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Old 31st May 2018, 11:21 PM   #41
Planigale
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Originally Posted by casebro View Post
But after the DBPC study, isn't there a feedback from actual practicing clinicians? Though I don't think it is as easy as say "Yup, the rash is gone". It would have taken a decade to see an actual effect for Statins.

I chose to use an HMO because I felt they would be more evidence based, they won't do stuff just to make more money. They will do stuff that is proven to save them money in the long run. They still push statins, so they must have some efficacy. And I say they know EXACTLY the efficacy in a clinical setting. And if it was better efficacy than the Big Pharm DBPC studies showed, they would all be trumpeting it from the roof of the Big Pharma Ass Headquarters building. So it must be less efficient than the DBPC's show. And that info is file-drawered- by BP for profit sake, and by the HMO because they don't want us to stop taking it, even if it only shows a 2% benefit.

So what do they call that type of clinical tally? Does the FDA do it? It's the kind of tally that gets drugs taken off the market because of side effects that show up in the huge number of subjects in actual practice. An NSAID? Celebrex? A diabetes med, Actos? You've all heard of Black Box Warnings. They ae usually added after downsides show up in clinical practice. Do they not keep track of actual up-sides?
I do not know the US legislation. In Europe companies can only use certain types of information (those they have submitted to licensing authorities) in marketing their drugs. The licensing authorities insist on RCT.

It is hard to measure the impact of a drug once it is in use as you do not know what would have happened without it. One study identified nocebo effect for statins side effects increased once people knew they were on the drug as compared with when they thought they were on a placebo.

Overall there has ben a dramatic fall in acute heart attacks.
e.g. https://academic.oup.com/ehjqcco/article/1/2/72/2367136
probably due to better preventative drug treatment. As people are in general more obese.
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Old 31st May 2018, 11:40 PM   #42
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Originally Posted by shemp View Post
So, if the drop was from 1% to 0%, it would still be a 1% drop? No, it would be a 100% drop. Their math is correct.

Let's say that 2000 people are in the study, 1000 taking Lipitor and 1000 taking a placebo. With a placebo, 3% of 1000 (30) have a heart attack. With Lipitor, 2% of 1000 (20) have a heart attack. The drop from 30 to 20 is a 33% drop, not 1%.

I'm no friend of drug companies, and they do lie to sell drugs, but I really hate innumeracy. You're barking up the wrong tree.
This. The highlighted bit makes it particularly clear.
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Old 1st June 2018, 06:48 AM   #43
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In this case, the 100% drop is trivial , meaningless and no good reason to take a drug with possible dangerous side effects..
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Old 1st June 2018, 08:41 AM   #44
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Originally Posted by Planigale View Post
It is hard to measure the impact of a drug once it is in use as you do not know what would have happened without it. One study identified nocebo effect for statins side effects increased once people knew they were on the drug as compared with when they thought they were on a placebo.
But the side effects are not my point. Regardless of side effects, the good benefit of treatment will show. But wht you are saying is that, in clinical use, the Big Pharma studies are non-falsifiable. But I am a clinical patient, not a study patient.

Originally Posted by Planigale View Post
Overall there has ben a dramatic fall in acute heart attacks.
e.g. https://academic.oup.com/ehjqcco/article/1/2/72/2367136
probably due to better preventative drug treatment. As people are in general more obese.
And smoking is down 60%, and trans fats are down a while lump too. I don't hink we can credti Statins with that whole fall.
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Old 1st June 2018, 09:17 AM   #45
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Originally Posted by casebro View Post
And smoking is down 60%, and trans fats are down a while lump too. I don't hink we can credti Statins with that whole fall.

I would add: prescribing exercise and dieting both to prevent heart attacks but also for recovering patients. Other kinds of treatment: balloon angioplasty seems to lower the risk of new heart attacks considerably.
Statins probably play a minor role in all of this.

