There are, to my mind, two camps of doctors in terms of their attitude to statins. Some maintain these drugs are ‘highly effective’ and very safe (and might even be put in the water supply). Others (who bother to look objectively at the research) tell us that statins only help a small minority of people who take them, and have potential harms that are real but underplayed by statin proponents.
Well, some prominent doctors in the latter camp came out swinging recently in the form of a letter they have written to the National Institute of Health and Clinical Excellence (NICE – a body in the UK that sets healthcare policy and is considering recommending much wider the use of statins in people who are well).
The doctors raise a number of concerns about the planned expansion of statin prescribing and the evidence on which this mooted recommendation is based. The authors raise six major issues:
1. The medicalization of millions of healthy individuals
NICE is suggesting we treat ever more people who are healthy. The problem is, in healthy individuals with no evidence of cardiovascular disease, the benefits of statins are vanishingly small, though the hazards are real and significant.
2. Conflicting levels of adverse events
Many ‘experts’ claim that trials show statins rarely cause problems. Actually, there are many reasons why trials can simple missed harms (like screening out people who are intolerant to statins before the study starts or recognising harms once there is extreme derangement in blood values)
3. Hidden data
The Cholesterol Treatment Trialists’ Collaboration (CTT) regularly makes very pro-statin pronouncements based on the ‘evidence’ from trials given to them by drug companies. The problem is, no one is allowed to take a look at this data to verify it and assess its accuracy.
4. Industry bias
It is well recognised that industry funded studies tend to report more benefits and fewer harms than independently funded studies. The problem is, almost all the statin studies are industry-funded and subject to this bias.
5. Loss of professional confidence
There is opposition to the proposed changes to the guidelines from within the medical profession. Apparently, the British Medical Association General Practitioners Committee, has recently decided that: ‘[it] will request that NICE refrain from recommending a reduction to the current treatment threshold for primary prevention of cardiovascular disease with statin therapy, unless this is supported by evidence derived from complete public disclosure of all clinical trials’ data’.
But I think there’s another crisis of confidence here, concerning the professional standing and trustworthiness of doctors in their patients’ eyes. The public is gradually wising up to the fact that statins are virtually useless for the vast majority of people who take them, and also have significant risks. You can imagine that a doctor making a case for these drugs can quite easily look ill-informed, biased or just plain stupid in the eyes of their patients.
6. Conflicts of interest
These are rife. They exist in those who conduct the statin studies, but even affect the majority of people who sit on the NICE committee due to make a decision about widening statin prescribing.
The letter comes from a group of doctors, some of whom might be regarded as ‘heavy weights’ in the medical arena, including the President of the Royal College of Physicians and a past chair of the Royal College of General Practitioners. Here’s a full list of the signatories:
Sir Richard Thompson, President of the Royal College of Physicians
Professor Clare Gerada, Past Chair of the Royal College of General Practitioners and Chair of NHS Clinical Transformation Board
Professor David Haslam, General Practitioner and Chair of the National Obesity Forum
Dr J S Bamrah, Consultant Psychiatrist and Medical Director of Manchester Mental Health and Social Care Trust
Dr Malcolm Kendrick, General Practitioner
Dr Simon Poole, General Practitioner
David Newman, Director of Clinical Research, Dept of Emergency Medicine, Icahn School of Medicine at Mt Sinai, New York
Here’s a quote from one of the letter’s signatories Dr David Newman, Assistant Professor of Emergency Medicine and Director of clinical research at Mount Sinai School of medicine in New York:
I am always embarrassed when I have to tell patients that our treatment guidelines were written by a panel filled with people who stood to gain financially from their decisions. The UK certainly appears to be no different to that of the United States. The truth is for most people at low risk of cardiovascular disease a statin will give them diabetes as often as it will prevent a non fatal heart attack—and they won’t live any longer taking the pill. That’s not what patients are looking for.
Sums it up nicely, I reckon.
Dr Briffa you can add this one to the list also.
http://www.telegraph.co.uk/health/healthnews/10900296/Evidence-for-NHS-statins-advice-wholly-inadequate-says-expert.html
Thanks,
Bill.
Didn’t check to see if this person was part of the group you mentioned, apologies if he is.
