I, Al. Lohse, was not following this thread. "Zocor causing
eye problems" sparked no curiosity in me. That is why Steve
Marcus went ballistic. For some reason, he might have though
I was. I am not after statins in particular, I am after drug
safety in general. Statins are a good example for the
problem of drug safety because their potential benefits are
systematically overstated while their potential harm is
systematically understated. So........
Steve Marcus said:
"Zee" <[email hidden]> wrote in message
"]news:[email hidden]...
Quoted message said:NoSpamo~ <[email hidden]> wrote in message
news:<[email hidden]-
.net>...
..........snipped >>>>>>>>>>>
Quoted message said:Quoted message said:Just possibly, stress, attitude and inflammation are.
Read...and make your own decisons. I have.
ravnskov.nucholesterol.htmOpen ↗
OK. I'll play. Comments on the key material from the above
link appear in parentheses. Nota bene, there is on such
comment that follows material in the original that is also
contained within parentheses.
From the above link: ***Begin quoted material; see the
above for an important note on my comments being inserted
therein.***
6. The effect of the statins is not due to cholesterol-
lowering:
As mentioned in section 4 cholesterol-lowering by itself
does not prolong your life. In the experiments, that have
shown this fact beyond all doubt, cholesterol-lowering was
performed by diet or by use of various older drugs such as
clofibrate (Atromidin®), gemfibrozil (Lopid®),
cholestyramine (Questran®), colestipol (Lestid®), and
nicotinic acid (Nicangin®). But a new type of cholesterol-
lowering drugs, the so-called statins (for instance
Zocord® and Pravachol®) have been succesful. **For the
first time cholesterol-lowering have shown significant
improvement of mortality, both coronary mortality, stroke
mortality and total mortality. These trials are therefore
considered as strong arguments for the idea, that a high
cholesterol is dangerous.** (Emphasis added by me- and the
reader will note that the rest of what follows is a
circular argument constructed by the good Doctor Ravnskov
in order to be able what he himself has just admitted in
the emphasized sentence.)
Your comment sentence is, of course, incomplete.
You might be trained in the art of dissecting a paragraph
(analytical linguistics?), but you may not be aware of the
concept that is being conveyed here. The concept is that
after all the cholesterol lowering trials which brought
nothing, how come we, all of a sudden, with the advent of
statins, have cholesterol lowering trials which bring
something. Rather than making a circuitous argument, he is
presenting evidence which backs his case, toward the simple
conclusion that, if statins actually reduce cardiac events
and cardiac deaths, then, since other cholesterol lowering
trials have failed to demonstrate same, mechanisms other
than cholesterol reduction must be causing the desirable
effects. Then he goes beyond that, but one cannot say he
brings his topic paragraph into his conclusions as one might
expect in a circular argument. His is a linear analysis, and
it appears to be very, very good.
A circular argument suggests there will be no new
information given, a closed system. The author clearly,
often, presents new information, with references, as
evidence to support his case. Certainly not like: If
rectangle is like square and if square is like triangle and
if triangle is like trapezoid then trapezoid is like
rectangle. That, I would offer, is an example of a circular
argument. (It could have been done with colours or fruits,
etc. instead of shapes.)
Finding fault with his presentation would require showing us
where his ** science ** is in error, what has been
misinterpreted, not the (though erroneous ) form of the
presentation.
What we have here is strong evidence that the small benefits
derived from statins are almost certainly NOT due to their
cholesterol lowering effect. And, I would add, the
cholesterol lowering effect is what is sold because it can
be measured, while the real benefit of taking these drugs in
even the post MI population has yet to be demonstrated out
side of industry funded clinical trials.
Quoted message said:
Have these trials really demonstrated that raised LDL
cholesterol has importance for coronary heart disease, as
the trial directors concluded in the reports?
Quoted message said:There is reason to question that, because some of the
results are not consistent with what we have learned about
cholesterol.
First, the statins were effective also for women. This is
most surprising because most studies have shown that a
high cholesterol is not a risk factor for women. (Most surprising-
but the good Doctor Ravnskov doesn't rebut it.)
