Statins For Low Risk Patients

For people who have HAD a heart attack, random clinical trials tell us that in five years, one person in 86 will benefit from taking a statin. That is worthwhile.

However, if your risk of a heart attack in the next TEN years is less than 20%, taking a statin has no effect on your mortality risk. Most of the people on statins are in this group.

The drug companies argue that only one person in ten has adverse side effects. That's a disputed claim.

Research Paper: Should people at low risk of cardiovascular disease take a statin? (2013) by John D Abramson, Harriet G Rosenberg, Nicholas Jewell, and James M Wright.
Only the abstract is available to the public. It's not very informative.

A review of statins for primary prevention of cardiovascular disease could alter guidance in the UK, for those with a ten-year risk of less than 10%. John Abramson and colleagues argue that statins have no overall health benefit in this population and that prescribing guidelines should not be broadened.

This is relevant in the UK, because NICE, the National Institute for Health and Care Excellence, which is charged with giving evidence based guidance to health care professionals, has recommended the use of statins for those with a ten-year risk of only 10%.

Dr Aseem Malhotra tells us that eight members of the panel making this decision had links to the pharmaceutical industry.

Malhotra challenged the National Institute of Health and Care Excellence's recommendations of prescription of statins for people at low risk of heart disease. This letter was signed by Dr Clare Gerada, past chair of the Royal College of General Practitioners, and by Sir Richard Thompson, the president of the Royal College of Physicians.

Dr Aseem Malhotra

Epidemic of Obesity and Type 2 Diabetes

Dr Aseem Malhotra is one of the most influential cardiologists in Britain and a world-leading expert in the prevention, diagnosis and treatment of heart disease.

The British Journal of Sports Medicine published their editorial providing evidence that sugar and excess carbohydrates were primarily responsible for the global surge in type 2 diabetes and obesity. A subsequent editorial "Take off that Fitbit. Exercise alone won't make you lose weight," that Aseem Malhotra wrote in the Washington Post had over 1.1 million page views. He has since become one of the leading doctors in the world fighting the obesity epidemic.

Two in three UK adults are overweight or obese. One in three children. The current cost of obesity to the NHS is £6 billion a year. However, the story for diabetes is even worse. The cost of diabetes to the NHS is £20 billion a year today, and is predicted to double in 20 years.

Against the advertising machine of the food industry, public education on healthy eating is ineffective. Poor diet is a major contributor to the lifestyle diseases that result in hospital treatment. 25% of those who die of CVD when under 65, have clearly created their own disease, by lifestyle choices.

We can show that education is ineffective, by comparing the overweight and obese general public (60%) with overweight and obese health professionals (50%).

"Most doctors still believe that eating fat increases the number of calories in the diet and makes people fat. They also believe that increased exercise is a good strategy for reducing obesity. Both of those ideas are quite wrong. For instance, I advocate a Mediterranean diet. In my own daily practice, I eat ten tablespoons of olive oil every day. Each tablespoon has 119 calories, of omega-3 fats. That's 1190 calories a day, without eating any meals. Look at me, where is the fat?"

More Short Videos

Sadly the "reporter" in each of these videos manages to complete muddy the message, so at the end you can't be sure what you are supposed to believe. This is how news organisations protect themselves against legal action by producers associations or pharmaceutical companies. It's also a way of protecting the advertising revenues that come from those sources.

Magazines and news reports are NOT very useful as guidance for the public on how to be more healthy.

The BMJ editorial published "Saturated fat is not the major issue," in October 2013. Dr Aseem Malhotra busted the myth that eating saturated fat causes heart disease. That became one of the most influential medical journal articles with over 100 000 downloads. The editorial made front page of three British newspapers, as well as receiving coverage on BBC News, CNN International, and Fox News.

Action on Sugar

Dr Aseem Malhotra is leading the campaign against excess sugar consumption, to make sugar reduction a health priority in the UK. He was instrumental in establishing a coalition of experts called Action On Sugar.

Aseem supports studies that implicate sugar as the number-one culprit driving obesity, type 2 diabetes and heart disease, and has worked with a leading sports scientist, Dr Tim Noakes, to dispel the myth that links physical inactivity and obesity. This was first proposed by Prof. John Yudkin in 1972. He was so strongly attacked by industry, his career destroyed, that nobody has had the courage to challenge the sugar industry for 40 years.

In 2009, Dr Robert Lustig produced a 90-minute lecture called "Sugar the Bitter Truth" on Youtube. Sugar is much more than empty calories. The fructose in sugar encourages the formation of non-alcoholic fatty liver disease. That's fundamental to the development of metabolic syndrome, and that raises the risk of CVD death significantly.

"Aseem has been speaking truth to power not in one venue, but rather in three: the sugar myth, the saturated fat myth, and the statin controversy. Most importantly, he represents and strives for the health of the British people, against the special interests that would keep Britain fat and sick. Aseem's voice is the clearest clarion call for change in the British health system today. And I am proud to consider him my good friend."
Dr. Robert Lustig, one of the leading voices on childhood obesity and diabetes in the U.S.

Cholesterol as a CVD Marker

It's been clearly demonstrated that cholesterol is a very poor marker of cardiovascular risk. The medical focus should be on things that have a positive effect.

The focus for the last 40 years on cholesterol lowering has delivered no positive benefit. High cholesterol does not kill people or cause heart disease.

Stopping smoking was the key to reducing the number of heart attacks.

Effective action against diabetes, is a sensible way to reduce future heart attacks, given the trends we now see.

Too Much Medicine

Malhotra has highlighted concerns that medicine and medical procedures can be over-sold and under-deliver, and also maintains that most of our nutrients can be delivered more efficiently from food than from supplements.

