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The Cholesterol Con
The Cholesterol Con - Where Were the Doctors?
By Maggie Mahar Health Beat Wednesday 20 February 2008 After the stock market bubble burst, the New York Times asked: "Where were the analysts? Why didn't they warn us?" To be perfectly honest, this was a somewhat disingenuous question. As experienced financial journalists understood all too well, the analysts plugging the high-flying issues of the 1990s were employed by Wall Street firms raking in billions as investors bet their nest eggs on one hot stock after another. It really wasn't in their employers' interest for analysts to tell us that their products were wildly over-priced. When a small investor wades into the financial world, there are two words he needs to keep in mind: "caveat emptor." But physicians, I firmly believe, are different from the folks employed by Merrill Lynch. (I don't mean to knock people who work at ML. I am simply saying that they have a very different job description.) When consulting with your doctor, you should not have to be wary. You are not a customer; you are a patient. And your physician is a professional who has pledged to put your interests ahead of his or her own. This brings me to the question I ask in my headline: during the many years of the Cholesterol Con - where were the doctors? When everyone from the makers of Mazola Corn Oil to the Popes of Cardiology assured us that virtually anyone could ward off heart disease by lowering their cholesterol, why didn't more of our doctors raise an eyebrow and warn us : "Actually, that's not what the research shows" ? No doubt, you've heard about the recent Business Week cover story, "Do Cholesterol Drugs Do Any Good?", which blew the lid off the theory that "statins" - drugs like Lipitor, Crestor, Mevacor, Zocor and Pravachol - can cut the odds that you will die of a heart attack by slowing the production of cholesterol in your body and increasing the liver's ability to remove L.D.L., or "bad cholesterol," from your blood. It's true that these drugs can help some people - but not nearly as many as we have been told. Moreover, and this is the kicker, we don't have any clear evidence that they work by lowering cholesterol. Although medical research suggests that statins can definitely benefit one group - men under 70 who already have had a heart attack - researchers are no longer convinced that the drugs stave off a second attack by lowering the patient's cholesterol. The drugs do lower cholesterol, but that is not what helps the patient. In other words, researchers are questioning the bedrock assumption that high levels of "bad cholesterol" cause heart disease. "Higher LDL levels do help set the stage for heart disease by contributing to the buildup of plaque in arteries. But something else has to happen before people get heart disease," Dr. Ronald M. Krauss, director of atherosclerosis research at the Oakland Research Institute, told Business Week. "When you look at patients with heart disease, their cholesterol levels are not that [much] higher than those without heart disease," he added. "Compare countries, for example. Spaniards have LDL levels similar to Americans', but less than half the rate of heart disease. The Swiss have even higher cholesterol levels, but their rates of heart disease are also lower. Australian aborigines have low cholesterol but high rates of heart disease." "Current evidence supports ignoring LDL cholesterol altogether," Dr. Rodney A. Hayward, professor of internal medicine at the University of Michigan, told Business Week's reporter. In recent years, researchers have begun to suspect that statins help patients, not by lowering cholesterol levels, but by reducing inflammation. If this theory is right, "this seems likely to shunt cholesterol reduction into a small corner of the overall picture of heart disease," the Guardian reported four years ago. And if the key to statins is that they reduce inflammation, it's worth keeping in mind that this is what other effective heart treatments like aspirin and the omega three fatty acids found in fish oils, garlic and Vitamin E do - at a much lower cost and with far fewer side effects. But hold onto your hats, I still haven't gotten to what is most shocking about the cholesterol story. What raises my blood pressure is the knowledge that Business Week's scoop isn't really "new" news." With all due respect to Business Week, which showed real courage in putting the story on its cover, and to its author, John Carey, who did a superb job of explaining the medical research, the truth is that medical researchers have been questioning the theory that widespread use of statins to lower cholesterol will save lives for many years. You can find the research questioning the benefits of statins in medical journals like Lancet (2001) and BMJ (2006), as well as in reports from medical conferences ("Tales From the the Other Drug Wars," 1999). Occasionally, doubts popped up in the mainstream press and then disappeared. Five years ago, veteran healthcare blogger Matthew Holt pointed to a BMJ article suggesting that statins might be no better than aspirin. That same year, Holt raised pointed questions regarding the risk of taking statins, including possible memory loss." Nevertheless, the very next year, the National Cholesterol Education Program at the U.S. National Heart, Lung and Blood Institute issued new recommendations that drastically lowered the threshold for statin therapy. According to its 2004 report, people at a moderately high risk of developing heart disease (with LDL cholesterol levels between 100 and 129 mg/dL) should be offered statins - even if they have no previous history of heart disease. Statin therapy also should be recommended to very high risk patients, the panel said, even if their LDL levels are as low as 70. NCEP declared that the recommendations applied to both men and women, regardless of age. The bottom line: NCEP was urging millions of Americans to go on statins. Not everyone agreed, recalls Merrill Goozner, editor of "GoozNews," a top-drawer investigative healthcare blog. In 2004, a few months after the