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176 thoughts on “Red Yeast Rice and Cholesterol

  1. WilliamLawrenceUtridge says:

    The mainstream scientific consensus is indeed that man-made carbon emissions are altering climate world-wide, and the data is now strong enough that former scholarly skeptics have changed their mind. And pretty much the entire world has accepted the desirablility for universal health care – the US is an outlier. I’m not sure what point you’re making here. If you’re being sarcastic, that suggests you don’t think climate change is happening, or is man-made – and if that is the case then you are almost certainly wrong. If you’re being serious, then I’m curious why you’re bucking that trend when it comes to this issue in particular. And in both cases, there is a problem of arrogance – you think that your opinion is worth more than the opinion of thousands of other scientists who dedicate their lives to these topics. That seems foolish to me, like asking a bicyclist to repair your Prius (note – not a bicycle mechanic, just someone who rides a bike).

    Iconoclasm has some merit in some situations – but they’re mostly in social, political and cultural circles. In science, iconoclasm is usually a waste of time unless you’ve got a viable alternative paradigm that accounts for more data than the current dominant one. So I’m not saying “just shut the heck up”, more that the strength of one’s argument is unrelated to the strength of one’s rhetoric. Calling statins “poison” is rhetoric, not argument, and I’m far more comfortable trusting hundreds of real experts than I am a small group who must publish on the internet.

  2. nwtk2007 says:

    Skeptical, have you noticed that your main response to most things is to insult the chiropractor. I probably had my masters in molecular biology before you got out of high school. Your continued antichiro response is a bit silly and continues to demonstrate huge bias such that you would turn down a life jacket and drown just because it was offered by a chiro. I do relish the silliness however. It continues to demonstrate the extreme self praise of the medical profession; an observation not un-noticed by many, many of your peers.

    If you had read the article posted, it was an analysis of some data from JAMA on the debate about statins. Does the author’s point, based upon your reading and cognitive skills, have merit. For example, the author discusses one point of improvement with statins, “one person in every hundred seeing any benefit. Pitching that as a 44% improvement is number jerking, plain and simple!” He actually made several points of similar character. Being science based and objective, I would think that there could be some comment on his analysis, be it bogus or well thought out and why. Too much to expect? You are one of the experts, yes?

    And I’m not sure what you mean by moving the goal posts or changing the topic. A sidebar comment is not a topic changer, although, if you are referring to my side comment on global warming then yes, Lawerence, it is obvious that there is strong evidence for global warming and it being a direct effect of man made effects. Not sarcasm but a subtle point to be sure. Maybe I should dress up everything with lots of smiley faces so you won’t think me arrogant or sarcastic. (This, by the way, IS sarcasm.)

    @weing, this was an analysis of data taken directly from the JAMA. It sounded somewhat reasonable in a few ways I thought. Try not to assume that I am trying to argue as a chiro in their anti-drug/medications stance. I point my patients to meds daily and refer to MD’s/DO’s also for just such concern. Of course, I also do not treat heart disease.

  3. Harriet Hall says:

    Medical evidence is never as black and white as we would wish. The benefits of statins are not in question. Questions remain about the extent of benefits for individuals with various risk levels.

  4. weing says:

    @nwtk2007,

    “this was an analysis of data taken directly from the JAMA.” I am familiar with the discussion in JAMA, and it is nothing new. I can tell you, however, that the analysis in JAMA did not discuss statin poisons.

  5. nwtk2007 says:

    Calling it poison or not, this is the final conclusion:

    “So what can we take away from this debate? Well, pretty much what I said at the beginning.
    Although the medical community often seems to speak with one unified voice, in truth, it is often very divided on key issues. Unfortunately, the mainstream media does not do a good job of publicizing the “secondary” POV. This creates a huge misconception as to where the medical community stands on many issues.
    Despite the stance of the AMA, there is actually a growing movement in the medical community for more natural — less interventionist — approaches.
    And even though it seems as if the medical community is firmly behind statin drugs to lower cholesterol — even to the point of debating whether or not they should be added to the public water supply — there are a number of strongly dissenting voices…and a number of studies that back that dissent. Again, virtually all of the contrary studies are independent, whereas virtually all of the studies in support of statin drugs are industry sponsored. You can decide which you think are more credible.”

  6. nwtk2007 says:

    Actually, he makes a similar observation of bias as I have over the years. Is there bias in the data thus far?

  7. I hardly think the medical community is seriously advocating puting statins in the water supply. That, along with calling statins “poisons”, is pure alarmist nonsense.

    Is this what debates have come to? Someone posts a ridiculous, biased article, and expects people to go read it and give a crap what some random goober writes?

    Congratulations on your masters, why did you waste that education by going into chiropractic? It’s like you canceled out so many years and actually regressed your knowledge base. Sad.

  8. weing says:

    @nwtk2007,

    “Although the medical community often seems to speak with one unified voice, in truth, it is often very divided on key issues. Unfortunately, the mainstream media does not do a good job of publicizing the “secondary” POV. This creates a huge misconception as to where the medical community stands on many issues.
    Despite the stance of the AMA, there is actually a growing movement in the medical community for more natural — less interventionist — approaches.”

    If that is what you got out of the debate, then I suggest you read the articles again in JAMA without the poison commentary that can poison your outlook. This is the debate I go through when I weigh the risks vs benefits of treating a patient in the intermediate risk category.

