Dear American Heart Association and American College of Cardiology:

I’m writing to thank you for issuing your new expanded guidelines on prescribing statins.  I must admit, I was hopping mad when I first read about them.  I mean seriously, we’re talking about a drug with lots of nasty side-effects that prevents maybe one heart attack (not necessarily one death) for every 100 people who take it – and that’s only for men who already have heart disease.   So you can understand my anger when I read paragraphs like these in an online article by New York Post:

The nation’s first new guidelines in a decade for preventing heart attacks and strokes call for twice as many Americans — one-third of all adults — to consider taking cholesterol-lowering statin drugs.

The guidelines, issued Tuesday by the American Heart Association and American College of Cardiology, are a big change. They offer doctors a new formula for estimating a patient’s risk that includes many factors besides a high cholesterol level, the main focus now. The formula includes age, gender, race and factors such as whether someone smokes.

“The emphasis is to try to treat more appropriately,” said Dr. Neil Stone, the Northwestern University doctor who headed the cholesterol guideline panel. “We’re going to give statins to those who are the most likely to benefit.”

Well heck, you guys, I knew even before I continued reading that “treat more appropriately” would somehow translate to “give statins to even more people.”  And you didn’t disappoint me:

Doctors say the new approach will limit how many people with low heart risks are put on statins simply because of a cholesterol number. Yet under the new advice, 33 million Americans — 44 percent of men and 22 percent of women — would meet the threshold to consider taking a statin. Under the current guidelines, statins are recommended for only about 15 percent of adults.

Only about 15 percent of adults may not sound like much, but as you and I both know, that’s only because adults includes people in their twenties and thirties.  One-fourth of American adults over the age of 45 are already taking statins, and since I read elsewhere that the new guidelines could double the number of statin-takers, I figure that means your long-term goal is to sell statins to at least half of the over-45 population.  We all know why:

Roughly half the cholesterol panel members have financial ties to makers of heart drugs, but panel leaders said no one with industry connections could vote on the recommendations.

“It is practically impossible to find a large group of outside experts in the field who have no relationships to industry,” said Dr. George Mensah of the heart institute. He called the guidelines “a very important step forward” based on solid evidence, and said the public should trust them.

Riiiiiight, we should all trust the panel of experts who have financial ties to statin-makers.  I’ll rank that one right up there with “Read my lips – no new taxes!” and “If you like your current healthcare plan, you can keep it – period!”  If any of you members of the panel ever decide to give up medicine, you should seriously consider running for office.

Anyway, as if I weren’t already suspicious enough of the new guidelines, I read these tidbits in a New York Times article online:

Last week, the nation’s leading heart organizations released a sweeping new set of guidelines for lowering cholesterol, along with an online calculator meant to help doctors assess risks and treatment options. But, in a major embarrassment to the health groups, the calculator appears to greatly overestimate risk, so much so that it could mistakenly suggest that millions more people are candidates for statin drugs.

Mistakenly suggest? Heh-heh-heh … as we programmers like to say, “That’s not a bug.  That’s a feature.”

The problems were identified by two Harvard Medical School professors whose findings will be published Tuesday in a commentary in The Lancet, a major medical journal. The professors, Dr. Paul M. Ridker and Dr. Nancy Cook, had pointed out the problems a year earlier when the National Institutes of Health’s National Heart, Lung, and Blood Institute, which originally was developing the guidelines, sent a draft to each professor independently to review.

This week, after they saw the guidelines and the calculator, Dr. Ridker and Dr. Cook evaluated it using three large studies that involved thousands of people and continued for at least a decade. They knew the subjects’ characteristics at the start — their ages, whether they smoked, their cholesterol levels, their blood pressures. Then they asked how many had heart attacks or strokes in the next 10 years and how many would the risk calculator predict.  The answer was that the calculator overpredicted risk by 75 to 150 percent, depending on the population.

On Saturday night, members of the association and the college of cardiology held a hastily called closed-door meeting with Dr. Ridker, who directs the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital in Boston. He showed them his data and pointed out the problem. On Sunday, officials from the organizations struggled with how to respond.

