I had an email recently from a journalist friend of mine this week which included a communication he’d had from a reader. The reader had been refused health insurance on the basis of his ‘raised’ cholesterol. It was suggested to him that he would be eligible for insurance once his cholesterol ‘problem’ was ‘under control’. His doctor suggested statins. However, he was concerned that the risk:benefit ratio for statins was weighed more heavily in favour of risk. He took umbrage at the fact that he was being forced to take “poison” (his words) in exchange for insurance.
I have to say, I have enormous sympathy for this man’s plight. I don’t know his medical history, but the likelihood is he has no history of prior ‘cardiovascular’ disease or events such as heart attack and stroke. This would put him into what is termed the ‘primary prevention’ category.
The majority of people who take statins fall into this category, and even quite conventionally-minded researchers have started to ask questions about the appropriateness of statins in this group. It is a plain and simple fact that while statin use are limited in their ability to prevent heart attacks. Studies show that around 1 or 2 in every 100 men treated with statins will be spared a heart attack. In other words, 98-99 per cent of men will not benefit in terms of heart attack prevention.
The risk of significant side-effects from statins is not inconsiderable, either. They increase the risk of type 2 diabetes, and also a significant minority will suffer side effects such as muscle pain, fatigue, mental symptoms, liver damage and kidney damage. Last week one of my blog posts highlighted the idea that statins may also be contributing to weakening of the heart muscle known as ‘heart failure’ or ‘congestive cardiac failure’. An unbiased review from 2010 concluded that statins don’t have overall benefits for healthy people.
So, chances are the man who was refused insurance would not see any improvement in his health as a result of taking statins. If anything, his health is more likely to suffer. Yet, if he were to take statins and see a subsequent reduction in his cholesterol, he would apparently be eligible for health insurance.
This, to me, seems an utterly mad situation and one which serves neither the man nor the insurance company. But it’s the sort of situation that can arise all too easily when insurance companies become convinced that cholesterol levels are a major arbiter of health (they are not). Lowered cholesterol does not assure improved health or health risks over time, but the common thought is that it does.
A similar situation seems to exist with regard to life insurance. I was recently talking with a business executive who told me his life insurance premium had tripled on the basis of a recent test which revealed a ‘raised’ cholesterol. He was informed that if he got his cholesterol level down, his premium would fall too.
The suggestion here, of course, is that by taking statins and reducing cholesterol, this man would be less likely to die. However, in the primary prevention category, statins do not reduce overall risk of death. Again, insurance company policy seems out of step here with what the evidence shows.
The people who establish such policies and calculate insurance premiums are usually professionals known as actuaries. Not all actuaries, it seems, are similarly blinded. Back in 2011 the trade magazine The Actuary carried from a piece from an actuary to deftly disassembled the cholesterol theory (you can read about it here). Let’s hope that more professionals in the insurance industry catch on.