Map of life expectancy at birth from Global Education Project.

Tuesday, November 11, 2008

Pills pills pills pills pills pills pills

Commenter MAM on the previous post points us in the right direction, toward a fundamental issue that the breathless corporate media reports on the JUPITER trial completely miss. C reactive protein is indeed a general marker of inflammation. You can knock it down with a statin, but if you do that, you are ignoring the underlying cause of the inflammation.

CRP is not, itself, a causal factor for heart disease. That was shown in a study published just a couple of weeks ago, also in NEJM, which found that people who have elevated CRP due to a genetic predisposition are not at elevated risk for heart disease. It's chronic inflammation that's the culprit, CRP is just an indicator. Rather than just writing prescriptions for statins, physicians who find elevated CRP in their patients ought to try to find out why, don't you think? First of all, if it's applicable, the people need to quit smoking. The doctor and patient would want to work together to determine if the patient is chronically exposed to other sources of air pollution, whether from living or spending time near a highway, a nearby factory, occupation, lack of a working range hood and exhaust fan, you name it. Does the person have gum disease? Good oral hygiene and regular dental care might be the answer. And oh yeah, universal, comprehensive insurance that includes good dental coverage is part of the policy solution. And yes, believe it or not, dental care and stopping gum disease are associated with reduced cardiac risk, it isn't speculative.

Some people have chronic inflammation due to autoimmune disorders with poorly understood etiology, such as rheumatoid arthritis. They are typically already taking powerful anti-inflammatories, and maybe statins on top of the rest couldn't hurt. When all is said and done, pills are going to make sense for some people, but our problem is that we don't bother to say all and do all first.

This is just a single example. Statins were originally prescribed for elevated plasma LDL, but why do people have that symptom? It's because we don't eat the way our ancestors did -- mostly whole grains and veggies and some very lean meat. Instead we eat unnaturally fatty meat, grain with the bran and germ stripped out, refined sugar, dairy products, and even synthetically altered oils -- trans fats -- that couldn't have been better designed to kill us if somebody was trying. Instead of walking everywhere and running after game and away from predators as our ancestors did, we travel around sitting inside a ton-and-a-half of fossil fuel-powered steel. Instead of digging and pounding and building and throwing things, we sit on our lard butts all day staring at electronically generated images. That's why we have hypercholesterolemia.

That's also why we have diabetes, but all we do about it is take pills.

I've been bummed out for the past eight years by the gang of murderous thieves who took over my country, but if I'd been foolish enough to mention it to a doctor, he just would have given me pills to make me feel better.

Not that pills are bad per se. Our ancestors didn't usually make it to an age when they even had to worry about heart disease, because infectious diseases or parasites got them first. To be sure, those tiny critters get a better shot at us because of the way we live, crowded into cities, drinking our own excrement, and oh yeah, eating wrong and being out of shape, but still, even the most stringent public health measures can't eliminate infectious disease. Antibiotics and immunization have definitely changed the basic parameters of our existence.

No matter how wise we are about how we organize our societies and how we live our lives, we're going to get sick sometimes and scientifically designed chemicals are sometimes going to be part of the answer. But we make a big mistake by always assuming that they are the answer, that all our problems can go away if we just swallow a magic pill. We've gotten to this point because it is in the commercial interest of drug companies to shape the culture that way, and we've let them do it. Just one more power we've got to fight.


Anonymous said...

I know how you feel. It's like the lines from the classic Jefferson Airplane song "White Rabbit:"

"One pill makes you larger
And one pill makes you small
And the ones that mother gives you
Don't do anything at all"

We've been conditioned to look for answers in pill bottles.

The solution to good health can still be found in your grandmother's advice: eat healthy foods and exercise regularly. No pill will ever be a substitute for that.


Cervantes said...

I think it was actually "the pills the doctor gives you don't do anything at all." Perhaps more apt.

Cervantes said...

Okay, I looked it up -- it was mother. But the practice of medicine is modeled on the parental relationship, and mother probably got the pills from the doctor in the first place, so it still works.

roger said...

the stones have a song about pills too. "mother's little helper."

i'd say both songs are advice from experts.

we're still dealing with a relatives' health problems due to bad drug reactions left undiscovered by the doctor, who prescribed prednisone for the life-threatening symptoms created by simvastatin. now there are possible withdrawal problems from the prednisone. it's like trying to let go of flypaper.

Anonymous said...


Anonymous said...

