Cholesterol/Statin Claims: Science or Self-Serving Propaganda?

2023-03-25 • SEND FEEDBACK |
Related: air quality, atherosclerosis, cholesterol, health, ischemia, Medical Industrial Complex, nutrition, statin

re: ethics in medicine
re: Medical Industrial Complex

Don’t take your medical advice from a photographer and engineer (me). Trust your doctor. After all, the past few years have shown us the incredibly high ethical and intellectual standards of science and medicine, right? And Americans are getting healthier and healthier too, right?

In the context of my double century training, I once asked a cardiologist friend what effect a statin had on athletes. His response captures it perfectly:

Hope that your competitors are taking them.

And that’s ignoring brain fog and diabetes and a host of other issues, all minimized and rationalized-away by mainstream medicine—see for example nasty statin side effects rationalized-away in real-time in this interview, and a shocking lack of discussion of the only endpoint that matters*.

* I like Huberman’s podcasts, but one-sided perspectives are problematic. For too many they are persuasive, yet in truth they lack credibility because the essential competing viewpoint is totally absent. In that particular podcast, Huberman not only fails to ask the right questions, but deferentially accepts every claim made going so far as to sign up for statin treatment. And... the two are friends. And Attia has a direct financial stake in his claims via his bespoke medical practice and the need to justify his practices. These are not small issues. The credibility of both men suffers—Huberman by lack of knowledge/preparation and his failure to ask even one probing question on cholesterol/statins and his highly deferential manner and de facto endorsement in real time. Attia in his “settled science” perspective, his use of analogy (smoking) vs evidence, and the financial interests of his bespoke medical practice. Unacceptable.

Side effects? If one is unpleasant, another should be fine!

Side effects, some clinical and some subclinical with subtle and not so subtle loss of function*, all cheerfully dismissed by overworked practicing physicians, who must follow SOC or suffer the consequences.

Do you ever wonder what incentive harried physicians have to pay attention to anything but obvious issues, the ones that cannot be easily ignored? Negative incentive. Let alone establishing benefit for an individual patient. Ditto for all medications. That is our system.

Ya gotta take that statin the rest of your life, though 99/100 people will never see a benefit and the benefit is at best dubious for that 1/100. Since side-effect X is not tolerable, we’ll switch to another statin variant, and if nothing obvious shows up, you’re so much better-off for taking it the rest of your life. Really? That is Standard of Care. Feckless.

* See Lipitor® Thief of Memory, by MD Duane Graveline @AMAZON.

Epidemiology to treat individuals

To treat an individual based on epidemiological statistics is a serious intellectual error. Also the basis for modern medicine. We don’t see that as acceptable in law enforcement, but it’s fine in medicine?

Medicine assumes we can treat individuals based on epidemiological data and large studies in which individuality is eliminated. Yet virtually everything biological has variation, most coarsely among male/female but mainly as huge variance among individuals.

Thus when it comes to cholesterol, the nail that stands up gets hammered down. In the face of a total lack of insight into any individual’s particular physiology. Get out that risk calculator!

Corrupt science is not science

Consider the following passage from an MD interacting with another MD:

He advocates a wider use of cholesterol-lowering statin medications than I do, and he started to cite the literature about why I should be taking more cholesterol-lowering medicine than I already was. I asked him if he had read the studies underlying that literature, and of course he had. I then asked him if he understood that the endpoint of many of those studies wasn’t really appropriate to determine the benefit of statins, and he acknowledged there was some debate about that. Finally, I asked if he was aware that when peer-reviewed articles are published in medical journals—even the most reputable medical journals—the peer reviewers don’t have access to the actual data from the clinical trials being reviewed. And he answered, somewhat meekly, that yes, he was aware of that.

In other words, he was aware that his recommendation that I increase my use of statin drugs was based entirely on incompletely vetted commercially-sponsored and largely commercially-influenced medical journal articles....

And that’s from an MD already taking a statin and accepting that it has some benefit! One has to wonder if his condition wasn’t promoted by a statin.

The fact is that much of “settled medicine” is bad science, bad logic, and most of all: groupthink stemming from follow the money. If not outright intellectual fraud.

Cholesterol and statin deceptions

xkcd: Meta Analysis

I cannot possibly call out all the misleading claims and outright lies about statins and cholesterol. Nor am I claiming certainty. But science is about rigor and logic, and that is the antithesis of what is going on with cholesterol and statins.