Here’s how I’d suggest you respond:

“What we said was that if you like your insurance, you can keep your insurance, period, as long as it meets certain conditions we’ll write into the law later.  And besides, it wasn’t the law we passed that canceled your insurance; it was your insurance company.  And we actually did you a favor by passing a law that canceled your insurance because your insurance was substandard.  But even though it wasn’t the law we passed that canceled your lousy insurance and we actually did you a favor by canceling your lousy insurance, we’re now going to fix the law we passed that didn’t cancel your lousy insurance so you can keep your lousy insurance for another year.”

Wait … sorry.  That was my advice to someone else who got caught lying.  In your case, I’d suggest going with something like “Dr. Ridker’s study subjects didn’t have nearly as many heart attacks as our risk calculator predicted because he accidentally studied unusually healthy people.”

The chairmen of the guidelines panel said they believed the three populations Dr. Ridker and Dr. Cook examined were unusually healthy and so their heart attack and stroke rates might be lower than expected.

Good work.

Anyway, the New York Times article goes on to explain that under the new guidelines, “your average healthy Joe” would end up being told to take statins.  And that’s why, in spite of my initial anger over your brazen attempt to sell more statins, I’m now writing to thank you.

What prompted my change of heart (pun intended) was receiving an email from someone who liked one of my old blog posts – the one in which I thanked the USDA for giving my kids a competitive advantage in life by ordering schools to serve crappy grain-based meals to the other kids and thus suppress their brain development.  That in turn got me thinking about the movie Idiocracy, in which a soldier with an average IQ participates in a botched experiment and wakes up hundreds of years later to discover that he’s now the smartest guy on the planet.

That’s when I realized how much your new guidelines will benefit me personally.  You see, as a software programmer, I’m what’s known as a “knowledge worker.”   My livelihood depends entirely on my ability to memorize, conceptualize, and think my way through complex problems.  In my field, experience is considered a major asset, largely because solving a software problem often involves recalling how we solved a similar problem in the past.  It’s no coincidence that most of the other programmers I work with are in their 40s or 50s.

So as I was chuckling to myself about a couple of the scenes in Idiocracy, it occurred to me:  How much more valuable would I be if my fellow programmers all started taking statins and became a bit stupid?  Give them a few years on a high dose of Lipitor, and I daresay I could triple my billing rate.  I’d be the only one remaining with enough cognitive ability to tackle the really tough assignments.

I could probably even get away with relaxing my programming standards.  Since I’m not a government contractor, I test and test and test the software I design before rolling it out – partly because I’m persnickety by nature, but largely because in private industries, people who launch mission-critical software systems that crash and burn tend to get fired.  But if your new treatment guidelines convince everyone over age 45 to start taking statins, I’m pretty sure I could avoid the blame for any lousy software I created.  I suspect the conversations would go something like this:

“Naughton!”

“Yes, boss?”

“The foreign incoming royalties module of the payment distribution system keeps crashing!  Did you write that module?”

“Well, I … uh … No, sir.  It was Crockett.”

“Crockett!”

“Yes, sir?”

“Did you write the foreign incoming royalties module?”

“Uh … I don’t remember.  Maybe.”

“Well, fix it!”

“But I don’t remember the logic.”

“Well, damnit, get Naughton to help you.”

“If I’m going to help Crockett fix the mess he made, I’m going to need another bump in my billing rate.”

“Yeah, yeah, okay.  Just promise you won’t quit.”

So while I know providing me with job security wasn’t your intention, I’m grateful nonetheless.

By the way, would it be possible for you to convince the federal government to subsidize statins and provide them to needy people in the developing world, sort of like the USDA does with grains?  It would be awesome to know I won’t lose my programming gig to some guy in India.

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53 Responses to “Why I’m Grateful For The New Statin Guidelines”
  1. Idiocracy: On the surface a stupid movie, you say? Funny and insightful, predicting the deterioration of modern society. On par with WALL-E, but much STUPIDER!

    I loved it. The courtroom scene had me laughing out loud.

  2. Lori says:

    I don’t suffer fools well, but there’s probably an ideal ratio of knuckleheads to smart people. Too few fools, and life’s hard because everybody else is brilliant. Too many, and you’re on your own because nobody’s any help to you.

