Oops, they got it wrong about cholesterol

[claig]

"We've all spent time worrying about our cholesterol levels, but what if it was all... a conspiracy! What if the truth was that eating lots of fat doesn't clog your arteries and kill you, and that there's been a deliberate effort to ignore that evidence in order to secure the financial fortunes of Big Pharma's major anti-cholesterol drugs?"

www.cbsnews.com/news/dawn-of-the-cholesterol-skeptics-big-pharma-conspiracy-theorists-get-a-turn-in-the-spotlight/

"Flawed science triggers U-turn on cholesterol fears"
...
Its Dietary Guidelines Advisory Committee plans to no longer warn people to avoid eggs, shellfish and other cholesterol-laden foods.

The U-turn, based on a report by the committee, will undo almost 40 years of public health warnings about eating food laden with cholesterol. US cardiologist Dr Steven Nissen, of the Cleveland Clinic, said: 'It's the right decision. We got the dietary guidelines wrong. They've been wrong for decades.'

Doctors are now shifting away from warnings about cholesterol and saturated fat and focusing concern on sugar as the biggest dietary threat.

The Daily Mail's GP Martin Scurr predicts that advice will change here in the UK too.
...
He added that the food industry had effectively contributed to heart disease by lowering saturated fat levels in food and replacing it with sugar.

Matt Ridley, a Tory peer and science author, yesterday said there should be an inquiry 'into how the medical and scientific profession made such an epic blunder'.

He described the change of advice in the US as a 'mighty U-turn' and said studies linking high cholesterol and saturated fat in food to heart disease were 'tinged with scandal'."

www.dailymail.co.uk/health/article-3096634/Why-butter-eggs-won-t-kill-Flawed-science-triggers-U-turn-cholesterol-fears.html

I wonder if a similar thing will happen in about 40 years to the "save the planet" climate change warnings.

Oops!

The advice should come from GPs but they prescribe them and in my case played down a significant side effect to get a box ticked with serious consequences

I'm afraid I don;t understand the arguments about the side effects at all.

As Orlando says - all drugs have side effects -I know that better than most as I was hospitalised with a massively rare but life threatening side effect to a drug that had/has ongoing impact on my life.

My mum takes statins with no or minimal side effects and has done for years.

There are discussions all the time on MN about drug side effects - AD's causing weight gain, contraceptive pill and the general advice is to go back to your GO and discuss alternatives and lo and behold drug will be changed or another route with be chosen.

Even the doctor mentioned in the article said his leg pains had disappeared when he stopped taking them. So whats the problem, if the side effects become a bigger problem than the drug is solving then you discuss it with your GP. Its not difficult to spot muscle inflammation is stated on the side effects on the packet. That doctor must have been a bit dim if he couldn;t read the side of the packet.

'Even the doctor mentioned in the article said his leg pains had disappeared when he stopped taking them. So whats the problem,'

The problem is lots of people don't stop taking them because their doctors don't tell them to. oldsu's DH was nearly crippled. Much better GP training needs to be given, penalties if they don't give the right advice if someone is nearly crippled and are not told to stop, and much more education and warning material handed to patients so that they can ring alarm bells early.

This is the Deputy Chairman of the British Medical Association and even he and his doctor were in the dark about the side effects he ws suffering

"He’d been a GP for a quarter of a century and had written ‘tens of thousands of statin prescriptions’.

Then two years ago, Dr Kailash Chand, too, started taking the cholesterol-lowering pills to protect his heart.

As Dr Chand, who is the deputy chairman of the British Medical Association — the doctors’ union — explains: ‘I was in my late 50s and I’m Asian, so I ticked various boxes for being at raised risk of heart disease. It seemed the sensible thing to do.’

Within two weeks, however, Dr Chand, who is now 60, began experiencing pains in his back and legs unlike anything he’d suffered before.
...
I didn’t even consider statins,’ he says. ‘I was wondering instead about things like too much travelling or bad posture when sitting.

'I did various checks, like a liver function test, X-rays and an MRI scan. All came back clear.

‘So last year I thought it was worth seeing what would happen if I stopped taking the drug.

'Within two to three weeks my back and legs began to feel a lot better and my sleep improved.

‘For me that was the litmus test that showed that the statin was the cause of the problem.’

www.dailymail.co.uk/health/article-2582958/Statins-Millions-healthy-Britons-set-prescribed-GPs-say-wont-statins.html

And yet there are millions of patients around the world who are fine.

The ones you don't hear about. The ones where there were no side effects. Where things worked out well.

You don't hear those stories. Because they are positive.

I have no doubt that there have been fuck ups, probably cover ups because of the money involved.