new guidelines came out, a coalition of more than 30 academic physicians and researchers, inspired by Dr. John Abramson (author of Overdosed America: The Broken Promises of American Medicine), decided to write a letter to the National Heart Lung and Blood Institute (NHLBI). Goozner, who does research at the Center for Science in the Public Interest, organized the group. The letter "outlined all the evidence, which was there in published clinical trials for anyone who cared to look," Goozner recalls, and concluded that while statins, "may lower cholesterol in people at low risk and even many sub-groups at moderate risk of a heart attack ... there was no evidence that the drugs actually saved lives." How could this be, if statins lower the risk of heart attack, at least for some people? Preventing a heart attack does not necessarily mean that a life is saved. In many statin studies that show lower heart attack risk, the same number of patients end up dying, whether they are taking statins or not. "You may have helped the heart, but you haven't helped the patient," says Dr. Beatrice Golomb, an associate professor of medicine at the University of California, San Diego, and co-author of a 2004 editorial in The Journal of the American College of Cardiology questioning the data on statins. "You still have to look at the impact on the patient overall." "The letter we sent to the NHLBI also called for an independent panel to review the evidence," Goozner notes, "since the NHLBI panel that made the recommendations had been dominated by physicians with ties to statin manufacturers." Indeed, the National Institutes of Health later admitted that eight of the nine experts on the panel had received financing from one or more of the companies that make statins. (None of the panelists had publicly disclosed their ties to manufacturers when they made their recommendations.) Just how much "financing" were the panelists receiving? According to the LA Times, from 2001 to 2003 Dr Bryan Brewer, a leader at the National Institutes of Health, and "part of the team that gave the nation new cholesterol guidelines in 2004" had accepted "about $114,000 in consulting fees from four companies making or developing the cholesterol-lowering drugs. But "this is relative peanuts compared to Dr P. Trey Sunderland III, a senior psychiatric researcher at the NIH, who took $508,500 in fees from Pfizer, Inc. whilst collaborating with them, and endorsing their drug [Lipitor]," says Dr. Malcolm Kendrick, who is a member of The International Network of Cholesterol Skeptics (THINCS) - a growing group of scientists, physicians, other academicians and science writers from various countries. Dr. Abramson, who is a clinical instructor at Harvard Medical School, charges that the study that accompanied the updated 2004 guidelines "knowingly misrepresented the results of the clinical trials that they supposedly relied upon to formulate their recommendations. The problem is that the experts claimed to rely on scientific evidence, but they act as if empowered to ignore the evidence when it is not consistent with their beliefs." This is a serious allegation. Keep in mind that statins are the most popular drugs in the history of human medicine. World-wide sales totaled $33 billion in 2007. More than 18 million American now take them. Nevertheless, "medical research suggests that only about 40 percent to 50 percent of that number are likely to benefit," says Abramson. "The other 8 or 9 million are exposed to the risks that come with taking statins - which can include severe muscle pain, memory loss, sexual dysfunction - and one study shows increased risk of cancer in the elderly - but there are no studies to show that the drugs will protect these patients against fatal heart attacks." Abramson can cite many studies to support his claims. But first, he stresses that statins can help some people. "Statins show a clear benefit for one group," he says: "People under 65 who have already had a heart attack or have diabetes. But even in these very high risk people, about 22 have to be treated for 5 years for one to benefit." What about middle-aged people who are not diabetic and have not had a heart attack? A 2006 study published in the Annals of Internal Medicine that focused on seven trials involving nearly 43,000 middle-aged adults concluded that statin use did not cut their chances of dying from heart disease. Is there any benefit for this group? "If they are high risk, statins can be beneficial to people under 65 who haven't had a heart attack, but 50 such men have to be treated for 5 years for one to benefit." says Abramson. "The other 49 will not be helped. The problem is that we can't know who is going to be the 50th man," he adds. And all 50 will be exposed to the side effects. Older adults have little to gain. The drugs don't help people over 70 even if they have elevated cholesterol levels, according to a report in the Journal of American Cardiology. Finally, "there is no evidence of any benefit for women who don't already have heart disease or diabetes," says Abramson. According to a 2004 article published in the Journal of the American Medical Association which reviewed all trials in which women with high cholesterol had been randomly assigned to take a cholesterol-lowering drug or a placebo, there was no evidence that statins prolonged women's lives or cut their chances of dying of heart disease. An editorial published in the Journal of the American College of Cardiology came to the same conclusion - though there does seem to be a risk that women on statins develop memory loss so severe that their relatives may begin shopping for a nursing home. Memory loss that can mimic Alzheimers is the second most common side affect for people taking statins, right after muscle pain, according to researchers at the University of California at San Diego. For a number of years, they have been running a randomized controlled trial examining the effects of statins on thinking, mood, behavior, and quality of life. Separately, the UCSD researchers have been collecting anecdotal experiences of patients, good and bad, on statins. "We have some compelling cases," Dr. Beatrice Golomb, the study's lead researcher, told the Wall Street Journal. "In one of them, a San Diego woman, Jane Brunzie, was so forgetful that her daughter was investigating Alzheimer's care for her and refused to let her baby-sit for her 9-year-old granddaughter. Then the mother stopped taking a statin. 