Drugs to Help Lower Cholesterol Levels
ROBERT SIEGEL, host:
Dr. Jerry Avorn studies how we use medications and how effective those medications are. He's a professor of medicine at Harvard Medical School and he runs the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women's Hospital in Boston. Welcome to the program once again, Jerry.
Dr. JERRY AVORN (Medicine, Harvard Medicine School; Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital): Thank you.
SIEGEL: Since at least Pfizer saw the great need to have more effective drugs, what's the problem with the drugs that exist right now?
Dr. AVORN: Well, they're actually quite good. They're among the safest and most effective drugs that we have. It just would be nice, since heart disease is the number one killer of Americans, to have an additional set of drugs, preferably that work in an additional way that's different from the statins.
But of course, there's the other drugs that are not as heavily marketed called exercise and diet which are also quite effective.
SIEGEL: I suppose most people hear from their physician that you should be taking off some weight, getting exercise and not eating trans fats. That's not that unusual nowadays, is it?
Dr. AVORN: It's not unusual to hear those recommendations, no. But the difficulty is that our consciousness and our airwaves are really saturated with promotions for products that are patented and simple lifestyle things are really no one's business to advertise. So we hear perhaps less about that then we ought to.
SIEGEL: Of the drugs that are out there and that are being advertised heavily in television and people are being told to contact their doctor, are they all essentially the same? Are there different kinds of drugs? Do they work for different kinds of people?
Dr. AVORN: Among the statins that are out there, they are all quite good drugs and they have varying degrees of potency. The older drugs are a little bit less potent and I'm thinking here about the drugs that are now generic, like simvastatin, pravastatin, and lovastatin, all of which are available at very low price.
They are not as potent as some of the newer drugs but an awful lot of patients don't need the most potent statin there is. Most folks recommend the newer, most costly drugs like Lipitor for patients who really need big, industrial strength lowering of their cholesterol and that's a minority of patients.
SIEGEL: And for the statin class of drugs, are there problematic side effects?
Dr. AVORN: There are some but for drugs that we use so commonly, they are surprisingly safe and well tolerated. Sometimes they can cause muscle discomfort and even muscle damage in very rare cases. Sometimes they can cause a bump in one's liver enzymes and on rare, rare occasions some liver disease. But they are among the safest drugs that we have on the market.
There are some other drugs, too, that are useful for treating cholesterol. One of them is niacin. The problem is that a lot of patients experience flushing or itching with it and it's not real easy to tolerate. But it is a drug that does raise the good cholesterol, just like torcetrapib was attempting to do. And for some patients, that can be an important piece of their regimen. It doesn't get a lot of attention because it's also generic and it's been around for decades and no one's really out there advertising the way they are for the newer statins.
SIEGEL: Lipitor is a brand name for a drug.
Dr. AVORN: That's right.
SIEGEL: And statins are a generic class of drugs.
Dr. AVORN: That's right.
SIEGEL: Torcetrapib, does that describe some configuration of some molecule somewhere? Is it a word that means anything?
Dr. AVORN: Yeah, that is the generic name of the drug that was just found to be unacceptably dangerous and it will never see the light of day. It does have a difficult to pronounce name, in part because generic names are chosen by the drug manufacturers and often one suspects they are chosen in order to be as unpronounceable and/or non-memorable as possible so that it's a lot easier to just remember whatever the trade name is for a given product, which is always mellifluous and short and easy to remember.
SIEGEL: So if I'm a drug company and I intend to market this drug someday as We, I'll give it the most complex and unmemorable generic name possible. That's what my competitors will have to use down the road.
Dr. AVORN: Exactly, and that way when you lose your patent, no body will be able to remember what the generic name was anyway, which is a common practice.
SIEGEL: Well, Dr. Jerry Avorn, thank you very much for talking with us.
Dr. AVORN: You're very welcome.
SIEGEL: Dr. Avorn is the author of the book, "Powerful Medicines." He's a professor of medicine at Harvard and the director of the Center on Pharmacoepidemiology and Pharmocoeconomics at Brigham and Women's Hospital in Boston.
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