Drug manufacturers possibly are in a hurry to recommend statins for nearly everybody now, because novel drugs, different from statins, as for instance this one that lowers LDL cholesterol are fast approaching
http://www.hcplive.com/articles/Novel-Drug-Lowers-Cholesterol-in-Patients-with-Type-2-Diabetes-
and-Hypercholesterolemia
5. Loss of professional confidence
My partner and I said ‘no to statins’ at our recent health checks. We have lost confidence in our doctors and now my partner wants to give up his blood pressure medication. He feels completely isolated and cannot believe what the doctors say. We don’t know what constitutes high blood pressure any more, the definition keeps changing. We know it’s a good money maker for Big Pharma and we don’t know who to turn to.
Dr Briffa, we have been following you in the BMJ. Fantastic work! Thank you.
Lesley,
a book by Craig Cooney and Bill Lawson may interest you. It’s called ‘Methyl Magic’. The book would have been a landmark publication in 1999. The core themes still hold good, whilst additional understanding has emerged in the intervening years. I think you would like.
The books title may sound a bit technical and off-putting but it is nonetheless quite readable. Something about the books prescription is that levels of something called homocysteine are more of a risk factor for heart disease than is cholesterol — and that should come as no surprise because cholesterol is very poor indicator for risk of heart disease. Cooney also claims that ‘methyl magic’ can reduce blood pressure. So what is ‘methyl magic’?
Billions of times every second biochemicals within you are interacting. These interactions are bit like debits and credits in book-keeping. The dealings are called oxidation and reduction, or ‘redox’ to sound hip. Think of it as if a large molecule of something or other must be progressively dismantled to release energy. It controlled burning of fuel, if you like. Many of these dealings result in what’s called reactive oxygen species, and these morsels must be rendered less reactive and damaging. It is a relentless game of goodies and baddies if you will.
Reactive oxygen species are rendered harmless by antioxidants, and there are four leading ways in which this can be done. ‘Methylation’ is prominent amongst the four.
The magic of methylation describes a process whereby an antioxidant that can spare a methyl (CH3) group donates it to a reactive oxygen species. The other name for a reactive oxygen species is free-radical. The good molecule hands over a CH3 group to the bad molecule and the bad molecule is placated.
Methyl magic is a delicate and important balance. If enough methyl donating antioxidants are supplied by diet and/or by supplements such that all the free-radicals can be neutralised then wellness is a prospect that may be preserved. But if some reactive oxygen radicals are not neutralised and get to persist then over time there will be additional wear and tear going on inside the body; the body ages faster and may trend away from wellness and towards chronic disease. One indication of methylation not working all the magic it should is a rise in levels of homocysteine.
In terms an average reader could follow Cooney explains how to restore and maintain methyl magic — which in turn is a positive step to preserve good health and deter ageing. Many a GP would be wiser for reading the book, and even the good people at NICE, I think.
Finally, I don’t think Cooneys advice upon saturated fats is as sound as it could be. Basically no evidence backs the notion that fat is ‘bad’ so there is no reason not to include it in the diet, having sufficient fat in the diet is another way to diminish levels of oxidative stress.
Thank you so much Christopher for taking the time to reply. We have looked for the book you recommend and second-hand it’s outrageously expensive. Using information from lots of different sources it’s now much more possible to take responsible for our own health. That seems to be what we do on these blogs, with the help of a few people we trust.
I agree on the price, Lesley! I think I managed to source from the only supplier who listed a copy at a readable price — which is why I snapped it up!
‘The Homocysteine Solution’ (Holford & Braley) might be a more affordable option. It has advantages of being written more recently and more in keeping with the average readers needs.
It is worth remembering that local lending libraries accept lender requests. It’s been my experience that they’ll often buy-into-service something that has pertinence to lenders needs. They might see Methyl Magic as being a bit special. The other service to think about is ILL.
ILL stands for inter-library-loan. So if a book is not is not in service, and if its not one they might ordinarily buy in, they search library services in other areas, and can make copies available for payment of a fee (£3.00 last time in my case).
