The Cholesterol Con

The Cholesterol Con - Where Were the Doctors?
By Maggie Mahar
Health Beat

Wednesday 20 February 2008

After the stock market bubble burst, the New York Times asked:
"Where were the analysts? Why didn't they warn us?"

To be perfectly honest, this was a somewhat disingenuous question.
As experienced financial journalists understood all too well, the
analysts plugging the high-flying issues of the 1990s were employed by
Wall Street firms raking in billions as investors bet their nest eggs
on one hot stock after another. It really wasn't in their employers'
interest for analysts to tell us that their products were wildly
over-priced. When a small investor wades into the financial world,
there are two words he needs to keep in mind: "caveat emptor."

But physicians, I firmly believe, are different from the folks
employed by Merrill Lynch. (I don't mean to knock people who work at
ML. I am simply saying that they have a very different job
description.) When consulting with your doctor, you should not have to
be wary. You are not a customer; you are a patient. And your physician
is a professional who has pledged to put your interests ahead of his
or her own.

This brings me to the question I ask in my headline: during the
many years of the Cholesterol Con - where were the doctors? When
everyone from the makers of Mazola Corn Oil to the Popes of Cardiology
assured us that virtually anyone could ward off heart disease by
lowering their cholesterol, why didn't more of our doctors raise an
eyebrow and warn us : "Actually, that's not what the research shows" ?

No doubt, you've heard about the recent Business Week cover story,
"Do Cholesterol Drugs Do Any Good?", which blew the lid off the theory
that "statins" - drugs like Lipitor, Crestor, Mevacor, Zocor and
Pravachol - can cut the odds that you will die of a heart attack by
slowing the production of cholesterol in your body and increasing the
liver's ability to remove L.D.L., or "bad cholesterol," from your
blood.

It's true that these drugs can help some people - but not nearly
as many as we have been told. Moreover, and this is the kicker, we
don't have any clear evidence that they work by lowering cholesterol.

Although medical research suggests that statins can definitely
benefit one group - men under 70 who already have had a heart attack -
researchers are no longer convinced that the drugs stave off a second
attack by lowering the patient's cholesterol. The drugs do lower
cholesterol, but that is not what helps the patient.

In other words, researchers are questioning the bedrock assumption
that high levels of "bad cholesterol" cause heart disease. "Higher LDL
levels do help set the stage for heart disease by contributing to the
buildup of plaque in arteries. But something else has to happen before
people get heart disease," Dr. Ronald M. Krauss, director of
atherosclerosis research at the Oakland Research Institute, told
Business Week. "When you look at patients with heart disease, their
cholesterol levels are not that [much] higher than those without heart
disease," he added. "Compare countries, for example. Spaniards have
LDL levels similar to Americans', but less than half the rate of heart
disease. The Swiss have even higher cholesterol levels, but their
rates of heart disease are also lower. Australian aborigines have low
cholesterol but high rates of heart disease."

"Current evidence supports ignoring LDL cholesterol altogether,"
Dr. Rodney A. Hayward, professor of internal medicine at the
University of Michigan, told Business Week's reporter.

In recent years, researchers have begun to suspect that statins
help patients, not by lowering cholesterol levels, but by reducing
inflammation. If this theory is right, "this seems likely to shunt
cholesterol reduction into a small corner of the overall picture of
heart disease," the Guardian reported four years ago.

And if the key to statins is that they reduce inflammation, it's
worth keeping in mind that this is what other effective heart
treatments like aspirin and the omega three fatty acids found in fish
oils, garlic and Vitamin E do - at a much lower cost and with far
fewer side effects.

But hold onto your hats, I still haven't gotten to what is most
shocking about the cholesterol story. What raises my blood pressure is
the knowledge that Business Week's scoop isn't really "new" news."
With all due respect to Business Week, which showed real courage in
putting the story on its cover, and to its author, John Carey, who did
a superb job of explaining the medical research, the truth is that
medical researchers have been questioning the theory that widespread
use of statins to lower cholesterol will save lives for many years.

You can find the research questioning the benefits of statins in
medical journals like Lancet (2001) and BMJ (2006), as well as in
reports from medical conferences ("Tales From the the Other Drug
Wars," 1999).

Occasionally, doubts popped up in the mainstream press and then
disappeared.

Five years ago, veteran healthcare blogger Matthew Holt pointed to
a BMJ article suggesting that statins might be no better than aspirin.
That same year, Holt raised pointed questions regarding the risk of
taking statins, including possible memory loss."

Nevertheless, the very next year, the National Cholesterol
Education Program at the U.S. National Heart, Lung and Blood Institute
issued new recommendations that drastically lowered the threshold for
statin therapy. According to its 2004 report, people at a moderately
high risk of developing heart disease (with LDL cholesterol levels
between 100 and 129 mg/dL) should be offered statins - even if they
have no previous history of heart disease. Statin therapy also should
be recommended to very high risk patients, the panel said, even if
their LDL levels are as low as 70. NCEP declared that the
recommendations applied to both men and women, regardless of age.

The bottom line: NCEP was urging millions of Americans to go on
statins.