(Can anybody tell me why Ben Goldacre's Do Statins Work? won't be available for Kindle from amazon.com until 2019? You can get it at amazon.co.uk, but I can't because I live in Denmark.)
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Old 1st June 2018, 01:12 PM   #46
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Originally Posted by dann View Post
(Can anybody tell me why Ben Goldacre's Do Statins Work? won't be available for Kindle from amazon.com until 2019? You can get it at amazon.co.uk, but I can't because I live in Denmark.)
Publication date appears to be Jan 2019. You can pre-order it on amazon.co.uk, but you won't get it until next year in the UK either.
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Old 1st June 2018, 01:16 PM   #47
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Originally Posted by dann View Post
(Can anybody tell me why Ben Goldacre's Do Statins Work? won't be available for Kindle from amazon.com until 2019? You can get it at amazon.co.uk, but I can't because I live in Denmark.)
Publication date iappears to be Jan 2019. You can pre-order it on amazon.co.uk, but you won't get it until next year in the UK either.

ETA: sorry, that's the Kindle edition. The hardback was published inJan 2017 (but is out of stock) and the paperback is out in July.
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Old 1st June 2018, 01:33 PM   #48
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Thank you!
I my version it just says: "Kindle titles are available for US customers on Amazon.com."
Apparently Danish customers are considered to be US customers.
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Old 1st June 2018, 03:32 PM   #49
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Originally Posted by Skeptical Greg View Post
In this case, the 100% drop is trivial , meaningless and no good reason to take a drug with possible dangerous side effects..
Well, if you don't know your initial risk, a percentage drop is pretty meaningless.

Which might actually be an argument to use the language suggested by the OP, I guess.
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Old 2nd June 2018, 12:27 AM   #50
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Interesting article:

Quote:
Those who challenge the cholesterol hypothesis are accused of ‘cherry-picking’ the data. Ironically, pro-statin researchers themselves are the ones who are guilty of cherry-picking. A recent article in The Lancet, published in 2016, purported to end the statin debate, ostensibly to silence dissenting views. Yet, despite billions invested in developing medicines to reduce LDL-C drastically, there remains no consistent evidence for clinical benefit with respect to either events or mortality.
For instance, there are 44 randomised controlled trials (RCTs) of drug or dietary interventions to lower LDL-C in the primary and secondary prevention literature, which show no benefit on mortality. Most of these trials did not reduce CVD events and several reported substantial harm. Yet, these studies have not received much publicity.
The cholesterol and calorie hypotheses are both dead — it is time to focus on the real culprit: insulin resistance (The Pharmaceutical Journal, Jul. 14, 2017)
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Old 2nd June 2018, 05:27 AM   #51
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Originally Posted by dann View Post
Interesting article:
I'll drink to that!
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Old 2nd June 2018, 05:51 AM   #52
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Originally Posted by dann View Post
I would add: prescribing exercise and dieting both to prevent heart attacks but also for recovering patients. Other kinds of treatment: balloon angioplasty seems to lower the risk of new heart attacks considerably.
Statins probably play a minor role in all of this.

(Can anybody tell me why Ben Goldacre's Do Statins Work? won't be available for Kindle from amazon.com until 2019? You can get it at amazon.co.uk, but I can't because I live in Denmark.)
Interesting that you are skeptical about drugs but accept a procedure for which there is far less evidence. There is no evidence that angioplasty is better than drugs for reducing risk of future heart attacks.
https://www.bmj.com/content/348/bmj.g3859
(This is not true for coronary artery grafts, or drug eluting stents the former is definitely better the latter probably better than drugs).

Remember most people getting intervention will be given statins to take afterwards.
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Old 2nd June 2018, 06:31 AM   #53
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Originally Posted by dann View Post
Interesting article:
I mentioned earlier :

Statins: No benefit as primary prevention in elderly.

I have seen studies that show all cause mortality is lower in elderly individuals with elevated LDL ..

Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study.


I love this:

INTERPRETATION:

Quote:
We have been unable to explain our results.
Really?

Why do the results seem obvious to me?
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Old 2nd June 2018, 08:24 AM   #54
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Originally Posted by Planigale View Post
Interesting that you are skeptical about drugs but accept a procedure for which there is far less evidence. There is no evidence that angioplasty is better than drugs for reducing risk of future heart attacks.
https://www.bmj.com/content/348/bmj.g3859
(This is not true for coronary artery grafts, or drug eluting stents the former is definitely better the latter probably better than drugs).

Remember most people getting intervention will be given statins to take afterwards.