He has been instrumental in bringing the BMJ campaign "Too Much Medicine" to mainstream media. There are many ways to improve the system, but that requires much better information sharing. He passionately believes in transparent communication with patients, "shared decision making" and personalized medicine.

There is a financial incentive to do more procedures and more investigations. Profits often come before patient care. A US cardiologist was imprisoned for fraud for ordering $19 million dollars worth of unnecessary investigations and procedures.

The fee for service model encourages overuse. Payment for results models also have that effect.

In addition, there is a technological imperative to use machines and equipment. There are many procedures which are commonly done, where random clinical trials show there is no benefit for the patient.

This is also reflected in end of life care. About 30% of patients have a hospital admission for some surgical procedure in the last year of life. In the majority of cases that effort was ineffective. 8% of patients have that procedure in the last week of life. We need to understand that there is a limit to the power of medical treatments.

The Food and Drink Federation

"Aseem is not only a very gifted media communicator; he is also an extremely intelligent and caring doctor who speaks from the heart on behalf of his patients, your family and mine."
Professor Simon Capewell, Vice President of the Faculty of Public Health.

The food industry attaches itself to sports, schools and hospitals, and patient advocate associations, trying to give the impression that good health is a real concern. The misinformation they spread is everywhere. This makes the whole health environment toxic. Even in hospitals. The drinks' trolley on which the nurse brings tea or coffee, also carries Coca-Cola, and Mars bars and potato chips.

The food industry has adopted the tactics of the tobacco industry to fight against any regulation of industry in an effort to improve community health. In the USA, manufacturers oppose explicit labels indicating the sugar content of the food. An obvious good health strategy currently being proposed is a sugar tax, but industry is strongly against that because the low-fat products they rely on for sales revenue, contain lots of sugar, often in "hidden" forms.

The Food and Drink Federation in the UK, are very active talking to MP's and building political support for their industry objectives. They have actively exploited the "low-fat diet" idea creating thousands of "low-fat products that make our health much worse. We need to reverse that message; fat is not the enemy, fat does not make you fat, and fat does not cause heart disease.

If you don't understand that, read "The Big Fat Surprise; Why Butter, Meat and Cheese Belong in a Healthy Diet" by Nina Teicholz.

Saturated fats are not all the same. For diabetes in particular, dairy fat is protective. Eating saturated fats is likely to cause a rise in cholesterol, because both HDL-C and LDL-C are likely to rise. But HDL rises much more, so that's protective. And LDL-C changes from containing possibly dangerous type A particles, to harmless type B particles. That's a double win.

The Food industry encourages us to use omega-6 seed oils, because they are low cost. They were supposed to be "heart healthy" 30 years ago. We now know that they cause some cancers, especially if used in cooking.

Doctors and Statistics

When studies are reported it's common to report the findings in a way that attracts the most attention. For instance, the British Committee on Safety in Medications reports that for the 3rd generation contraceptive pill, there was double the risk of thrombosis. That was a report of the relative risk. Thousands of women went off the pill based on that report, with the blessing of their poorly informed GP.

The following year there were 13,000 additional abortions in the UK. Where was the greater health risk?

Those abortions cost the NHS about £5 million. Was that a good use of our money?

Here is the absolute risk of 3rd generation contraceptive pills, that doctors didn't understand and didn't explain to their patients. The original risk of thrombosis was 1 in 7000. 100% increase makes the risk 2 in 7000. Is that new information, properly understood, likely to require you to change your contraceptive method? Of course not.

The poor training of GP's in understanding statistics, leads to far too many procedures being requested that are not needed. Breast cancer screening is a good example. Thousands of screens are done. For every life saved, ten women go onto unnecessary treatments, too often extensive surgery.

Misinformation on Health

There is an epidemic of misinformation on health, much of it deliberately propagated. For instance, go the gym and almost everyone is carrying a drink bottle. In an hour's gym work, no matter how hard you think you are working there is absolutely zero need to drink anything. If you do need a drink, a small sip of water will do. Anything more takes away from your performance. The need for hydration is promoted by industry to promote the sales of sugary drinks, with a little salt. These "sport drinks" are entirely without merit, and their overuse has caused the deaths of several (13) athletes and some people in the US military. Dr Tim Noakes, has written a book about this topic, Waterlogged: The Serious Problem of Overhydration in Endurance Sports.

In the same way, industry insists that every calorie is the same and that if you eat a "little bit" of whatever substance that are selling, that is part of a "balanced diet." Research shows that the calories of each food are metabolised in a different way. Some calories are conserved; some are wasted, and in an effort to maintain homeostasis the body upregulates or down regulates the metabolism depending upon the status of the whole-body system. Calorie counting is a waste of time.

Research shows conclusively that there is no cause and effect relationship between exercise levels and obesity. People who exercise more eat more, they must eat more, or exercise can't continue. The bias that tells us that the solution to obesity is to exercise more is not science based. The prime advocate of more exercise is Coca-Cola.

Far too much sponsored scientific research is intended to "prove" some insignificant and misleading point that can be used for product promotion. The intention is to use the "research" in marketing. Companies buy scientists, and use them to misinform the public.

Cardiovascular Surgery

The Whole Truth About Coronary Stents: The Elephant in the Room.

Stents do help people who have angina pain, but only for a limited time.

About 50% of the people who get stents, get no advantage from that procedure at all. However, 88% of patients with stents believe that the stent is improving their quality of life and perhaps prolonging life. If the heart itself is stable, the stent does nothing useful.

Right care and high-value cardiology: doctors’ responsibilities to the patient and the population

Sadly, in a medical team, there's often someone who recommends a stent, and 43% of cardiologists will put that stent in place, even if they personally believe it will have no benefit. We don't want anyone to say that we didn't do everything possible. As a result, we tend to do far too much medicine that has no value for patients.