact, results showed plaque continuing to grow in the statins only group while regressing in the niacin group. I’m not going to detail the study and author’s conclusions, Dr. Eades has done a wonderful job of that.

I’m not even going to get into whether or not reducing LDL prevents heart attacks. I’m taking a different approach.

Now, a normal thinking individual might conclude niacin as a better alternative to statins in preventing cardiovascular disease. Such as Dr. William Davis over at the Heart Scan blog. He’s not really normal thinking, more like forward thinking (WAY forward compared to his colleagues) and he’s been banging on statins and tooting the niacin horn for a while.

What really has me perturbed is a concerted effort to keep precious statins at the top of the prescription list. For example, a Google news search today (11/20/09) showed 800+ stories on the search term: statin+niacin. Scrolling through the headlines of those on the first page, you see phrases like, “Vitamin B niacin offers no extra benefit to statin therapy,” “Niacin may not help arteries,” “No benefit for statin patients,” and on and on.

Another example is this, a press release published November 20, 2009, which relates study details showing an approximate 1/3 drop in “bad” cholesterol levels in the US from 1999 to 2006 (study abstract here). The last sentence in the first paragraph sums it up nicely,

“But a high percentage of adults still are not being screened or treated for high cholesterol levels.” 

I’m not sure what they mean by high. As you’ll see in my next post, about 1 in 2 adults in the US are taking a statin. You would think this one-third drop would be cause for celebration, and it is among the statins crowd. But while there is a significant drop in the number of cardiovascular-related deaths, incidence hasn’t decreased.

So the question isn’t whether or not statins work. They reduce LDL cholesterol but they don’t reduce the incidence of heart disease. So why take them? Why prescribe them? It’s like the statinators and policy makers can’t see the forest for the trees.

The unfortunate (for them) news on the effectiveness of niacin, the quick-to-the-table message parroted by the media, that the incidence of cardiovascular disease has not decreased and the $7.4 billion cash cow of statins is enough to make one skeptical, or disgusted.

Your thoughts?

This post is part of the Kathleen Show, Prevention not Rx.

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In last weeks post I detailed the Top 10 prescription drugs for the US in 2008. And since I was half-way through before realizing it was non-generic only, I decided to complete it and follow up with this one.

In a follow-up post I’m going to get into the metrics a little more, comparing generic and non-generic.

Let me preface the descriptive nature of this post by saying it’s amazing we prescribe drugs at this rate. I knew we took too many prescription drugs. I knew we were too dependent on them. But actually looking at this data and what it says sheds light on the extent of the problem, which is why I’m writing a follow-up. So on with this one…

Forty percent of non-generic drugs are related, one way or another, to hyperinsulinemia. For generic drugs, it’s 50% and for the same conditions – metabolic syndrome. Table 1 shows Top 10 Generic Drugs by number of prescriptions (millions). Additionally, the table also shows total sales (billions) and rank (in parentheses).

Table 1. Top 10 Generic Drugs in US for 2008.

Metabolic Syndrome Fab 5

The 50% of drugs related to metabolic syndrome (italicized in table) account for 258.1 million (or 44%) of prescriptions and $3.3 billion (or 40%) of retail sales. Chew on that for a moment…258.1 million prescriptions related to hyperinsulinemia, which is 25.1 (edit: 21.5 – operator error) million prescriptions and $270 million in retail sales per month.

Think anyone’s interested in keeping that kind of cash flowing? Do I have to ask?

Furthermore, these dollars are only a small part of the direct costs. No estimates for other direct or indirect costs are included.

Pretty disgusting, actually.

I mentioned last week that cognitive dissonance was to blame. I’m not so sure anymore. In my opinion, what we’re seeing here is nothing short of disgusting. There is plenty of research showing most of these problems can be fixed with simple changes in diet and exercise. Yet those recommendations aren’t coming. The ADA, for example, thinks type 2 diabetics need to eat 45-60 grams of carbs at each meal! It’s like telling someone with lung cancer that it’s okay to smoke one cigarette a day. Statinators are blind or on the dole. American Heart still spouts the low-fat dogma that has blinded all of them.

The more I think about it and the more I write about it, the more disgusted I get. What I need is a good laugh.

This post is part of the Kathleen Show, Prevention not Rx.

References (both are pdf documents)

1. 2008 Top 200 generic drugs by total prescriptions

2. 2008 Top 200 generic drugs by retail dollars

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Most people I work with are significantly overweight – average weight > 300 pounds. As you might expect, all have a cluster of metabolic disorders. Coincident with their condition,  they take a laundry list of prescription medications. In general the lists are nearly identical and include prescriptions for hypertension, diabetes, cholesterol and digestive disorders.

Given this, I assumed their laundry list was similar to that of the general public. So I went looking for the top 10 prescription drugs of 2008 to see if my thoughts would be confirmed.

Finding the Data.
I scoured the FDA website and could find nothing (for some reason, I thought the organization in charge of controlling this industry might track this stuff – go figure). I decided to contact them by phone and the person I spoke with (after about 3 minutes of menu clicks – seriously), directed me to drugtopics.com – here is their about page.

Table 1 shows information for 2008 (1), including the top 10 prescriptions, the number of prescriptions (millions) and retail sales (in billions) (2). Note: the list is for non-generic drugs only. Additionally, drugtopics.com separates their publications by top prescriptions and top selling. Table 1 is a combination of the two. The Sales column includes rank information.

 Table 1. Top 10 Prescribed Drugs in 2008.

Confirmation and Surprise.

So what was the confirmation? Cholesterol, hypertensive and digestive (GERD) disorder medications occupy spots #1, 2, 7 and 10 (italicized in table). They represent 110.2 million prescriptions and $15.3 billion in retail sales. It’s 40% of the top 10, 45% of all prescriptions and 49% of total retail sales. Lipitor by itself is 20% of all prescriptions and 19% of all retail sales for those in the top 10!

What surprised me? For starters, no diabetes drug in the top 10. Actos was the highest rated and it was 18th, with 12.5 million prescriptions. The $2.4 billion in sales would have been good enough for 10th on the sales list. This piqued my curiosity and led to another visit to drugtopics.com.

Thankfully they track prescriptions and sales of generic drugs too. Guess what was in the top 10? I’ll give you a hint. It starts with “M” and ends with “M.” This list too is dominated similarly and I’m working on a follow-up post.

My thoughts…

Insulin resistance is big business in this country, playing a small or large role in nearly all of these on the list. And the Standard American Diet (SAD) is being pushed down our throats by so many factions, I don’t even know which way is up sometimes.

With all the healthcare debate going on, it’s amazing to me those in charge can’t see what’s right under their noses. I’m blaming cognitive dissonance and the powerful sugar, corn and wheat lobbies.

My advice, trash the food guide pyramid. Ignore nearly all advice from registered dieticians and your doctor – they’re part of the cognitive dissonance crowd. Eat quality protein and healthy fats (including naturally saturated ones) at every meal, along with vegetables and exercise vigorously 2-3 days per week. That and keeping your stress levels down will go a long way to keep you from being on this list.

This post is part of the Kathleen Show, Prevention not Rx.

References (both are pdf documents).

1. 2008 Top 200 branded drugs by total prescriptions.

2. 2008 Top 200 branded drugs by retail dollars.

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