Just yesterday, we were discussing Cholestrol levels in Medimanage Video Library Sessions. We discussed the thresholds, the causes, treatments  - the basics. The discussion reminded me of this article below from Forbes India, which touches upon, the umpteen number of instances, when Pharma companies lure Doctors to prescribe drugs, which may actually not necessary in the ideal sense.

Article reproduced "as is" below:

by Pravin Palande, Neelima Mahajan-Bansal, Shishir Prasad | Sep 14, 2009 | Original Article

When Radhika Nayyar, 47, at last agreed to take drugs to lower her cholesterol level, her cardiologist felt he had scored a mini victory. For months, the good doctor had tried to persuade her to go on a dosage of statins but she stoutly refused to do so. As the world’s largest selling drugs, statins have convinced millions of their power to reduce cholesterol and thereby the risk of heart attacks, but Nayyar is one of those other millions who believe them to be at best pills of dubious credibility and at worst, a tool of corporate conspiracy against humanity.

“Last time you ignored my prescription,” her doctor, a cardiologist, would say. “But one more time I’m requesting you to go on statins,” he would add painstakingly. But Nayyar would resist: “I am not classified as a heart patient. So why should I take drugs?”

Image: Abhijeet Kini

This sort of exchange went on several times before Nayyar’s cholesterol numbers became so high that she began to reconsider her decision. A compromise was then struck. She was put on a drug called Ezetimibe, a cholesterol lowering drug that is not a statin. It was only a partial victory for the doctor after all.

In Nayyar’s stubbornness lies the story of patients’ tussle with cholesterol and heart disease. Nobody argues with their doctors when put on medication because their upper blood pressure level is above 140 or blood sugar levels are above 140 milligram per decilitre (mg/dl). But when it comes to high cholesterol levels, people just don’t want to pop pills. Nayyar argued for long that she would change her lifestyle and her cholesterol would fall. That was never achieved.

The world over, cholesterol is one of the most controversial subjects in medicine and statins are among the most critiqued treatments. The connection between cholesterol and heart attacks is still challenged by some, but even among those who accept that link, there is a large group which says the pharmaceutical industry is raking in billions in profits by selling statins to people who don’t need them. These people say the fraternity of doctors also co-operates in this grand scheme. What’s the proof?

They point to the fact that the recommended cholesterol level has been lowered repeatedly over the last several decades. It is not that only laymen and activists hold this view. Some veterans in the business of mending hearts think so too. Dr. Devi Shetty, founder of Narayana Hrudayalaya which is the world’s largest centre for heart surgery, says the importance of statins as a drug to prevent heart attacks has been exaggerated. “Hundred percent it is the pharma companies. Pharma companies can influence the prescription process,” he says.

At the core of the debate is the threshold number for total cholesterol (TC) in a person that would require statin medication. This number is a blend of low-density lipoproteins (LDL), or “bad” cholesterol, and high-density lipoproteins (HDL) called the “good” cholesterol. For a person to escape statins, not only must the total cholesterol be low enough, but LDL should be within limits too. And the clinical world, after dozens of studies, has been lowering these threshold numbers bringing more and more people, previously considered healthy, under the category of cholesterol patients and statin pill-poppers.