  3. Oh you are good. As one of our other colleagues said –” the only way to get to these Statinators is through ridicule”. Please continue to thump them.

    I consider ridicule an important weapon … unless I’m dealing with someone breaking into my house. Then I prefer a shotgun blast followed by a sarcastic comment.

  4. Nads says:

    I think of Idiocracy all the time when I think about how we all have been indoctrinated about food and drink!

    http://youtu.be/-Vw2CrY9Igs

    It’s got electrolytes. It’s got what plants crave.

    One of the many good scenes. In my version of Idiocracy, we’d have a scene with doctors:

    “You need to take this statin. It lowers cholesterol.”
    “But why?”
    “Because your cholesterol will be lower.”
    “Does that mean I’ll live longer?”
    “No, but your cholesterol will be lower.”

    • gollum says:

      I don’t get the joke. Should I take more statins maybe?

      I’d suggest taking statins until your IQ drops to the point where you’re considered an ideal candidate to build a government web site.

    • Beau says:

      Why hasn’t anybody asked if statins have electrolytes?

      maybe I’m the smartest person in the world.

      Statins … they’re what plants crave.

  5. Diana Van Pelt says:

    Thank you Tom Naughton. Funny and truthful read, albeit a sad commentary.

  6. David F says:

    “Yet under the new advice, 33 million Americans…would meet the threshold to consider taking a statin.”

    OMG! That’s 1.5 times the entire population of Australia! That’s every single man, woman and child in Australia taking a statin, PLUS another whole half of our population. That’s disturbing!

    Disturbing and very, very profitable.

    • Sue O'Donnell says:

      I don’t get the money angle anymore. Isn’t Crestor the only statin still on patent?

      My guess is that they’re still selling plenty of the name brands.

      • neilfeldman says:

        There is a new genre of cholesterol lowering drugs that is currently angling to get FDA approval. They are called PCSK9 inhibitors.

    • Jill says:

      Aren’t they cunning? As soon as statins are shown to be risky they immediately widen the type of population that is miraculously advised to take something.

      And it’s all on the basis of juggling probabilities/risk factor-talk.

      The number of people that should be sued and otherwise shut away for society’s protection grows apace.

    • susan says:

      Yeah, very, very profitable…

      I keep seeing the rationalization that the drug companies can’t be making that much on statins since most are now generic. So, if they double the number of prescriptions, they REALLY aren’t profiting THAT much.

      But I also see that they are now making $20 billion/year on statins. I’m no math genius, but even I can figure out that two times $20 billion/year is a pretty good profit.

      I could live on it.

  7. If a doctor takes money from a big statin company we should know about it; but what if a doctor has shares in a smaller company that’s making, or about to make, generic drugs? This is the big windfall for investors, there are many such companies, and they don’t have names anyone associates with statins. Nor do they need to fund research, so doctors won’t be getting grants or speaking fees from them; but do doctors and regulators need to list all their investments?

  8. Lynda says:

    I just read Zoe Harcombe’s review of a book called “How statin drugs really lower cholesterol & kill you one cell at a time”. Sobering stuff – I learned quite a bit from it. I’d recommend it to anyone to read to see the lunacy of mass medicating a nation.

    http://www.zoeharcombe.com/2013/10/how-statin-drugs-really-lower-cholesterol-and-kill-you-one-cell-at-a-time/#utm_source=feed&utm_medium=feed&utm_campaign=feed

  9. Lisa says:

    My type 1 diabetic child just had his big first 12 monthly check up today, with full blood work done. His lipid profile was perfect, in fact better than someone without diabetes. His doctor was ecstatic. He has never seen such results in a diabetic EVER. We ran out of time, but I was about to tell him the reason for my success – a HIGH FAT LOW CARB diet!!! WE eat lots of saturated fat. That’s right, FAT. Coconut oil, macadamia nut oil, bacon, avocados, eggs, meat with fat on it, pork cracking, butter, cream, olive oil, walnut oil. But never any wheat, grains, sugar, processed food, junk food or industrial oils. His HbA1c is that of a non diabetic. He takes no supplements.

    This should be evidence enough for anyone that eating fat does not give you heart disease and all the other problems we are told it does. If this can be achieved in a type 1 diabetic, then it should be a walk in the park for a non diabetic who eats the same diet. No statins required. Just eat the way our species was meant to eat, and you can most likely avoid modern disease.