• No causal evidence has ever been shown. The hypothesis has been overhauled and changed so many times with so many ridiculous variations that one cannot help but marvel at the tenacity of its proponents.
• If cholesterol causes atherosclerosis, why is there no analog in veins? Does the cholesterol just “know” it is not supposed to have any effect in veins?
• Just as many people with low cholesterol have heart attacks as those with high cholesterol. People with very low cholesterol have even more heart attacks. Why is that?
• No study has ever shown that women benefit from statins. Yet feckless and ignorant doctors give statins to women as a matter of course.
• Higher cholesterol correlates increasingly with increased longevity the older you get. Yet we treat the elderly to lower it. Are we killing people and degrading them overall?
• No study has EVER shown that men benefit from statins, excepting the next point, which is exceptionally weak.
• The ONLY group that ever has shown a (tiny) benefit from statins is men under 65 who have already had a heart attack. This “benefit” probably stems from a mild anti-inflammatory effect and has nothing to do with cholesterol, but no one really knows. Probably there are lifestyle interventions vastly more effective, so the whole thing is ridiculous.
• Statins double and might triple the risk of diabetes, a far more serious issue than some non-existent theoretical “benefit” with the persuasion trickery of risk reduction of 25% based on tiny absolute numbers.
• The NNT (number needed to treat) is astronomically high (see points above), incurring massive financial costs and untold costs from side effects, including quality of life.
• If LDL cholesterol ("apo B") is causal, there must be a dose-response relationship. Yet no credible dose-response causal relationship has been demonstrated. And someone with very high cholesterol for decades can have a zero coronary artery calcium score, zero ischemia, zero clinical anything. The idea that a dose-response relationship comes with wild exceptions (no response whatsoever) is ridiculous, a scientific having your cake and eating it too.
• The Big Lie leads to feckless care: doctors keep trying to force statins on my mother (80's, cholesterol high 200's into 300's and off-the-chart triglycerides for decades) in spite of zero calcium in her heart and zero clinical or even subclinical evidence of anything—ever. Same asshole-doctor behavior with my wife, also having zero atherosclerosis. With zero evidence ever shown for benefit to women and negative benefit for anyone her age, this kind of malpractice is nonetheless widepread. The hands of death and destruction, courtesy of SoC.
• Studies on statins are invariably weak, requiring relative risk to look good based on small numbers over short time frames. They are cut short to hide issues, ignore and minimize side effects, do not study cohorts to which they are applied, data is not made public, papers are ghostwritten by the pharma companies, unsupportive studies were/are terminated or not published, etc.
• Low cholesterol might be associated with violent crime.

The human body is not stupid; it regulates everything according to its needs. Which includes more when under duress, adjusting for dietary intake, etc.

Yet modern medicine assumes the body is somehow badly designed, and needs help with pharmacological intervention. Perhaps formula instead of breast milk, or toxic grains or seed oils we never evolved to eat, or trans fats (Oleo) instead of butter, smoking is good for you, and much more. The destructive hubris of the medical profession over the last 70 years should be self evident. Is this the case for statins, and if so, how bad are they? It remains to be seen, but if they are so great, why only worsening heart disease? Statins have had decades now to show all their benefits. Yet things are only worse.

Cholesterol is one of the most critical substances in the body necessary for everything from cell structure/repair to every hormone. We were told for decades to avoid high-cholesterol foods such as eggs (now debunked). We’re still told that the body creates “too much” cholesterol, and that needs fixing with drugs. The meta message is that your body physiology is defective and needs help, pharmacological help.

When a doctor opining on heart health initiates a conversation on cholesterol with an analogy on smoking instead of logical and factual rigor around endpoints on heart disease, it shows a self-deception that likely stems from cognitive commitments causing cognitive dissonance requiring rationalization. And when such a high-end comprehensive lifestyle care doctor ($$$$$) touts statins as being great based on settled science (“the evidence is very clear”), studiously avoids even mentioning competing theories, not once discussing treatment outcomes from statins, ignoring elephants in the room like "apo A", signs up for “saturated fat = BAD”), works around a high level of side effects as a matter of course while discounting all but common ones, etc... it sure looks likean intellectual blindness stemming from follow the money.