Statins work in women; Cholesterol is not a risk factor for
women; Therefore, the mechanism must be something other than
cholesterol lowering. Get it?
Quoted message said:Second, old individuals were protected just as much as
young ones, although most studies have shown that a high
cholesterol is a weak risk factor, or no risk factor at
all, for men above fifty. (So there are individuals who
die of causes other than cardiac induced ones. Big
surprise. How many degrees does a doctor have in order to
figure that out? Meanwhile, for those who are over fifty
and who are at risk from cholesterol???)
Statins work in the elderly; Cholesterol is not a risk
factor for the elderly; Therefore, the mechanism must be
something other than cholesterol lowering. Get it?
(The "take home" message here, and it is vitally important,
is that cholesterol only correlates with CHD in men, and
then only in men under the age of about 50.)
Quoted message said:Third, also the number of strokes was reduced after statin
treatment, although no studies have shown that a high
cholesterol is a risk factor for stroke. (So if drug X was
shown to combat the risk of contracting cancer, yet no
studies should that it protected against contracting
multiple scelorisis, the drug should not be prescribed???)
The notion of "CardioVascular Disease" (CVD) has ascribed
similar ** mechanisms ** to heart attack and stroke. (Hence,
also, the Heart and Stroke Foundation.) Cholesterol is not a
risk factor for stroke. (I did not know that.) Cholesterol
reduction by statin therapy reduces incidence of stroke.
Hence, it is unlikely that cholesterol reduction caused the
benefit observed. It is something else. Get it?
Quoted message said:Fourth, patients who had had a coronary were protected
although most studies have shown that a high cholesterol
is a weak risk factor, if any at all, for those who
already have had a coronary. (In fact, this finding should
have stopped all the previous, secondary preventive
trials). (First parenthetical statement the good Dr.
Ravnskov's, this comment is mine. Most studies??? In other
words, he'll choose the studies that support his position.
I had a first heart attack, and then a second before any
intervention regarding cholesterol could be taken. Is it
okay with the good
Dr. Ravnskov and with you that I be permitted to take a
statin?)
As far as I am concerned, all cholesterol studies could
have been stopped after the publication of MR FIT. If the
small benefit of statin treatment is verified out side of
industry funded clinical trials, then that benefit is
serendipitous, it was discovered by accident. Possibly
similar results could be found with cinnamon, parsley,
clover, or what have you.
By all means, present other studies if you are going to
question his rigor. You might be looking for "beyond a
reasonable doubt..."
Quoted message said:And finally, the statins protected against coronary heart
disease whether the cholesterol was high or low although
most studies have shown that a normal or low cholesterol
is no risk factor for coronary disease.
How come that the statins are effective for women, for old
people, for patients who already have had a coronary, and
even for those whose cholesterol is normal? If the
cholesterol level for these people is no risk factor for
coronary disease, how could a lowering of that cholesterol
improve their chances to avoid a coronary? The only
reasonable explanation is that the statins do more than
just lower cholesterol. There is much evidence for that.
(So we ought to throw the drugs out because, although they
are effective against coronary risk, in the good Dr.
Ravenskov's not so humble opinion which simply discards
those studies that don't support his ideas, simply because
the mechanism involved might, in his not so humble
opinion, be unknown? And in the meanwhile, folks can
continue to be at risk for coronary problems.)
Throwing the drugs out is not his conclusion, but yours. His
conclusion will be the drugs be used minimally and
appropriately with due consideration to good and harm, cost
and benefit.
Quoted message said:The statins inhibit the body's production of a substance
called mevalonate, which is a precursor of cholesterol.
When the production of mevalonate goes down, less
cholesterol is produced by the cells and thus blood
cholesterol goes down as well. But mevalonate is a
precursor of other substances also, substances with
important biologic functions.The metabolic pathways are
not known in all details, but less mevalonate may explain
why simvastatin makes smooth muscle cells less active and
platelets less inclined to produce thromboxane. One of the
first steps in arteriosclerosis is the growth and
migration of smooth muscle cells inside the artery walls;
and thromboxane is a substance which promotes the clogging
of blood. Thus, by blocking the function of smooth muscle
cells and platelets, simvastatin may benefit
cardiovascular disease by at least two mechanisms and both
of these mechanisms are independent of the cholesterol
level (82).
