Archive for the “Bad Medicine” Category
Here’s another callback for you longtime Fatheads. It’s from the end of a two-parter I wrote on the State of Illinois’ attempt last year to regulate raw milk producers out of business, “The Older Brother’s notes from the sausage factory floor…” At the end, after over a hundred people showed up to politely but loudly protest the state’s heavy-handed actions, I noted:
“I’ve heard from a couple of folks who think the regulators got an education on raw milk… Maybe the bureaucrats would change things up substantially. Maybe even remove impediments to raw milk while setting a few common-sense protocols, as it fits in with the buy local/real foods programs the state and others talk up.”
Feeling I had a better understanding of bureaucratic sausage-making than those good, honest people, I ended with…
“I’m guessing they’ll lay low for a few months or more, and then pass pretty much all of those rules as is, maybe without the 100 gallon limit. Or maybe they’ll bump the limit to 500 gallons. But they didn’t learn anything, and they’re there to pass those rules.
It’s what they do.”
… Well. Sorry to be right again, but really, it was an easy call.
Apparently, in the last week or so, the FDA-funded lickspittles at the Illinois Department of Public Health went ahead and promulgated new rules concerning raw milk because… well, because there were no rules and how can you just let people mind their own business without someone writing rules to give them permission to do their own business and regulations detailing how that business is to be minded.
This go-round, they’ve posted for comment regulations that will require anyone selling raw milk to gather the name, address, and phone number of anyone they sell raw milk to and turn it over to the state on request. They will also be prohibited from milking a cow with any dirt on its udder or belly, and be required to only milk cows in a building with floors and walls that can be cleaned. In other words, you can’t milk a cow outdoors, and you’ll have to build a building for several tens of thousands of dollars to do it in.
These are, of course, only a start. Once they get some regulations on the books, they can keep expanding them and “re-interpreting” them until they’ve driven all raw milk producers out of the market. Mission accomplished!
I wouldn’t have known about this as my local paper — the one in the state capital and the middle of ag country — didn’t actually mention any of this. It did, however, helpfully print a letter to the editor from one of the FDA’s useful idiots – the (prepare to be impressed) president of The Illinois State Medical Society. Here’s a few of what the medical establishment’s public mouthpiece seems to think are compelling arguments on why educated, intelligent, health-conscious people shouldn’t be allowed to choose to consume milk in the way it’s been consumed for the last 7,500 years or so…
As the Illinois Department of Public Health advances rules governing the sale of raw milk, the Illinois State Medical Society remains opposed to the sale and distribution of “raw” or unpasteurized milk in any form. Federal law prohibits dairies from distributing raw milk across state lines in final package form and about half of U.S. states prohibit the sale of raw milk completely.
Correct answer: So what?
According to the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration and other medical and health organizations, raw milk that is not pasteurized may contain a wide variety of harmful bacteria, including Salmonella, E. coli, Listeria and other bacteria, that can cause serious illness and, in extreme cases, death. And studies show that children, particularly, are most susceptible to illness due to consuming unpasteurized raw milk.
You mean, there might be germs in milk? Like just about any other food out there. Only as the statistics show, not so much. The nice thing about raw milk is that, unlike pasteurized milk, it also contains all kinds of good bacteria that, in addition to controlling the baddies mentioned, also brings both documented and anecdotal benefits. Probably in about another twenty years, the adherents to the type of medicine practiced by the Illinois State Medical Society will discover the wonders of the gut biome. (Don’t tell them now – you’ll ruin the surprise!)
Pasteurization, simply put, is heating milk to a high temperature and then rapidly cooling it to eliminate harmful bacteria, yet maintaining the milk’s freshness for an extended period of time. Even the Illinois Farm Bureau advocates that individuals drink pasteurized milk.
