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Triumph of the Heart: The Story of Statins 1st Edition

by Jie Jack Li (Author)

2.9 9 ratings

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Over 25 million people in the U.S. alone have benefited from statins--such drugs as Lipitor, Zocor, Crestor, Pravachol, and other cholesterol-lowering medicines--in preventing stroke, heart attack, and other forms of coronary heart disease. But how did these remarkable, life-saving drugs come into being? In Triumph of the Heart, Dr. Jie Jack Li, a medicinal chemist and expert on drug discovery, tells for the first time the fascinating story of statins. Drawn from discussions with many scientists involved in the discovery and development of these drugs, the book illuminates the human side of science by revealing the role played by persistence, luck, and sudden insight that characterize major discoveries. For scientists in the drug industry, health care professionals, students of medicine, and all those intrigued by the basic human drive to explore and discover, Triumph of the Heart offers a compelling view of one of the most important drug discoveries of our time.

Editorial Reviews

Review

"In Triumph of the Heart, Jie Jack Li tells the fascinating story of statins, from the discovery and development of these drugs to their clinical application...Triumph of the Heart is recommended for those who are intrigued by the drive to explore and discover."--New England Journal of Medicine

"Easy to read, engaging and educational."--Paediatric Nursing

Book Description

Li, a medicinal chemist and expert on drug discovery, tells for the first time the fascinating story of statins, drawn from interviews with many scientists involved in the discovery and development of these drug

Product details

Publisher ‏ : ‎ Oxford University Press; 1st edition (April 3, 2009)
Language ‏ : ‎ English
Hardcover ‏ : ‎ 224 pages
ISBN-10 ‏ : ‎ 0195323572
ISBN-13 ‏ : ‎ 978-0195323573
Item Weight ‏ : ‎ 1.15 pounds
Dimensions ‏ : ‎ 6.2 x 0.9 x 9.2 inches

Best Sellers Rank: #1,088,252 in Books (See Top 100 in Books)
- #83 in History of Medicine (Books)
- #129 in Pharmacology (Books)
- #200 in Industrial & Technical Chemistry (Books)

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2.9 9 ratings

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chazza
Pass the sick bag
Reviewed in the United States on April 2, 2012
What saints these people were. They developed statins (well they didn't really - statins started life as a poisonous natural red mould on rice) and promoted them with no thought of making money but by accident made so much that they impoverished healthcare worldwide.

And they helped people to get cancer, diabetes, congestive heart failure and all the rest of statins side effects at no extra charge.

We can be truly grateful.

These selfless people have also successfully concealed the truth about statins ineffectiveness so that we may feel better about taking them.

As my doctor said to me, the bad old days when people died of heart disease are at an end...

"When I started practice I remember a young man who smoked like a chimhney and drank like fish, and he died at 30. That wouldn't happen now thanks to statins".

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Prof D
Four-five star book, undeserving of the off-topic challenges appearing
Reviewed in the United States on February 2, 2016
Apologies for redundancies here, but portions of this review appeared in response to what I believe are ill-informed one star reviews that are not about the book, rather, they are about either a personal experience with a particular statin, or, the commentator's general qualms about people profiting from discovery in capitalist societies. Let me following in a similar, but opposing vein.

Negative ratings seem to have been motivated not by evaluation of the content of the book for what it proposes to be, but rather in response to an individual's adverse reaction to a particular statin (or, on a subject I choose to pass over, more general issues of the commentators with the idea of employment in / profit from healthcare-directed activities in this society). While the first of these motivations can lead us to sympathize, it should not be mistaken for the basis of a review about a book on the manner by which a class of molecules was discovered and developed.

That there have been therapeutic agents that were neither efficacious nor safe, but were nevertheless brought to the public will not be disputed. Absent actual corruption, that mistakes have been made in drug development will also not be disputed. Corrupt practices should be prosecuted, and incompetence should be exposed and corrected.

