[herring_RN]

http://www.healthbeatblog.org/2008/02/the-cholesterol.html

[3rdcareerRN]

So much for placing the patient's interests equal to or ahead of one's own!

Excerpt from the Hippocratic Oath (translated):
"I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone. To please no one will I prescribe a deadly drug nor give advice which may cause his death."

Excerpt from that article:
"... the NLHBI panel that made the recommendations had been dominated by physicians with ties to statin manufacturers.” Indeed, the National Institutes of Health later admitted that eight of the nine experts on the panel had received financing from one or more of the companies that make statins. (None of the panelists had publicly disclosed their ties to manufacturers when they made their recommendations.)

Just how much “financing” were the panelists receiving? According to the LA Times, from 2001 to 2003 Dr Bryan Brewer, a leader at the National Institutes of Health, and “part of the team that gave the nation new cholesterol guidelines in 2004” had accepted “about $114,000 in consulting fees from four companies making or developing the cholesterol-lowering drugs.

But “this is relative peanuts compared to Dr P. Trey Sunderland III, a senior psychiatric researcher at the NIH, who took $508,500 in fees from Pfizer, Inc. whilst collaborating with them, and endorsing their drug [Lipitor],” says Dr. Malcolm Kendrick..."


It's no wonder that NURSES lead the Gallup poll in being considered most honest and ethical. I'm not knocking all doctors, but I have not yet found any NURSES who are such unethical shills for deep-pocket industry. Don't get me wrong...I am all for accepting fees and "exercising clinical judgement", but these relationships must be disclosed up front!

[TiredMD]

Originally Posted by 3rdcareerRN

I am all for accepting fees and "exercising clinical judgement", but these relationships must be disclosed up front!

These financial ties are disclosed in all publications and presentations of research even tangentially related to the products in question. Where do you think the reporter got that information from in the first place? It's public information. Your average FP doc actually prescribing the medications are unlikely to receive any financial support at all from these companies.

I assume, based on the tone of your post, that you now recommend to all your patients that they no longer take statins?

[CHATSDALE]

i am on statin, i don't have any side effects and my choldestral count is down, triglycerides skky high but tha is a different story
i don't want to quit and have them tell me on my death bed [from MI]
oh that was internet talk, you really should have continued on your meds
i believe that the govenment wouldn't pay for them if they were bad
you just have to take a chance in lif, this is my turn of the cards

[ingelein]

I have continually refused to take statins, total cholesteral starting at 229. now down to 210, by eating oatmeal daily and taking 2400 mg. fish oil. Also use flax meal and seeds in the bread I bake.Statins have vicious side effects, if diet alone works why go there at all? Trigylcerides excellent.

[dream'n]

Statins made me miserable. Felt like I had a bad case of the flu due to the really awful body aches. Don't know why, but I've been a bit skeptical about them anyway. No reason really, just a feeling I have had about them not being as useful as purported. At a previous place of employment, basically every patient was on them, or encouraged to take them. It was almost ridiculous.

Of course, diet and exercise are the amoung the most important things to do to keep oneself healthy. But lately, as a society, I think we've gone just a little overboard. I see lots of people who eat nothing but 'healthy foods' and are miserable, but some are certainly smug about it. A bit of Hersey's is a certain death sentence to them (not diabetics.) I feel everyone should watch their diet, but moderation is the key. No need to be miserable all the time due to complete self-denial of any food enjoyment. Just MHO.

[BBFRN]

Originally Posted by TiredMD

These financial ties are disclosed in all publications and presentations of research even tangentially related to the products in question. Where do you think the reporter got that information from in the first place? It's public information. Your average FP doc actually prescribing the medications are unlikely to receive any financial support at all from these companies.

I have to agree with the Doc here. As a chronic disease manager, I work with lots of patients who either have primary mixed hyperlipidemia, ischemic heart disease, or type 2 DM. Most docs will try Omega 3 fish oil, niacin, and flax seed oil, in addition to nutritional counseling & exercise for primary hyperlipidemia before going to statins. There are parameters on these treatments, though- and it can depend on how much of the problem is influenced by genetics.

As for the type 2 diabetics & ischemic heart disease patients, statins are the gold standard, according to evidence-based medicine. If a patient can bring their lipids down by diet and exercise, then the statins can be d/c'd. Some T2DM patients do achieve this after nutritional counseling in diabetes ed and with a standard exercise regimen, but a good number of them do not. I'm guessing that if a lifelong poor diet and a sedentary lifestyle are the source of your problem in the first place, then it's going to be really hard to change that overnight. It may take years, and statins do a good job of filling in that gap where needed. For your ischemic heart disease patients, they've already had heart damage, and their risk of another cardiac event or stroke (because of atherosclerosis, carotid stenosis, etc.) are already much higher than a healthier person's. These people will probably be on statins for the rest of their lives because of that.

I guess what I'm trying to convey, is that in working with this population, I do see that most medical practitioners do try to incorporate nutritional/activity counseling in their treatment of hyperlipidemia- it's just not as well received by their patients as it should be. In those cases, statins would be the next step in treatment, unfortunately. I feel there is probably no need for kickbacks, because the great market demand for statins is created by a very large, unhealthy population- not by the physicians.

[llg]

Science changes all the time. That's the nature of it. People make decisions based on their interpretation of the available evidence -- and that available evidence changes daily.

The fact that people's judgment may not be perfect is also not news. It is PEOPLE who are planning the scientific studies, PEOPLE who are carrying the out, and PEOPLE who are interpreting the results. The whole process is, by its very nature, fraught with opportunities for bias -- both conscious and unconscious.

... And who do you think is to fund research on any topic? Certainly not some 100% objective organization. There ARE no 100% objective organizations that goes around spending billions of dollars on research on topics with which they have no connections. Someone has to pay for the research -- and it is always paid by someone who has connections to the topic being studied.

... And who do you think has the expertise to conduct research? Certainly not someone who doesn't work in that field. Anyone with enough expertise to conduct high-level research HAS to be someone who has worked in the field for a while -- and who therefore has financial entanglements of one kind or another.

I'm not saying statins are good or bad. I'm just saying that anyone who ever thought that medical research on ANY topic is -- or ever was -- 100% pure and unbiased has been living in a dreamland. There are some fundamental characteristics of science that we should all know by now:

1. Science is a human activity, subject to human frailties at every step in the process -- planning, conducting, reporting, interpreting, etc.
2. Scientific knowledge changes daily. The best scientists in the world once thought the world was flat ... the sun revolved around the earth ... "bleeding" the patient was a good idea for almost every illness ... there was no need to wash your hands or your instruments between patients ... etc.
3. The process of developing new knowledge and incorporating it into practice is messy -- with a lot of false starts, blind alleys, mistakes in judgment, and modifications necessary. That is to be expected.

The best we can do is to acknowledge our potential biases and ask others to disclose theirs. We also need to understand the scientific process and all of its inherent imperfections.

[BBFRN]

Actually, the standards of hyperlipidemia treatment are based on research done by the American Heart, Blood, and Lung Institute. http://www.americanheart.org/present...dentifier=4638

There is some industry representation in the research done, but it is largely a collaborative and multidisciplinary effort.

[herring_RN]

Three years ago my doctor looked at her laptop and told me she was writing a Lipitor prescription.
I told her I didn't want to take it. THEN she began working with me.
I've gotten it down nicely with not only low fat, but keeping sugar infrequent too.

And fish oil & flax seed oil.

I've seen much suffering and one death due to rhabdomialysis in active people taking it.
Rare, yes. But why not try all safer measures first?