Wow. You mean, the industry group representing the commodity dairy producers who keep their livestock in confinement pens, inject them with hormones and antibiotics, then mix milk from thousands of cows from different producers, to be shipped hundreds of miles, think people should only drink pasteurized milk? The ones who also put artificial coloring and aspartame in their products?
Now, if you’re going to drink milk from one of these producers, you damned well better want it to be pasteurized. That has nothing to do with the environment of healthy dairy cows raised on pasture with sales going to people within driving distance, who can walk around those fields if they want to see what conditions their food is being produced in.
(Don’t worry about that aspartame thing though. The FDA of which the guardian of our health at the Illinois State Medical Society speaks is engaged in an effort, at the behest of these same producers, to allow aspartame to not be listed in the ingredients of your store-bought, “healthy” milk.)
And these commodity producers, having seen milk sales drop over 20% to the lowest levels in thirty years, are more than happy to advise the FDA, the USDA, the Medical Society, and any other economic illiterates, on how to best put small farmers — who are producing a healthy, ethical, vastly superior product at premium prices — out of business.
I’d say that if the good doctor’s medical expertise is in line with his depth of understanding exhibited in the areas of epidemiology and economics, it would explain why there are over 90,000 medical malpractice-related hospital deaths a year.
That’s an interesting number, because coincidentally, according to an excellent breakdown of the real numbers done by Chris Kesser here, that’s about the odds (1 in 94,000) of a person even getting ill from raw milk (not dead – just a reportable tummy ache). The odds of being hospitalized due to raw milk are around 1 in 6 million, or about three times less than dying in an airplane crash. As for dying, well that’s hard to calculate, since the last reportable deaths associated with raw milk were in the late 1990’s, and those were from homemade “bathtub” queso cheese, which was assuredly contaminated by the maker.
Now, back in 1985, both the worst case of food poisoning deaths (52) and the worst case of salmonella poisoning deaths (possibly up to 12) since the CDC began keeping records in 1970 resulted from consuming dairy products. However, both of those cases involved pasteurized milk. You know — the safe kind.
In fact, there has never been a death reported from just drinking raw milk. That’s according to the CDC. But it took a Freedom of Information Act request to get that out of them, cause it tends to mess with their mission, which is to produce press releases that say “Majority of dairy-related disease outbreaks linked to raw milk.”
Not that food can’t kill you. Since that last death associated with raw milk products, people have died from spinach, green onions, cantaloupe, peanuts, drinking water, apple juice, various types of meats, and again, pasteurized milk products, among others.
If the sundry State Medical Societies worked on “physician, heal thyself” and “first, do no harm” instead of acting as the PR wing for the FDA, CDC, USDA and other Big Ag-owned agencies, they could save countless lives. Up to 90,000 just for starts. That’s without even touching all the havoc and suffering they create helping out their other good buddies over at the pharmaceutical companies.
NOTE: If you live in Illinois, you’ve got until October 20th to let your elected representatives know that you’re not interested in less freedom, crappier food choices, and putting small farmers out of business. Remember, nothing gets a bureaucrat’s attention like a lawmaker who’s getting an earful from irritated (but polite, please) constituents two months before an election.
the Older Brother
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Six months ago or so, I wrote a couple of posts praising a two-part series titled The Heart of the Matter, which ran on ABC Catalyst in Australia. I also embedded videos of the episodes that ABC Catalyst had put on YouTube. Part one of the series questioned the Lipid Hypothesis, and part two questioned the benefits of statins.
If you click the play button for the video embedded in this post now, you’ll get a message that the video doesn’t exist. That’s because ABC Catalyst bowed to pressure from the Statin Empire and agreed to pull the videos.
The excuse was that the program violated the network’s journalist standards. (Yes, I know … these days journalistic standards is almost as oxymoronic as government assistance.)
I sincerely doubt the program violated ABC’s standards. I suspect it was more of a case of someone from the network being sat down and given an updated version of this speech from the 1976 movie Network – which, if anything, seems more relevant now than when it was released.
