Adherence to statins saves lives

17th February 2019

[Adherence to placebo saves lives]

To an extent I am cursing myself for doing what I am about to do. I have been dragged, yet again, into reviewing a paper that has made headlines round the world which proved, yes proved, that adherence to statins saves lives. I am doing this review because a lot of people have asked for my opinion on the paper.

I do feel like saying. ‘Look, I wrote the book Doctoring Data so that you could read papers like this and work out why they are complete nonsense for yourselves’. Clearly, not enough people have read my book, and I would therefore heartily encourage another million or so people to do so. [Conflict of Interest statement – I will get lots of money if this happens, which I think of as “win, win”].

The paper, in this case was called ‘Association of statin adherence with mortality in patients with atherosclerotic cardiovascular disease.’ It was published in the New England Journal of Medicine (NEJM) a couple of days ago.

The main finding was:

‘Using a national sample of Veterans Affairs patients with ASCVD (atherosclerotic cardiovascular disease), we found that a low adherence to statin therapy was associated with a greater risk of dying. Women, minorities, younger adults, and older adults were less likely to adhere to statins. Our findings underscore the importance of finding methods to improve adherence.’ 1

First thing to say is that this was an observational study. So, it cannot be used to prove causality, especially as the improvement in outcomes that they observed was an increased mortality risk of 1.3 (HR) in those who were least adherent – compared to those who were most adherent.

As many people know… sorry I shall rephrase that… as many geeks like myself know, if the hazard ratio is less than two, in an observational study, the best thing to do with said paper is to crumple it up and throw it in the bin. Because it is almost certainly meaningless. To quote Sir Richard Doll and Richard Peto, two of the fathers of medical research and epidemiology:

“when relative risk lies between 1 and 2 … problems of interpretation may become acute, and it may be extremely difficult to disentangle the various contributions of biased information, confounding of two or more factors, and cause and effect.”2

Observational studies with relative risks between one and two, are the type of studies which find that drinking five cups of coffee protect against CVD – or would that be increase the risk of dying of CVD.  Or maybe it is tea, not coffee? [I apologise for mixing up odds ratios, hazard ratios and relative risk. For ease of understanding, think of them as the same thing].

For example, I was looking at this paper:

‘Tea and coffee consumption and cardiovascular morbidity and mortality’.

Where they found that drinking between three and six cups of coffee reduced CV mortality by 45%:

 ‘A U-shaped association between tea and CHD mortality was observed, with an HR of 0.55 for 3.1 to 6.0 cups per day.’3

That is a far better result than adhering to statins. After all it is a 45% reduction vs. 30% reduction. My advice therefore would be to stop the statins and have nice cup of tea instead. Life would be so much better, and you would live longer as well. Sorry, but I don’t know what sort of tea. English breakfast, Earl Grey, Darjeeling… So many questions. So many stupid studies to read. So much crumpling. So many bins to empty.

Leaving behind the nonsenses they are – the observational studies with a minute difference in hazard ratio – let us move on to the major confounder of this latest crumple, bin, paper. Which is that people who adhere to medications do far better than those who do not – even if that medication is a placebo.

This was first noted, with regard to cholesterol lowering medications, nearly forty years ago in another paper, coincidentally published in the NEJM. It was called:

Influence of adherence to treatment and response of cholesterol on mortality in the coronary drug project.

I have copied the abstract in full. In part because it is written in something akin to understandable English. Most unusual in any medical journal. In this study the researchers were looking at drugs used to lower cholesterol levels, prior to the invasion of the statins.

‘The Coronary Drug Project was carried out to evaluate the efficacy and safety of several lipid-influencing drugs in the long-term treatment of coronary heart disease.  Good adherers to clofibrate, i.e., patients who took 80 per cent or more of the protocol prescription during the five-year follow-up period, had a substantially lower five-year mortality than did poor adherers to clofibrate (15.0 vs. 24.6 per cent; P = 0.00011).

However, similar findings were noted in the placebo group, i.e., 15.1 per cent mortality for good adherers and 28.3 per cent for poor adherers (P = 4.7×10-16). These findings and various other analyses of mortality in the clofibrate and placebo groups of the project show the serious difficulty, if not impossibility, of evaluating treatment efficacy in subgroups determined by patient responses (e.g., adherence or cholesterol change) to the treatment protocol after randomization.’ 4

I think it is worth highlighting the main findings again.

Those who adhered to taking clofibrate               =          15% mortality

Those who had poor adherence to clofibrate     =          24.6% mortality

Those who adhered to taking placebo                 =          15.1% mortality

Those who had poor adherence to placebo        =          28.3% mortality

From this is can be established that it was worse for you to not take placebo regularly than it was to not take clofibrate regularly.

If we move forward in time, others have looked at adherence to taking statins. The first thing they noted was people who take their medication regularly are different in many, many, ways to those who have poor adherence.

The paper is called: ‘Statin adherence and risk of accidents, a cautionary tale.’ Published in the American Heart Association journal Circulation.

As they say in the introduction:

‘Bias in studies of preventive medications can occur when healthier patients are more likely to initiate and adhere to therapy than less healthy patients. We sought evidence of this bias by examining associations between statin exposure and various outcomes that should not be causally affected by statin exposure, such as workplace and motor vehicle accidents.’

As they conclude:

‘Our study contributes compelling evidence that patients who adhere to statins are systematically more health seeking than comparable patients who do not remain adherent. Caution is warranted when interpreting analyses that attribute surprising protective effects to preventive medications.’ 5

This takes us back to Hill and Peto:

“when relative risk lies between 1 and 2 … problems of interpretation may become acute, and it may be extremely difficult to disentangle the various contributions of biased information, confounding of two or more factors, and cause and effect”

In the case of this latest ‘nonsense’ paper on statins, it is not actually difficult to disentangle the various contributions of biased information.

We already know that people who take tablets regularly, and placebo regularly, are more health seeking than those who do not. We already know that if you take a placebo regularly, this almost halves your (absolute) mortality rate. These are both enormous confounders in the latest NEJM study.

In fact, the confounder effect unearthed in previous studies is far larger than the effect they found. Which, if you are going to be ruthlessly logical, would suggest you would be far better off regularly taking a placebo than regularly taking a statin. If you choose to do so, you could entitle their paper “Proof that statins have no beneficial effect”.

You sure as hell cannot use such data to suggest that adhering to statins is beneficial. Yet, the authors of this study have done so. I give their paper a mark of D-Fail, please try again.

Or else, I would say, please inform yourselves of the previous research done in this area before writing a paper. This will avoid wasting everyone’s precious time.

1: https://jamanetwork.com/journals/jamacardiology/article-abstract/2724695?fbclid=IwAR20HUGfxI9Cq8KVAgW0GY8Mu0MmK5goqGkqmErIb-hl5QZbcy_zahgNEvc

2: Richard Doll & Richard Peto, The Causes of Cancer 1219 (Oxford Univ. Press 1981).

