We Need to Stop the Overdiagnosis Disease. Step 1: Remove Vested Interests

Yves here. This setting of overly stringent boundaries for health versus disease is widespread, and also annoyingly contrast with conventional medicine’s indifference to what they regard as subclinical problems like fatigue. For instance, the American Heart Association and the American College of Cardiology published “new” cholesterol guidelines in 2018. I have been told for at least a decade that Homocysteine and triglyceride levels are much better indicators of heart disease risk that cholesterol. So why the fixation on cholesterol?  Because statins? Research shows statins are beneficial only for people with actual heart disease, not people at risk of getting heart disease. From a 2018 article:

A comprehensive new study on cholesterol, based on results from more than a million patients, could help upend decades of government advice about diet, nutrition, health, prevention, and medication. Just don’t hold your breath.

The study, published in the Expert Review of Clinical Pharmacology, centers on statins, a class of drugs used to lower levels of LDL-C, the so-called “bad” cholesterol, in the human body. According to the study, statins are pointless for most people.

“No evidence exists to prove that having high levels of bad cholesterol causes heart disease, leading physicians have claimed” in the study, reports the Daily Mail. The Express likewise says the new study finds “no evidence that high levels of ‘bad’ cholesterol cause heart disease.”

The study also reports that “heart attack patients were shown to have lower than normal cholesterol levels of LDL-C” and that older people with higher levels of bad cholesterol tend to live longer than those with lower levels.

Note the Daily Mail actually does a very good job of reporting on science, despite its love of the tawdry.

The link above to the new guidelines also finesses that a few years back, the heart disease officialdom lowered the level of LDL, the “bad” cholesterol, that they considered to be OK, and pushed statins; the “update” backs off on them a bit and discusses other treatment options. See this section from a writeup of the 2013 guidelines:

Cholesterol-lowering statin drugs could be prescribed to an estimated 33 million Americans without cardiovascular disease who have a 7.5 percent or higher risk for a heart attack or stroke within the next 10 years. That’s according to a new cholesterol guideline from the American Heart Association and American College of Cardiology.

This is a dramatic change from the 2002 federal cholesterol guideline, which recommended that people should only take a statin if their 10-year risk level exceeded 20 percent. The old guideline only considered a person’s risk for heart disease, leaving out the risk for stroke.

The American Heart Association and American College of Cardiology also recommend that total cholesterol be lower than 200 mg/dl. Yet in women, the level of total cholesterol correlated with the lowest all-factor death rate is…drumroll…270: From reader davidgmills:

I was talking to my brother (PhD in biochemistry as was my father) not too long ago about another PhD in biochemistry, Dr. Ray Peat. Peat did his dissertation on progesterone and had spent 40 years researching it. Progesterone is made from cholesterol and is the precursor of the hormones testosterone, estrogen and hydrocortisone. In other words, four of the body’s six major hormones are derived from cholesterol.

Peat did some extensive research on the deaths of women, to find out what was the optimal cholesterol level for longevity. His conclusion was the number women needed for longevity was 270 (very high according to the AMA which wants it under 200). Peat found that low cholesterol did in fact decrease a woman’s chances of dying from a heart attack but caused a woman to die sooner from something else.

My brother couldn’t believe what I was telling him about Peat’s research, but after checking out Peat’s articles and references, he concluded Peat was right. In fact, one of the things my brother found in his research was that LDL is very good at killing bacteria. My brother jokingly commented to me that in lowering one’s LDL that you don’t die of heart disease, you die of MRSA much sooner.

So both my brother and I who were on statins got off of them. Plus my brother found a new meta study of 62,000 people showing they did no good for those who didn’t have cardiovascular disease, making the decision even easier.

My dad, who taught medical students biochemstry for 40 years, found very few MD’s that knew enough biochemistry to give him any confidence in their ability to decide whether medications were justified. So I have always been very skeptical of what they recommend.

This is a very long-winded way of supporting the thesis of the article below, that the medical industry has taken to setting the bar for disease too low for fun and profit.

By Ray Moynihan, Assistant Professor, Bond University and Paul Glasziou, Professor of Medicine, Bond University, Originally published at The Conversation

Did you know the definition of high blood pressure (hypertension) in the United States was recently greatly expanded? Overnight, tens of millions of people were reclassified, leaving one in every two adults with a diagnosis of hypertension.

The move has been welcomed by some but also widely criticised, amid concerns the expanded definition may bring more harm than good to many people, from unnecessary illness labels and unneeded drugs.

What about the condition called “chronic kidney disease” (CKD), diagnosed by measuring blood levels to estimate kidney function? Because it does not account for normal ageing, the current definition labels up to one in two older people as having “CKD”.

But many of those labelled will never have any kidney symptoms, chronic or otherwise, and there’s been repeated criticism within the medical literature. That broad new “disease” was created at a conference sponsored by a major drug company.

Then there are the recent changes to the definition of gestational diabetes which mean up to one in five pregnant women may now be diagnosed. But it’s unclear whether many among the newly diagnosed mothers or their babies might benefit from this expansion.

It’s time for a major change in how disease definitions and diagnostic thresholds are set. We outline a proposal for how this might happen today in the the journal BMJ Evidence-Based Medicine.