I could go through the excuses the network offered for its cowardly cave-in point by point, but I don’t have to. Dr. Malcolm Kendrick already did. Here are a few paragraphs from a lengthy post I urge you to read in its entirety:
As an important aside, I find it fascinating that the committee accepted that there is no ‘definitive proof’ that saturated fats cause heart disease. Check.
Yet, in a complete rupture of logic, the report stated that the ‘National Heart Foundation believe there is enough good quality evidence to recommend a diet low in saturated and trans-fats.’
Well, if there is enough good quality evidence, there must be, by definition, definitive proof. Either one statement is correct, or the other. They cannot both be, as they are mutually contradictory. This I am afraid is the level of thinking that goes on here. As expected, there is no criticism of the National (Australian) Heart Foundation for recommending a diet for which where is no ‘definitive proof.’ ‘It’s okay, they believe there is enough good quality evidence, and they are good chaps. So that is good enough for me.’
This is the usual kowtowing to the experts. If the roles had been reversed, Catalyst would have been crucified for promoting dietary advice based on nothing at all. Yet, the NHF are completely let off the hook with this pathetic statement.
‘Notwithstanding the lack of definitive proof, mainstream medical organisations such as the National Heart Foundation (NHF) believe there is enough good quality evidence to recommend a diet low in saturated and trans fats.’
Hang your heads guys. What is sauce for the goose should also be sauce for the gander.
There was another part of the report where the judgment is so weird that I cannot understand it. I defy anyone else to understand it either. You can read the whole report if you wish, and see what you think.
It seems to be saying that stratifying risk in primary prevention of heart disease is something that is contentious, but a lot of doctors believe in it, so it should have been mentioned. Something with no evidence to support it, that happens to be believed in by a number of doctors, should be presented as what….the truth? That bit is bonkers. It seems they thought they should say something, but descended into gibberish.
ABC Catalyst isn’t the only organization to retreat recently after being attacked by the Statin Empire. The British Medical Journal did likewise with a report of statin side-effects. Here are some quotes from an article in The Australian:
Patients have been urged not to shy away from statins after a key claim about potential harm caused by the cholesterol-lowering drugs was withdrawn.
The British Medical Journal has accepted that research that claimed that 20 per cent of patients on statins suffered side-effects was flawed. That claim, which was likened to scaremongering over the MMR jab, has been retracted after the journal accepted it was the result of errors not spotted by researchers, peer reviewers or editors.
Author John Abramson, of Harvard Medical School had used the claim about higher rates of muscle pain, tiredness and diabetes to raise concerns over more widespread use of statins.
The error the researchers failed to spot is the unwritten rule that you’re not allowed to criticize statins in medical journals. Billions of dollars depend on that rule being vigorously enforced.
BMJ editor-in-chief Fiona Godlee said the journal was making a public retraction “so that patients who could benefit from statins are not wrongly deterred from starting or continuing treatment because of exaggerated concerns over side-effects”.
Yes, indeed, let’s not have patients suspecting the muscle pain they’re experiencing is caused by statins. Much better for The Statin Empire if doctors attribute the muscle pain to old age or some other cause and prescribe a painkiller – as my mom’s doctor did. In what was apparently a matter of pure coincidence, however, I talked my mom into giving up the statins and her mysterious muscle pains vanished soon after.
The paper the BMJ is retracting concluded that the rate of statin side-effects is around 20%. The researcher who (ahem) corrected the data in the BMJ paper says that according to his research, only about 1% of people on statins experience adverse side-effects. That conclusion, of course, is based on data provided by the manufacturers of statins, who routinely 1) don’t publish studies with negative outcomes and 2) refuse to release raw study data to independent researchers, even for the positive studies. I wouldn’t expect their data to show anything other than a very low rate of side-effects.
