Today I passed the Boerhinger Pharmacovigilance Adverse Event Reporting Certificate of Competency! If it meant anything, it would be because I was a UK pharmacist who was responsible for selling BI products and needed to be a responsible person when it came to reporting hazards. As it is, I’m not and it doesn’t. But it made me think about the need to know what the side-effects of drugs are and how to deal with them – if not for others, then for oneself. This in turn reminded me of my experience with statins.
What is an ailment? Assuming it is something physical and we have it, rather than something psychosomatic (something metaphysical which we think we have, and which we therefore have, which is a metaphysical truth) then it is something which ails us – something worth complaining about, something worth trying to right.
Let’s assume we have ailments that are no more than irritations, as opposed to life-threatening diseases. For me that might be the ache I experience in my thumbs or wrists, or a tingling in the neck brought on by pinched nerves. There are some ailments that, though they present as irritations, are somehow indications of a more serious problem, or potential problem. Losing weight? Cancer! Strange dark patch under the arm? Cancer! Headache? Brain tumour! So we listen, and we check out what that might mean, and we take preventative action or we don’t.
Till I went to the doctor and had a blood test for something else which I can’t for the life of me remember (perhaps it was alzheimers), I didn’t know I had high cholesterol. That is, I didn’t know that my score was higher than the average for my age. I had a 6.9 against an expected 5.5 or whatever.
So, I could have surmised it might be because my father had very high blood pressure on account of his narcolepsy drugs, and his father died of heart disease aged 51, and because my diet has always ignored the risks of saturated fats (notice the de-personalisation of blaming my diet, rather than myself directly). But I felt nothing bad from the high cholesterol, and would have done nothing about it, except the doctor was ‘slightly’ concerned as were those around me who have some sort of vested interest in my good health. Then, on a trip to Barcelona with my brother-in-law, it became clear that the generic version of the statin I would have to take to get my cholesterol down was only €2 per month, rather than the branded version costing €45 on prescription in Ireland, so I bought a couple of years’ worth, as you do, started taking them and waited for my score to drop. Which was all very well except I wasn’t prepared to pay the €50 for a blood test to find out how well they were doing their job.
I didn’t notice any side effects, and the cost was negligible, but the question occasionally came to me as to whether I was creating some sort of physical dependency on the statin, and should I stop taking it, it would react by allowing my cholesterol levels to rise dramatically. There’s no evidence for that, but when one starts to fantasise about medical issues, the universe is your oyster. I imagined that the cholesterol molecules must have been waiting patiently somewhere in my bloodstream to attach themselves to my artery walls and once allowed to do so by the absence of statin policemen, they’d fight each other for their bit of space, and like bats in a cave, they fill every part of the wall and the blood stops flowing… OK enough!
So, about two or three years later, on a trip to India, I decided to stop taking the statin – a unilateral decision, based on nothing other than a negative feeling about permanent medication, and because I’d never actually been prescribed the statin in the first place. Three months later, for some reason, I had another blood test, and lo and behold, the score was way up – 7.7 now. Stupidly, I’d never checked the score whilst in the middle of taking the statin, so I didn’t know how effective it had been at reducing my cholesterol level. This time, the doctor expressed more concern as the score was higher, and actually prescribed a statin, which I then took again for about two or three years.
There is evidence that statin-type cholesterol-lowering drugs reduce testosterone levels (BMC Med, Feb. 28, 2013).
This time, my wife told me she had read online or on the packet, that one big side-effect of statins was the way they suppress the sex drive. And it was true that I didn’t want sex as often as I used to, but we’re talking about five or six years since I’d started on it, and that between the ages of about 50 and 56, an age when my sex drive might have declined anyway. Still, the mere pressure of her message made me concerned. That in turn made sex an ‘issue’ and she started saying the same thing in front of other people – not pointing the finger at me, but whenever statins came up in conversation – yes, that’s indeed another issue worth raising – she would mention in passing that they are reported as suppressing (or is it repressing?) the sex drive. It would be tempting to digress to another topic for the middle-aged – what is suitable table talk and how much do we wash our dirty linen (or in this case not dirty enough linen) in public.
OK, let’s move on from that one.
