Bruce Psaty and the risks of calcium channel blockers

On a fine March day in 1995 Dr Bruce Psaty ascended the podium to present a scientific paper as he had many times before. At a hotel in San Antonio he was speaking before the Epidemiology and Prevention Council of the American Heart Association, a small meeting of academic researchers. Psaty and his colleagues had been studying complications associated with drugs for treating hypertension. The paper seemed innocuous. “It was merely an observational study, so it was unlikely to be seen as important or controversial”, he says. But a hostile question and answer session presaged a relentless attack from drug manufacturers. And the apparent controversy piqued the interest of journalists attending the meeting. Psaty had found that a class of relatively new and expensive drugs—calcium channel blockers—was associated with a higher risk of myocardial infarction than older less expensive drugs.1 This was especially true for short acting calcium channel drugs. As soon as he returned home to Seattle Psaty found himself at the center of a maelstrom. Press reports had already appeared, doctors and patients were alarmed, and drug makers were surly. Psaty's office was inundated with telephone calls and faxes, requiring him to divert staff from research to public relations. The press reports were generally accurate but lacked the caveats and context needed for a clear perspective on the findings. They offered little help for patients who were taking the drugs and wondered what to do. In his interviews Psaty consistently recommended that patients see their own doctors rather than stop taking current medications. He recommended that physicians follow the current guidelines from the Joint National Committee on the Detection, Evaluation and Treatment of High Blood Pressure, which recommended the older cheaper diuretics and beta blockers, unless contraindicated or poorly tolerated.2 Furthermore, Psaty was already under attack …