However, there was a study conducted a couple of years ago that calculated the rate of side-effects by (how’s this for a wacky idea?) checking the records of patients from two large medical centers. As an article on the NPR site explained:
With one-quarter of adults over age 45 taking cholesterol-lowering statin drugs, it figures that more than a few people would have trouble sticking with the program.
More than a few, actually. A big new study of statin use in the real world found that 17 percent of patients taking the pills reported side effects, including muscle pain, nausea, and problems with their liver or nervous system.
That’s a lot higher than the 5 to 10 percent reported in the randomized controlled trials that provided evidence for regulatory approval of the medicines.
This study, which was published in Annals of Internal Medicine, looked at more than 100,000 people who’d been prescribed statins from 2000 through 2008 at two academic medical centers.
About two-thirds of people with side effects quit taking statins. All in all, half of all the people who been prescribed the drugs quit them at last temporarily. Twenty percent quit for more than a year.
So in a real-world setting, 17 percent of the patients on statins reported nasty side-effects. Twenty percent of the patients quit taking statins for more than a year. Darned if that doesn’t sound eerily similar to the 20 percent figure cited in the BMJ paper – which the BMJ later decided to yank.
Those are likely older patients, by the way. Three years ago, I wrote a post about a study showing that 72 percent of professional athletes on statin therapy ended up dumping the drugs. Why? Because while a middle-aged desk jockey may not notice if he gets a little weaker thanks to statin-induced muscle damage, a professional athlete will notice right away. His livelihood depends on it.
So what’s the BMJ’s fear here, exactly? That people will become too aware that statins might cause muscle pain and other side-effects? Isn’t that better than being too unaware that a drug can cause damage to your muscles and nerves? For Pete’s sake, medical organizations think nothing of warning everyone to cut back on salt, even though only a tiny fraction of the populations is salt-sensitive. They’ll tell me not to smoke cigars because my risk of developing mouth cancer will climb from 1 in 10,000 to 2 in 10,000 (thus doubling my risk!!) Seems to me they have a rather different standard for warning people about hugely profitable drugs that can make you weak and foggy-brained.
I suspect someone at the BMJ got the same updated version of the speech from Network that caused ABC Catalyst to tuck its tail and lick the master’s hand.
Let’s not be pessimistic, though. These incidents may be the Statin Empire’s version of the Battle of the Bulge – a last-gasp attempt to turn the tide of a war they’re going to lose eventually. In case you didn’t read it, here’s another quote from Dr. Kendrick’s post:
As a disclosure of interest, I did help the programme’s producer and presenter, Dr Maryanne Demasi, with questions and background information whilst she was putting the Catalyst programs together. I tried to give her as much factual information as possible. The day after the programmes came out, I wrote her this e-mail on 31st October 2013:
Just seen part II. Brilliant, well done…….. I feel a sense of pride being able, in a small way, to help you put this together.
I now hope that you are viciously attacked, because that means you have won. (And it also means that thincs has won). Be ready – I suspect the attacks have already started.
THINCS is The International Network of Cholesterol Skeptics, a group of doctors and researchers who believe anti-fat and anti-cholesterol hysteria is misguided. And while THINCS may not have won yet, I believe it (along with many other like-minded individuals and organizations) has the Statin Empire more than a little worried. That’s why the ferocious counter-attacks were launched so quickly.
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I received an interesting email from the American Diabetes Association more than a week ago, but I saved it until today because I’m reasonably sure it’s intended to be an April Fools’ joke. Here it is, with my comments:
Yup, that’s an exact quote. No name after Dear , just a space for my name should I care to insert it.
Our country is headed down a costly, and dangerous, path – leading to 1 in 3 adults having diabetes by 2050. However, you can act to change that, and it only takes a minute!
Well, I’m a pretty busy guy, so I don’t know if I have can spare a full minute to save the country from diabetes. But okay, I’ll keep reading.
Congress needs to know that the cost of diabetes to our nation – over $245 billion a year – is unacceptable.
Congress needs to know having nearly 26 million Americans with diabetes and 79 million more with prediabetes is unacceptable.