The Growing Problem of Overdiagnosis

In all these examples, the danger is that more and more people may be overdiagnosed. Overdiagnosis means receiving a diagnosis that isn’t likely to benefit you.

Supporters of expanded definitions often have the best of intentions, motivated to diagnose ever milder problems and treat them early.

But early detection can be a double-edged sword. For some people you prevent serious illness, for others you overdiagnose and overtreat things that would never progress and never cause any harm.

One common example is prostate cancer. Researchers recently estimatedthat more than 40% of all the prostate cancer now detected via testing healthy men in Australia may be overdiagnosed. In other words, those cancers would not have caused symptoms or problems during a man’s lifetime, yet they are now being detected and treated with surgery or radiotherapy, often with major complications.

Our research a few years ago studied the panels of experts who actually change the definitions of common conditions, such as high blood pressure or depression.

We found three things. When they made changes, panels tended to expand definitions and label more previously healthy people as ill.

Second, they did not appear to rigorously investigate the downsides of that expansion.

And third, these panels tended to be dominated by doctors with multiple financial ties to drug companies with interests in expanding markets.

A Proposal to Reform How Diseases Are Defined

Today, an international group of influential researchers and family doctors launch a proposal to address this problem of expanding disease definitions. Published in BMJ Evidence-Based Medicine, our proposal is for new processes and new people.

The new processes include rigorously examining evidence for benefits and potential harms, before reclassifying millions of healthy people as diseased. This was proposed in a world-first checklist for groups seeking to change definitions, developed by the Guidelines International Network.

As for new people, today’s article suggests new multidisciplinary panels led by generalists, rather than specialists. It calls for strong representation from consumer or citizen groups, and all members being free of financial ties to drug and other interested companies.

Where to From Here?

Responding to overdiagnosis remains a complex and uncertain challenge, both for individuals, and those who run health systems.

But it’s clearly being taken more and more seriously. The World Health Organisation is co-sponsor of the Preventing Overdiagnosis conference in Sydney this year, where the science of the problem and solutions will be debated.

And just last week, leadership of the Nordic Federation of General Practitioners endorsed this proposal to reform the way diseases are defined. It’s likely others will follow suit, against strong resistance from vested interests.

But as we conclude in today’s BMJ Evidence-Based Medicine article, the time for change is now. We shouldn’t treat people as an ever-expanding marketplace for diseases, for the benefit of professional and commercial interests. We can no longer ignore the great harm to those unnecessarily diagnosed.

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64 comments

  1. dearieme

    “Note the Daily Mail actually does a very good job of reporting on science, despite its love of the tawdry.”

    That is why I refer to it as The Old England Journal of Medicine.

    You’ll learn far more about reality from the Mail than from the Guardian.

    Reply
    1. orange cats

      Lol, the Daily Mail is my guilty pleasure. They had better coverage of hurricane Katrina than U.S. newspapers. And maybe Jeremy Corbyn IS the devil, ever consider that?

      Reply
    2. rd

      That was the joke in “Men in Black” which was that the only newspaper that got the real picture was National Enquirer.

      These days, even The Onion has been struggling to come up with headlines that aren’t transcripts of government representatives’ communications.

      Reply
  2. john BOUGEAREL

    CoQ10 and Cholesterol also share the same synthesis pathway. Statins inhibit the synthesis of not just cholesterol, but CoQ10.

    Reply
  3. clarky90

    I have an old friend, now in his late seventies. He goes to the gym most days and is still working. About five years ago, he developed an awful, all-over, itchy, scabby, weeping, skin rash. It was driving him nuts. His sleep was broken which also disturbed his wife’s sleep. Utterly desperate, he went repeatedly to a specialist dermatologist (very expensive), who put him on various anti-fungicides, antibiotics, NSAIDs, sleeping pills, anxiety pills, steroids…. He was prescribed special creams and soaps to use on his skin. Nothing seemed to help.

    This awful torture, continued for three years. Then his old GP retired. He got a new doctor. The new doctor reviewed his medications and decided that he didn’t need his daily statins.

    And his rash instantly disappeared….
    True story.

    Reply
    1. Juneau

      I know this is a complicated debate. Ford Brewer MD MPH on you tube gives a very sophisticated discussion of cardiac risk factor testing (he used to run the preventative medicine clinic at Hopkins) and there are many tests that delineate risk that don’t always get done. Cholesterol testing is covered and readily available and for people with multiple risk factors IS relevant. It is a lot more complicated than that unfortunately and the testing can get expensive. These tests include triglycerides, APO E testing, stricter guidelines on diagnosing insulin resistance (extremely important) etc…statins can prevent and reverse heart disease in some cases but it is much more complicated than that according to Dr Brewer. The diabetes issues (and prediabetes when damage can start to occur) are widespread and HUGE.

      Reply
    2. Christian Thwaites

      I had a similar story. Prescribed statins in my late 40s. Started to have bad muscle aches every time I ran (5x a week). Got slower and slower. Spent $$$$ on chiropractors and all sorts of muscle exercises. Changed doctor, no statins and almost immediate relief. Upped running schedule and no problems for 4 years.

