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364 thoughts on “The International Network of Cholesterol Skeptics

  1. raygee says:

    This argument just goes round and round, I have long known that doctors are as fallible as the rest of us, although most have the best interests of patients at heart.

    I believe that you must have financial interests or career positions that make it inconceivable to you that the problems are real, true, and making many lives miserable for the foreseeable future through statin use.

    If all these reports are anecdotal, then those reported in trials have also been treated as anecdotal, unless of such a proportion that they would not go away, so whenever does a report get on to an outcomes report. The variables do not see the light of day, and we get such terms as “nocebo” invented to ridicule those whom they affect.

    Large studies have little merit unless there is a desire to address all sides of the situation, and the fullest and latest knowledge of the matter under trial is taken into account. the trial must proceed with TOTAL reporting of problems, with no recourse to such subterfuges as the run-in period, when initial problems get swept under the mat. Thoroughness, not size, is the keynote, power of the outcome should rest on the integrity of those involved, and a totally independent body should oversee those where huge markets are likely to be involved. Woe betide a researcher who allows a dent to appear in the billions of dollars flowing from statin use. A real effort should be made to work out the mechanisms by which the drug works and try to foresee what other problems these could cause. This most certainly has not been done for statins, or perhaps the damage to energy supply ATP to all systems in the anatomy would have been foreseen, or maybe it was foreseen and ignored for financial reasons.

    But all these huge trials leave important substances which cannot be patented out in the cold, and research passes them by as insignificant, and the side effects of the popular drugs need more drugs to control them, a vicious circle.

    In all this, the individual patient’s welfare assume less importance than the report of success of the final criteria, the individual is not believed, or he/she is somehow blamed for being intolerant of the potentially toxic statins. I know the feeling only too well.

    One can only bang one’s head against a brick wall for so long, and I am unwilling to endanger my blood pressure in carrying on the fight in this arena, I am certain others will be opening up all the time in other places, I have made my mark in plenty of them, and will continue to do so as long as it is necessary and I am able.

  2. jayemcee says:

    “Science-based medicine” that title is, prima facie, ridiculous given that not even one single piece of evidence provided, has been discussed by the resident medics of this site; within 200 posts.

    simply an observation

  3. Joe says:

    pec wrote “We have to think. We cannot expect scientific research to replace common sense.”

    As you have amply demonstrated, “common sense” is not very common. That is ad hom, and I am proud of it.

    The scientific method was developed because we discovered that we easily fool ourselves without it. Scientific medicine has brought us sanitation, vaccination, antibiotics, cancer cures, insulin, (somebody stop me!). Nothing in CAM has produced a demonstrable improvement in health care.

  4. pec says:

    “CAM treatments are much less likely to be toxic, because the philosophy respects the intricacy of natural systems.”

    “That statement is, prima facie, ridiculous. No, this isn’t an ad hom statement, simply an observation.”

    Your brain has been well-washed if you don’t think the currently popular cancer and AIDS drugs are toxic.

  5. PalMD says:

    Wow…a whole new level of teh stupid. “Philosophy” has nothing to do with it.

    Of course cancer and HIV therapy can be toxic…they also happen to save and improve more lives than any harm they cause. The real test will come when you or a loved one gets a serious disease….I hope very much that never happens.

  6. Freddy the Pig says:

    pec wrote “We have to think. We cannot expect scientific research to replace common sense.”

    That is one the most arrogant and ridiculous statements I have ever heard.

    Common sense – “My grandmother smoked a pack a day and lived to be 90. Therefore smoking does not cause cancer”

    Science – “Large scale epidemiological studies indicate smoking causes cancer and here are some biochemical mechanisms of how it happens”

    Common sense – “The sun goes around the earth. The earth does not move”

    Really what you are saying is “when scientific research with control groups, placebo arms and large samples contradicts my limited personal experience or what I wish was true I will ignore it.

    By the way – a couple of days I ran into a guy who has had brain cancer since before I met him (6 years ago). He looked as healthy and happy as I ever seen him (a little over a year ago he could barely walk). The chemo was toxic – but it has kept him alive.

  7. raygee says:

    @PalMD

    Everyone knows that a doctor is “licensed” to administer potentially poisonous drugs to overcome a greater evil. But does that same implied authority extend to giving a potential poison to attempt to prevent an event, for which the possibility is only implied by reference to a rather arbitrary formula in which cholesterol plays a dubious role, only forecast to affect 2 out of every10 of those selected, and tackling cholesterol level, one of the least of the risk factors. The Qrisk study showed that the “formula” overestimates the risk by 30% for UK populations, so that nearly 9 out of every 10 patients treated will not need the benefit of such treatment, but will attract the risks of statin side effects. Not the most accurate of scientific forecasting, when the more accurate forecasting tool of CVD is Homocysteine level, which gets no mention at all.

    I know you will say where is the data, but a disdainful attitude to real life problems, not recorded in trial reports, possibly for the same reasons that you disbelieve what today’s patients are saying, can hardly be described as medicine in the best interest of the patient. I have many friends who find problems with statins, locally and on line, can they all coincidentally have onsets of muscle and joint pains, peripheral neuropathy, confusion etc, etc, when starting with a statin, that is an awfully large number of improbalities for a logical mind to accept.

  8. UK-Bloke says:

    @ Synaptix

    “UKguy – I’m not argueing with the fact that Statins can cause the problems brought up here. I just completely disagree that the “truth” is being somehow suppressed – the science is being done to adress these issues and the medical community does it’s best to make it so that people can get treatment. No system is perfect, people are going to have bad side effects – to misrepresent and what the authors of this blog are trying to accomplish helpes no one.”

    Please take a look at this article from ABC News and read the comments left by real people who have had experience and maybe you can see what happens while all around the people who are pushing this rubbish totally ignore its existence.

    http://abcnews.go.com/Health/HeartDiseaseCenter/story?id=4281162&page=1

    The above link was found on http://www.spacedoc.net/board/ the folk that are in the forum as well as the site owner are all victims of this “wonder drug”.

    Please look at the statement you wrote – {to misrepresent and what the authors of this blog are trying to accomplish helpes no one} – the authors of this blog went all guns blazing to ridicule anything that has been in a negative way about the effects statins have in the real world.

    Initially while blogs like this keep trying to make the suffering of thousands of statin users seem to be insignificant and keep talking about how they are saving x amount of lives and that they would have died if they had not taken them and as in the link above {Doctors have largely discredited an anecdotal link between the popular cholesterol drug Lipitor and memory loss.} you have to ask where is the science in this?

    If you have read the readers comments, you will see reality in the raw, no glorified puppet who is getting paid a fortune to say this rubbish is the best thing since sliced bread or whatever the catch phrase is that suits the moment. In the meantime doctors and patients are being told or mislead about the effects that Statins actually ARE causing. Too many people are being told “Statins don’t do that” and they are so very very wrong.

    Anyone who has experienced the side effects of a Statin and reads what has been written by professionally trained medical practitioners is bound to get annoyed at the lack of knowledge on the subject that they the professionals are trying to prove or disprove.

    Thank goodness for sites like spacedoc’s and the ability to access places like THINCS as well as being able to read online most of the major medical journals and published reports and references to other papers.

    You may care to read the article here but even more so the comments that have been left by readers ok.

    http://www.businessweek.com/magazine/content/08_04/b4068052092994.htm?chan=magazine+channel_top+stories

  9. UK-Bloke says:

    @ Synaptix

    my previous effort could have been worded much better but I am actually tired and it is the best I can do for now. Unless you experience or have seen what these drugs are capable of doing to people with your own eyes, you will not be able to comprehend the true severity of the situation.

    It is good that people like youself actually ask questions or raise doubts about different aspects, apart from sometimes being annoying it does get thing brought out into the open, this is not the impression that I got from the author of this blog. A healthy debate is better than a one sided conversation and I thank you and everyone else for taking the time to ask and listen to what has been argued.

    I personally know that statins cause considerable damage to many people but it is up to yourself whether or not you think that if the millions of people taking statins were actually made aware of what they are capable of doing, would still be taking them at all.

    The reality is that doctors were not made aware of the problems these drugs can cause, if a doctor was aware or had doubts about them they would surely have asked about a possible link via the sales reps or manufacturer etc.

    You will also see that the old and vulnerable have had to take this medication because scientists and the medical profession believed that it was so wonderful. The amount of pain and suffering they have inflicted on those poor souls is unthinkable.

    I am just waiting for them to add it to petrol so that cars will last longer or something equally as stupid to keep sales going.

    I will leave this for now, but I think you already know what is going on from your own observations and from what you have also just read from the 2 links I mentioned in the last post, no one can see what they do not want to see but I think maybe you are better than that, either way everything is there to be seen for those who open their eyes.

  10. pec says:

    Nothing is True unless it has been demonstrated by research funded by big drug companies.

    Nothing is True unless your MD tells you it is True.

    Your own experiences are not True, unless they agee with what your MD and the big drug companies say is True.

    Now be good little sheep and get back in your herd.

  11. UK-Bloke says:

    @ pec

    I am pleased I know you wrote this comment tongue in cheek and I know you expected someone is bound to say:-
    “it’s flock and not herd”

    and you they are right, BUT DO NOT SAY IT FAST!