Congress needs to know that inaction is unacceptable.
So that’s why we have so many diabetics these days – not enough action by Congress. Back when diabetes rates were a fraction of what they are today, Congress must’ve been all over the issue. I suppose my daughters will eventually endure a history lesson in school explaining how diabetes was low during the Great Depression because of a New Deal program that was later canceled by Ronald Reagan, leading to the current epidemic of diabetes.
(Sara was recently taught that the New Deal lifted the United States out of the Great Depression. She asked my opinion on that lesson, which led to one of those heart-to-heart conversations she’ll remember fondly when I’m gone.)
Can I count on you to take just one minute and act now?
The letter was signed by someone whose official position at the ADA is National Advocacy Committee Chair.
Now, I have nothing against advocacy per se. I consider myself a health advocate. But when I come across the words advocate or advocacy in an organization’s name or a person’s title, little alarm bells go off in my head … because it usually turns out that advocacy translates to trying to get Congress to spend a shootload of the taxpayers’ money on our cause.
So I clicked the COUNT ME IN! link in the email and ended up at a page with the headline Tell Congress to take action to Stop Diabetes! Here’s some of the text:
Some Members of Congress want to derail ongoing diabetes research and undermine proven prevention efforts despite the fact a staggering 100+ million Americans either have or are at risk of developing diabetes.
So let me wrap my head around this: 1) we have proven prevention efforts, but 2) diabetes rates are through the roof. Those proven prevention efforts must not be working out so well. And if we already know what the proven prevention methods are, what’s the big concern with derailing diabetes research? Sounds as if the ADA has it all figured out already.
We must act now – Congress is in the process of making crucial budget decisions about vitally important diabetes research and prevention programs.
Send an email and urge your Members of Congress to support funding for diabetes research and prevention and add your voice to those of Diabetes Advocates who will be in Washington, D.C. next week for our Capitol Hill Advocacy Day.
Translation: Yes, we receive a ton of funding from the makers of food-like products consisting largely of sugars and grains – but it’s not enough. TELL CONGRESS TO GIVE US MORE OF YOUR MONEY!
Your email will have more impact if you personalize it, so please take a moment to explain the impact diabetes has had on your life.
Diabetes hasn’t had an impact on my life because I ignore the ADA’s advice. Well, okay, that’s not entirely true. One of my relatives who’s a type 2 diabetic recently went into the hospital and was served pancakes and syrup for breakfast. Then an obese dietician stopped by to tell him to follow the ADA guidelines and eat plenty of carbohydrates while avoiding fat. That made me really, really mad. So I guess that had an impact on me. My cortisol levels went up for awhile.
Just so we don’t personalize that email to Congress too much, the ADA was kind enough to write most of it for us:
Dear [Decision Maker],
As your constituent, I stand with the American Diabetes Association in urging you to support funding for diabetes research and prevention programs.
A 2013 study showed that diagnosed diabetes cost our country $245 billion in 2012 alone, up 41% from 2007. Nearly 26 million Americans have diabetes and another 79 million have prediabetes. Our country is facing a diabetes epidemic and we need a stronger federal investment in diabetes research and public health initiatives.
And remember, Congressperson, if we spend the money now, it will save money in the long run! (Everyone who wants to spend taxpayer money uses that line. That’s why we’re awash in government budget surpluses these days– all that federal investment during the last 40 years that saved money in the long run.)
I urge you to request the following actions of the Appropriations Committee:
Allocate $2.066 billion for the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the primary federal agency that conducts research to find a cure and advance treatments for diabetes.
Provide $137.3 million for the Centers for Disease Control and Prevention’s (CDC) Division of Diabetes Translation (DDT) whose mission is to eliminate the preventable burden of diabetes through research, education, and by translating science into clinical practice.