3: https://www.ncbi.nlm.nih.gov/pubmed/20562351

4: https://www.ncbi.nlm.nih.gov/pubmed/6999345

5: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2744446/

270 thoughts on “Adherence to statins saves lives

  1. Rachel Brett (@ArborVS)

    Do these people think we are stupid or what!!

    Well, there was a recent paper that said that there was little or no reduction to heart disease in the last twenty years. Perhaps you could a chart showing that during this time, statins were prescribed, and therefore had no effect on morbidity/heart disease whatsoever….

    Reply
      1. chris c

        My theory is that whatever “caused” the initial spike in CVD – probably more than one thing at once – fell away so CVD decreased. But low fat diets were invented that cause obesity, diabetes and a whole bunch of different “causes” so CVD didn’t decrease as much as it would have done if Ancel Keys was a shoe salesman.

        The effect of statins is just noise not signal.

    1. James DownUnder

      Yes Rachel, they do hope that the sheeple are both incapable and un-informed. Or stupid enough to swallow their bilge…
      It would appear ‘they’ are so focussed on ‘doing trials’ that they’ are unable to stand back and see the forest…

      Reply
  2. nightskywp01

    Once again , thank you Malcolm for an enlightening and entertaining article.
    Attributing causality has, and I suspect always will be a big problem in any investigation. I intuitively feel that studies might suggest that people reading your books and blogs have lower mortality rate than those who do not 🤪.

    Tom McMaster

    Reply
  3. GC

    Dr Kendrick

     

    You are surely a national treasure! Thank you for all you do.

     

    I am going to recommend you for a knighthood.

     

    Jay

     

    Sent: Sunday, February 17, 2019 at 8:22 AM

    Reply
  4. HenryL

    Most enjoyable Sunday morning read. In a black humour kind of way. I know its the season for trying to worry people about their health/habits but it -almost- surprises me the relentless trickle (?!) of propaganda aiming to worry people into CVD-related treatments that just keeps on coming in the media etc. and of course with papers such as this being used as the hooks to hang the stories on. There is a saying ‘keep on telling it like it is and eventually your word becomes law in the universe’ – cuts all ways of course… Even those of us of a Doctoring Data persuasion can get psychologically worn down, don’t find it in our lives to read every touted medical paper that pops up and critically analyse it even when we feel confident enough of our analytical chops to do so (the age-related-fog-bank that rolls in periodically takes some concerted effort to re-disperse sometimes!). Do please keep shooting down those mechanical ducks.

    Reply
  5. jeanirvin

    I don’t need this info myself, having read your books, but it is always useful to have some information to tell to friends when they talk about it. Thank you.

    Reply
  6. TS

    We need to support you Dr K.
    I have worn my ‘I Love Cholesterol’ T shirts to hospitals and even stood wearing one next to a ‘Heart Foundation’ stall which was giving out information on the benefits of reducing cholesterol. It is not an easy or pleasant thing to do but it has its rewards, I think.
    I am not sure the wording is good though. I was once walking along some cliffs in a busy touristic area when a young lady wanted to have her photo taken beside me because she was wearing a ‘I Love Chocolate’ T shirt. My message seemed to her to say “I am naughty!” too.
    Any ideas for a better motif? One we could feel proud to wear?

    Reply
    1. binra

      If you make it 85% Green and Blacks organic chocolate as an accompanying image – then I feel the photo would be of life-affirming attitudes, rather than ‘medically incorrect’.

      How about an image of a brain with the % of cholesterol of its composition?
      I’ve seen range of high numbers on this but its significant enough to immediately recognize that messing with your body’s balancing of cholesterol is asking for a brain degradation.

      And so perhaps many will not immediately recognize anything – whatever you say or show – because cretinism is induced and managed by the state.

      Reply
      1. Gary Ogden

        Fiona Weir: Or the Raphio 102% Ecuadorian (the 2% is for the nibs stuck to the bottom). The 92% Ecuadorian is quite good, too, for those who need a bit of sweetness.

    2. Martin Back

      Cholesterol is an important constituent of the cell membrane and helps to make it more rigid. So you could say “Cholesterol keeps you stiff”. Of course, it might be misinterpreted.

      Reply
  7. Tom Welsh

    As Dr Kendrick, Dr Ioannidis and many others have been pointing out for some time now, there tends to be an extremely worrying abyss between what can legitimately be inferred from the results of a study and what that study’s conclusions actually claim.

    Unfortunately, I feel that one of the main causes of this trend is money – the green folding stuff. The effect is seen throughout Western culture. The other day I saw a remark, about American politics, that the deciding factor in any congressperson’s voting is neither red (Republican) nor blue (Democrat) but green (cash). Since political success depends to a great extent on the size of one’s “war chest”, that is understandable.

    Even when doctors, scientists and others have not actually been bribed, money exercises indirect influence. Recognition and career success lead to affluence, whereas disgrace and scapegoating lead to grinding poverty.

    I feel it is time for a global popular movement in support of truth and honest knowledge. How that is to be brought about is a tricky question when we are all immersed in an ocean of money – the universal corrosive.

    Reply
  8. Mr chris

    Malcolm
    I was going to read the paper, but come across this on the Jamanet page
    Association Between Push-up Exercise Capacity and Future Cardiovascular Events Among Active Adult Men.
    This paper includes the wicked words “low cost” which must question its validity.
    Your conclusion about placebos is great, I feel so much better on them.

    Reply
    1. Jonathan Bacon-Sandwich

      Excellent study thank you! You may also like these:
      https://www.lipid.org/sites/default/files/16-thompson.pdf
      Key quote “statins appear to block the aerobic traning response”
      https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0179534

      Loathed as I am to throw in some personal experience, since I binned atorvostatin 80mg daily, 2 years after an NSTEMI which resulted in no infarction and normal systolic function depite3 vessel disease, my capacity to run has increased dramatically and it was OK even on the antifatdope! No arguments from the doc as exercise capacity is the defining predictor of mortality IHD or otherwise.

      Reply
      1. Mr Chris

        Colin
        yes it was a double blind study. Not doing placebo pushups was not as bad as not doing real ones. 40 real push ups for the old is quite strenuous

  9. Paul Arnold

    This article is not only informative (new statin study…that he debunks), but it includes an adjectival phrase that is new to me, “health seeking.” As in, “Bloomingfoods attracts more health seeking people than Kroger.” Enjoy the read. Maybe I should carry a print-out of this email to Schmalz’s office when we next visit, to hand to him if he mentions the new study. ~pfa

    On Sun, Feb 17, 2019 at 3:27 AM Dr. Malcolm Kendrick wrote:

    > Dr. Malcolm Kendrick posted: “17th February 2019 [Adherence to placebo > saves lives] To an extent I am cursing myself for doing what I am about to > do. I have been dragged, yet again, into reviewing a paper that has made > headlines round the world which proved, yes proved, that adh” >

    Reply
  10. Martin Back

    Dr Sisyphus pushes yet another rock up the hill. Keep going, Doc. One day it won’t roll back down.

