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  #1   ^
Old Sun, Jun-23-13, 20:34
aj_cohn's Avatar
aj_cohn aj_cohn is offline
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Posts: 3,948
 
Plan: Protein Power
Stats: 213/167/165 Male 65 in.
BF:35%/23%/20%
Progress: 96%
Location: United States
Default Bad Medicine: Statins

URL:http://bad4umedicine.blogspot.co.uk...ne-statins.html
Quote:
Bad Medicine: Statins
An old man told me how the two boys be sat beside at school died in a Diphtheria outbreak in the 1920s. But diphtheria, tetanus, epiglotitis, measles, and hopefully soon, bacterial meningitis are illnesses of the past. Today, infectious disease consultants are left playing table tennis in the Doctors' mess. Vaccination is medicine's miracle, protecting individual and the public health. The anti-vaccination lobby is illogical. Today’s courageous public health policy is the suggestion of offering statins to all the middle-aged to prevent vascular disease. For a recent Cochrane review states that that statins are safe and effective in primary prevention [1], with another meta-analysis reporting statins effective even in low risk groups.[2] There is no longer a ”normal” cholesterol level. Is treating everyone over a certain age good medicine?

The cardiovascular disease model is a paradigm based on risk factors, all now morphed into “diseases”. Cholesterol, glucose, and the elasticity of arteries based assessed by a Victorian hearing aid! Yet you can fly a jumbo-jet between the confidence intervals that support this model. [3, 4] A simplistic model is riven many paradoxes, like the decline in vascular disease predating modern medications by decades.[5] Also, we are told that vascular disease is a product of modern lifestyle but a study irrefutably demonstrates IHD was common in prehistory.[6] And why has vascular disease not increased with the increase in diabetes and obesity ? [7] But medicine believes in this model, worshiping at the educational cathedrals of the pharmaceutical industry.

Also, the effects of statins need quantified. In those low-risk, over-60 on standard statin treatments, the NNT per year to prevent cardiovascular events is 450 and to prevent vascular death 1,250. [2] So, unlike vaccination, virtually none of these patients will actually benefit directly despite taking statin for the rest of their lives. For any benefits are seen only at a population level, this the treatment paradox. And with much of statin research now twenty years old, since then, background incidence has halved, these NNTs could have doubled. Finally, already we prescribe 60 million statins yearly [8], so why can’t we categorically prove that statins work in the real world? What happens if there is some unforeseen long-term side effect?

But skeptism is futile. Guidelines will be issued expanding statin use, and these orders dutifully followed. Patients trust doctors, will go along with this advice, eroding societies well-being and fanning health anxiety. Soon, the natural extension of this logic will see a clamor for statins in ever younger age groups and for more aggressive treatment. Is statins-for-all bad medicine? Time will tell.

[1] Taylor, F., "Statins for the primary prevention of cardiovascular disease." The Cochrane Library Published Online: 31 JAN 2013
http://onlinelibrary.wiley.com/doi/...10%3A00-12%3A00
+BST+%2805%3A00-07%3A00+EDT%29+for+essential+maintenance

[2] Cholesterol Treatment Trialists' (CTT) Collaborators. "The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials." Lancet 2012; 380: 581-590
http://www.thelancet.com/journals/l...0367-5/abstract

[3] Piotr Bandosz, "Decline in mortality from coronary heart disease in Poland after socioeconomic transformation: modelling study," BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.d8136 (Published 25 January 2012)
http://www.bmj.com/content/344/bmj..../bmj.d7809.atom

[4] Belgin Unal, Modelling the decline in coronary heart disease deaths in England and Wales , 1981-2000: comparing contributions from primary prevention and secondary prevention BMJ 2005; 331 doi: http://dx.doi.org/10.1136/bmj.38561.633345.8) http://www.bmj.com/content/331/7517/614

[5] CDC Achievements in Public Health, 1900-1999: Decline in Deaths from Heart Disease and Stroke -- United States, 1900-1999 August6, 1999 / 48(30);649-656 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4830a1.htm

[6] Thompson R, "Atherosclerosis across 4000 years of human history: the Horus study of four ancient populations." The Lancet, Volume 381, Issue 9873, Pages 1211 - 1222, 6 April 2013http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60598-X/abstract

[7] Wang, C., "Health and economic burden of the projected obesity trends in the USA and the UK." The Lancet Volume 378, Issue 9793, 27 August–2 September 2011, Pages 815–825
http://www.sciencedirect.com/scienc...140673611608143

[8] Health and Social Care Information Centre. Prescription Cost Analysis— England , 2012. April 2013. www.hscic.gov.uk/catalogue/PUB10610
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  #2   ^
Old Mon, Jun-24-13, 04:02
ojoj's Avatar
ojoj ojoj is offline
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Posts: 3,184
 
Plan: atkins
Stats: 210/126/127 Female 5ft 7in
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Progress: 101%
Location: South of England
Default

Scary isnt it. IMO an example of the pharmaceutical industries power and greed

Jo xxx
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