    “Now be good little sheep and get back in your herd.”

    another report was descussed here:-
    http://forums.wsj.com/viewtopic.php?t=1351

  12. pec says:

    UK-Bloke,

    I must disagree with you on this point. Sheep can belong to either a flock or a herd. We know this because we speak of herding sheep.

    Now repeat after me:

    Bahhhhh. Everything my MD tells me is true.
    Bahhhhh. Research funded by big drug companies is never biased.
    Bahhhhh. We must never have an opinion on anything unless it has been demonstrated by big science, preferably funded by big drug.
    Bahhhhh. My MD is all-knowing and must never be questioned.

    Now go back to your herd (or flock).

  13. PalMD says:

    @raygee

    You have no idea what you are talking about.

    The data that supports statin use is not just aimed at cholesterol levels, but, as I and every other actual professional has mentioned, at real life outcomes.

    Primary and secondary prevention ARE legitimate reasons to prescribe a medication.

    I would suggest you look the terms primary and secondary prevention up.

  14. weing says:

    pec, are you taking statins? If not, then I definitely will continue taking mine.

  15. UK-Bloke says:

    @ pec

    Bahhhhh humbug EWE got me there I say rather sheepishly :-)

    Someone else talking about statins had similar comments about people being treated like sheep and came out with the name Sheeple ie those who are easily led and was very apt for the context of which they wrote at the time. I don’t have a problem with that but the first time I see a jar of mint sauce on my doctors desk I think I will make a hasty exit (unless he pulls the wool over my eyes), I will also start worrying if he comes to work wearing wellington boots and says hey ewe, come here my little lamb hehe :-)

    I can’t blame any medication for my warped sense of humour but after visualising my doctor in green wellington boots, I think I am starting to like the idea :-) Help!

  16. raygee says:

    @ PalMD

    I know that primary prevention efforts with statins have 80 deaths recorded against them in UK Yellow Cards, and thousands of varied other problems, varied because the damaging suppression of Coenzyme Q10 and other mevalonate products prevents ATP being made in the mitochondria wherever in the body that deficiency happens to occur, it is not controllable. Those with a good supply of Q10 may not notice the death or cessation to operate of a few cells in a particular function, but others, particularly those in the second half of life, cannot afford any loss, and problems are almost inevitable.What price is primary pevention prepared to pay, and could everyone be told the full extent of the risks attached to it?

    As for secondary prevention, those whom I know who have had MIs and been given statins have had such severe side effects that they had to give up the statins, still experiencing the side effects, but their hearts keep working OK. The same has been reported in trials by clinicians trialling the use of Q10 in such cases. Note: medical personnel appear to have no idea how to treat those severe side effects, some food for thought there.

    Primary prevention must be essentially risk free, extension of life at the expense of quality of life is a very doubtful advantage, and the medical press has questioned if attempting to prevent CVD in the elderly is not likely to make the eventual cause of death something much more sinister and unbearable.

    If the data that supports statin use is not aimed at cholesterol, why use a cholesterol lowering drug, and not fully investigate the real reasons why statins save some lives, for example prevention of inflammation, reduction of homocysteine, or Nitric Oxide support.

    The influence of commerce has been much greater than that of science in the cholesterol field, commencing with Ancel Keys’ assertion that saturated fat and cholesterol were linked, only publishing the minority of studies that agreed with his theory, and ignoring the others. The Food Industry has made a great pile out of Lite products, and the drug industry much more. Lipitor is said by its manufacturer to be the most researched of drugs, but trials are not research, mainly they are market preparation. True research is necessary in much narrower and deeper biological fields, to ensure that the whole of the area of influence of the drug is known.

    I am sure you will not let me convince you in all this, but the days of the paternalistic doctor, believed to know everything, are long past, and patients have access to more information with which to choose and make up their own minds on the course of action to take. I have studied this subject for several years now, I would have been dead long ago if I had not done so, and I have found that the big organisation is by no means the only fount of knowledge. Dedicated individuals and groups, interested in finding real answers to particular problems, find things that help, without having to try to invent mass market goods.

  17. jayemcee says:

    @ raygee

    raygee, It is futile to address the authors and residents of this so-called science-based medicine blog. Clearly, they are all either unwilling, or incapable, of examining the scientific literature in a manner that does not support their personal prejudices.

    It is absolutely disgraceful conduct to deflect anything with which they collectively disagree. It means this erudite site is little more than a mutual masturbation society.

    I would have expected something more from people with the elevated and trusted role of the family medical practitioner. Nevertheless, the statin gravy train is finally coming off the rails. It follows that there will not be another social milieu that automatically lauds medics and places them on a pedestal, after this egregious display of quackery.

    As for big pharma… the attitudes on this blog have obviously been bought and paid for by the drug overlords (to judge from the obfuscation and the reluctance to address a single point made in opposition to the prevailing one that is favoured by the residents of this blog) and it is a concrete example of the belief that drug companies, and their medically qualified stooges, can be left to act in an untrammelled manner because they have pots of gold to dispense to the hard of thinking.

  18. PalMD says:

    “It means this erudite site is little more than a mutual masturbation society.”

    Hmm…when groups of scientists agree about something, it’s usually called “consensus” rather than “masturbation”. Your idea does sound more fun, though.

  19. weing says:

    If I recall correctly there was the PROVE IT study that compared low dose Pravachol to high dose Lipitor to see if something other than cholesterol lowering played a role. The study was run by the makers of Pravachol, who were hoping that a pleiotropic effect would be shown for their drug. Unfortunately their competitor drug came out on top showing that the amount of cholesterol lowering was what was important in preventing recurrent coronary events. Not everyone can benefit from a statin. They are safe as long as you monitor for side effects. There are people who have intolerable side effects from them and unfortunately there is little that can be offered them other than TLC and they die sooner. Others are too stupid to listen to their doctors and listen to CAM quacks and don’t benefit from them either and they also die sooner. Everybody does die, sooner or later. Some have a choice, some don’t.

  20. UK-Bloke says:

    @ weing,

    That was a pretty decent post right up to the point about :-

    *Others are too stupid to listen to their doctors and listen to CAM quacks and don’t benefit from them either and they also die sooner. Everybody does die, sooner or later. Some have a choice, some don’t.*

    I think you will find that most of the victims have listened to their doctors telling them that statins don’t do that or you are just getting older and even that you will die if you stop taking them. We believed in what our doctors tell us, it is a disgrace when we find out that a patient has more knowledge about statins than the person who prescribed them, this is fact and not a fairy story.

    You may not realise that most doctors did not even know about the side effects that statins cause, there are still doctors as on the ABC News article I mentioned in an earlier post claiming they have nothing to do with memory problems.

    I have put the link here to save you searching, read the comments that have been left by ordinary people who have been affected by something that has been kept away from the doctors prescribing this stuff and the people who have taken it.

    http://abcnews.go.com/Health/HeartDiseaseCenter/story?id=4281162&page=1

    also a PDF copy of some interest:-
    Primary and secondary prevention
    http://www.dustri.com/ze/cp/samplecopy/cp12567.pdf

  21. weing says:

    I am very much aware of the effects and side effects of statins. Have been prescribing them to patients and using them personally since my own MI in 1994. I have always carefully monitored my patients and have not forced anyone to stay on them. There are patients who do not tolerate them and we stop them. I would not take a medicine if it was making my life miserable and would not expect a patient to do what I wouldn’t. (Unless it was for a brief period. Unfortunately that is not the case with statins.) There are other medications that we try, unfortunately they are not as good as the statins, but we do our best. Even then, patients may not tolerate them either. There are no medications without side effects. Statins are only part of the treatment of the patient and lifestyle modifications are essential. My approach to patients is not a one size fits all, and therapy is individualized for everyone based on risk factor analysis (to determine risk of cardiac event over the next 10 years) for primary prevention and goals of treatment, risks and benefits are discussed, and the patient then decides on what he wants to accomplish.

  22. McDoctor says:

    The Steinberg article was very informative. Thanks for the link.

    (It’s worth pointing out that he ends the article with a few unreferenced, and I’d have to assume relatively unproven, claims about statin benefits in women and the elderly, in an otherwise rigorously referenced historical account.)

  23. jayemcee says:

    @weing

    PROVE-IT – 4,162 patients following an MI, or unstable angina. Half were given atorvastatin and half were given pravastatin. LDL was shown to have been reduced more with atorvastatin than with pravastatin. The principal finding was a 16% reduction in the ***relative risk*** of dying from a cardiovascular event.

    All-cause mortality, for patients taking atorvastatin, fell by one percent from 3.2% to 2.2% in two years thus equating to one half of a percent reduction in absolute risk for each year. Not quite the stunning 16% reduction in cardiovascular events that reading the PROVE-IT study had suggested.

    The PROVE-IT study exhibited a basic error in using two variables and the startling 16% reduction in relative risk was found in patients taking a different drug to that which was under scrutiny. The trial proof should have been derived from a single drug… not two different drugs; which did provide for one uncontrolled variable.

    Deriving meaning from PROVE IT would have required that there was an identical mode of action from both drugs used. All PROVE IT managed to ‘prove’ was that atorvastatin appeared to offer more protection that pravastatin. It may have had little or nothing to do with any assumed effect on LDL. Hardly earth-shattering news and not really a scientific study either.

