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It ain't necessarily so

by dvx Wed Feb 27th, 2013 at 02:07:08 PM EST

[Hoisted from today's Newsroom.]

Once again, medical conventional wisdom is being overturned:

Doubts Emerge on the Value of Very Low Cholesterol Levels: Scientific American

Soon after Joseph Francis learned that his levels of ‘bad’ LDL cholesterol sat at twice the norm, he discovered the short­comings of cholesterol-lowering drugs — and of the clinical advice guiding their use. Francis, the director of clinical analysis and reporting at the Veterans Health Administration (VA) in Washington DC, started taking Lipitor (atorvastatin), a cholesterol-lowering statin and the best-selling drug in pharmaceutical history. His LDL plummeted, but still hovered just above a target mandated by clinical guidelines. Adding other medications had no effect, and upping the dose of Lipitor made his muscles hurt — a rare side effect of statins, which can cause muscle breakdown.

So Francis pulled back to moderate Lipitor doses and decided that he could live with his high cholesterol. Later, he learned that other patients were being aggressively treated by doctors chasing stringent LDL targets. But Francis found the science behind the target guidelines to be surprisingly ambiguous. “You couldn’t necessarily say lowering LDL further was going to benefit the patient,” he says.

The standard advice may soon change. For the first time in more than a decade, the US National Heart, Lung and Blood Institute is revising the clinical guidelines that shaped Francis’s treatment (see ‘How low can you go?’). Expected to be released later this year, the fourth set of guidelines, called ATP IV, has been drawn up by an expert panel of 15 cardiologists appointed by the institute. The guidelines will set the tone for clinical practice in the United States and beyond, and will profoundly influence pharmaceutical markets. They will also reflect the growing debate over cholesterol targets, which have never been directly tested in clinical trials.

What other pharmaceutical panaceas do we need to revisit?

"You couldn't necessarily say lowering LDL further was going to benefit the patient," he says.

But you can say with certainty that chasing that goal with more pharmaceuticals is going to positively impact the bottom line of big pharma. I and others I know have met all the goals just with Omega 3 fish oil supplements. With me it took going to two one-gram capsule a day, morning and evening, though I used three a day for a while to get there. With three I can make the levels ridiculously low. Now if only I am not poisoned by some contaminant. :-)

As the Dutch said while fighting the Spanish: "It is not necessary to have hope in order to persevere."
by ARGeezer (ARGeezer a in a circle eurotrib daught com) on Wed Feb 27th, 2013 at 03:50:55 PM EST
Fixing up your diet and lifestyle is so goddamn easy and cheap.

you are the media you consume.

by MillMan (millguy at gmail) on Thu Feb 28th, 2013 at 03:36:09 PM EST
[ Parent ]
I very much disagree... regrettably proper nutrition, leisure time, and the expenses involved of practising sport cost a lot. Add to the above the individual and the social resistance to change, and it becomes clear why people resort to (often short term-ist) medications instead of fundamental lifestyle changes.
by Ivo on Sat Mar 16th, 2013 at 03:51:01 PM EST
[ Parent ]
easy, cheap and slow, especially with some garden to grow yer own in.

it's time that's expensive, and it's ignorance the culprit, as usual.

it's a lot cheaper to get chem veg and fruit all the time, but you lower your odds in the great roulette of life.

it's easy when you learn the basics, like combining, pre-soaking grains and beans, sprouting, meal balancing, but for many people it's all just food.

it's cheap if you are a good shopper, buy in season and 'put up' for winter.

trying to stay healthy on average supermarket food takes some pretty sophisticated label-reading skills, and if you take the shortcut of wholefoods, there goes cheap right there.

whatever you spend extra on food will save you more in med bills, skimping on that aspect is the definition of false economy.

just stopping over-eating saves you quite a bit right there! the better quality food you eat, the less you need to pack yourself full of it.


"We can all be prosperous but we can't all be rich." Ian Welsh

by melo (melometa4(at)gmail.com) on Sat Mar 16th, 2013 at 06:21:35 PM EST
[ Parent ]
Well, i've heard that aspirin wouldn't make it through today's approval process. And coffee for sure wouldn't...
by asdf on Wed Feb 27th, 2013 at 10:45:48 PM EST
Pharma-induced headaches are something that is gaining attention in migraine circles.

A vote for PES is a vote for EPP! A vote for EPP is a vote for PES! Support the coalition, vote EPP-PES in 2009!
by A swedish kind of death on Thu Feb 28th, 2013 at 07:35:55 AM EST
[ Parent ]
my mother suffered from migraines, what a nightmare... she would go through a whole tube of veganin in a day, and we'd all have to tiptoe and whisper, while she would lie with the curtains closed.

it was probably caused by all the lead fumes in the city traffic right under the window.

i get headaches when the temperature or barometric change too abruptly, like happened today. i had to go do a massage on a new client, and as happens sometimes, the only* time during the whole day i didn't feel the pain was during the treatment. funny that...

