The Cholesterol Con -- Where Were the Doctors?

After the stock market bubble burst, the New York Times asked: "Where were the analysts? Why didn't they warn us?"

To be perfectly honest, this was a somewhat disingenuous question. As experienced financial journalists understood all too well, the analysts plugging the high-flying issues of the 1990s were employed by Wall Street firms raking in billions as investors bet their nest eggs on one hot stock after another. It really wasn't in their employers' interest for analysts to tell us that their products were wildly overpriced. When a small investor wades into the financial world, there are two words he needs to keep in mind: caveat emptor.

But physicians, I firmly believe, are different from the folks employed by Merrill Lynch. (I don't mean to knock people who work at ML. I am simply saying that they have a very different job description.) When consulting with your doctor, you should not have to be wary. You are not a customer; you are a patient. And your physician is a professional who has pledged to put your interests ahead of his or her own.

This brings me to the question I ask in my headline: During the many years of the Cholesterol Con, where were the doctors? When everyone from the makers of Mazola Corn Oil to the Popes of Cardiology assured us that virtually anyone could ward off heart disease by lowering their cholesterol, why didn't more of our doctors raise an eyebrow and warn us: "Actually, that's not what the research shows"?

No doubt, you've heard about the recent Business Week cover story, "Do Cholesterol Drugs Do Any Good?", which blew the lid off the theory that "statins" -- drugs like Lipitor, Crestor, Mevacor, Zocor and Pravachol -- can cut the odds that you will die of a heart attack by slowing the production of cholesterol in your body and increasing the liver's ability to remove LDL, or "bad cholesterol," from your blood.

It's true that these drugs can help some people -- but not nearly as many as we have been told. Moreover, and this is the kicker, we don't have any clear evidence that they work by lowering cholesterol.

Although medical research suggests that statins can definitely benefit one group -- men under 70 who already have had a heart attack -- researchers are no longer convinced that the drugs stave off a second attack by lowering the patient's cholesterol. The drugs do lower cholesterol, but that is not what helps the patient.

In other words, researchers are questioning the bedrock assumption that high levels of "bad cholesterol" cause heart disease. "Higher LDL levels do help set the stage for heart disease by contributing to the buildup of plaque in arteries. But something else has to happen before people get heart disease," Dr. Ronald M. Krauss, director of atherosclerosis research at the Oakland Research Institute, told Business Week. "When you look at patients with heart disease, their cholesterol levels are not that [much] higher than those without heart disease," he added. "Compare countries, for example. Spaniards have LDL levels similar to Americans', but less than half the rate of heart disease. The Swiss have even higher cholesterol levels, but their rates of heart disease are also lower. Australian aborigines have low cholesterol but high rates of heart disease."

"Current evidence supports ignoring LDL cholesterol altogether," Dr. Rodney A. Hayward, professor of internal medicine at the University of Michigan, told Business Week's reporter.

In recent years, researchers have begun to suspect that statins help patients, not by lowering cholesterol levels, but by reducing inflammation. If this theory is right, "this seems likely to shunt cholesterol reduction into a small corner of the overall picture of heart disease," the Guardian reported four years ago.