The Political Economics of Niacin

Dr. Abram Hoffer on Niacin and Cholesterol  2006 -private correspondence.

 

Dear Brad,

 

I agree with you assessment. It’s a fiasco. Ignorance of the amazing properties of a very safe vitamin which is non toxic, has very minor and easily controlled side effects and which has major positive side effects is rampant. This is proof of the fact so few doctors seem to know. The popularity of a drug is not dependent upon its efficacy of lack of side effect. It is dependent upon the size of the advertising and promotional budget. There are no large beautiful full page ads extolling the value of niacin. The medical journals are full of ads praising the value of the statins and down playing their negative side effects. But this may be changing as companies have realized the remarkable properties of niacin if only they could decrease its major initial side effect which is the vasodilatation or flush that occurs when one first starts taking niacin.

 

Niaspan was introduced in the United States in 1997 by KOS Pharmaceuticals Inc. for its cholesterol normalizing properties. It is a one a day slow release product with minimal flush. Recently ( November 2006) Abbott bought KOS for $3.7 billion. The cholesterol market is worth many billions. An analyst stated that the HDL raising world is going to be largely Abbott and Merck. Cheng et al (Merck) reported that a compound MK-0524 reduced the symptoms of flushing and increase in skin perfusion after niacin. This compound will be incorporated into a niacin preparation and we predict that it will be enormously successful because it will be advertised in medical journals and elsewhere and because doctors everywhere will no longer remain ignorant of it nor fear its flush. They are also fearful of the factoid that niacin causes liver damage but as there is no evidence for this, this factoid will be overwhelmed by positive advertising.

Cheng et al wrote “this approach could be used to increase the tolerability of nicotinic acid (NA) thereby allowing more patients to access the demonstrated cardiac benefits of this underutilized drug”. When was the last time any drug company has said anything good about niacin, the orphan drug for so many years.