Not everyone agreed, recalls Merrill Goozner, editor of
"GoozNews," a top-drawer investigative healthcare blog. In 2004, a few
months after the new guidelines came out, a coalition of more than 30
academic physicians and researchers, inspired by Dr. John Abramson
(author of Overdosed America: The Broken Promises of American
Medicine), decided to write a letter to the National Heart Lung and
Blood Institute (NHLBI).

Goozner, who does research at the Center for Science in the Public
Interest, organized the group. The letter "outlined all the evidence,
which was there in published clinical trials for anyone who cared to
look," Goozner recalls, and concluded that while statins, "may lower
cholesterol in people at low risk and even many sub-groups at moderate
risk of a heart attack ... there was no evidence that the drugs
actually saved lives."

How could this be, if statins lower the risk of heart attack, at
least for some people? Preventing a heart attack does not necessarily
mean that a life is saved. In many statin studies that show lower
heart attack risk, the same number of patients end up dying, whether
they are taking statins or not. "You may have helped the heart, but
you haven't helped the patient," says Dr. Beatrice Golomb, an
associate professor of medicine at the University of California, San
Diego, and co-author of a 2004 editorial in The Journal of the
American College of Cardiology questioning the data on statins. "You
still have to look at the impact on the patient overall."

"The letter we sent to the NHLBI also called for an independent
panel to review the evidence," Goozner notes, "since the NHLBI panel
that made the recommendations had been dominated by physicians with
ties to statin manufacturers." Indeed, the National Institutes of
Health later admitted that eight of the nine experts on the panel had
received financing from one or more of the companies that make
statins. (None of the panelists had publicly disclosed their ties to
manufacturers when they made their recommendations.)

Just how much "financing" were the panelists receiving? According
to the LA Times, from 2001 to 2003 Dr Bryan Brewer, a leader at the
National Institutes of Health, and "part of the team that gave the
nation new cholesterol guidelines in 2004" had accepted "about
$114,000 in consulting fees from four companies making or developing
the cholesterol-lowering drugs.

But "this is relative peanuts compared to Dr P. Trey Sunderland
III, a senior psychiatric researcher at the NIH, who took $508,500 in
fees from Pfizer, Inc. whilst collaborating with them, and endorsing
their drug [Lipitor]," says Dr. Malcolm Kendrick, who is a member of
The International Network of Cholesterol Skeptics (THINCS) - a growing
group of scientists, physicians, other academicians and science
writers from various countries.

Dr. Abramson, who is a clinical instructor at Harvard Medical
School, charges that the study that accompanied the updated 2004
guidelines "knowingly misrepresented the results of the clinical
trials that they supposedly relied upon to formulate their
recommendations. The problem is that the experts claimed to rely on
scientific evidence, but they act as if empowered to ignore the
evidence when it is not consistent with their beliefs."

This is a serious allegation. Keep in mind that statins are the
most popular drugs in the history of human medicine. World-wide sales
totaled $33 billion in 2007. More than 18 million American now take
them.

Nevertheless, "medical research suggests that only about 40
percent to 50 percent of that number are likely to benefit," says
Abramson. "The other 8 or 9 million are exposed to the risks that come
with taking statins - which can include severe muscle pain, memory
loss, sexual dysfunction - and one study shows increased risk of
cancer in the elderly - but there are no studies to show that the
drugs will protect these patients against fatal heart attacks."

Abramson can cite many studies to support his claims. But first,
he stresses that statins can help some people.

"Statins show a clear benefit for one group," he says: "People
under 65 who have already had a heart attack or have diabetes. But
even in these very high risk people, about 22 have to be treated for 5
years for one to benefit."

What about middle-aged people who are not diabetic and have not
had a heart attack? A 2006 study published in the Annals of Internal
Medicine that focused on seven trials involving nearly 43,000
middle-aged adults concluded that statin use did not cut their chances
of dying from heart disease.

Is there any benefit for this group? "If they are high risk,
statins can be beneficial to people under 65 who haven't had a heart
attack, but 50 such men have to be treated for 5 years for one to
benefit." says Abramson. "The other 49 will not be helped. The problem
is that we can't know who is going to be the 50th man," he adds. And
all 50 will be exposed to the side effects.

Older adults have little to gain. The drugs don't help people over
70 even if they have elevated cholesterol levels, according to a
report in the Journal of American Cardiology.

Finally, "there is no evidence of any benefit for women who don't
already have heart disease or diabetes," says Abramson. According to a
2004 article published in the Journal of the American Medical
Association which reviewed all trials in which women with high
cholesterol had been randomly assigned to take a cholesterol-lowering
drug or a placebo, there was no evidence that statins prolonged
women's lives or cut their chances of dying of heart disease.

An editorial published in the Journal of the American College of
Cardiology came to the same conclusion - though there does seem to be
a risk that women on statins develop memory loss so severe that their
relatives may begin shopping for a nursing home.

