When The Latest May Not Be The Best..

When it comes to healthcare, using the latest piece of equipment or taking the latest medications may not always be the best thing for you to do..

Take a look at the following examples:

  • The anticholesterol medication Vytorin was introduced with great fanfare 5 years ago, touting to be the most efficient way of reducing cholesterol in the blood. Vytorin is actually two drugs in one: simvastatin (Zocor) and ezetimibe ( Zetia , Ezetrol). It works in two ways – preventing cholesterol from being absorbed in the intestines as well as cutting the production of cholesterol in the liver. It claimed to be superior to the other existing anticholesterol drugs in the market.  Now, a series of studies have shown, among other things, that Vytorin may not be better than the existing drugs (ENHANCE study) in thinning the walls of arteries. Worse, last month it hit the medical headlines when it was shown (SEAS study) that those taking Vytorin had a higher chance of getting cancer, although this needs to be proven conclusively. So don’t stop taking it yet pending further proof as further studies are being done.
  • Diabetic patients with heart problems were told in recent years to control their blood sugar on a stricter basis (the ADVANCE study) so much so many doctors, including the writer, were seeing patients suffering from the unwanted effects of low blood sugar due to the stringent control. Then, another study (ACCORD) showed that these patients had a higher chance of getting fatal heart attacks! So, doctors are now advising controlling diabetes as usual pending further studies.
  • Heart-scans, (also known as 64-slice CT scans, cardiac CT scans, MSCT heart-scans, CT coronary angiograms), were the rage when they were first introduced; to the extent that they were offered (even at present) by some centers as part of a medical check-up for otherwise healthy individuals. Radiation danger aside (see my earlier post), such scans have not been found effective in screening for heart disease in healthy people despite the exhortations of those who own these machines. Often, they have led on to more unnecessary expensive tests and have caused needless anxiety. To find out who needs these scans, see here.

    Heart-scans: beautiful images but at what cost?

Unlike the latest electronic gizmos, in healthcare the latest devices or medications may not be the best.  After all, the art of medicine is really an imprecise science applied to an even more imprecise subject -the human body. Sometimes it may be better to stay on the older time-tested pills than to reach out for the new ones!

The decision whether you need to take a particular medication or to do a test requires a thorough discussion with your doctor. All medications carry side-effects of varying importance and taking them is on the premise that the pros outweigh the cons. After all, the ancient Roman poet Ovid said, Medicine sometimes snatches away health, sometimes gives it.

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2 responses

  1. I respectively disagree that people should stay on ezetimibe (Vytorin, Zetia). Given that (1) ezetimibe has never been shown to prevent heart attacks and strokes, (2) the results of ENHANCE were negative, and (3) the possibility that it increases cancer risk has not been ruled out, I believe it would be reasonable and prudent for patients to have a discussion with their doctors about switching to a statin alone. For patients who are taking Zetia because they are intolerant to statins, there are other possibilities such as resins and niacin.

  2. Correction, “respectfully,” not “respectively.”

    Doctor2008 says: I agree with the points you put forward and I know doctors who have started taking their patients off Vytorin. However, in the era of evidence-based medicine, more definite studies have to be undertaken to add weight to the ENHANCE study which has several limitations. An ongoing study called IMPROVE-IT will be ready in a few years. Meanwhile, the last paragraph of my post best summarises the stance we all should be taking. Thanks for your contribution!
    P.s. Just to keep everything in perspective, the best way to lower cholesterol is still to practise healthy life-style measures, like not smoking, increasing exercise and eating properly 🙂

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