Right or Wrong?

When two physicians give you two different answers to the same question, one of them is right and one of them is wrong.

In these situations, what do you do? Blindly accept the advise of one or the other?

No. You become a gumshoe. You read. You investigate. You become Columbo.

I have truckloads of sympathy for those who are hoodwinked and corralled into taking medications that not only do them no good, but do them harm. My dear mother in law is one of them.

Her doctor put her on statins after she had a heart attack last year. She's fine now and doing well but if the doctor bothered to read a smattering of the scientific literature on cholesterol and women, she would know that statins are useless and cause everyone who takes them liver and neuromuscular harm.

What did Hypocrites say again? Do no what?

It's a shame really. And I feel sympathetic towards the doctors too. But when there is conflicting evidence in a particular area of medicine, don't you think that the doctors have a responsibility to know both sides? So very often they don't. They are entirely clueless to the opposing evidence.

To me this is malpractice. It's certainly wildly irresponsible and disgustingly lazy. This medical malaise is hurting and killing people everyday. Our president wants to know how to fix healthcare. How about insisting that doctors educate themselves on issues that have conflicting evidence?

Sometimes when something breaks, you need to throw the item away. There's just no repairing it. Time for a new one.

Comments

[fred hahn]

For those of you who are following this John vs Fred comment war, read the below link and see what you think.

http://www.proteinpower.com/drmike/statins/statin-panic/

[fred hahn]

The time it would take me to answer the entirety of your last post is not worth my time. You are not reading what I am saying critically. You're just spouting - fuming more like it. I'll at least address a few points:

You said:

"So Dr. Mike is trying to argue that 'adherers' (whatever that means)..."

You don't know what the word 'adherer' means? C'mon. He explains it quite thoroughly in the blog post. "People who take their medications religiously..." Perhaps you need to actually read the entire post. Clearly you didn't.

Read closely and slowly: There is no research proving that statins, by lowering LDL cholesterol alone, improve CVD health leading to less CVD events. None whatsoever. The study you cited that has been cited 1500 times or so does not indicate that if your cholesterol is elevated, taking a statin will decrease the chance that you will have a CVD event. They DO seem to protect a very small group of men (although at a cost in side effects), and the evidence is good that they extend the life of certain men who take them typically men at high risk who have had a CV event.

The issue is HOW they protect some men from CVD. Do they do it by lowering cholesterol or LDL or do they do it via mechanisms that are identical to restricting carbs (without the added side effects) by lowering VLDL and so LDL and triglycerides, raising HDL, maybe selectively removing small dense LDL or lowering the total number of LDL particles, reducing inflammation, etc.

If a statin reduces your total cholesterol, because cholesterol is considered a risk factor, you now have a lower risk.

But a high cholesterol level isn't a risk factor at all. There is no science indicating such which all of the books I mentioned (which you haven't read and more than likely won't read) discuss - all of which are heavily referenced.

Statins it is now believed lower inflammation and it is this aspect of statins that appears to be beneficial - in men who have already had a CVD event and in no one else. It has nothing to do with cholesterol levels as fully half of the people in this country who experience a CVD event have normal cholesterol numbers. And there are many other ways to decrease inflammation than by taking liver damaging, muscle wasting drugs that cost a small fortune.

You also said:

"You (Fred) and Dr. Mike are not at all empowering anyone by your Stick it to The Man mentality."

You are quite wrong about that. The dozen or more people I have convinced to flush their statins down the toilet and adopt a low carb diet have all markedly improved their blood profiles and lost their muscle pain and weakness. For Mike it is probably exponentially more.

And:

"Seriously man.. the ONE citation that kinda, sorta looked like a decent thing to read wasn't even the same drug class that we are discussing here. Now who needs to read more literature? And by literature I don't mean Muscle Magazines, or www.proteinpower.com."

The point of adding that citation was not to discuss statins. But again you sidestep the point. Interesting how you side-stepped this:

"A pooled analysis of 8 randomized trials in primary prevention populations showed that statins did not reduce overall mortality, indicating that lipid-lowering therapy with statins should not be prescribed for true primary prevention in women of any age or in men older than 69 years."