      Reply
    3. jrs

      Lots of people that are on statins never should have been. They are overprescribed just on cholesterol readings and no other evaluation of risk factors.

      But reduced deaths from heart disease are as I understand it are largely attributable to statins (the fact less people smoke also likely figures in). I mean it’s to the point that people say epidemiological trials etc. that look at heart disease have become largely irrelevant at this time, due to the introduction of statins.

      Reply
      1. dearieme

        “But reduced deaths from heart disease are as I understand it are largely attributable to statins (the fact less people smoke also likely figures in).”

        Not remotely. Deaths set into decline in the late 60s, long before statins, well before people started giving up smoking in large numbers, and well before government diet propaganda had any effect.

        In other words, it had nothing to do with either the medical trades or the powers that be.

        Reply
  4. dearieme

    By the way, in the UK the NHS pays GPs a bonus for diagnosing diabetes.

    Ditto for imposing statins on their patients.
    https://www.telegraph.co.uk/news/2018/05/21/gps-paid-handing-statins-puts-patients-review-finds/

    In 2011 the bonus for discovering “high” blood pressure apparently had little effect.
    https://www.telegraph.co.uk/news/health/news/8280636/Paying-GPs-to-treat-blood-pressure-had-has-no-impact.html

    So since then the threshold for “high” has been moved down.

    Reply
  5. clarky90

    Re “today’s BMJ Evidence-Based Medicine article”

    Scientific Opinions — For Sale by Dr Jason Fung
    https://medium.com/@drjasonfung/scientific-opinions-for-sale-5b3e7cdec8d9

    “One of the greatest problems in medicine today is that academic medicine has been sold to the highest bidder. Under the guise of ‘Evidence Based Medicine’ the public has been sold fraudulent goods, and the result is that people suffer from unnecessary but lucrative procedures and take unnecessary but lucrative medications. Let me explain. Much of the data we use in medicine comes from epidemiology studies — where one thing is associated with another. It is easy to prove association, but much harder to prove that one thing causes the other, which is what we want to know…..

    It is very dangerous to accept data from epidemiologic studies because there are too many confounding factors. That is how we wound up with millions of women prescribed hormone replacement therapy (HRT), which turned out to be giving them cancer….”

    Reply
    1. el_tel

      Sorry but this kind of comment is old and I’m pretty sure was made clear in the early days of NC. Yes, epidemiology is riddled with confounding. One of its “stars”, Professor George Davey-Smith at Bristol University has a brilliant slide he has used for 20 years showing the “ring of fortune” as to whether coffee/this drug/that drug is beneficial today or not.

      I must admit I’m a little depressed at NC reporting on health issues recently. Where once NC was ahead of the curve reporting (long before the MSM) on things like pregabalin, opioid abuse, now it is reporting on something already known to be suspect. I have blepharitis, a minor eye condition but which has a known statistically significant increase in relative risk of stroke (they still don’t know exactly why). But when coupled with my high pulse – an issue you can easily look up on Medline and which has a ridiculously high absolute risk of stroke independent of BP – it means I have a 20% risk in next few years. Sorry, statin abuse, although a real issue, is old news that many of us NC readers have been aware of for years. OTOH NHS doctors are ridiculously behind the curve on things with HIGH ABSOLUTE RISK of death like fast pulse (yet it clearly is an input to the automated risk assessment calculator).

      Plus I won’t even start on the influx of anti-vaxxers and suchlike in the commentariat recently. That might just have been due to being one moderator down due to illness but I spotted that a bunch of “regular” commenters were missing….self-censoring in frustration?

      Reply
      1. Yves Smith Post author

        I’m sorry you don’t like the reporting, but you also don’t appear to appreciate the nature of moving the needle on mainstream messaging. Needing to throw senior bankers in jail is also an old idea. Do you want us to stop writing about that because we wrote about it years ago and you therefore deem it to be not news? We still have banker executives getting away with serious misconduct, hiding behind the “I’m the CEO and I know nothing” excuse.

        As to the anti-vaxxers, NC is not an echo chamber. We moderate and ban people based on how they comport themselves, and not to them failing to hew to views we hold personally and are widely shared by readers. You have no idea how many anti-vax comments we don’t let through due to their failure to meet basic NC standards of presentation and evidence. Some of the ones that make plausible-sounding cases we let through because there is merit in having the site admins and readers keep their argumentation skills sharp by taking them down. Those advocates of bad causes predictably self-destruct by not being able to respond effectively or honestly to objections to their arguments.

        As long as disinformation keeps being pumped out, or bad practices persist, the pushback needs to continue. You may not like what you deem as repetitiveness, but repetitiveness is how Big Lies get cemented, and the only way to fight that is to keep showing they are false.

        Reply
        1. el_tel

          OK I accept I was too harsh, sorry. If I may try to be more constructive: would it be possible to have a “read this first sub-header” for key articles that refer to an earlier comprehensive NC article to head off repetitive comments?

          Whilst I just about keep up with BREXIT articles I’m aware that there are NC ones I may have missed that detail key “nagahappen issues” for instance.

