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-   -   Can you live your life without statins? This cardiologist says you can (http://forum.lowcarber.org/showthread.php?t=484984)

Demi Sun, Aug-15-21 00:51

Can you live your life without statins? This cardiologist says you can
 
Quote:
Can you live your life without statins? This cardiologist says you can

Dr Aseem Malhotra argues that lifestyle choices are better at tackling heart disease than the pills taken by millions in the UK


Heart disease is the primary cause of death – and the most common cause of premature death – in the western world. To reduce their risk, over six million people in the UK take statins, which lower ‘bad cholesterol’ (LDL-C). This is the accepted science.

Consequently, NHS-trained consultant cardiologist and researcher Dr Aseem Malhotra’s latest book, A Statin-Free Life – A revolutionary life plan for tackling heart disease – without the use of statins, is bound to raise blood pressure in certain medical quarters.

In it, he examines the claims for statins – including whether lowering cholesterol really is the key to preventing heart disease.

Most astonishingly – but always citing data – he claims there is no convincing evidence that statins have lowered death rates from heart disease on a population level. Furthermore, that there is no consistent correlation between lowering LDL cholesterol and reduction in heart attacks.

"It’s a useless biomarker in terms of predicting someone’s risk of heart disease and therefore we shouldn’t obsess about lowering it," he says. Instead, he believes the best predictor of the risk of heart disease is reached by measuring the ratio of total cholesterol to HDL, or 'good' cholesterol.

Such views flatly contradict the established view and the advice given by charities such as The British Heart Foundation, which point to major studies such as the one published in the Lancet in 2019 where University of Oxford and University of Sydney scientists analysed data from 28 randomised controlled trials involving a total of 186,854 patients. It found for every mmol/L reduction in LDL cholesterol, statins reduced the risk of a heart attack by 25 per cent and a stroke by 21 per cent.

When this is put to him, Dr Malhotra says it doesn’t correspond to "the totality of evidence." Last year, he and two other cardiologists undertook an independent analysis to determine whether this statement withstood scrutiny. "We published it in the BMJ Evidence-Based Medicine – systematically reviewed, peer reviewed – and we found there is no clear correlation with LDL lowering and reduction in heart attacks and strokes."

It feels like a war, with bitter accusations of misinformation and ‘fake news’ flying on both sides.

The BHF has said claims such as Malhotra’s lead people to quit statins early, causing "a 26pc greater risk of a heart attack and an 18pc increase in the risk of cardiovascular mortality."

Dr Malhotra rejects this, and says, "The most important message is let’s have that transparent, honest communication with patients – explain to them the absolute benefits, respect their decision, give them alternatives."

He says statins are vastly over-prescribed. He believes debilitating side effects are common, mainly muscle pain and fatigue. (This remains another highly contested issue. An Imperial College London study in 2020 showed that side effects are rare and even caused by a ‘nocebo’ effect – symptoms brought on by the belief a pill will cause you harm.)

Dr Malhotra, meanwhile, argues that patients in clinical trials on statins are often a "selected group" – chosen because they do "not suffer side effects from the drugs".

The son of two GPs, from the age of eleven he knew he wanted to be a heart specialist – fittingly, a desire inspired by love. His older brother, Amit, was born with Down’s Syndrome. Aged 13, he developed myocarditis after a stomach bug and died within days.

Malhotra clearly feels his duty is to his patients – to "reduce suffering". He’s forthright, and long been unafraid of ruffling feathers.

He says there is a place for statins – they improve outcomes in those with heart disease. But, he adds, "Most people being prescribed statins in this country are probably in the lower risk category – they’ve not had a heart attack or stroke already." This, he says, equates to roughly "a one percent benefit" – a one in a hundred chance of preventing a non-fatal heart attack or stroke – "over five years of taking the drug."

A patient may still decide to take a statin, based on their individual risk factors, perhaps "a family history of heart disease" – but his mission is "informed consent for patients." Too often, he says, there’s little discussion.

A Statin-Free Life contextualises his arguments. For example, he notes that cholesterol – a fatty substance made in the liver and present in all our cells – has important functions, and that LDL cholesterol plays a crucial protective role in our immune system.

This could explain its presence at the site of coronary plaques (fatty deposits). Rather than a perpetrator, it’s likelier part of the rescue party, he says. "When there’s damage to the cells, because of stress, or poor diet or inflammation, the LDL responds as part of the immune system to heal or repair that."