Memory loss that can mimic Alzheimers is the second most common
side affect for people taking statins, right after muscle pain,
according to researchers at the University of California at San Diego.
For a number of years, they have been running a randomized controlled
trial examining the effects of statins on thinking, mood, behavior,
and quality of life. Separately, the UCSD researchers have been
collecting anecdotal experiences of patients, good and bad, on
statins.

"We have some compelling cases," Dr. Beatrice Golomb, the study's
lead researcher, told the Wall Street Journal. "In one of them, a San
Diego woman, Jane Brunzie, was so forgetful that her daughter was
investigating Alzheimer's care for her and refused to let her baby-sit
for her 9-year-old granddaughter. Then the mother stopped taking a
statin. 'Literally, within eight days, I was back to normal - it was
that dramatic,' said Mrs. Brunzie, 69 years old."

According to the Journal, "Doctors put her on different statins
three more times. 'They'd say, "Here, try these samples." Doctors
don't want to give up on it,' she said.' Within a few days of starting
another one, I'd start losing my words again,' added Mrs. Brunzie, who
has gone back to volunteering at the local elementary school she loves
and is trying to bring her cholesterol down with dietary changes
instead."

Returning to Goozner's story, did the letter his group wrote to
the NHLBI in 2004, spark public discussion about the new cholesterol
guidelines? No. "We released the letter to the press, but the
mainstream of the national press ignored us," Goozner recalls.

In 2008, Goozner is happy to see the statin controversy hit
Business Week's cover - though he can't help but wonder, "Where were
these guys three years ago? Now, call me a cynic, but why does my
perverted mind think to itself as I watch this coverage: Yeah, now we
hear, just when the world's best-selling drug [Lipitor] is about to go
off patent."

I suspect Goozer is right. It would have been much harder to
publish this story a few years ago.

But there also was a trigger that probably helped spur the
Business Week investigation. Last month, Merck -Schering/Plough
released a long-awaited study revealing that Vytorin, an expensive
combination of two drugs designed to lower cholesterol, brought no
added benefits for patients suffering from heart disease.

The two cholesterol-lowering drugs were Zocor, which is a statin,
and, Zetia, which is not. When combined, the two drugs did drive
cholesterol levels much lower. But the clinical trial offered no
evidence that the two cholesterol-busters were more effective in
reducing heart attacks than Zocor alone. This raises an obvious
question: is cutting cholesterol levels really the key to avoiding
heart attacks?

The results of the study helped buttress the strong suspicion that
insofar as statins like Zocor do help anyone with heart disease, the
beneficial effect has little to do with lowering cholesterol levels.

Meanwhile, Zocor is now available in a generic form that can be
purchased for less than $6 for a 30-day supply. By contrast, the new
combination, selling under the brand name Vytorin, was fetching more
than $100 for a 3 - day supply. In 2006, the drug brought in $1.5
billion with sales climbing 25% in the first half of 2007 to over $2
billion, according to IMS Health.

Naturally, Merck and Schering/Plough, who were marketing Vytorin
in a joint venture, were shy about reporting the results of the
clinical trials. It was only when they were threatened with a
Congressional investigation that they made the results public on
January 15 - more than a year and a half after the clinical trials
were completed.

The day after the drug-makers released the news, the American
Heart Association rushed to their defense, declaring that the study
was too limited to draw conclusions about Vytorin's ability to reduce
heart attacks or deaths compared to Zocor alone. The AHA advised
patients not to abruptly stop taking Vytorin without consulting with
the doctors who had prescribed it.

The New York Times, to its credit, was quick to respond, noting
that "what the [American Heart Association] did not note in its
statement ... was that the group receives nearly $2 million a year
from Merck/Schering-Plough Pharmaceuticals, the joint venture that
markets Vytorin.

When I return to the saga of the "Cholesterol Con," in the second
installment of this post, I am going take a closer look at the
American Heart Association - and others who stood to gain by
persuading Americans of the absolute link between high levels of
cholesterol and heart disease.

It is a story that begins long before Pfizer and other drug makers
invented statins. And it explains why so few American doctors stood up
and questioned the widespread use of drugs like Lipitor.

The belief that cholesterol causes heart disease wasn't just a
theory. It became a matter of faith, brought to us by a motley group
that included food companies advertising margarine and corn oil, the
American Heart Association, and doctors who joined the bandwagon. At
first the American Medical Association resisted - but soon it too
capitulated. Finally, when the American College of Cardiology signed
on, it became very difficult for physicians to speak out.

At that point, anyone who questioned the cholesterol connection
could easily be painted as "reckless" - a doctor willing to put
thousands of lives at risk by encouraging patients to question what
had become the Holy Grail of cardiac care.

More at: http://www.truthout.org/issues_06/022908HA.shtml

On Sun, 02 Mar 2008 20:41:41 GMT, "FOB"
wrote:

The Cholesterol Con - Where Were the Doctors?
By Maggie Mahar
Health Beat

*yellow journalism article snipped*

Wow! That was as whacked-out, biased, negative an article as I've
ever read in my life. All it does is spew innuendo and crap about
statins with absolutely nothing concrete to say whatsoever. It states
that statins don't work by lowering cholesterol, but gives no proof,
nor does it reveal how statins do in fact work if that is the case.
Someone has an agenda.