He just introduced new information with a reference number.
Quoted message said:In one of the experiments, performed by Dr. Yusuke Hidaka
and his team the inhibitory effect on the muscle cells
could not be abolished by adding LDL-cholesterol to the
test tubes (83); and in experiments with various cholesterol-
lowering agents, thromboxane production was inhibited by
statins only, indicating that the effect was not due to
cholesterol lowering but to something else (82).
He just introduced new information with reference numbers.
Quoted message said:The protective effects of simvastatin was also
demonstrated in animal experiments. In one of them,
performed by Dr. B.M. Meiser and colleagues from Munich,
Germany, hearts were transplanted into rats. Normally, the
function of such grafts gradually deteriorates because the
coronary vessels are narrowed by an increased growth of
smooth muscle cells in the vascular walls, a condition
called graft vessel disease. In Dr. Meiser's experiment,
however, rats that were given simvastatin had considerably
less graft vessel disease than control rats not given
simvastatin, and this was not due to cholesterol lowering
because simvastatin does not lower cholesterol in rats. In
fact, LDL cholesterol was highest in the rats treated with
simvastatin
(84).
He just introduced new information with a reference number.
Quoted message said:In another experiment, Dr. Maurizio Soma and his
colleagues from Milan, Italy placed a flexible collar
around one of the carotic arteries in rabbits. After two
weeks arteries with collars became narrow but less so if
the rabbit had been given simvastatin. Again, the effect
was unrelated to the rabbits´ cholesterol level (85).
He just introduced new information with a reference number.
Quoted message said:**Thus, the statins in some way protect against
cardiovascular disease, but their effect is not due to cholesterol-
lowering.** (Emphasis mine. It's important to note what
the good Dr. Ravnskov has just stated; it's really game,
set and match. Again, if drug X was shown to combat the
risk of contracting cancer, yet no studies should that it
protected against contracting multiple scelorisis, the
drug should not be prescribed???)
No, No, No. He has presented supporting evidence. Your
cancer MS analogy is, of course, preposterous in this case.
Quoted message said:But why bother about pharmacological mechanisms? Isn´t it
wonderful that the statins work? Shouldn´t we all take
statins?
(Absolutely, those for whom statins are indicated as
prescribed by their physicians should. What follows from
the good Dr. Ravnskov is simply the same tired argument
that folks like Lohse have been posting. There are side
effects. Yes indeed. And I choose to risk them in order to
obtain the benefits.)
If and only if the physician is thoroughly informed. Pharma,
quite apparently, treats physicians like mushrooms. (See
post script.) If pharma had its way they might be putting
statins into the drinking water.
Quoted message said:The costs:
To answer that question it is necessary to look at the
figures from the trials. To be short I have chosen the
figures for coronary death. According to the results
from the 4S trial (86) there was a 41% reduction in the
risk of coronary death. According to the results from
the CARE trial (87) the reduction was 24%, and according
to the WOSCOP (88) trial the reduction was 28%. These
figures seem impressive, but let us look at the absolute
figures also.
In the treatment group of the 4S trial five percent, or
111 individuals, died from a heart attack; in the control
group 8.5 percent, or 189 individuals, died, a difference,
or a risk reduction of 3.5%. To prevent these 3.5% of the
patients (8.5% - 5%) or 78 individuals, from dying it was
necessary to treat 2221 individuals during five years. You
could also say that to prevent one death it was necessary
to treat 25 individuals for five years. Or said in another
way, if you have had a heart attack the chance to avoid
death from a new one during five years is 91.5%. If you
eat simvastatin this chance increases to 95%.
In the CARE trial 5.7%, or 119 individuals died from a
heart attack in the control group and 4.6%, or 96
individuals in the treatment group. Thus, to prevent 23
coronary deaths (1.1%) it had been necessary to treat 2081
individuals for five years, which means that 90 patients
were treated for each life saved.