          Reply
    1. whiteylockmandoubled

      Absolutely not. Overtreatment is not a factor in high US medical costs, certainly not relative to other countries. The UK system operates at 40% of US per capita costs, and the issues of mis/overdiagnosis exist in both systems.

      The US health care system spends on average twice as much per capita as other countries, and we get LESS care for it — we see the doctor less often and go to the hospital less often than people in comparably wealthy countries. There may be an argument that over/misdiagnosis is a cost driver across western medical systems, but the US’s peculiar and outrageous cost problem is caused by unregulated, secret prices and radical administrative inefficiency, both the result of a profit-driven multipayer insurance industry that does nothing but extract rent purchasing services from monopoly providers and drug companies who extract further rents by exercising market power.

      Reply
  6. Steve Ruis

    Ah, the same scam was played over obesity. The standard makers for Body Mass Index (BMI) standards in the US apparently received pressure to align with the international standards already in place. As a consequence obesity was set at a BMI of 25 or higher when all of the research showed that health problems only come up when you get north of BMI 40. It turns out the the “international” standards were set at a European conference that was sponsored by … wait for it … a pharmaceutical corporation that had anti-obesity drugs on their books. (Learned from a documentary of health and obesity.)

    Reply
    1. Jen

      A friend of mine is a former Olympic rower. While she was in the midst of training for the 2000 Olympics, she went for a physical, and her GP commented that her BMI was too high.

      Reply
  7. TBone

    My significant other was recently prescribed a new cholesterol-lowering drug by a nurse practitioner in his cardiologist’s office after a yearly checkup appointment. There had been no bloodwork done (no measurement of cholesterol numbers) despite our efforts to lower cholesterol through diet and exercise, so we were perplexed as to why the new prescription for the new drug…then we started receiving phonecall after phonecall from reps of the manufacturer, asking if we needed help getting the cost of the new drug covered by insurance…then we insisted on blood work and guess what? His numbers did NOT show that he needed medicational intervention, they were still in the “okay” range! How did the manufacturer get authorized to phone us AT HOME every other day for weeks as if this new prescription was some kind of important, life-saving drug? SO glad we read up on possible side effects & “benefits” of the unnecessary injections and getting updated labs before blindly following “expert” medical advice!

    Reply
  8. Arizona Slim

    I came very close to being one of those overdiagnosed people.

    As mentioned previously, I had an episode of severe back and leg pain. Happened last fall, and after several weeks of suffering, I went to a medical office in Downtown Tucson. It was touted as the medical home for people who live, work, and play Downtown.

    First sign of trouble was in the waiting room. I couldn’t get my information entered into the sign-in kiosk. The staff had to intervene, and that included their having to make a phone call to the IT department.

    Second warning sign was the waiting room itself. Where were the people? I mean, come on. This waiting room was as big as the first floor of my mother’s house. And it’s not like there’s a shortage of people who live, work, and play in Downtown Tucson.

    Third warning sign was in the exam room. The doctor was much more interested in running me through a battery of screening tests and immunizations than anything else. I even broke into this soliloquy and said, “Let’s solve the problem I came here for!”

    Well, he did a perfunctory exam, diagnosed the problem as sciatica, recommended physical therapy at the in-house clinic, and then he sent me on my way. Although I received a physical therapy referral slip in the mail — which included a note to call the patient to set up an appointment — I never heard from this place again.

    Was it because I didn’t want to run through the screening test and immunization gauntlet? I don’t know, but I suspect that this may be the case.

    As for my back and leg pain, I’m feeling a lot better. During my quest to get rid of it, I went to a massage therapist who recommended the late Dr. John Sarno’s book, Healing Back Pain. I borrowed it, and two other books by Sarno, from the Pima County Library.

    I’m also working the mind body program that Dr. Howard Schubiner lays out in his book, Unlearn Your Pain. Schubiner is a Michigan-based doctor who is continuing Dr. Sarno’s work.

    Reply
    1. Karen

      Sarno is a genius (recovering PT) whose book cured my back pain immediately, along with a variety of other aches and pains that have arisen over the years. He knows what he’s talking about!

      Reply
  9. Ignacio

    I agree very much with you about statins and cholesterol. Cholesterol levels are quite variable, related with multiple genetic factors and almost certainly the cholesterol level bar has been set too low to promote those. Apparently, when there is true a disease, rather than bad habits, like in familial hypercholesterolemy, statins have shown to be ineffective. This migth explain in part the push to indicate statins in cases that migth not even be considered true diseases.

    Reply
  10. Avid Lurker

    Miettinen and Bjorklund: The mevalonate pathway as a metabolic requirement for autophagy–implications for growth control, proteostasis, and disease.

    ABSTRACT

    Autophagy is responsible for the degradation and recycling of cellular proteins and organelles. Our recent work shows that the mevalonate pathway influences cell size, growth, and proteostasis by regulating basal autophagic flux through geranylgeranylation of the small GTPase RAB11. The control of autophagy by the mevalonate/cholesterol pathway has potential implications for statin toxicity, inflammation, cancer, and neurodegenerative diseases.