    J-LIT studied more than 30,000 patients and the drug, simvastatin, was given at a single 5mg dose OD to all participants. That study demonstrated that there was NO CORRELATION between the amount of LDL reduction and the mortality rate.

  24. jayemcee says:

    @ PaIMD

    [quote] Hmm…when groups of scientists agree about something, it’s usually called “consensus” rather than “masturbation”. Your idea does sound more fun, though. [unquote]

    Methinks thou dost protest too much.

    To qualify for the appellation ‘groups of scientists’ it is a given that science is the mutual glue that binds them into a group. Rubbishing anything that runs counter to the current religion or that is just disagreed with, from a position that is neither inviolate (practising clinicians) nor unassailable, is not the practice of science.

    This site is inhabited by clinicians, who appear to be bent on refusing to look at any of the scientifically derived evidence proffered, from appropriately conducted clinical trials and collectively could never be considered to be a ‘group of scientists’.

    It will be clear, to any half-sensate human being, that unless the clinicians on this site get around to answering any of the scientifically founded criticisms against statinisation, they are doomed to remain a random collection of individuals, whose sole purpose appears to be the tedious promulgation of unfounded personal opinions.

  25. UK-Bloke says:

    @ weing,

    I am pleased to hear that you are amongst the enlightened doctors who are aware of side effects and treat your patients with care and monitor their progress closely. Without going into too much detail, the myriad of both mental and physical (memory problems, tiredness and pain sites etc) seem at first to be unrelated until it was observed that the statins depleted other vital resources in its blocking of cholesterol.

    Unfortunately this information has not been passed on to so many doctors and their patients where it could and really would have made such a vast difference to the way treatment was carried out.

    There are so many people who are exhausted all the time and have problems with names, stringing a sentence together and often in pain. When you go to see your doctor and try to explain your symptoms to him, all you end up doing is looking like a hypochondriac, even more so when nearly all tests come back negative unless the blood CK level becomes elevated etc.

    If doctors were made aware about side effects and the depletion problem, I dare say that a lot of people would not have been made so miserable for so long and for some, that pain and misery could be permanent.

    Most doctors do the right thing with the knowledge they have by getting blood tests, x-rays of joints, MR scans of the brain etc and get you to see a neurologist and rhumatoligist as well as cardiologist and all the tests entailed. The shame of it all is not one of them may know about statin side effects either!

    For a doctor to do make the right decision, he/she should have vital information about side effects and symptoms passed on to them, Statins have been in use for around 20 years or so. Why are doctors still in the dark about the side effects and still unaware about the depletion issue?

    I had my own MI in 1995 and statins soon started after that, I also had a triple bypass December 2004. My Zocor – Simvastatin was raised from 10mg to 40mg prior to the operation and my health issues rapidly got worse from there on in. Everyone including myself thought it was because of the need for bypass surgery, all I can say about that is we were all so very wrong.

    You obviously know what to look for in your patients who are receiving statin therapy, I do hope that you will pass on your knowledge to your colleagues as it really could save a lot of people from coming to harm even with the very best intentions.

  26. daedalus2u says:

    jayemcee

    Project much?

  27. jayemcee says:

    @ daedulus2u

    I suggest that you try a little harder to find a credible scientific argument for the use of statins; rather than attacking the messengers arriving with bad news.

    Oh wait… you don’t have one.

  28. weing says:

    jayemcee,
    “PROVE-IT – 4,162 patients following an MI, or unstable angina. Half were given atorvastatin and half were given pravastatin. LDL was shown to have been reduced more with atorvastatin than with pravastatin. The principal finding was a 16% reduction in the ***relative risk*** of dying from a cardiovascular event.

    All-cause mortality, for patients taking atorvastatin, fell by one percent from 3.2% to 2.2% in two years thus equating to one half of a percent reduction in absolute risk for each year. Not quite the stunning 16% reduction in cardiovascular events that reading the PROVE-IT study had suggested.”

    The above is a beautiful example of a straw man argument.

    “The principal finding was a 16% reduction in the ***relative risk*** of dying from a cardiovascular event.” is not true and need not be defended.

    “All-cause mortality, for patients taking atorvastatin, fell by one percent from 3.2% to 2.2% in two years” is true. So what?

    “Not quite the stunning 16% reduction in cardiovascular events that reading the PROVE-IT study had suggested.” is false.

  29. daedalus2u says:

    UK Bloke posted a link that was pretty compelling in favor of statins.

    http://www.dustri.com/ze/cp/samplecopy/cp12567.pdf

    So what is “wrong” with this study? Other than it doesn’t show that statins are the death substances you believe/want/need them to be?

  30. pc says:

    “All-cause mortality, for patients taking atorvastatin, fell by one percent from 3.2% to 2.2% in two years” is true. So what?

    I take statins myself but I have to say that if raised LDL is the main cause of heart disease, and statins lower this substance by such a big margin, I would hope for a much larger reduction in all-cause mortality than an absolute 1% or a relative 16%.

  31. jayemcee says:

    @ weing

    translation… I don’t believe what you have said so I will ignore it.

    Yet another demonstration that the clinicians writing on and for this web site eschew scientific evidence in toto and are completely unwilling to address peer-reviewed evidence against statins.

    Your (lack of) argument relies on this web site’s common currency of claiming ‘logical fallacy’ or ‘strawman argument’ in every instance where some point is made that does not fit with your worldview. It is precisely the sort of Google logic 101 nonsense that is typical of protagonists with nothing to say. A little training in symbolic logic would possibly serve you better.

    Care to try turning your hand to dismissing J-Lit?

  32. weing says:

    pc,

    All-cause mortality is one thing, a cardiac event is another. You don’t really expect a statin to prevent you from being shot or hit by a car and many other causes of death do you? Not all cardiac events are fatal too. And here, you are talking about only 2 years. Unfortunately, the best that statins can do is to decrease coronary heart disease risk by 30% max.

  33. weing says:

    jayemcee,
    I would not try to convince you of anything. I am just pointing out that you are using fallacious logic which results in wrong conclusions. There is no need for belief.

    Regarding J-Lit:

    Let’s imagine you have a country where the people are starving. Food that will save them costs 40 cents. They have no money. Some kind people decide to see if they can help them by giving them money. They allocate 5 cents to each starving person. They end up starving to death. The kind people deduce that money does not prevent starvation and stop wasting their efforts in this direction.

  34. jayemcee says:

    the date from J-Lit is not imaginary

  35. jayemcee says:

    Apart from the typo (date instead of data) what possible relevance does imagining anything have to with the data gathered from Japan which is not considered to be a country where the people are starving.

    This is another example of the consistent failure of members of the pro-statin lobby, to address any factual evidence. On its face, one may easily conclude it was myopia. A little further consideration reveals the mass hysteria of clinicians who refuse to deal with facts.

    Not a single factual piece of evidence (provided by the anti-statin lobby) has been addressed in a scientific manner since the beginning of this thread!

  36. weing says:

    I see my analogy was totally lost on you. That explains why you misrepresented the findings in PROVE-IT. You simply are unable to understand it. You do not have to take statins, you may or may not need them. I have no way of knowing that. Anyone that needs to take them ,and who you convince not to use, will only feed the medical-industrial complex with heart attacks, strokes, peripheral vascular disease that will keep the cardiologists, cardiac and vascular surgeons, neurologists, and medical device makers, busy and making lots of money for a long time.

  37. pc says:

    weing

    “All-cause mortality is one thing, a cardiac event is another. You don’t really expect a statin to prevent you from being shot or hit by a car and many other causes of death do you? Not all cardiac events are fatal too. And here, you are talking about only 2 years. Unfortunately, the best that statins can do is to decrease coronary heart disease risk by 30% max.”

    I take your point and whilst I agree with what you are saying, you simply cannot ignore all-cause mortality rates. Yes, the drug could be doing a good job at reducing cardiac events (and statins do, thats why I am taking them), but wiping you out in another way (heart failure, cancer etc). If the positive effects of the drug are totally negated by other means that have nothing to do with cardiac events then the drug is useless. I believe this is one of the points that the THINCS lot (Dr Malcolm Kendrick in particular) are trying to get across. I understand that in tests on rats with statins, there was a statistically significant increase in cancer. If this effect translates into humans there are going to be a lot of upset people!!

  38. weing says:

    You say Japan is not a country where people are starving. You are correct. What is the prevalence of coronary disease in Japan? What is the prevalence in the US and European countries? Compare the risk of an MI of an average 40 year old man in Japan to that of the average 40 year old in the US. If the risk of MI is high, statins will help if the risk is low statins will not be of benefit. That is why individualize treatment. I would not prescribe statins to anyone whose risk of MI is low, there is no benefit and all you’ll get is side effects.

  39. weing says:

    pc,
    Fortunately for you and me, they have not been shown to cause cancer. I keep wondering though, if you were supposed to get cancer at 80 but an MI killed you at 40 or 50 or 60 or 70, would you say the MI prevented cancer? Now suppose you took a statin that prevented the MI from killing you and you reached 80, would you say the statin caused cancer?