In the WOSCOP trial, which concerned healthy individuals
with a high cholesterol, the result was even less
impressive. Here, 61 died in the placebo group, 41 in
the treatment group, a risk reduction of 0.6%. To save
these 20 lives it had been necessary to treat 3302
healthy individuals for five years, or 165 individuals
for each life.
Said in another way, the risk of dying from a heart attack
during five years if you are about 55 years old and if
your cholesterol is around 272 mg per dl is 1.8%. With
pravastatin treatment the risk is reduced to 1.2%. You
could also say that the chance to avoid death from a heart
attack for five years is 98.2%; with pravastatin the
chance is 98.8%. The reason why trial results should be
given in absolute figures and not in relative is because
the side effects are given in absolute figures. Let us
assume that a mortal side effect occurs in 0.5 percent of
the patients. You may belittle that if you compare this
figure for instance with a relative risk reduction of 28%.
But as the absolute risk reduction was 0.6% the effect of
treatment has almost disappeared.
**To be fair it should be mentioned that the number of non-
fatal heart attacks was reduced also. In the WOSCOP trial
for instance, 248 individuals in the control group had a
fatal or non-fatal coronary, in the pravastatin group the
number was 174.** This means that to prevent a heart
attack in a healthy 55 year old man with a high
cholesterol it is necessary to treat about 45 men for five
years. To prevent a new heart attack it is necessary to
treat 34 patients for five years according to the CARE
trial and 28 patients according to the 4S trial. (Emphasis
again is mine. I haven't commented on the above paragraphs
under the heading of costs, because they don't amount to
more than a statement that "the drugs have benefits, but
there are risks. I've commented here because it
demonstrates that manner in which the good Dr. Ravnskov
constructs arguments. All of the above figures need to be
considered against the backdrop of preventing non-fatal,
as well as fatal, infarcs. Or does anyone out there think
that non-fatal infarcs are a good thing, and the lasting
effects thereof do not lead to other health issues?)
He touches on that below. Be patient. (Your lack of comment
on the portion containing numbers is not entirely lost on
me. It takes all kinds to make a world.)
Quoted message said:It is necessary also to look at the costs, but this is not
an easy task. For the drugs only the price for one extra
year for one person was about $41,000 in the 4S trial,
about $148,000 in the CARE trial and about $205,000 in the
WOSCOP trial. To that should be added the costs for
laboratory tests and doctors´ fee.
**There are economical gains also, of course. The
directors of the most succesful trial 4S claim that the
reduced costs due to the lower number of non-fatal heart
attacks outweigh the expenses. But that trial concerned
patients at a very high risk of cardiovascular disease.
To treat healthy individuals with a high cholesterol
must be very expensive, however, because the gain was
very small.** (You figure that those who survived the
risk and had infarcs prevented don't think that the cost
was worth it?)
Those people are so few and far between, they, themselves,
will never know if they have benefited. On the other hand,
albeit fewer and further between, those who suffer permanent
damage know almost certainly what the culprit is.
Quoted message said:The 4S directors´ optimistic views presuppose that the
effect is just as positive after ten or twenty years of
treatment as it was after five. Unfortunately we cannot
guarantee that. (There are no guarantees about anything.
I'll settle for five years as a fist step.)
Indeed, then you must be in the very high risk group with
relatively short life expectancy. Sharon Hope's husband was
not and, apparently, neither was (zee badant mfg). Speaks
volumes to their attitudes!
I would not travel to the Philippines with cancer for
"chicken giblet therapy" as Andy Kaufman did, but I would
take statins, if I could tolerate them if I have severe
clogging of the coronary arteries. I do not so I do not.
Quoted message said:
Recently, Drs.
Thomas Newman and Stephen Hulley published the results from a meticulous
review of what we know about cancer and lipid-lowering drugs. They found
that clofibrate, gemfibrozil and all the statins stimulate cancer growth in
rodents (90).
Quoted message said:
Newman and Hulley asked themselves why these drugs had
been approved by the Food and Drug Administration at all.