    … Our recent data show that although inhibition of the mevalonate pathway promotes the initiation of autophagy, it simultaneously blocks the maturation of autophagosomes, leading to a reduced basal autophagic flux.2 This block in the maturation of autophagosomes increases the levels of autophagic markers, which has often led to the incorrect conclusion in biomedical literature that statins increase autophagy. Our data further show that mevalonate pathway inhibition results in autophagosomal rather than lysosomal defects, as lysosomal activity increases in the presence of statins. Mechanistically, the blockade of autophagic flux was found to be caused by reduced prenylation, and more specifically geranylgeranylation, of RAB11 (Fig. 1A), a small GTPase required for normal recycling of endosomes and maturation of autophagosomes.4 Importantly, the reduced autophagic flux was apparent with submicromolar statin concentra- tions in primary human cells,2 suggesting that such effects could be physiologically relevant responses to statin therapy.

    … This, together with the observation that statin toxicity is intensified by blocking autophagy,7 suggests that the reduced autophagic flux caused by inhibition of the mevalonate pathway may function as a mechanism for statin-induced myopathies, which are a relatively prevalent side-effect of statin use.8 The reduced autophagy will also inhibit the clearance of damaged mitochondria, which may further exacerbate muscle toxicity and induce inflammation. Indeed, inhibition of autophagy has been suggested to induce inflammation in mevalonate kinase deficiency, a rare autoinflammatory disease caused by genetic blockage of mevalonate pathway activity.9 In line with this, patients with this disease display myopathy as well as hepatosplenomegaly as common symptoms.

    In recent years, statin use has been suggested to contribute to diseases such as cancer and neurodegeneration.

    Autophagy wins the 2016 Nobel Prize in Physiology or Medicine: Breakthroughs in baker’s yeast fuel advances in biomedical research

    Reply
  11. Moelicious

    Dr. Joel Kahn pointed out during a podcast that most statins are generic and the manufacturers make nothing off of them. I believe my insurance plan has a $0 copay for statins – they are free for me to take. So moving the guidelines to get more people on statins is not a push by big pharma to make more money.

    I know statins get beat up because something like 100 people have to take statins to prevent only one or two cardiovascular events but they are largely benign drugs and I would take them if my numbers don’t improve on diet and exercise.

    And cholesterol numbers fall when people are sick so to say that the optimum cholesterol numbers are 200+ because those people live the longest isn’t really fair.

    Reply
    1. Yves Smith Post author

      What nonsense. There are entire companies that make ONLY generics like Apotex that are large and very successful businesses. Generics are profitable to the manufacturer. And generic manufactures have been raising prices on cholesterol meds:

      https://www.marketwatch.com/story/big-pharma-games-the-system-to-make-generic-drugs-more-expensive-2018-07-27

      And cholesterol levels fall temporarily after a minor illness. Getting a cold or flu does not reduce longevity.

      Agnotology is against our written site Policies. I suggest you read them before commenting again.

      Reply
      1. colinc

        Thank you, Yves, for introducing me to the term “agnotology.” :) I find it “interesting” that it doesn’t appear in any dictionary and that, per Wiki, is still classified as a neologism despite being coined 2+ decades ago. Nonetheless, much appreciated as it contributes to an understanding of the problem, as I see it, of “WTMSP” (Way Too Many Stupid People). Thanks again.

        Reply
    2. Ted

      You do realize that one cannot be “fair” or “unfair” to an industrial commodity? You seem to be under thenunderstanding that statins that are “free” to you cost nothing to anyone and are not a major profit center for their manufacturers. Or that physicians receive other benefits from the manufacturers for prescribing them. The evidence is that long term statin use is net negative on a population wide basis over the long term. In otherwords, they do more harm to a population of recipients than good. The Hypocratic oath, therefore, suggests that they not be used at all. Then there is the apparent lie that LDL is “bad” for you, again, we now have scientific evidence that states otherwise (or at least that the levels of LDL can be much higher than current thresholds suggest). In a for profit health system, the tendency is to misinform the public about health and medicine in order to generate profit. It therefore falls on the public to arm itself against charletans in the system. This is what the reporting here is allowing.

      Reply
      1. beth

        Last summer I was hospitalized for a stroke caused by my genetic disease, Fabry. The head nurse fed me statins throughout my stay and gave me a statin rx to take home. I also got diabetes pricks every four hours throughout my stay. I argued with the nurse and one doctor that I did not need these since I do not have high cholesterol not high sugar. It would have been impossible since I had eaten almost no sugar for 6 months.

        One of my doctors thinks it was not the hospital’s decision to give me statins, but Medicare’s requirement that they will not pay the bill unless the hospital gives me these tests and statins. I argued with each physician who come in that I did not need the statins. If you can comment on this, please do.

        Last night, I watched “Statin Nation ll: what really causes heart disease”
        you can find it online. Robert Lustig along with others at UCSF are archiving documents in order to sue the sugar industry similar to the tobacco lawsuits.

        Reply
        1. orange cats

          @beth, this is probably a thread hijack but it was literally last night that I read that older patients in hospital who were already taking statins are less likely to die of infections than those who are not. Preliminary evidence is showing that statins seem to boost the immune system in older people by helping aging white blood cells (neutrophils) get to the site of infection faster and to cause less damage on their way. Large scale clinical trials are in the pipeline, but maybe they have already started.

