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January 29, 2009
JUPITER
As mentioned in the previous post, JUPITER is the latest of the GALAXY trials to be announced. It is particularly welcome to the commercial interests which sponsored it because it extends the use of this drug to 20% of the population that otherwise could not have been convinced to spend the money.
As also mentioned in the previous post, I have avoided spending any precious time on the Statin studies, in large part because the basic premise and justification, upon which all these subsequent studies have built, is fatally flawed. There is perhaps a mild statistical significance in the decreased measures of heart or brain disease. But there is no meaningful improvement in these, and no improvement at all in overall mortality.
I will undoubtedly be challenged on that last statement. But I would refer you to Worried Sick or to Joel Kaufmann's articles and letters in JAPS especially this one.
Back to Jupiter. Basically, low risk patients older than 50 for men or 60 for women (why the difference? because that is the only way to make the results statistically significant) were screened for low cholesterol but elevated hsCRP (high-sensitivity C-reactive protein). Those qualifying (only 20% of those screened) were enrolled and put on very high doses of The Statin. (They knew from other studies with other statins that low doses would not show an effect.) These news items (I realize some of these links require a password, but you can't have opened your eyes in the last two months without seeing something about Jupiter) give a good idea of the significance of the study, which has been touted as "paradigm-changing" and "one of the most important clinical trials in the long history of statin studies."
But it rather is just another attempt in the long train of confused commercial/clinical jumbles. I do not fault the drug company in question for trying to create a new market for their very expensive drug. But when this is confused with good medicine, there are problems. The very minimal absolute risk reductions for so-called hard events (death, heart attack, and stroke) require treatment of 170 patients to prevent one yearly event.
At more than $100 per month, medication costs alone would exceed $300,000 per event per year (more than $500,000 to prevent a death). It is not that a price can be put on life. Rather, it is absurd to spend so much money for so little benefit. If you are spending your own money, you answer for that. If you are spending mine, quit.
| By Robert Maddox | 12:46 PM