Drug Companies Lie To Sell Drugs

[casebro]

But the critical thing about Statins is that their advantage cones about via growth facotr, not LDL changes. As show by other drugs that lower LDL and do not benefit hearts.

[blutoski]

Originally Posted by Skeptical Greg

98.1% Of subjects taking the statin did not have a CV event, but neither did 97% of the subjects taking the placebo.

How much of such a small number might be accounted for by other co-founders.
Maybe the placebo group ate more fried chicken, or maybe they smoked more.

Ideally, such factors would have been filtered out.

I will see if I can find the details on the actual study.

Probably the ASCOT study. Pubmed: [ASCOT-LLA]

There was a follow up, [The Anglo-Scandinavian Cardiac Outcomes Trial: 11-year mortality follow-up of the lipid-lowering arm in the U.K.]

[blutoski]

Originally Posted by blutoski

Probably the ASCOT study. Pubmed: [ASCOT-LLA]

There was a follow up, [The Anglo-Scandinavian Cardiac Outcomes Trial: 11-year mortality follow-up of the lipid-lowering arm in the U.K.]

casebro's point is valid: we are at a stage for atorvastatin similar to where Jenner was when he confirmed vacaccination provided protection from smallpox. He didn't know exactly how it worked, but the studies show it did.

What Diamond's doing is what I call the French Philosopher's Disease: "Sure it works in the real world, but I don't understand how it works on paper, so I'm going to make a youtube video saying it doesn't actually work in the real world."

[blutoski]

Originally Posted by Skeptical Greg

98.1% Of subjects taking the statin did not have a CV event, but neither did 97% of the subjects taking the placebo.

How much of such a small number might be accounted for by other co-founders.
Maybe the placebo group ate more fried chicken, or maybe they smoked more.

Ideally, such factors would have been filtered out.

I will see if I can find the details on the actual study.

To put the numbers in context, if this was the ASCOT study, the timeframe was two years. If we extrapolate to lifetime benefits, let's say 30 years, the number of incidents would multiply by roughly 15, so instead of 3% placebo arm deaths we'd have 45%, the atorvastatin arm would be a third less at 30%. These numbers compare to the protection the population gets from not smoking vs smoking. It's potentially a big deal, but we don't have any studies performed this long to verify, my numbers are just back-of-the-envelope for illustrative purposes.

As mentioned in an above post, we're not sure how atorvastatin is protective. Diamond's hyperfocused on the lipid hypothesis (his rants seem to have originated from an outrage over health insurance pricing related to his cholesterol level, so he's on a mission to prove the lipid hypothesis wrong), and missing the other probable mechanisms, specifically there's a good case that the primary mechanism of protection is antiinflammatory.

[Skeptical Greg]

In which case, it would make more sense to address the cause of the inflammation..

Diet?

[blutoski]

Originally Posted by Skeptical Greg

In which case, it would make more sense to address the cause of the inflammation..

Diet?

Age, for most of us. Genetics prevails. There are dietary suspects, but once the damage is done there's no known reversal.

(ref above, my undergrad is MBI, my primary focus was immune system, my masters was specifically research into how the immune system adapts/fails with exposure to HIV, but there is a lot of general knowledge; my second research project was lupus, which is an immune system glitch due to genetics)

[blutoski]

Originally Posted by blutoski

Age, for most of us. Genetics prevails. There are dietary suspects, but once the damage is done there's no known reversal.

(ref above, my undergrad is MBI, my primary focus was immune system, my masters was specifically research into how the immune system adapts/fails with exposure to HIV, but there is a lot of general knowledge; my second research project was lupus, which is an immune system glitch due to genetics)

ETA: also, the immune connection with statins' benefit is unproven at this time.
It would be too early to advocate a hypothetical treatment when statins are demonstrated to work.

[casebro]

I suspect that the data exists to tell which DNA variant is helped by Statins. Which will explain how Statins actually work. But don't expect Big Pharma to tell us that 60% of us shouldn't by their chemical.

Inflammation is a good candidate, via IRS-1 or another hormone receptor gene. Seems a known fact that statins lower insulin resistance, also raise IGF-1 levels. That, wah-lah, might be the answer.

[Skeptical Greg]

Originally Posted by blutoski

Age, for most of us. Genetics prevails. There are dietary suspects, but once the damage is done there's no known reversal.

