More ‘McStatin’ Researcher Replies

      25 Comments on More ‘McStatin’ Researcher Replies

Darrel Francis, the “McStatin” researcher who replied to a post last week, has read your comments and written another reply covering various topics raised.  I’m posting it here instead of leaving it in the comments, where it’s likely to be missed.

Side effects
Many correspondents have discussed side effects. These are common in people taking statins. But they are almost exactly as common in people who are given blank tablets and asked the same questions (have a look at the major trials). It is that which made me said that the power of suggestion is large, and larger than we might think from everyday living. Ironically, it is the strength of our belief in the powers of medicine that makes it able to exert a large nocebo effect too.

Tracee
Good question, and we did not pick on one manufacturer of junk food, or on one item, other than as an example that would be familiar to anyone. Yes it would apply to any unhealthy food. Of course (as all correspondents have agreed) the sensible thing is to not eat unhealthy food and to exercise healthily. But unfortunately many people do not do this. Telling people what to do doesn’t work (neither you nor I like being on the receiving end of nannying) but giving people a choice might sometimes work.

Salt being a necessity
True but not in little packets of extra salt. I contest whether the salt in packets is ever needed to keep anyone alive in the developed world. There is plenty already included in every processed meal and probably in every fresh meal (since plants and animals themselves normally contain salt too)

Shops being forced
Nobody should force shops to hand out anything. All I am doing is highlighting the contrast between what they choose to hand out, and what they choose not to.

Whether fat is the evil element in junk food
I do not believe it is just the fat, or just the sugar, or just the salt, in junk food that makes it unhealthy, and I am sorry if in the paper if it appeared I was implying that if we could leave out one element, everything would be fine. But I don’t think anybody on this board, or anywhere else for that matter, thinks junk food is particularly healthy. And as a cardiologist, it is heart attacks that I am concerned about.

Whether statins prevent heart attacks caused by high blood pressure
Strangely, it seems they do, regardless of your baseline cholesterol and blood pressure. Weird but true: anyone can check it for themselves, for example in an analysis of 90,000 patients that is now available free: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2805%2967394-1/fulltext

Exercise
Ned Kock – I agree with you fully – exercise does work in improving cardiovascular health but (I am sorry to say) ADVISING people to do exercise does not work. That is not because exercise does not work, but because there is a block between receiving the advice and acting on it: free will.

“Free” salt
I only meant without additional charge: I realise it does cost the shop something. It would be interesting if they charged a little, even a few cents. I bet that would have a small healthy effect…

Dave Wilson re CORONA and GISSI
These two trials were at the opposite end of the risk spectrum to primary prevention. In these, patients had advanced heart failure and many died from that process which was not significantly slowed by prevention of myocardial infarction. But in people who did not have advanced heart failure – like the 90,000 enrolled in trials described above, there was a distinct effect in reduction of heart attacks. Not perfect prevention, and not a magic bullet but, for those who value not having a heart attack higher than being free of tablets, worthwhile.

Sugar in diabetes
I apologise if I have given the impression that sugar is uniquely bad for diabetics, and apologise even more if I have implied that it is the cause of diabetes. That was not my intention. I was only using it as an example of excess calories in an environment (junk food shop) in which calories are hardly in shortage. Your correspondents and the ADA are quite right that any calories in excess of what the body needs for the level of exercise it does, are unneccesary and potentially harmful.

Tom – mother’s muscle pains
I am sorry for your mother’s muscle pains and I am glad they resolved. In that context I suppose you took very unkindly to my attribution of this to imagination. But all I request you do is have a look at the muscle pain count in the placebo arms of all the statin trials. It makes horrific reading. Did the placebo tablet itself cause that, or was it the act of asking? I am not uncaring for people who experience side effects – they are real. Its just that they occur almost as often in the patients getting blank tablets.

Prescription only
Yes I can see that from the USA point of view, where statins are prescription only, this seems like a crazy idea (just as it seems in UK crazy to talk about antihypertensives etc being provided in that way). But an old, off-patent statin is available in the UK off prescription (simvastatin), so it does not seem so immediately crazy here. No license is required from the inventors of the drug to make it, so there are many manufacturers and the government obtains it cheaply (~5c/day, according to wikipedia).

