Being the curious sort, I leapt to the phone when a
recent TV advertisement from Merck urged me to call a 1-800 number
to discover a solution to
high cholesterol. I asked the nice young man named Brad on the other
end of the line whether the particular product he was peddling contained
information about how doctors such as Dean Ornish and Neal Barnard
were recommending a strict vegetarian diet to reduce cholesterol and
the
risk of heart disease.
Brad didn’t know the answer to that one, so he sent me Merck’s
kit. Two documents made up the kit: both — "Surviving High
Cholesterol" and "The Cholesterol Survival Study" —
brought to me, not by Drs. Ornish and Barnard, but by "Merck, Maker
of ZOCOR (Simvastatin)." We’ll get to "The Cholesterol
Survival Study;" first, "Surviving High Cholesterol."
"Surviving High Cholesterol" tells us that cholesterol is
"a major risk factor for coronary heart disease, which kills 500,000
Americans each year." It talks about High LDL (what it terms "Bad")
and High HDL ("Good") cholesterol and what can happen when
LDL is high and HDL is low. These, along with smoking, high blood pressure,
diabetes, heredity, and being older than 55 are the risk factors for
heart disease, which, it says, can be reduced by stopping smoking, controlling
high blood pressure and lowering cholesterol. (You can’t change
your family history, the booklet sensibly notes.)
What about diet I hear you ask? Well, says the booklet, "Here is
a list of foods you should eat and those you should avoid." As
well as fruits and vegetables, grains, beans and other such non-cholesterol
containing foods, we’re encouraged to eat "lean cuts of red
meat, chicken and turkey — roasted or baked (with skin removed);
fish — baked or broiled; skim milk, ice milk, low-fat/non-fat
yogurt and cheeses labeled ‘low fat,’ ‘light,’
or ‘part skim’." Many of you, looking at this list,
will wonder what — given what’s good — the bad foods
are. Well, obviously, fatty meat, butter, whole milk, cream, eggs and
doughnuts, Danish pastry and many cakes, cookies, and pies. For good
measure, avocado and coconut are added to the "bad" column
("they’re high in fat"), although — not being
animal products — they contain no cholesterol at all.
Although, as we can see, our friends at Merck do recommend changes
in diet and tell us to exercise more, it’s ZOCOR/Simvastatin that’s
being sold. We are told that sometimes diet and exercise simply cannot
lower cholesterol levels; although, given the diet Merck recommends,
that may not be surprising. Nevertheless, a recent article in the New
York Times also reported that sometimes even very low fat or vegetarian
diets don’t help. Very well, I thought, let’s look at this
wonder drug which has, according to the other booklet — "The
Cholesterol Survival Study" — reduced heart attacks by 34%,
the need for heart surgery by 37%, and deaths from heart attack by
42%.
To ensure its safety, we are told, "ZOCOR was required to be tested
on animals before it was marketed for human use. Often these tests were
designed to achieve higher drug concentrations than humans achieve at
recommended dosing." At first glance, the results didn’t
seem pretty: mice with high dosages had an increased risk of developing
cancerous tumors and male rats’ fertility decreased. However,
being one of those crazy people who don’t think animals make good
scientific models for people I figured (perhaps unwisely) I could let
these results slip by as inapplicable. As instructed, I studied ZOCOR’s
ingredients (cellulose, lactose, magnesium stearate, iron oxides, talc,
titanium dioxide, and starch), and was as sure as I could be that I
wasn’t allergic to any of them. Since I was not breastfeeding,
pregnant, or likely to become so, I could still take the pill. I was
even willing to risk being the one percent of patients who experience
liver abnormalities after taking ZOCOR.
So, if like me, you leapt over these hurdles, should you rush out and
pop this particular pill? By all means, although in the spirit of public
service I feel duty bound to quote in full and verbatim the "Side
Effects" section helpfully printed in both these pamphlets.
Side Effects
"Most patients tolerate treatment with ZOCOR well; however, like
all prescription drugs, ZOCOR can cause side effects, and some of them
can be serious. Side effects that do occur are usually mild and short-lived.
Only your doctor can weigh the risks versus the benefits of any prescription
drug. In clinical studies with ZOCOR, less than 1.5% of patients dropped
out of the studies because of side effects. In a large, long-term study,
patients taking ZOCOR experienced similar side effects to those patients
taking placebo (sugar pills). Some of the side effects that have been
reported with ZOCOR or related drugs are listed below. This list is
not complete. Be sure to ask your doctor about side effects before
taking ZOCOR and to discuss any side effects that occur.
Digestive System: Constipation, diarrhea, upset stomach, gas, heartburn,
stomach pain/cramps, anorexia, loss of appetite, nausea, inflammation
of the pancreas, inflammation of the mouth, hepatitis, jaundice, fatty
changes in the liver, and, rarely, severe liver damage and failure,
cirrhosis, and liver cancer.
Muscle, Skeletal: Muscle cramps, aches, pain, and weakness; leg pain;
shoulder pain; joint pain; muscle breakdown.
Nervous System: Dizziness, headache, insomnia, tingling, memory loss,
damage to nerves causing weakness and/or loss of sensation and/or abnormal
sensations, anxiety, depression, tremor, loss of balance, psychic disturbances.
Skin: Rash, itching, hair loss, dryness, nodules, discoloration.
Eye/Senses: Blurred vision, altered taste sensation, eye irritation,
progression of cataracts, eye muscle weakness.
Hypersensitivity (Allergic) Reactions: On rare occasions, a wide variety
of symptoms have been reported to occur either alone or together in
groups (referred to as a syndrome) that appeared to be based on allergic-type
reactions, which may rarely be fatal. These have included one or more
of the following: a severe generalized reaction that may include shortness
of breath, wheezing, digestive symptoms, and low blood pressure and
even shock; an allergic reaction with swelling of the face, lips, tongue
and/or throat with difficulty swallowing or breathing; symptoms mimicking
lupus (a disorder in which a person’s immune system may attack
parts of his or her own body); severe muscle and blood vessel inflammation;
bruises; various disorders of blood cells (that could result in anemia,
infection, or blood clotting problems) or abnormal blood tests; inflamed
or painful joints; hives; fatigue and weakness; sensitivity to sunlight;
fever; chills; flushing; difficulty breathing; and severe skin disorders
that vary from rash to serious burn-like shedding of skin all over
the
body, including mucous membranes such as the lining of the mouth.
Other: Chest pain, edema (swelling), loss of sexual desire, breast enlargement,
impotence.
Laboratory Tests: Liver function test abnormalities including elevated
phosphatase and bilirubin; rare reports of thyroid function abnormalities."
Having read this, I’m sure you’ll join with me in rejoicing
that once more animal-testing has provided us with so safe a drug with
so few side-effects. And I, for one, find my toes curling with pleasure
at the thought that — with ZOCOR on our bedside tables — we
can continue eating animals and animal products until we all go to
that great pharmacy in the sky.
Martin Rowe
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