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  #1   ^
Old Tue, Jul-25-17, 05:40
JEY100's Avatar
JEY100 JEY100 is online now
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Default CardioBrief: Statin Denialism Is 'A Deadly Internet-Driven Cult'

Blistering attack from Dr Steve Nissan on MedPage:

Quote:
CardioBrief: Statin Denialism Is 'A Deadly Internet-Driven Cult'

Steve Nissen says the battle for patients' hearts and minds is being lost

by Larry Husten, CardioBrief
July 24, 2017

A leading cardiologist has unleashed a blistering attack on "statin denial," which he calls "an internet-driven cult with deadly consequences."

In an editorial in Annals of Internal Medicine**, Steve Nissen (Cleveland Clinic) expressed grave concerns over statistics showing that only 61% of people given a prescription for a statin were adherent at 3 months. "For a treatment with such well- documented morbidity and mortality benefits, these adherence rates are shockingly low. Why?" he asks.

Nissen writes that "we are losing the battle for the hearts and minds of our patients to Web sites developed by people with little or no scientific expertise, who often pedal 'natural' or 'drug-free' remedies for elevated cholesterol levels." The anti-statin forces employ two distinct strategies, "statin denial, the proposition that cholesterol is not related to heart disease, and statin fear, the notion that lowering serum cholesterol levels will cause serious adverse effects." Nissen admits that some patients will have statin-related adverse effects but "intolerance in many patients undoubtedly represents the nocebo effect."

Outcomes After Adverse Reactions
The editorial accompanies a study from Brigham and Women's Hospital looking at what happened to 28,266 people who reported an adverse reaction to statin therapy. 70.7% continued to receive statin prescriptions after reporting the adverse reaction. After 4 years, the rate of cardiovascular events was 12.2% in those who continued to receive statin prescriptions versus 13.9% in those who did not.

"Statins remain a first-line therapy for managing cardiovascular risk, but many patients do not reattempt statin therapy and remain without treatment for prolonged periods after an adverse reaction," said Alexander Turchin, senior author of the paper, in a press release. "Alternative therapies such as ezetimibe are not as effective, and new classes of drugs are expensive. Improving our understanding of the benefits and risks of reattempting statin therapies before switching to a different class of drugs could help both patients and physicians make informed choices about care."

The authors acknowledged that, because it was a retrospective study, they "could establish only associations rather than causal relationships." In his editorial, Nissen acknowledged these limitations but said the study is "reasonably convincing: Discontinuing statin treatment has serious negative consequences."

How Did We Get Here?
Nissen placed a substantial portion of the blame for statin denialism on the Dietary Supplement Health and Education Act of 1994, which loosened regulation of dietary supplements, spurring what is now a $30 billion a year industry selling an "array of worthless or harmful dietary supplements." According to Nissen, supplement makers "commonly imply benefits that have never been confirmed in formal clinical studies." Nissen singled out "The Dr. Oz Show" for an article, "Reverse Your Heart Disease in 28 Days," that didn't mention statins but instead focused on the Ornish lifestyle-based approach.
Responding to email questions, Nissen defended the use of statins in primary prevention, writing "we have abundant scientific evidence demonstrating that treatment of high risk primary prevention patients substantially reduces the risk of cardiovascular morbidity."

Nissen acknowledged that statins, like other drugs, have adverse effects, "but the benefits are so well documented that every effort should be made to encourage use of these drugs in appropriate patients. The diversion of patients away from evidence-based therapy by advocates of unproven dietary supplements must be vigorously opposed by physician-scientists. Similarly, the claims that cult diets can reverse heart disease have no scientific basis and represent a danger to public health."
Asked to comment on the papers, James Stein (University of Wisconsin) expressed strong support for Nissen's editorial: "I have scores of patients who stop their statins based on fears that mainly come from the internet, though I have to say, 'friends,' pharmacists, and many primary care docs play into the fears. We spend a lot of time trying to sort out various aches and pains, non-specific symptoms, and anxieties that are not due to statins. Many lives have been lost or impaired because of statin non-compliance. There is a special place in hell for people who use fear tactics and misinformation to promote books and natural health aids, including crazy diets, at the expense of proven medical therapies, rather than as complimentary options under medical direction. I am not sure why Americans are so susceptible to these charlatans."



No holds barred, coming right after the Coconut Oil will Kill You AHA advisory and its Internet response. Though notably, in this excerpt, only Dr. Oz and Dean Ornish are named.

