Comments

Tom, I would encourage you to look at the latest research that questions whether cholesterol, as an indicator of heart disease, is valid. Low cholesterol, in fact, is associated with higher incidence of "all cause" mortality then high, and as people age, high cholesterol actually lowers the risk of heart disease. The research bears this out, and is being willfully ignored by the drug companies.

There are a growing number of prominant scientists and medical researchers who are taking a careful look at the science upon which the medical establishement has proclaimed high cholesterol to be bad, and are finding that there are reasons to question the veracity. Here, for example, are two studies which refute the idea that high cholesterol has any effect on heart disease:

In this double-blind, randomized trial, there was no decrease in coronary heart disease from lowering saturated fat by half, and decreasing cholesterol from 207 to 175:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=2643423&query_hl=10&itool=pubmed_DocSum

In this study lowering fat intake and increasing the ratio of polyunsaturated fat to saturated fat did nothing for decreasing CHD:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=2571009&query_hl=12&itool=pubmed_docsu

Statins do cary significant risk. Much more risk than the drug companies would have us believe. There is a long-term study being conducted at the university of San Diego, cataloging the number and types of side effects associated with these drugs, and their early findings are worrisome.

If you haven't watched this Frontline episode, I encourage you to do so. You can see it online.

http://www.pbs.org/wgbh/pages/frontline/shows/prescription/

I too used to be on Lipitor until I started suffering odd episodes of memory loss, prompting me to investigate this arena. I made a decision based the information to take myself off of all statins. I don't know with 100% certainty whether this was the correct decision.

I do know, however, that we have no long-term studies on the effects of statins, nor do we even know with certainty what the correlation between cholesterol and heart disease is, and as I mentioned, there is stong evidence that suggests that cholesterol isn't the right indicator to hang our hats on. Until we have those answers, I consider statins dangerous.

Posted by Rick Ellis at August 9, 2006 3:34 PM

For me - Patients rule!!

Patients (you Tom as regards Lipitor) always know best - and patients can make judgements and weigh up risk - just look at how many people still smoke after all!

Posted by Trevor Gay at August 9, 2006 5:03 PM

I heard on the radio yesterday that Lipitor is the best-selling drug in the world. That strikes me as telling--either most of us can't control our cholesterol with diet (I struggle with it) or cholersterol isn't what we thought it was (per Rick Ellis above).

My father always says "In the old days, people usually died before all these diseases had a chance to kill them..."

Posted by Mike at August 10, 2006 7:14 AM

Trevor's (almost) right: "patients (should) rule" but I'm concerned with the ability or willingness of ALL patients to do so. Tom didn't outline his decision making process to begin taking Lipitor or to remain on it but I trust there was a level of critical judgement involved. Rick's decided against statins and the critical thinking he employed in making that decision, ultimately correct or not, is obvious. I'm troubled by what I believe is the vast majority of patients who employ zero sum thinking when their physician says "take this." Frankly, there's also more than a bit of concern that there are too many docs out there saying "okay" when their drug rep lays out a fancy spread for their staff and then says "recommend (read sell) this."

I'm thinking that the number of people still smoking--and, looking out my office window, more young people are starting--is not a matter of their weighing up the risks. I think it's a matter of blindly ignoring them. All this said, I don't have the answer but I'm concerned that while patients "should" rule, many/most don't have a handle on the responsibilities entailed.

Posted by Ed Di Gangi at August 10, 2006 7:47 AM

ACCOUNTABILITY!!!!

In my opinion: If we (patients) have to rely on our own knowledge (choice) of Lipitor, cholesterol, heart disease or any other ailment that might come our way, then you wouldn’t have time to read this blog. You would be in medical school working twelve jobs to pay for the cost of it. My question: Who do you trust? OR Who is willing to be accountable?

Posted by Frank J. Foti at August 10, 2006 9:06 AM

I'm very libertarian with regard to choice, but I agree with Frank that it's nearly impossible for a lay-person to sort through the data and make an educated choice. I would go so far as to say that the average doctor is probably incapable too.

I consider myself to be reasonably intelligent, and yet after months of reading everything I could get my hands on I was left with more questions then answers. When I spoke at length with my doctor on these issues, sadly I had acquired more information on the subject of statins and cholesterol then he had.

So while I agree with the basic premise that we should have the right to make our own choices, in the realm of medicine, it's not so easy.

Posted by Rick Ellis at August 10, 2006 2:01 PM

Hi Ed - you are right of course that all patients don’t know all the answers all the time. However, in my 35 years healthcare experience listening to patients and their families I am constantly surprised by how much patients do know. The best outcomes of course always happen when there is an honest and up front true partnership between Doc and Patient – no doubt. One of my best friends is a Vascular Surgeon and he loves it when patients come to consultations armed with the latest Google search information because he recognises their motivation. More importantly it means he has to be one step ahead of the patient in terms of his own professional development so that he can justify the large salary he is paid. Otherwise why do we bother to pay him more than a nurse? – What does he bring to the table that Google doesn’t is another way of looking at it. What added value is the Consultant bringing? One of the greatest myths is that professionals know best. Professionals know a lot but I am sorry that simply does not mean they know best. One of the chapters in my book is 'Ten Great Myths of Patient Involvement' – happy to share it – just let me know if you want a copy Ed :-)

Posted by Trevor Gay at August 10, 2006 6:36 PM