          Reply
          1. beth

            You are not funny. You do not give evidence in any way. Who is paying you. I think you need to reread the information that Yves supplied and watch the Statin Nation video I mentioned above.

            I would never take statins since they do not work. Many physicians around the world who are not paid by the pharm. industry see it as a waste of money.

            I am trying to find out whether it was the hospital or Medicare that is requiring me to take medicine that I oppose.

            Reply
            1. orange cats

              Janet Lord, immunologist and director of the Institute of Inflammation and ageing Birmingham UK pages 124-125 of “Borrowed Time The Science of How and Why We Age” by Sue Armstrong, A LEGITIMATE SCIENCE WRITER.

              I wasn’t claiming this was the reason you were given statins and was going to supply the reference but now that you’ve revealed yourself as a rude little snottie I’m glad I didn’t.

              Reply
    3. urblintz

      Sounds like you are drinking the kool-aid to wash down those “free” statins. Maybe you ought to think twice… I’d recommend B vitamins and folate instead.

      Reply
  12. PlutoniumKun

    This is one reason why the one apparent bright spot in the US health system is its apparent good rate of success in curing cancer. Most specialists think the reason is, quite simply, an enormous number of ‘false positives’ are being treated, and then declared cured. This is down to what from a European perspective is a gross over-reliance on cancer testing which produces too many false positives – all so convenient for the industry, but very distressing for the individuals.

    In reality, cancer testing the general population (i.e. people without symptoms or outside specific risk categories) can only be justified (according to most authorities I’m aware of) for a very small number of cancers, notably cervical and breast cancer for women over 50.

    Reply
    1. Yves Smith Post author

      Yes, one example in the US is the aggressive recommendation of colonoscopies for everyone over 50. In most if not all other advanced economies, colonoscopies are recommended only for people with a risk factor, like family history. If you are not in a risk category, a cheap non-invasive fecal occult stool test done annually (you do need to get the test every year but your MD can do it as part of a visit) is an effective screen.

      Reply
      1. orange cats

        This. Get yourself screened enough and they will find something. False positives are a real problem too. The justification for asymptomatic screening is they might “catch” something early–we’ve all heard the stories of the grateful, seemingly healthy patient who was saved from sudden death due to a routine test. But statistics have shown that more people are damaged from false positives and “preventative” interventions (“pre-cancer” cells for example) than are rescued in the rare cases of serious conditions discovered in an annual checkup.

        Reply
        1. Yves Smith Post author

          Yes. The fact is that people are generating teeny cancers all the time and they somehow normally go away all on their own. The fact that abnormal growth are normal if they don’t go into runaway cancer growth mode isn’t widely acknowledged. And there are scary misleading stats as a result, like “One in eight women will develop breast cancer”. A very high percentage of those are “cancers” that are so slow growing that women die with them rather than of them.

          Reply
          1. Annotherone

            Yves, I do understand the point you are making, but it becomes very difficult when one is actually involved in these issues personally.

            About a year ago I was diagnosed with early breast cancer after a mammogram, breast MRI and ultra sound examinations. I underwent a lumpectomy. Meds prescribed to supposedly prevent recurrence left side effects I was unable to take for long. Almost a year to the day onward, last month, after follow-up tests it was found that another early stage breast cancer had arisen in the same breast. I had a left breast mastectomy a week ago. I was 80 in January by the way.

            Perhaps I would have died “with” my cancers rather than “from” them – but it’s devilish hard to gamble on such a thing!

            I’ll add, too, that around the same time my cancer issue resurfaced I had intestinal problems – diarrhea. I went through the usual – blood sample, stool sample tests with nothing untoward discovered. Surgeon suggested a colonoscopy – something I’d been refusing at every invitation in past years. This time I accepted, and had the procedure one week before the mastectomy. Pathologist found evidence of lymphatic colitis – but otherwise no probs and no cancers colon-wise. The med recommended for this ailment cost me $1,400 for a 6 week course! Sigh.

            What was it Shakespeare said? “When sorrows come, they come not single spies, but in battalions”

            Reply
            1. Lunker Walleye

              Dear Annotherone,
              We were diagnosed about the same time last year. I am very sorry to hear about your recurrence and mastectomy and further health issues. Like you, the aromatase inhibitor is causing nagging side effects and I see oncologist next week. The fatigue is real and it seems impossible to get a good night’s sleep. After taking a daily walk up and down my beloved hills, I’m done in. This is the second pill that has been prescribed and I’m weighing whether or not to continue on any hormone blocker. I used to have lots of energy. Now I rest a couple of times of day and feel quite unproductive.

              Reply
              1. Annotherone

                Hey there – yes, I remember you from last year. I’m sorry to read that you are suffering side effects from those flippin’ aromatase inhibitors – my body rebelled against them after a couple of months. I tried something else which also supposedly helped osteoporosis – fine for 6 months, then joint and muscle pain got so bad I couldn’t even get into the car. I stopped taking them and it took 2 months for the side effects to subside. Damned if we do, damned if we don’t it seems.