We now know that heart disease is linked to two biological processes, he says: "Insulin resistance and chronic inflammation." Insulin resistance is when cells don’t easily absorb glucose from your blood – from sugar and high GI foods – so it’s chronically raised. "Insulin itself directly damages the inner lining of the heart arteries," he says.

Simultaneously, "if the damage and repair mechanisms in the body are overridden - if there’s more damage than repair - then within the heart arteries you can develop these deposits that are full of cholesterol, actually a response to the injury - but also inflammatory immune cells."

How do we combat it? By making lifestyle changes, he says, you can "theoretically, stabilise, prevent, reduce the risk of heart attack, the risk of heart disease and, potentially, reverse heart disease."

Besides not smoking, there are four main factors to address. One – "poor diet, full of ultra-processed foods – junk foods, packaged foods high in starch, sugar, unhealthy oils. Going back to more traditional ways of eating is a very powerful step in preventing or managing heart disease."

The foods we should eat? "A combination of oily fish, nuts, whole fruit and vegetables, extra virgin olive oil - and whatever else as long as you’re minimising the sugar and low quality carbohydrate, the breads and the pastas."

Exercise is important. "Exercise itself reduces insulin resistance. It keeps your cells more sensitive to insulin and therefore means there’s less insulin required to maintain your blood glucose in normal range, and therefore less damage to the cells of the inner lining of the heart arteries."

No need for anything fancy. "It’s really moderate activity – thirty minutes of brisk walking every day for example."

In the world’s ‘blue zones’ – areas of notable longevity and almost no heart disease – "They weren’t pounding in the gym, running marathons. They were just moving all the time, not being sedentary." Nor he adds, were they taking statins.

The third aspect, "often neglected", is stress. Part of this, he says, is that we’re not prioritising our relationships enough. "We know that external stress, chronic stress, in itself does increase chronic inflammation – so part of the immune system essentially attacks the body and the lining of the heart arteries." Also, chronic stress is associated with increased fibrin, a protein involved in clotting, in the blood.

Consequently, "meditation, yoga or something that reduces your stress levels will have a big impact." He cites an Indian study that found forty minutes of daily mediation had the strongest impact on heart disease reversal – "more than diet, more than exercise."

Number four is sleep. "Poor sleep exacerbates stress, makes you likelier to eat junk, and gives your body’s repair mechanisms inadequate time to kick in."

Ultimately, whether you choose to take statins or not, Dr Malhotra says, "Please, please, please do not neglect the lifestyle aspect, because eighty percent of heart disease is environmental and lifestyle related." He hopes people will read his book, consult their open-minded medical experts, and make informed decisions.

A Statin-Free Life by Dr Aseem Malhotra is published (in the UK) on August 19

https://www.telegraph.co.uk/health-...ogist-says-can/

Quote:
Statins are among the most widely prescribed drugs in the world. Yet many report unacceptable side effects and a US survey revealed that 75 per cent of respondents stopped taking them within a year.

So what is the evidence for their benefits? Dr Aseem Malhotra, author of the bestselling The 21-Day Immunity Plan and co-author of the bestselling The Pioppi Diet, examines the claims for statins and their role in lowering cholesterol and preventing heart disease. He introduces us to his targeted heart-health plan, which, with a diet plan, recipes and advice on reducing stress and increasing movement, can help us to live statin-free and take control of our own health.

https://www.amazon.co.uk/Statin-Fre.../dp/1529354102/

https://www.amazon.com/Statin-Free-.../dp/1529354102/


WereBear Sun, Aug-15-21 03:36

I'm just sorry he didn't bring up the fact that women get zero benefits for their side effects.

Quote:
Lack of benefits

The Scandinavian simvastatin survival study found the biggest effects of all statin trials—in men. However, what is less publicised is that, overall, three more women died in the statin arm than in the placebo arm. The more recent heart protection study was hailed as a major success for men and women, but despite the hype there was no effect on overall mortality in women.

In the studies of primary prevention neither total mortality nor serious adverse events have been reduced. A meta-analysis published in the Lancet found that statins even failed to reduce coronary heart disease events in women. Of greater concern is that a further meta-analysis of statins in primary prevention suggested that overall mortality may actually be increased by 1% over 10 years (in both men and women).

https://www.ncbi.nlm.nih.gov/pmc/ar...%20in% 20women.


