Statins Bad press

[Pace]

ind out what treatment works the best for the greatest number of afflictees.

Obigraham

I stress I am not medically qualified so you will have to take my comments as such. I am not against patients with serious disease going for the better of two evils but you know that it was not long ago that there was pressure to mass medicate all over the age of 50 with Statins based on the evidence of the drug then? This was for perfectly healthy people.
My friend for his age was put on statins not because he was ill but because of his age and as a precaution with a dramatic negative change in his well being ( See my earlier post}

Pace

[onetrack]

It is an unfortunate fact of modern medicine today, that young doctors are taught to prescribe a pill for everything.
Drug companies send commission sales agents around to medical practices and convince doctors that their companys product provides incredible results, while the agent plays down any side effects, or fails to mention the important ones.

Virtually every drug produced, has side effects of some kind. A large number of drugs produce tolerable side effects. A minority of drugs have particularly bad side effects.
It helps enormously when drug companies are clear, concise, and uninhibited in providing full disclosure of ALL side effects.

Unfortunately, the primary aim of the corporate world is profit, increased return to shareholders, and increased salaries to senior management.

Patient health, and attention to ethics, morals, and honesty by revealing the full range of side effects takes a very much lower rung on the ladder if profits are going to be compromised by revealing some nasty side effects, that are better off being kept hidden.

The side effects of numerous drugs are very often downplayed, with soothing statements that only a minority suffer the side effects, whilst the majority see huge benefits.

Where a major conflict of interest arises, as in the case of drug companies being the ones telling clients the downsides of their product, the drug companies cannot be trusted to reveal the full story.

[obgraham]

Pace, actually we're not that far apart: I think we, especially in the US are vastly overmedicated, and I'm not a great fan of any plan which involves "medication for all", or routinely medicating for a lab test result.

But likewise, I'm not in favor of making any decision on the basis of "what happened to my sister-in-law's uncle when he was given that drug".

[Radgirl]

Oh dear, every few months the same old posters start up about statins. Raised from their hibernation by some dodgy newspaper article or obscure laboratory work, they inform us of a friend or relative that falls into the 1% of severe symptoms and had the misfortune to be under the care of the 0.1% of doctors that underperform.

The fact is that doctors do not over prescribe, patients over demand. In the UK the government has just had a tiz about the massive over prescription of antibiotics for sore throats. The result? GPs all agree but patients demand them and they are handed out.

I am dismayed that thalidomide has now been brought into the argument. It was because of the unpredicted side effects of this drug that most countries around the world set up the regulatory framework that require new drugs to go through animal and then human studies and this is why we have not had a recurrence.

We all want a cure, but the reality is that cures are rare. My practicing lifetime has seen the greatest lengthening of life expectancy not because of medical advances but because of improved diets, less smoking and improved lifestyles/jobs/air quality. Those cures we are expecting (HIV, macular degeneration etc) will be so labour intensive or costly that only the ones that seriously improve quality of life will be affordable, and even then only in a handful of first world countries.

To those of you who slander doctors and the drug industry (I havent met a sales rep in 20 years) think what life would be like without antibiotics. Think what the second and third world would consist of without drugs and vaccinations.

Statins save far more lives than they harm. As the 'opposition' have posted, side effects are reversible. Heart attacks and strokes kill, and death is not reversible.

Can we please remember nobody is forced to take statins. Those who believe the science is wrong can go without. But lets not keep going round this argument again and again.

[Gordomac]

Radgirl ; Oooops. Chill. Little bit too feisty. Just because you haven't seen a Rep in twenty years doesn't mean that they have ceased knocking on your door does it ? I was a Medical Rep donks ago and know the deal. As a professional airline pilot, I was diagnosed with Type 2 Diabetis. I was oversubscribed "medication" and STATINS nearly killed me. I threw the medication down the drain. Through diet, I dropped 20kg. In retirement, I exercise a lot more (not gym or running marathons but general hairing about the house & garden & walking to the Taverna rather than drive, etc etc). I tossed the medication seven years ago.........................still here !

In a balanced world, of course there is room for everything. Find what suits you. Professional pilots are highly trained and analytical. We are trained to spot tunnel vision & are very suspicious of the medics who have direct control over our professional well being but, OFTEN, get it completely wrong but will never admit it.