    The clofibrate study was an eye-opener, where the good adherers and poor adherers had similar differences in outcome, whether they were taking clofibrate or a placebo.

    The reason given was that good adherers are more health-seeking.

    Perhaps another reason could be stress. We know stress is medically deleterious. Maybe poor adherers were more stressed because they knew (even if they wouldn’t admit it) that not taking prescribed medication is likely to be bad for your health, or the doctors would find out and punish them in some way. Whereas good adherers had peace of mind because they had faith in the doctors and knew they were doing what the doctors wanted.

    Reply
  11. Jerome Savage

    Mass placebo exposure for everybody would surely save thousands of lives per year. Is it not incumbent on medical authorities to advocate such treatment- and between 3 & 6 coffees per day !

    Reply
  12. Topsygirl

    Well what can I say thank you not only has this given me another good laugh it is hard to type with tears streaming down your cheeks but it also arrives after a disturbing news item (the journalist introduced this as an exiting health initiative but I have long since decided to place my own tags) this evening on Australian TV, I have designated this as disturbing as it is being proposed that 35 mill or was it 35 bill it doesn’t matter it is health and we have plenty of money should be allocated to have every Australian over a certain age tested and checked for their risks for heart disease, some will be medicated (no prizes for guessing with what) and some will be both medicated and given life-style changes including diet and exercise. Much of this of course will cause some to become anxious and depressed then there will no doubt be some more lovely medication and counselling I think this is the rat in the wheel syndrome, and of course they will need heaps more of dietitians, food and exercise folk the list is endless we have been looking for something to bolster employment and this might be the one; they keep going on and on about the death rate like death for people and animals is a choice we will all die of something and to a degree it is up to us to be responsible sift through the rubbish and take responsibility for ourselves i.e there is enough evidence re cigarettes and the like, the abuse of alcohol. over indulgence of sugar and a myriad of other things. Get a second opinion, talk to friends, be grateful, get involved in life, learn something new, go for a walk, look at the flowers, trees, sunsets all of these things will help your heart and make you happier. and thanks again laughter and apples are good medicine.
    Dr K do you have enough bins and minions for the crumpling of all this paper we would be devastated if you developed mouse arm or such like if you have a need we could possibly crowd fund some for some containers and a part-time minion.

    Reply
  13. Angela Plotel

    On behalf of all like myself who suffer from discalculia – making research papers swim before our eyes – grateful thanks. l only wish I’d been introduced to your writing sooner (thank you Alan Watson for your tweet.) I shall enjoy showing my GP when she’s worrying about my non-compliance.

    Reply
  14. David Bailey

    Thanks, Malcolm for pointing out the bizarre fact that “Adherence to placebo saves lives”. It is sort of obvious when it is pointed out, but I would certainly not have thought of it. Remember that even those of us who have sworn off statins for life, sometimes need a neat explanation when someone discusses a report like this, otherwise we get accused of being “too sceptical”.

    This comes back to the fact that, as you (Malcolm) have pointed out many times, that it is no longer considered ethical to do random trials comparing statins with placebos!

    I seemed to remember that clofibrate was one of those cholesterol reducing drugs that actually caused more deaths in those who took it – perhaps it would have been worth pointing this out explicitly:

    https://en.wikipedia.org/wiki/Clofibrate

    So a similar study seemed to show the value of taking clofibrate, which was subsequently withdrawn after it was shown to cause excess deaths! (I hope I am not garbling any facts there).

    I guess the inability to perform proper studies has opened the floodgates for observational studies that are, perhaps, deliberately contrived to demonstrate the effect that is ‘required’.

    Now for a terrifying thought: Imagine if Dr K sold himself to Big Pharma and was employed to design studies that would seem to prove the value of harmful drugs!

    Reply
  15. JanB

    A Sunday morning treat in the inbox. I’d like very much to be able to reach through my iPad screen and shake your hand.
    Thank you.

    Reply
  16. Kathy Sollien

    Always a pleasure reading your blog, Dr. Kendrick. I hope you are finding a small check or two in your mail from my purchases of your book. I often buy Doctoring Data to have for myself but I keep giving it away to those I think need to read it. Just did it again the other day. You had mentioned once you were updating The Great Cholesterol Con, another excellent read but after all your new observations on causes of CVD, etc the last half of this book needs to reflect that. I gave my cardiologist a copy of that one several years ago by the way. Keep up the good work, I look forward to more great information from you and all these great responses to your message.

    Reply
    1. Anne

      I think you might find that Dr Kendrick’s latest book ‘A Statin Nation’ is the update of The Great Cholesterol Con’ !

      Reply
      1. Jerome Savage

        I ordered and received a book “statin nation” that i thought was by Dr K. However what I received was a book of that title but by a Justin Smith, – roughly the same subject matter. I think the book U want is “A statin nation” ,
        U can’t always get what U want !

  17. The Wizard

    Another excellent post.
    I find it extremely irritating when the medico/pHARMa cartel AND their loyal lapdogs (Govt/ regulatory authorities/mainstream media) shout from the rooftops about the “unequivocal proof” and “new evidence” of a “ground breaking study”, in the full knowledge that it is observational only.
    These same charlatans inject pregnant women with DTap and flu vaccines without any RCT , telling their victims that there is no “evidence of harm” whilst relying on contemporaneous short term observational studies(in other words the expectant mothers are guinea pigs!)
    In the very same breath, they then dismiss the efficacy of medical cannabis citing the lack of evidence because all the evidence this far is from “observational studies” and ” cannot be relied upon”!
    To quote Donald Tusk ” there is a special place in hell……. “

    Reply
    1. AhNotepad

      My daughter-in-law was injected for flu, she miscarried shortly after. Of course the vaccine had nothing to do with it. Next time there were no jabs, and with grandaughter now about 20 months and neither of them having any jabs or other medication. How? Good food and lots of vitamin C. How much? refer to Andrew Saul (and others).

      Reply
      1. Gary Ogden

        AhNotepad: RFK, Jr. has recently filed suit against the FDA for this very reason. No biologicals, and I suspect no pharmaceuticals, have ever been safety tested in pregnancy. Approving The DTaP and flu shot in pregnancy is then a violation of the law by the FDA. Horrifying that any medical professional would justify doing such a thing. In the U.S. the miscarriage rate doubled during the “double-dip” flu season of 2009 (the “swine flu” scam). John Rappaport wrote a good piece about this fraud.

  18. PD Mangan

    I would just like to point out that a .55 hazard ratio for tea drinking works out to 1.8 times increased risk for non tea drinkers, close to the 2 we’re looking for to be worth considering.

    Reply
    1. Bill in Oz

      PD are you thinking of tea as a placebo or as a ‘prescribed’ treatment ? I’m sure the tea companies would love to generate extra revenue from such prescribed sales !

