Everyone, it seems, is writing about the results of the recent JUPITER trial.
In case you haven't heard, this is the trial that showed that healthy middle-aged people (men over 50 and women over 60) with normal cholesterol levels (LDL less than 130) but high levels of C-reactive protein (CRP) had fewer deaths, especially cardiovascular deaths, when they took 20 mg of the statin Crestor.
Reactions have ranged from the gushing of some reporters who suggest that we should put statins in the drinking water to the lambasting by writers who say the trial was just another gimmick by wicked pharmaceutical companies trying to sell expensive drugs (Crestor costs more than $3 a day) that will hurt or even kill us.
My position is intermediate between these extremes. Drugs can save lives. Drugs can also kill. In some cases, a drug that saves the live of one person might fail to help, harm, or even kill another person. How do we know which one will benefit us?
In 50 or 100 years, if civilization survives that long, we'll probably have genetic/metabolic profiling tests that will allow physicians to determine which drug will benefit which particular patient. But that time isn't here yet, and we have to make some guesses. Physicians often prescribe one drug and have the patient check back to see if it's working without side effects. If not, the physician tries another drug. But it's pretty hit or miss.
Studies have shown that statins help younger men who have already had heart attacks. Evidence that they help older women has been lacking. One good thing about the JUPITER trial is that it did include women, and the women seemed to benefit more than the men.
Remember that a lack of evidence doesn't mean that something isn't true. It just means it hasn't been proved yet.
I don't think there's ever been a randomized, controlled, double-blind study that proves that aspirin helps headaches. But most of us agree that it does. Or maybe it's all just a placebo effect. I have a friend who claims that only cheap aspirin helps her headaches; the expensive brand names don't work, she says. I once had an experience in which plain aspirin knocked out the pain from a bad earache but aspirin plus codeine had no effect because I thought those pills were antibiotics.
One problem we face when trying to decide whether or not to take any drug is that there may have been studies showing that the drug was effective -- or dangerous -- in a particular population, in this case healthy, nondiabetic middle-aged men and women with normal cholesterol levels and elevated CRP levels, but there may be no proof that it will work for people like us.
In the JUPITER trial, for instance, people with diabetes were excluded. And recent studies have suggested that low-dose aspirin therapy, which has been shown to reduce cardiovascular events in the general population, are not effective in people with diabetes.
But then, are "people with diabetes" people who have been diagnosed with diabetes regardless of their control? Or are they people with high BG levels as expressed in A1c levels of 9 or 10 or even higher? What if we have diabetes but we maintain A1c levels below 6, or even below 5? Should we then consider ourselves with the general population (aspirin will help us) or with the people with diabetes (aspirin won't help us)?
