Designing a Smart Patient

The September 24-25, 2011 weekend edition of The Wall Street Journal had an article entitled: Designing a Smarter Patient.

In the article, the two authors, members of Harvard’s Medical School, talked about a 45 year old woman, identified as Susan Powell, whose tests determined that she had a high level of cholesterol in her blood stream. As would be expected, her doctor wanted to put her on statins – drugs designed to lower, especially, the bad LDL cholesterol in her blood.

Ms. Powell refused, based on a statistical analysis of the performance of statins and the side effect risks. An analysis that determined the risk/reward relationship did not justify taking the drug. Leaving aside the faulty premises upon which the analysis was performed, the wrong risk was evaluated.

All drugs do not perform the same on all patients, and all drugs have potential side effects that are problematical for some percentage of the drug’s takers. But that is a secondary concern that takes a back seat to treating the ailment which the drug is designed to address. Especially when there are means for compensating for side effects. If there is to be a risk analysis, it should be on the risk of not treating the ailment, and only secondarily on how perfect are the drugs designed to “fix the ailment”.

Below is Tom Polizzi’s Letter-to-the-Editor of The Wall Street Journal. It describes precisely the danger Susan has put herself in by making a treatment decision based on math, rather than an informed understanding of the dangerous risk of a heart attack that an overweight person with globs of cholesterol in her blood faces. After the Letter-to-the-Editor, Tom Polizzi has a Post Script about the danger to medical care that the Harvard mindset represents.

Letter-to-the Editor, The Wall Street Journal

A Smarter Patient Who Is Not Smart at All

Susan Powell, in the September 24-25, 2011 Wall Street Journal article Designing a Smarter Patient, is unknowingly playing Russian Roulette. The issue is not how statins perform statistically, or their side effect risks. For her, the life-threatening issue is how to minimize the high amount of cholesterol found in her blood that possibly is accumulating on the wall of her arteries in the form of soft plaque. Soft plaque is unstable, really can’t be identified by current diagnostic methods, and for reasons not yet well understood, can erupt without warning triggering a heart attack. That is why persons who pass their annual medical exam with flying colors then go on to suffer heart attacks and die if treatment is not immediately available. Soft plaque eruptions represent the cause for some 80% of heart attacks annually. The only known attempt at preventative measures includes drastically reducing the level of bad (LDL) cholesterol (fat) plaque in the arteries, along with other very important heart healthy lifestyle changes. And, that is what statins are designed to do. Yes! Susan may be one of the fortunate who, without taking preventative measures, escapes experiencing a heart attack. But with a high level of cholesterol in her blood, and the added attack risk of being overweight, not using statins is a big “fat” mistake, and not smart at all.

Thomas A Polizzi

Post Script: Anyone who reads my book, The Muscles of My Heart, will fully understand the importance of minimizing the level of cholesterol in the blood, beyond what is necessary for building cells and producing estrogen and testosterone hormones. Beyond that, it becomes the fodder for creating heart attack blockage plaque. Statins are pivotal in seeking to prevent plaque buildup. But they are only part of the necessary treatment.

The point to be made is that it is extremely dangerous to the patient to isolate one element of a treatment, and play math games with that element’s efficacy in isolation from all the other elements needed to make the treatment effective – whether the patient is a smart patient or not.

In that context, the mindset of the two Harvard medical authors is frightening. Frightening because it represents a Harvard Bureaucratic mindset that is poised to be deciding what treatments – sub-treatments – will or will not be covered by medical insurance. That is, unless something is done to restore medical care to the mainstream practitioners.

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