Food/Medicine
I do agree that randomly applying medications to oneself has risks – but this is the case with aspirin (acetylsalicylic acid), paracetamol (acetaminophen) and ibuprofen, as well as with many others (sorry if the names are unfamily – I am using the UK generic names). And I think that salt, sugar, etc escape the net because they are tasty and hence classified as food. But they affect metabolism, generally adversely. If I suggested we limit freedom to eat unhealthy food, I would be chased through the streets by raging mobs; so I took the approach of pointing out that medication may be safer than the food or its associated condiments. I think there may be a common thread in your feeling as with mine, although obviously I am approaching things differently.

If my spelling is imperfect, this may be partly because I am in the UK. For my grammar I have no excuse.

Finally Tom, thank you for quoting me in entirety and being courteous and fair in your criticism. If some way is ever found (that works even in people who have no interest in their health, unlike the correspondents here) to help people actually be cardiovascularly healthy, naturally without medical interference, by eating and behaving healthily, we will both be able to rest easy.

Thank you, Dr. Francis.  I’m pretty sure we’ll have to agree to disagree on the overall benefits of statins. Nonetheless, I enjoy debates (a bit too much at times, according to some) and appreciate your replies.

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25 thoughts on “More ‘McStatin’ Researcher Replies

  1. Sarah

    Something tells me Dr Francis would love nothing better than to be able to legally limit the foods we eat.

    Let’s hope not.

    Reply
  2. labrat

    Didn’t answer any of my questions. Here’s another one.

    If it’s been demonstrated that over 100 people need to take a statin for 5 years in order to “prevent” one heart attack, how can you possibly make the claim that there is any benefit at all (other than to the drug company profits perhaps)to taking one pill to offset the supposed damage done by one meal?

    And the 1 in 100 is for men under age 65 with known risk factors. So the number needed to treat to actually prevent one heart attack is greater than 100.

    Reply
  3. damaged justice

    “there is a block between receiving the advice and acting on it: free will.”

    Gosh darn that pesky free will!

    “I apologise if I have given the impression that sugar is uniquely bad for diabetics, and apologise even more if I have implied that it is the cause of diabetes.”

    Why would you disagree with either of those statements?

    Reply
  4. Walter

    I’m not sure there really is much of a down side to salt. Carbohydrate has a much bigger impact on high blood pressure than salt. Its my understanding that for the average man, cutting salt consumption in half (which is hard to do) only lowers blood pressure 3 to 5 torr.

    I don’t buy the argument that if enough people do it it might save lives. I think its much more likely that executing a bad plan and failing or producing only a small result will result in people becoming discouraged and possibly feeling bad about themselves.

    Gary Taubes wrote a long article about the politics behind the anti-salt campaigns. Bottom line is that even drastic salt reduction has little or no effect on most people. If your kidneys are damaged, then salt intake affects blood pressure, but as a lecture I posted awhile back indicates, kidneys are damaged by uric acid, which is produced to too much fructose, not too much salt.

    Reply
  5. Lori

    I think we can all agree that there’s value in eating healthful foods and avoiding junk. But there’s also value in letting people do what they want to, and putting out information for people who are interested. After all is said and done, people are going to do what they want to do.

    This brings us to the subject of junk food. Some of us believe that sugars in general and wheat in particular are junk foods–in other words, the things the USDA pushes us to eat. We could push to have bakeries and fruit stands offer acid reducers (Google Norm Robillard’s “Heartburn Cured”) and metformin, or we can just make our case to people who want to know.

    I’m all about making the case and letting people decide for themselves.

    Reply
  6. AP DUBYA

    It’s crazy how such a vital substance like salt is demonized. We moderns tend to underestimate salt’s value & overestimate its dangers, maybe because it seems as common as dirt. But if it’s so bad for us, why did Roman soldiers get paid with it (from which we derive our word salary)? cf. Pliny’s Natural History, & why did societies hoard it & go to war over it? I don’t think anyone’s going to go to war over statins!

    The anti-fat salt campaigns began much like the anti-cholesterol campaigns: there was some weak observational evidence linking it to hypertension, everyone jumped on board without waiting for confirmation, then explained away the contrary evidence.

    Reply
  7. shutchings

    Thank you for posting Mr. Francis’ comments. Shows you’re after the truth and not afraid of debate. So refreshing. 🙂

    If he’s willing to take to the time to respond to a blog post, his replies deserve a full airing. And while I don’t agree with his views on statins, I give him credit for replying to the individual points instead of trying wave them off with something like “I’m a PhD and you’re just a blogger, so you can’t be right” — which is how T. Colin Campbell attempted to dismiss Debra Minger’s analyses.

