Every time I see a patient, and on every visit, I review their current medication list. This process has recently been mandated by Medicare, but most doctors like myself have been doing it all along — without a mandate — because it is just good practice.
What I often find are medications given to patients for the purpose of prevention. And the most notable of these are the “statin” drugs, i.e. drugs that claim to lower cholesterol.
Most of these patients have never had a heart attack, and the only reason they are taking statin medications is because their cholesterol levels are elevated above a rather rigidly defined “normal range.” Studies show pretty convincingly that only one out of about 300 such patients actually live longer because they are taking these drugs. That may sound counter-intuitive, because heart disease is so common and so deadly. But, the reality is that there is more to heart disease than just cholesterol, and statins have side effects of their own that actually make some aspects of heart disease worse, rather than better. Therefore, on the whole, the benefits are real, but only slight. And, good doctoring means weighing risks and benefits for individual patients, not by focusing on large statistical groups.
Now, I am going to tell you something you probably didn’t know: patients with advanced cancer almost never suffer heart attacks. That’s because of the very little known fact that cancer itself lowers cholesterol! If you are surprised to read this, you are not alone. For reasons that are more political than anything else, most doctors and even cancer researchers avoid discussing this issue. Their rationales for doing so often sound something along the lines of: “We don’t really know…” or “That’s not my field…” But, we really do know… if, by we, one is referring to real practicing doctors like myself, not ivory tower academics writing journal articles. The fact is, oncologists virtually never see cancer patients suffer from angina or a myocardial infarction.
And this little-known fact is not because these cancer patients are taking their statin drugs. Instead, it’s because cancer itself puts the human body into a hypermetabolic, or catabolic, state, similar to what happens during starvation. (The same often happens to end-stage HIV sufferers, which is why patients in both groups often lose weight so dramatically.)
Now, here is the hard part: I know that the statin drugs my advanced-cancer patients are taking are doing them far more harm than good. (And they aren’t cheap either.) But, getting them to acknowledge and accept this is often quite difficult.
Why? Because when you tell a patient that taking preventive medicines is of no practical use, he or she becomes more fully aware of the fact that their condition is indeed ultimately terminal…and the consequences of this sober reality may feel overwhelming.
And that is the greatest challenge a cancer doctor faces. Anyone who has graduated from medical school can master the chemo protocols and order CAT scans. But patients need and deserve a doctor who is more than a technician. They need someone who is honest, but also someone who is compassionate and spiritual enough to be honest in a way that guides them away from fear and towards their own true realization.
I like to think that this is another very important way that faith in the undying soul can be so very helpful, to both patient and doctor.
Photo Source: By AJC1