  40. pc says:

    weing

    Yes, I understand from my cardiologist that a cancer link in humans has not yet been proven. As you say it would be hard to prove a definite connection using simple statistical analysis, mainly because a large proportion of the people given statins are the elderly (who are at increased risk of cancer anyway). Besides, being a fact based man, I would want someone to be able to explain the mechanism by which statins cause cancer rather than just relying on a set of numbers pointing to a possible link. However, I am still wary of taking statins having had several friends have such a bad time with them (one was off work for 5 months due to statin side effects. The doctors simply would not believe it was the atorvastatin, until he eventually saw a neurologist who decided the nerve damage he was seeing had to be statins. 4 weeks after coming off them he was back at work).

  41. Dacks says:

    Dr Hall and others,
    Thanks for taking the time to explore this subject so thoroughly. This discussion will inform my decision if my doctor were to prescribe statins for me (not that it seems likely in the near future.)

    My very naive question for those who are more focused on statins’ risks than their benefits: If you feel that taking statins would be harmful to you, why not just say no? Medicine is a collaboration between doctor and patient. There are multiple ways to treat any disease; if you wish to avoid certain treatments you should work out other options with your doctor. And if the doctor refuses to be flexible, you should find another doctor.

  42. UK-Bloke says:

    @ Dacks,

    your question is a valid one and if either the doctors or the patient had been made aware of all the problems that can and do occur to a great many people, then there is no way on earth that most people with a hint of common sense would take such a vast risk of letting themselves come to harm.

    The answer to peoples choice in this matter is that they were not made aware of the dangers and were told that this medication is safe other than a very few people had liver problems with it (hence the blood work).

    To top it all, there are still doctors proclaiming the virtues of this wonderful medication and denying that there is a problem. (ABC News report etc)

    I am not going to get on my soap box and try to persuade you either way, everything you need to know IS coming to light now, but it was not a few years ago and people like those at THINCS and Spacedoc.net have helped so many people come to terms with there symptoms that they should be praised for it and not ridiculed by someone who really should know better.

  43. pc says:

    The problem is, for those of us who have heart disease, there is no other proven medication that has the efficacy of statins. I tend to agree with Dr Malcolm Kendrick on the use of statins. That is, if you have heart disease then I would strongly advise you to at least try them. If you have not got this particular risk then I wouldn’t bother. I would concentrate on diet and exercise.

  44. jayemcee says:

    @ Dacks

    [quote] My very naive question for those who are more focused on statins’ risks than their benefits: If you feel that taking statins would be harmful to you, why not just say no? [unquote]

    People who have tried to just say no are frequently considered mad by their medical practitioner and in the UK, they are left without a doctor when the practice has them removed as awkward patients.

    (you may not realise that the UK assigns the medical practitioner to the patient and rarely is there any choice… unless you are a private patient)

    [quote] Medicine is a collaboration between doctor and patient. [unquote]

    Nonsense. When does a medic accept the patient’s own view about a proposed course of treatment? ANY questioning of a clinical opinion by a lay person is met with incredulity.

    Read above and note the sneering tone inherent in the following enlightened statement… [quote] It wasn’t a day or two at “google university”[unquote] from PaIMD, whom one would assume is an enlightened medic who would accept your statement in its entirety.

    [quote] There are multiple ways to treat any disease; if you wish to avoid certain treatments you should work out other options with your doctor. And if the doctor refuses to be flexible, you should find another doctor. [unquote]

    As indicated, you cannot transfer easily between assigned medical practitioners. There is an issue of informed consent. I happen to believe that the patient has a right (the clinician has the obligation) to be informed about any proposed treatment. It is the clinician’s role to make explicit the likely outcomes and the risks involved in pursuing any particular form of treatment.

    Given the unwillingness of the medics (a large number of whom accept pharmaceutical company funding) to consider the possibility that statins may be harmful and furthermore, given the lamentable state of knowledge about basic biochemistry demonstrated by clinicians, it is clear that the patient cannot be informed appropriately before agreeing to take statins.

    Statins aside, the cholesterol heart disease hypothesis has been demonstrated to be untrue on many occasions. Patients are being coerced into lowering the substance that their body needs. People with low cholesterol levels have been shown to die earlier than people with high cholesterol levels.

    Explain to me why aboriginal Australians with very low cholesterol, get a lot of heart disease and then explain to me why the Swiss, with very high cholesterol levels do not get a lot of heart disease. Explain also why the other products of the body that are inhibited by statins within the mevalonate metabolic pathway, somehow become unwanted by the body just because statins are lowering cholesterol.

    You original question was why not just say no. I do but I am concerned for the large numbers of people who believe that their doctor will never get it wrong nor do them any harm. I am happy to devote my time and my energy to preventing people from taking statins. An instructive phrase that has been attributed to Edmund Burke follows…

    “All that is necessary for evil to succeed is for good men to do nothing.”

    Take statins if you must but permit me to try to prevent that act.

  45. weing says:

    “Take statins if you must but permit me to try to prevent that act.”

    I’ll permit you, if you permit my family to sue you for everything you have and garnish your wages should I subsequently get a heart attack.
    The problem you describe with physicians discharging patients like you from their practices is coming to the US as physicians are increasingly being paid on the basis of performance. If my patients have less heart attacks, I will make more money and I’ll be penalized if they have more cardiac events.

  46. jayemcee says:

    [quote] I’ll permit you, if you permit my family to sue you for everything you have and garnish your wages should I subsequently get a heart attack. [unquote]

    This pre-supposes too much. To whit, that statins prevent MI (they don’t) and that heart disease will never occur when statins have been given (it does) Furthermore, people do not die through lack of statins. they have died over the aeons because from a myriad of causes… non of which statins address. Your family, as well as you, need to understand the damage done to the ability of cells to derive energy from food via, heme a, before rushing off to a lawyer.

    [quote] The problem you describe with physicians discharging patients like you from their practices is coming to the US as physicians are increasingly being paid on the basis of performance. If my patients have less heart attacks, I will make more money and I’ll be penalized if they have more cardiac events. [unquote]

    It is ridiculous to penalise you for not prevent an MI when there is no prevention available. Take away stress inducing factors and inflammatory causes before you remove anything else and you may be in with a fighting chance. until then, it would be unjust to make you suffer because of a poorly understood multi-factorial event taking place on your watch.

    There is a shocking unwillingness to acknowledge that none of us (clinicians especially) are infallible. I object to large amounts of support being given by drug companies to medics who push their products but there is no case for penalising a medic doing his best for a patient, who may not even be compliant.

  47. pc says:

    weing –
    “Fortunately for you and me, they have not been shown to cause cancer.”

    This is not strictly true. Go to pub med and. search on this:
    “Effect of the magnitude of lipid lowering on risk of elevated liver enzymes, rhabdomyolysis, and cancer: insights from large randomized statin trials.”

    Alsheikh-Ali AA, Maddukuri PV, Han H, Karas RH state in the conclusion:
    “Furthermore, the cardiovascular benefits of low achieved levels of LDL-C may in part be offset by an increased risk of cancer.”

    By no means evidence but a worrying finding nevertheless.

  48. weing says:

    jayemcee,
    Sorry to burst your bubble but those types of wrongful death lawsuits are a reality for physicians. They should also be a reality for cranks but they are not, so you need not worry. Just because you chose to ignore research and say statins don’t prevent MIs does not make your assertion true. As I posted previously, you cannot prevent coronary events 100%. 30% is about the maximum reduction in coronary disease that has been shown. I know, I’m disappointed too.

  49. weing says:

    pc,
    Definitely needs more studying. The association that they found does not imply causality. There are confounding factors. It is well known that cancer will lower your cholesterol level and low levels are an indicator or effect of the disease. This association was found in patients with lower baseline levels of cholesterol which would support that hypothesis. But definitely needs more studying and will be studied. In the meantime, I’ll keep my fingers crossed and continue to take my statin.

  50. jayemcee says:

    @ weing

    [quote] jayemcee,
    Sorry to burst your bubble but those types of wrongful death lawsuits are a reality for physicians. [unquote]

    No bubble to burst. My recall is that it was the clinicians, themselves, who had invited lawyers to advertise in emergency rooms throughout the UK because of some additional sponsorship for equipment and FREE appointment cards with the law firm’s details printed on them.

    When you give houseroom to a viper, you can hardly be surprised if it should choose to bite you.

    [quote]
    They should also be a reality for cranks but they are not, so you need not worry. [unquote]

    pfft.

    [quote] Just because you chose to ignore research and say statins don’t prevent MIs does not make your assertion true. [unquote]

    I have not ignored any of the relevant research. I happened to choose to read a little more research concerning cholesterol, heart disease and the biochemistry of cells. I don’t object to you having a disagreement if you would support it with some references.

    In fact, I accept what you say is true and statins do prevent MI. Just explain to me how statins manage to do that (the mechanism by which taking statins prevents a heart attack) and then cite some appropriate references… if there are any.

    [quote] As I posted previously, you cannot prevent coronary events 100%. 30% is about the maximum reduction in coronary disease that has been shown. [unquote]

    So for every 100 people taking a statin, 70 are taking the drug needlessly? Or is this a very selective 30% and we can all reduce our relative risk of a cardiovascular event by 30% if we all take a statin?