Quote:
Statin Use Linked to Rare Autoimmune Muscle Disease, Study Finds
Johns Hopkins researchers discover how cholesterol-lowering drugs can cause body to attack its own proteins; caution patients not to fear popular medication

https://www.hopkinsmedicine.org/new...ase_study_finds


And this also happened to Dr Stuart Graveline:

Quote:
STATINS, LOU GEHRIG AND BIG QUESTIONS
The cholesterol-lowering drugs known as statins have proved remarkably popular, but might they contribute in a few cases to debilitating neuromuscular disease?

Dr. Greg Burns (not his real name) is a 72-year-old retired radiologist living in Connecticut. Until early last year, he ran with his dog at canine agility meets, skied, ice skated and played 18 holes of golf. He is now unable to walk and is taking a course of medication that will postpone, by a few months, his death.

Burns' rapid decline began in December 2007 when he suffered a short-acting stroke from which he fully recovered.

His cholesterol level was elevated and so as a preventative measure his doctor prescribed a 20mg daily dose of Crestor, a cholesterol-lowering drug in the "statin" class. Statin drugs are designed to inhibit cholesterol synthesis, and about 20 million people are taking statins, most for life.

A few months after beginning Crestor, Burns developed muscle cramps. He was assured by his doctors that these were not serious side effects of taking the drug. But in December 2008 when tests showed that his creatine phosphokinase — an enzyme that is released into the blood stream when muscle cells are damaged — was elevated, Dr. Burns stopped taking Crestor. When his enzyme levels returned to normal, he began taking Pravachol, another statin drug. He quickly developed weakness in his lower legs and a right foot drop. In January 2010, following an extensive neurological exam, Dr. Kevin Felice at The Hospital for Special Care in New Britain, Conn., diagnosed Burns as having amyotrophic lateral sclerosis or ALS, commonly known as Lou Gehrig's Disease.

...

This week, new research from the London School of Hygiene & Tropical Medicine suggests that the research underlying statin drugs may have been "cherry-picked" to present the best possible outcomes, and that statin drugs may be inappropriate for low-risk patients.

A significant relationship between muscle toxicity and statin drugs was confirmed in a study published in the American Academy of Neurology in 2002. Danish epidemiologist David Gaist found that "long-term exposure to statins may substantially increase the risk of polyneuropathy," a neurological disorder that occurs when peripheral nerves throughout the body malfunction simultaneously. Gaist cautioned against throwing the baby out with the bathwater, however, noting "the substantial protective effect of statins, particularly on coronary artery disease, is well documented and by far outweighs the potential risk of statin-induced polyneuropathy."

Sometimes the negative side effects of statins are downplayed, and conclusions can be skewed by the limited parameters of the trials. As a 2007 Scripps Mercy Hospital study noted: "The incidence of statin-induced rhabdomyolysis (acute breakdown of skeletal muscles) is higher in practice than in controlled trials because of the exclusion of potentially susceptible subjects."

Also complicating matters is how ALS is defined. Dr. Ralph Edwards, director of the World Health Organization's drug-monitoring center, told me that U.S. Food and Drug Administration's definition is too limiting. "The FDA uses a classic description of ALS which may not pick up all the cases, despite our emphasis that any study ought to think more widely about a condition that is seriously disabling and may also lead to death."

In 2007, the year of the Scripps study, Edwards found evidence that statins may be linked to an illness not typically defined as ALS: "It was an odd condition that was a mix of muscle and neurological damage which did not fit the classic ALS definition but could result in mortality."

This side effect alarmed Edwards so much that he made his suspicions known to the FDA. The government responded by asking the drug companies to examine their pre-marketing clinical data relating to statin and ALS. The FDA also reviewed the outcomes of 41 pre-marketing trials conducted by the drug companies. It concluded that the data was "reassuring" about statin safety.

Edwards was not reassured. He conducted his own research, but both The British Medical Journal and the Lancet rejected his paper. It was published in 2007 in the specialty journal, Drug Safety.

