Wednesday, January 13, 2010

Expanding the Use of Statins (Implications for Aging Research)

A "News of the Week" piece in the latest issue of Science notes that an advisory committee to the U.S. Food and Drug Administration has endorsed a wider use for Crestor, a statin traditionally only prescribed to people with high cholesterol to lower the risk of heart attack and stroke.

Back in 2008 the results of the JUPITER trial were published, and they showed that statins could reduce the incidence of major cardiovascular events in people with normal cholesterol levels. The FDA is considering permitting as many as 6 million people whose cholesterol levels fall within a normal range to take statins.

I find the case of statins interesting to follow for I believe it foreshadows the challenges that await the first anti-aging drug that will come to market in the not-too-distant future (perhaps one of these drugs).

Such a drug will first be prescribed only for patients suffering a particular disease, like diabetes. But if this drug not only has a therapeutic benefit, but also delays the other diseases of aging with little or no side effects, then the door would be open to prescribing everyone take it.

The case of statins addresses issues that commonly arise with concerns about an aging intervention- like equality of access. These statins cost about $3 a day.

But the issue I found most fascinating about the Science piece is that the public's attitude about taking a drug that reduces risk of cardiovascular disease is different than one that reduces cancer risk. A sample from the News story:

If history is any guide, approving Crestor for a much wider audience could result in many takers. Statins are already enormously popular, and physicians working in prevention in other fields have been intrigued by the number of people who willingly take them for years. In breast and prostate cancer, on the other hand, for which drugs exist that can cut 5-year risk of those cancers by as much as half, relatively few opt for them. "We apply a different standard when it comes to cancer risk reduction" than when slashing cardiovascular risks, says Victor Vogel, national vice president for research at the American Cancer Society in Atlanta. In cancer, "there was a lot of criticism that drugs used for prevention have to be absolutely safe," a standard Vogel considers unrealistic—and one that doesn't apply to statins, either.

If people are willing to tolerate a higher level of adverse side-effects from a drug that reduces cardiovascular risk than they are for cancer risk, I wonder what the attitude would be for a drug that reduced the risk of cancer, cardiovascular disease, AD, arthritis, disability and all the other afflictions of aging?

The case of statins is important as it highlights many of the challenges of moving towards a more inclusive vision of the medical sciences.

This recent article on public attitudes towards life extension also reveals the challenges that lay ahead for tackling aging. For the following attitude is a common obstacle:

The fundamental religious belief to me is a belief and acceptance of the natural course, or I hate to use the term ‘God’s will’. . . there’s kind of a higher entity and we shouldn’t be interfering with what’s been kind of determined for us whereas part of our—yeah, our life plan
(Individual Interview 40)

This shows the importance of "framing" the issue. Asking what a person's attitude about "life extension" is is the wrong question to ask. Would you really need to ask is what someone's attitude is towards chronic disease. When it comes to preventing disease few people will think that it is part of "God's will" that they suffer a stroke or die from cancer. So aging researchers need to be careful about how they describe the aspirations of the field. Emphasising how an aging intervention can prevent disease, rather than simply adding years of health, is more likely to illicit a more rational response from beings with the cognitive biases and limitations that we possess.