      🙂

      Reply
  19. Marjorie Daw

    Doing my own observational study, I have found that the current occupant of the Oval Office of the White House, who has been taking statin drugs for years and whose prescription is being upped to the maximum dose of 40mg gets more deranged every day.

    Reply
      1. Jodi L Abel

        Zocor and Lipitor, and I presume the rest of the statins are dosed differently.From experience. I no longer take any of them.

    1. David Bailey

      Marjorie,

      I would definitely have voted for DT if I had been American. I dreaded the thought of Hillary becoming president, because she had more or less promised to start a big war in Syria – and for what – probably to create the same mess as she did as Secretary of State in Lybia.

      OK this blog is about medicine, but both medicine and politics can save lives or waste them on a horrible scale.

      Reply
      1. Gary Ogden

        David Bailey: It does concern me that Trump takes statins, and that they just upped the dose; nevertheless, some people seem to tolerate them well. Time will tell.

      2. Eric

        Well, they certainly don’t seem to slow down the muscles operating is loud mouth, and he probably didn’t use to bother engaging his noodle before opening said mouth even before being perscribed statins.

    2. goransjoberg2015

      ….Hasn’t it been established that that people of this size live healthier than the thin guys?

      Anyway, I lost 20 kg on adhering to strict LCHF 10 years ago but am still alive kicking, today on a 20 km bicycle ride.

      Reply
      1. Gary Ogden

        goran: And glad we are that you’re alive and kicking! I merely lost my visceral fat, about half the weight you did, but then I wasn’t very much overweight, when I reduced the carbs. I’ve since added almost that much in lean muscle mass from strength training.

    3. Soul

      I wish they would do away with the annual physical, not only for the President but for Americans overall. I know other countries pass on the annual physical. It’s been found of limited helpfulness.

      A doctor that advised President Obama, Dr. Ezekiel Emanuel, and who helped create Obamacare wrote an OpEd in the New York Times on this. His article can be seen here ~

      “Skip Your Annual Physical”

      Of course Dr. Emanual’s suggestion was ignored. I used to chuckle about that somewhat, as I doubt his article was a popular one within the White House and elsewhere.

      The timing of President Trump’s physical and highlighting his cholesterol levels comes across as suspicious to me. With the recent questionable cholesterol articles being widely published in the news i doubt it to be a coincidence. A bit conspiratorial on my part, yes of course! It wouldn’t surprise me though if true.

      Reply
      1. Angelica Nelson

        On skipping the physical. I have a lot of unexplained medical issues that I feel are just failures of the medical establishment to determine a reasonable course of action. Fibro and ME/CFS have both been diagnosed for me, but if I had to pick one, I’d say it was ME/CFS because of the way it responds well to Valtrex and Celebrex, but not Celebrex alone. (this is also called the “Pridgen Protocol, I found out later.) I consider my yearly physical as documentary proof of medical failure to treat, or even decide on what treatment to use. It’s not against my doctor. He’s doing his very best within the limits he’s allowed. It’s the limits he has that bother me. Together we’ve covered a lot of ground. I can’t imagine him pushing statins on me, he’s just not the type, despite my high TG. My TG go down whenever I employ a ketogenic diet, so it’s some wierd processing of carbs causing it. It also goes down when I take metformin. So there’s a mystery for you.

        For the past 20 years I’ve been just a few points away from having a diabetes diagnosis. But it never ticks over into the real thing and moves away from diabetes when I’m keto. Now with Epic being the new hot thing, I’m hoping to build a medical history that accurately reflects what I’m going through. From what I’ve heard from others online, I’m not alone. And not just online. My family members also fit my pattern of illness to various degrees. There’s something not being diagnosed correctly, and nobody’s treating it. I want there to be a record of it. That means being treated like a mental defective nearly 100% of the time when I see a specialist, but I’m willing to pay that price. When ME/CFS cropped up before (see MEpedia for details of previous outbreaks), there wasn’t any Epic (a medical documentation system), so a systematic record couldn’t be kept. Now there can.

  20. Frederica Huxley

    It is ironic that placebos would appear to have the same – relative – effects as pharmaceuticals, given that the same boffins propounding these studies often treat vitamin and mineral supplements as placebos! When told yet again that supplements are only expensive pee, I point out that exactly the same thing happens with pharmaceuticals, which are far more expensive and cause havoc in the body.

    Reply
      1. abdlomax

        Well, I’m a Muslim so I’m not going to recommend bacon, but, I get the idea, having eaten bacon before I accepted Islam.

        My equivalent is a ribeye steak, say, with lots of fat. Especially the fat. Yay fat!!!!

        “Living off the fat of the land” (from Genesis 45:17-18) meant something!

      2. chris c

        That’s what I had for dinner! Well actually half a rump steak, with Brussels sprouts and a couple of thickly buttered oatcakes, and a large glass of Carmenere. Same principle, same outcome. Same kind of placebo that my parents and grandparents used, and generations before them.

  21. JDPatten

    Um, thanks!
    “In for a penny; in for a pound.”
    You gotta still be doing this sort of thing for confused folks stumbling on answers here. Having been reassured, they can now go to “Doctoring…” for the full logic class.

    Reply
  22. Gary Ogden

    Thank you, Dr. Kendrick. With healthy-user bias, such a tiny effect I find quite damning to statin use. We should all be taking placebo, provided we get to choose the color!

    Reply
    1. AhNotepad

      Perhaps we should be selling placebos. We cal truthfully claim they equal costly pharmaceutical drugs in efficacy, at a much lower price, and far lower risk..

      Reply
      1. AhNotepad

        Yes, the bloke who did the tobacco industries publicity, and later the publicity for adding fluoride to drink water.

      2. abdlomax

        Ah, but we should sell the *most effective* placebos. There is a Nasruddin story, I tried to find it, but failed, so I will have to tell it, with your gracious permission.

        Nasruddin had set up as a physician and had an apprentice to help him. One day, as a man was opening the garden gate to walk to the office entrance, the apprentice said, “I can see, by how this man is walking, what he needs!” Nasruddin said, “You can take this case.” So when the man walked in, the apprentice immediately told him, “Eat some pomegranates, you will be healed!” The man huffed, “You didn’t even ask me about my pains!” and walked out. Nasruddin said, “Next time we see one of these cases, I’ll handle it.”

        So it came to pass that another patient came with the same malady. Nasrudding welcomed him in, had the apprentice serve some tea, and asked him, when they were sitting comfortably, to what he owed the honor of the visit. The man explained his symptoms, and Nasruddin listened, nodding his head in sympathy, asking questions that showed he had heard everything. He then rubbed his beard, obvious in deep thought, and then he exclaimed, “Pomegranates! You need pomegranates!” The man left a large payment and left, happy to know he could now have hope.

        So the “placebo business” already exists and it already uses sugar pills, and openly so. Homeopathy is Andrew Weil’s article. It sets up the inquiry into symptoms, and with a good practitioner, all the supporting aspects of medical manner, including whatever will fit the patient.

