In medicine, we would like to believe that treatment decisions are black and white, evidence is clear cut and uncertainty is a bygone impediment, squashed decades ago by the tight jaws of the scientific method. Yet it seems the more we learn, the more we have to argue about. Uncertainty is here to stay.
As evidence of this, last month the Journal of the American Medical Association published new guidelines on the use of cholesterol-lowering statin medications for prevention of cardiovascular disease in adults, created by the U.S. Preventive Services Task Force (USPSTF). Without fail, every new iteration of a USPSTF guideline prompts voracious scientific debate and public bewilderment, and the recent update on statins is no exception.
The new guidelines recommend statin use for patients ages 40 to 75 who have at least one condition that puts them at a 10 percent or greater risk of a cardiovascular event in the next decade—including high cholesterol, high blood pressure, diabetes or smoking. The guidelines go on to say that those with 7.5 to 10 percent risk “may also benefit,” and people in this group “should make an individual decision with their doctor” about the risks and benefits of statin therapy. Although more than 43 million Americans are already prescribed statins, more than 150 million could now be eligible for cholesterol treatment with these drugs. Many experts are balking at these numbers, arguing that statins are overprescribed; the benefits are inflated, and the evidence is weak.
Nonetheless, is it possible these new guidelines are the harbinger for a new age of pharmacotherapy? Are we approaching an era when everyone, healthy or not, takes medication? Should we use our growing understanding of pharmacology, biology, and genetics to create universal mortality-busting drugs?
In fact, we may already be closer than you think. Recent reports have estimated that 60 to 70 percent of Americans take at least one prescription medication. Add consumers of caffeine-infused beverages and people who use vitamins, and the percentage shoots much higher.
Many are already imagining a future of universal medicines as a means of mortality prevention. Governments mandated food fortification and other public health strategies to increase life expectancies decades ago. Fluoride is added to public drinking water; and processed cereals are fortified with folate, salt with iodine, and milk with vitamin D. Some countries have seriously considered adding lithium, a mood stabilizer widely used in psychiatry, to public drinking water in tiny amounts, as a result of numerous epidemiologic studies which have demonstrated that regions with a naturally higher lithium level in the groundwater have lower rates of suicide.
Even startups such as Elysium Health, led by MIT aging scientist Dr. Leonard Guarante and backed by a scientific advisory board touting 6 Nobel Laureates, are capitalizing on this trend. The company has managed to raise over $20 million in Series B funding for their “longevity pill”, heralding a new era of scientific rigor and economic investment in the typically unregulated, unverified world of vitamins and supplements.
Of course, no medication or supplement is without risks and side effects. A pill will never substitute for a nutritious diet and consistent exercise. Yet if the science is strong, the evidence is robust, and the harms are negligible, I wouldn’t mind dolling out some extra years of life in pill form to everyone I know.