* until i got home and finally took one, then one more cephyl, which did the trick.

cephyl is good stuff, from france. they don't sell it here, unfortunately. a lot less side effects than any other aspirin i ever tried.

my poor mom, aspirin never made a dent with her headaches, i feel so lucky not to have one of mine more than once or twice a month.

sometimes headaches come from your liver, especially this time of year. lucky it's artichoke season, so that medicine tastes good!

big pharma have made some great products which enable better lives for millions, but their motives are hopelessly mixed, and pillpopping has become a way of life. treating the people as well as the disease, not so much...

i had a client once who took 23 medicines on an empty stomach every morning. talk about killing her with kindness!

then there's the healthfood version where people throw every superfood they've read about on the internet into a blender and chug that down for breakfast, the more the merrier.

kale-pineapple-wheatgrass-peruvian tree bark shavings, raw chocolate-probiotic-high-enzyme minestrone.

gag or yum, we're all dead in the long run, so buon appetito!

"We can all be prosperous but we can't all be rich." Ian Welsh

by melo (melometa4(at)gmail.com) on Sat Mar 16th, 2013 at 06:51:42 PM EST
[ Parent ]
My mother, who used to manage a cardiologist's office, was saying this 20 years ago.

Be nice to America. Or we'll bring democracy to your country.
by Drew J Jones (pedobear@pennstatefootball.com) on Thu Feb 28th, 2013 at 08:33:32 AM EST
There has been media noise around this in France recently, with the publication of a book by Philippe Even denouncing the cholesterol myth and the supposed usefulness of statins (which have a very high cost level for national health insurance). Unsurprisingly, he was immediately attacked.

This seems to have had no echo in English-language media, but here are a couple of excerpts translated from French:

Le cholestérol ne boucherait pas les artères et les statines seraient inutiles et dommageables | PsychoMédia Cholesterol does not clog arteries and statins are useless and harmful | PsychoMédia
Le Pr Philippe Even, dont le livre "La vérité sur le cholestérol" vient de paraître, n'est pas le seul à affirmer que le cholestérol n'est pas la cause de l'arthérosclérose, que les concepts de bons et de mauvais cholestérol ne sont pas fondés et que les médicaments anticholestérol, dont la principale classe est celle des statines (1), sont inutiles et même dangereux.Professor Philippe Even, whose book "The Truth About cholesterol " just published, is not alone in asserting that cholesterol is not the cause of atherosclerosis, the concepts of good and bad cholesterol are not grounded, and anti-cholesterol drugs, of which the main class is the statins, are unnecessary and even dangerous.
Il y a plus de vingt ans, rapporte Rue 89, le Pr Marian Apfelbaum expliquait dans "Vivre avec le cholestérol" que la croisade anticholestérol repose sur un illogisme, celui de considérer que parce que les niveaux élevés de cholestérol et de crises cardiaques se trouvent dans les mêmes populations, les premiesr seraient la cause des secondes.More than twenty years ago, reports Rue 89 , Professor Marian Apfelbaum explained in "Living with Cholesterol " that the anticholesterol crusade is based on a logical fallacy, that of considering that one because high levels of cholesterol and heart attacks coincide in the same populations, that the former is the cause of the latter.
Interrogé par Le Point, Michel de Lorgeril, cardiologue et chercheur au CNRS, auteur de "Cholestérol, mensonges et propagande" et "Prévenir l'infarctus et l'AVC", explique que le cholestérol "est indispensable au bon fonctionnement des cellules, des muscles, des neurones, du coeur, du cerveau et de la digestion. Sans lui, aucune communication entre les cellules ne serait possible, et il est à l'origine des hormones sexuelles, de celles du stress, de la reproduction, ainsi que de la très précieuse vitamine D.". Et d'ajouter: "Le perturber avec des médicaments, c'est vraiment jouer à l'apprenti sorcier."Questioned by Le Point , Michel de Lorgeril, cardiologist and researcher at CNRS, author of "Cholesterol, lies and propaganda" and "Preventing heart attack and stroke", explains that "cholesterol is essential to the proper functioning of cells, muscles, neurons, the heart, brain and digestion. Without it, no communication between cells would be possible, and it is at the origin of sex hormones, stress and reproduction hormones, and the precious vitamin D.". He added: "Interfering with it using drugs, is really playing the sorcerer's apprentice."

