If I collect bivariate data and you find out I ditched half before correlating, you have no usable information. (Not strictly true when you know which corner of the plot I ditched, but let’s not quibble.) However, if I ditch identifiable cohorts of data, the logic is quite different.

The rim groper tells us the Seven Countries Study disregarded states with low heart disease and high fat diets. As I see it, this still leaves:
1. In the Seven Countries, there is a positive correlation between high fat and heart disease.
2. High fat/cholesterol is not the principal cause of heart disease.
3. Whatever the real principal cause is, it afflicts the populations of the Seven Countries.
4. When the principal cause is present, high fat/cholesterol exacerbates its effects.

He now admits to high blood cholesterol and an intentionally high fat diet. I deduce that
Either he knows the true principal cause of heart disease, and why he’s safe from it, but he isn’t letting on,
Or he doesn’t appreciate the points above and is inadvertently risking his health,
Or he is deliberately perverse.

Quite separately, I have trouble reconciling his statement that statins are completely ineffective (as supported by Erenard) with Skyesteve’s “the number of heart attacks and strokes in our practice has plummeted … since we started using statins on a widespread basis”.

So, while I could accept The rim groper’s arguments about “side” effects and wrong reporting of statins, I’m wary of accepting his whole story.

Thanks for the apology. I must have seemed a bit prickly and I apologise for being hypersensitive. Of course, the whole point of the report was that it was not the hard data of a fully controlled, double blind research study. The anecdotal accounts were just self-reported experiences. The fundamental question remains: should those anecdotal accounts be ignored because they were not the numbers collected by Pfizer or Merck inspired and funded research? I happen to think that clinicians should not ignore those accounts. They were remarkably congruent and consistent with each other.

What it leaves is a summary of the personal accounts (the soft-edged numbers) and an uncomfortable feeling that adverse reactions are more common than supposed hitherto. The incidence of ALS, for example, is not on all fours with what is known about ALS. The MND association in the UK puts the incidence of ALS/MND at 2 cases per 100,000so 18 cases still looks too high, to my mind. How can we explain the anomaly?

The total of neurological adverse reactions was confirmation that inhibition of Dolichols, Heme A, Coenzyme Q10 and prenylated proteins is not a good thing. The science does not support the notion that cholesterol is the principle actor in cardiovascular disease, and it never did,save in the minds of Ancel Keys and Dr William Kannel.

I would like to commend the work of Professor Bruce Ames and his co-workers to you. His work is illuminating in the field of Mitochondrial oxidative decay and apoptosis. his understanding of Heme A depletion is second to none and it underpins the inability of the cells to derive energy from the food we eat. Low cholesterol predicts higher mortality than high cholesterol.

I have never taken a statin (too long a story for this blog) and I have not yet developed CHD. Of course I avoid visiting my family medical practitioner because he wont like my 8.8 total cholesterol or my mild hypertension nor will he like my high fat, low carbohydrate diet. It has helped me to lose weight without even trying. In turn, I wont be medicated needlessly or because of government targets. Blanket Rx for whole populations is not the practice of medicine but it is most assuredly the practice of the expedient and one would hope that the medical profession is much better than that.

AH: Settle down and stop referring to yourself in the 3rd person.

TRG: Four occurrences of the first person singular.

AH: Pop yourself a statin before you have a heart attack.

TRG: Dear me, what an unpleasant character you are.

Since the elegant and open minded Julie O would like to see my take on ‘vitamins’ I feel obliged to. Here it is, the summary page: www.health-heart.org/simple.htm
For Ben, the science: www.health-heart.org/why.htm and
for anyone’s critique, my take on statins et al:
www.health-heart.org/cholesterol.htm with here JUPITER / rosuva
www.health-heart.org/JUPITER_Table_3_Outcomes.gif
For some hard vitamin benefit: www.health-heart.org/HIPandHOPE.gif
For those curious about my person and record:
www.health-heart.org/author.htm ; Email vos{AT}health-heart.org

This DISTRACTION from the subject at hand was NOT my choice which is why I used a variation of my name.

The name of the website is “Nutrition, Health & Heart Disease; Cause & Prevention”. It is after having looked the matter of ’cause’ for decades that I was forced into dealing with the fallacy of cholesterol.

I’d agree with our host that the ‘supplement business’ is no more ethical than Pharma and they are joined at the hip. ‘Vitamins’ are basically controlled by Bayer, Roche and some other Pharmas, and the Chinese. Micro-nutrients, however, can and do affect ’cause’. Moreover, probably less than 1 American/year dies from the IMproper use of ‘vitamins’ versus 1 each and every 5 minutes in a hospital setting from the PROPER use of drugs [reported JAMA]. Pick your cure, or windmill.

