25 YEARS OF EVIDENCE BASED MEDICINE PART II: WHAT WE CAN LEARN ABOUT EBM FROM THE CHOLESTEROL / STATIN DEBATE / DEBACLERead Now
25 YEARS OF EVIDENCE-BASED MEDICINE PART II
"The new guidelines would increase the number of U.S. adults receiving or eligible for statin therapy from 43.2 million (37.5%) to 56.0 million (48.6%). Among adults between the ages of 60 and 75 years without cardiovascular disease who are not receiving statin therapy, the percentage who would be eligible for such therapy would increase from 30.4% to 87.4% among men and from 21.2% to 53.6% among women."
WHY DOES IT MATTER?
For the record, the COA's revealed by Dr. Pencina and his chief co-author included
- McGill University Health Center: McGill does a lot of research in the area of heart disease, cholesterol, and drugs to lower cholesterol (both statins and non-statins).
- AbbVie: AbbVie, a division of Abbott Laboratories, manufactures the non-statin cholesterol drug "Niaspan", which is commonly prescribed along with statins. Clinical trials have shown it provides no benefit in lowering cholesterol. They are also heavily involved with stents, vessel closure devices, endovascular and coronary technologies.
- Janssen: Janssen is the collective name of the Pharmaceutical Companies of Johnson & Johnson. They recently came up with a new class of Type II Diabetes drug, and are involved with several dyslipidemia drugs.
- Eli Lilly: Eli Lilly makes the stain drug Livalo. They have also been working on a class of drug to increase HDL --- something which has proved elusive to the pharmaceutical industry. They have also been involved with the non-statin drug PCSK9 as well. As a side note, Eli Lilly has claimed that their drug Livalo has fewer side effects than other statins. Listen to what Dr. John Briffa has to say about the way that Eli Lilly is exploiting this fact on the July 13, 2012 issue of his blog. "It’s well known that about 75 per cent of people who start statins stop again within a year. Recently, the drug company Eli Lilly issued a press release regarding a survey called ‘Understanding Statin use in America and Gaps in Education’ (‘USAGE’). The USAGE survey was an attempt, on the face of it, to better understand the reasons for why so many individuals stop taking their statins. More than 10,000 people were polled, and the results are in. It turns out that off all of the reasons individuals might stop their statin medication, ‘side effects’ was the most commonly cited reason. According to the survey, a full 62 per cent of respondents cited side effects as the reason for stopping their medication." According to Eli Lilly, Livalo is the perfect solution for these folks.
- Boehringer Ingelheim: Boehringer Ingleheim makes about 30 different drugs, including many for the cardiovascular system.
To read more about the COA's in this area of industry guidelines within the field of cholesterol, you can go to the blog of Dr. Barbara Roberts --- a professor at Brown University (HERE) and read a short article she wrote on the subject. She says the conflicts in this area are over half a billion dollars.
THE MORE THINGS CHANGE, THE MORE THEY STAY THE SAME
Statins Get High Marks in New Cardiac Prevention Guidelines. The headline from Tuesday's MedPage Today article by Todd Neale
These guidelines will provide updated guidance to primary care providers, nurses, pharmacists, and specialty medicine providers in how best to manage care of individuals at risk for cardiovascular diseases based upon evidence. ACC president doctor John Harold of Cedars-Sinai Heart Institute in Los Angeles
The new Cardiovascular Health Guidelines suggest that people should be given STATIN DRUGS, not simply based on HIGH CHOLESTEROL levels, but on the basis of their age, sex, lifestyle (sedentary, smoker, TYPE II DIABETES, blood pressure, etc) and weight. In fact, the group's recommendations were so sweeping that if they had their way, (I am not making this up) 1 in 3 American adults would be on these drugs. Re-read this last sentence and let it sink in a moment. Also understand that with large scale Socialized Medicine, sooner or later these "recommendations" are going to become "regulations" --- something you will be forced to do --- quite possibly against your will.
The group chose a couple of doctors to actually physically write / type the guidelines (Donald Lloyd-Jones, MD, and Neil Stone M.D. both of Northwestern University in Chicago). It should be noted what MedPage Today said about these two doctors; "Stone and Lloyd-Jones reported that they had no conflicts of interest." This makes you feel all warm and fuzzy until you read a bit further (you know; the fine print at the bottom) and realize that, "Eckel [you will meet him momentarily] reported relationships with Amylin, Eli Lilly, Esperion, Foodsminds, Johnson & Johnson, Novo Nordisk, Vivus, GLAXOSMITHKLINE, and Sanofi-Aventis/Regeneron, and Ryan reported relationships with Alere Wellbegin, Amylin, Arena Pharmaceuticals, Eisai, Novo Nordisk, Nutrisystem, Orexigen, Takeda, Vivus, and Scientific Intake." Of the dozens of other doctors and scientists who were part of the Guideline Committee, this is what the rest of the fine print at the bottom said. "The other members of the writing groups reported numerous relationships with industry." Do you have any idea what that really means? It means that there were so many financial conflicts of interest, it would have taken pages (that would be plural) to list them all? HERE is more on this topic.