The author may very well change her mind after she has his first heart
attack. It sure changed mine; and now that my cholesteol and
triglycerides are both down to 117 thanks to diet, Lipitor and Tricor
(with absolutely no side effects that the moronic scare-mongers would
try to shock us with) , and my HDL/LDL ratio has tripled, I have a
much brighter prospect for a long life than I did 6 months ago. This
unsubstantiated negative crap refuting dozens of legitimate studies
with absolutely no facts, just innuendo, is dangerous and
irresponsible IMO.
---
Peter
270/227/180

FOB wrote:
Yes, this theme of poor research documenting the statins and cholesterol
lowering has been advocated numerous times recently.

There is growing evidence that the "Cholesterol Con" was real, and a
self induced intrepretation of poor statistics -- as well as "if it
isn't cholesterol, then what is it" lack of understanding of heart
disease which has marked much of the last half century and more.

If the medical community understands heart disease, why is there so much
of it and why is it not decreasing in rate of incidence?

We seem to have some technology to prolong life after the heart attack,
but there is little evidence to indicate that the rate of first heart
attack is in decline.

For Peter, you can read some of this same stuff in "Good Calories, Bad
Calories" (2007), "The Cholesterol Myths" (2000), "Cholesterol Con"
(2006), and "The Great Cholesterol Con" (2007), and a number of other
published works.



The Cholesterol Con - Where Were the Doctors?


By Maggie Mahar
Health Beat

Wednesday 20 February 2008

After the stock market bubble burst, the New York Times asked:
"Where were the analysts? Why didn't they warn us?"

To be perfectly honest, this was a somewhat disingenuous question.
As experienced financial journalists understood all too well, the
analysts plugging the high-flying issues of the 1990s were employed by
Wall Street firms raking in billions as investors bet their nest eggs
on one hot stock after another. It really wasn't in their employers'
interest for analysts to tell us that their products were wildly
over-priced. When a small investor wades into the financial world,
there are two words he needs to keep in mind: "caveat emptor."

But physicians, I firmly believe, are different from the folks
employed by Merrill Lynch. (I don't mean to knock people who work at
ML. I am simply saying that they have a very different job
description.) When consulting with your doctor, you should not have to
be wary. You are not a customer; you are a patient. And your physician
is a professional who has pledged to put your interests ahead of his
or her own.

This brings me to the question I ask in my headline: during the
many years of the Cholesterol Con - where were the doctors? When
everyone from the makers of Mazola Corn Oil to the Popes of Cardiology
assured us that virtually anyone could ward off heart disease by
lowering their cholesterol, why didn't more of our doctors raise an
eyebrow and warn us : "Actually, that's not what the research shows" ?

No doubt, you've heard about the recent Business Week cover story,
"Do Cholesterol Drugs Do Any Good?", which blew the lid off the theory
that "statins" - drugs like Lipitor, Crestor, Mevacor, Zocor and
Pravachol - can cut the odds that you will die of a heart attack by
slowing the production of cholesterol in your body and increasing the
liver's ability to remove L.D.L., or "bad cholesterol," from your
blood.

It's true that these drugs can help some people - but not nearly
as many as we have been told. Moreover, and this is the kicker, we
don't have any clear evidence that they work by lowering cholesterol.

Although medical research suggests that statins can definitely
benefit one group - men under 70 who already have had a heart attack -
researchers are no longer convinced that the drugs stave off a second
attack by lowering the patient's cholesterol. The drugs do lower
cholesterol, but that is not what helps the patient.

In other words, researchers are questioning the bedrock assumption
that high levels of "bad cholesterol" cause heart disease. "Higher LDL
levels do help set the stage for heart disease by contributing to the
buildup of plaque in arteries. But something else has to happen before
people get heart disease," Dr. Ronald M. Krauss, director of
atherosclerosis research at the Oakland Research Institute, told
Business Week. "When you look at patients with heart disease, their
cholesterol levels are not that [much] higher than those without heart
disease," he added. "Compare countries, for example. Spaniards have
LDL levels similar to Americans', but less than half the rate of heart
disease. The Swiss have even higher cholesterol levels, but their
rates of heart disease are also lower. Australian aborigines have low
cholesterol but high rates of heart disease."

"Current evidence supports ignoring LDL cholesterol altogether,"
Dr. Rodney A. Hayward, professor of internal medicine at the
University of Michigan, told Business Week's reporter.

In recent years, researchers have begun to suspect that statins
help patients, not by lowering cholesterol levels, but by reducing
inflammation. If this theory is right, "this seems likely to shunt
cholesterol reduction into a small corner of the overall picture of
heart disease," the Guardian reported four years ago.

And if the key to statins is that they reduce inflammation, it's
worth keeping in mind that this is what other effective heart
treatments like aspirin and the omega three fatty acids found in fish
oils, garlic and Vitamin E do - at a much lower cost and with far
fewer side effects.