Even so, for each drug on market---whether heinous as those, or all but entirely safe and so therapeutically invaluable contributions: Health care consumers must realize that that there will always be some cases within a population where the efficacy of a prescribed medicine is not "normal" or the safety is unacceptable. This also cannot be disputed. Medical research is about behaviors (of drugs, pathogens, toxins, processes, etc.) <bold> in populations </bold> of organisms. The <ital> practice </ital> of medicine—and so each of our personal experiences with medicines and medical practitioners—is not a matter of populations, but of the behavior of the medicine in <bold> an individual, us or our loved one, within the population </bold>. Each of us are but one, and are almost certainly not one whose experience was considered in bringing the drug or other therapy forward. Even had we participated in the trial for the agent or device, our experience would have had to aggregate with other individual experiences to rise to a level for it, whether poor efficacy or adverse event, to become detectable and significant in the studies that brought the therapy forward. (This is the very nature of clinical trials, and why statisticians are their unsung heroes.)

If one does not accept the very nature of science in medical research (its statistical basis and the implications of the same), and the role of medical research in producing all medical agents, devices, and procedures, then one should simply not participate in use of any of these. Even when the process is entirely free from all corruption, it remains simply what it is, the practice of studying things on populations, to inform their use by individuals. Many, many academicians and professionals are devoted to improving the process, with regard to specific products, but also in general. But one cannot have it both ways---making use of therapies, but denying their very nature and inherent risks. Blanket condemnations of process, motivation, etc. based on individual stories of failed therapy (anecdotal information) help little in allowing us to arrive at the truth of the matter.

With regard to the matter of the statins in biomedical understanding and medical practice—this is a matter for cardiology and research experts.

I will cite but one recent review (Cochrane) to make clear that the negativism of other book reviewers appearing in response to Dr Li's book is not shared by the preponderance of experts. Writing in 2013, Fiona Taylor of the London School of Hygiene and Tropical Medicine, in "Statins For the Primary Prevention of Cardiovascular Disease" ([...]), states that "Reducing high blood cholesterol, a risk factor for cardiovascular disease (CVD)… in people with and without a past history of CVD is an important goal of pharmacotherapy. Statins are the first-choice agents. Previous reviews of the effects of statins have highlighted their benefits in people with CVD. The case for primary prevention was uncertain when the last version of this review was published… and in light of new data an update of this review is required… Authors' Conclusions: Reductions in all-cause mortality, major vascular events and revascularisations were found with no excess of adverse events among people without evidence of CVD treated with statins."

Does this make statins right for all, or for any one person? No, individual decisions are made by the ones involved, in consultation with the medical experts that they consult---not by Amazon books, or reviewers, or commentators. As the Mayo Clinic website notes, while statins have been "shown to be effective in lowering cholesterol, [and] may have other potential benefits" the site also notes that "doctors are far from knowing everything about statins" and the role of cholesterol, and the best way for clinicians to respond to individual cases. As that site and any should indicate, translating the population-based conclusions of research studies to the needs of the individual is a matter between each and their physicians.

This said, ON TO THE BOOK, which actually regards a discovery process---specifically, the process of modern, small-molecule pharmaceutical discovery. Dr Li chooses for his subject a wonderful and clearly successful case study, that of the development of biological understanding around the target processes against which the statins are directed, and then, specifically, and in historical and scientific detail, the discovery of this class of small molecule agents. (The phrase small-molecule is used here to differentiate this class of drugs from "biologics," for instance agents that are antibodies.) Li elaborates on this case study with his usual enthusiasm and quality of thought and production. That Li believes in the positive role of pharmaceutical agents such as these, and the process for discovering them, is clear; if one vociferously opposes this view, then there is likely no need for 220 pages of self-flagellation.

I for one am very happy for the energy that this author has shown in bringing this and other chemical subjects before a broader audience---he is one of very few that has made chemistry a component of popular science writing. I am sure he will be unaffected by stray one star comments, and am very happy for this as well. May he continue to find that energy for years to come. May readers evaluate material for what it proposes to be, and so for what it is worth, and not as an easy springboard for philosophical rejection of a mainstay of modern life based on personal experience.

