Eric Topol, Megamind 2

Ralph Waldo Emerson famously wrote that “a foolish consistency is the hobgoblin of little minds.” If this is true then Eric Topol, who earlier today wrote a New York Times editorial highly critical of statins, is Megamind.

Here’s what he wrote in a 2004 editorial in the New England Journal of Medicine:

Even today, only a fraction of the patients who should be treated with a statin are actually receiving such therapy. It is estimated on the basis of the criteria in current national guidelines that 36 million people in the United States should be taking a statin, but only 11 million are currently being treated. Worldwide, the discrepancy is even more staggering; more than 200 million people meet the criteria for treatment, but fewer than 25 million take statins.

There will soon be a sea change in the prevention and management of atherosclerotic vascular disease. The proportional reduction in major clinical outcomes that results from aggressive statin therapy is of the same order of magnitude as that seen when statins were compared with placebo in controlled trials. Intensive therapy with statins, monitored by means of measurements of LDL cholesterol or biologic markers of inflammation, is likely to result in even greater steps toward actualizing the full benefit of this remarkable class of medicines.

To be fair, I think Topol deserves credit for being willing to change his mind. It’s a rare trait. But I’m not sure that every single current controversy in medicine should be seen in the light of a crusade in favor of genomics, so when a cardiologist with a long memory sent me this editorial I couldn’t resist posting this blast from the past.

Update: In all fairness, here is Dr. Topol’s response to the above post:

The op-ed on the risk of diabetes from statins had nothing to do with changing my mind. It has everything to do with new data that were not available in 2004. As I pointed out in the Times op-ed, the diabetes issue only surfaced in recent trials with higher doses (40 mg of Simvastatin) and atorvastatin (Lipitor) and rosuvastatin (Crestor). Prior to these trials, there was no signal about the risk of diabetes. The trial my NEJM editorial was written on in 2004–PROVE IT–showed no difference in diabetes for intensive vs moderate statins (5.9% in both groups). All of the subsequent intensive statin randomized trials–TNT, IDEAL, SEARCH showed an important excess. Even folding PROVE-IT to the mix, collectively the excess of an absolute 0.8% equates to developing diabetes in 1 of every 125 patients treated with intensive statins compared with moderate dose statins.

JUPITER, one of the largest trial of statins, with 17,802 patients, was not published until 2008, nor did we have diabetes data available from many of the other placebo-controlled trials until after 2004.The initial HPS trial primary report published in 2002 did not even mention the diabetes risk, which only came out much later!

Furthermore, this is not a crusade about genomics, which is a baseless point. This op-ed was aimed at consumers, who have every right to know the real data, the real risks and benefit of primary prevention with potent statins. The fact that we are in 2012, and have recognized the problem of statins engendering diabetes for the past 4-5 years, have no clue for why it occurs, and that nothing has been done about it in the medical community or by the life science industry, is truly remarkable.
Finally the author of this blog and I have a history of working together for many years on theheart.org — as a journalist he should recuse himself of writing on this subject with clearcut evidence of bias.

 

 

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2 comments

  1. Kudos to Larry Husten! How absurd if not ridiculous for a practicing endocrinologist for the last 34 years, like me, to make a comment: “We need honesty and truth in medical science from clinical trials, and not biased and self-serving opinions from our distinguished medical scientists and experts for the good of the society.” We get plenty of those from our politicians. We surely need investigative medical journalism now.

    It appears that both leading cardiologists, Dr. E. Topol and Dr. S. Nissen, on the subject of statins and diabetes, have their own diametrically opposite bias built in, in making their opposing opinions on this issue compared to their mutually supporting comments made, while they were at the Cleveland Clinic. Of course, their agenda and bias have changed now to suit their present “status”. Sorry for being politically incorrect, couldn’t help it.

    If I sound biased, that is because I am. Disclosure: semi-retired, not looking for career achievement, fame or fortune.

    Joseph Chemplavil, MD

  2. Eric’s points are well taken.
    He says all secondary prevention patients should be treated – with intensive statin therapy as he said so nicely in 2004
    The diabetes risk is there, but modest.in size and is really only relevant to the lowest risk primary prevention patients.
    Although as seen in the actual paper the risk of DM seems to be age related and only seemed to occur in those over 60 –
    And they would have some reasonable CV risk
    so it seems to me that almost all roads lead to statin treatment for Patients with a measurable CV risk.

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