        Nowadays, an ethical homeopath will never recommend that “evidence-based medicine” — that which is truly so — be abandoned for some sugar pills. Some homeopaths may believe in “water memory,” or this or that concept of the “spirit” of materials, that survives and is even enhanced by huge dilution. Personally, I’d prefer one more thoughtful and less certain, but that holds for medical practitioners in general. And there are exceptions to everything.

        Homeopathy doesn’t work — or does not work well — when double-blinded, which is a huge clue. That is the same with all placebos. Homeopathy, I suggest, treats the mind, and the body through the mind and through language, and as another article suggested in comments on this blog pointed out, it is not necessary to “believe” the theory of homeopathy, one can (and I would suggest, should) understand that the remedies are physically all the same, in effect. But they have different names and indications. If they are cheap, and if the patient is not encouraged to abandon effective therapies, they are, at worst, harmless.

        However, a more expensive placebo tends to be more effective. High-dilution remedies are prescribed when a more powerful effect is desired, and they require more work to make.

        If you want a powerful placebo, then, see a homeopath. From how the placebo effect operates, I expect it will generally be more effective if you see an actual, trained homeopath.

        If you want a downer, for some reason I cannot fathom, consult a pseudoskeptic who is sure that anything involving belief is nonsense, but who misses all the crap that he, himself, believes. “Faith is for stupid people! I believe in science-based medicine,” as if it actually exists, just because of his imagination and fervent desire.

        Yes, there is such a thing as real science. Unfortunately, the state of medical science is primitive, too often. In addition to Doctoring Data, I recommend Gary Taubes, Good Calories, Bad Calories, as the investigation of a science reporter, who, ironically, also wrote Bad Science about cold fusion, which is a field where another information cascade ensconced itself (with his assistance!), where the “mainstream” firmly believes in “facts” that have not been correct for almost thirty years.

        Taubes may or may not be right about the “insulin hypothesis,” but he does not pretend there is proof when there is not. And he actually has facilitated funding for basic research.

  23. Bill in Oz

    Thanks Malcolm once again.

    But can I be a ‘devil’s advocate’ for a moment ? Surely all of us who read and take your advice and survive well without statinising ourselves, could also e considered survivors because we are on placebos !

    Placebos are definitely good for us !

    Reply
    1. Gary Ogden

      Bill in Oz: Excellent point. Knowledge of real science is indeed a powerful placebo. Not only is following the ten steps protective against CVD, believing that they do is even more protective. About the only thing I believe in any more.

      Reply
      1. David Bailey

        Maybe one way to think about alternative medicine, is as treatment that tries to max out on the placebo effect. It worked on my sciatica, so I am not complaining!

      2. abdlomax

        One of the most disempowering of fears is the fear of being wrong. I was trained and have learned to declare the future, to state a possibility as real. It is absolutely not necessary to “believe” it. The placebo effect operates through, I suspect, the amygdala, which is programmable through language.

        Little story: I was going out to eat with my daughter, who was about 13. I said “This is going to be great!” We were going to Taco Bell, freaking Taco Bell! Then I asked her, “How do we know that?” She immediately said, “Because we say so!” “Absolutely, I replied. And then what happened?

        Best damn tacos I ever ate! And they gave us free desserts. I wasn’t going to eat them, low-carb diet, after all, but she did! Why did they give us free desserts? Well, I know pretty well: we were having a great time, smiling, happy, and people want to join that and amplify it. I’ve seen this effect again and again.

        When I was in the hospital for pulmonary emboli (the only time I’ve ever been hospitalized, so far, aside from childhood tonsillectomy), I was asked what I wanted to eat, there was the regular food and there were also choices. And I said, “This is going to be great!” And it was. I threw up the first meal, because they were giving me a heavy painkiller, but the food was fantastic! Freaking hospital food!

        Those are all predictions of what it is easily within the power of the mind to create. How far can this go? I don’t know. I’ve seen “miracle” after miracle, though. But people are afraid to declare the future. After all, what if it is “wrong”?

        Lightning will strike them? What? Here is what I have found. Declaring an inspiring future is never wrong.

        “Declaration” is not “belief,” and trying hard to “believe” in something positive is actually self-contradictory. Just declare it! Say the words, and see what happens? This is literally magic, operating in the realm of the mind.

        When I declare a specific outcome . . . often something else happens, instead, and my declaration is that this is better than the idea I had, and that’s my generic declaration: reality is better than I can imagine.

        Really? But what about . . . ? And then that fearful mind will fill in something supposed to be
        Really Awful. I thank it for sharing, after all, it wants to protect me, but I tell it we are taking care of business, I’m carrying nitroglycerin, and I always make sure I have my cell phone with me and charged, so, my faithful lizard brain, you can go back to sleep or bask in the sun, which I am eagerly anticipating when the weather changes, and it will. The sun will rise again.

        But . . . but . . . what if it doesn’t?

        I don’t care. I am happier and healthier if I expect it will. Come to think of it, I think there is free Reiki at the Senior Center here. I think I’ll check it out!

      1. Christrohm Morriss

        Terry Pratchett’s famous witch in his Discworld books, ‘Granny Weatherwax’ had an invaluable medicine for the country folk. She gave them what she termed ‘Suc-rose and Aqua’ for minor ailments with the instruction that if they swallowed it twice a day, at the defined times, it was guaranteed to work.
        Placebo power in action!

  24. Mike Smith

    Those who adhered to taking clofibrate = 15.0% mortality
    Those who adhered to taking placebo = 15.1% mortality

    So in reality clofibrate is 0.1% better (allowing for rounding up/down) than a placebo ? Or in other words its a complete load of bollox! As an engineer I would be ashamed to publish this data – I guess they rely on MD’s who only read the paper title or headline.

    On another note, I wonder how big the grant was from the makers of clofibrate to commission the report ?

    Reply
    1. annielaurie98524

      If you look at the mortality stats for non-adherence, those are 28.3% for not taking your placebo, vs. 24.6% for not taking your clofibrate. I believe those are the numbers Dr. K had in mind when he noted it was worse for you not to take your placebo than to not take your clofibrate. There was a 3.7% mortality increase among those not taking their placebo vs. those not taking their clofibrate.

      Reply
    2. Chris Morriss

      As a design engineer myself, I think it would be wise for doctors to study the ways of engineers, especially as engineering is genuinely an evidence-based discipline.
      I am struck that the body, in its healthy state of homeostasis, requires that there be a multitude of negative-feedback loops to maintain the desired operating points.
      Any design engineer knows that negative-feedback loops can become unstable, if even simple changes are made. For example, if the speed of the feedback response to an external event is slowed down, the loop can change start to oscillate, with the controlled function swinging between two saturated states.
      There are many drugs which alter the speed of response of the body’s control loops, with beta-blockers and statins up there at the top. The body’s control loops are far more complicated than any industrial process.
      Indulging in polypharmacy is playing with fire in the case of a patient’s health.