                I shall seek quality of life rather than quantity now – in any case I’m lucky to have arrived at 80 reasonably unscathed, and do feel relatively grateful. Warm wishes to you for the future.

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                1. Lunker Walleye

                  Thank you for remembering. I’m still able to get in and out of car so maybe that is a victory! Yes, damned if we do or don’t. I had two friends who tried alternative medicine approaches to their b.c. and they both died within 5 years. Best wishes to you.

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                2. Antagonist Muscles

                  This was the only comment that mentioned osteoporosis so my opinion of osteoporosis and overdiagnosis goes here.

                  I did some research on osteoporosis after my mom had been diagnosed with it. Apparently all healthy postmenopausal women have cells in their bodies that absorb more calcium in their bones than the cells whose responsibilities are to create new bone. Some very prominent doctors at the World Health Organization then defined osteoporosis in terms of the bone density of a healthy 25 year old woman. This is most unfortunate because that definition is so broad that it includes just about every women my mom’s age. In consequence, the pharmaceuticals are peddling drugs that increase bone mineral density, which is not necessarily correlated with the outcome we want: less fractures for the elderly.

                  Nevertheless, my mom is taking calcium and vitamin D supplements. My understanding is those supplements are probably safe and slightly effective, but the jury is still out for the safety and effectiveness of osteoporosis medications. (Well, I’m sure the pharmaceuticals can “prove” the efficacy of any drug.) I am also leery of the overly simplistic view of measuring a certain physiological chemical – calcium in bones or cholesterol in blood – and eating more of whatever is low. Or eating less of whatever is high.

                  The treatments that do work well are fall prevention training and exercise. My mom could get free advice and demonstrations on strength training from me (and I would certainly know how to adjust the exercises for somebody elderly), yet she has not expressed much interest in my services. Her laziness for exercise is another story.

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                  1. Lunker Walleye

                    Agree that osteoporosis is over-diagnosed. Women with osteopenia are made to think they have a disease. Sometimes I think they invent machines for testing and create “abnormal” ranges to make people think they need drugs.

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                    1. Annotherone

                      Osteopenia in my spine had slipped over just into the osteoporosis range around the same time I had the lumpectomy last year. I was advised to have 6 monthly injections of some med (best not name it here) but the side effects sounded to me so horrendous that I refused it. The alternative I did take made me more likely to fall, due to severe muscle and joint pain, so I stopped that after 6 months. The”cures” are worse than the disease it seems. I currently take calcium and Vit D. and hope for the best.

    2. Joe Well

      How much of this hysteria is being driven by the not-completely-nonprofit “awareness” industry? The pink wristbands, etc.

      Reply
      1. PlutoniumKun

        Cancer charities play a huge role in this, not an honorable one at all.

        I once heard a radio interview where a statistical specialist was put up against a doctor representing one of those charities who was arguing for much wider breast cancer screening (in reality, its only useful for older women). The guy was trying to present a rational scientific argument but was pretty much shouted down by an ‘but it will save women’s lives!’ argument. He didn’t have a chance.

        I talked later to a relative who works in the field and I asked about the doctor in the radio interview – he just sighed and said they’d been trying to get her to stop promulgating simplistic arguments for years, but she was entirely single minded and possibly not un-influenced by industry money and there was no way to prevent her from doing it. The media saw her as ‘good radio’ and ‘good TV’ so regularly asked her on to comment. The counter arguments are just too complex for a 2 minute segment.

        Reply
  13. FriendlyNeighborhoodRPh

    Pharmacist here: a few quibbles- the redefinition of the indication for statin therapy was accompanied by a change in the algorithm to assess cardiac risk. The old guideline of >20% risk was based on the Framingham Heart Study. The new guideline if >7.5% risk is based on the Pooled Cohort Equations- an entirely different algorithm, so that 7.5% on one is not the same as 7.5% on the other. It’s not exactly an adjustment downward so much as a change to a new scale.

    The change in the hypertension definition also came with the caveat that you should still only treat the old group with drugs. The newly defined hypertensive patients should receive diet and exercise counseling alone.

    Reply
    1. orange cats

      The problem is that some research does not support the new guidelines (that systolic 130 bp calls for “early intervention”) while proposing that diagnosing/labeling people with hypertension may be harmful to mental health. Yes, the new guidelines don’t recommend drug therapy in MOST cases, but doctors tend to push on open doors.

      Reply
  14. Carla

    We want Medicare for All, but I have to admit that at our house, the approach is: avoid doctors as much as possible! I have been reading at peoplespharmacy.com about the dangers of statins for many years.

    Reply
    1. Arizona Slim

      I’m with you on that one, Carla. To summarize the experience I posted above, nearly five months of traditional and alternative therapies didn’t do much for me. Reading three library books changed the game.

      Reply
    2. jrs

      the avoid doctors as much as possible only works if you are basically healthy. And I really think it’s people with no real health issues that give this advice.

      If you have health symptoms (actual physical symptoms not abstractions only found via tests like high cholesterol) and no diagnosis, it’s to the doctor, especially if the symptoms are painful. The thing is in my experience doctors are also very poor at diagnosing anything.

