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I can strongly recommend this book to everyone.

I think the Mary Lasker story can be instructive to us in the National Lipid Association.

On pages 231- 233, John Bailar and Elaine Smith wrote in the NEJM, May 1986,  wrote an article about "age adjustment" for mortality analysis in cancer treatment.

"It shook the world of oncology by its roots."

They wrote that "between 1962 and 1985, cancer-related deaths had increased by 8.7%."

"Some thirty-five years of intense effort focused largely on improving treatment must be judged a qualified failure."

"As Cairns had already pointed out,  the only intervention ever known to reduce the aggregate mortality for a disease---any disease--at a population level was prevention."

Page 234, "In 1974, describing to Mary Lasker the comprehensive  activities of the NCI, the director, Frank Rauscher, wrote effusively about its three-pronged approach to cancer:'Treatment, Rehabilitation, and Continuing Care.'  That there was no mention of either prevention or early detection was symptomatic:  the institute did not even consider cancer prevention a core strength."

I am proposing a NLA project to prevent 100,000 Sudden Coronary Deaths each year by:

1- Early detection of plaque or atheroma with CAC, CIMT  (both independent risk factors in the MESA trial).(Cost for two tests in my area $150)

2- Inexpensive combination therapy with generic statin and niacin (OTC brand endur-acin causes little flushing)(Cost $100 a year)

3- Goal to reduce  LDL-P to < 750 to regress plaque (or apoB < 60 - however I am concerned about reliability of apoB immunoassay in people with metabolic syndrome)

4- Follow up CIMT in three to determine effectiveness of treatment.

This is an inexpensive and safe "Secondary Prevention" program.

Generic Lipitor will be available and is even safer and stronger than generic Zocor.

Critical step is to start at low dose of statin to avoid muscle side-effects and losing a patient forever to taking statins.

Adding 1,000 mg of niacin decrease LDL-C by 16%.

We need a niacin that will allow compliance in a big group.  It has been my experience that over the counter endur-acin at 500 mg bid with meals rarely causes flushing.  I take 1,000 mg at a time and experience a mild flush.

At 1,000 mg Niacin rarely causes increase in liver function tests or glucose.

Compliance is critical in the success of a large program.  Cost is critical.

I think Endur-acin is cheaper than Slo-niacin and the wax matress allows the patient to break the capsule in half if tapering up dose is needed.

Niaspan is a brand that should be used when doses greater than 1,000 mg are needed because of cost and flushing.

Lets step forward boldly and make a statement of prevention and early treatment.