Dangers Associated With Cholesterol Drugs

[JustinSmith]

In April 2004, the National Health Service (NHS) in the UK introduced the Quality and Outcomes Framework (QOF). This is a kind of performance related pay and is applied to every general practitioner medical practice. QOF contains a number quality indicators which doctors have to report on. The better the practice does in terms of these indicators, the more money it will get from the NHS.

Around half of the potential revenue from QOF is associated with indicators of clinical quality. Specific indicators have been identified for a range of common conditions. For example, a list of indicators has been identified for diabetes. These include body mass index (BMI) and blood glucose levels. The more diabetic patients that have a BMI and blood glucose level below a specified value, the more money the doctor will get from the NHS.

One of the problems with QOF is that many of the indicators are based on risk factors for disease rather than disease itself and targets are set without regard to how they are achieved. There are performance measures, or targets, set for cholesterol.

If a patient has heart disease, diabetes, or if they have had a stroke, doctors are expected to lower their cholesterol so that it is below 5mmol/l.

For example, if 40% of a doctors diabetic patients have a cholesterol level below 5mmol/l, the doctor will be paid less than if 50% of diabetic patients have a cholesterol level below 5mmol/l.

In summary, there is a financial incentive for doctors to lower the cholesterol levels of certain patients.

Since the majority of people in the UK happen to naturally have (and have always had) a cholesterol level above 5mmol/l, the doctor has little choice but to put more people onto statins.

Especially given the fact that doctors have a heavy workload and do not have sufficient time to work through lifestyle changes.

An article published in the New England Journal of Medicine describes the problems associated with performance measures being based on risk factors for disease. This paper cites a number of examples where the focus on the risk factor has actually caused more harm and increased the number of deaths.

References:

Gravelle, H, Sutton, M and Ma, A ?Doctor Behaviour under a Pay for Performance Contract: Evidence from the Quality and Outcomes Framework? CHE Research Paper 28. University of York and University of Aberdeen. May 2007.

Krumholz, HM and Lee, TH ?Redefining Quality ? Implications of Recent Clinical Trials? New England Journal of Medicine 2008; 358:2537-2539

Justin Smith

[ruffers]

???? Wrote:

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>

> A reasonably practiced 'longtail' approach to

> selling anything (books included)on the internet

> is to have a standardish intro that is C&Pd into

> numerous forums with a link to your own website,

> don't need that many people to buy...the really

> cynical bit of me is even a bit suspicious that

> Justin's lives here , although he has posted on

> another thread so I'm just about giving him the

> benefit of the doubt.

>

> Come on - he should be crystal clear. And the

> Forum has clear sections for commercial offers.

The cut and paste nature of Justin's post above and lack of reference to the points raised in the intervening posts seems to bear this out somewhat..

[JustinSmith]

????,

I have been crystal clear right from the outset. Your accusations about commercial gain have been a total fabrication.

I have already stated that the seminar will be free, or at the cost of the room. I am now here officially stating that any profit that I make from my book (or anything else that you imagine that I will make money from) as a result of posts on this forum or as a result of the seminar will be donated to charity.

I am already trying to arrange a donation of a number of my books to a particular charity that I have in mind. It is a small orphanage in India that wishes to build an extention to take in more children.

And before you start, I will find a way to provide evidence that this has been done on my website and on this forum.

If anyone has bought my book as a result of this thread please let me know where you bought it from and I will donate any profit I get from this to the same charity.

You seem slightly obsessed with '????' if I may say so and your suspicion in this case is misplaced.

Justin Smith

[????]

My questions about about commercial gain were just that and not answered until now...nothing fabricated.

However, it appears my suspicions were as you say misplaced. Glad to hear that you'll give everything to charity. Perhaps if you'd read the rules of the forum before posting and answered us cynics a bit clearer, earlier or even at all in some cases we'd have not dared to challenge you in a way that clearly irks you so much.....

Anyway, I won't be attending but probably see you around in a local restaurant or on LL hey?

[JustinSmith]

ruffers Wrote:

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> The cut and paste nature of Justin's post above

> and lack of reference to the points raised in the

> intervening posts seems to bear this out

> somewhat..

The post you are referring to is taken from my book. And you can see the references that it is based upon listed below the post.