(ref above, my undergrad is MBI, my primary focus was immune system, my masters was specifically research into how the immune system adapts/fails with exposure to HIV, but there is a lot of general knowledge; my second research project was lupus, which is an immune system glitch due to genetics)

Diet and othe4r lifestyle changes can definitely limit increases in risk factors and longevity..

[Skeptical Greg]

Blutoski:

I would seriously be interested in an educated opinion of my post above...

If you feel it would be inappropriate, I would be fine with that, also.

[blutoski]

Originally Posted by Skeptical Greg

Blutoski:

I would seriously be interested in an educated opinion of my post above...

If you feel it would be inappropriate, I would be fine with that, also.

Basically. It's one thing to discuss research, in this case the accuracy of how a company describes results from a specific study; it's another to give medical advice.

[casebro]

Originally Posted by Skeptical Greg

Blutoski:

I would seriously be interested in an educated opinion of my post above...

If you feel it would be inappropriate, I would be fine with that, also.

I'm only studying on the net to become an amateur Gynecologist, but I'll give an opinion. And I don't even need no history or tests.

Most people do not die of heart problems. It looks to me that you are one of those.

[Skeptical Greg]

Originally Posted by blutoski

Basically. It's one thing to discuss research, in this case the accuracy of how a company describes results from a specific study; it's another to give medical advice.

Does an educated opinion necessarily have to be advice?

Don't take this as contentious, but my question came from what I feel was " an argument from authority " on your part..

Quote:

I get it, and I have my own opinions on the topic (My MSc is Research Medicine, my wife is an MD who does medical research - evaluating medical research is what passes as dinner conversation at our house).

How do medically trained people make the decision to prescribe cholesterol lowering drugs, other than some arbitrary and often misleading numbers. Calculated LDL ( LDL-c ) is very arbitrary, and the only possible criteria she may have had.

" Your LDLc is higher than guidelines. We need to lower it. "

MY PCP was oblivious to scientifically sound information that suggested I am not a good ( have nothing to gain, other than possible serious side effects ) candidate for statin therapy..

[casebro]

Here's a bit of info re: the different functionality between Insulin, and Insulin like Growth Factor, IGF. Keep in mind that the IRS-1 ( Insulin Receptor Substrate) gene defect lowers the amount of IGF in your system- same substrate used for both the insulkin receptor and the growth hormone receptor, which kicks off the production of IGF.

Quote:

https://www.ncbi.nlm.nih.gov/pubmed/11606465:

Thirty genes, 27 of which were not previously known to be IGF-1 responsive, were up-regulated by IGF-1 but not by insulin. Nine genes, none of which was previously known to be insulin responsive, were up-regulated by insulin but not by IGF-1.

So the fact that you have Diabetes (and obesity) means LOTS of health problems are in common, but probably NOT caused by the high sugars.

[Skeptical Greg]

What do you mean by " high sugars "? High blood sugar?
A diet that is high in sugar will definitely drive all kinds of health issues.

[casebro]

Originally Posted by Skeptical Greg

What do you mean by " high sugars "? High blood sugar?
A diet that is high in sugar will definitely drive all kinds of health issues.

We are talking diabetes and insulin resistance, so yeah, blood sugar levels.

And what I am saying is that high BS may not be the driver of morbidity that we have been taught. Hyperinsilinemia and low IGF are the drivers of much of the Diabetic morbidity.

IGF injections have been used to treat the hyperinsulinemia. I may try some to treat my leg muscles that have been bad since childhood. (Insulin resistance is life long, the diabetes symptom starts later) My endogenous IGF level is only tenth percentile.

To get the IGF, I think I can go to the muscle man gym, and hang put in the locker room, wait for some one to ask if I want to speed up the body building process. The steroids they use are IGF. Try it a couple weeks, see if my legs are capable of tap dancing- and want to.

[Skeptical Greg]

The fact remains, in most cases, a low carb diet will reverse type 2 diabetes..

[casebro]

Originally Posted by Skeptical Greg

The fact remains, in most cases, a low carb diet will reverse type 2 diabetes..

Let me say this slowly: DIABETES IS ONLY THE SUGARS.

The patient still has the insulin resistance, the cause of so many of the side effects that get blamed on the sugars.