  9. You know what’s scarry? Here we have nwtk2007, who has no understanding of the basics of hyperlipidemia, and yet he’s writing that he refers to MDs, etc, for health issues. But he has no understanding of these issues. So what patients is he actually referring? And how is he identifying these patients? This is one of the big issues with chiropractors seeing people that walk in off the streets. They have no medical knowledge, and once they’ve suckered some poor soul into their “care”, they then negatively influence the outcomes.

    It’s very enraging.

  10. nwtk2007 says:

    Once again, I see your bias prevents you from objective comment regarding evidence or, in this case, interpretation of evidence.

    Skeptical, your enragement is humorous to say the least. You’d be surprised how many very knowledgable folks are in the chiro profession doing what I have described what I do many times, yet you just let it slide from btwn your bitty little ears.

    How could you possibly have gotten through med school with such a big old glitch in your thinking?

    And thanks for the congrats on my masters work. I studied under guys who worked with Delbruck. That would be Max not Hans. Incredible insight into the genius of the fathers of molecular biology.

  11. If there are knowledgeable folk in the chiropractic community, then you aren’t one of them. You don’t even know about the basics of treating hyperlipidemia. And that’s about as basic as it gets. I’m sure the people you “studied under” are disappointed that you studied science, then immediately turned to anti-science in your pursuit of professional quackery.

    The mere fact that you consider my distaste for quackery as a “glitch in my thinking” further demonstrates that you are just nuts. Are you the same quack that previously said I must have been sexually abused as a child? And just recently you called me a white supremist? Boy, your stupidity is unparalleled. Go fix some subluxations, you mediocre fraud.

  12. P.S., you’re a chiropractor. Haha!

  13. nwtk2007 says:

    I take it that you have no other crtisism of Jon Barron’s analysis of the debate on JAMA other than his referral to statins as poison. If not then I have made my point.

    Skeptical, you poor thing, I simply said you sound like a white supremist, not that you are one. Your take on truth and reason seems a bit off as it is skewed by the “glitch” in your thinking, as I put it, which is your bias, not your distaste for quackery. My guess is that you would be a person who would vote for Romney, assuming you are a US citizen. His lack of truth and reason are astounding to be sure.

    Oh, here’s another tid bit for you, the guys I was studying under were going to chiro’s long before I ever considered becoming one. And truly, they were of genius stature.

  14. weing says:

    “I take it that you have no other crtisism of Jon Barron’s analysis of the debate on JAMA other than his referral to statins as poison. If not then I have made my point.” His analysis is not worth reading. I suggest that you read the original articles yourself.

  15. nwtk2007 says:

    Point made. Extreme bias prevents objective consideration of possible errors in mainstream practice. And, of course, that bias is effected by influences from outside sources such as big pharma and other money oriented entities to the exclusion of patient safety and well being; at least as far as the use of statins is concerned.

  16. nwtk2007 says:

    Like Fox news when presented with any facts that appear to contradict their views, they simple refuse to accept them with the emphatic statement,” I just can’t and won’t believe that. Are you sure you are not one of those straight chiropractors? Preacher? A sheep?

    Like so many in the religious world; no need to question that which I already know so well. Love your response to people also. Probably the talk of the medical community, or so you might think. Har, Har. Love the smiley face.

  17. WilliamLawrenceUtridge says:

    You’re both trading insults and getting nowhere. Perhaps let this comment thread lapse, shall we?

  18. nwtk2007, what facts contradict my views? Please re-read my posts and demonstrate any accepted “facts” that are contrary to what I wrote. Please. If you’re referring to the article that called statins poisons, then no, I did not read much further than the title. Why would I waste my time reading an article that starts off with a biased (and unsupported) title?

    You were wrong – there is no big debate in the medical community on the usefulness of statins. Your selected quote form the article is also wrong. There is no discussion in the medical community to put statins in the water – that’s downright ridiculous. If a handful of doctors have “dissenting views” on statins, that simply means they are ignorant to the research behind them. If they are aware of the research and deny it, then they are idiots. People of any profession can be idiots, and there certainly are some doctors that are idiots.

    PS, all the weird analogies, political references, etc, are irrelevant. We aren’t discussing any of those things. Please demonstrate that anything I wrote has an abundance of facts finding the contrary.

  19. nwtk2007 says:

    Since you won’t read the article then there is nothing to demonstrate as contrary as this is what I am referring to. However, perhaps you could respond to the following:

    1. The discussion mentions data from three studies:

    The WOSCOPS trial, which showed that treatment with 40 mg of pravastatin resulted in a 31% reduction in heart attacks and related deaths.3
    AFCAPS/TexCAPS, which found that 20-40 mg of lovastatin reduced the incidence of first major coronary events by 37% and myocardial infarction by 40%.4
    The Jupiter trial, which found that treating patients who had normal cholesterol levels but high C-reactive protein levels with 20 mg of rosuvastatin reduced the risk of myocardial infarction, stroke, and revascularization by some 44%.5

    2. The author states as regards to the Jupiter study – “the Jupiter trial found is that whether you used the statin drug or not, your chances of having a heart attack were essentially the same: 1%. Or more precisely, if you take it out one more decimal place, that dramatic 44% improvement they talk about comes down to a drop from a 1.4% chance of having a coronary event to a 0.8% chance if you use statin drugs. You’re talking about maybe one person in every hundred seeing any benefit. Pitching that as a 44% improvement is number jerking, plain and simple!”

    (The discussion involved cardiologists both for and against the use of statins.)

    3. The author also states – “The pro cardiologists also suggested that a way to sort out who would be the best candidates for statin therapy is to offer them a coronary artery calcium (CAC) scan” but then “But are cholesterol and arterial calcification actually linked? Not necessarily, according to a 2006 study that found that calcium plaque continues to accumulate in coronary arteries even in the face of aggressive cholesterol reduction (-53% LDL cholesterol) with a statin drug.” The anti-cardiologists refute that.

