Viewpoint: An apple a day

"If we aren't supposed to eat animals, then why are they made out of meat?"-Jo BrandBritish stand-up comedian (1957–)

My little sister, Mary, refers to it as "the tube of death" because she thinks it must be so unhealthy. My test results came back fine, with a low overall number and a very high percentage of "good" cholesterol.

Shortly thereafter, a fellow ophthalmologist and I starting talking about our annual checkups.

"What was your cholesterol?" he asked, and I told him. He grimaced.

"What was yours?" I inquired.

"Twice as high as yours," was the reply. When he told me the actual number, it turned out he wasn't kidding. "You're lucky," he said.

But it turns out that I am the unfortunate one. A recent study confirms that taking oral cholesterol-lowering drugs actually is a good thing. According to an article in the February 2010 issue of the journal Annals of Epidemiology, a decade-long study of 180,000 patients showed that taking statins lowers the risk of cataract. Men in the age range of 45 to 54 years (the acknowledged peak period for virility, intelligence, and attractiveness in males) who took statins daily lowered their chances of developing cataracts by 38%. In women, the effect was less dramatic but still significant (18%).

"Now we have even more good reasons to keep taking statins-like an apple a day," says the study's author, Gabriel Chodick, PhD. So by having a low cholesterol level and not taking this drug, I am increasing my risk of cataract.

Reading about this caused me to wonder about whether it would make sense for a company to try to develop and sell an anti-cataract pill. If you knew that taking such an oral medicine daily, starting around age 45, lowered the risk of cataract by 50% or so, would you take it?

It would be an interesting scientific achievement to prove that cataracts could be reduced so much, but I don't think I would take the pill myself. Personally, I am not a fan of taking pills. And at a time when our society seems to be developing a consensus that the cost of medical care in the United States has to be brought under control, are we willing to pay for multiple decades of therapy to lower the risk of cataract when the surgical correction is so cost-effective?

And then there are the inevitable side effects of chronic drug therapy. Certainly the statins have theirs. Unless the only side effect of this future anti-cataract pill was the same 4-hour-long problem mentioned in the erectile dysfunction commercials, the morbidity and associated costs probably would be worse than the cataracts that were prevented.

References

1. Chodick G, Heymann AD, Flash S, Kokia E, Shalev V. Persistence with statins and incident cataract: A population-based historical cohort study. Ann Epidemiol. 2010;20:136-142.

2. http://www.sciencedaily.com/releases/2010/02/100209200758.htm

By Peter J. McDonnell, MD
director of the Wilmer Eye Institute,
Johns Hopkins University School of
Medicine, Baltimore, and chief medical
editor of Ophthalmology Times.

He can be reached at 727 Maumenee Building
600 N. Wolfe St. Baltimore, MD 21287-9278
Phone: 443/287-1511 Fax: 443/287-1514
E-mail: pmcdonn1@jhmi.edu