Keep up the posts. Well respected & grateful as we are to you and Gingernuts. The good that you guys do (as a profession) far outweigh the errors. But, gees, radgirl, I need to take you up to my local & buy you a Pinacolada with stacks of cream (full fat), fake cherries (coated in sugar), loadsa other naughties, but, hey, balance (?). Next day, .............clean out diet................!

Now, I'm off to the Mill base at Dhekilia for MY idea of the mediterranean diet ; Fried eggs & chips washed down with a Keo shandy. STATINS (?) noo, noo, noo, noo !!

[Radgirl]

I'd love to have a drink with you Gordomac. Someone who can be complementary and shoot me down at the same time would be fascinating.

Sorry to disappoint but I am not crouched over my keyboard with steam coming out of my ears. You will notice I refrained from posting for some time. An issue arises however when so many people post anecdotal stories because others might take them as science and compromise their care. It seems you may have reversed your type 2 diabetes as I have described in another thread so well done, but simply throwing drugs down the drain and not seeking further advice was d@@@.

Luckily as you say pilots are analytical and most will understand studies looking at tens of thousands of patients over decades carry more scientific weight than an individual's anecdote or your claims of some great conspiracy....... But you are being mischievous: if you were a 'rep' you should be aware knocking on my door is actually banned! You should be aware I dont control any patient I merely advise (albeit often from a perceived position of power). And to claim I 'often' get it wrong is the same as me saying you often crash your plane. Mistakes occur in both professions and both have massive regulation and regulators with sharp teeth!

Now how about that drink?

[Mr Optimistic]

Father in law is an ex-gp and gas been on and off statins. They don't suit everyone, the side effects can be unacceptable, but there are many different sorts and the trick is to find one that works.

The NHS is in need of a major overhaul wrt costs though and over prescription for blame avoidance is endemic, as is sending for blood test, prescribing over the counter medicines to the 97% prescriptions which are free to the patient etc. So yep can beliveve that statins are over prescribed.

Water retention medicines have been the big life savers.

[Pace]

RadGirl

I appreciate your posts and knowledge and past help on a delicate matter! None of us are against medication but some have light side effects some medium and some debilitating side effects which can cause damage in their own rights like Statins which are proven to cause diabetes!
While not questioning the benefits to seriously ill patients where they are considered the better of two evils at what point do you recommend their use ? Fit and healthy ? Mild problems ? Or severe ?
Maybe we should label drugs as green Amber or Red depending on their known or even suspected side effects to give patients a better idea of what they are taking!
While maybe not scientifically proven there is enough smoke around Statins to indicate a fire and these claims which pop up in the press should be scientifically disproven rather than the other way around ?

Pace

[gingernut]

I feel the need to make another post, but first I need a lie down, and some time to collect my thoughts, so in the mean time, let's all take a chill pill, (not a statin) - here's a photo from Fistral Beach last night, now breatheeeeeee....

[Winnerhofer]

@Uplinker

Agree with you 100%
Sedentary lifestyles is a silent killer and that's why 70% of men get prostate cancer because the more you sit, the more the prostates risks inflammation from a benign condition to a malign one.
As for sports, cycling is a prostate killer.
Now back to cholesterol: it's only a symptom and not the cause.
All medication is POISON and must be used as a last resort as all illnesses are triggered by psychosomatic visceral imbalances caused by emotional traumas.
As for sports, lateral and multidirectional movements mixed with braking are the ultimate get-fit-quick fix.
I don't breathe when doing UHIE (Ultra High-Intensity Exercise) which increases burn rate dramatically.

[Radgirl]

I thought all illness was caused by histamine Winnerhofer!!!!

Sorry

Pace your question is spot on. A lot of the anecdotes do not reflect well on the healthcare provider. There are some patients who definitely do need statins - those with type 2 diabetes for example. This group should already be monitored by a doctor and side effects picked up and dealt with.

When it comes to the worried well, a good GP will provide lifetime care and within this relationship discuss lifestyle choices and ongoing cardiac risk. Selective and proven screening such as blood pressure and later virtual colonography will selectively try to identify and manage common pathology.

Statins are one cog in this, not started on a whim but as part of the process, recommending statins that reduce diabetes (statins do not cause diabetes but some appear to accelerate its onset) and only with the patient's agreement. We would always monitor liver function tests and monitor for side effects, if necessary changing the brand and then if necessary stopping. Doctors will review new research but give it weighting according to its providence. Newspaper selection is vital!