    Basically, the “pro-cardiologists” disagree with the “anti-cardiologists” in the need for statin use. Thus there is substantial disagreement among the doctors as to the benefits of statins versus risks. You will have to read their positions ot be able to comment either in agreement or not with either.

    One of the most telling of the conclusions by this author is the following: “virtually all of the contrary studies are independent, whereas virtually all of the studies in support of statin drugs are industry sponsored.”

    Don’t worry about it. You’ve already made up your mind enough that anything else said, even if by cardiologists in this discussion from JAMA who are opposed to the use of statins for patients with elevated cholesterol who are otherwise healthy, would not be worthy of review.

  20. weing says:

    @nwtk2007

    “Extreme bias prevents objective consideration of possible errors in mainstream practice.” You still don’t understand do you? Extreme bias is preventing you from objective consideration of possible errors in your understanding of what is written. Please read the original articles and not some biased commentary to find out what is really written and form your own opinion. As I said before, in patients of intermediate risk, I must do a very careful risk/benefit analysis. The articles are very good in pointing out what needs to be considered.

  21. DavidRLogan says:

    This thread was so helpful (particularly “International Network…” link, thanks Dr. Hall).

    It was actually THIS issue that made me hate “modern medicine” etc. for so long until I found SBM (I thought you were “profoundly incompetent” and I railed against statins online, etc…I hate myself for being so arrogant/having no perspective).

    Still I have a modicum of compassion for my former self…when you have zero science education some of these arguments from perceived authorities seem good and SCARY (for instance Ron Rosedale claims inhibition of CQ10 by statins trump everything else, or the advice of a chiro who was perceived as an authority when I was 20).

    It’s too bad you don’t have a larger platform to help people, particularly young people who will use the internet to “research” their health issues and their parent’s health issues.

    Thanks again, SBM. Ough! Ough! Ough!

  22. Nwtk, I’m going to lunch. Will reply, I are exactly where you are 100% wrong. Do yourself a favor and google “Jupiter trial” and read at least the full abstract and you’ll see why what you (or that author) wrote is absolutely ridiculous. If you can’t figure it out by time I’m done eating then, well, yikes.

  23. nwtk2007 says:

    Weing – “Extreme bias is preventing you from objective consideration of possible errors in your understanding of what is written.”

    Quite the contrary, I was hoping to hear some objective points of view about this authors analysis of the debate. I’m not arguing wither pro or con for statins and their use. I think the author has some good points which seem to be based upon the discussion between the cardiologists and the cited studies. Also, is it or is it not of interest that the industry sponsored studies are so different from the ones done by independents? Or is that also bunk?

    For those who are seeking information yet find that some of the info garnered here on this site has some contradictory evidence not to hear those here’s take on it other than “the author said statins are poison so he must be a quack so don’t listen” is a bit weak.

  24. weing says:

    @nwtk2007

    “I was hoping to hear some objective points of view about this authors analysis of the debate.”

    Here it is. The author’s analysis is biased.

  25. nwtk2007 says:

    Well, that just about says it all. Could the industry based studies also be biased also?

    Nuff said.

    Wallow in your own bias. Vote for Romney. (Not)

  26. weing says:

    @nwtk,

    Would you think an analysis of chiropractic that used the term crippling chiropractors to be anything but biased? I gave you my opinion of the original articles. I much prefer the source rather than looking through someone’s filters to form my own opinion.

  27. @nwtk2007,

    I am still waiting on you to point out anything that I wrote that you have “facts” that demonstrate the opposite.

    Regarding your copy-pasted biased article:

    “the Jupiter trial found is that whether you used the statin drug or not, your chances of having a heart attack were essentially the same: 1%. Or more precisely, if you take it out one more decimal place, that dramatic 44% improvement they talk about comes down to a drop from a 1.4% chance of having a coronary event to a 0.8% chance if you use statin drugs. You’re talking about maybe one person in every hundred seeing any benefit. Pitching that as a 44% improvement is number jerking, plain and simple!”

    That simply isn’t true. First of all, the JUPITER trial administered statins to people that had both normal LDL levels and elevated CRP levels (an inflammatory marker.) The trial found, specifically, that people given the statins experienced significantly fewer cardiovascular events and deaths. Just read the conclusion of the trial (below – again, just Google “jupiter trial”, the entire PDF is available to download):

    JUPITER conclusion:

    In conclusion, in this randomized trial of apparently healthy men and women who did not have hyperlipidemia but did have elevated levels of high-sensitivity C-reactive protein, the rates of a first major cardiovascular event and death from any cause were significantly reduced among the participants who received rosuvastatin as compared with those who received placebo.

    So, the biased authors “conclusion” is simply not true. Your chances of suffering from cardiovascular events are decreased by using statins. Furthermore, the implications of the JUPITER trial are interesting. These were people with LDL levels that are currently considered “healthy.” Read that again. These were in healthy people. We further reduced their LDL and CRP levels and they experienced even fewer cardiovascular events. This may mean that when the new ATP IV guidelines are released this year that the “healthy” level for LDLs may be even lower. In fact, I believe Dr. Nissen, author of Heart 411, hinted that more aggressive statin use will be recommended in the new ATP guidelines. I believe Nybgrus already said this, but it seems that with LDLs, there is no bottom number, meaning that we want them as low as possible. This trial hits that point home. We can further reduce the incidence of cardiovascular events by treating seemingly healthy people with a statin.

