My next-door-neighbor is a lawn guy.  I see him all the time from my office window, puttering around in his yard … seeding, fertilizing, watering if we haven’t had rain for awhile, and of course, mowing and trimming.  Not surprisingly, he’s got a healthy lawn, which anyone can tell from the rich, green color of the grass.

I’m not a lawn guy.  Never have been.  I spent most of my adult life living in apartment buildings, where the lawn (if there was one) was the landlord’s problem.  We rent a house now, so I’ve finally got the lawn, but I still have no desire to put any work into it.  I pay a guy to ride his lawnmower around the place, and that’s the extent of my involvement.  No seeding, no fertilizing, no watering.  The grass isn’t just grass; it’s a motley mix of grass, clover and weeds, with a corresponding mix of hues.  During dry spells, there are brownish patches.

So as you might expect, my lawn isn’t going to win the local association’s “Most Beautiful Lawn” award anytime soon.  (Yes, they have one.)  That doesn’t matter to me, but I wouldn’t mind having a nice, healthy lawn.  So after comparing my neighbor’s lawn to mine, I’ve figured out a solution:  I’m going to hire a company to spray-paint my grass the same color as his.  Then my lawn will be just as healthy.

The company I have in mind is Merck.  I’m picking them because they apparently believe that since people with high HDL are less prone to heart disease, they can prevent heart attacks by developing a drug that artificially jacks up HDL.  Riiiiiight.  Paint the grass green, and the lawn is healthy.  And if I have a mechanic tinker with my Mitsubishi so it produces exactly the same amount of exhaust as a Maserati, it’ll do 180 on the highway.

What’s amazing is that Merck is jumping in where Pfizer already failed, as the Wall Street Journal reported in this article:

It’s been nearly three and a half years since Pfizer abruptly pulled the plug on its $800 million effort to develop torcetrapib after the HDL-cholesterol raising drug was linked to a higher risk of death in a 15,000-patient study.

The disastrous outcome contributed to Pfizer’s stunning decision in September 2008 to sharply curtail early-stage research for drugs for cardiovascular disease, a franchise the company has owned for more than a decade with the blockbuster statin Lipitor and the blood pressure pill Norvasc (now generic).

Pfizer ended its clinical trial three years early because the death rate among the subjects taking torcetrapib plus a statin was 60% higher than in the group that only took a statin.    (Since the patent on Lipitor will run out soon, Pfizer was hoping to create a new miracle combo drug.)  The higher death rate, by the way, included a higher rate of fatal heart attacks.  Gee, you’d almost think something was wrong with the Lipid Hypothesis.

And here’s the interesting part:  the drug did exactly what it was supposed to do.  In early phases of clinical testing, Pfizer breathlessly reported that the miracle combo boosted HDL by 44 to 66 percent, while lowering LDL by 41 to 60 percent.  Wowzers!  … high HDL, low LDL.  Your doctor would read your drug-induced cholesterol score and happily sign a declaration that you’ll probably live to be 100.  Then a couple of years later, your family could take that declaration, fold it up neatly, and put it in the pocket of your burial suit.

The point is, high HDL and low LDL don’t confer benefits in and of themselves.  It’s far more likely that they’re markers for good cardiovascular health, not the cause.  (In the case of low LDL, it’s not even a good marker.  See this post for more on that topic.)  Pushing markers up or down with drugs is nothing more than treating a lab score.  And as Pfizer found out, the drugs can produce nasty side effects that far outweigh any benefits.

My HDL on my last lab test was 64.  Combined with a score of 70 for my triglycerides, it makes for an impressive lab result.  But it’s not those numbers that are keeping me healthy; it’s the diet that produced those numbers.  A diet rich in natural fats raises HDL.  A diet low in sugar and starch reduces triglycerides.  A diet rich in natural fats and low in sugar is also a diet that’s more likely to keep blood sugar under control, and less likely to produce the inflammation that can damage arteries.

As I’ve said before, I don’t expect pharmaceutical companies to abandon the drug business and start recommending a change in diet.  That’s not why they exist … and some of the drugs they’ve produced have been modern wonders.

Unfortunately, it’s the cholesterol-manipulating drugs that have been raking in the big bucks for the past 20 years, so of course Merck is going to jump on the HDL bandwagon.  Prepare yourself for the press releases coming down the pike over the next few years.  First you’ll see headlines about how Merck’s new drug raises HDL by 90%.  Then you’ll read about clinical results that are “inconclusive.” Finally, Merck will quietly put out a release giving the pharmaceutical version of “The operation was a success, but unfortunately the patient died.”

Then I’ll hire some of their former employees to paint my lawn.

