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Saving lives, City Councils, Ocean liners
- david j Kinshuck (29 April 2007)
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Statins, Statistics And Saving Lives
- Paul J. Rosch (30 April 2007)
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Re: Statins, Statistics And Saving Lives
- Raymond G Holder (3 May 2007)
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david j Kinshuck, Associate Specialist, Ophthalmology, Good Hope Hospital, B75 7RR
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Professor Blackman discusses the benefits of local councils taking responsibility for health. In theory this should be a step forward, and indeed was part of previous Government policies. But in practice this does not always work out. As an ophthalmologist wanting to reduce diabetic retinopathy, I see the most effective way to reduce the increase in type 2 diabetes is by encouraging exercise, and there is no better way to encourage walking and cycling. I therefore sit with the two public health physicians on our Council’s Children’s Health and Obesity Task Force, and this group has asked for slower speeds across the city and cycling training. These are probably the most effective measures of making a cycling and walking safer and more popular, and are part of European Union policy. But these and all other large scale slow speed or pro-cycling measures have been rejected by other committees in the Council. The Transportation Department sees its role as preventing traffic jams and accidents and helping industry (and accident rates have dropped at the same time as cycling and walking rates have fallen). And Government policies support this…the last Transport plan implemented included many ‘Red Routes’, which increase speed of traffic flow, and certainly do not aid cycling and walking. The planning department approves large hypermarkets with masses of car parking and which increase traffic, and large entertainment complexes which in practice cannot be reached by walking, whilst allowing many smaller green spaces in the city which are used for improvised sport to be developed into housing. These changes are occurring in all UK cities, basically opposite to planning decisions in cycling cities such as those in Holland and Denmark. Our Council leader has adopted Government policy, and if the policy will ever change it will be a slow job. And the potential captains of the liner, whilst talking ‘green’, have rejected proposals such as city wide cycling networks (personal communications). Local and national leaders have to take public health and environmental issues a lot more seriously if Councils are to act effectively. Competing interests: None declared |
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Paul J. Rosch, President, The American Institute of Stress, Clinical Professor of Medicine and Psychiatry, NYMC 124 Park Avenue, Yonkers, NY 10703 USA
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Preventive medicine based on using drugs to treat risk factors is inane. Many risk factors might be more appropriately referred to as "risk markers", since they are merely statistical associations rather than causative agencies. Cholesterol is a good example; with the oft cited "for every 1% fall in cholesterol there will be a 2% reduction in coronary heart disease. This is another deceptive shibboleth, ("a common saying or belief with little current meaning or truth") since what this really refers to is a reduction in relative risk, rather than absolute risk, which is quite different. Statin manufacturers have capitalized on this in their TV and media blitz in the United States because of the power of direct to consumer advertising. For example, you could be told of a statin that is safe and will significantly "reduce the risk" of having a heart attack if taken every day for the next five years. A study is cited showing that over five years, patients on this statin had 34% fewer heart attacks than controls on a placebo, which is correct, since this is relative risk reduction. What you are not told is that 2.7% of patients on the drug had a heart attack compared to 4.1% on placebos, so that the absolute risk reduction is only 1.4%. Also not revealed is that if this statin is taken by seventy-one people every day for five years, it will prevent one person from having a heart attack - but it is not known if that person will be you. In point of fact, you will never see a statin ad claiming that the drug actually reduces heart attacks. In many instances, a disclaimer is mandated stating that it has NOT been shown to prevent heart attacks or heart disease, although this is usually in fine print. It is quite clear that the cardioprotective effects of statins are not related to lowering cholesterol or other lipids. (1) Thus, the current goal of lowering LDL to an arbitrary value that is often difficult to achieve insures increasingly higher doses for longer periods of time. (2) This means more money for drug companies but it also insures a higher incidence of adverse side effects, many of which have been ignored or suppressed. (3,4) As Professor Blackman implies, what we call a health care system is a mighty double misnomer. What we really have is a sickness cure system. Similarly, health insurance primarily provides compensation when we are sick, rather than health enhancement. What is sorely needed is to make prevention a priority by emphasizing the importance of regular exercise, proper nutrition, adequate sleep, reducing stress and other lifestyle changes shown to reduce coronary disease. The public would profit much more from this than from putting statins in the drinking water, especially since statins have not been shown to reduce coronary disease in men over 65 or women of any age. Unfortunately, a shift to this preventive approach is not likely to happen because of powerful pharmaceutical companies who will do anything to perpetuate and preserve their prodigious profits. 1. Rosch, PJ. Guidelines for Diagnosis and Treatment of High Cholesterol. JAMA. 2001;286:2400-2402 2. Rosch PJ. Determining optimal statin dosage. Mayo Clin Proc. 2003 Mar;78(3):379, 381 3. Rosch PJ. Peripheral neuropathy. Lancet 2004;364:1663 4. Graveline D. Statin Drugs – Side Effects and The Misguided War on Cholesterol. 2006 published by www.spacedoc.net Competing interests: None declared |
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Raymond G Holder, Retired engineer None BH9 3NF
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The role of preventive medicine, such as in the use of statins, does not get to the heart of the matter. An old senior engineer, for whom I worked, once remarked of complex electromechanical systems " Put it into the state which the designer intended, and it will work" Now we may not know what our designer intended, but we do know what things are necessary for healthy living, vitamins, all the necessary nutrients, etc, and we know what levels of these substances are found in a healthy body, if we look far enough into current knowledge. It is routine to measure blood chemistry to measure iron, potassium, sodium, calcium etc levels and vitamin levels and those of other body necessities. Some of the more recent discoveries are less often examined, or the need to examine them is not recognised, for example Coenzyme Q10, Carnitine, homocysteine and the B vitamins etc necessary to prevent its production. Making sure that all these substances, and others in similar need, are available in sufficient quantity, is surely the first step to getting the body into full working order. The use of drugs to alter that state to something less than optimum is only counter productive in the longer term, probably because an unforeseen side effect has not been imagined or properly thought through. The treatment of hypertension is a case in point. I believe that a lot of this effect is due to CoQ10 reduction with age, and the strength of the heart pumping action is impaired. But Beta blockers are known to affect CoQ10 production just as statins do, and the heart problem suffers more. Calcium antagonists alter muscle action, and have also been found to worsen statin side effects, supplementary CoQ10 often makes their use unnecessary. We are bound up in a system where the first approach is to reach for the "system modifier drug catalogue", instead of looking for what is that particular patient's personal deficiency, and bringing it back into the normal range. If more attention were to be paid to this approach, the many statin side effects which now go unexplained by the doctors in charge of their cases, because CoQ10, carnitine, and similar damage sites would be recognised, and the cry "statins have very few side effects" would be shown to be more than untrue, and some global recognition of the problem would have to be made. Competing interests: Statin damaged patient |
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