    [quote]I know, I’m disappointed too. [unquote]

    What disappoints me is the large number of people who have been damaged by statin therapies. The possibility of preventing any more cases of iatrogenic damage is precisely why I admit to being the crank to whom you would ascribe that epithet.

    The damage to the body, caused by statins, is profound and incapacitating. Should you feel like discussing the why and the how, I will be around.

  51. weing says:

    jayemcee,

    You can look up how statins prevent a heart attack in any standard cardiology or pathophysiology textbook.

    If you had a 50% chance of having an MI in the next 10 years, then by taking a statin you will lower your risk of an MI to a 35% chance.
    What disappoints me is that you can’t lower it to 0% chance.

    Damage caused by statins is real, easily recognized and dealt with.
    There are no drugs without any risk of damage. Medicine is constantly learning and evolving. Remember cerivastatin? It got pulled from the market because of excess rhabdomyolysis.
    I remember when I was a resident and people were using Quinidine for atrial fibrillation and palpitations. It worked great. Studies showed that it worked true enough, but people treated with the drug died faster. It didn’t take long to find out either. Guess what happened? We stopped using it. The statins have been in use since the late 1980s and no such studies have been forthcoming, in fact the opposite is true.

  52. jayemcee says:

    [quote]You can look up how statins prevent a heart attack in any standard cardiology or pathophysiology textbook.[unquote]

    I have. I wanted to learn about the current theoretical basis for statins preventing cardiovascular events. If things work in a standard way, then the standard studies (double-blind RCTs) should be available to support the proposition.

    My request was for you to provide those scientific references because this site arrogates the title Science-Based Medicine to itself and anecdotes are, presumably, not required here.

    [quote] If you had a 50% chance of having an MI in the next 10 years, then by taking a statin you will lower your risk of an MI to a 35% chance. [unquote]

    So you say but where is your evidence for adopting this position?

    [quote] What disappoints me is that you can’t lower it to 0% chance. Damage caused by statins is real, easily recognized and dealt with. [unquote]

    Agreed, although I don’t support the notion that the damage is easily recognised because so many people appear to be damaged and the clinician not only did not recognise the damage but refused to believe that such damage could devolve from the use of statins.

    [quote] There are no drugs without any risk of damage. [unquote]

    A fine example of a tautology.

    [quote] Medicine is constantly learning and evolving. Remember cerivastatin? It got pulled from the market because of excess rhabdomyolysis. [unquote]

    Would that were really true. Medicine ought to be constantly learning and evolving but the profession has ceded much of its professional responsibility to administrators, governments and pharmaceutical companies. Cerivastatin was rightly pulled.

    I believe that a later examination had revealed rather more people were killed than Bayer had initially owned up to. Pfizer were informed of an increased death rate for the compound atorvastatin/torcetrapib and that study was pulled in December 2006. ENHANCE appears to have been pulling the wool over rather too many sets of eyes.

    Merck not including CoQ10 with their original product shows the pharmaceutical companies’ willingness to betray the medical profession, governments and the people who will be buying and using their products.

    [quote] I remember when I was a resident and people were using Quinidine for atrial fibrillation and palpitations. It worked great. [unquote]

    Quinidine was not the treatment of choice in say… re-entrant paroxysmal SVT when I was working in an ER environment 3 decades ago. We used either carotid sinus massage, attempted to get the patient to carry out a Valsalva manouvre or we tried to harness the vestigial diving reflex and splashed ice cold water on the face of the patient. If these methods failed then treatment progressed to cardioversion and finally the drug verapamil were used.

    [quote] Studies showed that it worked true enough, but people treated with the drug died faster. It didn’t take long to find out either. Guess what happened? We stopped using it. [unquote]

    It was the only rational course of action, to stop using quinidine, when it was seen to be killing people faster than if they were not treated with it.

    [quote] The statins have been in use since the late 1980s and no such studies have been forthcoming, in fact the opposite is true. [unquote]

    Are you saying that statins are not harming people and that there are no studies to demonstrate such a happening?

  53. weing says:

    No, I am saying that the studies show that high risk patients taking statins are less likely to have MIs and strokes than those not taking them. If you are one of the unlucky few, who experience disabling side effects from them, you will unfortunately, not be able to benefit from them.
    You seem to be saying that high risk people should not use statins because they may experience disabling side effects from them. They should therefore not benefit from them because of your worry of side effects.
    That’s very paternalistic of you.

  54. jayemcee says:

    Back to the cholesterol heart disease hypothesis. It has been falsified on more than one occasion and the hypothesis does not stand up to scrutiny. It does not hold true for every single study and black swans abound.

    Given the facts, why should anyone be attempting to lower cholesterol in the first instance? Why should anyone have to be undergoing cholesterol reduction through the use of toxic drugs that are inimical to cellular life?

    Yes, I know it is really paternalistic of me… not to want to see more people being harmed by a supine medical profession, that successfully gives the impression of being universally happy to take drug company largesse and carry out large scale research projects for the reflected glory that they can bask in while collecting industry sponsored accolades. You may have missed the NEJM study of that particular situation.

    It is an utter disgrace that the medical profession still tolerates the fraud of highly paid (by the drug companies) clinicians, who have been permitted to make public pronouncements that uncritically recommend the products of their paymasters, in the face of evidence to the contrary.

    It is no more paternalistic of me to want to see an end to the unsupported and falsified hypothesis, that cholesterol is the causative villain of the piece in heart disease, than an equally paternalistic medical profession… desiring to medicate large numbers of people for life (with everything that presages) with a deeply toxic preparation, without a proven clinical need.

    The world is now redolent of ‘Alice Through The Looking Glass’ where everything is turned upside down and patients are only healthy if they take drugs (needlessly) for life and visit the medical practitioner every three months for vital sign monitoring, LFT’s and heck knows what else… to no other purpose than to sell more drugs and collect more fees for service from patients and drug companies alike.

    I will remind you that it was the well-named Dr Reckless, who had advised government bodies, when they were deciding national health policies, that statins should be put into the water supply! Not just paternalistic but an indiscriminate blunderbuss approach to cardiovascular health.

    It was a sad testament to the times we live in, that Reckless felt able to publicly declare his support for a clinical policy so obviously bereft of common sense. In the halcyon days of clinical practice, he would have had his future clinical career destroyed by declaiming his support for such nonsense.

    Ward and Law had wanted to medicate everyone for life, with a polypill that they had the prescience and presence of mind to patent, BEFORE, they had published their life-saving stratagem for the developed world, in an execrable article that had graced the pages of a once august BMJ. The howls of protest to the BMJ did nothing to embarrass those fools.

    Yes, I am paternalistic and advocating for the patient (who cannot advocate for themselves) is a paternalistic act that is to be deprecated. [/sarcasm]

  55. weing says:

    Wow, you appear to have knowledge that has eluded all the researchers of the medical profession. I am sure the cardiologists, drug and medical device makers and surgeons will be grateful to you for giving them business. Are you sure you aren’t working for them?
    Wait a minute, you are in the UK where they have socialized medicine. Maybe there is a conspiracy and you are working for the government trying to kill people off early in order to save them money?

  56. jayemcee says:

    I’m done with you now and your poor excuse for scientific debate.

    Not one single scientific paper presented as proof of the need to take statins. It is just some universal truth that we are supposed to absorb by osmosis and accept as correct

    Not a single reference refuted. No interest in examining evidence against the cholesterol hypothesis.

    Whichever drug company pays for this site, they sure got their money’s worth.

    bye

  57. weing says:

    I gave you one study and you showed yourself incapable of understanding it whether deliberately or otherwise. Why should anyone waste their time giving you more studies to misinterpret. Learn first to analyze and interpret them. Take a course.

  58. Razwell says:

    Cholesterol lowering trials have repeatedly been shown to be complet failures for reducing CHD mortality and incidence.

    The Lipid Research Clinics Coronary Primary Prevention TRial

    Out of 3,806 Using cholestyramine a NON statin

    30 CHD deaths TREATMENT vs 38 CHD deaths CONTROLS

    0.04 % ABSOLUTE CHD mortality risk reduction

    How is this supportive of the Cholesterol Theory?

    There are 18 clinical dietary intervention trials to date NONE fo which show any support to the false idea that saturate fat increases CHD mortality or incidence.

    ANTHONY COLPO exposses all of this

    Did YOU know Ancel Keys started this crap by OMITTING natiosn that ate alot of saturated fat and had VERY little CHD and nations that ate low saturated fat and had MUCH CHD

    Ancel Keus study had no scientific validity at all.

  59. Razwell says:

    The ENHANCE trial 58 % reduction in LDL (far more than ANY statin trial ever produced) and the result?

    An INCREASE in atherosclerotic plaque at ALMOST DOUBLE the rate of those taking Zocor alone.

  60. Razwell says:

    And if YOU want the NALYSIS of the J-LIT trial YOU can read here by ANTHONY COLPO

    http://www.lowcarbmuscle.com/forums/showthread.php?t=162

  61. Razwell says:

    NONE of YOU doctors on here have the intellect of ANTHONY COLPO.