I recognise that this perfect world doesn't exist and the NHS in particular is in crisis but only by identifying the cause can we improve

[gingernut]

ay, I've had a lie down so I'll try and sift through some concerns, I hope it's helpful, please feel free to agree or disagree, or if there are any epidemiologists/public health/experts in the fields of critical appraisal, please feel free to chip in.

The following is my opinion, and any individual medical advice should be backed up by your doctor and medical authority.

I've retired from The NHS but do still see patients. I've been proud to be part of three main achievements that I've observed over the last 30 years:

-Cancer is now classed as a "chronic disease" (We've got a long way to go.)
-We now afford dying patients the care they deserve (We've got a long way to go.)
-People my age aren't dying, or becoming irreversibly damaged by the effects of atheroma-furring up of the arteries (We've got a long way to go.)

I trained in Manchester, if you think of "Joe Average" chances of dying early through heart disease as equaling 100, then some parts of my ward scored 176. (SMR rates).

I have total respect for Pace and those others who have posted on here, exacerbated by the fact that we seem perhaps a little too eager to commit them to a lifetime of medicating.

I'll try and sift through things as best I can.

Firstly, the "cure" thing. I can't remember the last time I cured someone.

My surgical colleagues may disagree with me, but let's face it, one of the major reasons cancer patients have better surviveability is because the surgeon now talks to the radiologist, who now talks to the oncologist etc etc.

I think it may have been when I syringed someones ears in the nineties- they stopped us doing that, as someone worked out that the "risk/benefit" equation demonstrated that we burst more eardrums from the silver thing that flew off the end on the syringe, than the inconvenience we would cause by saying to the patient "put olive oil in your lug hole until the wax falls out."

How we define "health" is riddled with problems. I've dealt with 18 year old patients, who, on the face of it, appear healthy to me. Correct BMI, "normal" blood pressure, low cholesterol etc etc, - the fact that he can't face going to work in the morning, makes him, in his eyes, unhealthy. Conversely, there's a girl who works down our local ASDA on the tills, who was obviously born with the most terrible congenital abnormalities. She daily serves me with my crate of Pinot and Rustlers burgers. She always looks happy, and smiles all the time. I'd love to ask her if she feels healthy.

Medicine seems fascinated by "The Absence of Disease but I suspect that there is more to this than meets the eye. We sometimes don't seek to promote positive health, and sometimes we tend to overlook the wider determinants of health.

The evidence bit. Heart disease and stroke kills and maims hundreds of thousands of people in the UK each year.

I'm not that arrogant to state that medicine makes that much difference. Pound for pound, spending money on pre-school education and town planning can probably do more than anything I can write on my prescription pad. Getting my patients to walk 30 minutes a day for 4-5 days a day is far more effective than any pill I can prescribe.

Medication, actually, is only a part of the solution.

I think what we are talking about here on this thread is primary prevention, which essentially involves asking someone to take a chemical for the rest of their life-when they are actually well. They won't feel any better for taking this chemical, but they may actually have adverse effects.

It's a hard sell.

I think it's a fair comment to say we have been influenced by external factors that haven't always served the best interests of the patients.

I, like Radgirl have not had a "free lunch" from a drug company rep for a very long time.

I wouldn't dare :-)

There are checks and balances in the system, a sort of "division of the powers" involving the statutory bodies such as NICE, the local regulators, Medicines Management as well as our own accountability to our employer, civil law, criminal law, etc.

In terms of how we do it?

Secondary prevention (treating people who already have established disease) is a no brainer and actually causes us (prescribers) no hassle-a touch near to death is a great concordance motivator.

Primary prevention is a bit more tricky, and it's a "hard sell."

In terms of evidence, we try to stratify things in terms of "robustness."

At the bottom of the pile
anecdotal evidence.........not always to be discounted, I'll even give some of my anecdotal evidence later.

In the middle
are cohort/population studies. (Let's see what happens to a hundred patients in Iceland who eat a lot of Fish compared to a hundred patients in Salford who eat MacDonalds.)

At the top of the evidence pile are the Multi-centred, Blind, Randomised Control Trials (Have a look at The BMJ)

It's this sort of stuff that our prescribing decisions are (or should) be based upon. We don't always achieve this (SSRi's anyone?)