Dear Lesley,
In light that blood pressure guidelines approx 40 years ago used to be 100 plus your age, and that this guideline has been steadily changed (downward) by people most of whom have direct financial to gain if you take the medication, I would strongly suggest two resources:
Utube video called: The TRUTH about high blood pressure and cholesterol…it’s apprx 45 minutes long: http://www.youtube.com/watch?v=PXe2xldWxtY . It talks about blood pressure being an adaptive function in your body, so if your kidneys are pumping more toxic blood, it may need to pump harder…if you are exercising blood pressure is higher; also Germans believe that treatement is needed to raise blood pressure if it is 140 or below.
Another utube video to review 7.2 minutes long: Death by Medicine by Dr. Joseph Mercola: http://www.youtube.com/watch?v=K7_e_4AOsFo. Visit his website at Mercola.com.
An excellent and informative book to read: http://www.amazon.com/Selling-Sickness-Pharmaceutical-Companies-Patients/dp/156025856X. It is about how target numbers are lowered every few years to obtain more customers.
The reason why I strongly recommend these sources is because I started taking high blood pressure medications and had the following side effects: blurry vision, high blood sugar, constant thirst, DIABETES (switched to another bp med):, heart palpitations, cold extremities, hair loss, muscular pain (could not sit still for more than 30 minutes without increasing pain), joint pain, arthritis, sleeping problems, constant nasal drip, extreme hot flashes.
My blood sugar average was clocked at 503…I kept forgetting to take the high blood pressure medication and it came down to 145, got off of the diabetic medicine and it fell further to 142. I’m DONE with “preventative” care medications which need to be taken for the rest of your life!!!
As I recall, prior to being diagnosed with very high blood pressure, I had been on cold medicines, and lack of exercise. Cold medicines are toxic to the body, and perhaps this is why my kidneys were working harder. My current Blood pressure readings without medications are fine between 124 – 148 (often within the same 10 seconds of a reading).
Let me know if this helps. Best of health to you.
Thank you Karen. I just love You-tube too. I have watched your links and here is another for anyone out there with high blood pressure:
http://www.youtube.com/watch?v=h0w7buQrnAw
My partner is monitoring his blood pressure several times a day while he is experimenting with his medication. When we are told by the medical profession “it’s dangerous to stop taking them”, I don’t know what to believe, but it’s worrying me.
The good news is that I have been on a ‘low-carb high fat’ diet for a while now and my health has dramatically improved. Since I was a child I have had problems with asthma and allergies and the summer is a serious problem for me. But this summer I haven’t had hay fever – it’s quite extraordinary! A few days ago I ran out of my Qvar inhaler and haven’t asked for another prescription. It’s a preventative medication for asthma and I hope I don’t regret that decision. Hay fever is the major trigger for my asthma. I’m hoping the absence of hay fever will make my asthma inhaler redundant.
During the last few weeks I have become interested in improving my gut flora by eating fermented food and this week I have taken to grounding myself with an earthing mat. Here is another great You-tube link:
http://www.youtube.com/watch?v=11PC8AFrh5w
Taking responsibility for our own health is great, isn’t it!
With regard to high blood pressure I’d like to find out more about the German way of doing things.
Thank you so much for your help Karen.
I have long been persuaded that the research information should be fully available and cover truly random populations so that we can assess harms as well as benefits. I can also see that it is in the interests of pharmaceutical companies to medicalise as much of the population as possible. So on balance, I am sympathetic to the points made in this blog.
I just wonder whether you have read David Aaronovitch’s article in today’s Times, in which he accuses the signatories of this letter of taking an ideological position rather than a reasoned one and whether you have a response….
This article can be viewed by subscription only. However, the initial paragraph contains the following premise:
“For those who don’t know, statins work by reducing the production of a substance in the liver (LDL or “bad cholesterol”) that can block arteries or cause clots…”
Doesn’t inspire spending a pound to read the rest.
Regarding Dr. Newman’s quote: Does he insist on his patient’s following the guidelines even though he apparently does not agree with them?
When are more doctors going to push back against these extremely conflicted “guidelines?” Embarrassment is not enough. I want to be able to trust my doctor’s judgement about my medical care and not have to worry about what is driving the recommendations!
Please, excuse me Dr Briffa, for the comments shown above.
Here is the study
http://www.ncbi.nlm.nih.gov/pubmed/24385236
Regards
I think, also, the more we medicalise the healthy population, the more people will come to expect a ‘pill for all ills’. This can only eventually lead to a complete abdication of responsibility by the patient for their own health. That would be great for the pharmaceutical companies but not the NHS.
