November 17, 2019- by Steven E. Greer, MD
The big news from the 2019 American Heart Association meeting is the large trial known by the acronym ISCHEMIA. The principal investigator was NYU cardiologist Judith Hochman.
Dr. Hochman was interviewed by NBC national news and stated, “Statins truly are the miracle drug…amazing drugs” But wait. This trial did not test the efficacy of statins at all. She was clearly pushing an agenda of the ACC and AHA that empowers her specialty of cardiology.
These ivory tower “thought leaders” who run large trials want everyone on statins because that gives them power. They have little interest in therapies beyond their control that are proven to actually reverse coronary artery disease. And why? Statins still generate billions in revenue for the drug companies and those companies fund the medical societies and their meetings.
The Physician Payment Sunshine Act database (which I helped create in a very small way) makes it easy to spot bias among these “thought leaders” In 2018 alone, Judith Hochman’s received $755,619.04 in “research funding” from AstraZeneca, the maker of the statin drug Crestor.
The ISCHEMIA is just another large cardiology trial with all of the same fatal flaws rendering it junk science (i.e. clinically meaningless composite endpoints, being conducted in dozens of overseas medical centers where quality control and prevention of fraud is impossible, soft-science endpoints, etc.). Based on the slides from the AHA, given that there is nothing even published yet, the study was neither a controlled nor blinded study. It merely randomized patients to receive either interventional stenting or CABG, or sent them to the cohort that received statins and “advice” of dietary changes and exercise.
Because it was not controlled with a cohort that offered no drugs or interventions, it is impossible to conclude, as Hochman erroneously did, that statins had lifesaving or quality of life benefits. All patients in the study still died at high rates exceeding 5% after just a few years. That certainly does not seem to me to be a signal or hint that statins are wonder drugs.
In reality, the only proven therapy to reverse coronary disease is aggressive dietary change to a plant-based diet. Dean Ornish, MD at UCSF was able to receive Medicare reimbursement for this back in 2010, and the national TV news, funded by the drug companies, made little fuss.
How does Judith Hochman know that statins work better than aggressive dietary and exercise changes? She does not. She is spewing misleading propaganda to please her sponsor, AstraZeneca.
Of note, one of the members of the steering committee for the trial, William Boden, MD, is under investigation by the Office of Special Council for possibly abusing his power for political means. Stay tuned.
To learn more about how all of these medical societies have been corrupted to the core by the drug and device industries, please see my new book, The Medical Advocate.
Update November 18, 2019- Wow. It gets worse. Hochman changed the design in the middle of the trial to add soft endpoints.
An article published online in Circulation: Cardiovascular Quality and Outcomes. “That the primary endpoint of the trial went from cardiovascular deaths and myocardial infarction (MI) to include the softer outcomes of hospitalization for unstable angina or heart failure went mostly unnoticed until Darrel Francis, MA, MD, of Imperial College London, and colleagues used it to accuse the investigators of “moving the goalposts into unblinded territory””
You were spot on regarding the overreach on the impact statins had. This wasn’t tested in the trial per se so to attribute all the benefit of event reduction to this is going beyond the data and is speculation.
Similarly, the quality life data are overstated. A significant minority of patients (44%) had only monthly angina at baseline so to justify PCI for such infrequent symptoms and ignore the early hazard of increased death or MI is really losing the forest for the trees.
Bill Boden, MD
(Part of the ISCHEMIA trial oversight panel)