As much as I love learning, I did not always love school. We moved a lot, and I was too shy to do well as the new kid. At a new high school during my freshmen year, I discovered the joys of the hall pass. Being handed one gave me a feeling of freedom. With it, I was safe to evade the pressures of the classroom and wander the halls aimlessly. If a teacher stopped me to see if I should be in class, all I had to do was show my hall pass, and I’d be on my way. I think of a hall pass as something that is assured to protect you. Let’s say a hall pass works at least 8 out of 10 times.

There are hall passes, and then, there are lottery tickets. I’ve heard it said that lotteries are secret taxes for those with poor math skills. If you have a few dollars to spare, it may be fun to buy a lottery ticket and imagine striking it rich. On the other hand, if you are hungry, your last few dollars are better spent on a meal than on an infinitesimally small chance at fortune. You cannot rely on a lottery ticket when it really needs to count. I’m not a seasoned gambler, but for the purposes of our discussion, let’s say your odds of a lottery ticket working are lower than 1 in 10.

Last week, a new patient told me she wanted to stop taking her cholesterol pills but was afraid to do so. Her prior doctors gave her the medicine with the implication that it would keep her safe and definitely work. To her, the medicine felt like a hall pass that was protecting her from heart disease, but how well do these medicines really work?

Remember we said hall passes worked 8 out of 10 times, and lottery tickets worked less than 1 out of 10 times? Are cholesterol pills hall passes or lottery tickets?

In the case of my patient, she had never had a heart attack. She was in her mid-50s, had high LDL cholesterol and a family history of heart disease. Based on studies involving 65,229 participants, here are the odds of the medication helping or hurting her: [1]

This is not a hall pass. At best, it is a lottery ticket. The odds of the cholesterol medication doing anything helpful are 1 in 104. That means if 208 people, like my patient, were divided into two groups, and one group took cholesterol pills and the other did not, the group on medicine would see one less heart attack. Interestingly, even though they would have one less heart attack, they would have no fewer deaths. Any reduction in death from heart disease would be outweighed by deaths from other causes. The odds of muscle damage were 10 times higher than the odds of preventing a heart attack. If this is not bad enough, the possible benefits may be even lower in women. [2]

Is this an indictment of cholesterol pills, such as statins? What about pills for blood sugar? Let’s look at some more numbers. Here are the results of over 35,000 people on medications to aggressively control blood sugar: [3]

Medications had no chance at all for preventing diabetics from dying, having a stroke, a heart attack or kidney failure, yet they had a 1 in 6 chance of causing severe enough reactions to require hospitalization.

Here are the numbers for blood pressure medications from over 8,900 people with blood pressure as high as 159/99. [4]

What do these outcomes prove? Medications do not work well for chronic diseases. Even when they do lower the marker of illness, like high cholesterol, high blood sugar or high blood pressure, they do nothing to prevent what matters: the complications.

I would argue that the dangers of these medications are even larger than it might seem because of the false sense of security they provide. Who will try harder to improve their health: someone who feels they need to, or someone who believes that a pill is protecting them? Many have the impression that radical, lifestyle change might be a nice idea, but pills are more powerful. After looking at the hard numbers, are pills hall passes, protecting us from chronic diseases? On the contrary, you can see that at best, pills are lottery tickets.

References:

1. Ray KK, Seshasai SR, Erqou S, Sever P, Jukema JW, Ford I, Sattar N. Statinsand all-cause mortality in high-risk primary prevention: a meta-analysis of 11 randomized controlled trials involving 65,229 participants. Arch Intern Med. 2010 Jun 28;170(12):1024-31. Review. PubMed PMID: 20585067.

2. Virani SS1. Statins in the primary and secondary prevention of cardiovascular disease in women: facts and myths. Tex Heart Inst J. 2013;40(3):288-9.

3. Hemmingsen B, Lund SS, Gluud C, et al. Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2013, Issue 11. Art. No.: CD008143. DOI: 10.1002/14651858.CD008143.pub3.

4. Diao D, Wright JM, Cundiff DK, Gueyffier F. Pharmacotherapy for mild hypertension. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD006742.

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