    Any attempt to put a negative spin on that is pure dishonesty.

    Regarding the coronary artery calcium score: irrelevant. The calcium score is not a good test. We don’t use it, and I did an informal poll and half my colleagues had not even heard of the test, and the others never use it. I don’t know much about it other than they do a CT scan of the chest and look for calcifications in the coronaries, and then add it up or something and use it to predict your risk for cardiovascular disease. I’m not even bothering reading the study your biased author mentioned that found no association between a patient’s calcium score increasing despite statin use, because it very well may be true. Simply put, we don’t regularly use the calcium score because it hasn’t been validated.

    Let me repeat that. A high-risk calcium score is not an indication to start statins. There are no guidelines that say if a patient has a high-risk calcium score that a statin should be used. The vast majority of doctors do not send patients for calcium scores because the test apparently sucks.

    The cardiologists I know will perform the test if a patient wants it, but I believe they counsel them that it’s not a very good predictor, and honestly I don’t think it would change the course of treatment (you certainly would not stop a statin if you had hyperlipidemia and a low-risk calcium score, likewise there is no indication to start a statin if you had normal lipids but a high-risk calcium score.)

    If any doctor that reads or posts here regularly sends patients for a calcium score, please speak up, and explain what body of evidence is supporting that decision, because as far as I know, there isn’t much if any. I may simply be ignorant of it.

    So, in your #3 point in the biased article, nwtk, the conclusion your author draws is simply invalid. He can’t claim that statins are useless because they didn’t affect the results of a test that is widely considered useless and the results of which likely will not influence outcomes. That’s like saying an antibiotic didn’t work because a patient’s depression didn’t improve.

    Simply put, the “points” made by the author in that biased article are nonsense. He took things out of context, drew ridiculous conclusions, and made comparisons that simply demonstrate he has no idea what he is talking about. I hope this explains why none of us wasted our time reading the article. It’s pure nonsense.

    By the way, next time, read the primary sources. Had you actually read the text of the JUPITER trial, instead of reading a ridiculous article that misinterpreted it, you would have saved yourself a lot of time and embarrassment.

  28. nwtk2007 says:

    Regarding the Jupiter study, you quote their conclusion but do not address the numbers; you simply assume their conclusion is valid. I read the original and to be honest, to say that such small decreases in cardiovascular problems with statin use outweighs the risks and deleterious side effects is disingenuous at best. The author of this study pointed to the very same numbers and made the same conclusion. The one example he cited, is essentially insignificant in its magnitude when compared to the risks; 1.4 per 100 person years down to 0.8 in otherwise healthy individuala with elevated LDL levels. The “con-cardiologists” came to this same conclusion and they point to a 2011 Cochran review to support their position. The con-cardiologists do, however, concede that the use of statins does reduce the chances of a second heart attack in patients who have experienced one already. It was also the Cochran folks who pointed out that the most of the other studies they reviewed were sponsored by pharm industry, yet it appears that examination of their own numbers doesn’t bear out their conclusions, at least according to the “con-cardiologists”. The author of this paper is more often than not, simply parroting the position of the con-cardiologists thus you are saying that it is not his conclusions that are invalid but theirs, the cardiologists.

    You say he takes things “out of context” and drew “ridiculous conclusions”. Perhaps they con-cardiologists, per you, did. In fact, the con-cardiologists pointed out that the studies minimized the side effects of statins by eliminating those who reacted poorly to statins before the trials actually officially began. Selective population? Random? No.

    I read the original Jupiter study and can see where this author and the con-cardiologists draw their conclusions. Did you? Now what I haven’t done is read the original debate out of JAMA to which this author is referencing. Perhaps he is lying about the con-cardiologists arguments against statin use, but I’m ready to give him the benefit of the doubt for now.

    Basically, the use of statins in healthy folks, even with elevated LDL levels, is not indicated according to the con-cardiologists, when weighed against the various side effects of statins. Perhaps something without the same side effects would do the job of lowering LDL,but it is simply not conclusive that lowering LDLs in healthy individuals is of significant benefit.

  29. BTW, in re-reading “point #2″, what the author did is simply idiotic. He took two values that were statistically significant and then simply delcared it insignificant. So we saw a drastic reduction in adverse cardiovascular events in HEALTHY people and the biased goober just says “well, it’s not that big of a deal.” Like hell it isn’t!

    Honestly, nwtk2007, I’m surprised you weren’t able to read that article and not immediately identify all the BS in it.

  30. I’m sorry, but you’re an idiot. I simply don’t have the patience to go back and forth with someone who keeps changing what they are arguing, who ignores mountains of data, and pulls things out of their rear. Your stupidity is exhausting.

  31. BTW, I appreciate that you consider the “statins are poison” turd a “study.”

  32. Harriet Hall says:

    @nwtk2007,

    “the use of statins in healthy folks, even with elevated LDL levels, is not indicated according to the con-cardiologists”

    It’s not indicated according to the pro-cardiologists either. The consensus is that it should be prescribed based on the overall risk picture, not on an isolated elevation in LDL.

    There is no disagreement about whether they work. The disagreements are opinions and personal value judgments based on how well they work in different groups and when the benefits outweigh the risks.

    You are right to point out the difference between relative risk and absolute risk. For informed consent, patients should be told those numbers as well as the NNT and the NNH. Given the same evidence, some individuals will opt for statins while others will not.

    Bottom line: statins work. Just not as well as some of the hype would have us believe.