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23 Responses to “Merck Hoping for Green With HDL Drugs”
  1. mezzo says:

    Follow the money. Now mind – I don’t object to companies earning money. Not in the least little bit. And I realise that research costs money. I do wish, however, that they were a little less greedy (greed is still one of the mortal sins and the older I get the more sense this makes to me). Why not focus on something that can really create a health benefit and make money out of that? Maybe that sort of things requires the type of brains the pharmaceutical industry doesn’t have. Not surprising really – the labour pool they can recruit from now was brought up on a healthy low-fat diet.

    I don’t object to them making money either … but I do find it suspicious that we’re finally seeing articles in the popular press about how LDL may not be so bad, just as the patents on statins are running out.

    I don’t consider greed per se to be a moral failling. One man’s definition of greed is another man’s definition of ambition. Andrew Carnegie was “greedy,” but he also vastly reduced the price of steel and everything made from steel, then built most of the country’s first public libraries with his greedy profits. But when greed causes people to be dishonest, that’s a moral failing … but the sin is the dishonesty, not the ambition.

  2. John Hunter says:

    This kind of thing makes me really sad. One of my best friends was normal weight, didn’t smoke, drank little, exercised and didn’t have bad cholesterol levels. Last year he had a massive heart attack at 49 years of age. He died twice and was brought back. He has made a great recovery but i hear him passing on his doctors advice. He takes statins to lower his cholesterol. He also preaches about eating a low fat high carbohydrate diet (just like he did before the heart attack) Some day i’m going to have to capture him and tape his eyes open (maybe rig him up like in A Clockwork Orange) and make him watch fat head. I just feel like the doctors are killing my friend.

    Just don’t play Beethoven while you force him to watch.

  3. Ned Kock says:

    I entirely agree with you that fixing a number is definitely NOT the way to go. Besides, lipids are in part a marker of a particular diet. The Kitavans have relatively low HDL and are healthy. People on a high fat diet, like the Optimal Diet, have high HDL (and LDL) and are healthy:

    http://healthcorrelator.blogspot.com/2010/04/long-term-adherence-to-dr-kwasniewskis.html

    Having said that, HDL particles are indeed protective, in the context of any diet. And there is one HDL-raising “drug” that I happen to think highly of: niacin. It is actually vitamin B3, taken in doses of 1 to 3 g per day. The instant-release formulation, which gives the infamous “niacin flush”, also boosts the endogenous production of growth hormone, a delayed effect:

    http://healthcorrelator.blogspot.com/2010/05/niacin-and-its-effects-on-growth.html

    HDL could be protective, but clearly there’s more to it … high HDL may only prevent plaque buildup in the context of other conditions that are brought about when HDL is raised naturally. Otherwise a drug that raises HDL 66 percent should be effective.

    As Dr. Malcolm Kendrick has pointed out, no one can actually describe the biochemical process by which HDL removes plaque, if indeed it does. So I’m wondering if niacin is similar to a good diet, protecting the cardiovascular system while also raising HDL, but not necessarily protecting cardiovascular system solely through the mechanism of raising HDL.

  4. MikeC says:

    I have an idea for a drug that might actually work: one that makes you violently ill as soon as you consume sugar or starch. Take one in the morning before breakfast.

    About the grass. At last year’s Epcot International Flower and Garden Festival (probably this year’s, too, but I didn’t go), there was a company exhibiting a total lawn replacement product. It was a spongy AstroTurf that looked pretty darn real even while standing on it. But it is bug resistant (nothing to eat), stays green year-round, and never grows. It was also very soft and pleasant under-foot. If I ever buy another house, I’ll seriously consider the stuff.

    I’ll take one of those if it’s in the shape of a putting green.

  5. 1956okie says:

    Yeah, my company just released its new list of “approved preventive medications,” and which list is the longest?? The list of cholesterol-lowering agents, of course!!! Those drugs make up the biggest chunk of prescription costs for our whole employee population, too. More people are on statins than ANY OTHER DRUGS of any kind–except diabetes drugs. And at the same time, our medical claims are through the roof. Why does no one see a connection there??? All we hear from the plan admins is JOIN WEIGHT WATCHERS! EAT LESS FAT! HAVE FRUIT & MUFFINS FOR BREAKFAST, not that nasty, artery-clogging BACON!! Sheesh. It’s idiotic.

    And of course through Medicare’s prescription drug program, we’re pumping billions more into the statin pot of gold.

  6. Cathryn says:

    My cardiologist wants me on some cholesterol-lowering drug. I quit taking mine last May when I realized it was causing me to gain weight–weight that I’m still having problems taking off a year later. He pushes it on me every time I see him. I take 500 mg of niacin every other night instead. That doesn’t quite appeal to him but he’s happy that I’m doing something–other than lifestyle changes and exercise. He tells me as we age, we naturally develop bad cholesterol so that’s why he wants me on the drugs. BAH!