'Literally, within eight days, I was back to normal - it was that dramatic,' said Mrs. Brunzie, 69 years old." According to the Journal, "Doctors put her on different statins three more times. 'They'd say, "Here, try these samples." Doctors don't want to give up on it,' she said.' Within a few days of starting another one, I'd start losing my words again,' added Mrs. Brunzie, who has gone back to volunteering at the local elementary school she loves and is trying to bring her cholesterol down with dietary changes instead." Returning to Goozner's story, did the letter his group wrote to the NHLBI in 2004, spark public discussion about the new cholesterol guidelines? No. "We released the letter to the press, but the mainstream of the national press ignored us," Goozner recalls. In 2008, Goozner is happy to see the statin controversy hit Business Week's cover - though he can't help but wonder, "Where were these guys three years ago? Now, call me a cynic, but why does my perverted mind think to itself as I watch this coverage: Yeah, now we hear, just when the world's best-selling drug [Lipitor] is about to go off patent." I suspect Goozer is right. It would have been much harder to publish this story a few years ago. But there also was a trigger that probably helped spur the Business Week investigation. Last month, Merck -Schering/Plough released a long-awaited study revealing that Vytorin, an expensive combination of two drugs designed to lower cholesterol, brought no added benefits for patients suffering from heart disease. The two cholesterol-lowering drugs were Zocor, which is a statin, and, Zetia, which is not. When combined, the two drugs did drive cholesterol levels much lower. But the clinical trial offered no evidence that the two cholesterol-busters were more effective in reducing heart attacks than Zocor alone. This raises an obvious question: is cutting cholesterol levels really the key to avoiding heart attacks? The results of the study helped buttress the strong suspicion that insofar as statins like Zocor do help anyone with heart disease, the beneficial effect has little to do with lowering cholesterol levels. Meanwhile, Zocor is now available in a generic form that can be purchased for less than $6 for a 30-day supply. By contrast, the new combination, selling under the brand name Vytorin, was fetching more than $100 for a 3 - day supply. In 2006, the drug brought in $1.5 billion with sales climbing 25% in the first half of 2007 to over $2 billion, according to IMS Health. Naturally, Merck and Schering/Plough, who were marketing Vytorin in a joint venture, were shy about reporting the results of the clinical trials. It was only when they were threatened with a Congressional investigation that they made the results public on January 15 - more than a year and a half after the clinical trials were completed. The day after the drug-makers released the news, the American Heart Association rushed to their defense, declaring that the study was too limited to draw conclusions about Vytorin's ability to reduce heart attacks or deaths compared to Zocor alone. The AHA advised patients not to abruptly stop taking Vytorin without consulting with the doctors who had prescribed it. The New York Times, to its credit, was quick to respond, noting that "what the [American Heart Association] did not note in its statement ... was that the group receives nearly $2 million a year from Merck/Schering-Plough Pharmaceuticals, the joint venture that markets Vytorin. When I return to the saga of the "Cholesterol Con," in the second installment of this post, I am going take a closer look at the American Heart Association - and others who stood to gain by persuading Americans of the absolute link between high levels of cholesterol and heart disease. It is a story that begins long before Pfizer and other drug makers invented statins. And it explains why so few American doctors stood up and questioned the widespread use of drugs like Lipitor. The belief that cholesterol causes heart disease wasn't just a theory. It became a matter of faith, brought to us by a motley group that included food companies advertising margarine and corn oil, the American Heart Association, and doctors who joined the bandwagon. At first the American Medical Association resisted - but soon it too capitulated. Finally, when the American College of Cardiology signed on, it became very difficult for physicians to speak out. At that point, anyone who questioned the cholesterol connection could easily be painted as "reckless" - a doctor willing to put thousands of lives at risk by encouraging patients to question what had become the Holy Grail of cardiac care. More at: http://www.truthout.org/issues_06/022908HA.shtml |
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The Cholesterol Con
On Sun, 02 Mar 2008 20:41:41 GMT, "FOB"
wrote: The Cholesterol Con - Where Were the Doctors? By Maggie Mahar Health Beat *yellow journalism article snipped* Wow! That was as whacked-out, biased, negative an article as I've ever read in my life. All it does is spew innuendo and crap about statins with absolutely nothing concrete to say whatsoever. It states that statins don't work by lowering cholesterol, but gives no proof, nor does it reveal how statins do in fact work if that is the case. Someone has an agenda. The author may very well change her mind after she has his first heart attack. It sure changed mine; and now that my cholesteol and triglycerides are both down to 117 thanks to diet, Lipitor and Tricor (with absolutely no side effects that the moronic scare-mongers would try to shock us with) , and my HDL/LDL ratio has tripled, I have a much brighter prospect for a long life than I did 6 months ago. This unsubstantiated negative crap refuting dozens of legitimate studies with absolutely no facts, just innuendo, is dangerous and irresponsible IMO. --- Peter 270/227/180 |
