There is no association between so-called “bad cholesterol” and cardiovascular disease in the over-60s. In fact, if you consider all causes of death, the trend is for fewer deaths the higher the cholesterol. One explanation is that cholesterol is involved in immune system protection against potentially fatal gastrointestinal and respiratory infections and possibly even cancer.
Only last week I saw a woman in her late sixties who was diagnosed with type 2 diabetes a quarter of a century ago. She had been on insulin injections for the past 17 years. But recently, after reading reports that type 2 diabetes is a condition of carbohydrate intolerance, she changed her diet. “What did you stop eating?” I asked her. “Bread, rice, and sugar,” she answered with a beaming grin. “But now I can enjoy eating cheese and butter again.” She no longer requires her 80 units of insulin.
The management of type 2 diabetes has been upside down for decades. The perception is that it is a chronic, irreversible condition. As such it is treated with drugs that cost hundreds of millions of pounds, and which marginally reduce the complications of kidney problems, eye and nerve disease, but have no impact on heart attacks, stroke or death. Furthermore, side effects of these medications contribute to 100,000 emergency room visits a year in the US alone.
How many patients are explicitly given this information? Too few. Instead, as the BMJ pointed out in 2013, the drug industry’s business plan for diabetes is “recruit tame diabetologists, [and] massage them with cash ”.
When doctors have to make clinical decisions based upon biased information corrupted by commercial influence, we cannot claim to practice ethical medicine. When I wrote an article pointing out that it was wrong not to tell patients that inserting a heart stent for stable angina does not prevent heart attacks and prolong life, I received a supportive email from a colleague. “Many interventional cardiologists would privately agree with you but find your message in public uncomfortable,” he wrote. “There’s a whole industry of people whose livelihoods are dependent on invasive cardiology.”
Perhaps the most sobering conclusion about medical research was reached by John Ioannidis, professor of medicine and health policy at Stanford University. He concluded, in a paper published more than 10 years ago, that most published medical research is likely to be false. “The greater the financial interests in a given field,” he noted, “the less likely the research findings are to be true.”
Aseem Malhotra is a NHS cardiologist and member of the board of trustees of the King’s Fund