The Media Buries the Message: Tobacco Prevention vs. High-Cost Drugs

StatinsCholesterol-reducing drugs called statins have been in the news lately following the release of a major medical study that found that statins can prevent heart disease and stroke in people with no previous history of heart disease.

Statins are among the biggest-selling family of drugs of all time. Many articles about the study mentioned above, including one on the credible web site WebMD, also mention the specific drug used in the study: Crestor.

The study has generated hundreds of articles, most of which repeat the same basic framing of the issue: if heart disease is the problem, a drug is the answer.

This is the typical framing the public gets from hundreds of news reports about heart disease.

Smoking prevention, known to be tremendously cost-effective in preventing heart disease, is never compared to the cost of a new drug touted as doing the same thing. News stories inevitably fail to compare the merits of tobacco prevention when a new and costly drug is promoted as preventing heart disease.

An Associated Press article titled "Wider cholesterol drug use may save lives," about the big statin study estimated that "treating [all at-risk people] with Crestor would cost $9 billion a year and prevent approximately 30,000 heart attacks, strokes or deaths ... That's pretty costly."


Every dollar spent on tobacco prevention saves $2-3 on health care costs down the line, so $9 billion invested in tobacco prevention could save $18-27 billion in eventual medical costs -- many times more than the cost of preventing heart-related ailments using statins.

The media literacy lesson here is that lifestyle strategies for health get downplayed -- even eliminated entirely -- when drugs are promoted, even if lifestyle changes are still the most cost-effective and least-risky answer.


CRP is a measure of inflammation, a risk factor for heart disease and cancer, among other conditions. The next question should be: what reduces inflammation? Among other things: Vitamin D from sunshine and supplements. (heart disease increases during the winter and in latitudes farther from the equator.) Fruits and vegetables in the diet. (the vast majority of Americans do not get enough.)

This trial was stopped half way through its designed period before adverse events ruined the slight gain they could claim. There was a biased selection and a high dropout or non compliance in trial participants that was not reported. Stopping a major clinical trial halfway through is a big deal, as it invalidates any credible statistical analysis of the benefits and effectiveness of a treatment, and makes safety and longer-term risks impossible to evaluate. The actual (absolute) difference in mortality between the statin and control groups after nearly 2 years in the JUPITER trial was only 0.25% and incidences of heart attacks and strokes differed by a mere 0.35% a year. Looking more closely at the design of this trial, its methodology, selection of participants, attrition, findings and adverse events; as well as the evidence of C-reactive protein (CRP) and safety data of Crestor to date, suggests that all of the amplified claims being heard deserve a much more cautious look. There is a very good analysis of the trial here. Claiming c-reactive protein as a new marker for heart disease is ridiculous. An analogy would be.... Looking down from above at all murder sites the day after discovery and noticing a team of detectives there and declaring that detectives cause murder because they are present at every site. It is not a bad thing to take something for inflammation as you age and the best thing one can take is Alpha Lipoic Acid 600 mg/day.