Special Place in Hell

After having written what is below the second headline, I found another article, same author, same day:  The deadly propaganda of the statin deniers: The drugs DO protect you from heart attacks but as this devastating investigation reveals thousands are refusing them

That article continues, at the bottom, with the screed I covered below, but the screed did not reference the main article, explaining the oddities I reported below. This article, on the face, is better, actually giving more evidence, but misrepresenting many significant facts. I’ll cover that in Deadly Propaganda, a parallel page not written yet.

 

There is a special place in hell for the doctors who claim statins don’t work, says BARNEY CALMAN

By BARNEY CALMAN FOR THE MAIL ON SUNDAY

PUBLISHED: 17:21 EST, 2 March 2019

Statistics are one thing. But it’s hard to argue against the dangers of stopping taking statins when they’re staring you in the face.

The dangers were not staring him in the face, and one doesn’t know if it is “hard” to argue against the dangers of stopping if one does not look at evidence, all of it, instead of an anecdote that actually tells us very little but what is already accepted by all sides. But he doesn’t look at all sides, obviously. This is typical of a yellow journalist, and so I was not surprised to see, in the Wikipedia article on the Daily Mail,  this:

The Daily Mail has been widely criticised for its unreliability, as well as printing of sensationalist and inaccurate scare stories of science and medical research,[12][13][14][15][16] and for copyright violations.[17]

However, I know this about Wikipedia, from long experience. Unless there is a notable source  not only criticizing, but asserting that criticism is “wide,” in which case, as an interpretation, this would normally be attributed in the text, “according to,” not merely in a reference note — unless, of course — this was itself widely known, being found in many neutral sources, that statement is an example of Original Research being allowed to creep into Wikepedia articles. Nevertheless, I’ve notice the Mail being a sensationalist publication before, and I looked at the sources a little. They were good enough to allow that text as a first approximation, but I did not read all of them. The sources were the The Guardian, citing Wikipedia itself, which rejected the Daily Mail as “reliable source,” The New Yorker, Forbes, and more, getting close to fact. The Guardian article is remarkable for its reasonably correct understanding of Wikipedia process, which is relatively rare. This article on cancer articles in the Daily Mail is hilarious, and, unfortunately, right on, and, also unfortunately, the Guardian may itself have gone downhill, I’ve seen a number of examples.

As to the Mail, this is a brilliant example. The headline and the lead shout “yellow journalism” to me. He starts with what he actually saw (which is great, in itself, a human story), but he has already telegraphed what he thinks it means, and the interpretation is an easy, casual one, ignoring the actual science of the field.

Last week, I met 49-year-old Colin Worthing as he recovered in his hospital bed following a heart attack in the early hours of Tuesday. He had been prescribed cholesterol-lowering tablets ten years ago but quit them – without any medical advice – having ‘heard they don’t really work’.

All sane medical advice is against quitting a prescribed medication without consultation. He did, based on his own casual, uncareful interpretation of what he had “heard.” Statins do work, certainly to lower cholesterol, but what effect do they have on heart health, what are the side effects, and what alternatives are there? Nobody, again nobody sane again, will suggest stopping any medication without at least having a conversation with a medical practictioner, and if one doesn’t believe the practitioner, then getting a second opinion. Instead, he stuck his head in the sand, without knowledge, just depending on rumor — but also on his feelings, which now he rejects. But he is still ignorant, as we will see.

Colin suffered his first heart attack in 2009, with little warning. ‘It was a shock as I’d felt well otherwise,’ he said. ‘Later I was told I had high blood pressure and high cholesterol. My mother has heart problems, so I think it runs in my family.’

First heart attacks are commonly like that. He says “little warning.” He didn’t already know that he had high blood pressure and high cholesterol? This is someone who neglects normal routine medical care. That is high-risk, at least for many.

He was prescribed statins and blood- pressure-lowering medication. ‘I took them to start with, but I felt lethargic.

There is a high probability here that he was experiencing a known statin side-effect. It’s quite dangerous, actually, if ignored. He sensed that it was due to the statin, but did not consult with his practitioner as to alternatives. There are alternative recommendations with higher effect on cardiac risk, with fewer side effects, but he shows no sign of being aware of them. So, this is known: there is an increased death rate from “non-compliers” with statin prescriptions, but that could easily be because non-compliers may have poor health in general, or at least poor health practices. The increase, by the way, is not large.

