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Public's Cholesterol Concern Feeds a Drugs-vs.-Diet Debate

July 05, 1988|ALLAN PARACHINI | Times Staff Writer

The young woman seemed on the verge of panic as she caught up with Dr. William Taylor, a Harvard University cholesterol expert, after a recent speech he gave at the National Institutes of Health.

She worked at the National Cancer Institute, was a non-smoker in her 20s with no family history of heart disease, rode a bike frequently and ate only tofu.

But she was still obsessed with cholesterol. "She said she'd been screened at a health fair and they told her her cholesterol was 198." Taylor recalled. She wasn't mollified by Taylor's insistence that the reading was safe, and normal.

She was instead curious about whether she could find a solution, or at least peace of mind, in a pill.

By all accounts, at least half of all Americans have cholesterol levels that are too high. That the American diet is too rich in fat is not in dispute. But there is mounting concern that the current national preoccupation with cholesterol may set off a premature rush to drugging in the name of cure.

For the Record
Los Angeles Times Wednesday July 6, 1988 Home Edition View Part 5 Page 6 Column 2 View Desk 1 inches; 31 words Type of Material: Correction
A story Tuesday about cholesterol medication contained an incorrect definition of "moderate" cholesterol risk. The correct range for moderate risk is from 240 to 260 milligrams of cholesterol per.1 milliliters of blood.

To Taylor, the exchange with the woman in Bethesda, Md., illustrates what he characterized as "the destructive and negative effects" of the growing cholesterol mania. The phenomenon, he said, may be focusing on a possible quick fix as opposed to the less pleasurable task of changing one's life style.

A study last year estimated that for many people with cholesterol levels elevated into the high-risk range, cholesterol reduction by itself adds on the average only about three weeks to total life span.

That was before the arrival on the drug market of the latest cholesterol-controller, lovastatin. Dr. Anthony Komaroff, who worked with Taylor on the study in question, estimated that the drug has doubled the life expectancy gain. Now, he said, it's 40 days.

"Some people," Komaroff said, "might regard that as a big deal and something they'd be willing to take a medicine for the rest of their lives to achieve." Taylor and Komaroff are at Harvard Medical School and Boston's Beth Israel Hospital.

The controversy over the appropriate role of drugs in controlling cholesterol levels attracted the attention earlier this year of the English medical journal Lancet, which urged caution in embracing drug therapy. "Although a low plasma cholesterol level may be a desirable objective," it concluded, "it is by no means certain that drug therapy is a good way of achieving it."

There are already seven prescription cholesterol-control drugs on the market. The newest, lovastatin (brand name: Mevacor), was prescribed for 350,000 people in its first nine months on the market after approval last year by the Food and Drug Administration, according to Merck Sharp & Dohme, its maker.

Nonprescription preparations sold at health food stores--ranging from fish oil capsules and high-fiber laxatives to the Vitamin-B derivative niacin--have attracted attention on their own, according to panelists at a recent American Medical Assn. cholesterol panel in New York. Merck partially sponsored the program, designed for journalists, as part of its national marketing program to call attention to cholesterol in general and its drug in particular.

Merck and its competitors have been careful to avoid the appearance of overpromoting their anti-cholesterol products, but at least one research expert contends that the industry's strategy is to increase cholesterol concern in the hope that patients will press their doctors for prescriptions.

"On a national basis, I think a lot of Merck's educational programs have been directed primarily at physician awareness of the whole cholesterol issue," said Dr. Donald Hunninghake, an expert on cholesterol pharmacology at the University of Minnesota. "Obviously, (an intended) byproduct is (that) the more they become aware of (the cholesterol issue), the more likely they are to use drugs."

"I think we do have concerns that drugs (will be) perceived as the magic bullet," he added, "and that every effort (instead) should be implemented to achieve maximum effect from diet before drug therapy is considered."

"We don't think that we are overselling or overpromoting the drug," responded Roy Walker, a Merck spokesman. The drug salesmen who call on physicians to promote Merck products, he said, "are instructed to rely on a fair balance in presenting information on the drug."

To specialists like Dr. Scott Grundy, a cholesterol expert at the University of Texas Southwestern Medical Center in Dallas, the vast majority of people with high cholesterol levels can successfully control their problems just by eating differently.

"We do not want people to view drugs as a panacea or as a replacement for (changing the) diet," added Dr. Antonio Gotto, another internationally known cholesterol authority at Baylor College of Medicine in Houston. "Only the most severe cases would require a drug and, even when a drug is needed, dietary (change) should be continued."

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