  33. nwtk2007 says:

    Exactly Harriet. Statins lower blood LDL-C levels, no doubt. My initial point was not that statins don’t lower it but is lowering it also going to reduce heart disease enough to offset the side effects. Based upon the studies cited and discussed by the cardiologists in this article (not “study” skeptical) and further discussed by this author, it would appear that statins reduce heart attacks in folks who have had a previous heart attack but, in some opinions, including the con-cardiologists cited in this JAMA discussion, not significantly enough in healthy individuals even if they have elevated LDL-C, and that based upon “studies” cited by them and discussed by this author.

    Also Harriet, what you refer to as hype, which it indeed is, to me, is reflected in the observation (if actually true) that the studies done by the pharm industry support the use of statins versus independent studies which apparently do not support so much use. I really have no data on that other than what the author has stated. It might or might not be true.

    And skeptical, like I said, it was an article, not a study. There were studies cited within the article but the article itself was only an article/report/piece/etc.

    I was unclear as to the use of patient versus patient-years, I believe it was. Stats are strange things sometimes. What is the difference between 0.8 and 1.4 patients or between 0.8 and 1.4 patient-years? When numbers like this come up, mathematicians and scientists tend to bring in significant figures and rounding errors inevitably pop up, especially in research. (Or it was person-years or man-years.)

  34. weing says:

    @nwtk2007,

    “My initial point was not that statins don’t lower it but is lowering it also going to reduce heart disease enough to offset the side effects.”

    Then you made your point very poorly. That is not what I got from what you wrote. So far the studies show that the lower you bring down the LDL-C, the lower the risk of MI. The question then becomes is it worth it to lower the LDL-C in the individual before you with intermediate risk. You then have to weigh the risk of side effects of the medications vs the marginal benefit. I discuss these with my patients and sometimes we opt for meds, sometimes just for TLC. I also have patients that are high and some even very high risk and they do not tolerate any of the medications. I wish we had more options for them, as TLC is not enough.

  35. @weing, that is because that was *not* his initial point. First his point was that something I stated was wrong (and nothing in my original post was wrong, it was nothing more than a collection of facts.) Then he wanted everyone to pay attention to a ridiculous article written by a know-nothing. Then his point was that there is a big disagreement in the medical community regarding the efficacy and use of statins, which again is wrong. Then he apparently argued against the idea that everybody should get statins, because he started mentioning a study in which otherwise healthy people — at least in terms of not having hyperlipidemia — received statins (and still noticed a statistically significant decrease in cardiovascular events and mortality – oh, but hold on, the chiropractor doesn’t agree with these findings!), despite the fact that no one in this thread was advocating giving statins to otherwise healthy people without concerning labs or risk factors. Now he’s agreeing with Harriet, and I can guarantee that the point she was making is infinitely far away from the point that nwtk2007 is apparently trying to agree with now. I’d bet that Harriet is saying that statins are fantastic, but they aren’t the wonder drug that some people make them out to be, whereas nwtk2007 is reading it as “statins have some minor efficacy, but may not be worth it in the end.” Of course, as always, he would be wrong.

    In other words, he never had a point, and kept changing the subject until he argued a point that nobody was actually arguing against, and then believes that he somehow made sense.

  36. nwtk2007 says:

    skeptical, the gist of my original entry into this thread was to discuss the evidence and biochemistry related to the notion that elevated HDL-C cholesterol caused plaque formation or not. It was that simple since the mechanism is not clearly known and there are suggestions that it doesn’t in the scientific community as there are also some who think tht lowering doesn’t decrease heart disease. You were so intent on dissing the dumb chiro that you just couldn’t see it. And I only am agreeing with Harriet after further reviewing the discussion I cited more thoroughly and discussing it here. I wasn’t even responding I don’t think to anything you had posted at the time. The argument regarding the use of statins goes directly to the question of LDL-C’s role in heart disease.

    You were blinded by the light. And so smart too. Really.

  37. HDL’s now, eh? Please proof read your posts and try to be somewhat coherent. You have thoroughly wasted a lot of people’s time with your nonsense.

  38. nwtk2007 says:

    Obviously a mistake Ms Petunia. If YOU will reread my posts you might see that I am pretty on topic, for the most part. Read without the chiro cloud in your judgement, you’d probably be fine. Once again, its called bias.

    Want to check my spelling, too? Enjoy.

  39. nybgrus says:

    nwtk has definitely shifted his stance and statements subtly without acknowledging it so that he is quite as wrong while still claiming to be right on his original point.

    also, even the interpretation of the Jupiter study that nwtk is touting is inane. A reduction of coronary events from 1.4% to 0.8% in an otherwise completely healthy population is f&^$*@ing huge. Remember in my previous post I mentioed that “law of large numbers?”

    We have 380,000,000 (or so) in this country. Lets say that 100,000,000 of them are otherwise healthy adults. And lets say we gave them all a statin. That means we would have prevented 600,000 coronary events. SIX HUNDRED THOUSAND in a HEALTHY POPULATION. So even THAT is pretty impressive. And nobody here is talking about giving statins to HEALTHY people.

    I wish I had the time to actually go through all this and lay down a serious analysis that DavidRLogan would appreciate. But I simply am too busy doing actual medicine these days to take the time.

  40. BillyJoe says:

    nwtk: “Obviously a mistake Ms Petunia”.

    Yes, obviously, which is why SH asked you to please proof read your posts

  41. WilliamLawrenceUtridge says:

    Obviously a mistake Ms Petunia. If YOU will reread my posts you might see that I am pretty on topic, for the most part. Read without the chiro cloud in your judgement, you’d probably be fine. Once again, its called bias.

    Want to check my spelling, too? Enjoy.