Also interesting is the fact that Dr. Mark Hyman heads Cleveland Clinic's Center for Functional Medicine. Guess they don't eat lunch together.

https://my.clevelandclinic.org/depa...tional-medicine

http://drhyman.com/blog/category/he.../heart-disease/



**The Annuals of Internal Medicine is also subscription, so until it shows up somewhere, the full version is here only if a subscriber.
http://annals.org/aim/article/26455...ly-consequences

Last edited by JEY100 : Tue, Jul-25-17 at 06:19.
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  #2   ^
Old Tue, Jul-25-17, 06:29
cotonpal's Avatar
cotonpal cotonpal is online now
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Quote:
Originally Posted by JEY100
Also interesting is the fact that Dr. Mark Hyman heads Cleveland Clinic's Center for Functional Medicine. Guess they don't eat lunch together.

https://my.clevelandclinic.org/depa...tional-medicine

http://drhyman.com/blog/category/he.../heart-disease/



Wow! Mark Hyman must be a brave man, working among the hyenas.

Jean
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  #3   ^
Old Tue, Jul-25-17, 09:26
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deirdra deirdra is offline
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Actually is is quite common for one institution to have doctors and professors at both ends of the spectrum. That is why I hate it when journalists say things like "Harvard" says this or that.

Last edited by deirdra : Tue, Jul-25-17 at 09:33.
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  #4   ^
Old Tue, Jul-25-17, 10:36
teaser's Avatar
teaser teaser is online now
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Default

Quote:
Nissen acknowledged that statins, like other drugs, have adverse effects, "but the benefits are so well documented that every effort should be made to encourage use of these drugs in appropriate patients. The diversion of patients away from evidence-based therapy by advocates of unproven dietary supplements must be vigorously opposed by physician-scientists. Similarly, the claims that cult diets can reverse heart disease have no scientific basis and represent a danger to public health."


Here's the risk; that people will take the small protection that statins provide vs heart disease as seriously as the medical profession does. I have friends that think the statins they take will somewhat offset the risks posed by their smoking.

There are lots of quack therapies out there, I don't think you can blame them for people's distrust of statins. More like distrust of statins and the medical community drives people to alternatives.

Quote:
After 4 years, the rate of cardiovascular events was 12.2% in those who continued to receive statin prescriptions versus 13.9% in those who did not.


Is it shocking if adherence to a drug is low when even if you're in the small percentage of people whose life it may have saved, there's no way for you to ever know it?
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  #5   ^
Old Tue, Jul-25-17, 10:46
JLx's Avatar
JLx JLx is offline
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I wonder how Dr. Ornish liked having his regimen described as a "cult diet"?

Pleased to see that most of the comments have not been in support of Dr. Nissan.
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  #6   ^
Old Tue, Jul-25-17, 17:42
Zei Zei is offline
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About supposed benefits of statins being so well documented, no. Even the quote by this author, around twelve versus thirteen percent difference, that's only slightly over one percent statistically better. In exchange for some nasty potential side effects considering statins target the mevalonate pathway which is pretty critical for a lot of life functions beyond having nicer looking numbers on a cholesterol test which may not even translate to reduced risk. I've taken a look at the evidence supposedly proving these great statin benefits and found what I've seen pretty unconvincing. Just statistical manipulations using "relative" rather than "absolute" statistical risk to inflate claimed benefits which are, as the author himself quoted, pretty small. I personally am of the opinion any (slight) benefit to statins comes from their anti-inflammatory effect and that cholesterol lowering is just a side effect which probably doesn't reduce heart attack risk. And there are a lot safer kinds of anti-inflammatory items out there if reduction of inflammation (which I personally think likely does positively affect heart disease) is the goal.
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  #7   ^
Old Wed, Jul-26-17, 03:37
JEY100's Avatar
JEY100 JEY100 is online now
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This study, published in April, is in one of the rebuttal comments.


Quote:
RECENT FLAWS IN EVIDENCE BASED MEDICINE: STATIN EFFECTS IN PRIMARY PREVENTION AND CONSEQUENCES OF SUSPENDING THE TREATMENT.
Mikael Rabaeus, Paul V Nguyen, Michel de Lorgeril

Abstract


Statin therapy is presented as a protection against ischemic heart disease (IHD) complications. As IHD is often a fatal disease, statins are thereby supposed to decrease cardiovascular mortality and increase life expectancy. However, these benefits are increasingly challenged in the medical community, the controversy being particularly intense when discussing the effects of statins in primary prevention and the consequences of statin discontinuation. Both primary prevention and treatment discontinuation have been recently used by investigators linked to the pharmaceutical industry to justify and boost prescription and consumption of statins and other cholesterol-lowering medications. We herein review some recent commercial data related to primary prevention with rosuvastatin and statin discontinuation and their respective effects on IHD and overall mortality rate.