    Perhaps you could get him to view the studies demonstrating that if your cholesterol goes down as you age, it could spell trouble.

  7. Ed Terry says:

    You forgot to mention that Merck would combine their new HDL raising drug, with their simvastatin product that’s gone off patent. It will increase your HDL to 80 and eliminate your LDL. Of course, it will only be prescribed with a low-fat diet with lots of carbs.

    At one point, eating a “heart-healthy diet” with lots of grains, fruits, and soy products, my total cholesterol was 97 and my cardiologist was thrilled. Shortly thereafter, I had the sudden realization that he was an idiot and I radically changed what I ate. I now use the rule-of-thumb that if something requires an industrial process to make it, don’t eat it. I’m now struggling to get my cholesterol back up to 200. However, the only way I ever got it to that point was eating a “heart healthy diet”. Restricting carbs but allowing all the natural fat I can eat, I’m only able to get it up to 180. I’ve more than doubled my HDL but my cardiologist remains fixated on my elevated LDL of 80. He still wants to put me on a statin.

    I can’t blame Merck for wanting to come out with a new drug for cholesterol. The statin legacy is shriveling up, and the first company to come out with a new class of drugs stands to make billions of dollars. In addition, their new HDL drugs will cause new adverse reactions, so they may have the opportunity to create a new drug to counteract these new effects. However, it’s much more likely they will disavow the existence of any side effects, just like they did with statins. In the meantime, cheapskates like me will opt for the cheaper and simpler approach of just eating better.

    Cheap or not, I’m with you.

  8. Tracee says:

    Do you remember that song when we were kids “I know an old lady that swallowed a fly”? That’s what modern pharmaceuticals remind me of. We have to take this pill to fix the side effects of that pill, etc…

    I’ve seen it happen. My mom was on a painkiller, not knowing the “old age” pains were caused by her statin. Now she’s off both.

  9. Lori says:

    When I worked at the Air Force Academy, the word was that they painted the lawns there. The AFA is in a semi-arid climate.

    Like you, I hate taking care of a water-sucking lawn. I planted my whole front yard and most of the back in flowers and bushes that like hot, dry weather, cold winters and clay soil. However, some cities forbid this and some postal carriers whine because they have to use the sidewalk instead of walking across a lawn.

    The government can’t even stick to delivering the mail and defending the shores without some foolishness.

    Fair point.

  10. Griff says:

    @Tracee – yes, it also makes me think of this:

    THE EVOLUTION OF MEDICINE

    10000 BCE You have bad health. Here, eat this root.
    1000 CE: That root is devil’s spawn. Here, say this prayer.
    1700 CE That prayer is nonsense. Here, drink this potion.
    1930 CE That potion is snake oil. Here, take this pill.
    2010 CE That pill is unnatural. Here, eat this root.

    Constantly changing information (and beliefs) about what’s good for us creates a moving target that we can never hit.

  11. Anne says:

    When I lived in Calif I had a neighbor who cemented his lawn and painted it green. That solved the watering, weeding and seeding problems but I don’t recommend it. Painted concrete is not a lawn.

    We saw a few creative alternatives for grass when we lived in Southern California. Rock gardens were popular.

  12. Bruce says:

    The good part about this type of “medicine” is, it keeps the “Voice Over Side Effects” announcer employed….

    May cause anal hiccups, ear bleeds, eye fungus, and wasted days and wasted nights,…But by god, it’ll cure your depression!!

    And the main talent seems to be announcing all those side effects within 20 seconds.

  13. Chris says:

    My dad was in the lawnmower business and fairly fanatical about the front lawn. Now I’m a city guy (Chicago) with a small courtyard that I can handlel with a Shop Vac once a week. Much better than mowing, bagging and watering. To your larger point, drug companies are going to do what they are going to do. And unsuspecting Americans who are eating “right” (low fat and high carb) and exercising, but still unhealthy will demand a pill. Sad situation. Keep banging the low carb drum and more and more people will hear it.

    I’m afraid the magic-pill approach appeals to a lot of people.

  14. John Hunter says:

    The magic pill appeals though because the magic bologna we’ve been told to eat doesn’t work.

    Too true.

  15. Crusader says:

    There’s no money it for the giant Pharma by telling people to just eat their fruits, veggies and exercise. Oh and a shot of whiskey every now and then doesn’t hurt. :-)))

  16. Thom Brogan says:

    Can they put bacon, eggs, and coconut oil in a patented capsule? That’d be something heart-healthy that also raises HDL.

    True, but I’d have to chew the capsules for the taste.