I said:

"...if the doctor bothered to read a smattering of the scientific literature on cholesterol and women, she would know that statins are useless and cause everyone who takes them liver and neuromuscular harm."

This was the crux of my blog and I am correct. They are useless in women and cause everyone who tkaes them harm.

[JohnDakota]

Fred,

You asked me to cite proper scientific studies. All you're citing back to me are opinion pieces. And horrible opinion pieces at that.

Let's looks at your first citation;

"More Statin Madness" By Dr. Mike

I wont bother with deconstructing his opinion piece by piece, but just to summarize he goes to explain how only double blind randomized studies are objective/useful. However, because you can't really perform these studies with diet, then these studies (non-double blind) are bad.

Dr. Mike then goes on to make a comparison between studies evaluating different diet regimes (and how people feel about themselves), and studies evaluating statins (which involve DEATH). There's a problem with this. Firstly, statins have to do with preventing death (people die). Self selecting yourself into some diet group and reporting how well you feel you performed is quite a different thing. Die /= Diet.

Next let me quote the central statement of this particular opinion piece;

"....based on the two studies I detailed above, it’s much likelier that the decreased mortality in those who took all their statins came about not because of the statins, but because those who stuck with them are adherers and have what ever quality it is that adherers have that makes them live longer."

So Dr. Mike is trying to argue that 'adherers' (whatever that means) have some innate predisposition to live longer. Since Dr. Mike seems so competent in deconstructing non-double blind research, maybe he'd like to present some evidence beyond his personal opinion that establishes exactly what 'adherers' actually are, and how this quality extends life.

But let me continue. 3 sentences later Dr. Mike states;

"What they’re [The researchers] saying here is that statins have been shown to reduce mortality from heart disease in those who have elevated LDL, which is true."

So now it's not the patient's 'adherer' quality, but STATINS. Your Dr. Mike friend can't even keep on his own message.

To be fair he then says;

" But this decrease in deaths from heart disease is compensated for by an increase in deaths from cancer and other causes, so there really isn’t a gain. You’re still dead."

Sure. However if we are to believe this logic then anything we do is futile. Don't buy gym memberships to get healthy, forget about eating right, don't take your AIDS prescriptions, or your antibiotics, or your EPI pen when you're stung by the killer bee. You're all going to die in the end and all the money you spend on fighting the inevitable is just going to go to The Man.

But seriously, dying from cancer in the distant future, years from now because of something totally unrelated to your statin therapy is a hell of a lot better than dying NOW from CHD because you didn't want to take statins. Are you, and Dr. Mike actually saying that the years from now until when you die are worth less than the money you'll spend on prolonging your life? I think so!

Dr. Mike; "Are you going to spend $200 per month for the rest of your life and stay on medications that may make you feel lousy and lose your memory just so you can die of something other than heart disease?"

Firstly; Dr. Mike just admitted that Statins prevent heart disease;
"....just so you can die of something other than heart disease?"

Secondly; Not all medications make you feel lousy. But given the choice of dying now, or dying 10-20 years from now, I believe most people will choose 10-20 years. However, that decision is ultimately up to the patient. The information necessary for the patient to make an informed decision should be presented in an HONEST, COMPASSIONATE and OBJECTIVE manner that respects the individual and to enable them to make THEIR OWN AUTONOMOUS CHOICE. If your Dr. Mike had attended any other Medschool other than the one off the back of a Shreddies box he would know that.

You (Fred) and Dr. Mike are not at all empowering anyone by your Stick it to The Man mentality.

Now let's move on to your next citation..

You cited a 30 year old ABSTRACT that says it's hard to do research on people and evaluate adherence. Yes.. research is HARD.. that's why few people do it well. However there are copious amounts of people who want to offer opinion (NOT OBJECTIVE RESEARCH). Also, forget that this ABSTRACT detailed research that only evaluated a single drug (clofibrate/tradename Atromid-S) which ISN'T EVEN A STATIN. Atromid-S is a fibrate. Just like die/=diet, statin /= fibrate. Seriously man.. the ONE citation that kinda, sorta looked like a decent thing to read wasn't even the same drug class that we are discussing here. Now who needs to read more literature? And by literature I don't mean Muscle Magazines, or www.proteinpower.com.

Beyond all that, you have complained that apparently I only read abstracts. At least I didn't cite you abstracts.

