The Magic of modern medicine

I'm currently doing my cardiology rotation over at the other hospital in town (they have a Cardiac ICU with a lot more cardiac patients than my hospital). Given that we live in America and particularly in the State of Wisconsin there are a lot of people with risk factors for heart disease and we see A LOT of heart attacks in people. One of the standard treatments that everyone gets on is a medicine called a statin (Crestor, Lipitor, etc) for lowering cholesterol as well as some medications for lowering blood pressure. I was talking with a patient, who was only 55, about changing his diet and exercising after a heart attack and mentioned that we would be starting one of these medications for him. His response was, "Good, then my cholesterol is covered." As if he could now eat what he wanted and the medication would take care of the rest.

Sorry folks, no such luck.

Here's the quick and dirty...the risk factors that brought him to the hospital with a heart attack will continue to be risk factors for future heart attacks, and he will likely have another heart attack in the relatively near future (years time frame, not necessarily months).
There is something in medical research called the "number needed to treat (NNT)". Basically it means that if we take 100 people on a certain medication to prevent a future outcome, how many of those people who take the medication will actually benefit from it, or in other words what is the number of people we need to treat to prevent one bad outcome (heart attack, death, stroke, broken femur, whatever). Unfortunately, a good NNT is 20 or so. Many medications or interventions have much higher NNTs, like 100. Meaning that only about 5% of people at best are helped with our interventions. Not terribly impressive for our vaunted medicine.

Now if I could reduce my risk of a heart attack by even 5% with a largely benign drug that only costs $4 per month, then it's not much of a choice. However, if that drug costs $200-300 per month what would I do. What about a couple thousand dollars per month, what about tens of thousands of dollars for a major surgery? Suddenly it's not as easy as all that.

In the end, I think people put too much stock in what modern medicine does for them and not enough in stuff that is harder, slower, but has much more far reaching effects; exercise, a diet based on fruits, grains, and whole grains.