Garth Rattray

Dr. Rattray's column is being reprinted today to correct an inadvertent placement of a quote under his photo yesterday which in fact represented the views of Dr. Anthony Vendryes with whom he has been debating the matter of cholesterol drugs. We apologise to Dr. Rattray for the error.

Patients deserve a fair and balanced approach to the topic of cholesterol and the agents that lower it. On this topic practitioner Dr. Anthony Vendryes has proposed that medical practitioners are not acting in the best interest of their patients. He boldly and publicly admonished us with this (arguably libelous) statement, "I would conclude by reminding Dr. Rattray and my other medical colleagues of the Hippocratic dictum - Primum, non nocere: First, do no harm!"

But, 'First, do no harm' is not in the Hippocratic Oath! It somehow became a catch phrase circa 1860. The Oath states, 'I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone'. That is precisely what my medical colleagues and I are doing.

Scientific evidence

Despite overwhelming scientific evidence that high cholesterol is harmful, Dr. Vendryes maintains, "There is nothing intrinsically dangerous with elevated blood cholesterol." And, like thinkers claim that people with untreated high cholesterol levels live longer, are less depressed and have better cardiac function. It's therefore extremely contradictory for him to offer to lower the cholesterol by stating: "As I have suggested in the past, if one really needs to lower cholesterol levels, there are far healthier ways than statin drugs."

Dr. Vendryes quotes from a finance publication and lists the possible side effects of one cholesterol-lowering statin under the headings: muscle pain and weakness, neuropathy, heart failure, mental impairment, depression, cancer, pancreatic disease and increased risk of death. His blatantly unbalanced approach has forced Assistant Professor of Medicine, Dr. Beatrice Golomb (whom he misquoted), to extricate herself by calling his statements, "patently untrue" and a "serious mischaracterisation of statements by those of us interested in adding balance to the discussion of statins" (Gleaner, March 29). Some of the other findings that he presented were speculative, deduced by loose association or made while experimenting on laboratory dogs.

If you look for exhaustive side effect drug profiles, you will find them. An extremely popular and very heavily prescribed, penicillin-containing antibiotic lists 49 possible side effects ranging from nausea and diarrhoea to toxic epidermal necrolysis, pseudomembranous enterocolitis, liver and kidney dysfunction and fatal hypersensitivity anaphylactic shock ,yet we prescribe it several times each day because its benefits far outweigh the possible side effects.

Drs. Joseph Goldstein and Michael Brown won the Nobel Prize in 2003 for groundbreaking studies leading to the development of life-saving, cholesterol-lowering statins. They explained that the evidence was experimental (1910 - German chemist Adolph Windaus reported extremely high concentrations of cholesterol in human aortic atherosclerotic plaques); genetic (1938 - Norwegian clinician Carl M?Ÿller described a familial link between high blood-cholesterol levels and heart attacks); epidemiologic (1955 - American biophysicist John Gofman confirmed M?Ÿller's finding and discovered that while high levels of low-density lipoproteins were dangerous, high levels of high-density lipoproteins were protective) and finally; therapeutic (1976 Japanese scientist Akira Endo discovered the first statin).

Great collaboration

Goldstein and Brown, in collaboration with Endo, showed that inhibition of cholesterol synthesis up regulated low-density lipoprotein receptors - which lowered that bad cholesterol while sparing the good. They concluded, "Very few, if any, chronic diseases of adults have ever been subjected to such intensive research, and in very few, if any, chronic diseases of adults has the cause been so convincingly demonstrated in so many ways."

I will always defend the ethical duty of physicians to practise evidence-based medicine. The benefits of statins outweigh the risks. Until irrefutable evidence to the contrary emerges, they should be used to save lives.