In 2008, the American Journal of Cardiovascular Drugs published a metastudy citing nearly 900 studies of statins' wide-ranging adverse side effects. The next year, the lead author of that piece, Dr. Beatrice A. Golomb, published her own research from the University of California, San Diego, on "Amyotrophic Lateral Sclerosis-Like Conditions in Possible Association with Cholesterol-Lowering Drugs." She noted: "An excess reporting of ALS in apparent association with lipid-lowering drug use was identified in our patient-targeted AE (adverse effect) surveillance study, prior to the corroborating reports of others, providing independent affirmation of elevated reporting."

While falling short of making the direct link between statins and ALS, Golomb raised significant questions. Do statins increase ALS overall? Do statins accelerate ALS, hastening its clinical presentation or progression in general or only in individuals where statins have oxidant effects? She suggested the "testable possibility of an identifiable vulnerable subgroup, an observation of high potential importance."

University of Oxford researchers funded by the British Heart Association took up the challenge. Their study represents the first time the complete human genome has been scanned to locate the genetic culprit of a drug's side effect. The culprit turned out to be a mutation, a sort of rogue gene that boosts the risk of myopathy caused by taking statins. The Oxford team determined that this variation in the DNA code of a gene called SLC01B1, which helps the liver regulate statin uptake, was responsible for 60 percent of the myopathy in people taking high-dose statin therapy. Patients on high statin doses who carry one copy of the rogue gene were at least four times more likely to develop myopathy than those without the gene. Patients who carried two copies of the rogue gene were 16 times more likely to develop ALS. Astonishingly, 1 in 4 people carries one or two copies of this rogue gene.

https://psmag.com/social-justice/st...questions-27449


My bold. Especially since I've yet to meet anyone on statins who got briefed on ANY possible side effects. Doctors don't have time to discuss risk/benefit. And so... they don't.

cotonpal Sun, Aug-15-21 07:30

What an absurd title for this article. It assumes that we have established and that it is common knowledge that statins are. beneficial and that to question their benefit is some radical position. But the safety and benefit of statins is not well established and has been credibly questioned. The answer, of course, is that yes you can live your life without statins and for millennia everyone did. Pharmaceutical companies might find it difficult to live without statins but that's a different issue. My one experience with statins, over 2 decades ago, was severe joint pain so for me I could not live my life successfully with statins and have lived ever since quite healthily without them.

WereBear Sun, Aug-15-21 08:35

Headline writing is a separate department. Just because the doctor wrote the article doesn't mean he gets to title it.

cotonpal Sun, Aug-15-21 08:39

Quote:
Originally Posted by WereBear
Headline writing is a separate department. Just because the doctor wrote the article doesn't mean he gets to title it.


It didn't occur to me that the good doctor had titled it. It seemed more about common erroneous assumptions promulgated by the media. Dr Malhotra clearly knows better.

GRB5111 Sun, Aug-15-21 08:53

Quote:
Consequently, NHS-trained consultant cardiologist and researcher Dr Aseem Malhotra’s latest book, A Statin-Free Life – A revolutionary life plan for tackling heart disease – without the use of statins, is bound to raise blood pressure in certain medical quarters.

In it, he examines the claims for statins – including whether lowering cholesterol really is the key to preventing heart disease.

Most astonishingly – but always citing data – he claims there is no convincing evidence that statins have lowered death rates from heart disease on a population level. Furthermore, that there is no consistent correlation between lowering LDL cholesterol and reduction in heart attacks.

"It’s a useless biomarker in terms of predicting someone’s risk of heart disease and therefore we shouldn’t obsess about lowering it," he says. Instead, he believes the best predictor of the risk of heart disease is reached by measuring the ratio of total cholesterol to HDL, or 'good' cholesterol.

Such views flatly contradict the established view and the advice given by charities such as The British Heart Foundation, which point to major studies such as the one published in the Lancet in 2019 where University of Oxford and University of Sydney scientists analysed data from 28 randomised controlled trials involving a total of 186,854 patients. It found for every mmol/L reduction in LDL cholesterol, statins reduced the risk of a heart attack by 25 per cent and a stroke by 21 per cent.

When this is put to him, Dr Malhotra says it doesn’t correspond to "the totality of evidence." Last year, he and two other cardiologists undertook an independent analysis to determine whether this statement withstood scrutiny. "We published it in the BMJ Evidence-Based Medicine – systematically reviewed, peer reviewed – and we found there is no clear correlation with LDL lowering and reduction in heart attacks and strokes."