    Just wished I had known how poisonous wheat was before I had children, and I would never had fed it to them. Wheat and carbs will kill you – not saturated fat. Whoever promotes statins should hang their heads in shame.

  10. TJ Huber says:

    Dang, I wish I could write as well as you do. Now, all I can do is quote you!
    Thanks for the great read.

    Always happy to be quoted.

  11. Rae says:

    I have not ever had my cholesterol measured, although my work offers “incentives” for submitting to a cholesterol test, but no thanks. I feel like as long as I eat real food, feel good and energetic, keep my weight in check, and move around once in awhile, I don’t need doctors and nurses constantly babysitting my health. I’m a little (okay, a lot) suspicious of this “just in case” style of healthcare. Very reckless, not to mention needlessly $$$. There are lots of compelling reasons not to take statins, and comparatively few legitimate reasons to take statins … “just in case” isn’t good enough.

    It’s called “preventive” medicine for a reason. It prevents statin-pushers from having to find real work.

    • Jill says:

      Same “reasoning” ie pressure-sales tactics used for HICCUP (human-induced climate change UN propaganda).

      Heh-heh … that acronym is a new one on me.

  12. Justin B says:

    Replace “Brawndo” with “Lipitor”, and I think at least part of this movie sadly has a huge chance of coming true. We could very well soon be watering plants and cleaning ourselves with statins.

    Well, some statinators want statins in the water supply, so that could happen.

  13. Elenor says:

    “unless I’m dealing with someone breaking into my house. Then I prefer a shotgun blast followed by a sarcastic comment.”

    Why would the guy you just shot make a sarcastic comment?
    {wink}

    At that point, it wouldn’t matter much.

  14. Kerstin says:

    I was just reading a Dr. Eades article, and at the end someone referenced this page…too funny, and sadly, pretty true…

    http://www.nytimes.com/slideshow/2012/07/08/opinion/sunday/the-strip.html#1

    Spot on.

  15. emi11n says:

    Hmm. One would think a “risk calculator” could actually calculate risk no matter how healthy the subjects were. Nice spin from the panel who doesn’t want us to know that it’s not really a risk calculator, it’s a statin propaganda tool.

    I bet the panel members are kicking themselves for not bribing Dr. Ridker ahead of time.

  16. bw says:

    I was going to send this to the other programmers I work with, but then thought that would just reduce my future earnings ;-).

    Let’s keep this between us until we have all the good contracts locked up.

  17. Blusette says:

    I have not visited your blog for quite a while, and this is totally unrelated to your blog post (sorry), but I just had to come on here and tell you that T. Colin Campbell (of The China Study) is releasing a new book titled The Low Carb Fraud. Actually the kindle version is already available. Why am I returning here? Because your intelligent breakdown/reviews/commentary always get to the heart of the matter – and in an entertaining way. And who better to tear apart – er, I mean write – a review?

    Nothing made me as sick as following the high carb, low protein eating recommendations of T. Colin Campbell. I just thank God I caught myself before diabetes kicked in, so yeah, I have an ax to grind!

    The hard copy version won’t be available until February, but the Kindle download is available now. Hope you have a Kindle….I say…..GO!!!!

    I guess my before and after pictures are a fraud.

    Campbell will say anything to convince people to stop eating meat, which he considers immoral. He’s a walking, talking example of “Scientists are freakin’ liars.”

    I may read the book later. No time right now.

    • Dave says:

      I loved The China Study when I first read it. I was never able to adopt a ‘whole plant food’ diet because without fat and salt (and sugar) it tastes awful and I lacked ‘willpower.’ So, I bought processed low fat foods instead and drank lots of banana smoothies. Yes, I was fooled by the raw foodists as well.

      And then, nearly two years ago someone challenged me to read Good Calories, Bad Calories, which I did with the idea of picking it apart based on the superior knowledge I supposedly had from reading TCS. I was extremely skeptical as I started GCBC, but as I got deeper into the book it dawned on me: T. Colin Campbell is THE FRAUD.