#3
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The Cholesterol Con
FOB wrote:
Yes, this theme of poor research documenting the statins and cholesterol lowering has been advocated numerous times recently. There is growing evidence that the "Cholesterol Con" was real, and a self induced intrepretation of poor statistics -- as well as "if it isn't cholesterol, then what is it" lack of understanding of heart disease which has marked much of the last half century and more. If the medical community understands heart disease, why is there so much of it and why is it not decreasing in rate of incidence? We seem to have some technology to prolong life after the heart attack, but there is little evidence to indicate that the rate of first heart attack is in decline. For Peter, you can read some of this same stuff in "Good Calories, Bad Calories" (2007), "The Cholesterol Myths" (2000), "Cholesterol Con" (2006), and "The Great Cholesterol Con" (2007), and a number of other published works. The Cholesterol Con - Where Were the Doctors? By Maggie Mahar Health Beat Wednesday 20 February 2008 After the stock market bubble burst, the New York Times asked: "Where were the analysts? Why didn't they warn us?" To be perfectly honest, this was a somewhat disingenuous question. As experienced financial journalists understood all too well, the analysts plugging the high-flying issues of the 1990s were employed by Wall Street firms raking in billions as investors bet their nest eggs on one hot stock after another. It really wasn't in their employers' interest for analysts to tell us that their products were wildly over-priced. When a small investor wades into the financial world, there are two words he needs to keep in mind: "caveat emptor." But physicians, I firmly believe, are different from the folks employed by Merrill Lynch. (I don't mean to knock people who work at ML. I am simply saying that they have a very different job description.) When consulting with your doctor, you should not have to be wary. You are not a customer; you are a patient. And your physician is a professional who has pledged to put your interests ahead of his or her own. This brings me to the question I ask in my headline: during the many years of the Cholesterol Con - where were the doctors? When everyone from the makers of Mazola Corn Oil to the Popes of Cardiology assured us that virtually anyone could ward off heart disease by lowering their cholesterol, why didn't more of our doctors raise an eyebrow and warn us : "Actually, that's not what the research shows" ? No doubt, you've heard about the recent Business Week cover story, "Do Cholesterol Drugs Do Any Good?", which blew the lid off the theory that "statins" - drugs like Lipitor, Crestor, Mevacor, Zocor and Pravachol - can cut the odds that you will die of a heart attack by slowing the production of cholesterol in your body and increasing the liver's ability to remove L.D.L., or "bad cholesterol," from your blood. It's true that these drugs can help some people - but not nearly as many as we have been told. Moreover, and this is the kicker, we don't have any clear evidence that they work by lowering cholesterol. Although medical research suggests that statins can definitely benefit one group - men under 70 who already have had a heart attack - researchers are no longer convinced that the drugs stave off a second attack by lowering the patient's cholesterol. The drugs do lower cholesterol, but that is not what helps the patient. In other words, researchers are questioning the bedrock assumption that high levels of "bad cholesterol" cause heart disease. "Higher LDL levels do help set the stage for heart disease by contributing to the buildup of plaque in arteries. But something else has to happen before people get heart disease," Dr. Ronald M. Krauss, director of atherosclerosis research at the Oakland Research Institute, told Business Week. "When you look at patients with heart disease, their cholesterol levels are not that [much] higher than those without heart disease," he added. "Compare countries, for example. Spaniards have LDL levels similar to Americans', but less than half the rate of heart disease. The Swiss have even higher cholesterol levels, but their rates of heart disease are also lower. Australian aborigines have low cholesterol but high rates of heart disease." "Current evidence supports ignoring LDL cholesterol altogether," Dr. Rodney A. Hayward, professor of internal medicine at the University of Michigan, told Business Week's reporter. In recent years, researchers have begun to suspect that statins help patients, not by lowering cholesterol levels, but by reducing inflammation. If this theory is right, "this seems likely to shunt cholesterol reduction into a small corner of the overall picture of heart disease," the Guardian reported four years ago. And if the key to statins is that they reduce inflammation, it's worth keeping in mind that this is what other effective heart treatments like aspirin and the omega three fatty acids found in fish oils, garlic and Vitamin E do - at a much lower cost and with far fewer side effects. But hold onto your hats, I still haven't gotten to what is most shocking about the cholesterol story. What raises my blood pressure is the knowledge that Business Week's scoop isn't really "new" news." With all due respect to Business Week, which showed real courage in putting the story on its cover, and to its author, John Carey, who did a superb job of explaining the medical research, the truth is that medical researchers have been questioning the theory that widespread use of statins to lower cholesterol will save lives for many years. You can find the research questioning the benefits of statins in medical journals like Lancet (2001) and BMJ (2006), as well as in reports from medical conferences ("Tales From the the Other Drug Wars," 1999). Occasionally, doubts popped up in the mainstream press and then disappeared. Five years ago, veteran healthcare blogger Matthew Holt pointed to a BMJ article suggesting that statins might be no better than aspirin. That same year, Holt