    Reply
  8. Jane

    “I’m all about making the case and letting people decide for themselves”

    Once upon a time, the mission of public health was to educate and inform. Then a concept called “social marketing” was introduced and adopted without hesitation. In other words, public health turned into sales (disregarding the moral questions that shift brought). Now, even selling isn’t enough — and the “we know what’s good for you” brigade doesn’t even blink at straight out coercion. Public health has moved from “here is the information to make an informed choice” to “we will force you to do this” ,

    So sad.

    And I really wonder about the people who care SO MUCH about my life. What motivates them so to want to save me – even against my will. I guess the same motivations that have strangers knocking at my door with religious pamphlets…

    I believe we’re talking about the control-freak personality.

    Reply
  9. Hilary Kyro

    Hold the McStatin packets for me, Doctor. I’d go to McDonald’s more, if they sold grass with grass-fed rib eyes.

    Reply
  10. Tony K

    Just to follow a little on the salt/hypertension (HBP) issue. There is a chain of reasoning that goes something like salt causes HBP, HBP causes cardiovascular disease.

    There are two things that must be true for this to work, 1st Salt causes demonstrably only minor changes in blood pressure. SO that first statement is weak. The 2nd one HBP causes CV disease may be even weaker. There is an association, but I suspect that the causality is backwards. Metabolic damage causes damage to arteries, which in turn causes high blood pressure.

    I have a post in progress on emotions for engineers on this issue.

    Cheers,
    Tony

    I’ll check it out.

    Reply
  11. Janet

    While I don’t agree with the good doc’s opinion about how benign statins are in comparison to their tauted benefits, I do agree with his plan to just put them out on the shelf and let me decide. After all if they are that safe, why not?

    However, there is too much money in the “fear factor” in this country to do that. “You’re going to die if you don’t take this”. Well sir, I’m going to die even if I do take it. My doc recently asked if I would take a statin. “Your numbers are okay but THEY recommend you should be on a statin”. I told him no. Later he had the office girl call to tell me he was ordering a statin and, of course I should come back ($$$) in 4 weeks for lab work(more $$$). Sure. Order away, I told her. The pharmacy called and said my Rx was ready. It was Lipitor at $109. I called the doc and told him I would let him collect his bonus($$$) for e-prescribing and get his gold star for following the protocol (bonus $$$)of his facility, but wouldn’t pay $109 for something I wasn’t going to take. He backed down to simvastatin at $4. Once it is in my house, he has no control (at least for now). If they just put statins out on the counter and leave it up to me, I can spend that $4 on a double quarter pounder.

    The doctor in the McStatin issue didn’t mention that a large percentage of people who are ordered statins don’t take them. Most of us don’t take medicine to make us feel bad (we call that adverse effects). We usually have different goals in treatment. “If it feels bad, don’t do it.”

    Reply
  12. Kate

    Don’t apologize for implying that sugar is BAD for diabetics. It IS bad for diabetics. Feel free for to apologize for implying that salt is bad for you, though. 🙂

    That guy shows some real guts. I don’t agree with him, but have to admire him posting here.

    Reply
  13. Archibald Springer

    OK, let’s pretend for a moment that McStatins are a good idea. Now who gets the job of going to McHeadquarters to sell this concept, one which is comparable to putting a health warning on a pack of cigarettes? “You want us to do what? Did I hear you say that you want us to dispense a drug which implies that our products are unhealthy and cause heart attacks? Yeah, sure, we’ll get right on that.”

    COMPLEMENTARY STATIN-DRUG DISPENSER

    Dear customer, since you refuse to adopt a healthy diet *
    and lifestyle, and are about to consume some of our McJunk,
    we have decided to make available a drug which may
    help prevent the otherwise inevitable heart attack.
    Take as directed, and if you get muscle pains it could
    be either your imagination or polio. It is NOT the drug.

    Have a good day,
    Ronald

    * What comprises a healthy diet? Sorry, we’re as confused
    about that as you are, but you probably won’t find it in here.

    Reply
  14. Dan

    What about the real world data collected by Beatrice Golomb at the UCSD statin side effects study? The real world incident of side effects is much greater than those experienced in the artificial world of clinical trials.

