If statins can reduce total cholesterol to 150 or below, what incentive is there to change the diet in ways that naturally reduce cholesterol levels?

The abstract form of this question is: "If man-made Solution X can achieve Goal Y, then why do natural Solution Z?"

Employing a mechanical crane for construction rather than oppressing hundreds of slaves is a brilliant application of this question in modern-day life. However, this type of shortcut-seeking approach is rather dangerous when applied to personal health; at its extreme, you might as well ask, "If electric wheelchairs can serve as personal transportation, what incentive is there to walk?"

The difference is that your health is not an engineering problem where the majority of variables are known, measured, and controlled. In stark contrast, medicine suffers from the opposite:

1. The majority of variables are unknown. For example, a 93-year-old female with perfect blood pressure, heart rate, cholesterol, and blood sugar falls and breaks her hip. Every surgeon would hesitate to take her to the operating room because the elderly are at significantly higher risk for complications due to their overall relative frailty. Why is this the case? That's the question behind virtually all geriatrics/anti-aging research.
2. We don't always measure the variables we do know about. A prevalent example of this is hypertension, which is famous as being a "silent killer" because it shows no symptoms until it's already caused significant organ damage. Blood pressure is easy to measure, but as a populace we just don't do it frequently. Men in particular tend not to go to doctors and so underlying problems can go unnoticed for years.
3. Our methods for controlling the variables we know about aren't flawless. Don't get me wrong, we have some phenomenal drugs available on the market now. But they too, rely on external factors. Sometimes a patient's genetics means they don't respond very well to a drug. Sometimes the medicine's side effects are too detrimental for a given patient. Sometimes the patient's finances don't allow them to always buy the medicines they need. Sometimes the patient's social situation means they miss follow-up appointments because they can't get a ride to the doctor or find a bus route that drops them off close enough. Life's complicated. Just because we have a solution doesn't mean execution of that solution is easy for everyone.

So back to cholesterol: it's an aspect of health that is known, measurable, and controllable. Sounds great, right? All we have to do is take a statin?

Well...remember what I said about us not knowing the majority of health variables? Yeah. Controlling your cholesterol with medicine and then not doing anything else to improve your life is like being proud of controlling a lone point in a spider web: there are directly and indirectly connected points which will continue to suffer unless you make overall lifestyle changes that include a healthier diet and consistent exercise regimen.

Don't fixate on one variable and ignore the hundreds of other intertwined mediators of overall well-being. Good rule of thumb: taking a medication to moderate any single element of health is, on its own, nothing more than a band-aid. Much like a band-aid, the medicine helps patch the problem but the vast majority of the solution has to come from you.

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