But you know what - most medical researchers are in the job to find out how the body works. What is a good way to be healthy. What affects our health. What can we measure and how can we keep the public healthy.

There is a lot of cynicism about science on here. How researchers are in the pay of companies or get grants so you can't trust their work. Most scientists do their best with the current knowledge. As we learn more stuff, we can see that what we thought back then is incorrect, inaccurate or just way more complicated than thought. Then advice on fats was probably though to be good advice when people learnt about atherosclerosis. Now we know a lot more about it and it's been modified. A mistake or advice with the best intentions.

Within two weeks, however, Dr Chand, who is now 60, began experiencing pains in his back and legs unlike anything he’d suffered before

Bit of a crap doctor. Takes medicine. Experiences a well known side effect. I'm sure Google was around 2 years ago. Can't he read the packet?

Stops taking statins. Pain goes away. Then he can try something else.

'You don't hear those stories. Because they are positive. '

Yes because newspapers and authors inform us when things go wrong, not if everything is fine. And when things go wrong, there needs to be early interventon, early correct advice etc before it is too late. Just because most people aren't involved in road traffic accidents, doesn't mean we should be complacent about road safety.

claig

What is your view on statins?

Not a Daily Mail article. Just your view.

'Bit of a crap doctor.'

He is the Deputy Chairman of the British Medical Association. He seems to have believed what he was told.

"There is a lot of cynicism about science on here."

He didn't show much cynicism. It ticked the boxes he seems to have been told about. He doesn't seem to have asked many questions.

‘I was in my late 50s and I’m Asian, so I ticked various boxes for being at raised risk of heart disease. It seemed the sensible thing to do.’

Are some of these meds being prescribed unnecessarily because they tick the correct box?

"GIVING a daily cholesterol-busting pill to all men over 50 would be the quickest way to cut deaths from coronary disease, the heart and stroke tsar said yesterday.

A mass medication programme that would also include all women over 65 would save money as well as lives."

'What is your view on statins?

Not a Daily Mail article. Just your view.'

My view corresponds with the Daily Mail articles. Up to now, I have not needed to use them. I would try not to use them because I tend to agree with the researchers and GPs who say they would no use them. I don't go into a lab and carry out my own experiments to make that decision, it is just what I believe. I don't believe the government's "heart and stroke tsar", but that's just me, others can believe what they believe.

"GIVING a daily cholesterol-busting pill to all men over 50 would be the quickest way to cut deaths from coronary disease, the heart and stroke tsar said yesterday.

A mass medication programme that would also include all women over 65 would save money as well as lives."

What I find frightening is that presumably there are some GPs who are not cynical enough to question this stuff. Soon anyone who says "hold on a minute" will be called a fruitcake and then the "tsars" will have their way.

As long as they aren't able to shut down the Daily Mail and regulate our free press then we will still be alright. At least there will be one powerful voice saying "hold on a minute".

"Statins should even be put in the water supply, according to one of Britain’s leading heart experts, Dr Mahendra Varma, who is vice-chairman of the Northern Ireland Chest, Heart and Stroke Association.

www.dailymail.co.uk/health/article-1340299/Why-taking-statins-pointless--bad-you.html

It probably ticks all the boxes.

Side effects are reported to GPs, but some don't listen.
If you are on a drug that is supposedly improving your health, without it you would struggle to have quality of life, and a dr tells you that it isn't causing side effects (despite them being listed), and it would be dangerous to come off them, what do you do?
You're fucked if you take them because of the side effects, you're fucked if you don't take them, because whatever illness they are treating will flare up.

If drs actually listened to their patients and helped to come up with alternative treatment, it might be that there aren't the tales of dreadful side effects, because a patient can be an active player in their health rather than a bystander watching the dr at work and blindly believing that they know it all.

I think in the end it comes down to whether human life is something to be valued, or not.

Clearly one "pragmatic" view is that individual human lives are of no consequence, except perhaps to themselves. [shrug]

'I think in the end it comes down to whether human life is something to be valued, or not.'

Absolutely. Some senior GPs talking about "ticking boxes", we hear of carers only having 15 minutes to care for the elderly before having to drive to their next patient and not being paid for travel time. There was a report the other day in my area that lots of paramedics were leaving their jobs because of the hours they are having to work as they are called out on new jobs just as they are about to end their shifts and then there is the general understaffing and lack of time for quality patient care and then talk of statins in our water and tickbox medication.

It's like some sort of industrial workflow management tickbox culture with meds in water and the patients on some sort of conveyor belt.

Can't he read the packet?

Thats what I thought Orlando.