We conclude that
(1) despite the recent hype raised by HOPE-3, the cholesterol-lowering rosuvastatin is likely not beneficial in intermediate-risk individuals without cardiovascular disease (primary prevention). This trial may even represent a typical example of how evidence-based medicine has been flawed in commercial studies.
(2) Statin discontinuation does not lead to increased IHD and overall mortality, at least in the months following interruption of treatment. On the contrary, one might even conclude that statin discontinuation could save lives. One possible explanation of this apparently paradoxical finding is that statin discontinuers, in the same time they stop statin therapy, likely try to adopt a healthy lifestyle. Further studies are needed to confirm the real effects of statin discontinuation in various clinical conditions. In the meantime, it is not evidence based to claim that statin discontinuation increases mortality or saves lives.


teaser, if your friends stopped statins, might they adopt a healthier lifestyle and stop smoking? Might be interesting if doctors framed it that way. Take this medication with side effects or clean up your diet?

http://jcbmr.com/index.php/jcbmr/article/view/18/36

Last edited by JEY100 : Wed, Jul-26-17 at 03:59.
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  #8   ^
Old Thu, Jul-27-17, 03:06
JEY100's Avatar
JEY100 JEY100 is online now
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Default

Amazing brave blog post by Dr Jason Fung on the Corruption of Academic Medicine, specifically calling out Dr Nissen on his Conflicts of Interest and the fear-mongering title of his editorial.

https://intensivedietarymanagement....demic-medicine/

Long blog post with eye-opening graphs about payments and the study showing a decrease in deaths since 50% discontinuation of statins at link.
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  #9   ^
Old Thu, Jul-27-17, 03:25
cotonpal's Avatar
cotonpal cotonpal is online now
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Quote:
Originally Posted by JEY100
Amazing brave blog post by Dr Jason Fung on the Corruption of Academic Medicine, specifically calling out Dr Nissen on his Conflicts of Interest and the fear-mongering title of his editorial.

https://intensivedietarymanagement....demic-medicine/

Long blog post with eye-opening graphs about payments and the study showing a decrease in deaths since 50% discontinuation of statins at link.


Dr Fung is indeed brave. Amazing article.

Jean
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  #10   ^
Old Thu, Jul-27-17, 04:09
JEY100's Avatar
JEY100 JEY100 is online now
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Plan: IF Fung/LC Westman/Primal
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Default

These recent fear-mongering titles are good for another reason..it has brought out the best of the LC humorists. Tom Naughton has been busy on his new movie, kids book and the farm, but he's back writing again to address scourge of cults in nutrition and medical advice.

I Admit It: I'm a Member of the Cult.

http://www.fathead-movie.com/index....er-of-the-cult/

Add this to Sears Coconut Oil Kills video, https://www.dietdoctor.com/will-coconut-oil-kill , and even big Pharma with all their millions in marketing budget are going to have a hard time capturing "our hearts and minds" (was anyone else creeped out by that comment?...this about our compliant use of drugs?)

Last edited by JEY100 : Thu, Jul-27-17 at 04:17.
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  #11   ^
Old Thu, Jul-27-17, 04:21
cotonpal's Avatar
cotonpal cotonpal is online now
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Quote:
Originally Posted by JEY100
These recent fear-mongering titles are good for another reason..it has brought out the best of the LC humorists. Tom Naughton has been busy on his new movie, kids book and the farm, but he's back writing again to address scourge of cults in nutrition and medical advice.

I Admit It: I'm a Member of the Cult.

http://www.fathead-movie.com/index....er-of-the-cult/

Add this to Sears Coconut Oil Kills video, https://www.dietdoctor.com/will-coconut-oil-kill , and even big Pharma with all their millions in marketing budget are going to have a hard time capturing "our hearts and minds" (was anyone else creeped out by that comment?...this about our compliant use of drugs?)


Thanks for this. Tim Naughton's article is perfect and it made me laugh, always a good thing.

Jean
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  #12   ^
Old Thu, Jul-27-17, 09:32
Bonnie OFS Bonnie OFS is offline
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Quote:
Originally Posted by cotonpal
Thanks for this. Tim Naughton's article is perfect and it made me laugh, always a good thing.

Jean


And had it not been for this article I might never have found the connection between my husband's smashing his thumb hammering in a t-post & his refusal to take statins.
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  #13   ^
Old Thu, Jul-27-17, 14:31
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Nancy LC Nancy LC is offline
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It's true! Paleo humans died from lack of statins. ;-)
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  #14   ^
Old Thu, Jul-27-17, 16:00
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mike_d mike_d is offline
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The Ornish Diet worked so well for Steve Jobs. Not!
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