Ecstatin.....then all fall down.....

Last week I was doing this post on Statins,.. the wonder drug of the new world. I am combining that with a recent post I wrote after the Exubera debacle this week.

Akira Endo synthesized the first statin way back in the 70s.But since the 4S and WOSCOPS studies of 1990s they have become domineering superstars- Lipitor outsells any other drug in this country still.At some time doing a thesis on statins was the most fashionable thing to do because there was a high chance you could get it published. Med Reps fought tooth and nail to outsell each other's brands to GPs.

A recent article from the AJRCCM mentions about the effect of statins on pulmonary function decline in a VA population. They tested FEV1 and FVC decline in smokers and non smokers over a ten year period. For those not using statins, the estimated decline in FEV₁ was 23.9 ml/year, whereas those taking statins had an estimated 10.9-ml/year decline in FEV_1.Within each smoking category, longtime quitters (quit 10 yr ago), recent quitters (quit < 10 yr ago), and current smokers the effect of statins was always estimated to be beneficial.


The cardiologists have raved about the statins for more than a decade.The neurologists, endocrinologists and nephrologists joined the bandwagon. Now the pulmonary guys too. They thought it was juts the lipid lowering. But when trial after successive trial showed mortality benefit the metabolism guys knew they were missing something.Then finally they came up with the prenylation of second messenger molecule theory which explained the pleiotropic effects.
Wonder why Dr Akira Endo has not been awarded the Nobel prize till now.




There is of course the other side of things:

There are many critics who say far too many people are on Statins than there should be- listen to Mark Porter's lecture on the BBC podcast series here: http://www.bbc.co.uk/radio/podcasts/medmatters/

Of course, the fact that Lipitor became a cash cow for Pfizer has also partly to do with the way it was marketed.The target was not just to the naive consumer- Dr Jarvik advising on DTC ads to take your statins to ensure you don't have to use his artificial heart ever- but also the practitioner.I have seen people get statins with no real indication, just because their doctor thought it was good for their heart.And of course the patient was hooked for life to the drug by naive doctor, disjointed thinking and the profit motive of the pharma companies.So then you have nonsense products like Caduet just for Pfizer to milk the Statin cow a little more.

Profits grew as midriffs did.Syndrome X was the pan affliction of a noveau riche affluent humankind and more and more research money was pumped into drugs that hit every angle of the kilo peccadilloes. Pfizer pumped in the millions into Torcetrapib, theoretically a fantastic concept of a drug.But it turned out to be a major failure and Pfizer was left wounded by a good billion.

At one point Pfizer had three of the world's ten top sellers: Lipitor for cholesterol, Norvasc for blood pressure and Zoloft for depression. But the latter two have lost patent protection, and their sales are vanishing. Lipitor will go off-patent by 2011.Since 1998 Pfizer as spent $55 billion on research and development and another $180 billion on acquisitions. Yet in that time only nine medicines from its labs have hit the market.Viagra, touted as a megahit, is now only a fairly good success, with annual sales of $1.7 billion. And the Exubera failure just rubbed things in.
The Pfizer share has seen a 40% price decline since 1998.Guess for once the Viagra magic did not hold things up.