    I’ll juxtapose this another comment you made nwtk:

    And skeptical, like I said, it was an article, not a study. There were studies cited within the article but the article itself was only an article/report/piece/etc.

    There’s obviously enough pedantic nit-picking to go around,* and focusing on that rather than points of substance may make people feel better but doesn’t advance any argument.

    *and as a pedantic nit-picker, I demand my fair share

  42. nwtk2007 says:

    Yes I do enjoy the objectivity of many who speak out on this site. We could go on and on about typo’s but I’ll refrain.

    Nygbrus, apply the big numbers analysis to the side effects and see what you come up with.

  43. nwtk2007 says:

    I will say,,however,, that I also refrain from like responses to much of the venom encountered here. There is much educational content to be garnered here. Its too bad more folks wont engage.

  44. nybgrus says:

    that’s called a risk benefit analysis. Exactly what we are talking about here. So lets break it down for you:

    For those taking statin for 5 years to prevent heart disease you can break it down into those with known heart disease and those without.

    For those without:

    None were helped by preventing death
    1.6% were helped by preventing MI
    .4% were helped by preventing stroke
    1.5% were harmed by developing diabetes
    10% were harmed by muscle damage

    So, NNT is 60 for MI and 268 for stroke and NNH are 67 for diabetes and 10 for muscle damage.

    Conclusion: not worth the risk benefit.

    For those with:

    1.2% were helped by preventing death
    2.6% were helped by preventing a second MI
    .8% were helped by preventing stroke
    .6% were harmed by developing diabetes
    10% were harmed by muscle damage

    So, NNT is 83 for saving a life, 39 for repeat MI, 125 for stroke and NNH is 167 for diabetes and 10 for muscle damage.

    Conclusion: worth the risk benefit

    And if you want to apply the law of large numbers again for that same hypothetical population, you would prevent 600,000 coronary events, have 10,000,000 people with muscle damage, and 150,000,000 with diabetes. Once again, for a HEALTHY population. Which nobody is advocating we summarily give statins to.

    And I’ll take the time to illustrate your shifting goal posts and stance. At first it was that statins just don’t work because lipids don’t effect cardiovascular outcomes. Then it was that they do work, but that it isn’t worth targeting because lipids don’t have that much effect on outcomes. Now it is that the reduction is ONLY around 1%… oh, and in healthy people BTW. That, my friend, is goal post shifting.

  45. After reading that ^^, does anyone actually oppose me calling this guy a moron?

    Is it worth actually replying to a blithering idiot? Or does such a ridiculously stupid post warrant a legitimate response?

  46. mousethatroared says:

    @SkepticalHealth – you probably don’t read my comments, but here goes.

    My cognitive therapist recommended this book to me. Maybe it’s methods could help you free yourself from aggravating discussions with people who refuse to listen.

    No offense intended on the title. I tend to think most normal people have their OCD moments.

    http://www.amazon.com/Brain-Lock-Yourself-Obsessive-Compulsive-Behavior/dp/0060987111

  47. @nybg, you left out the part that defines patient population in the second “analysis.” I don’t see how you came up with some of your numbers (150,000,000? That’s more than the people in your hypothetical population!) Also, let’s be realistic about “muscle damage.”

    Very strange, man.

  48. nwtk2007 says:

    nygbrus – “At first it was that statins just don’t work because lipids don’t effect cardiovascular outcomes.”

    Incorrect. It was simply a question regarding cholesterol, specificall LDL-C, as to how it causes, or its role in, plaque formation, if I remember correctly. If you could get off your pharm cheer leading, defensisve (I prescribe meds) mentality, you could have seen that.

    As to goal posts, please, a discussion without some wavering of the outcome/topic/conclusion is really quite boring and in essence, settles nothing. I must say though, that it is quite amusing to see your high horses riled by simple questioning of your perspective such that you need to think into your preset conclusion to, at the very least, verify it for yourself. You both would be fun students.

    Now skeptical, could you scan my post here for typo’s. My computer here won’t check spelling for me.

  49. nwtk2007 says:

    Nygbrus, I like your analysis, however, how could other cariologists have such a juxtaposed opinion on such an obvious conclusion, if indeed, you are correct?

  50. WilliamLawrenceUtridge says:

    @nwtk2007

    will say,,however,, that I also refrain from like responses to much of the venom encountered here. There is much educational content to be garnered here. Its too bad more folks wont engage.

    Most folks won’t engage because they lack the knowledge or consider the issue more or less settled by the posts (which themselves are based on mainstream recommendations by genuine experts considering the totality of the evidence). I frankly don’t see the point in debating you over this topic for a couple reasons – I don’t know enough about statins, there’s an obvious consensus statins are helpful when used appropriately, and you seem more invested in and convinced by the statin denialism arguments (note deliberate link to AIDS and climate change denialism) than the mainstream one. If you’re genuinely concerned and interested in whether statins are beneficial, it’s going to take you years to absorb the information, and probably training you don’t have. So rather than arguing here on the basis of a bunch of people who lack credibility, you might be better off exploring your genuine concern in the form of another graduate degree, this time focussing on statins. Then you’ll really be in a position to know whether statins are useful or if the cholesterol skeptics are blowing smoke out of their collective asses.

  51. @nybgrus,

    No offense at all intended, but there seems to be a whole lot of issues with your last post.

    I looked at the second link you provided, and reviewed the first 2 systematic reviews that it used for it’s data. Both of them found almost zero association between statin use and rhabdo (the so-called “muscle damage”), so I can’t begin to see where they got a ridiculous number of 1 in 10. The diabetes info was from a different study, which seems strange to include it as a factor in their little data pool. Combine that with the weird numbers you through out (150,000,000 with diabetes? lol. Only if you treated 5 earths worth of people.)