Let’s debate ‘vitamins’ when NOT talking statins. Ben: your next BadScience target has to be that NICE document!

What if the drug company was RIGHT??? I work for a drug company and I know the kind of thing that the MHRA and its sister agencies around the world want us to put on “product labels”. e.g. a certain disease causes some patients dizziness. Some patients with that disease who are taking your product report dizziness in a clinical trial. There’s no evidence that the drug causes the dizziness, the patients would have got it anyway, even if they were on placebo. But the agencies want you to write “MAY CAUSE DIZZINESS – CAUTION: DO NOT DRIVE OR OPERATE MACHINERY… etc.” on your patient information leaflet.

The trouble is, the drug industry is not generally allowed to talk to patients about the benefits of their products. Patients are too stupid to understand, so companies can only talk to doctors about the good stuff. However in the patient leaflet we have to breeze over the potentially life-saving “benefits” section in a trice and then list out a whole range of low level, rare side effects in enormous detail. Knowing the human mind’s capacity for making risk:benefit judgements, that makes all drugs seem so evil that patients who are prescribed them frankly are frightened to take them. That is why a pharma company might have objected to the decision of the agencies.

i’ve had an inkling for a while that you may have experienced personally some of the statin side effects that you mention? The fact that they are rare isn’t any consolation to the people who get them. However being personally affected doesn’t make one the best candidate for appraising their worth.

AH: Settle down and stop referring to yourself in the 3rd person.

TRG: AAAAAAAAAARRRRRRRRRRRRRGGGGGGGGGGGGGGGGHHHHHHHHHHHH GGGGGGGGRRRRRRRRR

AH: Pop yourself a statin before you have a heart attack.

Perhaps you have misunderstood. Every single patient on a statin had experienced side effects. Now we are told that side effects are rare and that serious side effects are very rare. I cite the incidence of amyotrophic lateral sclerosis as 1:200,000 according to the Neurology research paper and in 351 cases there were 18 incidents.

I explained and acknowledged the limitations of an informal report and you seem to have missed that five paragraphs which appeared immediately after the background information.

Notwithstanding that, your comment is unworthy of a clinician, if that is your work: I don’t suppose that 18 people gave themselves ALS in order to become part of a self-selected group for the purpose of completing a survey telling the world how they have developed a progressive and fatal condition.

As for your apology, it is as irrelevant as you so obviously are. These are ordinary people reporting what has happened to them. The report is designed to inform you, not to massage your huge ego and permit you to feel superior to anyone who is not you.

I sincerely hope you that never develop ALS or any other iatrogenic debilitating and progressive disease for that matter and hopefully, you wont hear someone else pass a similar judgement on the rationale with which you would want to inform others.

[deep sigh]

“The report details that 100% of a number of statin users experienced adverse side effects to the point where 61% had to stop the drugs because of the severity of side effects.”

Its not very surprising that 100% of people who have reported side effects have experienced side effects.
Your report seems like alot of anecdotal evidence from a self selecting group. It doesn’t really consitute strong evidence. Sorry.

TRG: do you have any point to make?

BG: i’d be grateful tho if the, er, lengthy frequent posters here could declare themselves properly.

TRG: Had you followed my previous link: files.me.com/jeffcable1/x9fh5b

you would have seen that I have declared myself. Which site rules have I transgressed?

if i was going to write a long tedious article reviewing the academic literature on the effectiveness of statins, rather than a fleeting throwaway comment in a piece about the entirely different and interesting issue of failing to flag up side effects, i wld cheerfully have said that the evidence from subgroup analyses looking only at women is not as persuasive, moreso in results from older trials (iirc), possibly because the numbers of women in statins trials have generally been smaller, possibly because subgroup analyses can just throw up some weird results sometimes (as we’ve seen in previous columns), and possibly because women’s bodies respond to these drugs in a completely different way to men, which is possible, although that doesn’t seem hugely likely. but it’s certainly possible.

relevant background here is that these are preventive drugs, preventing events that for each individual in each year are mercifully pretty rare, so the figures on deaths and heart attacks prevented will always feel thin, as i wrote about, eg in my piece on the way the benefits were overhyped in the JUPITER trial. everyone has to decide for themselves if they want to go through the bother of taking a pill every day that might make these fairly rare events a little rarer still, we’ll all have our own reasoning there, i don’t give readers health advice.

i’d be grateful tho if the, er, lengthy frequent posters here could declare themselves properly. At least one of you has a very colourful website about the magical healing power of vitamin pills which i think everyone here would like to see. do post a link to it, please, and respect the rules of the site, which are pretty friendly and reasonable. cheers.

