Flying Pigs and Affordable Healthcare

Flying Pigs
No matter where you live, affordable healthcare has become an area of concern, discussion and debate.

Whenever healthcare costs come under scrutiny, there seems to be a coincident increase in the number of “concerns” expressed by the conventional medical community about natural or traditional (read “less expensive”) forms of healthcare.  I don’t think that’s a matter of happenstance.

About two weeks ago, Michael Smith published Supplements Blamed for Liver Toxicity on MedPage Today.  If you read the article carefully, you’ll find that of the 845 cases of liver damage, 709 were attributed to prescription or OTC medications, and 136 were attributed to supplements.  But the article reads as though supplements are the main concern.

Last week, I was appalled to read Margaret Wente‘s oped piece, Why I’m Leaving the Vitamin Church. Ms. Wente came to her decision to abandon vitamins based on a recent Lancet-published study that concluded most adults do not need Vitamin D supplementation, and a study led by Edward Archer which reviewed the effectiveness of the methods employed in nutritional studies and concluded they lack scientific validity.  But Ms. Wente’s article failed to disclose the following:

Funding for the study was provided by an unrestricted research grant from The Coca-Cola Company. The sponsor of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report, and does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials.

Coca-Cola provided unrestricted funding but they didn’t influence the findings of the study?  Right – and I’ve seen pigs flying recently too.

About one week ago, new guidelines were published in the United States for the pharmacological treatment of high cholesterol.  The guidelines are based on a revised calculator for cardiovascular risk.  Both the guidelines and the calculator are considered to be controversial at this point.  They vastly increase the number of people for whom pharmacologic treatment will be deemed necessary and statins are considered the treatment of choice.

The treatment guide recommends statins for patients between ages 40 and 75 whose 10-year-risk of having a heart attack or stroke based on the calculator is 7.5 percent or greater.  Because of issues with how the risk calculator works, according to Brigham’s and Women’s Hospital research cardiologist Dr. Paul Ridker,

It is possible that as many as 40 to 50 percent of the 33 million middle-aged Americans targeted by the new guidelines for statin therapy do not actually have risk thresholds exceeding the 7.5 percent level suggested for treatment.

I have not done an exhaustive search on drug spending in the United States, however, let’s consider the possible implications of this potential increase of 33 million users of statin medications:

  • Sales of Lipitor in 2011 – $7.5 billion on approximately 18 million prescriptions (1)
  • Blood lipid regulators were one of the fastest growing drug classes in 2011 (2 – see page 29).  Total spending on this class was about 20 billion in 2011 (2 – see page 32).
  • Lipitor lost its patent protection in 2011(3).
  • It sales dropped in 2012 – for the first 9 months of that year, it generated $1.6 billion on about 3.8 million prescriptions – a drop of about 79% (4).
  • While all patented drugs go through this type of sales loss when the patent protection ends, drug companies try to compensate by finding new uses or new markets for their medications.
  • Assume the average cost of a statin prescription is $35.00 per month.  With 33 million new users, that adds $13.9 billion in spending in an otherwise saturated market.  Note that Crestor currently costs about $190/prescription, so these cost assumptions are very conservative (5)

To add to the murkiness of all of this, some experts contend that cholesterol levels are not highly predictive of cardiac events, with one expert stating 60 people would have to take a statin for five years for one to avoid a heart attack“.

It looks to me as if pharmaceutical companies are influencing healthcare practitioners and researchers to expand the market for their products when there is no consensus on the need for extended treatment.

Let’s get back to the place of vitamins in healthcare and its associated costs.

While there is no consensus yet on the value of treating hyperlipidemia with Vitamin B3 (niacin), there are studies that show that niacin can have beneficial effects on blood lipids, alone, or in combination with statins.

If half of the 33 million people identified as needing treatment in the new guidelines were treated with niacin instead of statins, it would cost about $12.50/prescription for a total of $2.5 billion per year, saving the healthcare system approximately $4.5 billion.

Pharmaceutical companies will never make as much on vitamins as they do on drugs so they have little incentive to research the treatment potential of vitamins and great incentive to imply vitamins are not effective.  If governments were serious about healthcare cost containment, they would do more to promote research into nutrient-based treatments.