  52. nwtk2007 says:

    William, I don’t know what makes you think that I am debating about anything. I have asked more questions and asked for opinion regarding a JAMA debate than I have offered conclusions or arguments to the contrary of anything. Asking questions is not debate or argument. The folks here are essentially claiming to know and given their knowledge, it just seems natural to ask for their take on some issues. This assumption that I am anti-statin comes from where, I have no idea although I did point out that there are those who do not agree with the “consensus”, as you put it; for example the cardiologists in this JAMA debate. Not me but them although I do admit that I can see their point.

    My last question was regarding that in particular; “how could other cariologists have such a juxtaposed opinion on such an obvious conclusion”. Do they represent “denialism” or do they have at least a modicum of a point in their position. Can the pro-statin group see any part of their argument as potentially valid?

    And no offense, as has been pointed out on this site so often, blood letting was the consensus treatment for many things at some point in the past, not that this compares to the “consensus” you are referring to. When asked a question, don’t assume that there is an implied position or opinion behind it.

    Also. when did I mention AIDS?

  53. weing says:

    @MTR,
    I find my OCD quite helpful in my practice.

  54. nwtk2007 says:

    nygbrus, of the 10% with muscle damage, which I would assume would be cumulative over years of statin use, will also develop concurrent kidney damage/accelerated decrease in kidney function?

  55. You would assume wrong. Completely wrong.

    In fact, elevated CK leading to any renal issues is extraordinarily rare with statin use. The “muscle damage” above is apparently nothing more than a possible myalgia, with absolutely no physical muscle damage occurring. It’s amazing that you’ll comment on these things without knowing anything about it.

  56. gziomek says:

    @nwtk2007

    It’s illogical to compare the “consensus” for blood letting to the consensus for using statins for so many reasons. Pick a better example next time.

    Not trying to jump on the bandwagon arguing with you- I’ll leave that to those that are doing so.

  57. weing says:

    The muscle damage numbers are suspect, IMO. Before starting patients on statin, I have them do a couple of squats and ask them how they feel. I use that as a baseline when they follow up.

  58. Calling it “muscle damage” is just plain bizarre. Some people do complain of muscle pains after starting statins, but they rarely have elevated CKs indicating actual muscle damage. (Some people get a baseline CK before starting a statin, but I don’t see where that’d really change the course of treatment, because you’re not going to routinely measure CK levels while asymptomatic, and if you had untolerable myalgias you’d just DC the medication.) If a patient cannot tolerate statins, then stop them. It’s very simple. To calculate it as if you’re causing “muscle damage” is just wrong. Sure, we can be semantic about it all day long, but let’s be realistic.

  59. mousethatroared says:

    @weing – “I find my OCD quite helpful in my practice.”

    yeah, then it’s not an obsessive compulsive disorder, it’s the obsessive compulsive advantage. :)

  60. nwtk2007 says:

    skeptical – “It’s amazing that you’ll comment on these things without knowing anything about it.”

    Do you know what a “?” is? You just can’t read anything without getting off on some incorrect assumption. It is truly a sad state to be in, really. Of course I did leave out the word “they” and it should have read, “…will they also develop….” In your bitty brain it must be such a huge disconnect to actually communicate in a rational way. Bottom line is that is wasn’t a comment, but an inquiry. I’m sorry but you are just too stupid. Highly intelligent I think but at the same time, stupid. I still think you must think you’re some kind of “House” doctor. Into the hydrocodone are ya?

  61. Actually, you’re right, I shouldn’t have added that last dig at you when you incorrectly predicted the clinical course of “muscle damage.” I apologize.

  62. nwtk2007 says:

    Not to argue, but I didn’t predict anything either. If there is muscle damage its just a logical next question as to the level of muscle damage and the potential sequence of events that can entail. If, as you have said, the muscle damage is, essentially, not muscle damage per se, then it is not a concern.

    Anecdotally, my dad as a mild form of Parkinson’s and was on statins for about two years. His condition worsened, especially in regions of his body not previously effected by the Parkinson’s. His doctor took him off the statins over a year ago now and those regions have returned to full function. Additionally his cholesterol levels have not become elevated in the mean time. (The Parkinson’s effected his hands from about the elbows down. His leg strength and control became significantly impaired as he was given medications including the statins but has since returned to normal with the discontinued use of the statins.)

  63. BillyJoe says:

    nwtk:

    “Do you know what a “?” is? ”

    A question mark can mean many things.
    In my experience in reading and commenting on blogs over the past few years it can mean:

    1) The person is ignorant of the topic and is genuinely looking for information.
    In my experience this is rare. I mean, if I want to find out about a topic I research it and study it and then, if I don’t understand something, I ask someone who I think has some expertise. There are some who are genuinely looking for information but the tone of their post is usually neutral or subdued and they are appreciative of any understandings given.

    2) The person is playing devils advocate.
    I have done this on occasion when I believe something should be true but I can’t completely convince myself that it is. I then think of all the reasons why it may not be true that I have no answer for and play devils advocate amongst those who agree with my point of view. I have learnt some important lessons this way.

    3) The person pretends not to have a view but his whole focus is to trip up those with the opposing view.
    I have never done this. I think it is dishonest. You should give your view up front and take whatever criticism comes your way. Then you can legitimately challenge the opposing view. It’s the only genuine way to learn anything. Put your view out there and be prepared to have it demolished.