I don't think that holds true for the new Multivessel Angioplasty technique (New England Journal of Medicine, Mar. 18, 2017) developed by Danish medical researchers (videnskab.dk, Apr. 5, 2015). By treating all narrowed or obstructed arteries or veins, they managed to lower the risk of death, new blood clots or having to undergo new angioplasty procedures by 44%.
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Old 2nd June 2018, 08:30 AM   #55
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Originally Posted by Skeptical Greg View Post

Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study.


I love this:

INTERPRETATION:

Quote:
We have been unable to explain our results.
Really?

Why do the results seem obvious to me?

"Only the group with low cholesterol concentration at both examinations had a significant association with mortality (risk ratio 1.64, 95% CI 1.13-2.36)."

Well, you can't blame them for being surprised. It was contrary to the expectations of all medical and nutritional expertise at the time!
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"Stupidity renders itself invisible by assuming very large proportions. Completely unreasonable claims are irrefutable. Ni-en-leh pointed out that a philosopher might get into trouble by claiming that two times two makes five, but he does not risk much by claiming that two times two makes shoe polish." B. Brecht
"The abolition of religion as the illusory happiness of the people is required for their real happiness. The demand to give up the illusion about its condition is the demand to give up a condition which needs illusions." K. Marx
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Old 2nd June 2018, 12:36 PM   #56
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Originally Posted by dann View Post
I don't think that holds true for the new Multivessel Angioplasty technique (New England Journal of Medicine, Mar. 18, 2017) developed by Danish medical researchers (videnskab.dk, Apr. 5, 2015). By treating all narrowed or obstructed arteries or veins, they managed to lower the risk of death, new blood clots or having to undergo new angioplasty procedures by 44%.
This study was done in patients who had a heart attack and then underwent angioplasty, in whom the angiogram identified other coronary artery lesions. The benefit is primarily in that giving everyone up front multiple interventions, prevents some people having to have subsequent interventions. Follow up was for one year.

It tell us nothing about primary prevention ie preventing heart attacks or strokes or deaths in people at risk but who have not had a heart attack, stroke or died. Which is what we were discussing.

There is a single study led by people who developed the technique. Would you accept this evidence for a drug? Or would you say we need other independent studies with longer follow up.
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Old 2nd June 2018, 12:57 PM   #57
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Definitely! The more, the better.
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"Stupidity renders itself invisible by assuming very large proportions. Completely unreasonable claims are irrefutable. Ni-en-leh pointed out that a philosopher might get into trouble by claiming that two times two makes five, but he does not risk much by claiming that two times two makes shoe polish." B. Brecht
"The abolition of religion as the illusory happiness of the people is required for their real happiness. The demand to give up the illusion about its condition is the demand to give up a condition which needs illusions." K. Marx
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Old 3rd June 2018, 11:50 AM   #58
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If you are really interested in the workings and mistakes and fraud and related in drug research and the drug industry, the place to go for the real info Is : http://blogs.sciencemag.org/pipeline/ run by Derek Lowe and well worth checking out!!!!!!!!!
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Old 3rd June 2018, 12:32 PM   #59
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Interesting.
The end of one of his posts (about statins):

Quote:
This is worth a thought whenever someone tries to pretend that drug discovery and development isn’t ( or shouldn’t be) so complicated. It is, it is.
Simple, Right?

reminds me of one of Ben Goldacre's books: I Think You'll Find It's a Bit More Complicated Than That
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"Stupidity renders itself invisible by assuming very large proportions. Completely unreasonable claims are irrefutable. Ni-en-leh pointed out that a philosopher might get into trouble by claiming that two times two makes five, but he does not risk much by claiming that two times two makes shoe polish." B. Brecht
"The abolition of religion as the illusory happiness of the people is required for their real happiness. The demand to give up the illusion about its condition is the demand to give up a condition which needs illusions." K. Marx
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Old 11th June 2018, 10:07 AM   #60
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Originally Posted by dann View Post
Interesting article:

The cholesterol and calorie hypotheses are both dead — it is time to focus on the real culprit: insulin resistance (The Pharmaceutical Journal, Jul. 14, 2017)
Now I'm reading that, after my post above. BINGO!

eta: Oh Crap! I typed a whole screed, then didn't hit 'post'. I hate to type, but I'll do over, different with that knoeledge gainde form the above link.
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Old 11th June 2018, 10:50 AM   #61
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Back to the OP:

It's not just the "Thrify Gene's" fat build up that has a positive effect, it is the off shoot of the insulin resistance.

in times of plenty, we eat more, and for some of us some insulin resistance kicks in. The body's feedback system then raises the insulin out put to keep glucose level in check. Continued times of plenty = greater IR, and more insulin output. Glucose stays steady, until the extreme maximum out put of insulin is reached, at which point Diabetes rises to a clinical level.

