Bad policy is hard to overcome once it is entrenched and once there are interests with a financial stake

 From Study questions benefit of cholesterol drugs by Serena Gordon.  I have posted on this a number of times over the years.  Cholesterol drugs were all the rage in the 1980s - the promise of better health and lower mortality by popping a pill.  It was expensive but worth it.

Or so it seemed in the lab and so it seemed to the policy wonks.  

And then the evidence began rolling in.  First major effectiveness study was in the late 1980s or early 1990s.  It found that while there was some lowering of bad cholesterol and some reduction in deaths from heart attacks, overall mortality did not change.  

By this time there was a whole regulatory regime built on the assumption that these drugs worked.  Institutional inertia had built.  And one shouldn't disregard that these class of drugs were enormously profitable to some of the major drug companies with enormous lobbying clout.  The first study raised doubts but no action to change.

A second similar study was conducted some time in the early 2000s with very similar findings.  No change of public health policy direction.

Now here is a new meta-analysis indicating that lowering cholesterol is horribly expensive (and correspondingly profitable) with almost no evidence of a change in mortality.  

The institutional interests are of course all over this trying to poke holes.  And I am sure there are some somewhere.  Meta-anyleses are hard to do well.  But at this point, I think the gravy train is so well established, even if it expensively makes no difference to public health, that it will be with us until something actually demonstrably effective comes along.  There are too many regulatory mouths to feed to stop this train.