Does Every Diabetic Really Need A Cholesterol PIll?

In 2009, HMSA (Hawaii's largest health insurance company) will start fining doctors who don't put every last one of their diabetics over the age of 40 on a cholesterol lowering pill. No matter what your cholesterol, if you are a diabetic, your doctor will probably write you a prescription. Even if you don't have heart disease. How can they justify this?

I asked HMSA's medical director. He says the practice is well supported by extensive research. But when I look at the articles cite by the company HMSA hired to outsource this decisionmaking process, I see some very fishy writing.

Two of the articles are based on the opinions of nine doctors, eight of whom are paid drug company consultants.

One citation is a CDC web site that has disappeared.

The only article of any merit is about a study done on about 2,000 people with diabetes, half of whom took a sugar pill and half of whom took a cholesterol pill. Almost two hundred people had to stop the cholesterol pill due to side effects. This effectively weeds out the more sickly people and so, it is not surprising that in the group taking the pill there were fewer heart attacks - at least to start with. The study was stopped early, for reasons they don't explain. What has me worried is that, when I look at the graph comparing death rates in the two groups, the first few years look pretty good for the group on the drug. But by the end of year three, people start dropping dead fast - so fast the line looks like its starting to go straight up. What is the real reason they stopped the study prematurely? Could it be that they saw where the line was heading, and decided to quit while they were ahead?

Remember, this line is the group of healthier people (b/c they could handle the side effects of the drug) and even they started to die after taking it for almost four years. HMSA wants diabetics to stay on it for life.

The research does show that people who have had heart attacks do benefit from statins. But the research does not support what HMSA plans to pay your doctor to do now. If I don't go along with this, I will loose money. This is not fair to me as a conscientious physician, and its not fair to HMSA's customers who may pay a price with their lives in four years time.



Safe For Four Years? In this highly selected group of people, problems seem to increase just before the study was ended prematurely by the organizers.