I mean I get that there are some crap GP's but he IS a doctor and presuambly he can read and does read the side effects leaflet in all pills he takes? I do and I'm a bleedin' accountant! And if a GO tells you it's dangerous to come off statins then they should be struck off - it isn;t dangerous it will increase your risk that is what they should discuss with you - exactly what your risk is. There are many other things GP's suggest to reduce cholesterol levels but as a population we tend not to be so good at doing them so many would prefer to take the pills.

And GP not paying enough attention to their patients isn't the reason to be dismissing drugs which are proven to be useful in certain circumstances. I do have a good GP thanks and I'd much rather have the full range of choices available to me.

In fact my GP says I do not need statins despite having high cholesterol, being portly and of advancing years based on NHS guidelines - doesn't sound to me like GP's prescribing them willy nilly if they're not thrusting them upon me

Maybe your GP practice doesn't prioritise money-making, Kewcumber. Who knows? Is he/she old? Principle may mean more to him/her than money, if so.

Yes fortunately we have lots of GPs who have some cynicism and ask some questions and can't easily be told what box to tick by anyone called a "tsar".

"Two-thirds of GPs disregard NICE advice to offer statins to more patients

The majority of GPs are not complying with NICE advice that they should prescribe statins to more low-risk patients, a Pulse survey has revealed.

Two-thirds of GPs said they have not begun prescribing statins to patients who are newly eligible for the drugs since NICE lowered the risk threshold for primary prevention from a 10-year risk of 20% to 10%, in updated lipid guidance released over the summer.

The chair of the GPC prescribing committee told Pulse there should be ‘no.. slavish devotion’ to guidelines, while GPs indicated they have ongoing doubts there is enough evidence that the benefits of statins outweigh the harms in lower-risk people, and concerns around the increased workload and ‘medicalisation’ of healthy people.

NICE pushed through the lower 10% threshold when it published revised lipid modification guidelines in July this year, despite strong objections from the GPC on the grounds it was not evidence-based and could lead to increased consultations and medicalisation of healthy people to the cost of more needy, unwell patients."

www.pulsetoday.co.uk/clinical/cardiovascular/two-thirds-of-gps-disregard-nice-advice-to-offer-statins-to-more-patients/20008226.article#.VWj4f6LbKic

"Almost half of all adults could be offered statins under new guidelines from the health watchdog.

NICE is advising GPs to consider prescribing the pills to up to 17million patients to prevent heart disease.

Family doctors are being urged to trawl medical records to find patients at risk who will then be invited in for check-ups.

However, GPs say that already overstretched surgeries will be deluged with patients booking the check-ups, leading to even longer waiting times for appointments.

Other doctors warn that the population faces being ‘medicalised’ when too little is known about the potential side-effects.

The known side-effects include type 2 diabetes and severe muscular pain and there is also evidence that patients regard the pills as an excuse to lead unhealthy lifestyles.

Guidelines issued by NICE today tell GPs to consider prescribing statins to anyone with a 10 per cent risk of developing heart disease within a decade (generally people over the age of 40). Currently, they are offered to patients with a 20 per cent risk.

www.dailymail.co.uk/health/article-2696691/GPs-warn-chaos-bid-offer-statins-17m-prevent-heart-disease-Doctors-told-trawl-medical-records-risk-patients.html

GPs are educated and intelligent so it will not be easy to get al of them to blindly follow guidelines.

How do you Fast Track a drug past its trials? I was 22 years in the industry and never heard of this. not ever. And for children prescribing us even harder as it's far harder to trial on children. Was the drug used off label? (Outside its regulated use)

As for GPs and incentives, that's just nonsense. The pharma industry is incredibly tightly regulated. When I started as a junior, straight from university we could leave promo items. Nowadays the items have to be directly related to medicine, so a branded pen rather than a paperweight, and under £8. If a GPs prescribing is influenced by that, then they're a disgrace to their profession.
Prescribers are always encouraged to prescribe the brand rather than the generic as there is a wider margin and tighter control of distribution of the brand. But it is exactly the same molecule and makes no difference whatsoever to the patient.

As for Daily Mail journalists helping to bring science to the masses, I could bang my head on the wall...

And I still haven't heard from Oldsu about what I personally should do about her husband....

Interesting to see how this "debate" has gone from cholesterol to statins.

GPs are educated and intelligent so it will not be easy to get al of them to blindly follow guidelines

According to some on here, they are in the pocket of the pharmaceutical industry, they don't take concerns seriously, they prescribe without thinking.

Make your mind up.

But....there are other ways of lowering blood cholesterol and altering the type of cholesterol which may be as effective and does not rely on medicine. Because yes,medicine can be a cop out for some and an excuse to not adopt a better lifestyle.

