Saturday, July 10, 2010

One Look At Statin Cost Benefit, Part 3


"The executive summary is 12 pages long and was published in JAMA, which is sent to every physician in America free of charge. The real report is 284 pages long and has to be pulled down from online or ordered from the government. (If you go to the website referenced in the executive summary to get the full report, you are sent here. See how much time it takes you to find it) Which of the two do you think most physicians read? Why should they read the full report when the prestigious authors of the executive summary assure them that
The full ATP III document is an evidence-based and extensively referenced report that provides the scientific rationale for the recommendations contained in the executive summary.
That says it all. According to the executive summary, the full report is like Fox News purports to be: fair and balanced. And the executive summary is then a fair and balanced report of a fair and balanced report.
What do we find when we read the full 284 page report (which you can get here)?
We find that the full report presents a totally biased misrepresentation of the underlying scientific material and seems intent on promoting the use of statin drugs despite any evidence to the contrary. Not the “evidence-based and extensively referenced report that provides the scientific rationale” for statin therapy that the executive report would have us believe.
Before we get into some of the specifics of this full report, let’s recall that the Framingham data, the Queen Mother of all dietary cholesterol studies, didn’t show a correlation between diet and cholesterol, cholesterol and heart disease, nor diet and heart disease. And we need to remember that, despite all the hoopla about statins and lowering cholesterol levels, that cholesterol is an extremely important molecule. The brain is rich in cholesterol, the sex hormones are made on a cholesterol structure, and even vitamin D is built on cholesterol. Consequently, statin drug use has been associated with decreased cognitive ability and sexual dysfunction. Statins can cause liver damage and the breakdown of muscle tissue, both of which can lead to death. In my opinion, these drugs would have to lead to huge reductions in risk for death from all causes to overcome the risk one accepts by taking them.
Let’s digress for a moment and discuss all-cause mortality. Let’s say we’ve got a drug that studies show decreases the risk of death from heart disease by 50%. Let’s say that the only half the subjects in study who are taking that drug die of heart disease as compared to those subjects in the control group. At first blush, it appears that we’ve got a great drug on our hands. But, what if the same number of subjects die in both groups? The study group has way fewer deaths from heart disease but has a lot more deaths from cancer so that the total number of deaths in both groups is the same. This would mean that the people taking the drug traded their decreased risk for death from heart disease for an increased risk for death from cancer. The all-cause mortality didn’t change. All that changed was the cause of death. If we had a drug that brought about the 50% decrease in heart disease deaths in the study group and no increased death from other causes, giving a big decrease in all-cause mortality, then we have something."
http://www.proteinpower.com/drmike/statins/statin-panic/

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