Meantime, for decades maybe, your body has had high insulin levels. Which act like IGF- Insulin like Growth Factor. (who would have think that insulin can act like an "insulin like" compound?) IGF is the steroid that body builders take to make bigger muscles. Meantime, back at the cave, that excess "growth hormone" makes for bigger, stronger hunter-gatherers. Og can haul a bigger chunk of Mammoth back to the cave. THAT is the evolutionary advantage of Diabetes, in line with the OP.

The down side is something called "pseudo acromegaly". The growth is not just to muscle mass, but to all soft tissues. Cardiomegaly, larger liver, bigger tendons cause trigger fingers and carpal tunnel. Skin tags, colon polyps, more cancer in general. Heart murmur, artery scar tissue, hypertension, kidney disease, etc etc etc. I got tired of hearing "... we see a lot of that among diabetics". I actually talked the docs into doing a brain scan looking for a tumor that would cause that excess growth factor. Awaiting the results, I wondered about the existence of a "pseudo acromegaly". BINGO !!!!

And in light of the article above, it's not the obesity. It's the internal organ overgrowht that causes a Beer Belly that is the culprit. Lard Ass is okay. Waist/hip ratio (.8) is the key, NOT weight or BMI.

I htink I'l c&p this over to the "evolutionary advantage of Diabetes" thread.
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Old 11th June 2018, 11:01 AM   #62
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Originally Posted by dann View Post
Interesting article:

The cholesterol and calorie hypotheses are both dead — it is time to focus on the real culprit: insulin resistance (The Pharmaceutical Journal, Jul. 14, 2017)

I followed the trail to the ACCELERATE trial. 12,000 subjects, quadruple blinded, multiple year study of a drug the dropped LDL like a rock, and jacked up the HDL to the moon. No benefit. Poor, poor Big Phamra, must have cost Ely Lilli millions.

Hmm, I wonder if E-L has noa Statin of their own to protect, else the study would have been file-drawered? Hmmm, I wonder if E-L has an IR drug in the works? hmm.....
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Old 12th June 2018, 12:14 AM   #63
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Originally Posted by casebro View Post
Originally Posted by dann View Post
Interesting article:

The cholesterol and calorie hypotheses are both dead — it is time to focus on the real culprit: insulin resistance (The Pharmaceutical Journal, Jul. 14, 2017)

I followed the trail to the ACCELERATE trial. 12,000 subjects, quadruple blinded, multiple year study of a drug the dropped LDL like a rock, and jacked up the HDL to the moon. No benefit. Poor, poor Big Phamra, must have cost Ely Lilli millions.

Hmm, I wonder if E-L has noa Statin of their own to protect, else the study would have been file-drawered? Hmmm, I wonder if E-L has an IR drug in the works? hmm.....
The mechanism of action is irrelevant, the question is do they empirically reduce vascular events? Do they have unacceptable side effects.

There is a very good drug, very old, that treats insulin resistance - metformin.
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Old 13th June 2018, 11:03 AM   #64
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Originally Posted by casebro View Post
Originally Posted by dann View Post
Interesting article:

The cholesterol and calorie hypotheses are both dead — it is time to focus on the real culprit: insulin resistance (The Pharmaceutical Journal, Jul. 14, 2017)

I followed the trail to the ACCELERATE trial. 12,000 subjects, quadruple blinded, multiple year study of a drug the dropped LDL like a rock, and jacked up the HDL to the moon. No benefit. Poor, poor Big Phamra, must have cost Ely Lilli millions.

Hmm, I wonder if E-L has noa Statin of their own to protect, else the study would have been file-drawered? Hmmm, I wonder if E-L has an IR drug in the works? hmm.....
No benefit?

How about deadly?

Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
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Old 10th July 2018, 02:22 PM   #65
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While looking into my insulin resistance and genes, I learned that there is a connection between rosuvastatin and Insulin like Growth Factor-1. (IGF) . BINGO !!! It's not the cholesterol, or the cholesterol lowering, it's the IGF 'control' that prevents the artery lining from growing. Seems statins also cut way down on cancers too- the definition is "less growth"(factor?) .

The most common gene causing IR (Insulin Resistance) is the IRS-1 gene. That is Insulin Receptor Substrate gene #1. That substrate is also used to build other receptors, like the Growth Hormone receptor, which then triggers the release of IGF-1. So my IGF level is only 10th percentile. BUT, insulin acts like insulin like growth factor. So my high insulin level caused by IR makes up for some of the low growth factor level. And then, goes on to cause growth within my arteries, WAH-La, restricted arteries. T2D have higher cancer rates as well as higher heart attack rates.

So,lowering cholesterol levels is only a confounder of Statins. No wonder several drugs that lower LDL do nothing for heart attacks.

That IRS-1 gene is in 40% of the population. I recently asked my diabetes nurse/educator if the probelms caused by diabetes were caused by high sugar,or high insulin acting like IGF. She said the high sugars, because T1D gets those same effects. BUT WAIT- 40% of the T1Ds also have the IRS gene defect, rolling in the growth factor problems.

Excessive growth factor is called Acromegaly, usually caused by a tumor in the brain Pituitary gland. Andre the Giant had it, died young. Hulk Hogan had ot, self inflicted, died young. Lets see how long Ahnold lasts.

What I haven't looked for yet is the relationship between that IRS gene and longevity. Tthe SNP is number RS 2943641c/c . It might be The Bad Health Gene. 40% of us have it, 40% die of heart attacks. Do 40% also have osteoarthritis? tendonitis? bad discs? I know I have fersure been told that "we see a lot of that in diabetics", "we see more of that in diabetics".....
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Old 12th July 2018, 12:26 PM   #66
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Originally Posted by ahhell View Post
Sure, pharma companies lie, this isn't a very good example of it though. Misleading use of statistics, yes but a very common way of doing it.
Nobody hates big pharma more than me (my wife and I are cofounders of the Canadian chapter of No Free Lunch)

But the OP's example is not a pharma lie. It's just the OP's mathematical ignorance. The OP seems to be unaware of how percentage differs from points. The pharmaceutical advertising is quite correct that there's a 36% reduction. 2% vs 3% = 36% reduction.

2% vs 3% can also be described as a one point reduction. But what it's not, is it's not a 1% reduction.

Wikipedia: [Percentage Point]



Whether these numbers are accurate or not is a different discussion. Dr. Hall did chime in on this in a 2015 SkepDoc: [Statins: The Impact of Negative Media Reports and the Risks of Discontinuing Treatment]

And I think she may be addressing a propaganda film that may possibly be the OP's influence for posting (?) in this 2017 article: [The Movie “Cholesterol: The Great Bluff” Is an Exercise in Denialism]


I've always been curious about what draws skeptics to antiscience like this, and never come up with a good answer.




ETA: link to [No Free Lunch USA]
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Old 12th July 2018, 03:19 PM   #67
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Originally Posted by blutoski View Post
Nobody hates big pharma more than me (my wife and I are cofounders of the Canadian chapter of No Free Lunch)

But the OP's example is not a pharma lie. It's just the OP's mathematical ignorance. The OP seems to be unaware of how percentage differs from points. The pharmaceutical advertising is quite correct that there's a 36% reduction. 2% vs 3% = 36% reduction.

2% vs 3% can also be described as a one point reduction. But what it's not, is it's not a 1% reduction.
Did you mean 33% ? What, are you mathematically illiterate too?

Did you post without reading the whole thread ?
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Old 12th July 2018, 04:42 PM   #68
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The lie is " Lipitor reduces the risk of heart attack by 36% . " which is what the ad so boldly proclaimed.

It doesn't .. Not even close.
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Old 13th July 2018, 12:48 PM   #69
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Originally Posted by casebro View Post
Did you mean 33% ? What, are you mathematically illiterate too?