Regarding any intervening points, I have entered almost 30 replies to points raised and many of these posts that I have made have been of considerable length with many references and supporting documents.

[mazza7103]

There is a shocking history of early onset heart disease in my family. This has made me very conscious of my cholesterol level. I have asked two different GPs to prescribe statins and I have each time been refused. Now my LDL has always been borderline high but rather than prescribe statins I have been given numerous blood tests to rule out any underlying issues and referred to a Cardiovascular Clinic.

I accept that pharmaceutical companies have a shocking amount of power but their influence certainly hasn't influenced my treatment.

[JustinSmith]

It is very encouraging to hear examples where an investigation is undertaken at an individual level. However, you might like to read about a study published in the American Heart Journal showing that LOW LDL levels are more likely to be associated with heart disease and not high LDL levels.

The study included 136,905 people ? all of these people had their LDL level measured within 24 hours of arrival in hospital. We can immediately see that the majority of these people with existing heart disease had an LDL level below the suggested ideal level. The average LDL level for this group of people was 2.7 mmol/l. However, the average LDL level for the general population around the same time was 3.2 mmol/l ? LOWER levels of so called 'bad' cholesterol were much more likely to be associated with heart disease than higher levels.

The idea that LDLs are 'bad' is propagated by the pharmaceutical companies. However if people with heart disease have lower LDL levels, this of course challenges the idea significantly. Unfortunately this study did not get into the media. If it did, more people would ask questions.

http://www.29billion.com/2009/12/bad-cholesterol-is-now-good.html

Not to mention the fact that LDLs are not even cholesterol!! They are lipoproteins that carry, yes some cholesterol, but also proteins. fats and vitamins. LDLs are an essential part of the transport mechanism used by the body to transport vitamins and nutrients to the cells of the body where they are needed. These simple facts are not talked about because there is so much money involved in statins.

[Huguenot]

It's amazing how big this conspiracy is.

There appears to be a helluva lot of Doctors out there actually murdering people for a bonus. Very clever people who pretend to care, but really are telling us lies in order to get in the good books of the sales reps.

In fact since nobody's blown the whistle, they're all in it together. Powered by hate, and the desire to furnish themselves with another second hand Vauxhaull Senator.

Thank God we've got people who studied very hard at University in Engineering who will stand up and be counted. They know the truth. That kind of valiant Spartacus shite must get them lots of sex as well!

All those times we visit the doctor, they're looking us in the eye and brazenly thinking "If I kill this one, I'll get a free pen"

Wow, there's just not enough Engineers in medicine, or in climate science. They should write a book or something.

[taper]

Justin

I had a look at the American Heart Journal report, and the reporting of it.

The study report itself is rather dry. But look here for an accessible interpretation -

http://newsroom.ucla.edu/portal/ucla/majority-of-hospitalized-heart-75668.aspx

If you can't be bothered here's a key quote

"Almost 75 percent of heart attack patients fell within recommended targets for LDL cholesterol, demonstrating that the current guidelines may not be low enough to cut heart attack risk in most who could benefit," said Dr. Gregg C. Fonarow, Eliot Corday Professor of Cardiovascular Medicine and Science at the David Geffen School of Medicine at UCLA and the study's principal investigator"

And from the ucla report:

"While the risk of cardiovascular events increases substantially with LDL levels above 40?60 mg/dL, current national cholesterol guidelines consider LDL levels less than 100?130 mg/dL acceptable for many individuals. The guidelines are thus not effectively identifying the majority of individuals who will develop fatal and non-fatal cardiovascular events, according to the study's authors"

So the conclusion of the person leading the research is somewhat different from your own, as far as i can tell.

Can you clarify what your views are? It's clear you think statins are overprescribed, but do you think they're worthless, or perhaps dangerous? And do you subscribe to the "cholestrol myth" view, ie that the notion of "bad" and "good" cholestrol isn't as big a problem as the medical establishment makes out (or indeed is not a problem at all).

Edit

To give you more to go on Justin, which elements (if any) of the BMJ's views on cholestrol (here - http://www.guardian.co.uk/lifeandstyle/besttreatments/high-cholesterol-summary) would you diagree with?