Cholesterol is a factor in heart disease. How it can be lowered / the ratio altered is a good question. Some people would find a diet change more helpful. Others would find it "easier" to use pills.

Information is key. Understanding the risks and the benefits is important.

If everyone over a certain age and with a 10% risk of heart attack took cholesterol lowering drugs, it would be interesting to know the effects on morbidity. Say there were 1000 people and maybe 10 of those would have had a heart attack in 10 years, would maybe only 8 have had one?

(not real figures, just speculating). So you've saved 2 people from a heart attack out of 1000 over a 10 year period.

But...you don't know which of those 1000 people would have had the heart attack. Which is why you give them all the drug.

At the same time, those other people who have not had the heart attack. What risks have they suffered so the 2 people in that group have not had the heart attack? Is it "worth it" so those 2 people have not had a heart attack?

Difficult questions.

1. Are there more effective ways of reducing the risks of cholesterol than giving a pill?

2. Is giving a cholesterol lowering pill to a large group who are at risk worth it to save a few lives in that group?

Questions that the Daily Mail can't answer. Can you answer those claig without cutting and pasting articles. Just try and answer them yourself.

Maybe your GP practice doesn't prioritise money-making, Kewcumber

Umm no idea. And I have no idea why following an NHS guidelines checklist would result in more/less money for them either.

My GP showed it to me on the screen because I was worried that despite having high cholesterol they weren't recommending statins so he shows me the computer checklist on his screen which was an NHS one - it took into account (from memory) age, sex, weight, cholesterol levels, blood pressure and possible family history it computed your risk of having a heart attack within 10 years and the prescribed statins if this was over 20%.

If I had a 1 in 5 risk of having a heart attack then I'd happily give statins a go - as I said my mum takes them with no side effects.

I'm not sure what extra money you think my GP would have got for failing to follow the guidelines My point was more that despite having high cholesterol levels, the NHS advice was not to put me on statins. Despite what the Daily Mail would have you believe it isn't a knee jerk reaction at all and high cholesterol is not equal to "prescribe statins".

didyouwritethe

"A bus being late is in no way comparable to damage to a person's health causing serious pain.

Is it?

But if you asked a bus driver, they would tell you why it happened and what they personally were doing about it, even if it were only to complain to management and speak to their union."

Oldsu is expecting a personal response for her personal situation.

"Oi bus driver, my bus was late and it had a huge impact on my life. What are you going to do about it?"

"Was it my bus?"

"I have no idea. But you're a bus driver! You should do something, and be sorry for my missed bus."

"But we are mostly on time."

"I don't care, my bus wasn't on time, you should be ashamed of yourself. The fact you provably weren't driving it is irrelevant as I have misplaced anger now against all buses and bus drivers."

"Oh."

Despite what the Daily Mail would have you believe

That should apply to all claig's threads.

It's scaremongering. Irresponsible scaremongering. There may be an element of truth, there may not.

I can't remember the DM view on Andrew Wakefield and MMR. I suspect they initially believed his results. How many children developed measles as a result of the bad science and the bad science reporting around that?

'So you've saved 2 people from a heart attack out of 1000 over a 10 year period.

But...you don't know which of those 1000 people would have had the heart attack. Which is why you give them all the drug.'

No that is not worth it due to the fact that the medicine has side effects on the 998. Mass medication is not suitable for all people and theefore a tick box approach dreamed on high by a "tsar" or "tsarina" like that which coincidentally also increases profits of pharma companies should not be used. I am against government "tsars" who want our water flouridated because they tell us it is cost effective and good for us.

"Add fluoride to water to improve British teeth, say Government's health advisers"

www.independent.co.uk/life-style/health-and-families/health-news/add-fluoride-to-water-to-improve-british-teeth-say-governments-health-advisers-9215241.html

'1) Are there more effective ways of reducing the risks of cholesterol than giving a pill?'

I think so by nutrition and studying correct nutrition advice not 40 year advice with u-turns by "experts" and "tsars".

2. Is giving a cholesterol lowering pill to a large group who are at risk worth it to save a few lives in that group?

No because of the side effects and risk and unnecessary use of medication. I am against the government "tsars" who say a "polypill" should be given to all over 50s for their own good

'Questions that the Daily Mail can't answer. '

The Daily mail doesn't answer questions, it asks them. It is in the Comments section of the Daily Mail that you will find the common sense answers of millions of people, and not a government "tsar" among them.

It is in the Comments section of the Daily Mail that you will find the common sense answers of millions of people, and not a government "tsar" among them

The Daily Mail comments section....That haven of sanity, reasonableness, open mindness