Did you post without reading the whole thread ?
I read the raw numbers. The percentages were rounding to the nearest whole percentage. The raw numbers showed a 36% reduction.
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Old 13th July 2018, 12:58 PM   #70
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Originally Posted by Skeptical Greg View Post
The lie is " Lipitor reduces the risk of heart attack by 36% . " which is what the ad so boldly proclaimed.

It doesn't .. Not even close.
Why? Could you clarify why you say that? I showed the error in your OP above that the math in the Lipitor ad is absolutely correct given the data they reference. You don't seem to understand how percentages work. Citations were provided, for your convenience and that of anybody else who is unclear on percentage difference versus point difference. This comes up in other topics, such as voter polls. eg: when support for candidate X goes from 45% to 40% it's a an 11% drop, or it can be described as a 5 point drop. When you minus percentages, the result is not a percent, it's a point.

Are you changing the argument to say that OK, 36% is accurate, assuming the research is valid, but you are challenging the research?

What I'm saying is, your reply above is too vague for me to understand if you have an argument, or if you're just ignoring my post and parroting. I've been arguing in good faith, but if you're not, then just let me know and I will move on.
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Old 13th July 2018, 01:14 PM   #71
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Bluto, I can't speak for Greg, but the "relative risk" is very important to big numbers f patients. Like HMOs and drug studies.

When it comes to my own decision making I want the "comparative risk" numbers.

A pertinent example is the statin drugs. Since 40% of us die of heart attacks, a 36% reduct could mean that my own chance of dying of a heart attack will drop only to 26%. Hmmm, If I knew a heart attack was my destiny it would be a 36%, since I don't know, it's only a 14%.

Either way sounds impressive, but now look at the study. They only studied people of a particular age group, and only long enough for 2-3% to die. Extrapolating that out to 100% give some pretty large error bars. And an average life extension of a couple weeks.

So, since I suffer from statin myalgia, no thanks. Now complicate that with the info in my post #65. Weeeelll, okay, they don't lie. But they sure exxaggerate.
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Old 13th July 2018, 01:34 PM   #72
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Lipitor lowers cholesterol. Affect on heart attack is less.
Quote:
The liver is the primary site of action of atorvastatin, as this is the principal site of both cholesterol synthesis and LDL clearance. It is the dosage of atorvastatin, rather than systemic medication concentration, which correlates with extent of LDL-C reduction.[18] In a Cochrane systematic review the dose-related magnitude of atorvastatin on blood lipids was determined. Over the dose range of 10 to 80 mg/day total cholesterol was reduced by 27.0% to 37.9%, LDL cholesterol by 37.1% to 51.7% and triglycerides by 18.0% to 28.3%
Wikipedia.
Lancet
https://www.thelancet.com/journals/l...566-5/abstract
Quote:
There were 189 coronary deaths in the placebo group and 111 in the simvastatin group (relative risk 0·58, 95% Cl 0·46-0·73), while noncardiovascular causes accounted for 49 and 46 deaths, respectively. 622 patients (28%) in the placebo group and 431 (19%) in the simvastatin group had one or more major coronary events.
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Old 13th July 2018, 01:39 PM   #73
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Originally Posted by casebro View Post
Bluto, I can't speak for Greg, but the "relative risk" is very important to big numbers f patients. Like HMOs and drug studies.

When it comes to my own decision making I want the "comparative risk" numbers.

A pertinent example is the statin drugs. Since 40% of us die of heart attacks, a 36% reduct could mean that my own chance of dying of a heart attack will drop only to 26%. Hmmm, If I knew a heart attack was my destiny it would be a 36%, since I don't know, it's only a 14%.

Either way sounds impressive, but now look at the study. They only studied people of a particular age group, and only long enough for 2-3% to die. Extrapolating that out to 100% give some pretty large error bars. And an average life extension of a couple weeks.

So, since I suffer from statin myalgia, no thanks. Now complicate that with the info in my post #65. Weeeelll, okay, they don't lie. But they sure exxaggerate.
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).