The decision to treat is based on some sort of risk assessment (don't shoot the messenger.)

This usually involves placing certain variables into an algorithm, (blood pressure/HDL/LDL/postcode (!), smoking status which then gives us a "ten year" risk figure.

The "ten year risk" figure is quite crap.

It tells me how many "People sat in front of me with this blood pressure/HDL etc etc) are likely to have an arteriosclerotic event in the next ten years.

What it fails to do, is tell me which patients, out of the theoretical hundred, will have an event, and which won't.

I use a 10 by 10 grid to sort of play odds management with my patients.

This is the most important point-statins only work if patients take them daily, from this thread, it sounds like many aren't. Communicating the facts is key, but at the end of the day, patient choice is paramount

In terms of doing good and doing harm, I can only report anecdotal findings.

Myalgia (muscle pain) is quite common, the key here is education, any muscle pains should be followed up with Blood Tests, to exclude Myopathy (Muscle Damage), I've seen a couple of cases of deranged liver function tests, both of which resolved on titrating the dose down.

The key here is to attend for the initial blood tests.

I walk round Manchester now and very rarely see IHD/CVA crippled people :-)

[Pace]

Gingernut and Radgirl

Thanks for your informative posts
There is a big difference from being prescribed a course of tablets like antibiotics and being given a life sentence to commit to taking a tablet with potentially serious side effects for the rest of your life!
Especially when feeling well as in some cases of HBP it is hard to stomach taking pills which make you feel unwell?
From a laymans perspective when the scientific conclusion is questioned or changed which does happen public confidence goes! Cholesterol and its mechanism and interaction is not fully understood and that is the case with HBP
It has recently been discovered That people with HBP are less likely to develop Alkzeimers so are you going to increase the chances of the patient developing Alkzeimers by lowering HBP ?
Smoking cigarettes is taking a drug or rather a number of harmful chemicals I am sure if you looked hard enough you would find some benefits in those poisons in lowering something ?
Wolfarin is a poison but has the effect of thinning blood!
Maybe I used the wrong word saying cure but more fully understanding the reason for something going wrong in the bodies balance and targeting that!
HBP is a good example where now research is looking more at control mechanisms in the brain controlling HBP going wrong or maybe it's natural in some and part of their makeup ?
So really we are looking at long term drugs which can make a patient unwell through the drugs and whether the benefits out way the negatives
When you see sections of the medical world pushing the use of Statins on fit healthy people over the age of 50 alarm bells have to ring
My grandmother years ago was told to take up smoking by her GP to help her relax ) that was a long time ago but things do change )

Pace not medically qualified just interested ))

[gingernut]

Antibiotics is an interesting one, ever wondered why we haven't seen any new ones in the past twenty years ? (there's no money in it).

However,I'm not against primary prevention. It is, a hard sell convincing someone that they need to take a chemical, which could make them feel ill, the benefits of which can be hard to demonstrate. I try and focus on the outcome measures, rather than the chemistry.

If someone asked me how to prevent heart disease, I'd give them 3 answers:
-walk thirty minutes 5-6 times a week
-don't (or give up) smoking
-choose better parents

the other medical bit's are fiddling round the edges.

We're paid to give advice, based on the facts that we gain from the evidence. I'm happy to explore that evidence with you further if need be.

The decision to take the advice, however, is ultimately your own.

[Pace]

However, today it's a different story.

Numerous studies have linked these drugs to an array of debilitating side effects. Even the lacklustre American Food and Drug Administration (FDA) slapped a warning about the increased risk of type 2 diabetes on statins.

Memory loss, muscle pain, fatigue, liver dysfunction and kidney failure are a few more well-known side effects that are now associated with these drugs.

Why do you think your doctor is supposed to send you for liver and kidney function tests every year when you are taking statin drugs? It’s because these drugs can seriously harm those organs.

In fact, the website netdoctor.co.uk states the following: "It is very unusual for a patient to have symptoms of liver damage due to taking statins because if liver function tests are taken occasionally to check the liver enzymes, the problem is never allowed to develop to the stage where symptoms occur."

This means that your liver is indeed at risk when you take statin drugs... and that your doctor should send you for regular tests to stop the risk from getting out of hand and destroying your health.

Statin drugs have now even been linked to an INCREASED risk of cardiovascular disease and heart attacks! That's because these drugs deplete the most important muscle in your body of the essential nutrient CoQ10, to the point that it literally can break your heart.