You have raised questions and yet you have not returned to the debate you opened. IDo you have a problem with people not sharing your viewpoint?

Amyotrophic lateral sclerosis features in 18 reports among 351 people. The incidence is put at 1:200,000 according to the literature and this anomaly is not explained. A further 11 cases of progressive neurodegenerative conditions were also found in this small participant group which included Parkinson’s disease, Alzheimer’s Disease, Progressive Supra-nuclear Palsy and Chronic Inflammatory Demyelinating Polyneuropathy.

Only clinicians will be able to decide on the value of this information and the implications for public health

Download the report from this link: files.me.com/jeffcable1/x9fh5b

For the science of this ‘nitroglycerin puffer’ NO effect, try this:
Rikitake Y, Liao JK. Rho GTPases, statins, and nitric oxide. Circ Res. 2005 Dec 9;97(12):1232-5.
www.ncbi.nlm.nih.gov/pmc/articles/PMC2633589/?tool=pubmed
or
Laufs U. Beyond lipid-lowering: effects of statins on endothelial nitric oxide. Eur J Clin Pharmacol. 2003 Mar;58(11):719-31. Medline 12634978

I quote: Therefore, the ability of statins to improve endothelial function through the release of NO may partially account for their beneficial effects at reducing the incidence of cardiovascular events. These effects are real, unquantified and statins are not indicated to affect NO production; there are other, safer and more targeted pathways for that.

This reality is something terrible to contemplate for those having hitched their reputations to the “cholesterol is evil and must be reduced at all cost” bandwagon.

Strangely, the blog owner, psychiatrist Dr. Ben has remained quiet in this topic. Why not deal with NICE as a BadScience issue? If that is because he does not understand their “Bayesian statistics”, I don’t blame him: nobody does! Why not simply count the tombstones?

www.nhsemployers.org/Aboutus/Publications/Documents/QOF_Guidance_2009_final.pdf

Remember this is only part of the way in which GPs earn money and, with each QOF point earning £110, for most GPs this amounts to betweem 10 and 20% of total practice earnings (out of which they don’t just pay themselves but they also pay their reception staff, medical secretaries, practice nurses, managers, energy bills, maintenance costs, etc., etc.). I belive QOF has led to improved quality of care, at least here in Scotland.
As you can see from the QOF document only one indicator in the CHD domain, CHD8, mentions a cholesterol target. None of the indicators mention statins at all. Again in the stroke domain a cholesterol target appears in one indicator, stroke 8, and their is no mention of statin anywhere. The only other domain where a cholesterol target is mentioned is in diabetes, DM17 but again statins are not mentioned anywhere. There is no mention of cholesterol targets in any of the other “cardiovascular” domains (primary prevention, hypertension, heart failure, atrial fibrillation and chronic kidney disease) and no mention of statins anywhere!
GPs therefore do not get paid for prescribing statins. You could argue that they do get paid for chasing cholesterol targets but the amounts are trivial (perhaps about £200 per GP per annum) and, in many cases, we actually cho0se not to chase the target.
I’ve read Gary Taubin’s book too and I do buy a lot of what he says. He’s right about selective evidence use. He’s right about the epidemic of sugar and refined carbohydrates in our diet. It’s been a year since I read it and it’s now with someone else but am I wrong in thinking that even he suggested a high LDL count was not a good thing? Is that true? And, if so, do statins help reduce LDL levels?

That leaves your question of morbidity, i.e. illness. Yes, statins reduce angina [proved Lipitor's ASCOT study], as does nitroglycerin. Stable angina is ‘morbidity’ as is knee pain. Statins reduce the interventions that may well be driven by ‘innocent angina pain’. Don’t get me wrong: UNSTABLE angina [a unique pain sometimes increasing over days and not normally experienced] is dangerous and warrants an IMMEDIATE hospital visit but that is, in my appreciation of the data, NOT the kind prevented by a statin.

The problem with NICE is that they don’t tell how many of a certain group and gender have to take statin to prevent one of what ‘event’. Moreover, there are at least 5 kinds of heart attacks, some silent, some not so much and the way studies are presented do not to help here. [ASCOT found no drop in 'silent', hospital detectable, heart attacks].

So, to finally answer your question: no I don’t think in secondary prevention statins are worthwhile in women.