But hold onto your hats, I still haven't gotten to what is most
shocking about the cholesterol story. What raises my blood pressure is
the knowledge that Business Week's scoop isn't really "new" news."
With all due respect to Business Week, which showed real courage in
putting the story on its cover, and to its author, John Carey, who did
a superb job of explaining the medical research, the truth is that
medical researchers have been questioning the theory that widespread
use of statins to lower cholesterol will save lives for many years.

You can find the research questioning the benefits of statins in
medical journals like Lancet (2001) and BMJ (2006), as well as in
reports from medical conferences ("Tales From the the Other Drug
Wars," 1999).

Occasionally, doubts popped up in the mainstream press and then
disappeared.

Five years ago, veteran healthcare blogger Matthew Holt pointed to
a BMJ article suggesting that statins might be no better than aspirin.
That same year, Holt raised pointed questions regarding the risk of
taking statins, including possible memory loss."

Nevertheless, the very next year, the National Cholesterol
Education Program at the U.S. National Heart, Lung and Blood Institute
issued new recommendations that drastically lowered the threshold for
statin therapy. According to its 2004 report, people at a moderately
high risk of developing heart disease (with LDL cholesterol levels
between 100 and 129 mg/dL) should be offered statins - even if they
have no previous history of heart disease. Statin therapy also should
be recommended to very high risk patients, the panel said, even if
their LDL levels are as low as 70. NCEP declared that the
recommendations applied to both men and women, regardless of age.

The bottom line: NCEP was urging millions of Americans to go on
statins.

Not everyone agreed, recalls Merrill Goozner, editor of
"GoozNews," a top-drawer investigative healthcare blog. In 2004, a few
months after the new guidelines came out, a coalition of more than 30
academic physicians and researchers, inspired by Dr. John Abramson
(author of Overdosed America: The Broken Promises of American
Medicine), decided to write a letter to the National Heart Lung and
Blood Institute (NHLBI).

Goozner, who does research at the Center for Science in the Public
Interest, organized the group. The letter "outlined all the evidence,
which was there in published clinical trials for anyone who cared to
look," Goozner recalls, and concluded that while statins, "may lower
cholesterol in people at low risk and even many sub-groups at moderate
risk of a heart attack ... there was no evidence that the drugs
actually saved lives."

How could this be, if statins lower the risk of heart attack, at
least for some people? Preventing a heart attack does not necessarily
mean that a life is saved. In many statin studies that show lower
heart attack risk, the same number of patients end up dying, whether
they are taking statins or not. "You may have helped the heart, but
you haven't helped the patient," says Dr. Beatrice Golomb, an
associate professor of medicine at the University of California, San
Diego, and co-author of a 2004 editorial in The Journal of the
American College of Cardiology questioning the data on statins. "You
still have to look at the impact on the patient overall."

"The letter we sent to the NHLBI also called for an independent
panel to review the evidence," Goozner notes, "since the NHLBI panel
that made the recommendations had been dominated by physicians with
ties to statin manufacturers." Indeed, the National Institutes of
Health later admitted that eight of the nine experts on the panel had
received financing from one or more of the companies that make
statins. (None of the panelists had publicly disclosed their ties to
manufacturers when they made their recommendations.)

Just how much "financing" were the panelists receiving? According
to the LA Times, from 2001 to 2003 Dr Bryan Brewer, a leader at the
National Institutes of Health, and "part of the team that gave the
nation new cholesterol guidelines in 2004" had accepted "about
$114,000 in consulting fees from four companies making or developing
the cholesterol-lowering drugs.

But "this is relative peanuts compared to Dr P. Trey Sunderland
III, a senior psychiatric researcher at the NIH, who took $508,500 in
fees from Pfizer, Inc. whilst collaborating with them, and endorsing
their drug [Lipitor]," says Dr. Malcolm Kendrick, who is a member of
The International Network of Cholesterol Skeptics (THINCS) - a growing
group of scientists, physicians, other academicians and science
writers from various countries.

Dr. Abramson, who is a clinical instructor at Harvard Medical
School, charges that the study that accompanied the updated 2004
guidelines "knowingly misrepresented the results of the clinical
trials that they supposedly relied upon to formulate their
recommendations. The problem is that the experts claimed to rely on
scientific evidence, but they act as if empowered to ignore the
evidence when it is not consistent with their beliefs."

This is a serious allegation. Keep in mind that statins are the
most popular drugs in the history of human medicine. World-wide sales
totaled $33 billion in 2007. More than 18 million American now take
them.

Nevertheless, "medical research suggests that only about 40
percent to 50 percent of that number are likely to benefit," says
Abramson. "The other 8 or 9 million are exposed to the risks that come
with taking statins - which can include severe muscle pain, memory
loss, sexual dysfunction - and one study shows increased risk of
cancer in the elderly - but there are no studies to show that the
drugs will protect these patients against fatal heart attacks."

Abramson can cite many studies to support his claims. But first,
he stresses that statins can help some people.

"Statins show a clear benefit for one group," he says: "People
under 65 who have already had a heart attack or have diabetes. But
even in these very high risk people, about 22 have to be treated for 5
years for one to benefit."