Cholesterol wars continue. As for the sentence in bold, I'm surprised that Malhotra didn't explain the difference between Relative Risk and Actual Risk (while he may have, it wasn't explained in the article). Pharma loves to use Relative Risk in their statistics due to it often favoring the drug over the placebo by a wide margin. However, it's all statistical manipulation allowing them to make wild claims. I agree with Jean, it's the pharmaceutical companies that can't live without selling statins, one of the largest revenue generators in history. Perish the thought of doing away with them.

wbahn Sun, Aug-15-21 08:55

I wonder what their position is on the very common practice of prescribing a statin, often as part of a three-drug cocktail that includes a blood pressure medicine and metformin, for diabetics independent of their blood pressure or cholesterol levels, on the basis that it has been "shown" to improve (or at least delay deterioration of) vascular health.

Dodger Sun, Aug-15-21 13:57

Around the turn of the millennium, I was a hard-cors low-fat, high-carb fanatic. The less fat that I ate, the worse my cholesterol values got, so I took a statin for a year. While my LDL did go down, my fasting blood glucose was high as was my insulin level.
Switching to low-carb eating and ditching the statins lowered my LDL, glucose, and insulin levels while raising my HDL. almost 20 years later, I no longer worry about my blood chemistry as my insulin level is always low and my HDL level is twice my triglyceride level.
Changing my eating style was much more effective for my health than the statin was.

wbahn Sun, Aug-15-21 16:24

My question, though, is specific to the vascular issues that diabetics commonly develop. My last cholesterol numbers were at or better than the targets they want diabetics at, so my cholesterol is not the issue at hand. The claim is that statins, particularly in combination with the other two drugs, forestalls the vascular degradation in diabetics. But is that real? Or is it just more "conventional wisdom" foisted on us by the mainstream medical establishment?

deirdra Sun, Aug-15-21 18:42

I think it is "conventional wisdom" and than Malhotra's lifestyle modification recommendations can actually improve values better than statins and with zero side effects.

WereBear Mon, Aug-16-21 03:43

Quote:
Originally Posted by cotonpal
It didn't occur to me that the good doctor had titled it. It seemed more about common erroneous assumptions promulgated by the media. Dr Malhotra clearly knows better.


You are correct! They make the headline conform to whatever they are pushing, while the article might completely contradict it.

Because they know most people only read the headlines in a vain attempt to stay informed...

WereBear Mon, Aug-16-21 04:16

Quote:
Originally Posted by wbahn
My question, though, is specific to the vascular issues that diabetics commonly develop. My last cholesterol numbers were at or better than the targets they want diabetics at, so my cholesterol is not the issue at hand. The claim is that statins, particularly in combination with the other two drugs, forestalls the vascular degradation in diabetics. But is that real? Or is it just more "conventional wisdom" foisted on us by the mainstream medical establishment?


The diabetic vascular issues are about inflammation and glycation. NOT cholesterol. The analogy I like is, "blaming the fire trucks because they show up at the fire."

When we actually look at the statistics, we have to throw out all the women, since there is no positive effect for them. Then we have to likewise throw out men who haven't had a heart attack, likewise, and also men who are not middle-aged...

Even in the narrow group they do work for, many anti-statin doctors consider any effect from them suppressing inflammation. Suppressing cholesterol is where the (frankly horrifying) side effects come from.

I find it especially insidious that one of the most common side effect is how it creates memory problems. Which get brushed aside as senior moments and basic "What do you expect, you're old!" from doctors.

Demi Thu, Aug-19-21 01:38

Quote:
Dr Aseem Malhotra: ‘We still hand out statins like smarties, but pills are not the answer to heart disease’

The cardiologist and campaigner argues in his new book that overreliance on the cholesterol-lowering drug has left the public thinking they can carry on eating what they like without harm


Few drugs divide the medical and scientific establishment like statins, and one person in particular has been on a mission to change the nation’s attitude towards the cholesterol-lowering drug once and for all.

“This has been a 10-year journey for me to try to understand a better way to prevent, manage and potentially reverse heart disease,” says Dr Aseem Malhotra, the London-based cardiologist and anti-obesity campaigner who co-founded Action on Sugar before turning his attention to statins.

“I was trying to understand why we hadn’t made further progress over several decades despite the fact that we give out statins like smarties when their benefits have been grossly exaggerated,” he said.