Site du Dr Michel de Lorgeril | Cardiologue et chercheur au CNRSSite Dr. Michel de Lorgeril | Cardiologist and researcher at CNRS
... il y a un empilement extraordinaire de données scientifiques réfutant globalement la théorie du cholestérol comme cause de l'infarctus ; et spécifiquement l'efficacité des statines pour en diminuer le risque.... there is an extraordinary stack of scientific data refuting the theory of cholesterol as a cause of myocardial infarction, and specifically the efficacy of statins to reduce the risk.
Une telle affirmation mériterait un développement scientifique qui est impossible ici ; mais je vais donner un argument décisif à l'appréciation des lecteurs : la plus puissante des statines en termes de réduction du cholestérol - le fameux Crestor que tant de malheureux patients se voient prescrire -  a été testé dans 4 essais cliniques en double aveugle [CORONA, GISSI, AURORA, JUPITER] : dans aucun de ces essais (publiés entre 2007 et 2009) les auteurs ont rapporté une diminution de la mortalité cardiovasculaire - le critère de jugement le plus solide et incontestable en cardiologie - et cela malgré des biais méthodologiques favorisant le Crestor.Such a statement deserves a full scientific explanation which is impossible here, but I will offer a decisive argument to readers judgement: the most powerful statin in reducing cholestero - the famous Crestor that so many unfortunate patients are prescribed - has been tested in four double-blind clinical trials [CORONA, GISSI, AURORA, JUPITER]: in none of these trials (published between 2007 and 2009) the authors reported decrease in cardiovascular mortality - the most solid and indisputable criterion in cardiology - and despite methodological bias favoring Crestor .
Aucun autre essai testant le Crestor n'a été publié ; soulevant une question terrible : pourquoi l'Assurance-Maladie rembourse ce médicament inutile ?No other trial testing Crestor has been published, raising a terrible question: why is national health insurance covering the cost of this useless medicine?
by afew (afew(a in a circle)eurotrib_dot_com) on Thu Feb 28th, 2013 at 08:42:35 AM EST
Mediterranean Diet Can Cut Heart Disease, Study Finds - NYTimes.com

One group assigned to a Mediterranean diet was given extra-virgin olive oil each week and was instructed to use at least 4 four tablespoons a day. The other group got a combination of walnuts, almonds and hazelnuts and was instructed to eat about an ounce of the mix each day. An ounce of walnuts, for example, is about a quarter cup -- a generous handful. The mainstays of the diet consisted of at least three servings a day of fruits and at least two servings of vegetables. Participants were to eat fish at least three times a week and legumes, which include beans, peas and lentils, at least three times a week. They were to eat white meat instead of red, and, for those accustomed to drinking, to have at least seven glasses of wine a week with meals.

They were encouraged to avoid commercially made cookies, cakes and pastries and to limit their consumption of dairy products and processed meats.

Since this stuff actually works, can I get social security to reimburse my olive oil and nuts?

It is rightly acknowledged that people of faith have no monopoly of virtue - Queen Elizabeth II

by eurogreen on Thu Feb 28th, 2013 at 09:14:44 AM EST
[ Parent ]
why is national health insurance covering the cost of this useless medicine?

What was the contribution to election campaigns in the recent elections, and in all elections going back to the introduction of the drugs, of the companies making the drugs in question?

As the Dutch said while fighting the Spanish: "It is not necessary to have hope in order to persevere."
by ARGeezer (ARGeezer a in a circle eurotrib daught com) on Thu Feb 28th, 2013 at 12:16:48 PM EST
[ Parent ]
Well, if there are any campaign contributions from big pharma in France, they are necessarily covert and illegal. Parties are financed by the taxpayer plus individual donations.

It's more a matter of mind control. The minister of health in France is generally a doctor, and if not, very much under the heel of the doctor lobby. And the doctors all seem to be taking the same pills (and I will not vouch for the notion that they are not, collectively, on the take from big pharma)

It is rightly acknowledged that people of faith have no monopoly of virtue - Queen Elizabeth II

by eurogreen on Fri Mar 1st, 2013 at 03:44:15 AM EST
[ Parent ]
I will not vouch for the notion that they are not, collectively, on the take from big pharma

US doctors are treated very well by pharma companies. Were there a ban on gratuities from pharma to doctors a different dynamic might emerge. Perhaps the suggestion that this pattern of gratuities is a significant factor in driving up the cost of French health care might get some traction. Given that phama can't contribute directly to legislators it is likely that their biggest return on any 'investment' is gratuities to doctors.

As the Dutch said while fighting the Spanish: "It is not necessary to have hope in order to persevere."
by ARGeezer (ARGeezer a in a circle eurotrib daught com) on Fri Mar 1st, 2013 at 12:59:53 PM EST
[ Parent ]
I find it interesting that the guidelines are being revised so close to the November 30, 2011 expiration of Pfizer's (Parke Davis..) Lipitor patent.

Another reported side effect of statins is short term memory loss. Since I've been taking 40mgs a day since 2008, my wife complains it has to be true, but my doctors won't agree to remove it from my regimen. Perhaps, now researchers will be free to reveal the true causes of coronary artery disease and doctors will not limit its treatment only to symptoms of its presence.

I can swear there ain't no heaven but I pray there ain't no hell. _ Blood Sweat & Tears

by Gringo (stargazing camel at aoldotcom) on Fri Mar 1st, 2013 at 11:40:32 PM EST

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