    ANTHONY COLPO has an OPEN CHALLENGE to ANYONE to SHOW THE TIGHTLOY CONTROLLED CLINICAL TRIAL SHOWING SATURATED FAT AND /OR CHOLESTEROL TO BE CAUSAL OF CORONARY HEART DISEASE

    I KNOW NONE of you doctors on here can do it – because the evidence does NOT exist.

  62. weing says:

    re ENHANCE, you are lying and totally misrepresenting the study. You are another one who can’t read and understand a study. Why don’t you read it to try to really understand it and not search for anything in it that titillates you to believe you have found the proof for your inanities. It really is a crime that you are not liable for adverse outcomes that any moron, that needs these meds, would sustain by falling for your nonsense and discontinuing them.

  63. PalMD says:

    cuz he haz gramer ishues

  64. fls says:

    I suspect it’s a parody.

    Linda

  65. Razwell says:

    Hey “Doctors”

    Your merit badges mean NOTHING.

    Arguments from “authority” carry little weight – because there are NO AUTHORITIES IN SCIENCE.

    HOW has Anthony Colpo misinterpreted ANYTHING?

    To the ‘doctors” on here:

    Anthony Colpo OPEN CHALLENGE

    PROVIDE the evidence from a tighly controlled clinical trials showing saturated fat and or cholesterol to be CAUSAL of coronary heart disease – OR SHUT IT !!!!!!!!

    You biult your careers on NONSENSE.

    Having elevated FASTING BLOOD SUGAR is a predictor of future coronary events NOT cholesterol.

    STRESS and elevated blood sugar are DIRECTLY causal of coronary heart disease.

    AGAIN GET FAMILIAR with the research. Thgere are EXCATLY 18 clinical dietary intervention trials to date NONE fo which support the Cholesterol Theory of CHD.

    The Women’s Health Initiative 2006 being the latest.

    AD HOMINEN attacks Anthony Colpo are A SURE SIGN OF SOMEONE WITH NO SCIENTIFIC ARGUMENT and they KNOW IT so they ATTACK THE PERSON PERSONALLY.

    READ COLPO AND LEARN

    Think HDL is protective?

    http://www.lowcarbmuscle.com/forums/showthread.php?t=1657

    THINK LDL causes CHD?

    http://www.jpands.org/vol10no3/colpo.pdf

    Bad Cholesterol OR BAD SCIENCE?

    YOu “doctors” have MUCH to learn from Anthony Colpo.

    He puts YOU to SHAME. You KNOW it.

  66. Razwell says:

    Think the Lyon Diet Heart Study supports the Cholesterol Theory of CHD “doctors”?

    THINK AGAIN – Anthony Colpo explains

    http://www.lowcarbmuscle.com/forums/showthread.php?t=111

    THINK The Anti Coronary Club 1966 supports the Cholesterol Theory of CHD? THINK AGAIN

    There were 8 deaths from CHD in those randomized to polyunsaturated vegetable oils DESPITE HAVING A CHOLESTEROL LEVEL OF 225 mg/dl COMPARED TO 260 mg/dl in animal fat crowd NO CHD DEATHS FROM PERSONS RANDOMIZED TO SATURATED FAT

    You ONLY would see this in a throw away line in the FULL TEXT of the study.

    At least they died with a low cholesterol level I am sure that was of great comfort to loved ones.

    Did YOU know DESPITE the fraud of Ancel Keys upon further examination NO RELATIONSHIP was found between saturated fat and CHD mortality WITHIN, WITHIN nations

    CHD varied 2-6 WITHIN NATIONS such as Italy and Greece and more.

    COLPO EXPLAINS

  67. Razwell says:

    AGAIN Cholesterol lowering trials have REPEATEDLY SHOWN cholesterol lowering is USELESS for lowering CHD mortality and incidence and potentially harmful.

    Look up the A to Z trial, J-LIT, ENHANCE LRC-CPPT.

    J-LIT for instance LOWER CVD risk at higher LDL and total cholesterol levels !!!!!!!!

    http://www.lowcarbmuscle.com/forums/showthread.php?t=162

    I HOPE I offended you Cholesterol Theory proponent doctors YOU have built YOUR careers on a bunch of scientifically untenable NONSENSE and I am NOT shy about telling YOU.

    Anthony Colpo and Dr. Uffe Ravnskov EXPOSE YOU

  68. weing says:

    Are you this Colpos’ butt boy? You mean he showed you the truth and you don’t think for yourself? Try reading the studies yourself to figure them out. A dictionary should be enough to help you. Don’t believe what anyone tells you about them. You might just learn something. Then again, you might not. Do you dare?

  69. David Gorski says:

    THINK LDL causes CHD?
    http://www.jpands.org/vol10no3/colpo.pdf

    I’d be careful about citing articles published in the Journal of American Physicians and Scientists (JPANDS). JPANDS is about as poor a source as any I have ever seen. It’s antivaccinationist, pushing the discredited claim that vaccines cause autism; it’s published some truly dreadful, ideologically driven “research” (and I do use the term loosely) that claims, against all evidence contrary, that abortion leads to breast cancer; in short, it’s a crank journal, and I do not say that lightly.

    That Colpo publishes in JPANDS tells me much about him, and what it tells me is not good.

  70. Razwell says:

    Statins can SLIGHTLY reduce CHD mortality rates. They do this via ANTI INFLAMMATORY, INCREASED NITRIC OXIDE SYNTHESIS, REDUCED FIBRINOGEN CONCENTRATIONS, REDUCED BLOOD VISCOUSITY ANTI SPASM qualities to name a few.

    The ENHANCE trial only FURTHER CONFIRMS THIS amoung mountains of other trials.

    Statins have worked whether cholesterol was lowered a little or alot

    Cholesterol lowering druge BEFORE statins which did NOT have statins 11 other effects WERE COMPLETE FAILURES FOR LOWERING CHD MORTALITY

    See Dr. Malcolm Kendrick’s video on statins here

    http://www.youtube.com/watch?v=jE_RIQY53ys

    You are big on insults to THINCS short on refutation with FACTS

    The ad hominen attack a classic sign of someone with NO ARGUMENT and can NOT refute with research.

  71. Razwell says:

    Also I did NOT misrepresent the ENHANCE trial at all

    You hero Dr. Nissen even said ” This is as bad of an outcome as you could have ”

    58 % reduction in LDL INCREASE in atherosclerotic plaque.

    Dr. Nissen ADMITS Zetia is USELESS. Recommends AGAINST IT

    hHe just hasn’t come to the obviouos conclusion that numerous cholesterol lowering trials have found – cholesterol lowering is USELESS for lowering CHD mortality or incidence.

    Perhaps if Dr. Nissen REVIEWED the research like DR KENDRICK DID he would admit this TOO

  72. weing says:

    You are still missing the point and you are lying regarding the ENHANCE results showing increase in plaque. Read the studies yourself and come to your own conclusions instead of listening to some charlatan. To me the study is useless as the patients were not brought to meaningful cholesterol levels. From the little data that is available, the lowest LDL achieved in the study was 139. The average LDL of a patient with an MI is around 135. If the study showed any significant benefit from Zetia, it would argue for an effect on something other than cholesterol.

  73. Razwell says:

    Please describe how Dr. Uffe Ravnskov and Anthony Colo are charlatans?

    How has he misrepresented the literature?

    See here:

    http://www.opinions3.com/Uffe_Ravnskov_Report.htm

  74. weing says:

    Why don’t describe how they are not charlatans. Give us their qualifications etc.

  75. Razwell says:

    I have challenged YOUR falsely held beliefs and you ahet me for it.

    The classic “appeal to authority” argument.

    Dr. Ravnskov is a REAL DOCTOR.

    Anthony Colo is a researcher.

  76. Razwell says:

    There are exactly 18 randomized clinical dietary intervention trials conducted to date examining the claim that saturated fat restriction lowers CHD mortality and incidence.

    NONE of these trials show saturated fat restriction to lower CHD mortality or incidence. In fact many just the opposite.

    The Women’s Health Initiative 2006 being the most recent.

    See Ancel Keys lies here:

    http://www.fathead-movie.com

    This movie is coming out soon exposing it all to the public.

    See the video proof of Dr. Robert Olson begging Senator McGovern for ” MORE RESEARCH ON THE MATTER” before recommending low saturated fat diets.

    That’s right, the low saturated fat diet was invented by a fraudulent scientists and pushed by a CONGRESSIONAL COMMITTEEE headed by Senator McGovern

  77. weing says:

    How about their CVs?

  78. weing says:

    The only dietary intervention that I remember showing something was the Dean Ornish diet along with all sorts of lifestyle modifications.

  79. UK-Bloke says:

    @ Razwell,

    you are wasting your time trying to get any sense out of the donkeys on this site, OOOP’s I mean doctors, oh no I was right the first time.

    They-ought, They-ought, They-ought to know better really!

    I am very pleased to know that most doctors would not act in such a stupid farcical fashion as this bunch of know nothings.

  80. apteryx says:

    weing writes:

    “Fortunately for you and me, they have not been shown to cause cancer. I keep wondering though, if you were supposed to get cancer at 80 but an MI killed you at 40 or 50 or 60 or 70, would you say the MI prevented cancer? Now suppose you took a statin that prevented the MI from killing you and you reached 80, would you say the statin caused cancer?”