  17. Sue says:

    Been low-carbing for over a year now with wonderful results in all areas: very good weight loss, good BP, higher HDL, lower triglycerides. My VA PA insist that I should not “treat” myself. Is certain that my arteries are going to clog up on me any moment now, because my LDL is a bit high (189) and wants to put me back on a statin, which I refuse to do. I had to say “PA, listen to yourself! You want to put me on a dangerous drug for ONE supposed risk factor! Think about what you are saying.” She looked at me with such a confused look on her nice face.

    I think I will continue to “treat myself”, thank you very much.

    It’s a shame that we have to ignore doctors and PAs to be healthy, but that’s often the case.

  18. Dave, RN says:

    I just told a relative on Face-Book who’s trying to “tone up” that body composition was 80% diet, and I gave her the gist of a paleo type eating pattern. A Registered Dietitian commented (paraphrased) “do you have any nutritional training? Low carb is a bad idea. We should eat a diet that is 60% carbs. We need carbs to protect muscle. I’m an RD so I know what I’m talking about”. I just told him “like the last 3-40 years of low fat high carb dogma have been such a success, what with diabetes at epidemic levels”.
    He responded that I should read some “published studies”. Then I’d change my mind!

    I told him to read GCBC, and buy FatHead. Bet he doesn’t.

    RD’s are the WORST (best?) at defending conventional wisdom. But geez 60% carbs?

    On a lighter note, I’ve got my sis in law on board. She’s lost 8 lbs the past couple of weeks and can fit in a dress she hasn’t worn in 3 years. Good thing she’s not listening to an RD… she’d be eating all those carbs and taking her statins like a good girl.

    The logic of registered dieticians works like this:

    You should eat at least 60% carbs.
    “Who says so?”
    The experts say so.
    “And how do they know that?”
    Because they were trained by experts.

  19. ethyl d says:

    “It’s a shame that we have to ignore doctors and PAs to be healthy, but that’s often the case.”

    What does it say about the health care industry that people get more accurate health information from a stand-up comedian’s blog than from their doctors?

    Well, I’d say it’s not a good sign. Of course, if doctors start telling better jokes than I do, I guess I deserve it.

  20. Dave, RN says:

    The logic of registered dieticians works like this:

    You should eat at least 60% carbs.
    “Who says so?”
    The experts say so.
    “And how do they know that?”
    Because they were trained by experts.

    Funny you should mention that. When I threatened a deeper discussion, he said “I’ve said all I’m going to say”. Translation: “I tell people this because it’s what I learned in school. I haven’t really done any research on my own”.

    Sounds like an accurate translation.

  21. Tracey says:

    Yup they were all trained by experts, and they are all doing what they think is best. They genuinely think spouting the same rubbish that hasn’t worked for decades is the right advice, and that obviously people are ignoring their advice, eating the wrong things and lying about it. My observation is that most of these people have always been slim, and therefore haven’t actually got a clue about what causes weight gain, but they don’t actually realise they know nothing – and therefore don’t realise their well-intentioned advice is doing more harm than good. Not an excuse, but if you think you’re right it’s hard to open your mind to other ideas – you need a reason for it.

    I know an RD who has coeliac, a gluten allergy, who has done a lot of research into wheat for her post grad studies. She’s convinced modern wheat is responsible for coeliac disease – human intervention has changed the plant over time to the point it’s hardier and produces more but causes problems in our digestive tracts. You’d think that she wouldn’t have far to leap from wheat/coeliac to wheat/grains/weight issues – but apparently not. She can’t (or won’t) connect those dots.

    Meanwhile I watch news items on diet and health and try to refrain from yelling back at the TV about the rubbish science they’re presenting. Now, as soon as an article comes on my 13yo looks at me and says “no mum, leave it, they can’t hear you!”. I blame you Tom – you started this for me :D

    Just an aside, my (type 1 diabetic) husband and I are 12 days into the Drs Eades’ 6 week cure – so far we’ve both lost over 5kg (11lb). Chris’ biggest issue is trying to balance his insulin requirement as it’s about a quarter – or less- of what he was taking each day. Gotta be a good thing. Mind you he’s desperately looking forward to the meat weeks – and coffee.

    That’s what I’ve always thought about people like Joy Bauer. Come on, she’s built like my wife, probably never been fat a day in her life. So of course her diet keeps her slim. So would almost any other diet that wasn’t full of garbage.

    That’s good news about your husband. Tell your 13-year-old I apologize for my role in the outbursts.

  22. Dan says:

    Those who do not learn from history are bound to repeat it.

  23. Chareva says:

    OK Tom, chiming in here…yes, I’m very lean, but I also eat low carb. You’ve seen photos of me when I was in the Peace Corps. I lived on millet and peanut oil and by the end of the two years I was 20 lbs heavier than I am now, and I wasn’t eating large portions. When you’re eating from a common bowl and literally taking food that would have otherwise gone into the mouths of children, you absolutely limit your portions.

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