Ok.. Onto your third reference... OY-VEY! Another opinion piece. Next I'm going to expect you to cite me some muscle magazine's 3 page advertizement that pretends to be a piece of research.

But let's go on with the deconstruction;

1. So what.. the media has it's slant. MSNBC, CNN, ABC etc.. LOVE Obama and the liberal/progressive perspective. Fox LOVES conservative issues. SHOCKER! I watch the news and read the paper for entertainment, not for objective fact reporting. I read scientific articles for that. (you have yet to cite me a single objective scientific article that shows your point(s)).

2. Your Doc picks one study that I didn't cite to you to bitch that it's too narrow in scope (only men >50 yo, only women >60 yo) that suggests a conclusion that runs in the face of some other study your Doc likes and had posted before. Again, I never claimed statins propose to decrease ALL motality. They're HMG-CoA Reducatse inhibitors, not the fountain of life.

So in summary of this last citation you gave me..... so what.. It's an opinion piece of a Doc who's bitching that some article he didn't like got a lot of media coverage from biased media outlets, and the scientific study claims something he doesn't want to believe. Sounds like someone is PMS'ing to me.

Fred.. for someone complaining that I don't read enough. You appear to read way too much OPINION and not enough RESEARCH.

[fred hahn]

I think what I'll do is an entire blog dedicated to the misunderstanding, misuse and misapplications of statins as well as their benefits and their dangers just for our polite friend John.

Brandon, John is a hot head. He reads my posts in an attempt to find fault, not to understand. Clearly this is the case given his many almost instant responses.

You are correct - if a company creates a drug and funds the research, that is a conflict of interest and you have to take the results with several grains of salt.

John is painfully naive WRT the research on statins. He reads abstracts, not the actual studies and if he does, he does not read them critically.

John you said:

"If the articles I had cited were BS it would be abundantly clear by this point. All the articles that referenced them would point to that fact."

Not necessarily.

I mentioned the adherer effect before. Here is a piece by Dr. Eades on the adherer effect which you probably won't read (but at least I tried):

http://www.proteinpower.com/drmike/statins/more-statin-madness/

From the study mentioned in the aforementioned blog post:

"A pooled analysis of 8 randomized trials in primary prevention populations showed that statins did not reduce overall mortality, indicating that lipid-lowering therapy with statins should not be prescribed for true primary prevention in women of any age or in men older than 69 years."

And while your at it, take a look at this abstract:

http://content.nejm.org/cgi/content/abstract/303/18/1038

And this:

http://www.proteinpower.com/drmike/cardiovascular-disease/1853/#more-1853

These I hope will help you John to evaluate whether or not you are reading the statin literature critically enough.

As for this statement:

"My bad.. they are so clearly different techniques of working out with the purpose of developing feeble lifters who blame genetics for their weakness."

Though this comment is childish and rude, I'll address it for the benefit of others. Genetics are responsible for many aspects of physical prowess. If it wasn't you and I could train and become as fast as the fastest men in the world, as strong as the strongest and as muscular and the most muscular. We can't.

However, we can ALL become strongER, fastER and more muscular by training. Training using heavy weights (for the individual) and using proper form and a slow and controlled repetition tempo will create great strength and added muscle IF you eat right, sleep right, etc.

I have a picture of what this type of training has done for me here:

http://seriousstrength.yuku.com/topic/1267?page=2

[JohnDakota]

Hi Brandon,

As far as I know the whole 3 vs. 6 debate misses something significant in much of the common discussion.

Those particular fats are not the active agent. Your body takes them up and converts them into a class of compounds called eicosanoids. Omega 3s are converted into eicosanoids that are either less pro-inflamatory than Omega 6 derived eicosanoids, or are actually anti-inflamatory eicosanoids. While Omega 6 (eg. arachidonic acid) is converted into pro-inflamatory eicosanoids.

If we're dealing with arteriosclerosis, anything that is anti-inflamatory is good, as pro-inflamatory agents will recruit macrophages to the area and following what was explained in my last post is a completely bad thing.

[Brandon Schultz, D.C.]