I was always hearing on the radio that statins didn’t really work, and drug companies were just trying to make money by getting us all on tablets. You do start think there’s no smoke without fire.’

Drug companies are trying to make money? Who knew? To think, I always thought they were charities, out to help people with no regard for profit. Not. This was irrelevant nonsense, not a reason to stop statins. There is a fire, in fact, but he has not recognized, not yet, the true source of danger to himself. Instead, he just got knocked upside the heat, a warning that he’s been running blind without a clue, and his immediate reaction is not to look for the cause in himself, it is in those nasty stupid critics.

If someone says, on the radio, that “statins don’t work,” they are being misleading. The truth is far more complex, and, in fact, still controversial. The real question is about real risk vs. relative risk and real options. Comparing a statin with “doing nothing” might actually save one’s life, in some cases, but this is not a sane choice, if one is actually at risk. Instead of researching the issue himself, he was passive, listening to the radio, and doing nothing positive for his health, nothing reported. He had high cholesterol and high blood pressure, and there is no sign that he continued measuring these things, that he made what might be advisable changes to his diet, that he started an exercise program, universally recommended for people with a risk of heart attack, that he had diagnostic tests, like stress tests, not even measurement of C-reactive protein, which is a better risk predictor than cholesterol, none of that.

In 2013 he decided to stop all medication. ‘I wrote to my GP saying I no longer needed my repeat prescription, and never heard any more,’ he says.

The GP left it in his hands, obviously not having educated him. Common. But the GP is not being blamed here for not responding, though this was an obvious failure. Instead, these events are being used to blame doctors and scientists and others who are skeptical about the benefits of statins, as if his case proves something.

Over the next five years he felt well, ‘although I suppose I was stressed with work, and I did put on quite a bit of weight’.

In other words, he had two clear risk factors (stress and major weight gain), more predictive of heart attack than cholesterol. He did nothing about it, because he “felt well.” And, in a way, he was well, but at risk, and ignoring the risk, because, after all, heart disease runs in his family, and he’s going to die, and he doesn’t want to think about it, doesn’t want to go to a doctor to hear bad news, which is what he expects, my guess. He is actually a good argument against the head-in-the-sand approach to self-care. Taking statins or not taking them is a choice that is wisely made with informed consent, so he had a choice: either trust his GP blindly, or ask his GP to educate him, ask his GP about what he is hearing, ask his GP about risks (not just “risk factors”), and keep in communication, or believe the conspiracy theory. He chose to believe that theory, which was actually irrelevant. Statins have effects, they “work,” but how well and for whom. It is obvious if one becomes informed: Not everyone is benefited, and it is possible some are harmed. How many? Informed consent would require that he do much more than passively take medicine or decide to quit based on rumors. It would require him to take responsibility for his choices. But in spite of a second heart attack, he still has not done that. But it’s soon after that additional warning, and it is possible that he will wake up and realize that his biggest enemy is his own ignorance and lack of attention to his health.

And then, at about 1am on Tuesday, he woke feeling clammy, with a familiar tightness in his chest. ‘I knew it was a heart attack, and called 999.’

Right. That, however, is not what I would do. Because I’ve been paying attention, even though I have never had a heart attack, I carry a small vial of nitroglycerin tablets with me, I would take a nitroglycerin, which is very fast-acting, and if the symptoms disappeared, I’d make an appointment for a consultation. If the symptoms did not disappear, and in 15 minutes, I would take another dose. If they did not disappear within 15 minutes, I would call 911 and take a third dose. I’ve been told that if the symptoms are going when the paramedics arrive, I can decline transport. Not being in communication with his doctor, he had no clue about any of this.

(But if the symptoms were severe enough, I would call 911 at the outset. Again, because I have been in cardiac rehab, I am sensitive to the mildest angina, but it has never been strong enough to take one tablet.)

Colin was rushed to hospital where he had surgery to insert a stent which will keep blood flowing through his cardiac arteries while he awaits a full heart bypass operation. His consultant at Hammersmith Hospital, London, Dr Rasha Al-Lamee, said: ‘We regularly see patients who, like Colin, have stopped taking statins because they believe the myth that they don’t do any good. In fact, he’s one of the lucky ones. He’s alive.

How did the author find this patient? It’s rather obvious. He was writing a story about statin denialism and the terrible harm it causes, over which there have been many scare stories. So he reached out for a case, and was supplied one. But was that heart attacked caused by stopping statins?

