The Indigestible

A month or so ago I went in for a gen­eral phys­i­cal checkup, the first I’d had in years. Overall things are okay — no unex­pected lumps, lesions or blood test results — but the physi­cian noticed that my cho­les­terol (both TC and LDL) was a lit­tle high.*

I knew that, but it wasn’t as high as it had been six months ago (I had neglected to tell him I’d had blood­work done prior to sign­ing up at the gym), so I was pleased. My counts were down by about 5% with rel­a­tively small changes in diet and with some­what larger changes in exercise.

(I’ve never been much of a fan of wor­ry­ing about diet, cho­les­terol, weight or exer­cise, at least not since I hit my early 20s. Cholesterol’s easy; just back off on the fats and eat more fiber. This, mirac­u­lously, auto­mat­i­cally keeps weight under con­trol. The phys­i­cal side of it is so easy to get that indo­lence of any kind is, to my mind, inex­cus­able. Strange atti­tudes, you’d think, from a for­mer high school fat kid — but then, by apply­ing the fore­go­ing to my own life, I stopped being a fat kid, so maybe those atti­tudes aren’t so strange after all.)

Anyway, owing to my lack of detail regard­ing my own habits — the exam­i­na­tion took all of five min­utes, so maybe that was part of the prob­lem — the physi­cian didn’t know about my more recent his­tory, and said he wanted me to go on Lipitor™.

Which I out­right rejected doing, because I know what statins do to peo­ple. I’m far too attached to my mus­cles and liver to want to go shit­ting them out wan­tonly in the name of drop­ping my TC by a few digits.

Beyond the ghastly adverse reac­tions to statins, though, there’s the dual-​​edged fact that (1) statins have not been shown to reduce heart dis­ease rates at all; and (2) one pill doth not a lifestyle change make.

Point 1 is impor­tant because drugs such as Lipitor™ are mar­keted on the argu­ment that high cho­les­terol leads to heart dis­ease; thus, low­er­ing your TC will reduce your risk of heart dis­ease. Problem is that, while peo­ple on statins do in fact have lower TC, they do not have lower heart dis­ease rates. In other words, there’s no pos­i­tive cor­re­la­tion between low­er­ing cho­les­terol and lower inci­dence of heart disease.

Essentially the forty mil­lion or so peo­ple on statins now are act­ing as a giant lab exper­i­ment, test­ing the claims of man­u­factuer effi­cacy — and more than a few putting their health at grave risk — with­out any sort of com­pen­sa­tion and damned lit­tle notice that what they’re doing might not actu­ally be doing any­thing good for them. (Pfizer has lately added a tiny lit­tle text dis­claimer to their ads admit­ting that there’s no link between Lipitor™ usage and reduced rates of heart dis­ease, but if you thought the breast-​​implant stink was bad in the ’90s, wait until the shit hits the fan on this one.)

Point 2 should already be tick­ling the brains of alert read­ers. If there’s no cor­re­la­tion between cho­les­terol and heart dis­ease, pre­sum­ably there must be other fac­tors that deter­mine inci­dence of prob­lems. Or that would be the sen­si­ble con­clu­sion, at any rate.

For exam­ple, if I had fol­lowed my physician’s advice, I would have started on Lipitor™ — but I would not have been advised to increase my phys­i­cal activ­ity, change my diet or — pre­sum­ably — give up smok­ing (which I did some time ago). I have the sad­den­ing impres­sion that I sim­ply would have left with a pre­scrip­tion and no other advice regard­ing ways to make a difference.

I could even argue that the physician’s first impulse — reach for the pad and pre­scribe a drug — was not the ideal one, not for some­one with a TC far too low to be regarded as severe. Sure, it’s a lit­tle high … but it’s not alarm­ingly high, and it’s well in the range that can respond quickly to diet and exer­cise. Which (as I men­tioned before) was already happening.

Nevertheless, rather than run the risk of annoy­ing me by telling me to mod­ify my diet and add some phys­i­cal activ­ity to my life, the physi­cian decided the cor­rect course would be to fill me full of a drug with a legion of mild to pos­si­bly fatal side-​​effects.

Now there’s an OTC ver­sion of Xenical, a drug that changes the chem­i­cal struc­ture of some fats so they can’t be absorbed, giv­ing Americans another excuse to ignore health­ful diet guide­lines. Rather than reduce fat in the diet, you can the­o­ret­i­cally just snork it up and take the OTC pill (pro­posed name Alli) to avoid any respon­si­bil­ity what­so­ever for your actions.

Between statins, Alli and fiber pills, you really don’t need to pay atten­tion to what you eat at all, actu­ally. Pack in ten pounds of red meat a day, take Alli to keep the fat from build­ing up, Lipitor™ to pull out the cho­les­terol, Metamucil™ to unblock your colon and Pepcid™ to han­dle the heart­burn. Oh, and a green tea cap­sule to reduce colon can­cer risk. Presumably you could pop Viagra™ to make up for the effects of lousy cir­cu­la­tion as well.

Now if there were only a pill that let you work out with­out hav­ing to actu­ally put forth any effort. Wouldn’t that be great? We’d all look like super­mod­els, eat like pigs and have absolute­lyy no self-​​discipline or self-​​restraint whatsoever.

But the les­son of statins might be telling us some­thing more. It might be telling us, for instance, that an exclu­sive focus on one sub-​​element of food — or key­ing in too much on one allegedly use­ful diag­nos­tic cri­te­rion — doesn’t really tell us much about over­all health. We might have a les­son before us that TC is one fac­tor in a con­tin­uüm of indi­ca­tors which may or may not sug­gest some­thing use­ful about a person’s over­all diet and risk of heart disease.

Maybe what needed to hap­pen was for my physi­cian to tell me, look, your TC is a lit­tle high; I’d like you to get off your ass and start exer­cis­ing, stop suck­ing down the pizza and, if you’re smok­ing, quit it … or you’re not going to be liv­ing a very com­fort­able life in another twenty years or so. Sure, that might have offended me; but it surely would have got the point across.

Maybe we could spend a lit­tle less time being polite to one another where health con­cerns are rife; and maybe our med­i­cine mau­fac­tur­ers could stop try­ing to pro­duce and mar­ket drugs to a seg­ment of soci­ety that sim­ply doesn’t need them.

Maybe Americans need to be insulted into behav­ing more health­fully, rather than funnel-​​fed pills to answer all our concerns.

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* By “a lit­tle high” I mean in the 230s for TC. That’s worse than the Federally-​​mandated 200, but it’s nowhere near a bad as the human-​​WMD level of 300 or more.