Hi John,
Thank you for the reply. I have read articles pointing to the role of a chronic imbalance of omega3:6 ratio, which deposits excessive omega 6 (and 3 and some saturated fat) into the walls of the arteries, not directly into the lumen, and these deposits cause a disruption of the arterial lumen, thus attracting cholesterol and other cells forming plaques within the lumen. This would seem to imply the real cause is chronic overconsumption of omega 6 oils, thus setting the stage for plaque buildup, oxidation, etc. What is your take?
Also, which is just my speculation, when people consume large amounts of omega 3s to offset this imbalance, they are also consuming more antioxidants (such as vit. e, c, rosemary oil, etc.) found in the oils. Would this be part of the reason why people are seeing benefits from fish oil (omega 3) supplementation in heart health? Could the combination of a healthier omega3:6 and a higher consumption of antioxidants help decrease this oxidized LDL formation?

In health
Brandon Schultz, D.C.

[JohnDakota]

"Decreases the 'risk' - get it..."

I do get it.. decreasing the risk of a fatal coronary event is important when compared to the infinitesimal chance of developing rhabdo. So really the only assured serious side effect, which is being decreased more and more with newer generations of statins is muscle cramps. Honestly, if you would prefer a stroke over muscle cramps, well you deserve to be off statins (assuming all other nutrition/exercise options failed).

"What if a risk is not a cause...
Get it?"

haha.. no because now you're making absolutely no sense.

Just so you know you still have yet to cite anything substantive to support any of your positions (which you began with... so if we play by YOUR RULES the ball has been in your court the whole time).

"Probably not."

It's easy to call that when you e-scream what could easily be interpreted as jibberish.

"Sad indeed."

It is sad that someone who has actually sold a few books can't properly articulate, or support his position in any substantive way.

"If you feel that the evidence points in favor of statins, go on and recommend them."

I will for people who have tried alternative dieting, exercise, supplementation and failed, or for people who refuse to modify their diets/exercise/supplementation accordingly. It's what any responsible person/doctor would do.

"I will do my very best to keep people from them."

By all means. And don't forget to warn them about the boogie man in their closet, and how traditional weight training is the devil even though every pro-athlete or olympian uses it as a foundation.

"Time will tell."

It has.. you just need to read the literature.

[JohnDakota]

Hi Brandon,

The difference between LDL and ox-LDL is, like you've said, ox is the oxidized form. This has less to do with DNA damage as it has to do with arteriosclerotic plaques. When macrophages take up LDL or VLDL in the plaques (which are localized to arterial walls) they also oxidize the LDL. In the process the macrophages turn into foam cells, and in late stages of arteriosclerosis rupture the plaque. This, in many cases results in a stroke. Not exactly something you want.

So the purpose of statins, which inhibit an enzyme that feeds into cholesterol biosynthesis (HMG-CoA Reductase), is to reduce cholesterol amounts, which will reduce LDL and VLDL levels, and the associated bad effects of them on coronary health.

Regarding your concerns of publications having alternative motives; Authors are absolutely required in reputable journals to completely disclose competing interests (ie. trademarks, patents, enterprise motives). This will appear at the very beginning, or in many cases at the end of an article after the conclusion and it will take the simple form of "The authors disclose competing interests." You can also get this information from the disclosure of where the fundings that support the research came from.

However, what Fred has done here has just said 'do you know who funds 90% of the research?' and accused me of being naive without showing me where the competing interests in ANY of my articles are.

[Brandon Schultz, D.C.]

Please correct me if I'm wrong, but I think what is mentioned about pharmaceutical companies isn't "conspiratorial", just pointing out potential problems. Here is how I see some of what they do:
Company comes up with an idea for a drug to treat a disease/symptom. Then decides to make drug. Drug goes through initial testing WITHIN company. Company reports potential for drug. More studies done at universities or facilities FUNDED BY company. Studies show positive outcomes are presented to FDA. FDA approves of trials (not doing any of their own testing), and drug is released to marketplace after extensive DIRECT advertising to consumer and Doctors.

As I emphasize above, there seems to be built-in conflicts of interest in the system of development, testing and release of a drug. No conspiracy, but potential ethical flaws in the system.

Again, just my observations.

In health
Brandon Schultz, D.C.

[Brandon Schultz, D.C.]

