Feature

A quarterpounder with cheese, french fries and... a pill?

Worried about cholesterol? Forget diet — the drug companies have plans. James Erlichman reports

The ultimate wonder cure for a lousy lifestyle has arrived: the anti-cholesterol pill. Take one a day and you can go back to junk food, throw away the running shoes, and even take up smoking again and still escape a heart attack.

The pharmaceutical companies say they hope their drugs will never be used in this way. But their salesmen are revving up for the biggest pay-day the industry has seen for decades — perhaps more than £1 billion in the UK alone.

It has been estimated that a quarter of all adults over the age of 25 have raised blood cholesterol. Raised cholesterol causes deposits to build up in the blood vessels, narrowing their diameter and making them prone to clots. The condition is called atherosclerosis and is a cause of heart disease.

Anti-cholesterol drugs scavenge the blood collecting this ‘low density’ cholesterol. Some also increase levels of ‘high density’ cholesterol which, to complicate matters, protects against heart disease.

Under 5 percent of the population is genetically stuck with high levels of ‘low density’ blood cholesterol, a condition known as familial hyperlipidaemia. Losing weight and cutting down on fat consumption are ineffective. These people will benefit from the new drugs.

But what about the rest of us? Why should we struggle to cut down on fat if help is at hand? Elsewhere in the world, notably the US and Finland, the rate of heart attacks has fallen dramatically. People have needed advice to cut down on total fat intake and to switch to oil rich in polyunsaturates, like soya or sunflower, or monounsaturates, like olive. But in Britain, which has the highest rate of coronary heart disease in the world, little has changed.

Official figures, which only cover home cooking, show that we are not reducing total fats and are switching only slowly to polyunsaturates. The complete picture is probably worse because many people regularly eat fast fatty foods like burgers and chips. A report from the Department of Health’s committee on medical aspects of food policy warned late last year that children are particularly prone to eating too much fat.

So far sales of existing anti-cholesterol drugs are not sky-high because few people as yet know their cholesterol levels. Dr Erling Refsum, an analyst for the stockbroking firm Nomura, points out: ‘The drug companies want people to ignore dieting, even though it is much more effective than drugs for 90 percent of people. Ideally the industry would like to prescribe anti-cholesterol drugs to everyone with a family history of heart disease — the market is enormous.’

In October 1988 hundreds of doctors were invited to the eighth international symposium on atherosclerosis held in Rome. One of the hosts was Merck Sharp and Dohm (MSD), the US drug company with a new anti-cholesterol drug approved in the US but not yet in the UK. Dr X was sent to Rome by MSD — all expenses paid. He depends on drug company money for his research and did not want to be named. But he said: ‘The drug companies were throwing money about. It must have cost MSD £1,200 each for the 50 people they brought. We were put up in the finest hotels.

’Anti-cholesterols are the hottest property in the drug world and people are being hounded into their massive use even before some of the long-term trials are completed. In theory they allow people to live on hamburgers and sausages and yet have the blood cholesterol of a Chinese peasant who eats rice and soybeans’.

Another way drug companies drum up goodwill is to hire a public relations firm to create an independent-looking ‘information bureau’ handling publicity. It helps to give the bureau an academic-sounding name. The International Lipid Information Bureau (ILIB) achieved press coverage for success last summer in reducing heart attacks with the anti-cholesterol drug, gemfibrozil. The ILIB receives ‘an educational grant from Warner Lambert’, the US manufacturer of gemfibrozil.

The story was strengthened by support from Professor Barry Lewis (St Thomas’ Hospital), an international authority on cholesterol. He said: ‘I didn’t really see the bureau as being promotional. Certainly there are drug companies whose morality I would not want to defend, and the last thing I want is for drugs to be over-used in treating hyperlipidaemia (raised blood cholesterol).’ But Professor Lewis is convinced that a quarter of the population suffers unknowingly from high serum cholesterol.

He accepts that changing the diet could reduce cholesterol But he is sceptical about how much GPs can achieve via dietary counselling.

In the US drug companies have distributed free cholesterol testing machines to doctors. People can even take the pinprick blood test free at shopping malls.

Doctors in Scotland have been given such machines by EJ Squibb, another US drugs firm seeking UK approval of its anti-cholesterol drug. MSD is also contemplating offering machines to GPs.

Patients take the drug for life. If only a quarter of males over 40 have increased cholesterol, only half of them are treated with drugs, the NHS bill would exceed £1 billion a year — a 50 per cent increase on the amount currently spent for all drugs in the health service. The drug companies deny they would charge this much. But former junior health minister Edwina Currie hinted that the government might even help fund the distribution of cholesterol testing machines.

This article is reprinted with the kind permission of The Guardian.