“They were promised to be the big miracle cure. In the 1970s Nobel Prize winners Joseph Goldstein and Michael Brown [whose discovery of the receptor in cells that takes in cholesterol became the basis for statins] were predicting we may see the end of heart disease by the beginning of the 21st century.

“But we haven’t – it is still the single biggest killer of both and men and women worldwide with 18 million deaths a year – so I began my own investigations.”

Dr Malhotra’s new book, A Statin-Free Life: A revolutionary life plan for tackling heart disease – without the use of statins, is the end result. The central argument is that the pills – the most commonly prescribed drug in the UK, with around seven million people taking them – are given out far too quickly in many cases, often causing unhelpful side effects, when a focus should be on specific lifestyle changes instead. It is advice he gives his own patients and follows himself.

“Lowering cholesterol needs to be relegated to division four of the league of tackling heart disease, because for 99 per cent of the population total levels of cholesterol, and so-called ‘bad’ LDL cholesterol, has almost no value at all in predicting whether or not someone is going to have a heart attack – therefore we should stop obsessing about lowering it,” he said.

“I understand why they became so popular: of all the drugs out there for managing patients with heart disease or those who have already had a heart attack, statins had the highest benefit compared to aspirin or anything else.

“That made it the weapon of choice among cardiologists in tackling heart disease, but it was then treated in a very black-and-white manner. The message became, ‘Let’s just put everyone on statins and we’ll help cure heart disease,’ but science and medicine are not black and white.”

Dr Malhotra, 43, argues this has introduced an “illusion of protection” for the public who think they can carry on eating junk food as long as their cholesterol levels remain low and they take statins – as well as for a medical profession that largely ignored the benefits of an improved lifestyle on heart health.

His activism has seen him butt heads with many individuals and organisations, including the British Heart Foundation, which says research has shown “a clear link” between cholesterol and heart disease.

Dr Malhotra counters: “We’ve now got real-world data from the last three decades that show statins have not reduced death rates from heart disease at all. For those with heart disease, taking a statin every day for five years results in a 1 in 39 chance of preventing a non-fatal heart attack and a 1 in 83 chance of delaying death.

“If you look at groups of people taking statins from all the trials, the overall extension of life span in people with heart disease if someone religiously took a statin every day for five years, without getting side effects, is just over four days. Sounds ridiculous, doesn’t it?

“I’m not saying statins don’t have any effect. I’m saying, ‘Be aware that their effects are marginal at best.’ And everybody – whether you choose to take statins or not – should be focusing on their lifestyle.”

Given almost one in five deaths worldwide are caused purely by bad diet, according to the 2019 Lancet Global Burden of Disease report, Dr Malhotra argues the a switch in focus from statins to lifestyle changes will prolong life and save lives.

Anyone already on statins should speak to their GP and ask them to explain “in absolute terms” what the benefits of statins are, he says, “and then make an informed decision with your doctor whether or not you want to continue taking the pill.

“Come to a shared decision. That’s the advice I give my patients and I’ve never had a single one come back to me to say they were not grateful that they had that information.”

Dr Malhotra said he had a family history of high blood pressure and relatives who had major risk factors of heart disease. “Knowing that 80 per cent of heart disease is environment and lifestyle and up to 20 per cent genetics, it means there’s something I can do about it, he said.

“The absolute base is making sure my diet is healthy. There are two things I avoid: no ultraprocessed food – that’s something which comes out of a packet and has more than five ingredients, and also minimising sugar and other low-quality carbs, such as white bread, pasta, rice, potatoes.

“I’m very active – cycle and resistance training, mainly for physical and mental health. Exercise for heart disease has been exaggerated though, you just need to do moderate amounts: 30 minutes five times a week to get the best benefits for preventing heart disease.

“It’s a brisk walk every day, which is something everyone can do. Reducing stress and getting a good seven hours sleep a night is important too. Combine all that and this heart disease pandemic would be eliminated within a few years.”

https://inews.co.uk/news/health/dr-...effects-1156413

Benay Thu, Aug-19-21 04:48

I have a woman friend who has been on statins for years
She is following doctors orders
She does not question her need for this prescription
I assume many women behave similarly
blind obedience to doctors orders
never question his judgements

WereBear Thu, Aug-19-21 06:43

For some, it's a generational thing, for anyone, when doctors did stuff that actually worked and people could access it, and they were literal miracle workers.

Now, we have to be cautious. We're in the midst of figuring out what doesn't work.


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