Isn't there a difference between demonizing LDL and oxidized LDL? Doesn't the oxidized LDL go along with the larger picture of "oxidative stress" on the cellular makeup of the body, particularly the DNA? Isn't this part of the whole idea of avoiding oxidizing and inflammatory foods such as grains and refined sugar and emphasizing fresh fruit and veggies and a grass-based meat intake? Isn't that what is supported on this site?
Nasty post, sorry to see such exchanges.

In health
Brandon Schultz, D.C.

[fred hahn]

Decreases the 'risk' - get it...

What if a risk is not a cause...

Get it?

Probably not.

Sad indeed.

If you feel that the evidence points in favor of statins, go on and recommend them.

I will do my very best to keep people from them.

Time will tell.

[JohnDakota]

Fred: "Big money is made on statins - perhaps this influences the research? Are you aware who funds over 90% of the research on statins? Are you really that naive?"

Are you kidding me? So you're a conspiracy theorist too?

Everyone has their motivations. I do, you do. Mine just happen to have nothing to do with promoting statins. I work with cancer therapeutics in a university. Avoiding personal skewing motivation is the whole point of reading peer reviewed, proper scientific articles that have been referenced over and over (which is why I mentioned how many times each article I referenced was cited). If the articles I had cited were BS it would be abundantly clear by this point. All the articles that referenced them would point to that fact (unless you're now trying to argue there are thousands of intertwined groups citing each other for some over arching Pharma conspiracy. If that's the case.. god help the people who follow your advice.)

However, if you actually read these other articles that cite the ones I referenced you'll see that they point to them because they make a point and not because they're flawed.

[JohnDakota]

So basically your response is you're not going to rebut anything.. you're going to;

1. keep sending me back to www.thincs.org, where there are absolutely zero peer reviewed articles cited.

or

2. Keep asking me about what particular acronyms/tests mean/are in the hopes that I will be awed by your all knowing, god-like aura.

Let's review what's been said;

Fred: "And you are constructing straw man arguments. I said nothing about LDL and VLDL in this blog post."

Correct, you didn't. However, in your original blog post you did say;

"Her doctor put her on statins ... She's fine .. but if the doctor bothered to read a smattering of the scientific literature on cholesterol and women, she would know that statins are useless and cause everyone who takes them liver and neuromuscular harm."

That's quite a specific statement. Let's break it down.

You mentioned CHOLESTEROL. Lipoproteins carry cholesterol. Fred, do you know that there are a number of types of lipoproteins?Presence of large amounts of particular types of lipoprotein (which carry CHOLESETEROL) is predictive of coronary heart disease (see my last citation). These particular types include low density lipoprotein (LDL) and very low density lipoprotein (VLDL).

So yes.. while you didn't directly say LDL or VLDL in your blog post, the fact that you mentioned CHOLESETEROL while discussing issues of CHD therefore implies LDL and VLDL.

Next, directly in your blog post you said that when treating a woman with high cholesterol, the use of statins are useless. You allude to even reading a 'smattering of the scientific literature.' I have, here's another citation that has been cited over 800x.

Larosa, J.C, et al. 1999
JAMA;282:2340-2346
Effect of Statins on Risk of Coronary Disease A Meta-analysis of Randomized Controlled Trials

I'll give you the take home message;
"Our meta-analysis indicates that reduction in LDL-C associated with statin
drug treatment decreases the risk of coronary heart disease and all-cause mortality. The risk reduction was similar for men and women and for elderly and middle-aged persons."

Seems as if men and women, no matter of what age, appear to respond in a positive way to statins.

The most odd thing is I have yet to find a single peer reviewed article that would argue;
"statins are useless and cause everyone who takes them liver and neuromuscular harm."

Not to be snide, but maybe YOU should go read more... A lot more.

[fred hahn]

John,

You're not reading the research critically. You are merely reporting the abstracts.

And you are constructing straw man arguments. I said nothing about LDL and VLDL in this blog post.

DO you know what a VAP test is? Do you know the difference between the different LDL particles?

My blog was written to suggest that there are 2 sides to the statin story and not knowing all the players is a recipe for disaster.

Big money is made on statins - perhaps this influences the research? Are you aware who funds over 90% of the research on statins? Are you really that naive?