    Nationwide disease rates, uncorrected for age, are in no way the basis for the concern that statins cause cancer. As far as I can tell, there are three major reasons for that concern: 1. They do cause cancer in lab animals. 2. People with low cholesterol have higher cancer risk; you note that cancer may cause low cholesterol but low cholesterol also seems to correlate with future cancer. 3. In a couple of large statin studies, statins had a definite cardioprotective effect (in males under 65), yet there was no reduction in overall morbidity and mortality in the treatment group, because that group – within the same time period – had a countervailing increase in other problems. Notably, cancer.

    Also, accidental and violent death. You remark elsewhere:

    “All-cause mortality is one thing, a cardiac event is another. You don’t really expect a statin to prevent you from being shot or hit by a car and many other causes of death do you? Not all cardiac events are fatal too. ”

    No, I don’t, but strangely enough, it seems possible that a statin could cause me to be shot or hit by a car, as rates of such misadventures have been seen to increase when cholesterol is lowered. If statinization subtly impairs mental function, it is plausible that that impairment could have negative health consequences.

    Given that for women and the elderly there is little evidence of cardiovascular benefit, the chances that total morbidity and mortality would be much improved for those people, especially in primary prevention, seem very low. Personally, I’d rather have a heart attack than cancer. As you admit, it might not kill me, and if it does, I won’t live long enough to be sold chemo in my last miserable weeks. You are vehemently hostile to the suggestion of patients’ forgoing statins, even if they might be trading a 3% extra cancer and misadventure risk with statins for a 3% extra heart attack risk without. Is the assumption that cancer is “better” than heart disease? The media are now reporting that aromatase inhibitors, though better than tamoxifen at preventing the recurrence of breast cancer (which already will not happen in most women), cause significantly more heart damage. Would you agree that women should consider avoiding these drugs because of the heart risk? If not, it starts to look like the unacceptable disease to you is the natural one, and the acceptable risk is the iatrogenic disease, no matter which is which.

  81. weing says:

    apteryx,
    re Tamoxifen, you have to weigh the risks and benefits and then make the decision. I agree that sometimes it is like a Sophie’s Choice. Regarding the cancer risk from statins, I definitely think it merits studying. If they cause cancer I want to know. But what have we got thus far? We have a proven benefit of statins of 30% risk reduction of cardiac events. We have speculation about a possible increase in cancer risk. For me the choice is easy. I’ll go with the devil that’s known. You may chose otherwise, again that is your choice, and as long as you are aware of these facts, I have no problem with your decision. My view regarding the relationship between cancer and cholesterol is that a low cholesterol is an effect of cancer and not a cause. Often its level will drop before the cancer is discovered. That is my hypothesis and I may be wrong, and that is why I think it merits further studying. I’m taking a statin myself since 1994 after an MI. My aim is to reverse my disease and I have kept my LDL below 60-70 from the beginning. I have been fortunate in being able to tolerate it without side effects and have had no recurrence of my disease since. As a matter of fact, a recent CIMT showed my vascular age to be about 20 years younger thant my biological age. I don’t want to have an invasive angiogram just to satisfy my curiosity. Do I want to be taking a medication all my life? Of course not. I am even considering a drug holiday, and maybe taking the medication one year on and one year off, but so far I am too chicken.

  82. weing says:

    One more thing. Life is a fatal condition, and we will all eventually die, so I do not expect a decrease in all cause mortality. Now, if something else comes around and changes that fact…… I can guarantee it won’t be a statin.

  83. apteryx says:

    But the statin studies that have shown no decrease in all-cause mortality aren’t looking at patients for a lifetime, until they die, and saying “yep, the death rate in each arm is 100%”! They are looking at deaths during a limited study period. If the statin reduced users’ chance of having a fatal heart attack during the next five years by an absolute 2%, say, and did not simultaneously increase their chance of dying from something else, then I certainly would expect a decrease in all-cause mortality during that period. People say that an observed decrease in mostly non-fatal heart attacks is very significant, but if the same study shows equal total mortality they say that this is speculative and not worth worrying about. Which number better reflects what patients really care about?

  84. weing says:

    That is not true. Check out the study published by Afilalo et al in JACC from its first issue this year. They showed a 22% decrease in all cause mortality besides decrease in CHD mortality, nonfatal MI, stroke, and need revascularization.

  85. apteryx says:

    You cannot claim it is “not true” that in certain statin trials all-cause mortality has been unchanged; this is a simple fact. Afilalo et al is not a clinical trial, it is a meta-analysis of published and unpublished data from elderly subgroups in selected clinical trials, using “hierarchical Bayesian modeling.” The results are far more favorable to statins than are seen in at least one of the included trials, the PROSPER trial, which apparently provided almost 30% of the data. PROSPER showed lowered CV risk but unaffected stroke risk, significantly increased cancer risk, and apparently no benefit for total mortality. Those results themselves are more favorable than seen in elderly subgroups of certain other studies (for which I don’t have citations handy at the moment). Afilalo et al are asserting significantly lowered stroke risk and are not mentioning cancer in their abstract. Now, in other contexts on this blog people have been very hostile to the idea of taking a bunch of studies and doing a meta-analysis to get a result that looks better than you would conclude from just looking at the raw results of many of the original studies. I’m no statistician and have no prejudice against meta-analyses per se, but “hierarchical Bayesian modeling” sounds like something rather more complicated than just counting up the numbers of heart attacks in the statin group vs. the placebo group.

  86. weing says:

    What trials have specifically looked for all cause mortality?

  87. weing says:

    Let’s see,
    Ulf Stenestrand et al in JAMA, January 24, 2001. Damn it. 9.3% mortality in one year in the no statin group, 4% mortality in the statin group. I guess that’s not good enough. The fact is, there are plenty.

  88. apteryx says:

    That would be an astonishing death rate for a primary prevention trial. Upon looking up the abstract, I discover that this deals with people who had just suffered a heart attack for which they were hospitalized. Here’s the address of the abstract.

    http://www.ncbi.nlm.nih.gov/pubmed/11242427?ordinalpos=95&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    It is not quite accurate to speak of “groups” as you do. This was a cohort study from a patient registry, not a randomized trial. When the figures were corrected for confounding factors, the relative risk of mortality in the statin users was 0.75, or a 25% reduction, rather than the 57% reduction you portray. “Damn it.” Still, good enough to warrant taking a statin if you have just had a heart attack.

    But that’s not what we are talking about; we are talking about putting people who have never had a heart attack on drugs for life. For those trials, you ask which have “specifically” looked at all cause mortality. I should jolly well hope they all did, since that is what matters to patients. In at least some of the primary prevention studies, all cause mortality was not affected. (In certain others, the available abstracts don’t specify, leaving me to suspect that results were not impressive.) Examples:

    ALLHAT, a trial often pushed as evidence of the benefit of statins, had no mortality difference; CV risks were lowered, but for the most part not significantly so. A later publication by Geraci and Geraci indicated that black statin users had lowered coronary events but more strokes.

    PROSPER was partly secondary prevention, meaning that the underlying CV risk was much higher. The statin users had a relative risk of 0.85 (p=.014) for the primary CV risk endpoint, but a relative cancer risk of 1.25 (p-0.02). I recall reading that the total mortality was not lowered, and I suspect that is so, or the abstract would have boasted of it. I can try to dig up further information, but don’t have it handy.

    AFCAPS/TexCAPS, touted as the first primary prevention statin trial in people with normal LDL levels, had a relative death risk of 1.04 for the statin users (1.21 RR for non-CV deaths, which were a large majority of the total, and 1.41 for cancer deaths in particular [p=.13, but suggestive]).

    ALERT (a study with kidney transplant recipients) and ASCOT-LLA (with hypertensive patients) did not have significantly lowered total mortality. WOSCOPS initially did not have, but a follow-up publication did find significantly lower mortality.

  89. Razwell says:

    See how the statin trials were manipulated with numbers in the ABSTRACTS That is why it is so important to read the FULL TEXT and CAREFULLY of all trials .

    Dr. Uffe Ravnskov analyzes the statin trials here:

    http://www.ravnskov.nu/myth5.htm

    http://www.ravnskov.nu/myth6.htm

    See how the statin trials are manipulated by using “relative risk ”

    http://www.opinions3.com/Uffe_Ravnskov_Report.htm

  90. pc says:

    Having read this discussion on and off for a while now it is becoming obvious that the medical profession will not be swayed from their cholesterol theory of heart disease. Even when evidence points to the contrary, they simply will not accept it. This reminds me of the story of the 2 Australian scientists (Robin Warren and Barry Marshall ) who hypothesised that most stomach ulcers were caused by the bacteria H. pylori.
    Even when they presented their evidence for this theory, they were ridiculed by their fellow scientists and doctors. In fact one American doctor said they should be put against the wall and shot for proposing such a stupid theory. Fortunately for us, despite all this abuse, these scientists persisted until eventually, after some 15-20 years of trying; they eventually got the medical fraternity to accept it. Bacteria caused stomach ulcers, not lifestyle (sound familiar?). Just think of all the people who needlessly suffered because of this. I wonder how many people will have to suffer heart disease and all of its debilitating (even fatal) effects before the medical world decide to take notice of descenters like THINCS. Then maybe, just maybe, the ultimate cure for this disease will be found.