raised pointed questions regarding the risk of taking statins, including possible memory loss." Nevertheless, the very next year, the National Cholesterol Education Program at the U.S. National Heart, Lung and Blood Institute issued new recommendations that drastically lowered the threshold for statin therapy. According to its 2004 report, people at a moderately high risk of developing heart disease (with LDL cholesterol levels between 100 and 129 mg/dL) should be offered statins - even if they have no previous history of heart disease. Statin therapy also should be recommended to very high risk patients, the panel said, even if their LDL levels are as low as 70. NCEP declared that the recommendations applied to both men and women, regardless of age. The bottom line: NCEP was urging millions of Americans to go on statins. Not everyone agreed, recalls Merrill Goozner, editor of "GoozNews," a top-drawer investigative healthcare blog. In 2004, a few months after the new guidelines came out, a coalition of more than 30 academic physicians and researchers, inspired by Dr. John Abramson (author of Overdosed America: The Broken Promises of American Medicine), decided to write a letter to the National Heart Lung and Blood Institute (NHLBI). Goozner, who does research at the Center for Science in the Public Interest, organized the group. The letter "outlined all the evidence, which was there in published clinical trials for anyone who cared to look," Goozner recalls, and concluded that while statins, "may lower cholesterol in people at low risk and even many sub-groups at moderate risk of a heart attack ... there was no evidence that the drugs actually saved lives." How could this be, if statins lower the risk of heart attack, at least for some people? Preventing a heart attack does not necessarily mean that a life is saved. In many statin studies that show lower heart attack risk, the same number of patients end up dying, whether they are taking statins or not. "You may have helped the heart, but you haven't helped the patient," says Dr. Beatrice Golomb, an associate professor of medicine at the University of California, San Diego, and co-author of a 2004 editorial in The Journal of the American College of Cardiology questioning the data on statins. "You still have to look at the impact on the patient overall." "The letter we sent to the NHLBI also called for an independent panel to review the evidence," Goozner notes, "since the NHLBI panel that made the recommendations had been dominated by physicians with ties to statin manufacturers." Indeed, the National Institutes of Health later admitted that eight of the nine experts on the panel had received financing from one or more of the companies that make statins. (None of the panelists had publicly disclosed their ties to manufacturers when they made their recommendations.) Just how much "financing" were the panelists receiving? According to the LA Times, from 2001 to 2003 Dr Bryan Brewer, a leader at the National Institutes of Health, and "part of the team that gave the nation new cholesterol guidelines in 2004" had accepted "about $114,000 in consulting fees from four companies making or developing the cholesterol-lowering drugs. But "this is relative peanuts compared to Dr P. Trey Sunderland III, a senior psychiatric researcher at the NIH, who took $508,500 in fees from Pfizer, Inc. whilst collaborating with them, and endorsing their drug [Lipitor]," says Dr. Malcolm Kendrick, who is a member of The International Network of Cholesterol Skeptics (THINCS) - a growing group of scientists, physicians, other academicians and science writers from various countries. Dr. Abramson, who is a clinical instructor at Harvard Medical School, charges that the study that accompanied the updated 2004 guidelines "knowingly misrepresented the results of the clinical trials that they supposedly relied upon to formulate their recommendations. The problem is that the experts claimed to rely on scientific evidence, but they act as if empowered to ignore the evidence when it is not consistent with their beliefs." This is a serious allegation. Keep in mind that statins are the most popular drugs in the history of human medicine. World-wide sales totaled $33 billion in 2007. More than 18 million American now take them. Nevertheless, "medical research suggests that only about 40 percent to 50 percent of that number are likely to benefit," says Abramson. "The other 8 or 9 million are exposed to the risks that come with taking statins - which can include severe muscle pain, memory loss, sexual dysfunction - and one study shows increased risk of cancer in the elderly - but there are no studies to show that the drugs will protect these patients against fatal heart attacks." Abramson can cite many studies to support his claims. But first, he stresses that statins can help some people. "Statins show a clear benefit for one group," he says: "People under 65 who have already had a heart attack or have diabetes. But even in these very high risk people, about 22 have to be treated for 5 years for one to benefit." What about middle-aged people who are not diabetic and have not had a heart attack? A 2006 study published in the Annals of Internal Medicine that focused on seven trials involving nearly 43,000 middle-aged adults concluded that statin use did not cut their chances of dying from heart disease. Is there any benefit for this group? "If they are high risk, statins can be beneficial to people under 65 who haven't had a heart attack, but 50 such men have to be treated for 5 years for one to benefit." says Abramson. "The other 49 will not be helped. The problem is that we can't know who is going to be the 50th man," he adds. And all 50 will be exposed to the side effects. Older adults have little to gain. The drugs don't help people over 70 even if they have elevated cholesterol levels, according to a report in the Journal of American Cardiology. Finally, "there is no evidence of any benefit for women who don't already have heart disease or diabetes," says Abramson. According to a 2004 article published in the Journal of the American Medical Association which reviewed all trials