[JustinSmith]

I am aware that various authors have attempted to use the study as justification for lowering cholesterol even more. The study itself was financially supported by pharmaceutical companies that make statins. Having spent many years researching this subject I was not at all surprised by the attempts of some authors to put a spin on the data that would support further cholesterol lowering.

The idea that so called 'bad' cholesterol needs to be lowered is built on an idea that people who have heart disease have higher levels of 'bad' cholesterol. The simple fact from the study is that people with heart disease do not have higher levels of 'bad' cholesterol.

As I said, this study was financed by companies that make cholesterol-lowering statins. It is highly unlikely that they will write something in the conclusion that will bring into question the whole basis of identifying someone who needs a statin.

Not to mention the fact that lower cholesterol correlates with a shorter life expectancy and the 12 studies I referenced in a previous post showing that lower cholesterol correlates with increased cancer mortality.

It is extremely important to state here that there is no conspiracy in all of this, only fact. Many people will find it difficult to believe that things are scewed in favour of drugs within the medical literature. But it is not just me who is saying that these problems exist, it is the editors of the medical journals themselves.

For example, you mention the BMJ.....

Richard Smith worked for the British Medical Journal (BMJ) for 25 years and was Editor and Chief Executive of the BMJ Publishing Group from 1991 to 2004. During this time he became one of the most influential people within medicine. In his book (The Trouble with Medical Journals), which is published by The Royal Society of Medicine, he analyses the problems and current trends in medical publishing. The book provides a fascinating and highly readable account of the issues within medical research and the reporting of research within journals. The book is is highly recommended to anyone who wishes to gain an insight into the world of medical research and how it influences our daily lives.

I was, frankly, shocked when I first read Richard Smith's book. Here is someone right at the core of medical research desperately trying to communicate the significant issues. After reading his book and other books written by editors of other medical journals, I was not at all surprised to find that the above mentioned study was being presented as evidence for cholesterol-lowering when it clearly does not support cholesterol lowering at all.

As for my position on statins. My aim is to present the facts about the risks and benefits so that people can make an informed choice. At the moment these facts have been heavy distorted.

As for my position on Cholesterol. There is no correlation between cholesterol levels and heart disease. Most people who have a heart attack have an average cholesterol level or a low cholesterol level. Furthermore cholesterol-lowering as a specific goal does nothing to reduce the risk for heart disease.

For example, according to data published by the British Heart Foundation, between 1994 and 2006 the percentage of men aged 65 to 74 with ?high? cholesterol decreased from 87% to 54%. Despite this, the rate of coronary heart disease for this age group stayed about the same. Other age groups have experienced an increase in the rate of heart disease as the number of people with ?high? cholesterol has decreased.

There are just so many examples like this that contradict the idea that higher cholesterol causes heart disease. Despite all this evidence, we the tax payer spend hundreds of millions of pounds every year on the specific goal of lowering peoples' cholesterol.

[HAL9000]

Huguenot Wrote:

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> It's amazing how big this conspiracy is.

With all due respect, you probably wouldn?t take that attitude if you knew what really went on behind the scenes in this field.

It's very rare for the relationship between a Pharmacuitical Company and the Medicines Regulators to enter the public domain. The case of Upjohn's Halcion (triazolam), a sleeping pill, is an informative exception.

This highly addictive drug caused severe mental illness and extreme violence (several cases of murder having been attributed to its use ? allegedly[1]) in some patients for 13 years while the manufacturer dragged dozens of experts through long, drawn out legal actions before its dangers were officially recognised. Nothing much has changed since then ? and Upjohn is still marketing Halcion in the US and many other countries.

If it weren?t for a libel action at the Royal Courts of Justice, little of this scandal would have seen the light of day.

See: Transnational industrial power, the medical profession and the regulatory state: adverse drug reactions and the crisis over the safety of Halcion in the Netherlands and the UK

[1] A number of Upjohn-related documents pertaining to this issue remain Sealed by Order of a Court in Kalamazoo, Michigan.

[Huguenot]

Yay!

More conspiracies! They're everywhere I tell you.

One libel case doesn't make every newspaper a liar, one faulty repair doesn't make every plumber a thief.

For every drug that has a sorry tale, there's dozens that make use of the best possible knowledge and research to improve people's lives.