You are not believing me, do your own search <pseudo acromegaly>

But here is a partial list of my symptoms, things I have heard the docs say "we see a lot of that among diabetics" :

Trigger finger
Carpal tunnel
tendonitis
ruptured discs
skin tags
colon polyps
clogged arteries
calcifications
lucent lesions (bones)
Mayalgia
Scalloped cervical bones
pseudo foramen (looks like I drilled a hole in my thumb bone)
Peripheral neuropathy.

ad on nearly infinitum, I had a list of 45. ALL are listed as possible symptoms of Acromegaly, in spite of patients having normal sugars. Acromegaly, a messed up hormone system- like hyper insulinism, is caused by too much IGF. Too much insulin acts like-.... too much IGF.

And some of my symptoms have been since childhood, I didn't turn obese and diabetic until my 20s. I know, diet and exercise will push diabetes into remission, but I still won't be able to snap my fingers or do the cub scout salute. Or feel my fingers and toes. (nerve sheath overgrowth, like artery lining overgrowth, cuts down circulation)

eta: In fact, being a diabetic, studies show that it's OK to allow sugars to run twice as high as normals. Because? trying for normal doesn't do much at all for preventing the side effects. Not even enough to pay for the extra drugs. Look up UKPDS, United Kingdom Prospective Diabetes Study.

[Skeptical Greg]

0h, I believe you.

I am talking mainly about type 2... lots of sugar creates the insulin resistance, and things like fatty liver disease.. Surprise! It's not dietary fat that does that.
Most of the items in your list can be attributed to nutritional deficiencies and/or excesses..

[casebro]

Originally Posted by Skeptical Greg

0h, I believe you.

I am talking mainly about type 2... lots of sugar creates the insulin resistance, and things like fatty liver disease.. Surprise! It's not dietary fat that does that.
Most of the items in your list can be attributed to nutritional deficiencies and/or excesses..

Are you assuming I am T1? Nope, it's my T2 that is tied inextricably to insulin resistance.

T1 is an auto-immune problem- your immune system attacks the insulin making beta cells in the pancreas. So you don't make insulin. It's only about 5% of diabetics. But guess what- the IRS gene defects are so common, T1 folks get all them disease symptoms too. Which adds to the confugalty of whether it's the high sugars or the high insulin that causes all those symptoms.

[blutoski]

Originally Posted by Skeptical Greg

Does an educated opinion necessarily have to be advice?

No, but on this forum, there's been an informal practice to not give opinions about specific cases when it's about a real person's medical diagnosis or prescription. There's no rule, and many members are happy to dispense medical advice all day, for example, the members in MLMs selling dietary supplements, but I personally prefer to fall on the side of caution.

Originally Posted by Skeptical Greg

Don't take this as contentious, but my question came from what I feel was " an argument from authority " on your part..

It was, and that's not necessarily a bad thing, despite what pseudoskeptics hide behind. The fallacy is 'argument from invalid authority' (eg: we should listen to her opinions on vaccines because she's a famous actress).

In contrast ("This is a heart disease topic, we should listen to the expert in heart disease") is not an example of argument from invalid authority fallacy, it is in fact a good argument.

Originally Posted by Skeptical Greg

How do medically trained people make the decision to prescribe cholesterol lowering drugs, other than some arbitrary and often misleading numbers. Calculated LDL ( LDL-c ) is very arbitrary, and the only possible criteria she may have had.

" Your LDLc is higher than guidelines. We need to lower it. "

MY PCP was oblivious to scientifically sound information that suggested I am not a good ( have nothing to gain, other than possible serious side effects ) candidate for statin therapy..

The answer depends on the guidelines communicated to MDs by their respective College in their region. As mentioned above, the drugs have long been demonstrated to work independently of their cholesterol reducing capacity, so many regions want GPs to consider multiple risk factors such as family history, current BMI, age, &c.

[casebro]

Originally Posted by blutoski

The answer depends on the guidelines communicated to MDs by their respective College in their region. As mentioned above, the drugs have long been demonstrated to work independently of their cholesterol reducing capacity, so many regions want GPs to consider multiple risk factors such as family history, current BMI, age, &c.