in which women with high cholesterol had been randomly assigned to take a cholesterol-lowering drug or a placebo, there was no evidence that statins prolonged women's lives or cut their chances of dying of heart disease. An editorial published in the Journal of the American College of Cardiology came to the same conclusion - though there does seem to be a risk that women on statins develop memory loss so severe that their relatives may begin shopping for a nursing home. Memory loss that can mimic Alzheimers is the second most common side affect for people taking statins, right after muscle pain, according to researchers at the University of California at San Diego. For a number of years, they have been running a randomized controlled trial examining the effects of statins on thinking, mood, behavior, and quality of life. Separately, the UCSD researchers have been collecting anecdotal experiences of patients, good and bad, on statins. "We have some compelling cases," Dr. Beatrice Golomb, the study's lead researcher, told the Wall Street Journal. "In one of them, a San Diego woman, Jane Brunzie, was so forgetful that her daughter was investigating Alzheimer's care for her and refused to let her baby-sit for her 9-year-old granddaughter. Then the mother stopped taking a statin. 'Literally, within eight days, I was back to normal - it was that dramatic,' said Mrs. Brunzie, 69 years old." According to the Journal, "Doctors put her on different statins three more times. 'They'd say, "Here, try these samples." Doctors don't want to give up on it,' she said.' Within a few days of starting another one, I'd start losing my words again,' added Mrs. Brunzie, who has gone back to volunteering at the local elementary school she loves and is trying to bring her cholesterol down with dietary changes instead." Returning to Goozner's story, did the letter his group wrote to the NHLBI in 2004, spark public discussion about the new cholesterol guidelines? No. "We released the letter to the press, but the mainstream of the national press ignored us," Goozner recalls. In 2008, Goozner is happy to see the statin controversy hit Business Week's cover - though he can't help but wonder, "Where were these guys three years ago? Now, call me a cynic, but why does my perverted mind think to itself as I watch this coverage: Yeah, now we hear, just when the world's best-selling drug [Lipitor] is about to go off patent." I suspect Goozer is right. It would have been much harder to publish this story a few years ago. But there also was a trigger that probably helped spur the Business Week investigation. Last month, Merck -Schering/Plough released a long-awaited study revealing that Vytorin, an expensive combination of two drugs designed to lower cholesterol, brought no added benefits for patients suffering from heart disease. The two cholesterol-lowering drugs were Zocor, which is a statin, and, Zetia, which is not. When combined, the two drugs did drive cholesterol levels much lower. But the clinical trial offered no evidence that the two cholesterol-busters were more effective in reducing heart attacks than Zocor alone. This raises an obvious question: is cutting cholesterol levels really the key to avoiding heart attacks? The results of the study helped buttress the strong suspicion that insofar as statins like Zocor do help anyone with heart disease, the beneficial effect has little to do with lowering cholesterol levels. Meanwhile, Zocor is now available in a generic form that can be purchased for less than $6 for a 30-day supply. By contrast, the new combination, selling under the brand name Vytorin, was fetching more than $100 for a 3 - day supply. In 2006, the drug brought in $1.5 billion with sales climbing 25% in the first half of 2007 to over $2 billion, according to IMS Health. Naturally, Merck and Schering/Plough, who were marketing Vytorin in a joint venture, were shy about reporting the results of the clinical trials. It was only when they were threatened with a Congressional investigation that they made the results public on January 15 - more than a year and a half after the clinical trials were completed. The day after the drug-makers released the news, the American Heart Association rushed to their defense, declaring that the study was too limited to draw conclusions about Vytorin's ability to reduce heart attacks or deaths compared to Zocor alone. The AHA advised patients not to abruptly stop taking Vytorin without consulting with the doctors who had prescribed it. The New York Times, to its credit, was quick to respond, noting that "what the [American Heart Association] did not note in its statement ... was that the group receives nearly $2 million a year from Merck/Schering-Plough Pharmaceuticals, the joint venture that markets Vytorin. When I return to the saga of the "Cholesterol Con," in the second installment of this post, I am going take a closer look at the American Heart Association - and others who stood to gain by persuading Americans of the absolute link between high levels of cholesterol and heart disease. It is a story that begins long before Pfizer and other drug makers invented statins. And it explains why so few American doctors stood up and questioned the widespread use of drugs like Lipitor. The belief that cholesterol causes heart disease wasn't just a theory. It became a matter of faith, brought to us by a motley group that included food companies advertising margarine and corn oil, the American Heart Association, and doctors who joined the bandwagon. At first the American Medical Association resisted - but soon it too capitulated. Finally, when the American College of Cardiology signed on, it became very difficult for physicians to speak out. At that point, anyone who questioned the cholesterol connection could easily be painted as "reckless" - a doctor willing to put thousands of lives at risk by encouraging patients to question what had become the Holy Grail of cardiac care. More at: http://www.truthout.org/issues_06/022908HA.shtml |
#4
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The Cholesterol Con
And your one experience shows that cholesterol was the culprit how?
