Garth Rattray

ON MARCH 23, Dr. Anthony Vendryes' piece titled, 'Rattray wrong on cholesterol drugs', was published in this newspaper. I have no vested interest in 'cholesterol drugs' (statins), neither do I sell nor promote anything (the same cannot be said of everyone). However, like all concerned physicians, I do have a deep interest in the well-being of my patients. Matters of efficacy versus risks in prescribing statins to lower bad cholesterol has little to do with one individual (me); it has everything to do with doctors trying their best to save lives. For the sake of accuracy, therefore, Dr. Vendryes should have titled the piece, 'All endocrinologists, neurologists, cardiologists, interventional cardiologists, cardiac surgeons, internists, most researchers and 99.9999 per cent of primary care physicians are wrong on cholesterol drugs'.

Over the years, I've learned that I am not self-employed - each and every patient that chooses to see me is my boss. I am 'employed' to givethem the best advice based onhard evidence gleaned fromyears of reputable and independent studies worldwide (evidence-based medicine).

Physicians are health managers and educators. We must provide information and guidance. We have an ethical and legal duty to adhere to universally accepted standards of practice. In the long run, we are risk managers. We must weigh the pros and cons of medications when treating potentially dangerous conditions. If the side effects outweigh the benefits, then we will not prescribe that medication.

Alternative ending

If Dr. Vendryes has his way, here's an example of what would transpire in my office, other medical offices, clinics and hospitals all over the world on a daily basis: "Good day, sir. I see that your father died from a heart attack when he was 55 years old. And, I also note that your mother had a serious stroke when she was 60. They both had high cholesterol levels and your mom was diabetic. Now I notice that at 40 years of age your cholesterol levels are quite high and your bad cholesterol is very high. Research all over the world has shown that with your family history and current high cholesterol, people like you are at high risk for heart attacks and strokes. In your case, regular exercise, weight management and stress control alone cannot adequately bring down your dangerously high cholesterol.

"There is a group of drugs called statins, which has been proven to lower the bad cholesterol and save millions of people just like you from heart attack and strokes it has been found that a small portion of people MAY have problems with these drugs, the vast majority do not. In fact, I have never seen any serious side effects. Over all the years that I have been prescribing these drugs, only a handful of patents have had to be taken off when minor problems appeared. However, since there is some questionable controversy concerning the use of statins, I can only recommend that you TRY Vitamins C, E, niacin, B complex, omega-3 fatty acids in fish oils, garlic, curry, soy and soluble fibre. Good luck and good-bye!" I wonder what Hippocrates would think of me then?

In his blind rush to vilify statins, Dr. Vendryes has chosen to totally ignore the millions of lives that they save every year. Statins may carry some risks for a minority of people, but, until something better/safer comes along, they are all that we have to reduce cardiovascular tragedies in moderate to significant at-risk patients.

Next week: Cholesterol, judge for yourself.