From this story, he was one who experienced a statin side effect, and had he continued without addressing the problems, he might have died from something other than a heart attack. Statin side-effects can be serious, especially if they cause reduced exercise.

‘There will be numerous reasons his heart disease progressed so far, but one of the factors will be because he stopped taking statins.’

That’s true, there will be numerous reasons. A “factor,” which must refer to a “risk factor” is here being confused with a cause. His stopping statins did not cause his heart attack. It is possible that it did not reduce a possible cause, but this cannot be known, because statins do not address the primary causes of atherosclerosis, that’s obvious. If they did, they would be much more effective than they are.

Colin added: ‘I was a fool to stop taking the medication. Who cares whether or not someone is making money from statins. If I had carried on taking them, I might not be where I am now.’

It’s possible, and it is also possible, even likely, that if he had done nothing more effective than taking statins to address his heart condition, he would also have had a heart attack.

He may not get any more warnings. He has a stent, which will, in his condition, probably extend his life, that’s crisis care, and medical science has gotten quite good at it.

He is still a fool, my opinion, he has not taken responsibility for his own choices and is, instead, focused on irrelevancies, like the conspiracy theory. I hope that he wakes up. This is not about whether he takes statins or not, it is a change in attitude.

I am still studying the research, and may be continuing that for the rest of my life. But it appears, so far, to me, that while statins have been shown in some studies to reduce risk of a cardiac event by 30% or so, that is a reduction in absolute risk of about 1%. It is difficult to apply the statistics to a case like this. From what we know, it is likely that this patient would have been in the 2% that had a heart attack, even though they were taking statins.

And if he focuses on cholesterol, and is happy that his cholesterol is reduced and uses this as an excuse to feel safe, and does not take other, more powerful measures, and they exist, he will remain at high risk.

The evidence is staring Calman in the face, but he ignores it for a sensationalist story. Because he is reaching millions with this, he may cause real damage, cost real lives, so . . . special place in hell.

And a special place of reward for those who carefully report reality, what they actually experience, and who practice the real methods of science, which include and even require full attention to criticism, to skepticism. Suppression of skepticism is fascist and may, under some conditions, be populist. It is not science-based. Scientific response to skepticism requires a serious consideration of criticism, and the design of studies to test theses and possible criticisms of prior work, until the issues are so settled that contrary opinion truly and naturally becomes the extreme fringe, safely to be ignored.

We are not there yet.

To paraphrase Donald Tusk, there is a special place in hell for the statins deniers who continue to fuel public confusion and a vague perception that the drugs, as Colin said, ‘don’t really work’.

OK, I don’t actually believe in hell. Or Donald Tusk, much, for that matter. But they need to realise that the ultimate fallout from high-risk patients, such as Colin, stopping proven treatment will be illness, disability and death. Debate should – must – be at the heart of science. Just because someone has been awarded the title professor doesn’t make them right. And some of our greatest medical discoveries have come from so-called mavericks who ignored the orthodoxies.

Who the hell is Donald Tusk and why does Calman not believe in him? So this yellow journalist uses a highly inflammatory phrase to attack “doctors” for pursuing research and reporting results, and analyzing the results of other research, but he doesn’t believe it? I do believe in hell, and strongly suspect that Calman is in it. He is willing to lie and state as fact what he does not actually know, on a matter of high importance for public health. The patient is not in Hell, not from telling his story, merely possibly mistaken about some aspects of it. Nor is the physician. Simply being wrong is not enough to create the entry into hell. Lying can be, as an aspect of the general cause, denial in the face of clear evidence.

His last sentence, though, is true. This, however, simply suggests that we should, collectively, pay attention to the outliers, the alleged fringe (even where ideas are more outside the mainstream than those of the people he will be naming). It is very dangerous to suppress diversity of opinion, and even more so to suppress research results (the data is not opinion, if not fraudulent, and fraud in the reporting of data is rare.)

The public should, my view, wake up and demand that scientific controversies with major consequences be resolved with more research, better data, which, long term, leads to the decline of fringe skepticism. The expense of this would be minor compared to the cost of accepting a mainstream consensus that is not backed by thorough and careful — and unbiased — research. If drug companies want to support this, they would provide no-questions-asked grants to agencies not depending on them, but more on public support. Governmental support can help, but also tends, in the real world, to be dominated by political and economic considerations.

For we should make no mistake: the statins deniers are no Barry Marshalls.

