Intelligent Medicine Blog

A study published this week in the Archives of Internal Medicine finds that individuals with high cholesterol levels who faithfully take statin drugs have a 45% lower death rate than those who neglect to take these medicines.  It is a massive study of almost 230,000 people over four to five years, and shows this dramatic effect in both people with existing heart disease and those at risk but with no pre-existing coronary event.

Therapy on my mind

This demonstrates yet again that adherence and persistence to pharmaceutical therapy is essential to health outcomes.  Or in the words of former U.S. surgeon general Dr. C. Everett Koop, “Drugs don’t work in patients who don’t take them.”

But there has also been some interesting commentary about the findings, challenging that the statins were responsible for the health benefits observed.  The Coronary Drug Project of the 1970s, for example, showed a benefit from faithfully taking a placebo that was almost as high as consistently taking active lipid-lowering drugs.  What’s going on here?  An incorrect conclusion to draw would be that the right mindset alone is the key to conquering disease.  It isn’t.  Or that drugs do not play a central role in the battle.  They do.

Dr. Mark Hlatky, a professor of medicine and health research and policy at Stanford University, has the insight:  ”It is definitely a very important observation that people who take their drugs always do better than people who don’t, even if the drug is not terribly effective, because they tend to take care of themselves better in a lot of ways.”

Engagement in one area of positive health decision making (drug adherence) has a multiplier effect in healthy behavior overall (diet, exercise, other lifestyle choices).  So if pharmaceutical products are effective, even modestly so, and the problem of medication adherence can be solved, this can have a profound effect by making pharmaceutical therapy the catalyst for better wellness management and disease prevention.  The so called “placebo effect” could therefore be thought about and used in a positive way, by harnessing the beneficial effects of attitude and expectations toward therapy in the delivery and support of effective pharmaceuticals.  With this as a guiding principle, pharmaceutical developers should focus not just on innovation to make new drugs, but on innovation around and beyond the drugs they already have.

Few companies are doing this today, but it is the future of the pharmaceutical industry.  It will require developing not just individual drugs, but “pharmaceutical systems” that support and empower consumers to take their medicines correctly and physicians to personalize the drug regimens they prescribe.  It will also require integrating sensor and information-based tools about drug taking behavior and physiologic response into pharmaceutical products, and making consumer communications and support-based services a part of the pharmaceutical business model.