    Furthermore, where is the proof that taking statins is effective for primary prevention? If it is no good for primary prevention, then McStatins won’t help.

    As far as I know, there’s no evidence statins do diddly for primary prevention. In clinical trials, people who report side effects from other drugs are often excluded, thus leaving a pool of subjects who are cherry-picked specifically to reduce the number of “adverse events.”

    Reply
  15. Sonah

    Hello,

    Check out this genius study promoted by Dean Ornish in the Huffington Post. And then read the commentators below the article, most of whom disagree. Turns out the study was comparing a 65% carb diet with a 35% one! This is sold as science to the public. Thank goodness people are getting smarter, but it’s still making me so angry that low-fat ideas are so insidious and hard to kill:

    http://www.huffingtonpost.com/dr-dean-ornish/an-atkins-diet-increases-_b_707005.html

    And thank you very much for your documentary. I saw it about a year ago, and since then I have learned so much, and you started it all for me and the people I care about (those who will listen, anyway!).

    Dr. Ornish’s interpretation of the study will the topic of my next post.

    Reply
  16. lovely lentilla

    I look forward to reading that post, Tom. One of the nice things about living all the way on the other side of the planet is that sometimes when you can’t sleep, you’ll put out a post in the wee hours of your morning and I’ll have it hot off the press…

    I had one of those “can’t sleep” nights last night.

    Reply
  17. Brendan

    Pretty soon, statins will be prescribed for all ailments like joint pains and arthritis.

    http://www.bbc.co.uk/news/health-11219708

    Great. So your muscles will ache, but at least your joints won’t hurt. Interestingly, when I read the article there was a link to an older that says drinking five glasses of wine per week may cut the risk of arthritis by 50%. Hmmm … daily statins or five glasses of red wine per week … I think I’ve made my choice.

    Reply
  18. Richard Tamesis, M.D.

    OT, I’m sure you heard of the article published in this month’s Annals of Internal Medicine claiming that people on an animal-based low carb diet had a higher mortality rate than people on a vegetable-based low carb diet diet. The study conducted by the Harvard Public School of Health and was funded by the NIH with taxpayer money.

    http://www.annals.org/content/153/5/289.abstract

    Denise Minger then turned her sharp analytical mind onto the paper after a few people pointed it out to her, demolished it and exposed it as another junk science POS that got published in a peer-reviewed journal.

    http://tinyurl.com/23m2f3v

    I was going to take a crack at it tomorrow.

    Reply
  19. RobR

    I found the tone of this article more relaxing… I still do wonder if he’d prefer an authoritarian tax or banishment of fast food though..

    One thing I’ve really been wondering is if the McStatin guy is familiar with your documentary and bloodwork…

    If you read this Dr. Francis.. Are you aware that Tom ate fast-food for 30 days straight and saw significant health improvements?

    I’m guessing he hasn’t seen it.

    Reply
  20. Paul451

    I read the article by Dr. Ornish and one statement (among many) stopped me dead in my tracks:

    “Your body makes HDL to remove excessive cholesterol from your body. Eating a stick of butter will raise HDL, but butter is not good for your heart. Pfizer discontinued a study of its drug, torcetrapib, which raised HDL but actually increased risk of heart attacks.”

    Now, what is wrong with this ‘picture’?

    Plenty. More on that tomorrow.

    Reply
  21. Andre Chimene

    Tom, love your site, love the movie, love comic timing.

    I found this at the bottom of the Lancet Study.

    Conflict of interest statement
    Most of the trials in this report were supported by research grants from the pharmaceutical industry. Some members of the writing committee (CB, AK, RP, RC, and JS) have had the costs of participating in scientific meetings reimbursed by the pharmaceutical industry. All other members of the writing committee declare that they have no conflict of interest.

    Your comic buddy, Andre

    Of course. And in their defense, drug studies are hugely expensive and not likely to draw funding from outside the industry. But they should never, ever get creative with the data.

    Reply
  22. Ann Childers

    Please go to Askapatient.com and key in the first three letters of any statin. There you will see reports from actual patients of miserable, health-threatening statin side effects. I can’t imagine these hundreds of patients conspired to produce the same responses. Where there is smoke there is fire.

    Great resource, thanks for letting us know. I noticed the average patient rating for Lipitor is 2/5, or “not satisfied.”

    Reply

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