What I was trying to clarify is whether the OP understands that the dig at the advertising math is not a good example, that it's a misunderstanding of how percentages work in this and other examples (such as polling). The exact question asked was: "How do the math wizards at Pfizer get 36% out of a 1% difference between their drug and a placebo?" The answer, is they did the math correctly. It's a one point difference, not a 1% difference.
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Old 13th July 2018, 01:42 PM   #74
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Antidepressants, prescribed for anxiety as well, are a mixed bag, and usually fail with long term use. The measurement seems to be how much harm they do. Side effects can be with other body functions or they can actually be worse in the CNS, depending on the patient. Often there are side effects at start and at end of use.
https://www.thelancet.com/journals/l...802-7/fulltext
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Old 13th July 2018, 02:29 PM   #75
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Then too is the fact that they don't "prevent" anything, they only postpone the inevitable. The death rate is still ONE.

Let me know when the death rate drops below 1.
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Old 13th July 2018, 02:45 PM   #76
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Originally Posted by casebro View Post
Then too is the fact that they don't "prevent" anything, they only postpone the inevitable. The death rate is still ONE.

Let me know when the death rate drops below 1.
Sometimes drugs can prevent suffering, which is the hope. And delay of bad outcomes means more good years. A metric I like to compare is quality years with treatment vs without, instead of raw life extension comparisons.

I had a friend who did not manage his diabetes, under the premise that he was going to die either way, and is life worth living if he has to avoid candy.

OK, true, but by neglecting his management he was blind by 20 and never saw either of his daughters, never drove a car, lost his feet and was chairbound in his mid 20s. So yes, he got to drink Coke, but was it worth it. Cost vs benefit.

So with some of these meds, 'preventing' chronic disabling conditions by accepting some side effects or avoiding certain foods or activities, I think there can still be a net gain even though we do all die someday.
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Old 13th July 2018, 05:54 PM   #77
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I understand that 1% is 33% of 3%.



As I said in the OP:
Quote:
The calculation they used is to produce a number called ' relative risk ' , which has virtually nothing to do with the actual effectiveness of the drug.
I did not question the accuracy of the math, I question the ethics of using misleading math to sell a drug.
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Old 14th July 2018, 08:23 AM   #78
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Originally Posted by blutoski View Post
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).
...
I would seriously be interested in you and your wife's opinion about my primary care physician's recommendation of statin therapy in light of the following information.

Age 69. Height 5'8" Weight 161

I take 2.5mg Amlodipine Besylate to keep BP in high 120's/60's

I stopped smoking over 30 years ago. Recent lung scan showed no concerns.

Latest lipid panel

Cholesterol,Total 239 mg/dL
HDL Cholesterol 47 mg/dL
Triglycerides 77 mg/dL
LDL Cholesterol ( Calculated ) 174 mg/dL (calc)

My HDL is slowly increasing over the last few months. I would like to see it higher.
My trygylycerides are going down.. I would like to see them lower than 60, compared to the standard of <150 .

When I asked my Dr about getting an NMR Lipid Panel, she said
LDL particle number and size don't matter.

She had no comment about the significance of my Coronary Calcium Score = ' 0 '

Or my Carotid Duplex Scan =
No hemodynamically significant stenosis by systolic velocity criteria.
No significant plaque identified in left or right

She didn't want to discuss my research about Statin treatment for the elderly ..
Total cholesterol and risk of mortality in the oldest old.
Quote:
INTERPRETATION:
In people older than 85 years, high total cholesterol concentrations are associated with longevity owing to lower mortality from cancer and infection. The effects of cholesterol-lowering therapy have yet to be assessed.

Effect of Statin Treatment vs Usual Care on Primary Cardiovascular Prevention Among Older Adults
Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study.
Gotta love this from the study:
Quote:
INTERPRETATION:
We have been unable to explain our results. These data cast doubt on the scientific justification for lowering cholesterol to very low concentrations (<4.65 mmol/L) in elderly people.

If you or your wife feel I have overlooked any important information, I will be happy to try to provide it.
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Old 19th July 2018, 02:05 PM   #79
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Originally Posted by Skeptical Greg View Post
I understand that 1% is 33% of 3%.



As I said in the OP:


I did not question the accuracy of the math, I question the ethics of using misleading math to sell a drug.
I'm still not sure what you're trying to say. Relative risk is a good description of drug effectiveness, especially if the condition addressed is relatively low probability, which 3% vs 1% clearly is. And this relative risk reduction is huge, statistically and medically significant, so not an exaggeration.

I don't find their math to be misleading in this example.

Wikpedia: [relative risk]
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Old 19th July 2018, 04:06 PM   #80
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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.
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