Trust no-one, trust nothing and whatever happens DON'T TALK TO THE EXPERTS. They're in on it.

[Ladymuck]

Huguenot Wrote:

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> Yay!...

>

> ...More conspiracies! They're everywhere I tell you....

>

> ...Trust no-one, trust nothing and whatever happens

> DON'T TALK TO THE EXPERTS. They're in on it.

Well now you're just being flippant!

*tutts twice*

Edited to say: and I'm 100% with HAL9000 on this one.

[Mick Mac]

Huguenot Wrote:

-------------------------------------------------------

>

> One libel case doesn't make every newspaper a

> liar,

> For every drug that has a sorry tale, there's

> dozens that make use of the best possible

> knowledge and research to improve people's lives.

We have the right to expect all drugs to have been properly tested and once there risks are highlighted for those drugs to be taken off market until the contentious issues are resolved.

We should expect drug companies to be prudent and conservative, not to push drugs upon needy people despite highlighted dangers.

As for newspapers and plumbers I don't see that errors in these areas have similar impact. Its very important for us to be able to expect our medicines to be safe.

[Ladymuck]

Mick Mac Wrote:

-------------------------------------------------------

> Huguenot Wrote:

> --------------------------------------------------

> -----

>

> >

> > One libel case doesn't make every newspaper a

> > liar,

> > For every drug that has a sorry tale, there's

> > dozens that make use of the best possible

> > knowledge and research to improve people's

> lives.

>

> We have the right to expect all drugs to have been

> properly tested and once there risks are

> highlighted for those drugs to be taken off market

> until the contentious issues are resolved.

>

> We should expect drug companies to be prudent and

> conservative, not to push drugs upon needy people

> despite highlighted dangers.

>

> As for newspapers and plumbers I don't see that

> errors in these areas have similar impact. Its

> very important for us to be able to expect our

> medicines to be safe.

Mick Mac, that is precisely what I wanted to say...but I have the brain the size of a pea...well done.

['bout now]

We have the right to expect all drugs to have been properly tested and once there risks are highlighted for those drugs to be taken off market until the contentious issues are resolved.

We should expect drug companies to be prudent and conservative, not to push drugs upon needy people despite highlighted dangers.

I believe that is what the National institute for Clinical Excellence is for.

[JustinSmith]

No its not.

The Medicines and Healthcare products Regulatory Agency (MHRA) is responsible for doing that.

The MHRA recently conducted a safety review of statins but it only investigated relatively minor adverse effects of statins and failed to look into the serious issues associated with statins and type 2 diabetes, heart failure or cancer.

We are now in the strange situation where a drug can be approved by the MHRA in the UK or the FDA in USA on the basis that the drug reduces a suggested risk factor for a disease ? even if this reduction in the 'risk factor' does not produce any real benefits to people.

The National Institute for Health and Clinical Excellence (NICE) provides guidelines to GPs in the UK based on an assessment of the benefits, risks, and financial costs associated with a drug. So NICE is more concerned with money.

When NICE did this assessment for statins, the costs associated with drug adverse effects were not included in the calculation. More worryingly, the calculation has been done on the basis of cardiovascular benefits alone, without addressing the issue of deaths from all causes ? these issues impact the cost-effectiveness of statins greatly but they decided not to include them.

[Ladymuck]

'bout now Wrote:

-------------------------------------------------------

> I believe that is what the National institute for

> Clinical Excellence is for.

However, whilst it is not disputed that NICE generally does what it is supposed to do - i.e. promote clinical excellence within the NHS, it is not quite as independent as it would like us to believe it is. How can it claim complete independence when, for example, any decision it makes must reflect the cost effectiveness of treatment(s)? In my opinion, as long as this conflict of interests remains front line services are going to fall short of the ideal and patients are going to suffer.

[taper]

This report suggests there is no effect Justin. Is it compromised by Pharmaceutical interests?

http://www.ncbi.nlm.nih.gov/pubmed/18384710

CONCLUSIONS: Statins, as a class, do not demonstrate a statistically significant positive or negative impact on a patient's risk of developing new-onset type 2 diabetes mellitus.

Ladymuck - Not clear to me why "reflect[ing] the cost effectiveness of treatment" compromises NICE's independence. It's part of NICE's core remit, surely? And a very valuable one too, in the face of intense pharma lobbying.