    My assessment is that you fall into category 3.
    It’s a falsely safe position because you can fall back to the “I’m only asking questions” gambit but most posters see right through that ploy.

  64. BillyJoe says:

    …of course, I apologise if I have mischaracterised you. ;)

  65. nwtk2007 says:

    If we were debating and not discussing, I could agree with a little of what you have said. But I have offered no counter argument on any topic other than to bring in other information; in this case the link to the article in which the author discussed the debate between cardiologists in JAMA. You can go back and re-read what I have posted and see for your self. If I am in an argument or debate, which I have on this site, then I am pretty direct and almost never ask a question. I would also think that the questions I have raised would be raised by others as well.

    There has always been a general defensive yet elitist attitude from the commentors on this site which is amusing but not a difficulty. It leads to misunderstanding many statements, even among themselves.

  66. @nwtk2007, I would challenge the idea that you “brought in information.” You linked an extraordinarily biased article that drew incorrect conclusions (“600,000 lives? Irrelevant!”) and honed in on non-issues (ie, in reality, nobody is seriously suggesting putting statins in the water supply, and nobody is seriously advocating treating perfectly healthy people with statins, however, it is possible our current understanding of “healthy” may be setting the bar too low, I’ll be genuinely interested to see the new ATP IV guidelines!) In fact, if we consider the word information to mean “something that was not previously known to the person” (Richard Dawkins uses this definition in a fantastic article he wrote) then you did not bring any information to this discussion. That is, I don’t think you “enlightened” anyone with anything that you wrote.

    You may be interested in learning more about statins, and if you are then that is fantastic, but I would not go as far as to say that you actually contributed anything beneficial, unless we consider the possibility of other posters learning from people answering your “questions.”

    @BillyJoe, I whole-heartedly agree.

  67. nwtk2007 says:

    The article I cited brought in the debate and a discussion of its contents. I’m wondering why the debate in JAMA hadn’t been brought up by anyone else. Given that, you could have gone to the actual debate and referred to that specifically. Having read it, there are some very interesting comments from the cardiologists about the use of statins to treat cholesterol alone in otherwise healthy individuals.

    By the way, you referring to something as biased is truly the pot calling the kettle black.

  68. mousethatroared says:

    @ BillyJoe – spot on.

  69. nwtk2007 says:

    Really fellas, you have a nice little fraternity but I can’t imagine why you would think I might want your approval such that you would dish out the BS so thickly. If I were ya’ll, I’d just try to keep up.

  70. nybgrus says:

    @skeptical:

    You are right… my math was incorrect. Between my clinical duties and my two research projects I just put in 120+ hours in the last 7 days and had three 21 hour days in a row, so my apologies. I still try to read a bit here to keep my sanity, but my last post was indeed not up to my usual standard.

    I also agree that the numbers cited were a bit… off… for exactly the reasons you claim. My point in them was that even in such a dire sort of “worst case” scenario calling it “muscle damage” and all that, it still meets the bar for being useful. It wasn’t my most eloquent or hard hitting riposte though, I’ll admit.

    And now that I actually have some time off and managed to sleep for 13 hours straight, I will go off to have a nice brunch with my lovely blonde rocket scientist and leave y’all to continue the great statin debate of 2012.

    Ta ta!

  71. I bet you can’t wait to be done. By the end of 3rd and 4th year I was so sick of being a student. But you’ll still look back at those 21 hour days fondly. It’s a whole different world when you’re actually responsible for what happens. My worst was 30 hour days (…) on our OB rotation (full day, plus having to stay for the didactic lecture that took the whole next AM, of course only if your OB call day fell on the day before the once a week lecture.) But the sheer fun of med school made it all worthwhile.

    Which residencies are you going to apply for? Are you going to be doing the upcoming match?

  72. nybgrus says:

    Actually I am rather enjoying it! Plus, “done” is a very relative term. I will be learning, reading, and improving every day till I die so I don’t ever see myself as “done.” Though having a paycheck… and especially an attending’s paycheck… would be nice at some point. LOL.

    I managed to avoid those crazy 30 hour days because of call and didactics. Partly by luck (holidays fell right when it should have happened to me) and partly because I saw no point in hazing myself when I could read the lectures on my own after I had slept so I managed to slink away ;-) But yes, OB was the one that has a penchant for that for some reason.

    As for which residency… I am 95% certain I will do internal medicine and then 95% certain I will do a pulmonary critical care fellowship afterwards. There is some wiggle room in case a decide anesthesia or emergency medicine is more my thing, but that is unlikely though I am trying to keep an open mind. There is also a little wiggle room once I get to residency and maybe discover something else catches my fancy even more. But my girlfriend is an aerospace engineer and we both kind of (i.e. she really, really and I am just one really) want to go to outer space, so pulmonary CC seems like a good choice for being the medical officer on a space mission. Thankfully I will know how to do reiki, acupuncture, and chiropractic so that we can still save lives with the limited resources available in space :-p

    I won’t be in the upcoming match but in the one after that. Because I am on a southern hemisphere schedule, my year starts in January and ends in November, so I will be done with Year 3 in November, apply halfway through my 4th year, and then hopefully match after I graduate a year from this November. There will be a lag time between finishing med school and starting residency during which I plan to interview, wrap up any research projects I have going on, and then ultimately travel for a couple of months after I match to unwind and recoup before getting back into it.

  73. nybgrus says:

    Conveniently the Jupiter trial has an update in the lancet:

    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61190-8/fulltext

    The risk of diabetes from statin use is basically none in people without risk factors. It its 28% in people with. Even then cardiac event prevention still outweighs diabetes risk.

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