(Barry Marshall discovered that H. Pylori caused ulcers.)

The trio mentioned in our piece aren’t the only ones. There is Dr John Abramson at Harvard, author of the misleading ‘20 per cent side effect’ BMJ study; Joseph Mercola, a discredited anti-medicine campaigner who claims to have millions of website views a day; Dr Uffe Ravnskov in Denmark, founder of The International Network of Cholesterol Skeptics, and others.

It is a particularly insidious type of fake news they peddle, apparently from a respectable, credible source, but laced with misinformation. They seem now even to have the ear of policy-makers.

So far, he has not mentioned any others, so this was terrible writing or editing. It appears he had an earlier draft, and removed material from it, and did not properly revise the rest.

Calling them “statin deniers” telegraphs that they are deniers of reality, that they insist on some fringe idea in the face of clear evidence. The evidence is nowhere near as clear as Calman believes, if he is sincere and not simply being paid. Is that comment, mentioning that possibility, a conspiracy theory? Well, I look at the article and what is featured at the top? A drug advertisement. Now, to think that there might be some possible conflict of interest is not a “conspiracy theory,” it is simply common sense that it’s possible.

There is far more evidence for the Big Pharma influence on scientific opinion and coverage of it, than there is for the “author and Big Food conspiracy theory” of others about these so-called “denialists.” But it’s actually irrelevant to the central theory. Someone is not wrong because they publish a diet book, as Calman seems to pretend. If there are problems with statin research — and there are clearly problems with many studies I have seen — then the scientific and rational approach is to look at the problems, not toss insults at those who point them out. Who raised an issue is an ad hominem argument, fundamentally fallacious from a logical perspective, unless the credibility of the person is the issue.

So this statement: There is Dr John Abramson at Harvard, author of the misleading ‘20 per cent side effect’ BMJ study — “Misleading”?

That is given as if it were a fact. Do the readers of this article know what “BMJ” stands for, and what it is?

And then he has, about this: “apparently from a respectable, credible source, but laced with misinformation.”

Great! This yellow journalist is calling an article “laced with misinformation,” published by the BMJ, formerly called the British Medical Journal, published since 1840, a wholly-owned subsidiary of the British Medical Association, using “apparently” to call the publication in question, when it is not in any doubt at all, it is a respectable, credible source, if any source is.

That does not mean that an article may not be misleading in some way or other. Articles in peer-reviewed journals can have errors in them, or may draw misleading conclusions, sometimes, but a credible journal will not allow that. The public does not read the BMJ, in general, rather, they read media reports, if the media thinks something newsworthy, and often the media exaggerates or misleads, and especially media like the Daily Mail. So the article:

Should people at low risk of cardiovascular disease take a statin? 22 October 2013

Calman refers to this as the “‘20 per cent side effect’ BMJ study“, adopting the language of critics of the “study.” It was actually a review, an analysis. The visible abstract does not refer to “20 percent side effects.” However, obviously the article did have something about the rate of side effects, because a correction was issued on that matter:

Corrections 15 May 2014 quotes or describes the withdrawn language:

The conclusion and summary box of this Analysis article by Abramson and colleagues

(BMJ 2013;347:f6123, doi:10.1136/bmj.f6123) stated that side effects of statins occur in about 18-20% of patients. 

And

The authors also mistakenly reported that Zhang et al found that “18% of statin treated patients had discontinued therapy (at least temporarily) because of statin related events.” 

However, the issue is actually much more complicated. In order to conclude that the report was a mistake, clarification from Zhang was sought. Zhang. The true rate of “statin related events” is not accurately known. The correction has:

The primary finding of Abramson and colleague’s article—that the Cholesterol Treatment Trialists’ data failed to show that statins reduced the overall risk of mortality among people with <20% risk of cardiovascular disease over the next 10 years—was not challenged in the process of communication about this correction.

How was the article “misleading.” It overstated the evidence. What it stated was not necessarily false, as to the true rate of statin side effects, and from my review of testimonies by statin users, the official rates are probably understated, from many causes. What people need to know, and what is clear, is that there is a significant rate of undesirable side effects, and that not only should they not ignore criticisms of statins, they should be vigilant for possible side effects, and consult if they believe they find one. Either way, statins are not emergency care, they only have a small long-term effect on cardiac risk, at best. If one becomes uncomfortable taking statins, and this is crucial: consult, period. Investigate, neither stop without consultation or continue without consultation. It is not the job of patients to worry about the nocebo effect, and attempting to “educate” them about it would be to discourage the patient from carefully reviewing their own condition and identifying *possible* side effects. The choice to continue or discontinue in the presence of a possible side effect is a complex one. There is no one-size fits all advice, other than Consult, Communicate, Co0perate — and Take Personal Responsibility.