The answer was that the doses used in the animal
experiments were much higher than those recommended for
clinical use. But as Drs. Newman and Hulley commented, it
is more relevant to compare blood levels, and the levels
achieved in rodents were very close to those seen in
patients.
Because the latent period between exposure to a carcinogen
and the incidence of clinical cancer in humans may be 20
years or more, the absence of any controlled trials of
this duration means that we do not know whether statin
treament will lead to an increased rate of cancer in
coming decades.
Thus, millions of asymptomatic people are being treated
with medications, the ultimate effects of which are not
yet known. Drs. Newman and Hulley therefore recommended
that the new statins should be used for patients at very
high risk for coronary disease only, whereas such
treatment should be avoided for individuals with life
expectancies of more than 10 to 20 years. And healthy
people with a high cholesterol as the only risk marker
belong to that category.
***End of quoted material****
As I have the time and incliniation, I'll look at the
other links that you've provided. I'll tell you up front
that if they are of the same "quality" as the one hawking
Dr. Ravnskov's wares, I will stop bothering.
IMHO Dr. Ravnskov is providing a very valuable service which
can only promote additional safety, reliability, and
effectiveness for drugs. As it is virtually impossible that
the small statin benefit is due to cholesterol profile
alteration, find the parts of the statin molecules that work
and improve on them.
Quoted message said:In the meanwhile, once one cuts through the smoke and
noise on the linked site, one finds that Dr. Ravnskov
agrees that the statins have been effective for doing what
they are advertised to do, but is disturbed by the fact
that they, **like virtually every other drug prescribed
today, and like many over the counter drugs** have risks
of side effects. This isn't news, although it does enable
folks like Dr. Ravnskov to make money selling books on the
premise that it is news.
This is not news to me today either, but it would have been
four short years ago, and I would have had great difficulty
in believing prescription drugs can maim and kill. I am
rather well informed and for that, I know I know virtually
nothing. I certainly lack naivety but that lack of naivety
did not protect me from a heart attack which was almost
certainly caused by the drug, Monopril, because the
symptoms were unusual, there was no blockage found, my
coronary arteries were clear, the events occurred at times
of low and no stress, and the manufacturer admits it can
happen in up to 1% of patients in the course of their short-
term clinical trials.
Drugs need to made safer; The whole system can use
improvement. As a critique, your annotations have failed.
They smack of contrariness. You tend to jump to the wrong
conclusions and, not unlike your having misread this fine
article, you have also misread peoples motives and
intentions.
CardioVascular Disease is almost certainly not a statin
deficiency disease; Nor is it likely to be an excess
LDL disease.
Dr. Ravnskov's position, articulated above, is strong and
well documented. (It is only a small subset of his good
works.) It is given in linear, not circuitous form. Even
physicians monitoring this NG have found nothing wrong
with the substance... The lawyer does not like the form,
he cannot speak to the substance...
All is not lost. Read on and write, participate, chill....
c_h_i_l_l.... c___h___i___l___l.
Have a nice day,
D.s.
Remember: sigma = Mc/I; M= Pl;I=bh^3/12; c=h/2
p.s.Not finished yet:
From Microsoft Encarta 2000: Coronary Heart Disease: (by:
Passamani, Eugene, M.D. Director of Cardiology, Suburban
Hospital, Bethesda, MD.): "Most physicians believe LDL
should be less than 100 mg/dl for patients with coronary
heart disease."
WHO INSTILLS THAT BELIEF??? WHERE IS THE SCIENCE??? Who has
stated, "There is no cholesterol dichotomy?"
D.t.
Quoted message said:Quoted message said:www.thincs.org.
ti.ubc.caletter49.htmOpen ↗
ti.ubc.caletter48.htmOpen ↗
www.nofreelunch.org www.publiccitizen.org
www.redflagsweekly.com www.healthyskepticism.org
B'adant
Steve
--
The above posting is neither a legal opinion nor legal
advice, because we do not have an attorney-client
relationship, and should not be construed as either. This
posting does not represent the opinion of my employer, but
is merely my personal view. To reply, delete _spamout_ and
replace with the numeral 3
