Abstract
Ezetimibe seems fated to remain a controversial drug. Initially, when this drug was discovered and then belatedly launched, no one knew how it worked. It was an acyl cholesterol acyl transferase inhibitor that happened to lower cholesterol levels in animal models - unlike the others which did not and have later failed conspicuously in human trials (1). This upsets the purists of object-orientated rational drug design who dominate the product development bureaucracy of the pharmaceutical industry. Clinicians were initially dubious about it - it did not offer the power of a statin, but many were becoming worried about the increasingly high rate of side effects seen with higher doses of statins.
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