      And now, he has the audacity to call HFLC/Paleo a fraud? I think there are more than a few of us former admirers of Campbell, and the new book is intended to plug the holes in the sinking vegan ship.

      I suspect you’re right. I also suspect it won’t work.

  18. Chris says:

    I downloaded the ‘risk’ calculator and played around with the numbers. Starting with a 50 yo male with the ‘optimal’ numbers, if your SBP goes up to 119, there is no impact on risk. if it then goes up 1 point, from 119 to 120, your life time risk abruptly goes from 5% to 36%, an increase of 31 percentage points and an increased relative risk of ASCVD of 620%.

    Same starting point, if total cholesterol goes up to 179, no impact. If it then goes up 1 mg/dl, from 179 to 180, life time risk goes from 5% to 36%, an increase of 31 percentage points and an increased relative risk of ASCVD of 620%. If your total cholesterol goes up from 199 to 200, that’s another 10 percentage point increase, from 36% to 46%, an increased relative risk of 27% (from 36%).

    It is telling that and SBP of 120 and a total cholesterol of 180 are ridiculously low, but predict a pretty big lifetime risk.

    Whatever helps sell those statins.

    • SB says:

      According to the guidelines, as a 27 year old “white” (really, in this day and age, those are the only options? Some people only see the world in black and white…literally) female w/ TC: 213 and HDL 95…39% risk. If I drop the total cholesterol number to 199, the risk goes down to 27%. Maybe I should’ve put liquid statin instead of cream in my coffee this morning. *eye roll*

      39% risk at age 27 with HDL of 95? Yeah, I’d say that risk is a wee bit exaggerated.

      • desmond says:

        You are missing how accurate these black-box calculators really are. The programmers have obviously mastered the art of predicting the “Butterfly Effect” — which most people assumed was too chaotic to allow calculation of a reliable outcome. That 1% increase is the tipping point.

        Now, if they would be so kind as to tell us where to put the butterfly, we can stop global warming, and kickstart the next ice age (still a form of “climate change” though).

        If we read the programmers’ notes, I wonder if we’d find comments on how to hide the decline.

    • The weird thing about the ethical argument for veganism is it doesn’t make sense unless you consider animals to be 100% equivalent to humans and to have individual rights.
      Otherwise, it would be most ethical for an animal rights activist to either hunt and eat overpopulating animals that threaten their ecosystems i.e. Canadian Harp Seals, Deer, etc. or buy game meat from those who do. That’s the most ethical model based on the harm-reduction/collective rights model.
      Giving animals individual rights and following this to its natural conclusion means if a small child is run down and killed by a grain harvester, its accidental death is the moral equivalent of a prairie dog also dying. Rats infesting your home would have to be arrested/evicted, not exterminated. A dead skunk on the side of the road would merit a police investigation and autopsy, same as a dead human.
      Carnivores would face jail time, psychotherapy and probation.

  19. Beowulf says:

    Thanks for the optimism! Now instead of looking forward to being a reasonably smart and healthy person in 30 years I can look forward to feeling like a super-fit genius!

    Nothing like moving forward by having the rest of the field move backwards.

  20. Miri says:

    A belated happy birthday, Tom! You know what they say, life begins at 40, so enjoy your second adolescence.

    I had heard about this statins nonsense, but have a little bit of good news to counteract it: for a college course I’m taking, I was required to write an argumentative essay on a topical subject. I picked “healthy” eating guidelines, and why they’re anything but. As a result my teacher – who is 70 and used to run a bagelry – announced she was giving up grains and seriously considering coming off statins. She and her husband (who is also on statins, despite having the cholesterol “of a mountain goat”) are going to watch Fat Head over Thanksgiving – I think you may well have a couple more converts there…

    That is good news, although I don’t expect Fat Head to compete with the NFL games.

  21. MarkH says:

    Tom

    read the novel ‘Snow Crash’ by Neal Stephenson, then talk about programming!

    Excellent post – as always.

    I haven’t heard of it, but I’ll give it a look.

    • Mark says:

      Yeah, Snow Crash. What a wild and crazy ride of a technopunk thriller! Written way back in the early 1990s, it prophetically featured many advances that have come to pass since. Central to the story is the “Metaverse,” an immersive three dimensional digital world complete with personal walking, talking avatars.
      Two other great titles by Neil Stephenson: “Cryptonomicon” and “The Diamond Age.”