What about middle-aged people who are not diabetic and have not
had a heart attack? A 2006 study published in the Annals of Internal
Medicine that focused on seven trials involving nearly 43,000
middle-aged adults concluded that statin use did not cut their chances
of dying from heart disease.

Is there any benefit for this group? "If they are high risk,
statins can be beneficial to people under 65 who haven't had a heart
attack, but 50 such men have to be treated for 5 years for one to
benefit." says Abramson. "The other 49 will not be helped. The problem
is that we can't know who is going to be the 50th man," he adds. And
all 50 will be exposed to the side effects.

Older adults have little to gain. The drugs don't help people over
70 even if they have elevated cholesterol levels, according to a
report in the Journal of American Cardiology.

Finally, "there is no evidence of any benefit for women who don't
already have heart disease or diabetes," says Abramson. According to a
2004 article published in the Journal of the American Medical
Association which reviewed all trials in which women with high
cholesterol had been randomly assigned to take a cholesterol-lowering
drug or a placebo, there was no evidence that statins prolonged
women's lives or cut their chances of dying of heart disease.

An editorial published in the Journal of the American College of
Cardiology came to the same conclusion - though there does seem to be
a risk that women on statins develop memory loss so severe that their
relatives may begin shopping for a nursing home.

Memory loss that can mimic Alzheimers is the second most common
side affect for people taking statins, right after muscle pain,
according to researchers at the University of California at San Diego.
For a number of years, they have been running a randomized controlled
trial examining the effects of statins on thinking, mood, behavior,
and quality of life. Separately, the UCSD researchers have been
collecting anecdotal experiences of patients, good and bad, on
statins.

"We have some compelling cases," Dr. Beatrice Golomb, the study's
lead researcher, told the Wall Street Journal. "In one of them, a San
Diego woman, Jane Brunzie, was so forgetful that her daughter was
investigating Alzheimer's care for her and refused to let her baby-sit
for her 9-year-old granddaughter. Then the mother stopped taking a
statin. 'Literally, within eight days, I was back to normal - it was
that dramatic,' said Mrs. Brunzie, 69 years old."

According to the Journal, "Doctors put her on different statins
three more times. 'They'd say, "Here, try these samples." Doctors
don't want to give up on it,' she said.' Within a few days of starting
another one, I'd start losing my words again,' added Mrs. Brunzie, who
has gone back to volunteering at the local elementary school she loves
and is trying to bring her cholesterol down with dietary changes
instead."

Returning to Goozner's story, did the letter his group wrote to
the NHLBI in 2004, spark public discussion about the new cholesterol
guidelines? No. "We released the letter to the press, but the
mainstream of the national press ignored us," Goozner recalls.

In 2008, Goozner is happy to see the statin controversy hit
Business Week's cover - though he can't help but wonder, "Where were
these guys three years ago? Now, call me a cynic, but why does my
perverted mind think to itself as I watch this coverage: Yeah, now we
hear, just when the world's best-selling drug [Lipitor] is about to go
off patent."

I suspect Goozer is right. It would have been much harder to
publish this story a few years ago.

But there also was a trigger that probably helped spur the
Business Week investigation. Last month, Merck -Schering/Plough
released a long-awaited study revealing that Vytorin, an expensive
combination of two drugs designed to lower cholesterol, brought no
added benefits for patients suffering from heart disease.

The two cholesterol-lowering drugs were Zocor, which is a statin,
and, Zetia, which is not. When combined, the two drugs did drive
cholesterol levels much lower. But the clinical trial offered no
evidence that the two cholesterol-busters were more effective in
reducing heart attacks than Zocor alone. This raises an obvious
question: is cutting cholesterol levels really the key to avoiding
heart attacks?

The results of the study helped buttress the strong suspicion that
insofar as statins like Zocor do help anyone with heart disease, the
beneficial effect has little to do with lowering cholesterol levels.

Meanwhile, Zocor is now available in a generic form that can be
purchased for less than $6 for a 30-day supply. By contrast, the new
combination, selling under the brand name Vytorin, was fetching more
than $100 for a 3 - day supply. In 2006, the drug brought in $1.5
billion with sales climbing 25% in the first half of 2007 to over $2
billion, according to IMS Health.

Naturally, Merck and Schering/Plough, who were marketing Vytorin
in a joint venture, were shy about reporting the results of the
clinical trials. It was only when they were threatened with a
Congressional investigation that they made the results public on
January 15 - more than a year and a half after the clinical trials
were completed.

The day after the drug-makers released the news, the American
Heart Association rushed to their defense, declaring that the study
was too limited to draw conclusions about Vytorin's ability to reduce
heart attacks or deaths compared to Zocor alone. The AHA advised
patients not to abruptly stop taking Vytorin without consulting with
the doctors who had prescribed it.

The New York Times, to its credit, was quick to respond, noting
that "what the [American Heart Association] did not note in its
statement ... was that the group receives nearly $2 million a year
from Merck/Schering-Plough Pharmaceuticals, the joint venture that
markets Vytorin.

When I return to the saga of the "Cholesterol Con," in the second
installment of this post, I am going take a closer look at the
American Heart Association - and others who stood to gain by
persuading Americans of the absolute link between high levels of
cholesterol and heart disease.

