Dear American Heart Association and American College of Cardiology:
I’m writing to thank you for issuing your new expanded guidelines on prescribing statins. I must admit, I was hopping mad when I first read about them. I mean seriously, we’re talking about a drug with lots of nasty side-effects that prevents maybe one heart attack (not necessarily one death) for every 100 people who take it – and that’s only for men who already have heart disease. So you can understand my anger when I read paragraphs like these in an online article by New York Post:
The nation’s first new guidelines in a decade for preventing heart attacks and strokes call for twice as many Americans — one-third of all adults — to consider taking cholesterol-lowering statin drugs.
The guidelines, issued Tuesday by the American Heart Association and American College of Cardiology, are a big change. They offer doctors a new formula for estimating a patient’s risk that includes many factors besides a high cholesterol level, the main focus now. The formula includes age, gender, race and factors such as whether someone smokes.
“The emphasis is to try to treat more appropriately,” said Dr. Neil Stone, the Northwestern University doctor who headed the cholesterol guideline panel. “We’re going to give statins to those who are the most likely to benefit.”
Well heck, you guys, I knew even before I continued reading that “treat more appropriately” would somehow translate to “give statins to even more people.” And you didn’t disappoint me:
Doctors say the new approach will limit how many people with low heart risks are put on statins simply because of a cholesterol number. Yet under the new advice, 33 million Americans — 44 percent of men and 22 percent of women — would meet the threshold to consider taking a statin. Under the current guidelines, statins are recommended for only about 15 percent of adults.
Only about 15 percent of adults may not sound like much, but as you and I both know, that’s only because adults includes people in their twenties and thirties. One-fourth of American adults over the age of 45 are already taking statins, and since I read elsewhere that the new guidelines could double the number of statin-takers, I figure that means your long-term goal is to sell statins to at least half of the over-45 population. We all know why:
Roughly half the cholesterol panel members have financial ties to makers of heart drugs, but panel leaders said no one with industry connections could vote on the recommendations.
“It is practically impossible to find a large group of outside experts in the field who have no relationships to industry,” said Dr. George Mensah of the heart institute. He called the guidelines “a very important step forward” based on solid evidence, and said the public should trust them.
Riiiiiight, we should all trust the panel of experts who have financial ties to statin-makers. I’ll rank that one right up there with “Read my lips – no new taxes!” and “If you like your current healthcare plan, you can keep it – period!” If any of you members of the panel ever decide to give up medicine, you should seriously consider running for office.
Anyway, as if I weren’t already suspicious enough of the new guidelines, I read these tidbits in a New York Times article online:
Last week, the nation’s leading heart organizations released a sweeping new set of guidelines for lowering cholesterol, along with an online calculator meant to help doctors assess risks and treatment options. But, in a major embarrassment to the health groups, the calculator appears to greatly overestimate risk, so much so that it could mistakenly suggest that millions more people are candidates for statin drugs.
Mistakenly suggest? Heh-heh-heh … as we programmers like to say, “That’s not a bug. That’s a feature.”
The problems were identified by two Harvard Medical School professors whose findings will be published Tuesday in a commentary in The Lancet, a major medical journal. The professors, Dr. Paul M. Ridker and Dr. Nancy Cook, had pointed out the problems a year earlier when the National Institutes of Health’s National Heart, Lung, and Blood Institute, which originally was developing the guidelines, sent a draft to each professor independently to review.
This week, after they saw the guidelines and the calculator, Dr. Ridker and Dr. Cook evaluated it using three large studies that involved thousands of people and continued for at least a decade. They knew the subjects’ characteristics at the start — their ages, whether they smoked, their cholesterol levels, their blood pressures. Then they asked how many had heart attacks or strokes in the next 10 years and how many would the risk calculator predict. The answer was that the calculator overpredicted risk by 75 to 150 percent, depending on the population.
On Saturday night, members of the association and the college of cardiology held a hastily called closed-door meeting with Dr. Ridker, who directs the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital in Boston. He showed them his data and pointed out the problem. On Sunday, officials from the organizations struggled with how to respond.
Here’s how I’d suggest you respond:
“What we said was that if you like your insurance, you can keep your insurance, period, as long as it meets certain conditions we’ll write into the law later. And besides, it wasn’t the law we passed that canceled your insurance; it was your insurance company. And we actually did you a favor by passing a law that canceled your insurance because your insurance was substandard. But even though it wasn’t the law we passed that canceled your lousy insurance and we actually did you a favor by canceling your lousy insurance, we’re now going to fix the law we passed that didn’t cancel your lousy insurance so you can keep your lousy insurance for another year.”
Wait … sorry. That was my advice to someone else who got caught lying. In your case, I’d suggest going with something like “Dr. Ridker’s study subjects didn’t have nearly as many heart attacks as our risk calculator predicted because he accidentally studied unusually healthy people.”
The chairmen of the guidelines panel said they believed the three populations Dr. Ridker and Dr. Cook examined were unusually healthy and so their heart attack and stroke rates might be lower than expected.
Anyway, the New York Times article goes on to explain that under the new guidelines, “your average healthy Joe” would end up being told to take statins. And that’s why, in spite of my initial anger over your brazen attempt to sell more statins, I’m now writing to thank you.
What prompted my change of heart (pun intended) was receiving an email from someone who liked one of my old blog posts – the one in which I thanked the USDA for giving my kids a competitive advantage in life by ordering schools to serve crappy grain-based meals to the other kids and thus suppress their brain development. That in turn got me thinking about the movie Idiocracy, in which a soldier with an average IQ participates in a botched experiment and wakes up hundreds of years later to discover that he’s now the smartest guy on the planet.
That’s when I realized how much your new guidelines will benefit me personally. You see, as a software programmer, I’m what’s known as a “knowledge worker.” My livelihood depends entirely on my ability to memorize, conceptualize, and think my way through complex problems. In my field, experience is considered a major asset, largely because solving a software problem often involves recalling how we solved a similar problem in the past. It’s no coincidence that most of the other programmers I work with are in their 40s or 50s.
So as I was chuckling to myself about a couple of the scenes in Idiocracy, it occurred to me: How much more valuable would I be if my fellow programmers all started taking statins and became a bit stupid? Give them a few years on a high dose of Lipitor, and I daresay I could triple my billing rate. I’d be the only one remaining with enough cognitive ability to tackle the really tough assignments.
I could probably even get away with relaxing my programming standards. Since I’m not a government contractor, I test and test and test the software I design before rolling it out – partly because I’m persnickety by nature, but largely because in private industries, people who launch mission-critical software systems that crash and burn tend to get fired. But if your new treatment guidelines convince everyone over age 45 to start taking statins, I’m pretty sure I could avoid the blame for any lousy software I created. I suspect the conversations would go something like this:
“The foreign incoming royalties module of the payment distribution system keeps crashing! Did you write that module?”
“Well, I … uh … No, sir. It was Crockett.”
“Did you write the foreign incoming royalties module?”
“Uh … I don’t remember. Maybe.”
“Well, fix it!”
“But I don’t remember the logic.”
“Well, damnit, get Naughton to help you.”
“If I’m going to help Crockett fix the mess he made, I’m going to need another bump in my billing rate.”
“Yeah, yeah, okay. Just promise you won’t quit.”
So while I know providing me with job security wasn’t your intention, I’m grateful nonetheless.
By the way, would it be possible for you to convince the federal government to subsidize statins and provide them to needy people in the developing world, sort of like the USDA does with grains? It would be awesome to know I won’t lose my programming gig to some guy in India.
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