I just got back form my diabetes nurse/educator. She doen't even want to test some lipids nowadays. Though they are included in the risk calculations, along with age, sex,race, smoker, some more items. My risk score for a heart attack in the next ten years is 33%. I'm a 65yo diabetic, I didn't think 33% is half bad.

eta:, Hmmm, life expectancy of 75, ten years from now, 40% of us die of heart attacks, looks to me that I am beating the numbers. But that just means that I'll die of cancer, ;like all of my brothers (2).

[casebro]

It's not the glucose level (diabetes), nor the obesity, it's the insulin resistance

Quote:

https://academic.oup.com/jcem/article/83/8/2773/2660508

In conclusion, approximately one of every five healthy, nonobese subjects in the most insulin-resistant tertile, followed for approximately 5 yr, had a serious clinical event. These data highlight the importance of insulin resistance as a predictor of CVD.

[blutoski]

Originally Posted by casebro

I just got back form my diabetes nurse/educator. She doen't even want to test some lipids nowadays. Though they are included in the risk calculations, along with age, sex,race, smoker, some more items. My risk score for a heart attack in the next ten years is 33%. I'm a 65yo diabetic, I didn't think 33% is half bad.

SG's personal inventory included having had smoked in the past, which according to Health Canada's website is actually up there as a risk factor with high lipid scores, obesity, and sedentary lifestyle. Lower than current smoker, but the risk seems to stay pretty high even after quitting. However, that's Health Canada's calculator. US regions may estimate risk differently and ask their GPs to act accordingly.

Originally Posted by casebro

eta:, Hmmm, life expectancy of 75, ten years from now, 40% of us die of heart attacks, looks to me that I am beating the numbers. But that just means that I'll die of cancer, ;like all of my brothers (2).

This is where I frustrate the risk analyzers: my parents both died in their 20s from situations that had nothing to do with chronic illness, so my risk level is unknown, and many calculators don't have the ability to incorporate that.

[Skeptical Greg]

If my lungs and arteries are all clear, what is the likelihood that my having last smoked over thirty years ago, actually a risk factor for me now?

Also as I mentioned above, my Cardiac CT calcium score is zero.. This indicates a risk of CVD at less than 5%..

My PCP is apparently using a risk calculator that does not include either of these factors..

The best calculator would include her own judgement which she seems to be reluctant to use..

[casebro]

Originally Posted by Skeptical Greg

The best calculator would include her own judgement which she seems to be reluctant to use..

And you wonder why I champion Genetics. It'll be the only consideration towards individualized medicine. Or I guess the "new speak" name is "Precision Medicine".

[casebro]

Quote:

http://citeseerx.ist.psu.edu/viewdoc...=rep1&type=pdf

RESEARCH DESIGN AND METHODS
— A total of 4,483 subjects aged 35–70 years
participating in a large family study of type 2 diabetes in Finland and Sweden (the Botnia study)
were included in the analysis of cardiovascular risk associated with the metabolic syndrome.
In subjects who had type 2 diabetes (n
1,697), impaired fasting glucose (IFG)/impaired
glucose
tolerance (IGT) (n 798), or insulin-resistance with normal glucose tolerance (NGT)
(n 1,988),

Looks like 'Insulin Resistance without Diabetes' is more common than T2D. And has a Relative risk of heart troubles of 1.7 the "normals", or 80% as bad as diabetes. (table 4)

It's the IR that kills us.

[casebro]

Nuther one:

Quote:

http://care.diabetesjournals.org/content/33/6/1179

CONCLUSIONS HOMA-IR is associated with all-cause mortality in the nondiabetic U.S. population but only among persons with normal BMI.

IR is genetic, NOT caused by obesity. Quite the reverse.

[casebro]

Originally Posted by casebro

Nuther one:

IR is genetic, NOT caused by obesity. Quite the reverse.

From that paper " Using a mathematical simulation model, Eddy et al. (9) recently estimated that insulin resistance was responsible for 42% of myocardial infarctions in the U.S. and was the most important single cause of coronary artery disease."

[casebro]

Originally Posted by casebro

I suspect that the data exists to tell which DNA variant is helped by Statins. Which will explain how Statins actually work. But don't expect Big Pharma to tell us that 60% of us shouldn't by their chemical.

Inflammation is a good candidate, via IRS-1 or another hormone receptor gene. Seems a known fact that statins lower insulin resistance, also raise IGF-1 levels. That, wah-lah, might be the answer.