So within a few months, I’d made another unilateral decision to drop the statin, this time on potency grounds. In the context of having become a daily drinker, not to excess, but certainly enough to take the ‘edge off’ each evening, I couldn’t be sure that it was the statin police who were emasculating the prisoner. So this time, rather than flipping the switch in private, I decided to ask a doctor.
How often do we, the middle aged, seek reassurance from doctors? Why do we feel we need to book face time with over-busy not always reassuring people in this age of google reality checks?
But when the visit to a doctor costs €50, it is irritating to have to spend one’s hard-earned just for this advice, and call me squeamish, but I wanted a man not a woman to discuss this with, and my doctors’ practice is nearly all women. So I waited until some other ailment (again I can’t recall what, and it may well have been that insipient alzheimers again) happened to bring me in front of a male doctor.
I waited till he’s fixed me up on the other ailment, and then told him I’d decided to give up on the statin because it was suppressing my sex drive. He was older than me, though not in his dotage and sexually inactive – though I didn’t ask – and immediately told me he takes a statin, but he completely understood where I was coming from, and that the world is divided on the beneficial versus detrimental aspects of statins. There’s some evidence that they reduce mens’ level of testosterone production, and that by up to 10%. I did wonder whether that would be translated into a 10% reduction in sex drive – that’s one time in ten not happening, or perhaps one woman in ten not appealing, or perhaps one erection in ten not holding up or whatever – but of course, like the cup that runeth over, 10% less water and it just doesn’t run over at all.
Would my Cholesterol level be an issue, I asked? Would I begin to store up problems by stopping which outweigh the problems I was storing up by taking it? And here’s the nub of the equation. Do you live a life which includes the pleasures of good food, alcohol, even cigarettes, and certainly regular sex in exchange for the risk of killing yourself more quickly? Not that regular sex should be a death sentence, unless it involves a lioness, so “yes, yes, and yes” I say. How much weight can you put in one of the weighing scales pans before it drops to the floor? That depends of course what is in the other pan. In this case, sacrificing one’s sex life for potentially curbing heart disease or strokes is quote a biggie, but one is actual and the other is potential. One involves inevitable misery and the other is a gamble on possibly having a possibly fatal problem at some time. Easy if you’re a risk taker, but less easy than it used to be.
Well, this doctor, despite his own situation, checked my cholesterol scores against various good cholesterol and bad cholesterol scales (yes, bad things are not all bad) and decided that the score was not as clearly negative as all that, and given my level of fitness, and determination, perhaps I should stop taking it. I guess that was an alternative to prescribing Viagra, which incidentally I’ve always fancied trying, like coke or some other recreational drug.
I felt strangely absolved. I’d confessed and said my penance and now it was time to sally forth and get back on the bike. OK, enough.
So in the last two or three years without the statin, my sex drive is probably within the normal range for my age, whatever that is; another score to worry about perhaps? And my cholesterol score is probably through the roof, but I don’t care, because I feel no better or worse than I did at 50 before I took the stuff. So why did I even think I should take it? Why did I begin to feel part of a club I don’t want to belong to? One that involves taking the drugs-run to Barcelona, or anywhere else that sells cheap prescription drugs over the counter. By the way, there is some sick pleasure in spending only €200 on a flight and accommodation for a 24 hour trip to Barcelona (with the inevitable rich food and plenty of alcohol thrown in) to spend another €100 or so on prescription drugs which would have cost perhaps €500 in Ireland, and go home feeling like you’ve just found treasure! The club we join because we want to find acceptance in our life-stage? I put that alongside buying corduroy trousers and cardigans, or wearing one’s specs on a string round the neck in order to seem fogeyish.
Did I start to identify with the older middle-aged people around me and decide it was time to act my age? If I’d reached the ‘age of reason’ about my body, why then didn’t I choose the alternative and reduce my cholesterol by switching to a more sensible diet without cheese and without fries and with much less drink, and perhaps no coffee, and only low fat spreads, and less sugar or carbs. Why, in fact was I not prepared to make my self miserable on a daily basis for want of comfort food and drink, but not prepared to make myself miserable less often for want of sex? Simple. It’s all about the weighing scales and what is in the two pans.