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Ashutosh S. Jogalekar
An industrial tour de force laid bare
Reviewed in the United States on August 24, 2009
Statins revolutionized the prevention and treatment of heart disease and saved hundreds of thousands of lives that may have been otherwise lost through heart attacks and stroke and millions of dollars that would have been paid by patients for surgery and other invasive treatments. The best selling molecule in this class(atorvastatin) is the best selling drug of all time and makes more than 12 billion dollars for its parent company, Pfizer. In this engaging and informative book Jie Jack Li, a scientist at Bristol-Myers Squibb company, tells us their story and drives home the importance of the pharmacautical industry at a time when much of the public has become cynical about its motives.

What makes the book valuable is that Li traces not just the history of the drugs themselves but the history of cardiovascular and obsesity research as well as the major players involved in this research. Li also spices up his accounts with amusing ancedotal information about scientists and companies. He narrates the famous Framingham study which definitively established the connection between high cholesterol and heart disease, a connection that has been tentatively explored for more than a hundred years. Also included are interesting historical accounts of several major pharmaceutical companies including Merck, Parke-Davies and Pfizer.

Cholesterol is a remarkable molecule that is the classic embodiment of a double edged sword. Michael Brown, a Nobel prize winning cholesterol researcher calls it a "Janus-faced" molecule, one which is critical in biological function while being harmful when employed incorrectly. No less than thirteen Nobel Prizes have been awarded to researchers who worked on this molecule. Lie traces the pioneering research of several chemists like R B Woodward and Konrad Bloch (Harvard), Lewis Sarrett and Max Tishler(Merck), Dorothy Hodgkin (Cambridge), John Cornforth (MRC, 91 and still going strong) and Wieland and Windhaus (Germany) who were key in elucidating both the pathway of cholesterol synthesis and metabolism, as well as the structures and syntheses of cholesterol and its analogs.

Most of the cholesterol in the body (~70%) is biosynthesized while the rest of it comes from the diet. It forms a crucial component of membranes and is a key signaling molecule. 23% of body cholesterol ends up in the brain where its critical functions are still being investigated. The connection between high cholesterol and heart disease was suspected early on but had to await much pioneering research in order to be deciphered in detail. The Framingham study in Massacusetts studied thousands of local subjects spread over almost 50 years and two generations and in the 70s established the best correlation between heart disease and cholesterol to date. It also established a critical standard; a 1% lowering of cholesterol can lead to a roughly 1% reduced risk of heart disease.

After the correlation was established, both academic and industrial scientists started looking for drugs that would reduce cholesterol. Key during this time was Michael Brown and Joseph Goldstein's discovery of the LDL receptor as a major player in cholesterol metabolism and the importance of LDL and HDL in causing heart disease. Today efforts are underway to both reduce LDL and increase HDL as strategies in combating heart disease. Lie talks about the three dominant pre-statin drugs that were widely used; niacin (vitamin B3), bile acid sequestrants and fibrates. All these drugs had unpleasant side effects although niacin is still seriously considered by companies like Merck as a possible cholestrol-lowering drug. It was in the 70s that research pioneered by Akiro Endo, P. Roy Vagelos and others suggested the initial steps in cholesterol synthesis as prime targets for possible drugs. The logic was rather simple; targeting later steps would lead to a buildup of high molecular weight lipophilic molecules that would cause problems. It was best to target early steps which would lead only small, relatively water soluble and easily excreted molecules to accumulate. Several studies finally settled on 3-hydroxy, 3-methyl glutaryl coenzyme A reductase (HmG CoA reductase) as the rate limiting enzyme in cholesterol biosynthesis, and one which could possibly be fruitfully inhibited.

