No-Logic Zone A company in Japan sponsors a program that discourages young people from taking up cigarette smoking. The same company is partnering with the drug maker Roche to develop a drug designed to help prevent heart disease by raising HDL cholesterol. Given those two details, you might imagine that the company is some sort of health advocacy group. Not quite. The company is Japan Tobacco (the third largest cigarette maker in the world) whose international headquarters is located in…Japan? Not quite. Geneva, Switzerland. These are just a few of the clues that tip us off about the world of cholesterol management drugs: Rules of logic don't apply. In the event of an emergency landing… This past December, torcetrapib went down in flames, and then late last month it officially crashed and burned. In the e-Alert "Beef 'n' Butter" (4/20/04), I first told you about torcetrapib, a Pfizer medication designed to increase HDL cholesterol. Torcetrapib was intended to complement Lipitor so that you'd have a drug to lower LDL and raise HDL. A match made in heaven! Just one little problem: torcetrapib tended to raise blood pressure, which is a REALLY inconvenient side effect in a medication that's supposed to prevent heart disease. Then came December 2006 - Pfizer abruptly shut down a torcetrapib clinical trial because a suspicious number of heart attacks and deaths appeared to be connected to the drug's use. Late last month this was confirmed in two articles that appeared in the New England Journal of Medicine. This was a huge blow for Pfizer. At one time there had been talk of combining Lipitor and torcetrapib into a single medication that would usher in a second golden age of cholesterol medications and, of course, staggering profits. And if Pfizer had been able to pull that off, there would have been no worries about Lipitor losing patent protection in 2010. Ah, but it was not to be. Unless…hmmm…unless you could somehow combine Lipitor, torcetrapib, AND a medication to lower high blood pressure. Clone wars You've probably seen the TV commercial where a healthy-looking middle-aged woman is walking along an ocean path. She's got two problems, she tells us. And then she splits into two identical women who walk side by side. I find this a little unnerving. But even more unnerving than a mutant who can split herself into two people is the product she's pitching that treats her two problems: a high blood pressure medication bundled with high cholesterol medication. The product is Caduet, which combines Lipitor with the hypertension drug, Norvasc - both made by Pfizer. This combo is touted as a convenience: fewer pills to take and one less copay when you fill your prescriptions. Now, I don't have the mad marketing skills of international drug company executives, but I've got an idea I'm going to pass along to Pfizer, free of charge. Why not combine torcetrapib with Caduet? High blood pressure problems? I don't THINK so! Not with Norvasc on board! And this plan solves the most obvious drawback of Caduet. If a patient has elevated LDL but he doesn't have high blood pressure, he's probably going to balk at the idea of taking a drug that contains hypertension medication. But with this three-in-one idea, lack of hypertension won't be an issue because you'll automatically be at risk of developing high blood pressure, but you won't have to worry about it because you'll already be taking a drug to address that! (This "logic" may require some upbeat spin in the barrage of advertisements.) Of course, the irony is that all these drugs are unnecessary except in the most extreme cases. High LDL? Low HDL? High blood pressure? For most people these conditions are quite manageable when you exercise regularly, eat a balanced diet of whole foods, avoid highly processed foods and sugar, and take a few key supplements. Side effects? Close to zero. Sources:
"Pfizer Illustrates Torcetrapib Failure" Mike Nagle, Drug Researcher, 3/28/07, drugresearcher.com | 