  22. Raul Johnson says:

    One small silver lining in all this is that the new guidelines seem to be conceding that whatever dubious benefit one may derive from statins has nothing to do with lowering cholesterol.That seems to be the implication of dropping the targets (though they do still seem to see extremely high cholesterol as a problem).

    They seem to be making that shift, but it statins don’t work by lowering cholesterol, then we should stop beating down people’s cholesterol levels.

  23. mlantenac says:

    You could always take these as guidelines on what not to do. “Take statins every day.” Great, so take them on no days? Got it.

  24. Ham-Bone says:

    Perhaps your best post to date, especially with a nod to Idiocracy…As I posted on my FB wall “Speaking of industry connections, did you know Dr. George Mensah of the National Heart, Lung, and Blood Institute worked for Pepsico 3 years ago? I’m not saying he isn’t a stand up guy, it just makes you wonder doesn’t it?”

    I also informed my measly 299 friends that “Before you fill your new (and inevitable) statin prescription you should check out who pays the bills at the American Heart Association. AstraZeneca, Bayer, Bristol-Myers Squibb, Merck, Novartis, and Pfizer. Yep, they’re all there. I know most of these companies’ statins have gone generic but they also make products for diabetes treatment. I’m told statin users have an increased risk for developing diabetes. How convenient. You should be ashamed of yourself AHA. Other notable donors….Walgreens, CVS, RiteAid, ConAgra (Healthy Choice, Pam, Egg Beaters, Fleischmanns, Parkay, Wesson), Jenny Craig, Aetna, Blue Cross Blue Shield, Kaiser Permanente. American Diabetes Association you’re next.”

    http://www.heart.org/HEARTORG/General/2012-Annual-Report_UCM_448427_Article.jsp

    As well as a link to “A Few Reasons to Avoid Statins” by the great Tom Naughton

    Statins are the gift that keeps on giving. First they sell you statins, then they sell you other drugs to treat the effects of the statins.

  25. Ham-Bone says:

    As well as this tidbit:

    The other half of the new guideline creation team was the American College of Cardiology. I can’t find current year financial reports so here is an excerpt from a 2010 press release. I promise to get back to you diabetes.org

    Corporate sponsors of the ACC’s CardioSmart programs include AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Boston Scientific, Bristol-Myers Squibb/sanofi Pharmaceuticals Partnership, Coca-Cola, Colgate-Palmolive Company, Daiichi Sankyo, Inc. and Lilly USA, General Mills, GlaxoSmithKline, Medtronic, Merck, Novartis, Pfizer, sanofi-aventis, and Takeda Pharmaceuticals North America, Forest Laboratories, Inc., and the California Health Care Foundation. The ACC has also partnered with Peoplechart Corporation in the development of CardioSmart disease management tools.

    “Heart disease remains America’s deadliest and most costly health problem. By engaging patients and those at risk in prevention strategies and self-management, our goal and hope is that Americans become healthier with an overall reduced risk of heart disease,” said Ralph Brindis, M.D., M.P.H., president of the ACC. “Our corporate sponsors will leverage their considerable reach to engage a broad population and deliver important prevention and disease management information and tools to consumers.”

    http://www.cardiosource.org/News-Media/Media-Center/News-Releases/2010/11/CardioSmartSponsors.aspx?w_nav=Search&WT.oss=corporate&WT.oss_r=126&

    • Jeff C says:

      No surprise that the list is dominated by pharma, but Coca Cola and General Mills?? What are they doing on there? Trying to avoid the conspiracy theories but it sure does make one wonder what is going on here. Big Food makes them sick, Big Pharma provides the “treatment” for the rest of their lives. Pharma’s market disappears without the likes of Coca Cola and General Mills. Hard to believe their isn’t some sort of coordination here.

      I think this is one of those cases where if you’re not feeling paranoid, it means you’re not paying attention.

  26. Walter Bushell says:

    Maybe this is an attempt to restore solvency to the Social Security system?

    Good point. If we could get most people to die by age 70 like they did when Social Security was enacted, it might almost balance out.

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