Marengo wrote: | | *yellow journalism article snipped* | | Wow! That was as whacked-out, biased, negative an article as I've | ever read in my life. All it does is spew innuendo and crap about | statins with absolutely nothing concrete to say whatsoever. It states | that statins don't work by lowering cholesterol, but gives no proof, | nor does it reveal how statins do in fact work if that is the case. | Someone has an agenda. | | The author may very well change her mind after she has his first heart | attack. It sure changed mine; and now that my cholesteol and | triglycerides are both down to 117 thanks to diet, Lipitor and Tricor | (with absolutely no side effects that the moronic scare-mongers would | try to shock us with) , and my HDL/LDL ratio has tripled, I have a | much brighter prospect for a long life than I did 6 months ago. This | unsubstantiated negative crap refuting dozens of legitimate studies | with absolutely no facts, just innuendo, is dangerous and | irresponsible IMO. | --- | Peter | 270/227/180 |
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The Cholesterol Con
On Mar 4, 12:55 am, Marengo wrote:
On Sun, 02 Mar 2008 20:41:41 GMT, "FOB" wrote: The Cholesterol Con - Where Were the Doctors? By Maggie Mahar Health Beat *yellow journalism article snipped* Wow! That was as whacked-out, biased, negative an article as I've ever read in my life. All it does is spew innuendo and crap about statins with absolutely nothing concrete to say whatsoever. It states that statins don't work by lowering cholesterol, but gives no proof, nor does it reveal how statins do in fact work if that is the case. Someone has an agenda. The author may very well change her mind after she has his first heart attack. It sure changed mine; and now that my cholesteol and triglycerides are both down to 117 thanks to diet, Lipitor and Tricor (with absolutely no side effects that the moronic scare-mongers would try to shock us with) , and my HDL/LDL ratio has tripled, I have a much brighter prospect for a long life than I did 6 months ago. This unsubstantiated negative crap refuting dozens of legitimate studies with absolutely no facts, just innuendo, is dangerous and irresponsible IMO. Dunno how I missed this one. Must have had something to do with hookers in Bangalore ;-) Peter, Lemme get this straight. You are a man (unless you're a woman named Peter, which must have sucked in high school). You have had a heart attack. I am going to assume you are under 69. Congratulations. You are in the only group of people who actually get a demonstrated life protective effect from the drug class known as statins. Everyone else (women, men over 69 and men under 69 without a heart attack on their jacket) doesn't get any protective effect from them, save lower cholesterol. You've been around here long enough to know that low cholesterol doesn't mean that much to total mortality. Before I get dismissed as a yellow journalist, I'll kick it to my buddy, the mostly respected Dr. Mike Eades, 1/2 of the team behind Protein Power, which most people around here seem to like as getting most of the science right. http://www.proteinpower.com/drmike/s...st-on-statins/ with excerpt from: http://www.thelancet.com/journals/la...ection=Comment "We have pooled the data from all eight randomised trials that compared statins with placebo in primary prevention populations at increased risk. Unfortunately, our analysis is imperfect because these trials are not solely primary prevention: 8·5% of patients had occlusive vascular disease at baseline. We used two outcomes to estimate overall benefit (benefit minus harm): total mortality and total serious adverse events (SAEs). Total mortality was not reduced by statins (relative risk 0·95, 95% CI 0·89-1·01). In the two trials that reported total SAEs, such events were not reduced by statins (1·01, 0·97-1·05) (data on SAEs from the other trials were not reported). The frequency of cardiovascular events, a less encompassing outcome, was reduced by statins (relative risk 0·82, 0·77-0·87). However, the absolute risk reduction of 1·5% is small and means that 67 people have to be treated for 5 years to prevent one such event. Further analysis revealed that the benefit might be limited to high-risk men aged 30-69 years. Statins did not reduce total coronary heart disease events in 10,990 women in these primary prevention trials (relative risk 0·98, 0·85-1·12). Similarly, in 3239 men and women older than 69 years, statins did not reduce total cardiovascular events (relative risk 0·94, 0·77-1·15)." "Our analysis suggests that lipid-lowering statins should not be prescribed for true primary prevention in women of any age or for men older than 69 years. High-risk men aged 30-69 years should be advised that about 50 patients need to be treated for 5 years to prevent one event. In our experience, many men presented with this evidence do not choose to take a statin, especially when informed of the potential benefits of lifestyle modification on cardiovascular risk and overall