Facts Believed to be Associated With All Statin Medications:

Statins are a class of medications specifically prescribed to lower LDL- one of five lipid parameters of a person’s lipid profile. There are 6 available statins to choose- with three that are combination drugs that have a statin as a component of these medications. There are other classes of medications for lipid management, such as bile acid sequestrants and nicotinic acid, which is known as niacin. Yet the side effect profile is more unfavorable of these classes of medications compared with the statin class.
One’s cholesterol level is primarily due to how they produce cholesterol in their liver, which is overall genetically determined. This level is also determined by one’s lifestyle and diet as well. If a person has too much cholesterol in their blood, it can lead to hardening and narrowing of their arteries, which can lead to cardiovascular events.
To measure one’s cholesterol, a blood test called a lipid profile is obtained from a person after they have fasted for at least 12 hours. The test should also be performed only if the person is free of any acute illness, as this may affect true lipid measures. If the results prove to be abnormal, lipid lowering therapy may be initiated, according to the discretion of the person’s health care provider. This therapy usually involves a statin medication.
Adverse events associated with the statin class of pharmaceuticals are thought to occur more often than they are reported- with high doses of statins prescribed to patients in particular at times that may not be necessary to control their dyslipidemia based on their lipid profile. However, since this class of drugs has existed for use for over 20 years, statins are considered safe and effective for enhancing the clearance of LDL noted to be elevated in the lipid profiles of patients. Also, they have proven to reduce cardiovascular mortality with one who is treated with a statin that has dyslipidemia. In addition to lowering LDL by up to 60 percent- depending on the statin- this class of drugs also raises HDL and lowers triglycerides, which are two other lipid parameters. Both of these effects from taking a statin drug are beneficial for the patient on a statin drug for lipid management.
Statin therapy is also recommended for those patients who have a greater than twenty percent risk of developing cardiovascular disease, or those patients that have clinical evidence of this disease
Additionally, there appears to be no comparable reduction in cardiovascular morbidity or mortality, as well as a difference in the increase of one’s lifespan, if one is on any particular statin medication for their lipid management over another, others have concluded. So caution should perhaps be considered if one chooses to prescribe a statin for a patient if they are absent of, or have only mild dyslipidemia to a significant degree. Furthermore, research should be done by the health care provider if they are under the belief that one statin medication provides a greater cardiovascular benefit over another. In other words, the health care provider should be assured that any choice of statin therapy for their patients is considered reasonable and necessary if the LDL in their patients need to be reduced, and the statin selection should be determined by the results that have been shown with a particular statin.
Abstract etiologies for those who choose to prescribe statin drugs on occasion for reasons not indicated by these statin drugs- such as reducing CRP levels, or for Alzheimer’s treatment, or anything else not involved with LDL reduction with prevention if not delaying the progression of cardiovascular disease, should be thoroughly evaluated by the health care provider. As statin therapy for such patients may not be considered appropriate prophylaxis at this point for any patient who does not have the indications for which statins are approved for and treat with patients. All other benefits that appear to have favorable effects in such areas are speculative at this point due to minimal research in other areas aside from lipid management, and require further research for these disease states aside from dyslipidemia, according to many.
Statins as a particular class of drugs that seem to in fact decrease the risk of cardiovascular events significantly, it has been proven. Statins also decrease thrombus formation as well as modulate inflammatory responses (CRP) as additional benefits of the medication. For those patients with dyslipidemia who are placed on a statin, the effects of that statin on reducing a patient’s LDL level can be measured after about five weeks of therapy on a particular statin drug.
Liver Function blood tests are recommended for those patients on continued statin therapy, and most are chronically taking statins for the rest of their lives to manage their lipid profile in regards to maintaining the suitable LDL level for a particular patient presently. Patients should be made aware of potential additional side effects as well, such as muscular issues.
Yet some have said that about half of all strokes and heart attacks that do occur are not because of increased cholesterol levels of these patients. Others believe that it is oxidized cholesterol that causes vulnerable plaques to form on coronary arterial walls, which is the catalyst for a heart attack, and that there is no medicinal treatment for the formation or stabilization of these plaques to prevent heart attacks or strokes. Others who promote and support statin medicinal therapy claim that these drugs, do, in fact, stabilize these plaques, and therefore are beneficial.
As stated previously, in regards to other uses of statins besides just primarily LDL reduction, there is some evidence to suggest that statins have other benefits besides lowering LDL. These other disease states include aside from what has been stated already, those patients with dementia or Parkinson's disease, as well as those patients who may have certain types of cancer or even cataracts. Yet again, these other roles for statin therapy have only been minimally explored, comparatively speaking. Because of the limited evidence regarding additional benefits of statin medications, the drug should again be prescribed for those with dyslipidemia only at this time involving elevated LDL levels as detected in the patient’s bloodstream.
Yet overall, the existing cholesterol lowering recommendations or guidelines should possibly be re-evaluated, as they may be over-exaggerated upon tacit suggestions from the makers of statins to those who create these current lipid lowering guidelines. This is notable if one chooses to compare these cholesterol guidelines with others in the past. The cholesterol guidelines that exist now are considered by many health care providers and experts to be rather unreasonable, unnecessary, and possibly detrimental to a patient’s health, according to others. Yet statins are beneficial medications for those many people that exist with elevated LDL levels that can cause cardiovascular events to occur because of this abnormality. What that ideal LDL level is may have yet to be empirically determined.
Finally, a focus on children and their lifestyles should be amplified so their arteries do not become those of one who is middle-aged, and this may prevent them from being candidates for statin therapy now and in the future, regarding the high cholesterol issue. Treating children with a statin drug for dyslipidemia is controversial presently.
Dietary management should be the first consideration in regards to correcting lipid dysfunctions that may exist in patients,

Dan Abshear