Thursday, November 10, 2005

A Drug for "Eliminating Cardiovascular Risk?"

The Washington Post recently reported on an interview with Pfizer Chief Executive Officer (CEO) Henry A. (Hank) McKinnell. (The PhD seems to have been in business, from Stanford, as per his official bio.). In it, he asserted that the combination of the new drug torcetapib with atorvastatin (the latter is now marketed as Lipitor) could potentially eliminate coronary disease,
It looks like a combination of raising HDL and lowering LDL cholesterol could have dramatic impact, maybe eliminating cardiovascular risk.
This is an extraordinary assertion.
Although high LDL (bad) cholesterol and probably low HDL (good) cholesterol are risk factors for coronary artery disease (CAD), they are surely not the only risk factors. Cigarette smoking, diabetes, and hypertension are also well known risk factors. In addition, CAD clearly afflicts people who have no known risk factors.
Therefore, it is hard to believe that any treatment, no matter how potent, that addresses only cholesterol would come anything close to eliminating the risk of cardiovascular disease.
So why would Mr. McKinnell say such a thing?
The possibilities seem to be marketing hyperbole, his ignorance of the epidemiological and clinical background, or misquotation.
The first two are particularly discomfiting.
Although we expect hyperbole in the marketing of ordinary products, laundry detergent for example, this sort of hyperbole in the marketing of drugs could have serious repercussions in this context. If people were lead to believe that they could prevent all CAD by merely taking a pill to improve their cholesterol profile, this might reduce their motivation to control their blood pressure or diabetes, or to give up smoking.
On the other hand, if Mr. McKinnell is so ill-informed about the drugs his company produces that he really believes that this new combination pill will eliminate CAD, what else about pharmaceuticals doesn't he understand? Having someone in charge of the world's largest pharmaceutical company who knows so little about drugs could lead to all sorts of mischief.
So I really hope he was misquoted.
If not, I really hope that he learns to restrain his tendencies to hyperbole, and/or to become better informed about what his company makes before something really bad happens.


Anonymous said...

Well spotted!This is an issue that plagues the financial/business press: early hyping by money people. The market makers aren't dumb. They do often check these things with independent experts. But sometimes these kinds of hyperbole get through the net.

Anonymous said...

May I suggest that the former CEO of Merck, Raymond Gilmartin, lacked medical credentials of any kind.

Anonymous said...

Extraordinary assertion, yes, but not as silly as you seem to think.

Hmmm. but what if the HDL raising drug performs in a manner to deplete atherosclerotic plaque of all lipids and make it stable and not prone to rupure? Wouldnt that be a drug that negates risk factors, especially since unstable plaque is the main cause of CV disease?

So neither of your points make sense - first, the drug is not available, so no one is going to abandon therapies yet. Maybe, however, they can. In theory, at least, smoking and hypertension dont HAVE to cause CV disease. They just aggravate plaque formation and rupture.

Mind you - this isnt necessarily the case with this drug - although it is not out of the realm of posssibility.

Looks like you might not know as much about drugs as you thought.