If on the one hand, you don’t trust your practitioner, it is urgent to find another. If you trust your practitioner, but think he or she might be mistaken in this case, get a second opinion, but be careful: if there is an error in “standard of practice,” it might be difficult to find a second opinion unless one does one’s own research and knows what questions to ask. A good physician will not pretend to knowledge and will tell you *if you ask* whether they personally know what is coming from their own experience and knowledge or standard of practice, and if the latter, they will tell you how they know (or will look it up to assist your research).

For many of us, without a scientific background, the core issue is personal trust. When I have found that a practitioner did not encourage me to question his recommendations, I fired him, I don’t need a petty god in my life. In that case, I checked on what he had told me, not only from my own research but also with other specialists. He was, quite simply, wrong, but apparently believing he was right or simply not willing to engage with a “stupid patient.” This is a problem: if a physician, believing the standard of practice is wrong , at least in some specific case, prescribes something else, he can be sued for malpractice and can lose his license. Because no advice, even if generally correct, guarantees a positive outcome, a bias is introduced that disallows physicians from recommending what they personally believe to be true. A way for physicians to handle that is through providing full information. I could imagine being handed a paper to sign that has, “I understand that the recommendations given me today deviate from standard of practice, as I have been informed, I recognize that I have the right to independently research this matter, or to obtain a second opinion, and I take full responsibility for my choices made with this information.”

Was this article “full of misleading information” The “20%” claim was slightly misleading as to the very high standards of that journal. But was it substantially misleading? Was there other “misleading information” in the article? Was the conclusion misleading? If so, the journal editors, on review, appear not to have thought so.

There was substantial controversy over this article. The Data Supplement is huge, with many letters and responses, reviewer comments, etc. There is a great deal of additional information and analysis in the Responses page.

What Calman has done is to take a strong position on one side of an obviously open scientific debate. But he is pretending that this is based on clear evidence, it is not. It is based on confusion and rumor and innuendo.

Invited to comment on the study which suggests thousands of patients have quit medication due to statin confusion, and of these, many will have heart attacks, Dr Kendrick claimed it was he who was the victim, as such a claim amounted to ‘reprehensible bullying.’

Again, Dr Kendrick was not mentioned before, and the study in question has not been cited. Kendrick has published the mail he received,

Cholesterol Games

Something is off, because Kendrick refers to a photo that does not appear in what is visible to me of the article. I looked at the Sunday Mail main page to see if there was some photo and link “up front.” Nothing. It is possible that the article has been modified. The article itself contains evidence of additional material that is not in the text I can see.

Kendrick publishes both the mail from Calman and his responses, both before the article was published and after. He has this:

The Mail on Sunday have published a very long article attacking ‘statin deniers’ with pictures of me Zoe and Aseem at the front. I think I look quite dashing. Not as dashing as Aseem who is a very handsome swine, and also young, and intelligent – and brave. Yes, I hate him.

Nor am I as attractive as Zoe Harcombe. But hey, at least I got my picture in the national press. I wasn’t very keen on the bit where they called me self-pitying. But I was quite pleased that they included some of the stuff that I sent.

Kendrick is an entertaining writer. I had not heard of him until I was accused by a troll of being the owner of a sock puppet who had attacked him, and I investigated, and I recognized who the true attacker was, and it was not the person being bandied about by internet commenters, following suggestions from the same sock master. So I corrected those to protect the innocent, and started to read Kendrick. His series on the causes of heart disease is a clear account of the investigations of a true skeptic. And then I bought his books, at least the Kindle editions, not for “advice about statins,” but because the general issue of information cascades and mainstream error in science has long been of high interest to me.

In what I can read Kalman lied about Kendrick’s response. It’s that simple. Kalman is a troll who should not be in any responsible editorial position. He has the right to his opinion, but editorials should be labeled as such. Of course, the Mail may not care, their reputation is already trashed, and if they want sensationalism, hysterical screeds, he may be perfect for them, and they can all take their seat in Hell.