So now I’m picturing my representative receiving this email from me and thinking to herself, “Man, this ordinary citizen is really specific in his demands for appropriations … exactly $2.066 billion for NIH, exactly $137.3 million for CDC … he must have really done his research to come up with those figures.”
The annual costs of diabetes will continue to skyrocket unless we invest in stopping the spread of diabetes and finding a cure. If Congress does not take action, diabetes will overwhelm the healthcare system with tragic consequences for all Americans.
Yes, the cost of diabetes could indeed overwhelm the healthcare system. I don’t care if we’re talking about private insurance, Medicare, ObamaCare, or all of the above; when a third of population is diabetic or pre-diabetic, we’re going to run up medical costs we can’t afford to pay without sinking the rest of the economy. No method of payment will solve that, because no method of payment will generate wealth that doesn’t exist.
But I’m pretty sure getting the federal government more involved isn’t going to avert this disaster by fixing the diabetes epidemic. In fact, I’m reasonably sure federal involvement in the food-production and dietary-advice business is part of what got us here in the first place – along with helpful advice from the ADA, which still tells people to avoid saturated fat and eat plenty of whole grains.
Happy April Fools’ Day, ADA. Thanks for the laughs.
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As I’m sure many of you know, a large new study concluded that saturated fat doesn’t cause heart disease. Here’s a quote from one of the many media articles about the study:
Many of us have long been told that saturated fat, the type found in meat, butter and cheese, causes heart disease. But a large and exhaustive new analysis by a team of international scientists found no evidence that eating saturated fat increased heart attacks and other cardiac events.
For decades, health officials have urged the public to avoid saturated fat as much as possible, saying it should be replaced with the unsaturated fats in foods like nuts, fish, seeds and vegetable oils.
But the new research, published on Monday in the journal Annals of Internal Medicine, did not find that people who ate higher levels of saturated fat had more heart disease than those who ate less. Nor did it find less disease in those eating higher amounts of unsaturated fat, including monounsaturated fat like olive oil or polyunsaturated fat like corn oil.
This ought to drive a stake through the heart of the Lipid Hypothesis, but it won’t. Here’s part of a blog post by Dr. Malcolm Kendrick, offering his prediction:
You see, the entire edifice of the cholesterol hypothesis is held together by two links in a chain. Link one is that saturated fat consumption raises cholesterol levels. Link two is that raised cholesterol levels then cause heart disease.
This is the cholesterol hypothesis, or the lipid hypothesis, and it has driven medical thinking for the last sixty years.
I have had it painstakingly explained to me, by very clever people, exactly how saturated fat raises cholesterol levels. Indeed, you will find ‘evidence’ for this almost universally accepted fact in literally thousands of clinical studies.
Okay, let us accept that eating saturated fat does raise cholesterol levels. However, if consumption of saturated fat does not increase the rate of heart disease then …. Then raised cholesterol levels can have nothing whatsoever to do with causing heart disease. Just keep chasing the implications of that statement around in your head for a while.
So what happens now? We now have a cholesterol/lipid hypothesis that just had its head blown off. Yet, it still continues to wander about, unaware that it is actually dead… I suspect it will continue to rampage about, stomping on puny humans for many years, before it finally keels over and admits that it is dead.
The cholesterol hypothesis is not only blissfully unaware of its demise, its proponents are pushing harder than ever to beat down everyone’s cholesterol levels. Take a look at the latest news on guidelines for prescribing statins:
The new American College of Cardiology (ACC) and American Heart Association (AHA) guidelines for the treatment of cholesterol would increase the number of individuals eligible for statin therapy by nearly 13 million people, an increase that is largely driven by older patients and treating individuals without cardiovascular disease, according to a new analysis.
Awesome. So we’d be giving statins to more older people (the group least likely to benefit from statins) and people who don’t have heart disease (the other group least likely to benefit from statins). Makes perfect sense. I don’t have cancer, but I’m considering signing up for chemotherapy just in case.
