Who killed Kennedy? Did we fake the moon landings? Is that really President Obama’s birth certificate? Is Fox News really true and accurate? Some ideas just won’t go away no matter how many negative facts build up against it.
Such is the case with niacin and coronary disease. In light of this latest news, there is a school of thought that researchers just keep looking in the wrong place for the right answer. They point to an ongoing study: The Heart Protection Study 2 THRIVE. This study is being run by a very prestigious study group and is utilizing a 25,000 participant cohort with atherosclerotic disease and statin. This is an “all comer trial” and adds a drug that Merck developed and is approved for use in Europe. The compound is niacin combined with a prostaglandin agent laropiprant which supposedly controls the prominent side effects of niacin.
Perhaps, this will be the death knell for niacin. It will have to show a significant benefit to be added to the regimen in use now. Here is one mind blowing factoid about this trial: in 2008, this drug combination was turned down by the FDA, and they told Merck to submit again in 2013. WOW, a 25,000 participant study with a drug we can’t even use here. So much for the global nature of medicine.
As I have blogged about before, the cost of these studies is increasing, and the value is decreasing. Medical management of coronary artery disease is so good now that researchers are having trouble proving anything works beyond aspirin, statins, beta blockers and angiotensin eliminating drugs. The government will unfortunately have to be more and more involved if researchers want to answer some basic questions about how we treat people. This is one of the goals of the new health care act. Prove that what we do and take for granted actually works or are we just spending and earning money.
“First do no harm” has a corollary which is “If you do something, have at least some evidence that there is a benefit to patients." That unfortunately is lacking in much of what is unquestioned but accepted as medical care. Patients want more and more tests and more and more pills but get less and less benefit. I feel the tide turning, slowly but turning nonetheless.
To those patients taking niacin, I would urge you to talk with your physicians and examine all of your drugs. Seriously ask yourself whether you can do better on diet and exercise and strive to improve your own fitness. Take ownership of a problem you likely didn’t cause but have not helped by your actions. Take as much statin as possible to achieve the lowest LDL possible and for heavens sake do not let doctors tell you your LDL is too low. Make them prove IT.
Finally, there is very little evidence that small doses of niacin do anything. It will not hurt you, but it will not help you. Instead of wasting your money, donate it to buy real medication for patients that cannot afford to.
I wish I had positive news for you. Researchers and big Pharma will, I promise, keep trying. One day our prince will come…