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Wednesday, October 19, 1994
Ralph D. Lach, M.D.Dr. Lach addressed the ethical issues involved in the commercial exploitation of public fears about cholesterol. High blood cholesterol is one of many risk factors for, atherosclerosis, arterial plaque, the leading cause of death in the U.S. But the notion that choles-terol reduction is itself the remedy opens the opportunity for vast markets for drugs and fad foods, while in fact there is no correlation between cholesterol level and mortality after age 50 and no correlation between cholesterol level and cardiovascular cause of death after age 60. Yet, _ of the $10 - $13 billion spent on drugs in the country is spent by people over 60, according to the Framingham Study.
With many informative charts on slides, Dr. Lach reviewed the major studies of cholesterol-lowering drugs conducted in the last twenty years (LRC-CPPT, Helsinki, etc.). None show that cholesterol reduction has statistical significance, much less clinical importance, in reducing mortali-ty. Yet, expensive drugs are routinely prescribed to lower choles-terol in spite of their poten-tially severe side effects. At the same time, the three big risk factors for cardiovascular disease can be controlled simply, safely, and cheaply: avoid tobacco, avoid obesity, avoid a sedentary life style.
What drives the use of cholesterol-lowering drugs and the marketing of low-cholesterol food are the enormous opportunities for business profits. Slick marketing campaigns in medical journals and perquisites for doctors give the commercial pharma-ceutical companies tremendous influence upon medical education and practices. The "cholesterol neurosis" of our time also leads to proposals for massive and wasteful public spending on "choles-terol educa-tion" when the message should be: avoid tobacco, get regular exercise, maintain your ideal weight. (These are the safe and economical preventive measures for both the general public and for those who have the risk factors for cardiovascular disease.) Dr. Lach stressed that his presentation concentrated on the 50 million Americans who represent the market of the "worried well." He indicated that the picture was virtually the same for those with established coronary disease but that those studies were as yet incomplete and inconclusive.
A "Cholesterol Reading List" was distributed (copies are available at CEE office). Dr. Lach emphasized, especially: Heart Failure by Thomas J. Moore and Disease Mongers by Lynn Payer.
 
 Council for Ethics in Economics
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