â€œThe idea that youâ€™re just going to lower LDL and people are going to get better, thatâ€™s too simplistic, much too simplistic,â€ said Dr. Eric J. Topol, a cardiologist and director of the Scripps Translational Science Institute in La Jolla, Calif. LDL, or low-density lipoprotein, is the so-called bad cholesterol, in contrast to high-density lipoprotein, or HDL.
Makes it sound like he is trashing statins like Vytorin right?
Here's Eric on two different ocassions: First, from his provocative blog on the ENHANCE study which I summarize:
Not all LDLs are the same. There are different ways to lower different LDLs based on the ways they are oxidized. Topol is emphatic in pointing for instance that women do not benefit as much from statins in LDL as men do. Are we not doing enough or have we overcooked the aggregate LDL-heart attack link?
Previously to that, Topol noted in the wake of the discovery of genes that cause differential response to different statins: "Researchers have known for years that cholesterol, a fatty protein that can cling to the walls of blood vessels and raise heart risk, is linked to the action of enzymes that can be blocked with medicines such as Pfizer Inc.'s Lipitor. The genes open up the possibility of new drugs that can help more patients avoid heart disease"
``Obviously, we only knew part of the story,'' Topol said Jan. 11 in a telephone interview. ``Now we can study whole new pathways and understand how they become deranged in people with blood vessel disease.''
On top of all this come this hasty fix of yet another Berenson boo-boo
"Correction: January 18, 2008
A headline in Business Day on Thursday with an article about research involving two widely used cholesterol-lowering drugs misstated the issue raised by the results. It is whether using drugs to lower cholesterol at all costs is always medically effective, or even safe; there is no question that cholesterol itself can pose dangers."
Rush to judgment or poor reporting or both? And who said the conclusion of ENHANCE was to lower cholesterol at all costs? Roy Poses? That sounds like a pretty ill-informed or biased reading of ENHANCE since the question once again whether or not Vytorin reduced the risk of heart attack caused by atherosclerosis in familial hypercholesterolemia. Nothing more. It did lower LDL more than generic Zocor alone but missed the athero endpoint as measured by the murky imaging marker. As Nissen knows, lots of trials designed to reduce plaque by reducing LDL or even increasing HDL tend to miss their mark. We don't know why, but I put my money with Topol instead of Nissen to come up with new drugs based on new insights and for someone else other than Healthcare Renewal to explain the clinical value in an unbiased matter that would benefit me as a patient.
It would have been nice to have given Topol's insights on personalized medicine more play. But that would have undermine the effort to paint Big Pharma as a bunch of thieves. So here's the point: the failure of the I hate pharma crowd in the media and blogosphere to address the personalized medicine story is not an oversight. It is Lysenkoism and Healthcare Renewal is leading the way.