And the benefits?

Well, one thing is certain, these drugs WILL lower your cholesterol — that's what they are designed to do.

But cholesterol is not the villain the mainstream is making it out to be. And that is a fact.

Instead it is an essential building block that you'll find in every cell of your body. It's essential for the synthesis of hormones and vitamin D and it helps with the formation of memories and normal brain function, to mention but a few of its essential functions.

In short, cholesterol is a natural occurring substance — produced in your liver — that your body NEEDS to function optimally.

So why on earth would anyone want to lower their cholesterol to ridiculously low levels? Especially when low cholesterol levels have been linked to numerous health problems, including decline in cognitive function, depression and suicidal thoughts.

If you have any doubts about taking these drugs, follow your gut instinct. And that's not because I'm saying so, but simply because evidence is piling up against the so-called benefits of these drugs.

The above are the sort of claims made some of it makes sense ? I can assure you I am not against the better of two evil theory with seriously ill patients but not sure on a preventive for mild indications and against these drugs being dished out to healthy individuals over 50
If the above is rubbish I wouldn't know but it's the sort of claims being thrown around

Pace ))

[gingernut]

I'd have to see their evidence, as such, it's just what it says it is, a claim.

It's easy to get hooked on the chemistry, the important aspect here is the outcome.

Do statins carry risk ? (Yes)
Can statins prevent heart attacks and strokes (Yes)
Do the benefits outweigh the risks (Yes)

[Radgirl]

Thanks Pace. I appreciate you have genuine concerns so lets look at your quote, given that you are my patient and I am advising statins either because

1 You are at high risk of cardiovascular death, or
2 I want you to consider the fact that in large multicentred controlled trials statins were shown to reduce the number of sudden deaths from strokes and heart attacks and that is the most likely reason you will die in your 50s or 60s

Diabetes: some statins are associated with an increased amount of diabetes, possibly due to making it happen earlier in an individual, others have the opposite effect. They are more expensive but the ones I take and prescribe.

Side effects: Memory loss is rare and reversible. We will monitor you for it if we remember. Muscle pain is common - we will stop and try another statin which usually works. Fatigue is normally part of this myalgia so ditto.

Liver failure: everyone should have a simple blood test to monitor the liver at a month, 6 months and then annually for 3 years. Late failure 'doesnt' occur. If the liver function tests are abnormal, we stop the statins and they go back to normal

Renal failure: this is the risk. Tremendously rare but happened to a colleague of mine who was poleaxed over a weekend. I take statins because the risk is minute and the benefit much more, but it is your choice

Increased cardiovascular risk: no I havent seen any paper suggesting this. CoQ10 is often added in the US and there is evidence this further reduces risk as low CoQ10 levels can see saw against the statin benefit, but bodies far more knowledgeable than me consider the actual benefit insignificant. But hey I will give you CoQ10 if you want it!

I am not eliminating cholesterol. The body has more than enough and no statin will lead to a deficiency. Yes if you eat a totally fat free diet some people will get bipolar disease, but you will continue to eat some cholesterol, except perhaps the fry up on sunday mornings. Or perhaps not.

So Pace my advice is to have a statin. One table each evening for the chance of posting on PPRuNE for many more years. I do so based on science not monetary gain, but you can walk out of my surgery without the prescription and we will remain good friends. Just please dont terrify the other patients with anecdotal mumbo jumbo or ask medicine to be abolished until every obscure paper is further researched because we might as well close down healthcare.

Next patient please

[gingernut]

The last paper I saw, suggested tfhe risk/benefit equation tipped at around 7% (risk of cardiac event in 10 years.)

The Government (UK) used to offer statins to those over 20% risk, but this was more to do with money than anything else.

They now offer it to those of risk of 10% and above.

[Gannet Driver]

If you are remotely concerned with Statins, one way or the other, I strongly suggest you read the article this link leads to.

Not light reading, and quite a lot of it, but give it a try

http://psychology.usf.edu/News/Exper...inResearch.pdf

Mike

[Pace]

Gingernut

Problem with statistics is they can be tailored to suit the case ?
This link has been posted on the other Statin thread
I have little knowledge in my argument but maybe this will better suit to at least give patients a document to discuss with their GPS

http://psychology.usf.edu/News/Exper...inResearch.pdf