      Reply
      1. beth

        The thing is in my experience doctors are also very poor at diagnosing anything.

        And how do you find a doctor that does. I felt that I was having problems with my heart, so went in for a treadmill test. I was right but did not fit the rest of the normal symptoms and kept asking doctors to find out why. They refused. Yes, I kept changing to another doctor when I realized they would not. Went through about 12 cardiologists over the years w/o any help. I should have been diagnosed with my rare disease that way. Actually I was only diagnosed when a relative discovered the disease. By then I was 68. It was very frustrating.

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  15. Unfinished

    Overdiagnosis creates preconditions, which in the US could prevent insurance coverage or raise premiums on medical insurance policies.

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  16. skk

    Looking at their proposal on how to define a disease:

    The new processes include rigorously examining evidence for benefits and potential harms, before reclassifying millions of healthy people as diseased. This was proposed in a world-first checklist for groups seeking to change definitions, developed by the Guidelines International Network.

    As for new people, today’s article suggests new multidisciplinary panels led by generalists, rather than specialists. It calls for strong representation from consumer or citizen groups, and all members being free of financial ties to drug and other interested companies.

    I like that last bit – “free of financial ties to drug and other interested companies” a lot. Although technically an interventionist cardiologist who makes a living out of mitigating coronary diseases can’t really be said to be totally free of financial ties can they ? But led by generalists ? and STRONG representation from consumer and citizen groups ? I’d like it to be more specific – People with expertise surely – e.g. people with the diseases who’ve demonstrated that they’ve studied it too and buy into and have studied scientific approaches are qualifications I’d like to see.

    And of course the infinite regression problem – who chooses the panels ?

    Reply
  17. Susan the other`

    I have a strange relationship with my doctor. I don’t trust him, I’ve observed his sloppiness, vanity and ducking blame for a few years now. Ever since I became a Medicare Cash Cow. But I’ve decided he’s a good bet precisely because I don’t trust him. These last two years I have followed my own instincts and tips on the internet and virtually ignored him. And I can see he’s miffed. He says sarcastic things and gives me disdainful eye contact. But I downplay it and there’s no way for him to know how I really feel. It’s kind of a fun place to be. So thank you for this overview, especially on cholesterol. Mine has always been high normal. My good cholesterol is very high as well. So when he prescribed me statins, I didn’t argue, I even bought them as they are cheap. But I don’t take them. It’s gratifying to know that 270 is optimal. That happens to be right where I am. I do have a long standing view that sugar is the root of all metabolic evil. So I don’t eat anything sweet. Extremely simple solution. Hopefully. ;-)

    Reply
    1. Yves Smith Post author

      I had one doctor tell me he had a patient whose total cholesterol was 400.

      He wasn’t worried because her HDL (good cholesterol) was 300.

      Reply
  18. Jeff N

    Interesting that I needed to take testosterone (and cialis) after several years on statins.
    I stopped the testosterone because it wasn’t making me any more motivated, also stopped the statins when it was mainstream-revealed that they weren’t helpful for those in lower-risk groups.
    I haven’t needed cialis ever since stopping the statins.
    My testosterone is still “low”.

    Reply
  19. Debra D

    My mother (who lived in Cincinnati, OH) had been on a statin for several years and while out of town at a conference in Vancouver, she lost the complete use of her legs while walking towards a meeting. The Canadian physician informed her that statins were contraindicated in her case due to the blood pressure medication she was also taking.

    My PCP called me on a Sunday afternoon to impress upon me how important for my health going on a statin is. Our conversation was nearly an hour long. He has been pushing this step every year for at least a decade. I have always refused. I assume he must document that he is giving me advice that conforms to the standard of care. I have always reassured him explicitly that I will not be suing him.

    Instead, since the first of the year, my husband and I have begun a ketogentic diet (low carbohydrate high fat “LCHF”), and I am very pleased. I learned about this diet when I came across an article discussing a trial conducted at Indiana University and Purdue University using this diet to reverse Type II diabetes. In 2019, we were looking at spending $5,000 on his diabetes medications annually. He is on Medicare Advantage plan through UHC. The thought of his being able to put his diabetes in remission, and all the other health benefits from the diet AND saving us $5,000 annually was VERY appealing. I signed us up to hear a presentation given by Purdue University’s Benefits Department about the program Purdue offers its employees with metabolic disorders and T2D. The presentation was given by Virta Health.

    I then began to watch the highly educational videos on YouTube which laid out the science and practice of the keto diet. One of the best channels I found is “Low Carb Down Under”. (The videos are exceptional because the presentations explain the scientific basis for how the LCHF works through the metabolic processes at the cellular level.) Many of the videos available through Low Carb Down Under’s channel focus on the way these dietary guidelines and standards of care are adopted to protect the interests of the sugar, grain, and medical/pharmaceutical multi-nationals.

    My husband has now dropped one of his 2 diabetes medications, has some of the best readings he has had in years. We are hopeful that he will be able to drop the other. We will know more after he has a new A1C test in May. I am off all my medications for GERD, IBS, and insomnia. I am now on no prescription meds.

    Reply

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