Originally Posted by casebro

But the critical thing about Statins is that their advantage cones about via growth facotr, not LDL changes. As shown by other drugs that lower LDL and do not benefit hearts.

Originally Posted by casebro

From that paper " Using a mathematical simulation model, Eddy et al. (9) recently estimated that insulin resistance was responsible for 42% of myocardial infarctions in the U.S. and was the most important single cause of coronary artery disease."

Building on my previous reading, I see that the IRS-1 gene (insulin resistance gene) also directly causes hypertension by interfering with a PPAR enzyme in the PI3 system. And guess what- Statins are PPAR ummm ligands or substrates or inhibitors, whatever... So it looks like the actual benefits of Statins are probably NOT from lowering cholesterol, but from boosting endogenous output of NOx in the endothelial cell lining the arteires, which relaxes arteries and lowers blood pressure.

Google points to papers looking into it circa 2004-2013, and a Cochrane review, but I couldn't find the Cochrane report.

eta: here's one https://www.ncbi.nlm.nih.gov/pubmed/20129921 " Does peroxisome proliferator-activated receptor-gamma (PPAR gamma) protect from hypertension directly through effects in the vasculature? "

[casebro]

A little closer to the OP subject:

And another data-bit today, sorry no link, was a Cochrane review looking at the efficacy of Statins: For every 1,000 people treated for 5 years, 18 heart attacks are postponed. They used the word "prevented" but I think it really means 'postponed beyond the five year mark'.

Ok. done with my flurry for today.

[Skeptical Greg]

WTF? That could mean 982 people out of a thousand had heart attacks!

Do you have a link to the study?

[casebro]

Time to re-open this thread, Iwas atmy dibetes nurse/educator to day. She recommended I start Zetia to lower my cholesterol.

Quote:

https://www.wikijournalclub.org/wiki/IMPROVE-IT : Published in 2015, the IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) randomized 18,144 patients with ACS to simvastatin 40 mg/d plus ezetimibe 10 mg/d or simvastatin alone. With median follow-up of 6 years, simvastatin+ezetimibe was found to reduce the primary outcome of CV mortality, major CV event, or nonfatal stroke (34.7% vs. 32.7%; P=0.016; NNT 50). There was no reduction in all-cause or CV mortality with simvastatin+ezetimibe, though there was a reduction in MI and stroke.

Hey look, a comparison of actual rates, not a rate-of-a-rate !!!

Numbers were mentioned in other cites/sites. The 34.7 vs 32.7 works out to the 18/1000 mentioned somewhere upthread. Or, 1.8 per hundred, or 2% OVER SIX YEARS. Or, I guess I'll not bother taking it. No improvement in total end points. But that 2% was in strokes? So it must have raised some other endpoints? (end points include not only deaths, but also hospitalizations for artery disease, bypasses, stents...)

And she mentioned my risk of having a heart attack has gone up from 33% in ten years to 44%. I asked wahh? She said because I got a year older. Hmm, I wonder how to prevent THAT?

But I will be doubling up on one of the 6 BP meds I take. Stroke, kidney disease prevention. But I do want to find a graph of Pressure vs "End points", I'm sure it's a curve, though they act like it's a spike at 130.

[Skeptical Greg]

Big surprise, the longer you live with heart disease, the more likely you are to die from it sometime in the future. However, this has nothing to do with statin therapy reducing the risk of heart disease. Ask the Dr how much the statin therapy will drive down that 44% risk.
It will be ' 0 ', because the risk formula doesn't include statin therapy.

Why not?

There are many studies that show that lowering cholesterol is of little benefit for CVD, but causes increased risk for dementia, T2D and Rhabdomyolysis to name a few..

Here is one study:

Statins: No benefit as primary prevention in elderly

Quote:

The primary outcome, all-cause mortality, was slightly higher in the statin group. For patients aged 65-74 years, there were 141 deaths with pravastatin vs. 130 with usual care, for a hazard ratio of 1.08, and for those aged 75 and older, there were 92 deaths with pravastatin vs. 65 with usual care, for an HR of 1.34. This represents a nonsignificant trend toward increased mortality with statin therapy. The results were similar, with pravastatin providing no significant benefit, regarding coronary heart disease, stroke, heart failure, and cancer events.

Note how the relative risk is portrayed as insignificant in this study, whereas a much lower relative risk was touted as miraculous in the drug sponsored study in the OP..