I am writing another review of an article on the cholesterol controversy that is far better, even though I consider it, in itself, misleading. At least it focuses on the issues! And it has links to sources, much of it is verifiable. If I look at the full debate in the BMJ on this issue, there is much information as well, links to sources and arguments by experts.

The issue is often presented as “Who should the public trust”? It’s not exactly the right question.

Nobody is infallible, but if we are paying attention, and if we act to inform ourselves and to test ideas, we are the world’s foremost experts on our own condition. Sanely, we consult with experts on the general field of interest, but blind trust in anyone else is dangerous, just as dangerous as blind trust in our own correctness. On the other hand, trust with eyes wide open will recognize when there are problems. Trust that also verifies and confirms, is far more powerful than blind trust.

Medical fascists, I’m starting to call them, do not want a fully informed public and they want to suppress and discredit and disable dissent, giving an old argument, that “quacks” or whatever term they use, it might as well be “socialists” or “liberals” or “fascists,” for that matter, will mislead the ignorant public. The answer to misleading information is not suppression and censorship, which the fascists would have, but verifiable information, or at least balancing argument, and all of us are responsible for our choices.

If I don’t have enough information, it is my responsibility to obtain it, if the choice matters to me.

Unless my doctors have actually lied to me or were grossly incompetent (in which case all bets are off), my doctors will not be sued for malpractice if I die because I chose to follow a recommendation that did not succeed in protecting me.

This is the obvious truth about statins and heart disease. They are not miracle drugs, silver bullets, that, if taken, strongly prevent heart disease. The reduction in risk is roughly from 3% to 2%. Another way to put this is that if I don’t take statins, I might die, and if I take statins, I might die, and if I die we don’t know, from that whether the choice was correct.

There are comparisons being made with vaccination, and “anti-vaxxers.” Vaccination, as a general practice, has made a *drastic* difference in the rates of many serious diseases, but there are also problems. I had a friend who died because his daughter was given Sabin oral vaccine. He was maybe in his thirties and had never been vaccinated, contracted polio, and died from it. This was a rare event, and as a public policy, given that the vaccines have saved millions of lives, and that is not controversial, at least not to me, a decision can be made to tolerate some level of harm to a few.

However, what was missing in that situation was a careful review of family members, and informed consent by the whole family to the child’s vaccination.

There are physicians who work with patients who decline vaccination, not to condemn them, but respecting their choice, and keeping up communication, and when risk becomes high, these physicians find that patients are willing to take the risks of side effects.

Blaming the anti-vaxxers for poor educational outreach, accusing vaccine refusers of ignorance and child neglect, is not a solution, it will only harden opposition.

Medical fascism is not a sane path to better health care.

From what little I have seen of anti-vax information, there are some concerns that appear legitimate, and it should be easy to research these, thoroughly. Is it?

To be sure, one of the concerns is that safety studies were never fully completed. Why not? Fact: the drug companies are not going to perform those studies unless they must, and they would be the wrong manager of safety studies. We need systemic changes, we, the public, must take responsibility for supporting the best science. The system we have expects drug companies to shoulder that burden, and there are reasons for that, to be sure, for medicines that are not so likely to be useful, but . . . who watches the watchers? In theory, governmental agencies do this, but they can be a revolving door with industry lobbyists, where are the lobbyists for the public interest? The only ones I have seen are ones with an axe to grind already. We need facilitation of basic science, not predetermined political positions.

Most of what I have seen of anti-anti-vax discussions, is polemic and hysteria, itself. The risk of not vaccinating is normally low, in a vaccinated society. Yes, there is a possible risk, from what has become a rare disease, which must always be balanced against other risks, to be sane.

If giving poor medical advice is to be considered murder (as it was in a recent case where the advice was actually outrageous), then hundreds of experts, and thousands (or even millions through compliance) were possibly guilty of murder in the original advice on dietary fat and cholesterol. That advice has been modified and clarified over the years, but it is still seriously defective.

If a patient depends on statins for controlling atherosclerosis, and does not implement “life style adjustments,” the statin prescription might actually be causing harm. Some of those harmed will die. “Murder by Standard of Practice.”

Standards of Practice should be subject to continual review, with controversy recognized, not deprecated as “denialism.” Where objections are incorrect, that can be examined and addressed with care, not with blind certainty that what was recommended for a long must necessarily be right.