      Reply
      1. David Bailey

        Chris,

        Your comment is spot on! If those intending to go into medical research were given a compulsory course in control engineering, I think it might be enormously beneficial. Even if they could not do exact calculations in their research, just becoming aware of some of the characteristics of complex systems, would help.

        As a boy, I used to tinker with electronics. I remember reading an item in an electronics magazine that pointed out that it was a mistake to replace broken valves (vacuum tubes) with higher quality equivalent components, because the rest of the circuit would have been optimised around the lower quality components when it was designed. The improved component might well cause an oscillation.

        Maybe if medical researchers were a bit more aware of the larger picture, they wouldn’t talk about ‘cholesterol lowering drugs’ without being aware that interfering with synthetic pathways in the body changes the levels of a whole range of chemicals (Q10 for example). The changed levels of these chemicals, no doubt disturbs yet more feedback systems.

        Of course, engineers are far more focused on discovering their mistakes before products are returned by customers who find they do not work properly, or planes crash. Covering up the flaws is a far less attractive option for them!

      2. Eric

        Well, I have been wondering about that for a long time, how we as scientists and engineers think thrice about touching a system we don’t fully understand, and how in medicine, they would happily tinker with things they don’t even begin to understand, just because they can.

        In our company, we have endless analyses on potential problems, risks and failure modes before we do a design change or deliver or retrofit a new design, and if we get it wrong, worst case we lose a couple of million but nobody gets hurt.

        Control loops are really advanced E. A semester of physical chemistry (equilibrium reactions) etc. is probably also ok to lay the groundwork.

        I can understand interim medication in an attempt to help a loop out of saturation but I less sure about anything that is given permantenly to change the equilibrium point.

      3. shirley3349

        Surely, the salient point is that living organisms were not designed according to some pre-arranged master plan but evolved in response to the pressures of their environment. Only those features incompatible with reproductive success were weeded out. The result is a paradox: living creatures are both supremely fitted to their situation and a bundle of flaws all at the same time.

        The complexity is mind-boggling, and the more that is discovered in the medical sciences, the more difficult it must become, for doctors to be more sure of improving things rather than making matters worse.

        This applies to those clinicians who put their patients’ interests first; I do not want to think of the position when financial reward is the priority.

      4. chris c

        I can think of some doctors who WERE engineers, for example Richard Bernstein and Michael Eades. Probably why they are so sensible and question dogma.

  25. Jane Jewell

    Great article, thanks!
    Loved the placebo study. Just like with kids; when they get an “owie”, give them some M and Ms (Smarties) and they feel so much better!

    Reply
    1. norahpower

      I just started this book yesterday and I am really enjoying it. He has a lot to say about ‘Big bad science’ that will resonate with readers of this blog. I cannot wait to read his chapter entitled ‘Stop the Awareness Now’. (The free preview (see above) is worth a look..)

      Reply
  26. Errett

    Suppose you live in a brick house and notice cracks in the mortar that let in cold air, rain and insect pests. You might call a brick mason to repair those leaks and to restore the barrier that keeps the great outdoors from getting inside.

    In much the same way, sheets of cells in our bodies called epithelial tissues coat our organs, creating wall-like barriers that protect us from bacteria, viruses and other disease-causing invaders. And when potentially harmful gaps between these cells emerge, a molecular switch gets flipped to call the repair crew and fix the leaks.

    Using a novel live-imaging technique they developed, University of Michigan researchers have achieved the first direct detection of short-lived leaks in epithelial tissues as they occur. Their new microscopy barrier assay also allowed them to discover that the repair mechanism involves local activation of a protein called Rho.

    The new assay could help provide insights into the mechanisms of diseases that target the epithelial barrier — ailments caused by microbes and allergens, as well as various inflammatory states, immune disorders, diabetes and even cancers. And the assay could potentially be used to screen drugs to treat those afflictions, according to the researchers.

    The team’s findings are scheduled for online publication Feb. 14 in the journal Developmental Cell. Ann Miller, an associate professor in the U-M Department of Molecular, Cellular, and Developmental Biology, is senior author of the paper. The first author is Rachel Stephenson, a research scientist in Miller’s lab who carried out the project for her doctoral dissertation.

    “An important unanswered question about epithelial tissues is: How are the junctions between cells able to maintain the biological barrier function even as cells change shape?” Miller said.

    In the study, Miller’s team used epithelial cells in live frog embryos, which have cell-cell junctions similar in structure and protein composition to those in human epithelial tissues.

    During embryonic development, many epithelial cells work together to bend and fold tissues. Using their new microscopy assay — which is known as ZnUMBA for Zinc-based Ultrasensitive Microscopic Barrier Assay — the researchers studied what happens at the cellular level when epithelial cell-cell junctions are stretched.

    They showed that leaks in barrier function happened when cell-cell junctions elongate. But the leaks are short-lived, suggesting there is an active repair mechanism.

    On further investigation, the researchers discovered that the repair mechanism involves local activation of the protein Rho, in a sudden burst of activity they dubbed a Rho flare. Rho then activates proteins that contract the junction, repairing it.

    “We discovered that cells are normally very proactive when it comes to maintaining the barrier,” Stephenson said. “This repair mechanism happens quickly and is carried out very locally, affecting only a small part of the cell junction, rather than multiple cells or the whole tissue.

    “We think that this proactive approach is what gives our cells the flexibility to move and change shape without compromising the barrier function of the tissue. Diseases involving a leaky barrier might be due to a faulty repair mechanism or the cells’ inability to detect leaks and flip the switch.”

    Stephenson and other members of the Miller Lab are now working to determine how the switch gets flipped to turn on Rho at the right time and place and to identify other proteins that are part of the cellular repair crew to plug leaky biological barriers.

    Story Source:

    Materials provided by University of Michigan. Note: Content may be edited for style and length.

    Journal Reference:

    Rachel E. Stephenson, Tomohito Higashi, Ivan S. Erofeev, Torey R. Arnold, Marcin Leda, Andrew B. Goryachev, Ann L. Miller. Rho Flares Repair Local Tight Junction Leaks. Developmental Cell, 2019; DOI: 10.1016/j.devcel.2019.01.016

    Reply
  27. wfperk@hotmail.com

    Still looking for research evidence for using beta blockers(metoprolol ) to treat CVD. Apparently recent studies indicate more harm than good.

    Reply
      1. Kathy Sollien

        Me too! Is standard medication that they pass out when you have any issues – blood thinners, beta blocker, and statins. Refused the beta blocker and statins and only took the blood thinners for 18 months.

    1. JDPatten

      Metoprolol helps relieve various cardiac arrhythmias by slowing the heart rate and reducing output. Good, right? Except for the fact that these are the same drug effects that induce lethargy – even depression.
      So, Good for arrhythmia; crap for QOL.
      Net: crap.