[Huguenot]

[Oops, missed a page - this post is in responses to assertions that it is possible to ban unsafe drugs]

Possibly Mick Mac, but I don't think that's practical. Medicine isn't a black and white issue.

Drugs aren't either safe or unsafe.

Every drug carries a risk - what the industry tries to do is manage that risk against proposed benefits. Look at chemotherapy and radiotherapy: massively destructive treatments carried out only when the risk of not employing them is considered worse than the risk of employing them.

I'll be betting the case for and against statins is not nearly as cut & dried as the conspiracy theorists will have us know. There are clearly medical practitioners who consider that the benefits outweigh the risks. The majority it seems.

Trotting out examples of where it's been injurious is hopeless science unless there's a balance of evidence.

Many people take aspirin, but these kind of anti-inflammatories are calculated to cause over 7,500 deaths a year in the US.

You drink beer, and that causes 85,000 deaths a year - because you perceive the benefits to outweigh the risks.

Read the Daily Mail: coffee causes cancer today, and cures it tomorrow.

So the question is, do we accept the view of isolated conspiracy theorists who profit from attacking contemporary medecine, or do we accept the majority view of the educated medical profession. Doctors who care about their patients?

[JustinSmith]

I was discussing these issues with a physician colleague recently and his response was that doctors are prescribing on the back of inadequate information and its happened before with Thalidomide, Co-Proxamol, HRT, Vioxx and scores of other drugs withdrawn from the market each year despite having passed ?safety? tests as set by medical governing bodies.

Huguenot, I believe that I have posted sufficient information and references on this thread for people to decide for themselves if we can just sit back and accept that everything is being taken care of for us. You openly admitted in a previous post that you have no interest in the subject of cholesterol or statins and that you are only posting on this thread because you didnt like something I posted on another thread. You dont like what I have to say, fine, but at least let people get to the facts for themselves.

[JustinSmith]

Taper,

With respect, you should go back and read my previous post on statins and type 2 diabetes. This was a lengthy post on the subject. The study I mentioned there (the JUPITER trial) came after the study you quoted and found a significant increase in type 2 diabetes in the people who took the statin.

In the JUPITER trial the increased risk for developing diabetes (associated with the statin) was around the same as the benefit in terms of all cause mortality.

Another meta-analysis was done (again after the one you quoted) containing more recent data. This meta-analysis confirmed that statins increase the risk for type 2 diabetes. This increased risk is reduced if the WOSCOPS study is included in the analysis, but WOSCOPS was so different in characterists that it should not be included in the analysis. This was explained in an editorial in the New England Journal of Medicine. This is the most recent and up to date information on this issue.

There are also other studies to show the link between statins and worsening control of blood glucose.

As someone else said, its the balance of the argument that matters and thats what I am presenting to people.

[HAL9000]

Huguenot Wrote:

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> More conspiracies! They're everywhere I tell you. ?

> Trust no-one, trust nothing and whatever happens DON'T TALK TO THE EXPERTS. They're in on it.

Hugo - you must be psychic, or something?

European Parliament to Investigate WHO and ?Pandemic? Scandal

The Council of Europe member states will launch an inquiry in January 2010 on the influence of the pharmaceutical companies on the global swine flu campaign, focusing especially on extent of the pharma?s industry?s influence on WHO. The Health Committee of the EU Parliament has unanimously passed a resolution calling for the inquiry. The step is a long-overdue move to public transparency of a ?Golden Triangle? of drug corruption between WHO, the pharma industry and academic scientists that has permanently damaged the lives of millions and even caused death. More...

See also: The ?false? pandemic: Drug firms cashed in on scare over swine flu, claims Euro health chief

[Huguenot]

HAL9000, indeed a symptom of healthy deomcracy ;-)

Justin "Huguenot, I believe that I have posted sufficient information and references on this thread for people to decide for themselves if we can just sit back and accept that everything is being taken care of for us. "

...Well of course, you've chosen a forum of non-medical people ill-equipped to respond to your debate. You've found yourself a room full of primary school children and proven to them that Justin is stronger.

and then you've asked them to join your gang.... at a price.

[????]

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