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.