      Reply
  28. annielaurie98524

    Bravo, Dr, K! Another blow to pseudoscience by logic! I was going to forward your blog to a few of my friends (women with no history of heart attacks) that take statins. But, then I remembered, I need to go take my placebo (a splash of pastured goat milk) in my 2nd cup of coffee of the day, and then chase it with a cup of Earl Grey. One has to adhere to one’s regimen for reducing one’s own mortality first, after all.

    Reply
  29. Jill Mitchell

    The reason less people die from CVD if they go to the doctor more often to pick up cholesterol lowering prescriptions, is because the waiting room is a high risk area for catching the flu. Cause of death: flu.

    Reply
    1. abdlomax

      Interesting idea, but not the issue with this particular paper, because they did not report CVD deaths, but all-cause mortality. There are other problems with the paper. (And by the way, here, at least, people do not pick up prescriptions at the doctor’s office, but at a pharmacy).

      Reply
      1. Gary Ogden

        abdlomax: Good point. What the paper seems to be saying is that not taking care of yourself kills you only slightly faster than statins do.

  30. Marguerite

    So informative…thank you!
    Doctoring Data is probably the most interesting book I have ever read, in all my 59 years.

    Reply
      1. abdlomax

        I just paid for the Kindle edition, which was cheap enough. In fact, I could have bought a used paperback for about the same price (about $10) but two reasons for buying the Kindle: (1) I can read it on my phone anywhere and (2) I can copy text if I want to write something derivative. I’d rather have the book for other reasons…. But I’m already reading it now, and, yes, as was already obvious, Malcolm is a splendid writer. For me, it’s preaching to the choir, having followed
        Taubes for years.

        Now, what is really needed, for breakthroughs, is actual debate and real consensus process, not fake consensus from a religious conference. This is needed all over the place, not just with this issue.

  31. abdlomax

    Well, Dr Kendrick, I apologize for not buying your book yet. I’m on a very limited income, but I will at least look at Amazon. In any case, thanks for addressing the paper. I had considered much the same. However, to be sure, this paper shows awareness of the placebo adherence issue, which I think should be mentioned.

    To attempt to control for the “healthy adherer” effect, we adjusted for adherence to β-blockers and angiotensin-converting enzyme inhibitors. We then performed a fully adjusted model that controlled for all patient and facility characteristics described previously.

    Adjusting for adherence to other cardiac medications attenuated the effect size but did not change the dose-response association between adherence and mortality. However, additional adjustments for patient characteristics strengthened the association between statin low adherence and mortality (Table 3). When LDL-C levels during follow-up were added as a categorical variable (including a category for missing), the effect size was attenuated but
    remained significant.


    However, high adherence itself may be a marker for overall healthy behavior, a term known as the healthy adherer effect.23 In fact, high adherence to placebo has been associated with improved outcomes after myocardial infarction and lower cardiovascular mortality.24,25 It is possible that patients with low adherence are also likely to engage in detrimental health behaviors, such as smoking, or have poor psychosocial support. To account for this, we controlled for adherence to other cardiac drugs (β-blockers and angiotensin-converting enzyme inhibitors) as well as blood pressure, which was higher among those with lower adherence. While this attenuated the association, there remained a strong dose-response association between the adherence to statins and survival. Although this healthy adherer effect may partially confound the association between statin adherence and overall mortality, it can help clinicians identify patients who are more likely to benefit from statin adherence and maintaining a healthy lifestyle.

    The failure to prescribe and intensify statins is not the only
    obstacle to improving guideline adherence. Even in well conducted randomized clinical trials, as many as a third of high risk patients who were prescribed statins discontinue statin
    therapy, with most of the discontinuations attributable to patient preference and not to drug adverse effects.11,12

    On that last quote, I intend to look up those sources. How do they know how to attribute discontinuations? “Patient preference” could mean anything from “just for the halibut,” to patient intuition, which might have a basis in experience, to believing internet scare stories. Or actual information and knowledge. Or living a dangerous life style.

    I was prescribed a statin about two years ago. I had always refused prescription before. Why? Well, I knew about the cholesterol myth, so why should I take a drug to lower cholesterol? Then, when I was diagnosed with a cardiac blockage (no heart attack, nuclear stress test) I accepted a prescription from my cardiologist. It was a high dose. The first time I took it, I accidentally took a double dose. I felt lousy. Other drugs, I take a double dose, I’ve done this more than once, I feel about nothing. I’m thoroughly aware that this would not prove harm, but . . . it put me off and I then did more research on statins and I never refilled the prescription, so I would not, were I a veteran, have been included in this study (they only followed patients who refilled prescriptions). But the authors of the study were clearly rationalizing away every bit of negative implication, very much what Taubes has written about in the establishment of the cholesterol and dietary fat myths.

    Reply
    1. Gary Ogden

      abdlomax: The books are not expensive. Dr. Kendrick was just kidding when he talked about making pots of money from them. If you can only afford one, I suggest starting with “Doctoring Data.” It covers a lot of ground.

      Reply
  32. John Cherup

    Dr K
    I have read many of your blogs and one of your books on cholesterol. I have seen the Liz get about statins but are some same arguments true for PCSK9 inhibitors? And where do you stand with patients that have very high triglycerides. Are tricot (fenofibrate) a useless drug to take since we’re not sure how high is too high in measuring fats inside lipoproteins? Please advise Thx JCIV

    Reply
    1. Gary Ogden

      John Cherup: A great deal of light is shed upon your question in “A Statin Nation.” Short answer: Run for the hills and hide the children. Apparently very expensive, too.

      Reply
  33. Annette Marslen

    Surely this alone negates any supposed result from this study:

    “Main Outcomes and Measures The primary outcome was death of all causes adjusted for demographic and clinical characteristics, as well as adherence to other cardiac medications.”

    Everything can be adjusted to suit their stance. Surely the very fact that the results were so miniscule, to the extent that placebo was better, once the statistics were “adjusted” for all the abovementioned. It just proves further the complete rubbish being published.

    Doctoring Data is a book that should be required reading at high school!

    Reply
  34. Rob Pankratz

    Kudos again for disentangling the fiction and interpretation from the facts. This very point was ingrained in me when so many women were killed in the ongoing nurses health study by giving them estrogens because, observationally, women taking replacement hormones regularly were seen to have lower risk of cvd. Same with vitamins. Now aspirin seems to have fallen under this same rubric.
    Sorry I am one who doesn’t do the statistical analysis myself. Laziness. Not ignorance. Ok
    I’ll buy your “doctoring data” book at the risk of it worsening my reactive depression
    A sincere thanks Malcolm

    Reply
  35. Ruth Baills

    😂 again I had a good laugh keep up your great work Dr Kendrick. I look forward to your next blog for a good belly laugh.

    Reply
  36. Gary Redman

    Ah the ramblings of the lunatic fringe. This food causes this then that then this. Will we ever be free from this verbal diarrhoea? Me thinks not. If I here the word statins again I think I’ll have a heart attack. So they don’t work after all. Biggest hoax since cereal is good for kids. I swear the powers that be seem to give advice completely at odds with what makes you healthy. Do I dare say the word conspiracy? Question everything and be sceptical of all things man in his infinite wisdom has tainted. Great article as per usual.