They have untold and unknown side effects and distract from and ‘unmotivate’ people to deal with the REAL causes of arterial decline, heart attacks and heart failure. As says the American TV ad: “Now, I trust my heart to Lipitor”, removing the motivation to deal with harder to swallow changes. THAT is a never quantified side effect of statins but possibly one of the more serious ones.

Yes, your theory two is correct. I am obviously a fanatic. On the other hand, should you want to debate the science I am quite happy to do that.

The issue is rather larger than a few hastily penned lines on a blog will address. NICE is just one tiny aspect of a much larger issue. The blog is entitled ‘Bad Science’ and the cholesterol/heart disease hypothesis IS bad science.

The hypothesis was falsified from day one by its chief proponent. Ancel Keys claimed in his Seven Countries study that high cholesterol and heart disease were linked and his study was supposed to represent the vital evidence. The study excluded all of the countries which had populations that ate high fat diets and low rates of heart disease.

The hypothesis does not even stand up to a superficial examination. If high fat diets cause high cholesterol, which in turn is supposed to cause heart disease, then how can the countries where a high fat diet is the norm, have low rates of heart disease?

The director of the Framingham study, Dr William Kannel, stated publicly: “Framingham – Although there is no discernible relationship between reported diet
intake and serum cholesterol levels in the Framingham Diet Study Group, it is incorrect to interpret this finding to mean that diet has no connection with blood cholesterol.”

Two mutually exclusive clauses are used. Either there was a discernible relationship or there was not. I can assure you that if you were to eat 8 eggs a day for a month, the effect on your serum cholesterol level will be negligible, yet Framingham underpins the present day UK policy on the treatment of cholesterol. Please explain how that is good science.

Statins inhibit the biosynthesis of cholesterol within the mevalonate metabolic pathway. Statins also inhibit the biosynthesis of Heme A which has nothing to do with cholesterol production. Statins inhibit the biosynthesis of Coenzyme Q10, which also has nothing to do with cholesterol production. Statins inhibit the biosynthesis of Dolichols, which have nothing to do with cholesterol production. statins inhibit the biosynthesis of prenylated proteins, which has nothing to do with cholesterol production.

None of the other products mentioned has any role in the production of cholesterol and their roles are not subsidiary to cholesterol but just as vital. This game of treating cholesterol levels is wanting for the lack of logic. Hey, your cholesterol level is now great… sorry that the statins have induced programmed cell death, that your cells cannot derive energy from the food you eat, that cell communication is chaotic and that you cannot now make sufficient myelin to protect your neurological tissue.

Most of the body’s cholesterol is found in the brain… perhaps because it serves no useful purpose. Your body controls your cholesterol level regardless of your diet. Why would it do that? Hasn’t your body heard that cholesterol is bad for you?

Absolutely no-one has died, because they did not have enough statins sloshing about in their body. If you are seriously interested in learning more, you can scribble your e-mail address here… in a form that wont attract spam senders and net spiders and I will send you a very recent report.

The report details that 100% of a number of statin users experienced adverse side effects to the point where 61% had to stop the drugs because of the severity of side effects. It also states that the number of patients who developed a serious neurodegenerative disorder was astonishingly high for the selected sample. 1:200,000 is the incidence rate of amyotrophic lateral sclerosis, for example. there were 18 cases in less than 400 people. Please explain that coincidence to me

As to the situation with money being more important than healthcare, If you cannot see anything wrong with the manufacturers of drugs sponsoring drug efficacy studies and publishing the findings themselves, then I don’t much chance of forward movement. Do you recall Elsevier being caught red-handed? They had published several fake medical journals in an effort to stimulate the sales of pharmaceuticals.

Where the drug companies are invited to help determine prescribing policies for their own products, then the opportunities for a corrupt manipulation are legion and the drug companies are not shy about taking them. They have more money to throw at marketing than would equate to the GDP of several countries.

Merck’s own patent called for the addition of CoQ10 to their product and it was patented 20 years ago. Why is it not a routine practice? More appropriately, what was the damage that Merck wanted to ameliorate? Myopathy is the correct answer. You should read: United States Patent 4,933,165 Coenzyme Q10 with HMG-COA Reductase Inhibitors, June 12th 1990

Remember that CoQ10 is one of the processes, which I mentioned earlier, that is inhibited by statins. It is certain that Merck knew that would be one effect of statins.

Money and UK medicine? Look up the department of health stats for QOF payments, both for the cardiac domain and all domains and see how much extra cash a GP practice can make if it meets targets. Examine the drug company funded research projects in the UK.

Yes. I am a fanatic and I make no apology for making every possible effort and taking every opportunity to prevent iatrogenic harm to patients.