Can we trust these doctors. Suuuuuuure we can. And I have this wonderful piece of ocean front property in Arizona that I would just looooooove to sell you ---- cheap. I bought it from George Strait himself! Seriously people; we have seen over and over and over again that power and money tend to have a corrupting effect on people. In the quote at the top of the page, Dr. Harold said that these guidelines were made in response to "evidence". Evidence? Don't kid yourself. EVIDENCE-BASED MEDICINE is part of the wall of double-speak that the industry leaders hide behind in order to make you think that what they are doing is "scientific". It's always embarrassing when the "evidence" shows that guidelines and treatment(s) are based solely on money. I promise that DR. KUMMEROW was never invited to be on this committee!
Were the lifestyle recommendations any good? Although the recommendations for people to get of their sedentary butts, quit smoking, and eat healthier foods, were exactly what we would expect, the dietary guidelines left something to be desired. Dr Robert Eckel of the University of Colorado at Denver, wrote the diet recommendations. It is exactly what I would expect. He issued a, "strong recommendation to consume a diet rich in fruits, vegetables, whole grains, low-fat dairy, legumes, fish, poultry, and nuts and low in sweets, sugar-sweetened beverages, and red meats." Some of this I would agree with wholeheartedly. However, the idea that eating a diet high in grains is simply fueling the fire that is AMERICA'S NUMBER ONE HEALTH PROBLEM. Not to mention, the issue of GLUTEN and GLUTEN CROSS-REACTORS. If you happened to read THIS POST that I wrote a few months ago, you already know that the majority of practicing physicians pooh pooh the idea of non-Celiac Gluten Sensitivity as a "fad".
Furthermore, the recommendations say to severely limit red meat. I have shown you TIME and TIME AGAIN that this is folly. It is amazing to me how these doctors cannot get the recent past out of their heads when it comes to red meat. In fact, if you will look at the PALEO DIET, you will see that about half of these "expert's" recommendations are going to actually cause INFLAMMATORY REACTIONS that lead to a host of disease processes. I should also note that the way that the guidelines are written implies that while "sugar sweetened beverages" are bad, DIET BEVERAGES are fine.
Then there are the non-dietary recommendations for dealing with OBESITY by Dr. Donna Ryan of Baton Rouge (Pennington Biomedical Research Center on the LSU campus). She wants at least 6 months of weight loss counseling and intense in-home interventions done by trained healthcare providers. Firstly, it sounds rather expensive to me. Secondly; has it been shown to work in the past? In a word; no.
WHERE ARE WE HEADED WITH ALL OF THIS?
What does all of this prove? Only what most of my readers already knew. You cannot trust the government, or the organizations which are funded by the government, to do what is right for your health. If you are concerned for your family's health, you'll have to take the bull by the horns and do it yourself. Do your own research, figure out what it takes to GET HEALTHY, and then take the steps to get it done. Never, ever, ever blindly listen to anything that any doctor tells you (self included) without studying the matter out for yourself. No; it's not easy. But then nothing good in life ever is.
SATURATED FAT AND HEART DISEASE
IS THERE A LINK?
"The mantra that saturated fat must be removed to reduce the risk of cardiovascular disease has dominated dietary advice and guidelines for almost four decades. Yet scientific evidence shows that this advice has, paradoxically, increased our cardiovascular risks. Furthermore, the government’s obsession with levels of total cholesterol, which has led to the overmedication of millions of people with statins..." Aseem Malhotra, Interventional Cardiology specialist at Croydon University Hospital of London
One of the oldest and most prestigious medical journals on the planet, the British Medical Journal, published an interesting (and controversial) commentary by Malhorta a couple of days ago called Observations From the Heart: Saturated Fat is not the Major Issue. The article, an overview of the peer-reviewed literature on the subject, showed that saturated fat is not the Great Satan it has been made out to be. Hopefully, this is not new information for you (HERE). TRANS FATS are the fats which are widely associated with disease; not Saturated Fats. This is why a PALEO DIET is so beneficial for people with a wide variety of chronic illnesses, including most cases of cardiovascular disease and OBESITY.
I would suggest you read the entire article (HERE), as it will only take you five minutes to get through it. While you are at it, you may want to check out our information on STATIN DRUGS as well. It all boils down to understanding and educating patients about what it takes to squelch INFLAMMATION at its source ---- something the worldwide medical community is, in my opinion, doing an extremely poor job of (HERE).
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).
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