Read more. A lot more. Then come back. If you keep up the BS I'll ban you.

[fred hahn]

John -

Are you a teenager? If so, your parents are failing you.

If not, they failed miserably.

[JohnDakota]

Fred,

That was an epic chutzpa if I have ever seen one.

Your whole original post is a claim that statins are not benificial. So if we are to play by your rules then I don't have to prove anything, you do. But then we just keep playing hot potato.

Look, your first claim is that LDL and VLDL play no part in CHD.

That's just flatly wrong.

Evidence:
Journal of the American Heart Association
Ehara, S. et al. 2001, 103;1955-1960

Elevated Levels of Oxidized Low Density Lipoprotein Show a Positive Relationship With the Severity of Acute Coronary Syndromes

You then say that since LDL and VLDL have nothing to do with CHD, therefore statins are bad because all their side effects are their only effects.

I only cited a single article showing the correlation between LDL/ox-LDL with CHD. I won't cite any more until you go beyond the Dean Esmay approach of telling me to go to some totally unreviewed organization (Dean would suggest Adiposity 101) and read all their literature that is also totally unreviewed.

What that sort of suggestion translates to is; "I have nothing substantive to rebut you with.. therefore I will send you to a bottomless pit of unorganized, unreviewed literature in the hopes you never come back."

[fred hahn]

And as for the NEJM paper you cited - did you read the full text of that study? Do you know what the 'adherer' effect is?

The group of experts are not part of a club. They are free thinking experts whose opinions are supported in researched based papers. You're just too lazy to read them. Or perhaps incapable of understanding them, which judging from your posts is a reasoanble assumption.

The burden of proof lays upon the claimant and the claim that statins reduce risk of heart disease and CVD is not by any stretch of the imagination proven. I do not have to prove the opposite.

You are, by anyone's account, someone who has scarce knowledge on the subject and are just an argumentative loud mouth.

Dr. Kendrick's book is but one of many on the subject all referenced and supported. Once you read the books, you'll feel like a horses a&* for posting here.

I doubt you'll read one.

[Joe]

John,

Opposing views make for excellent discussion, so as a reader I appreciate your additions to Fred's post. However, I don't understand your rudeness?? You muddle your points by berating Fred without warrant. If your citation/points are strong, they'll stand up. No need to behave like a child.

Joe

[JohnDakota]

Your club of friends who are statin skeptics have absolutely zero reading material that falls in the non-anecdotal. It's all opinion.

[JohnDakota]

1. Your club has zero publications. At best the 'members' can claim publications of their own, but to say the publications are a part of that club is a stretch.

They do however have dozens of unpublished letters and articles. Gee.. I wonder what that could mean?

2. You asked for scientific evidence and not self reporting.
Let me quote;
"Show me the research where it indicates the opposite. And no - observational studies don't count."

I have.. with a single 11 page article which has been cited ~1450x by other researchers that have also been published in peer reviewed journals.

You have yet to comment at all about this excellent article explaining how somehow your totally unpublished club trumps it, or the reserchers who cited Cannon, C.P. et al. 2004.

[fred hahn]

Read what the people / experts have to say there before you come back here and discuss the issue further.

[JohnDakota]

Sorry.. you believe you don't do super slow. You call it 'slow burn' right?

My bad.. they are so clearly different techniques of working out with the purpose of developing feeble lifters who blame genetics for their weakness.

[JohnDakota]

You found a club of people who are skeptical of statins.

w.o.w

Now do i have to provide you with a site for a club of people who love statins?

[JohnDakota]

Forget it.. I'll baby you.

http://stmarysresident.org/NEJM%202004%20350(15).pdf

That's the link to;
Cannon, C.P. et al. 2004.,
Intensive versus Moderate Lipid Lowering with Statins after Acute Coronary Syndromes,
The NewEngland Journal of Medicine,
Vol 350, No 215, p.1495-1504

That particular article has been cited 1452x in 5 years. For pretty much any article that's absolutely unprescidented. It points to how well the work was done, and how impactful it was.

How well cited is your friend's book?

You'll also notice that Cannon, C.P. et al. 2004 has 7 M.D's, 2 Phd's, and one MD/Phd authors.

[fred hahn]

And I don't do Super Slow exercise.