health. This approach, based on the best available evidence in the appropriate population, would lead to statins being used by a much smaller proportion of the overall population than recommended by any of the guidelines." Quickly, for Tunderbar, before he shows up, the conflicts of interest statement for the authors of the metastudy: "JMW declares no conflict of interest. JA is an expert consultant to plaintiffs' attorneys on litigation involving the drug industry, including Pfizer for its marketing of atorvastatin." So, maybe JA is biased against statins. But still, that's a pretty big finding, no? Statins (considering side effects) are worse than no harm or break even for everyone without a Y chromosome, and the same for most people with one. You're in the group that does better, but it's not a whole lot better with them. And how do you actually know you are going to live longer? You have suspicion because it's what the docs and the lipid hypothesists tell you. Check out this fun curve: http://www.health-heart.org/J-LIT_TC+LDLvsMortality.gif Good luck with your statins. By your admission, you're on the left side of both of those charts. Sorry. I don't like to bear bad news. PS- This might be the ugliest web page I've ever seen: http://www.health-heart.org/cholesterol.htm |
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The Cholesterol Con
On Tue, 04 Mar 2008 01:55:13 -0500, Marengo wrote:
On Sun, 02 Mar 2008 20:41:41 GMT, "FOB" wrote: The Cholesterol Con - Where Were the Doctors? By Maggie Mahar Health Beat *yellow journalism article snipped* Wow! That was as whacked-out, biased, negative an article as I've ever read in my life. All it does is spew innuendo and crap about statins with absolutely nothing concrete to say whatsoever. It states that statins don't work by lowering cholesterol, but gives no proof, nor does it reveal how statins do in fact work if that is the case. Someone has an agenda. Read this book: The great cholesterol con. It has all the data you need. There's tons of data out there suggesting the the culprit isn't LDL. The author may very well change her mind after she has his first heart attack. It sure changed mine; and now that my cholesteol and triglycerides are both down to 117 thanks to diet, Lipitor and Tricor (with absolutely no side effects that the moronic scare-mongers would try to shock us with) , and my HDL/LDL ratio has tripled, I have a much brighter prospect for a long life than I did 6 months ago. This unsubstantiated negative crap refuting dozens of legitimate studies with absolutely no facts, just innuendo, is dangerous and irresponsible IMO. --- Peter 270/227/180 -- Using Opera's revolutionary e-mail client: http://www.opera.com/mail/ |
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The Cholesterol Con
On Mar 5, 5:03 am, Bob wrote:
On Tue, 04 Mar 2008 01:55:13 -0500, Marengo wrote: On Sun, 02 Mar 2008 20:41:41 GMT, "FOB" wrote: The Cholesterol Con - Where Were the Doctors? By Maggie Mahar Health Beat *yellow journalism article snipped* Wow! That was as whacked-out, biased, negative an article as I've ever read in my life. All it does is spew innuendo and crap about statins with absolutely nothing concrete to say whatsoever. It states that statins don't work by lowering cholesterol, but gives no proof, nor does it reveal how statins do in fact work if that is the case. Someone has an agenda. Read this book: The great cholesterol con. It has all the data you need. There's tons of data out there suggesting the the culprit isn't LDL. Which one? The Kendrick or the Colpo. I'd go for the Kendrick, but the Colpo has value too. Both are extensively researched. |
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The Cholesterol Con
Marengo wrote:
On Sun, 02 Mar 2008 20:41:41 GMT, "FOB" wrote: The Cholesterol Con - Where Were the Doctors? By Maggie Mahar Health Beat *yellow journalism article snipped* Wow! That was as whacked-out, biased, negative an article as I've ever read in my life. All it does is spew innuendo and crap about statins with absolutely nothing concrete to say whatsoever. It states that statins don't work by lowering cholesterol, but gives no proof, nor does it reveal how statins do in fact work if that is the case. Someone has an agenda. The author may very well change her mind after she has his first heart attack. It sure changed mine; and now that my cholesteol and triglycerides are both down to 117 thanks to diet, Lipitor and Tricor (with absolutely no side effects that the moronic scare-mongers would try to shock us with) , and my HDL/LDL ratio has tripled, I have a much brighter prospect for a long life than I did 6 months ago. This unsubstantiated negative crap refuting dozens of legitimate studies with absolutely no facts, just innuendo, is dangerous and irresponsible IMO. --- Peter 270/227/180 See Article: LDL Cholesterol: “Bad” Cholesterol, or Bad Science? Journal of American Physicians and Surgeons http://www.jpands.org/vol10no3/colpo.pdf |
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