Dr Briffa, thank goodness for the few voices raised in protest, we can only hope they will be
heard Internationally as well is in the UK..
The Public in general I think are better informed and quite wary now, in contrast to 20 Years ago.
Dr Newman has assessed the likely reaction of patients very well .
That wont stop the vested interests from trying though, hopefully they wont succeed in the
latest outrage…
I too have written to NICE with examples of flawed research on which the current guidelines on CVD are based. I was told that I should join a “stakeholder group”. Investigating this showed that Big Pharma companies and charities (often beholden to business for donations) were mostly stakeholders – hardly my cup of tea. Then the membership of the NICE committee responsible for the proposals was released and the majority of the members were Big Pharma KOLs. One suspects that the non-KOL members were probably aspiring to that status!
From Dave Aaronovitch’s piece in the Times:
“At midday yesterday, in the middle of writing this, I took a break and walked down the hill to the GP’s surgery to pick up my prescription — two drugs for hypertension and one for cholesterol. The last is a statin and if the National Institute for Health and Care Excellence (Nice) maintains its present stance many more of you will join me in popping one of these little fellows every night.”
Dave and I were friends at university. If even such a clear-thinking bloke can be taken in by the statination propaganda, then the “evidence-based medicine” approach has been hijacked very successfully indeed! He’s based his ideas on what’s come out of the “official” trials, without ever investigating the kludged results. Pity his article’s behind the Times paywall…
I wonder how many doctors realise just how statins work (blocking the mevalonate pathway) and just how many crucial reactions in the body are consequently hampered. If they did, would they still be happy prescribing them?
When it comes to over-prescription are Statins the new antibiotics? I am not a doctor and leave myself open to attack by those whose knowledge s greater than my own but I was always led to believe that Statins were prescribed to those with high cholesterol; given this, if a person had CVD disease but normal to low cholesterol, why would a Statin be prescribed? Surely this is treating something the patient doesn’t have! Am I wrong to believe this?
The statin debate and their associated side effects is almost the secondary discussion and we sometimes lose sight of that. Take a drug blocking the mevalonate pathway and the only surprise is why anyone would be surprised when people start suffering nasty adverse effects.
The primary topic for discussion is why would anyone want to reduce their cholesterol levels anyway? I don’t think that’s a particularly controversial statement anymore based on (certainly) primary prevention studies and in the case of secondary prevention, the suspected (anti-inflammatory) method of statin’s action. However, if we start going down that discussion route, the “whole fat in the diet is bad for you” argument begins to unravel.
What real evidence is there that high cholesterol is a problem (or LDL, which is what is actually measured) when it is people with low cholesterol who have a higher mortality rate. Older people, especially women, seem to thrive better on high cholesterol than low.
In 1990 Merck took out 2 patents for a pill combining a statin and Q10 (vital for cell function) which they never acted on. Blocking cholesterol with statins also blocks the production of Q10.
Why did they take out this patent then not act on it?
I think you have other supporters with this and similar. Over the years looking at media I’ve seen somewhat similar mentions as in this article. There was one physician comment show recently were after watching I formed the opinion that a doctor was reading your sight Dr. Briffa. Few things bring out the hateful passion in the elites than the lipid theory I’ve found though. Positive change in this area is a tough nut to crack.
I hope statins are not added to the water supply!
I would be terrified if we reached a position where statins could be put in the water supply!
You wrote in an earlier piece, “doctors cannot force patients to take medication they do not want to take”. Actually this is exactly what is happening with fluoridation of water (it isn’t the doctors made this happen). All the same arguments apply. A dubious benefit for a small percentage of the population (who would be better off if they cleaned their teeth and gave up sweet drinks) with detriiments to everyone. Thyroid function is depressed by take up of fluorine reducing take up of iodine. Fluorine is a neurotoxin and can cause dementia (it has a synergenistic effect with aluminium which many people have in their bodies from some deoderants). My water filter does not remove fluoride so I’m left with the expensive option of putting in a new system to avoid it.
The choice of the individual to protect their health seems to be under threat.
Best wishes
Jackie
Jackie, why worry about the aluminium you’re spraying under your armpit when you happily allow your doctor to inject your veins with aluminium hydroxide each time you have for example, a tetanus jab?