Gregory A. Plotnikoff: What price prevention?

By GREGORY A. PLOTNIKOFF

Last update: November 11, 2008 - 7:33 PM

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Regarding the Tuesday editorial on the study of the benefits of the heart drug Crestor: Overall, the study found 83 heart attacks, strokes and deaths from cardiac causes among the 8,901 patients given Crestor, compared with 157 in the equal number getting a placebo. That means 120 people would need to be treated for two years at $3.45 a day per person to prevent just one cardiac event.

The total cost for the 120 people to prevent the one heart attack? It's $300,000.

This data is what the head of cardiology at the Cleveland Clinic called an "out-of-the park home run."

Now, taking the medicine still did not eliminate the risk; 83 people (who would be paying $3.45 per day each day for two years, roughly $2,500 per person) still had a heart attack.

One might say that a drop of 0.9 percent from an already low incidence is a low-risk reduction, especially if you are the one having to pay $3.45 a day on a fixed income. Is this 0.9 percent risk reduction worth $2,500 to the person? Is the one fewer heart attack over two years in an asymptomatic, otherwise healthy population worth $300,000 ($2,500 times 120 people) to the government, self-insured company or insurance company? Could the same reduction be achieved by less expensive means? After all, a too-low level of vitamin D drives inflammation and doubles the risk of heart attack and stroke. Omega-3s are as powerful as statins in prevention of secondary heart attacks and strokes. Both reduce all-cause mortality. And we know that mind-body approaches for stress reduction are powerfully synergistic.

So, given the potential cost savings, why are the government, corporations and insurance companies not funding studies in low-cost, low-toxicity, self-care interventions?

Maybe we citizens should insist that nonpharmaceutical prevention measures be at the top of the research agenda.

Gregory A. Plotnikoff, M.D., is medical director in the Penny George Institute for Health and Healing at Abbott Northwestern Hospital in Minneapolis.

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