Among older adults, those aged 60 to 75 years old, 87.4% of men would now be eligible for the lipid-lowering medication, which is up from one-third under the old Adult Treatment Panel (ATP) III guidelines. For women of the same age, the percentage of those now eligible for statins would increase from 21.2% under ATP III to 53.6% with the new 2013 clinical guidelines.
Headline from the future: Doctors baffled by sharp rise in Alzheimer’s, arthritis among elderly.
The increase, say investigators, is the result of more patients being eligible based on their 10-year risk of cardiovascular disease.
Yeah, that must be it. It couldn’t be the result of a desire to sell more statins.
The new guidelines identify four groups of primary- and secondary-prevention patients for physicians to focus their efforts to reduce cardiovascular disease events. And in these four patient groups, the new guidelines make recommendations regarding the appropriate “intensity” of statin therapy in achieving relative reductions in LDL cholesterol.
These four groups include individuals with clinical atherosclerotic cardiovascular disease, individuals with LDL-cholesterol levels >190 mg/dL, diabetic patients without cardiovascular disease aged 40 to 75 years old with LDL-cholesterol levels between 70 and 189 mg/dL, and those without evidence of cardiovascular disease, an LDL cholesterol level 70–189 mg/dL, and a 10-year risk of atherosclerotic cardiovascular disease >7.5%.
In other words, resistance is futile. Almost everyone needs to take statins at some point. Go get yours before the Christmas rush.
Let’s suppose that statins do prevent heart attacks in some people … say, middle-aged men already known to have heart disease. Does that make statins the best possible treatment? I hardly think so. Take a look of part of an article reporting on a comparison of statins vs. fish oil:
A clinical trial reported in the Archives of Internal Medicine compared people who took statin drugs with those who just took fish oil capsules. Both these groups were compared to a control group that took a placebo. The statin group decreased mortality by 10% over the placebo group; however, the fish oil group decreased mortality by 23% over the placebo group. In other words, the participants who took the fish oil capsules had over twice the health benefit of those who took the statin drugs.
Hmmm, statins or fish oil … tough choice. Statins cause muscle pain, joint pain, mitochondrial damage, liver damage and cognitive impairment. By contrast, here’s what WebMD has to say about omega-3 fatty acids, the type of fats found in fish oil:
Hundreds of studies suggest that omega-3s may provide some benefits to a wide range of diseases: cancer, asthma, depression, cardiovascular disease, ADHD, and autoimmune diseases, such as rheumatoid arthritis.
And I’m guessing fish oil probably won’t turn you stupid and make your joints hurt. The trouble is, nobody’s going to rake in $30 billion per year from fish-oil tablets or wild-caught salmon. As far as I know, you can’t patent a fish — although it wouldn’t surprise me to learn Monsanto has tried patenting a laboratory salmon that can’t reproduce.
The cholesterol hypothesis has indeed had its head blown off, but I agree with Dr. Kendrick: it will continue to stomp us tiny humans for years, or at least until nobody’s making a hefty profit selling cholesterol-lowering drugs.
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Dr. Malcolm Kendrick plugged his data into that new risk calculator developed by the American Heart Association and the American College of Cardiologists and discovered that he’s overdue to begin statin therapy. As he reported on his blog:
I now find that I should have started statins eight weeks ago. Naughty, naughty, me. My blood pressure was a bit higher than the calculator liked 138/82, my cholesterol quite a bit higher at 6.0mmol/l.
Which means that I have already passed the 7.5% ten year risk score. O….M…..G. (I think my picture makes me look a bit younger than I am, although it was only taken last year – honest.)
What to do? I am now well beyond my ‘Statin by date.’ No longer can I be healthy without taking a statin.
Can I be reassured that my parents are both alive and healthy in their late eighties? My grandmother, on my mother’s side, lived to one hundred and two.
You can read the rest here, and I suggest you do if you enjoy a good laugh.
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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.
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:
“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.”
“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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