Thursday, March 29, 2007


Lipitor is a common statin. There is a "Cholesterol Skeptics" site here

A doctor accused of wittingly prescribing useless or possibly lethal drugs would vehemently - and understandably - deny it. This makes it rather difficult to oppose the prevailing medical consensus on statins - the cholesterol-lowering drugs prescribed to four million people in Britain at a cost of 1 billion pounds a year. That's quite a sum. It could pay the salaries of 700,000 nurses or build two spanking new teaching hospitals.

An even bigger sum is 15 billion. That is the profit the pharmaceutical industry made last year from this, the most profitable class of drugs ever invented. They are so profitable that the latest statins to reach the market came with a 600 million promotion budget, to "promote" the notion to family doctors and policymakers that the lower the cholesterol the better, and that at least half the population would benefit from the drugs.

But it is not so. Statins are useless for 95 per cent of those taking them, while exposing all to the hazard of serious side-effects. Hence my ever-growing file of letters from those who regrettably have had to find this out for themselves, illustrated by this all-too-typical tale from Roger Andrews of Hertfordshire, first prescribed statins after an operation for an aortic aneurism (that he had cleverly diagnosed himself).

Over the past few years Mr Andrews had become increasingly decrepit -what can one expect at 74? - with pain and stiffness in the legs and burning sensations in the hands so bad that when flying to his son's wedding in Hawaii he needed walking sticks and a wheelchair at the transfer stops. However, he forgot to pack his statins, and felt so much better after his three-week holiday that when he got home he decided to continue the inadvertent "experiment" of not taking them. Since October most if not all of his crippling side-effects have gone. Several friends can tell a similar story, and they have friends too.

The take-home message is that statins are only of value in those with a strong family history of heart disease or men with a history of heart attacks. For everyone else they are best avoided as they seriously interfere with the functioning of the nerve cells, affecting mental function, and muscles. This is all wittily explained in a recent book by a Cheshire family doctor, Malcolm Kendrick, "The Great Cholesterol Con" (John Blake Publishing, 9.99). There are, I suspect, many out there, like Mr Andrews, wrongly attributing their decrepitude to Anno Domini, when the real culprits are statins.


Few benefits in stent surgery, researchers find

FOR patients with clogged arteries who have not had a heart attack, the widely used surgical treatment of balloon angioplasty with the insertion of a stent is no better than conventional drug treatment, researchers have found. In a study of more than 2000 patients, those receiving only drug therapy had the same number of heart attacks, strokes and deaths as those who received the drugs and underwent the artery-opening angioplasty, US Department of Veterans Affairs researchers told a meeting of the American College of Cardiology in New Orleans on Monday. The only difference was a slight improvement in the quality of life for those receiving angioplasty because of fewer chest pains, known as angina.

The finding could rock an industry worth $US6 billion ($7.4 billion) a year, of which $US3.2 billion is done in the US. As many as 65 per cent of the estimated 1 million stenting procedures performed each year occur in such patients at a cost of about $US40,000 per procedure.

"This is good news for patients and physicians," said William Boden, of the University of Buffalo School of Medicine, who led the study. In the rush to perform angioplasty, the effectiveness of drug treatment "was lost in the shuffle", Dr Boden said. "It was considered old-fashioned, ho-hum. Now we can say to physicians … 'You are not putting patients in harm's way.' That is something we didn't know before."

Experts cautioned the results did not apply to patients who had suffered a heart attack because of a blockage in the coronary artery. Numerous studies have shown that angioplasty is the gold standard for those patients, and physicians urge that it be implemented as soon as possible to reopen the artery and restore blood flow to the heart. But in non-emergency situations, the drugs act fast enough to forestall the need for angioplasty.

Stent makers said the study provided little new information, did not include the newest generation of drug-eluting stents and did not address the key issue of whether stents prevented the need for further angioplasties. They also argued that the device's greatest benefit was improving quality of life.

The study, also published online by the New England Journal of Medicine, is the first large analysis examining the stent's value for those with what is known as stable disease. The mortality rate was about 8 per cent in both groups at the end of the study. Related risks such as death, heart attack and other cardiovascular incidents were 20 per cent and 19.5 per cent, respectively, a statistically negligible difference.

The study's results "should lead to changes in the treatment of patients with stable coronary artery disease, with expected substantial health-care savings," wrote the cardiologists Judith Hochman and Gabriel Steg in an editorial in the same edition of the journal.

The study enrolled 2287 patients at 50 medical centres and hospitals in the US and Canada. All the patients had at least a 70 per cent blockage of their coronary artery and chest pains several times a week. Most also had high cholesterol and high blood pressure, and many had diabetes. After an average of 4.6 years of monitoring, there were 211 deaths, heart attacks or strokes in the group receiving angioplasty and 202 in the group receiving only drug therapy. The only difference between the two groups was that angioplasty patients had fewer symptoms of angina, although even that difference was not as large as had been expected. After three years, 67 per cent of those in the angioplasty group were free of angina, compared with 62 per cent in the medication-only group, according to the study.



Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

Trans fats:

For one summary of the weak science behind the "trans-fat" hysteria, see here. Trans fats have only a temporary effect on blood chemistry and the evidence of lasting harm from them is dubious. By taking extreme groups in trans fats intake, some weak association with coronary heart disease has at times been shown in some sub-populations but extreme group studies are inherently at risk of confounding with other factors and are intrinsically of little interest to the average person.