Semmelweiss was rejected because what his research found showed that doctors were transmitting puerpural fever to women giving birth, killing thousands of mothers, and that idea was so horrifying that it was rejected as not having any known mechanism. This was before Pasteur showed that bacteria could transmit disease, invisibly. It did not help that Semmelweiss himself was probably suffering from early-onset Alzheimer’s disease, and became quite angry at being rejected, and extreme on his attacks on those rejecting his research. The lesson: just because someone is crazy (“conspiracy theorist” asserts insanity) does not show that they are wrong. Factual assertions should be checked, at least by somebody.

One of the problems in medical science is that media reports new research with lurid or exciting headlines that often do not reflect what is actually shown. So a paper that finds “there is no evidence for the benefit of statins for a certain population group,” becomes, “Study claims statins are useless.” Media want punchy headlines and “news you can use,” so they take information and massage it into what they think people want to read.

And we, the public, tolerate that and that makes us responsible for it. We could create reliable media, this is a horn I have been blowing for years. We don’t. Why not? Too much work, too much bother, and I think I’ll check Facebook or Apple News for something exciting, or watch the football game, or whatever floats my boat for a while, even if the stream is heading for a huge waterfall.

The patient example here was absolutely brilliant. The real problem of that patient was obvious. He was high risk, he had already had a heart attack! That is an extremely high risk patient, who made have needed a stent many years earlier. I’m not eager to have a stent put in, but if I have an actual heart attack, I’ll could easily be on my back in an operating room with a catheter in my heart and a cardiologist will look at the images and decide, on the spot, whether or not to insert one of those little beasties, and I am not so likely to second-guess him.

This poor fellow actually had a heart attack at 39, and obviously failed to take the warning seriously. He was very, very high risk, and became more so. He did nothing at all, at least nothing that is reported. He was extremely high risk! Statins are only a part of this picture, and his doctor recognized that. But since the story was about statin denialism, that fact is deprecated, given no real coverage. Instead the focus is on alleged sources of statin denialism, vague. There is no sign that this fellow read any of the “denialist” research. No, he listened to the radio, to discussion programs, and took away only a conspiracy theory, that he believed.

He suffered from denial, avoidance of reality, of what was really going on with his body, and he wanted to hear that this drug that he didn’t feel good taking was useless, but he did not then look for what would be more useful, and there is really no controversy that there are more useful interventions (and better measures of risk than cholesterol). It also looks to me like his original cardiac care was shoddy and incomplete. Did he have a cardiac cat scan or a stress test or other tests? Was he advised to maintain contact with his cardiologist? Did he have a cardiologist?

It was easy for his physician to write a statin prescription, but this is what the “statin skeptics” have been pointing out: Statins, if they are effective at all, are not powerfully effective to prevent heart disease (i.e, they are very unlike proven vaccinations). If they belong in a cardiac care regimen, it would not be as the foundation, as the core, the must-have. What belongs there is probably exercise (including, initially, monitored exercise. Here in the U.S., now and probably then, cardiac rehab would have been prescribed. It is fairly expensive, but also effective, if the patient realizes that they need to exercise, or their risk of death at any time becomes high, and then the patient continues to follow a program. A long-term program is not at all expensive, it can be free. So much walking, for example, so many times a week.

And then there is diet, and we need much more research on diet. It’s shocking how little is actually known; rather the field of nutritional science is full of “facts” that aren’t. They are ideas that became popular, with some scientific foundation, generally, but not enough to develop clear conclusions.

So exercise and diet. The actual causes and mechanisms of the development of atherosclerosis are not well understood. When we no more, it may become possible to design drugs with much more powerful effect than statins. If it is true that cholesterol is not the cause of heart disease (and there are substantial claims of that), but is only, at best, an associated symptom of something else, then lowering cholesterol will not have much effect, if any, on disease progression. Statins also have other effects which may give some level of protection. The black and white arguments that yellow journalists love are “Statins are miracle drugs that save lives, except for people stupid enough to follow diet-book authors,” and “Statins are useless, and dangerous, and nobody should take them, and those that do are stupid blind followers or orthodoxy.”

It is not that reality is “somewhere in between,” and I would never suggest that “equal time” should be given to “two sides,” but rather that reality is not a position or point of view, and that it is never expressed fully in some simple-minded statement that attempts to shut off inquiry.

The fundamental problem, as seen long, long ago, is ignorance and attachment, combined. When we become more interested in reality, and trusting reality, rather than in promoting our own individual points of view, we will make progress, and the world will transform.

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