It was Japanese biochemist Akiro Endo who painstakingly discovered the first statin in a broth of a Penicillum fungal strain (it's interesting that this humble mold has yielded two of the most important drugs in history, statins and peniciilin). However it was Merck who ran with the idea and brought the first statin to market (lovastatin, Mevacor). The 1980s were the golden age of Merck. During this decade Merck was led by one of the best CEOs in the industry, P. Roy Vagelos who was an accomplished researcher himself and a true visionary. Under his direction Merck was voted as the best company (and not just pharmaceutical company) in the country for three successive years. The reason why Merck thrived and indeed the reason why everyone today should emphatically remember Merck's success was because it followed a time-honored tradition of recruiting only the best scientists (frequently from academia) and more importantly, focusing intensely on basic academic-style research. In the 1950s Merck hired two brilliant academic scientists, Lewis Sarret (Princeton) and Max Tishler (Harvard) whose work catapulted the company into the front lines of drug discovery. This trend continued in the 70s and 80s. Vagelos himself had been the head of the biochemistry department at Washington University School of Medicine when he was hired and had done important work in elucidating the role of Hmg CoA reductase in cholesterol biosynthesis. During the 80s Merck regularly published papers in the best academic journals. In an age where an emphasis on profits and a relative lack of interest in basic research has slowed down drug discovery, it should be time for pharmaceutical companies to again look at the 1980s Merck model of basic research.

It was this model that brought the first statin (Mevacor) to market after intense development. Li engagingly tells us the story of both Merck and Mevacor. However the bulk of the book thereafter is the story of the best selling drug of all time, Lipitor (atorvastatin). Atorvastatin was discovered by Parke-Davis (which was subsequently bought by Pfizer). By the time the Parke-Davis group plunged into statin discovery they already had a tough act to follow since four statins were already on the market. However, as Li describes, statin research at Parke-Davis benefited from a combination of thorough assay development and highly talented scientists, foremost among them Bruce Roth (a synthetic chemist who first synthesized Lipitor) and Roger Newton (a biologist who developed the assays). The researchers started with some known statin structures and experimented with installing novel cores and side chains by overlapping the molecules on top of each other. The synthesized molecules were shuttled into animal testing which was no cakewalk. The choice of animal turned out to be important since rats are not good models for testing cholesterol lowering medicines; among other factors this is because rats have a dramatically different LDL/HDL ratio compared to humans. Other animals including dogs and monkeys yielded valuable results.

Clinical trials finally demonstrated that atorvastatin had much better pharmacokinetic and bioavailability characteristics compared to earlier statins. Atorvastatin also has a much more favorable profile with respect to the one serious side effect seen with statins- rhabdomylosis or muscle weakness and wasting. Indeed, statins have emerged as some of the most well-tolerated drugs of all time. Total sales are now more than 20 billion dollars. Any new drug developed for lowering cholesterol will have to meet the extremely high bar that statins have set. These drugs are the best examples of the kind of genuinely life-altering research that can come from the pharmacutical industry.

These days the pharmaceutical industry is often maligned as a notorious example of the money-milking, profit-making entities that apparently exemplify the worst in capitalism. But the story of statins reminds us of some valuable facts. Firstly, it is always worth looking at the other side of the coin, at how many lives and dollars would have been expended had such drugs not been discovered; the immense benefits accruing from the avoidance of heart attacks and stroke handsomely pay off in social and economic terms. Secondly, contrary to some public perception, scientists in the pharmaceutical company are as dedicated not just to improving the lives of people but to gaining basic scientific knowledge as are academic researchers; as a corollary to this fact, a lot of industrial research is as exciting as academic research. Thirdly, the story of statins also shows the close interplay between academic and industrial scientists and discoveries that drive innovative drug discovery. As in many other case, the choice is not binary, and it is only healthy public support of both industrial and academic research that can lead to a thriving scientific establishment. Finally and importantly, the story is ominous but also hopeful in a sense since it demonstrates that true scientific and commercial productivity can only come from focusing on basic and long-term scientific research and not just on short-term profits. This is a message that today's pharmaceutical companies should heed well.

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