  91. marilynmann says:

    THINCS is not really at all like the scientists who proposed H. pylori as a cause of stomach ulcers, the reason being that they are not proposing a theory of causation for heart disease, at least not as a group (some of them may have their own individual theories). So far as I know, the only thing that unites the members of THINCS is that they do not believe that “cholesterol,” by which they presumably mean LDL-C, is a cause for heart disease. (I do not know their views on HDL.)

    I have had encounters with a couple of THINCS members, namely Malcolm Kendrick, Uffe Ravsnkov and Eddie something (can’t recall his last name). Kendrick and Ravsnkov are physicians, Eddie isn’t. In many cases when one encounters THINCS members, they do not say anything about their THINCS affiliation. Rather they post messages (on blogs, usenet, etc.) criticizing the use of statins for women or for primary prevention on the grounds that (according to them) statins have not been shown to lower total mortality in clinical trials for those patient groups. They also assert that any efficacy shown by statins is due not to LDL-lowering, but to pleiotropic effects. They tend to cherry pick which evidence they cite, ignoring anything that doesn’t match their positions. They also talk a lot about statin side effects (never about benefits of statins).

    My 14-year-old daughter has heterozygous familial hypercholesterolemia (heFH). Even the members of THINCS admit that there is a higher incidence of heart disease in people with heFH, although they assert that the incidence is not as high as many people think. Ravsnkov told me in an e-mail that the higher rate of heart disease in heFH is due not to high LDL, but to a tendency toward blood clotting in some patients.

    It is true that the incidence of heart disease in heFH is sometimes overstated, due to the fact that study populations have in many cases been drawn from lipid clinics. People who are referred to lipid clinics tend to already have heart disease, or a strong family history of heart disease, and may suffer from other risk factors. They are not a random sample of people with heFH, obviously. However, that doesn’t help us too much because even though we know that some people with heFH would live a normal lifespan even without treatment (or with less intensive treatment), we do not know how to predict who those people will be. So currently, everyone with heFH must be treated.

    It is also true that statins have pleiotropic effects, but it seems unlikely that none of the benefits of statins are due to LDL-lowering, since a number of other interventions that lowered LDL have reduced the risk of cardiovascular events.

    The bottom line for me is that my daughter, if untreated, could have a heart attack very early for a woman (say, late 40s, early 50s). She has male relatives who died of heart attacks at 35 and 40 (women with heFH develop heart disease about 9-10 years later than men, on average). My husband has also been told that he is at risk. I wish these THINCS people were right, but I just don’t believe them.

    Marilyn

  92. Razwell says:

    “Recent studies have shown that large reductions in the cholesterol levels of people with Familial Hypercholesterolemia were NOT followed by reductions in their vascular obstructions.”

    A quote from The Cholesterol Myths” and Dr. Ravnskov gives some references.

  93. pc says:

    I was not proposing that the THINCS members were equivalent to Robin Warren and Barry Marshall. This pair of scientists did have some evidence as to another cause of stomach ulcers; something that the THINCS, as a collective, do not have regarding heart disease. My point was that the medical fraternity, when faced with dissenting voices regarding the status quo get very defensive and at times damn right nasty against the dissenters. This appears to be the case with the THINCS. They might not be right in their ideas, but they do present some good data to backup their concerns regarding the current heart disease theories and as such should be given a respectful listen.

    Whilst there has been some pure LDL lowering investigations that have yielded a positive outcome, there also some that have not. The jury is still out on the absolute benefit of LDL lowering alone. Nobody, as far as I am aware, has been able to accurately document scientifically, with data, the process by which any form of LDL causes heart disease. Any process that has been documented is purely theoretical. This is very surprising given the number of years this has been investigated.

  94. pc says:

    “It is also true that statins have pleiotropic effects, but it seems unlikely that none of the benefits of statins are due to LDL-lowering, since a number of other interventions that lowered LDL have reduced the risk of cardiovascular events.”

    This may be true. But going back to my stomach ulcer example, the antacids given to the ulcer sufferers offered some reduction in ulcer discomfort and a reduction in the formation of further ulcers. However this was achieved by treating a facet of the problem and not the root cause. Could this not be the case with statins?

  95. marilynmann says:

    “Recent studies have shown that large reductions in the cholesterol levels of people with Familial Hypercholesterolemia were NOT followed by reductions in their vascular obstructions.”

    I do not know what studies he is referring to. Why don’t you cite them for us?

    I’m not sure what he means by “vascular obstructions,” but if he is talking about atherosclerosis, as measured by say carotid IMT, he is incorrect. Read this paper, for instance:

    Pernette R. W. de Sauvage Nolting, MD, PhD; Eric de Groot, MD, PhD; Aeilko H. Zwinderman, PhD; Rudolf J. A. Buirma, MD; Mieke D. Trip, MD, PhD; John J. P. Kastelein, MD, PhD, Regression of Carotid and Femoral Artery Intima-Media Thickness in Familial Hypercholesterolemia: Treatment With Simvastatin, Arch Intern Med. 2003;163:1837-1841.

    If by “reductions in their vascular obstructions” he means that all the accumulated atherosclerosis built up over a lifetime did not just magically melt away, that’s true, but so what? That doesn’t prove the point he’s trying to make.

  96. marilynmann says:

    “But going back to my stomach ulcer example, the antacids given to the ulcer sufferers offered some reduction in ulcer discomfort and a reduction in the formation of further ulcers. However this was achieved by treating a facet of the problem and not the root cause. Could this not be the case with statins?”

    Look, no one is saying elevated LDL is the only cause of heart disease. There are many other causes as well. But if LDL is not a cause of atherosclerosis and ultimately heart attacks, how do you explain why children with familial hypercholesterolemia, who generally do not have any risk factors other than very high LDL (except for family history of heart disease in some cases, and male gender in the case of boys), have endothelial dysfunction and accelerated atherosclerosis (as compared to normal children).

    The full story on how statins work is not known. In any case, even if statins did not work partly through lowering LDL, that would not mean we should not use them. The thing we’re trying to accomplish is not to lower LDL (or raise HDL, or lower blood sugar, etc.), but to prevent heart attacks, strokes and death.

    There are people who carry mutations that cause lower LDL from birth, the opposite of FH. These people have much lower rates of heart disease than you would expect given their other risk factors. How do explain that?

    Jonathan C. Cohen, Ph.D., Eric Boerwinkle, Ph.D., Thomas H. Mosley, Jr., Ph.D., and Helen H. Hobbs, M.D., Sequence Variations in PCSK9, Low LDL, and Protection against Coronary Heart Disease, NEJM;354:1264-1272.

    I’m done with this thread.

    Marilyn

  97. pc says:

    “Look, no one is saying elevated LDL is the only cause of heart disease”
    If this is true why were statins invented. Certainly not for their pleiotropic effects because they were unknown at the time of development. They were only invented to lower LDL. My doctor/cardiologist is only interested in 2 measurements; cholesterol and blood pressure. I totally agree that LDL is a factor but is not THE factor which is certainly how it is touted by the medical profession. Are they now turning their backs on the LDL theory of theory?

    However you have not understood my reasoning. By treating stomach acid they reduced the problems of stomach ulcers. By reducing the level of LDL they reduve the incidence of heart disease. In the first case they were only treating one facet of the ulcer problem and not the cause. I believe the same is true with LDL. I simply do not know what you find wrong with my statement because it is effectively backing up your conclusions.

    I totally agree with you that LDL it is one factor of many. For people with Familial Hypercholesterolaemia their cholesterol is not just high but mega high. Maybe 5 times the normal levels. I do not know of many substances that would not harm the human body when 5 times higher than normal!

  98. malcolmkendrick says:

    Hello Harriet Hall.

    I am the dreaded Dr Malcolm Kendrick MBChB MRCGP, peer-reviewer for the BMJ etc. I am also a thincer, who thincs quite a lot about CHD. I presume you have read my book ‘The Great Cholesterol Con,’ prior to dismissing my (and others within thincs) views.

    Pulling apart clinical trials in all directions is mildly interesting – if rather dispiriting. Rather than get dragged into this particular quagmire, the question I will pose to you is this.

    If a raised LDL causes atherosclerotic plaques to develop then can you explain to your readers HOW it does so. In this area I went back to the very basics to try and find the answer to this question. I found nothing.

    I ask four other things of your explanation

    1: Explain why atherosclerotic plaques only form in arteries, not in veins – their structure is identical (other than the fact that veins are thinnner).
    2: Explain why all artery walls, everwhere, do not fill up with LDL – if atherosclerosis is caused by LDL ‘leaking’ into the artery wall, why does this not happen in all artery walls.
    3: Explain how LDL passes through the endothelium into the artery wall behind. (The healthy endothelium is a barrier to LDL).
    4: Explain how you know that it is LDL that is found in plaques, and not Lp(a).

    If you can explain these facts, with clear supporting information, then I shall publically disown my skepticism of the LDL/Cholesterol hypothesis. I give you until the end of 2008 as I accept that this stuff is hugely complex and will taken many months to get to grips with.

    Regards

    Dr Malcolm Kendrick

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