It is a story that begins long before Pfizer and other drug makers
invented statins. And it explains why so few American doctors stood up
and questioned the widespread use of drugs like Lipitor.

The belief that cholesterol causes heart disease wasn't just a
theory. It became a matter of faith, brought to us by a motley group
that included food companies advertising margarine and corn oil, the
American Heart Association, and doctors who joined the bandwagon. At
first the American Medical Association resisted - but soon it too
capitulated. Finally, when the American College of Cardiology signed
on, it became very difficult for physicians to speak out.

At that point, anyone who questioned the cholesterol connection
could easily be painted as "reckless" - a doctor willing to put
thousands of lives at risk by encouraging patients to question what
had become the Holy Grail of cardiac care.

More at: http://www.truthout.org/issues_06/022908HA.shtml

And your one experience shows that cholesterol was the culprit how?

Marengo wrote:
|
| *yellow journalism article snipped*
|
| Wow! That was as whacked-out, biased, negative an article as I've
| ever read in my life. All it does is spew innuendo and crap about
| statins with absolutely nothing concrete to say whatsoever. It states
| that statins don't work by lowering cholesterol, but gives no proof,
| nor does it reveal how statins do in fact work if that is the case.
| Someone has an agenda.
|
| The author may very well change her mind after she has his first heart
| attack. It sure changed mine; and now that my cholesteol and
| triglycerides are both down to 117 thanks to diet, Lipitor and Tricor
| (with absolutely no side effects that the moronic scare-mongers would
| try to shock us with) , and my HDL/LDL ratio has tripled, I have a
| much brighter prospect for a long life than I did 6 months ago. This
| unsubstantiated negative crap refuting dozens of legitimate studies
| with absolutely no facts, just innuendo, is dangerous and
| irresponsible IMO.
| ---
| Peter
| 270/227/180

On Mar 4, 12:55 am, Marengo wrote:
On Sun, 02 Mar 2008 20:41:41 GMT, "FOB"
wrote:

The Cholesterol Con - Where Were the Doctors?
By Maggie Mahar
Health Beat

*yellow journalism article snipped*

Wow! That was as whacked-out, biased, negative an article as I've
ever read in my life. All it does is spew innuendo and crap about
statins with absolutely nothing concrete to say whatsoever. It states
that statins don't work by lowering cholesterol, but gives no proof,
nor does it reveal how statins do in fact work if that is the case.
Someone has an agenda.

The author may very well change her mind after she has his first heart
attack. It sure changed mine; and now that my cholesteol and
triglycerides are both down to 117 thanks to diet, Lipitor and Tricor
(with absolutely no side effects that the moronic scare-mongers would
try to shock us with) , and my HDL/LDL ratio has tripled, I have a
much brighter prospect for a long life than I did 6 months ago. This
unsubstantiated negative crap refuting dozens of legitimate studies
with absolutely no facts, just innuendo, is dangerous and
irresponsible IMO.

Dunno how I missed this one. Must have had something to do with
hookers in Bangalore ;-)

Peter,

Lemme get this straight.
You are a man (unless you're a woman named Peter, which must have
sucked in high school).
You have had a heart attack.
I am going to assume you are under 69.

Congratulations.

You are in the only group of people who actually get a demonstrated
life protective effect from the drug class known as statins. Everyone
else (women, men over 69 and men under 69 without a heart attack
on their jacket) doesn't get any protective effect from them, save
lower cholesterol. You've been around here long enough to know
that low cholesterol doesn't mean that much to total mortality.

Before I get dismissed as a yellow journalist, I'll kick it to my
buddy, the mostly respected Dr. Mike Eades, 1/2 of the team behind
Protein Power, which most people around here seem to like as getting
most of the science right.

http://www.proteinpower.com/drmike/s...st-on-statins/
with excerpt from:
http://www.thelancet.com/journals/la...ection=Comment


"We have pooled the data from all eight randomised trials that
compared statins with placebo in primary prevention populations at
increased risk. Unfortunately, our analysis is imperfect because
these trials are not solely primary prevention: 8·5% of patients
had occlusive vascular disease at baseline. We used two outcomes
to estimate overall benefit (benefit minus harm): total mortality and
total serious adverse events (SAEs). Total mortality was not reduced
by statins (relative risk 0·95, 95% CI 0·89-1·01). In the two trials
that
reported total SAEs, such events were not reduced by statins
(1·01, 0·97-1·05) (data on SAEs from the other trials were not
reported). The frequency of cardiovascular events, a less encompassing
outcome, was reduced by statins (relative risk 0·82, 0·77-0·87).
However, the absolute risk reduction of 1·5% is small and means that
67
people have to be treated for 5 years to prevent one such event.
Further
analysis revealed that the benefit might be limited to high-risk men
aged
30-69 years. Statins did not reduce total coronary heart disease
events
in 10,990 women in these primary prevention trials (relative risk
0·98,
0·85-1·12). Similarly, in 3239 men and women older than 69 years,
statins did not reduce total cardiovascular events (relative risk
0·94,
0·77-1·15)."

"Our analysis suggests that lipid-lowering statins should not be
prescribed for true primary prevention in women of any age or for
men older than 69 years. High-risk men aged 30-69 years should be
advised that about 50 patients need to be treated for 5 years to
prevent
one event. In our experience, many men presented with this evidence
do not choose to take a statin, especially when informed of the
potential
benefits of lifestyle modification on cardiovascular risk and overall
health.
This approach, based on the best available evidence in the appropriate
population, would lead to statins being used by a much smaller
proportion
of the overall population than recommended by any of the guidelines."

Quickly, for Tunderbar, before he shows up, the conflicts of interest
statement for the authors of the metastudy:
"JMW declares no conflict of interest. JA is an expert consultant to
plaintiffs' attorneys on litigation involving the drug industry,
including
Pfizer for its marketing of atorvastatin."

So, maybe JA is biased against statins. But still, that's a pretty big
finding, no?

Statins (considering side effects) are worse than no harm or break
even for everyone without a Y chromosome, and the same for most
people with one. You're in the group that does better, but it's not
a whole lot better with them.

And how do you actually know you are going to live longer? You
have suspicion because it's what the docs and the lipid hypothesists
tell you. Check out this fun curve:
http://www.health-heart.org/J-LIT_TC+LDLvsMortality.gif

Good luck with your statins. By your admission, you're on the left
side of both of those charts. Sorry. I don't like to bear bad news.

PS- This might be the ugliest web page I've ever seen:
http://www.health-heart.org/cholesterol.htm

On Tue, 04 Mar 2008 01:55:13 -0500, Marengo wrote:

On Sun, 02 Mar 2008 20:41:41 GMT, "FOB"
wrote:

The Cholesterol Con - Where Were the Doctors?
By Maggie Mahar
Health Beat

*yellow journalism article snipped*

Wow! That was as whacked-out, biased, negative an article as I've
ever read in my life. All it does is spew innuendo and crap about
statins with absolutely nothing concrete to say whatsoever. It states
that statins don't work by lowering cholesterol, but gives no proof,
nor does it reveal how statins do in fact work if that is the case.
Someone has an agenda.

Read this book: The great cholesterol con. It has all the data you
need. There's tons of data out there suggesting the the culprit isn't LDL.

The author may very well change her mind after she has his first heart
attack. It sure changed mine; and now that my cholesteol and
triglycerides are both down to 117 thanks to diet, Lipitor and Tricor
(with absolutely no side effects that the moronic scare-mongers would
try to shock us with) , and my HDL/LDL ratio has tripled, I have a
much brighter prospect for a long life than I did 6 months ago. This
unsubstantiated negative crap refuting dozens of legitimate studies
with absolutely no facts, just innuendo, is dangerous and
irresponsible IMO.
---
Peter
270/227/180



--
Using Opera's revolutionary e-mail client: http://www.opera.com/mail/

On Mar 5, 5:03 am, Bob wrote:
On Tue, 04 Mar 2008 01:55:13 -0500, Marengo wrote:
On Sun, 02 Mar 2008 20:41:41 GMT, "FOB"
wrote:

The Cholesterol Con - Where Were the Doctors?
By Maggie Mahar
Health Beat

*yellow journalism article snipped*

Wow! That was as whacked-out, biased, negative an article as I've
ever read in my life. All it does is spew innuendo and crap about
statins with absolutely nothing concrete to say whatsoever. It states
that statins don't work by lowering cholesterol, but gives no proof,
nor does it reveal how statins do in fact work if that is the case.
Someone has an agenda.

Read this book: The great cholesterol con. It has all the data you
need. There's tons of data out there suggesting the the culprit isn't LDL.

Which one? The Kendrick or the Colpo. I'd go for the Kendrick, but
the Colpo has value too. Both are extensively researched.

Marengo wrote:
On Sun, 02 Mar 2008 20:41:41 GMT, "FOB"
wrote:

The Cholesterol Con - Where Were the Doctors?
By Maggie Mahar
Health Beat

*yellow journalism article snipped*

Wow! That was as whacked-out, biased, negative an article as I've
ever read in my life. All it does is spew innuendo and crap about
statins with absolutely nothing concrete to say whatsoever. It states
that statins don't work by lowering cholesterol, but gives no proof,
nor does it reveal how statins do in fact work if that is the case.
Someone has an agenda.

The author may very well change her mind after she has his first heart
attack. It sure changed mine; and now that my cholesteol and
triglycerides are both down to 117 thanks to diet, Lipitor and Tricor
(with absolutely no side effects that the moronic scare-mongers would
try to shock us with) , and my HDL/LDL ratio has tripled, I have a
much brighter prospect for a long life than I did 6 months ago. This
unsubstantiated negative crap refuting dozens of legitimate studies
with absolutely no facts, just innuendo, is dangerous and
irresponsible IMO.
---
Peter
270/227/180

See Article: LDL Cholesterol: “Bad” Cholesterol, or Bad Science?
Journal of American Physicians and Surgeons

http://www.jpands.org/vol10no3/colpo.pdf