    Reply
  37. Angelica Nelson

    Thanks for this wonderful read! I consider “Doctoring Data” and “Death by Food Pyramid” to be classics of science reasoning, and a potent detox to today’s themes of fear, conformity and diet shaming.

    Reply
    1. Angelica Nelson

      That’s certainly a different way to reduce cholesterol. I can’t give an intelligent opinion on that. But this is where I ended up after looking at it:

      What is the normal function of cholesterol? https://www.livestrong.com/article/31887-function-cholesterol-body/

      What does the drug do? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163360/

      Sounds like they’re using the body’s immune system to destroy receptors in the liver. Is it just me, or is one of the side effects likely to be sterility? Is that why the big push for statins and similar drugs is after childbearing years?

      Reply
      1. chris c

        “it has been shown to significantly decrease hepatic
        production of PCSK9 and cause a marked reduction in LDL-C levels”

        so in other words the trial will effectively unblind itself

        Yup I don’t like it either

      2. Angelica Nelson

        Maybe. Depends on the design. If they only want to test all cause mortality, then I doubt if unblinded patients (who will certainly notice if they’re taking the real drug), would die at a different rate because they know. But if the goal is to see the side effects, then patients could very well be taking CoQ10 once they realize they’re on the drug and confound the study. It only takes a google search to find out that CoQ10 is “a thing.”

  38. TS

    More help please:
    Thank you for all your good suggestions. ‘Cholesterol saves lives’ sounds very good and would be a lovely title for an academic paper.
    If you wanted to talk to someone about cholesterol and you only have a minute or two of opportunity, what would be the best thing to say? What would be the best angle to take? (Incidentally, I find people tend to think you are only in favour of ‘good’ cholesterol and assume that you take it for granted that ‘bad’ is bad.)

    Reply
    1. Angelica Nelson

      I’d advise them to ask their doctor to tell them what normal functions cholesterol has in the body. My doctor, who’s a great doctor and has lots of experience, had to look it up!! I applaud his honesty for not blowing smoke and just finding out and getting back to me.

      If a doc can’t answer what the normal function of a drug target is, they cant reasonably tell you the side effects. I don’t like to tell people to change their mind. I like to have them discover the fallacies and decide whether they prefer life safe and conformist or raw and real.

      Reply
    2. Andy S

      TS: short 15 second reply when someone attempts to treat your cholesterol-
      It’s not the cholesterol it’s the sugar that causes most of the CVD problems.
      Also there is no good or bad cholesterol, it’s all good cholesterol unless if it is oxidized.

      Reply
  39. Soul

    Your new book much have the pharmaceutical gods worked up! I haven’t read the book, it isn’t available in the US, but from the title can guess what it is about. Watch out for royalty.

    I’ve noticed in the last week the statin commercials are showing up more frequently on TV here in America. I hadn’t seen them in years. In the last week the statin commercials are back. Hard to believe these tacky drug commercials are as effective as they are with the public.

    I recall reading 20 years ago drug firms spent 3 billion dollars on drug commercials. I can imagine twice that if not more is spent today. 6 billion dollars buys a lot of friends I can imagine.

    I’m just glad mom’s hip remains in good shape since she stopped taking a statin. Yesterday morning we went for a bike ride and later a walk on the beach. No problems for mom doing this. 6 weeks ago she wouldn’t have been able to do that. She was in to much pain from the statin apparently. Her quality of life has improved.

    Personally I’ve felt if someone wanted to lower their cholesterol levels as he felt it would improve his life, have a great time, knock your self out. I would suggest to do so naturally though. TO many side effects associated with cholesterol lowering medications. Changing ones diet to lower cholesterol comes with typical side effects of loosing weight, having more energy, feeling better, etc.

    Reply
    1. Eric

      Do a little more research. You will find that lowering cholesterol via diet ain’t a good idea either.

      The much hyped vegetable oils will probably lower LDL, but mainly because they are a liver poison. They also gang up with sugar to fatten you up, and their byproducts down the metabolic chain are cencerogenic. Just search for HODE-13.

      Reply
      1. JDPatten

        Medscape is easy to sign up for. Of course, you’ll have to make up a user name and yet another password, but that’s life today, innit? 🙂

      2. Jerome Savage

        Quick check (on wiki):
        Medscape owned by Webmd
        “Writing in The New York Times Magazine,Virginia Heffernan criticized WebMD for biasing readers toward drugs that are sold by the site’s pharmaceutical sponsors, even when they are unnecessary. She wrote that WebMD “has become permeated with pseudomedicine and subtle misinformation.”
        Is nothing sacred?

    1. abdlomax

      thanks for the link to Seth Godin on Placebos. About 40 years ago, I had a conversation with Andrew Weil about homeopathy.

      Homeopathy is the favorite punching bag of pseudoskeptics, and the theory of homeopathy is utterly ridiculous, it utterly fails double-blind testing, but it has also been shown to be “clinically effective” and I know a number of homeopaths. Very nice people.

      My idea in that conversation was that homeopathy worked by amplifying the placebo effect, through the process of diagnosis and treatment. I.e., homeopathic remedies, which are physically equivalent to sugar pills, i.e., “placebos,” work though the mind. It becomes possible, then, to prescribe a homeopathic remedy with complete honesty, even if one doesn’t “believe” in the physical theory.

      “People who take this remedy often get better (fact!). I think it probably works through the mind, but there is very little possibility that the remedy will harm you, and it’s cheap. I recommend you try it! And don’t be stupid. If you are having angina, sure, you can take Rescue Remedy, or whatever, but also toss in some nitroglycerin and if the pain doesn’t go away from this Powerful Combination, get your butt to a hospital. Your mind is telling you you need more help than that. Maybe there is a nurse there who will do Reiki on you!”

      Ah, that Wikipedia article is typical of Wikipediocy. They have the ontological sophistication of . . . what’s a good example? Ancel Keys? Skeptic from Britain? (and, seriously, SfB was allied with the faction on Wikipedia that made sure that articles were filled with narrow-minded insults.)

      Reply
      1. abdlomax

        As to homeopathic remedies being equally effective with animals and babies (presumably as with adult humans), any skeptic would point out, “That is expected.”

        This comment actually led me to write another comment about a certain pseudoskeptic who trolled here, because one model I use is “there is only one mind.” Is that “spiritual” or “material”? When there are possible communication media, it could be either.

        Animals can read our minds, and so can babies, and adult humans as well, even if it is unconscious, and that is precisely why double-blind studies are done when attempting to distinguish a “material effect” from a “spiritual effect.”

        If we want healing, if it is healing that is important to us, do we care if the “medicine” operates materially or spiritually?

      2. AhNotepad

        I think most maladies will be cured by the body’s system, so whether the treatment is homeopathic, placebo, or even no treatment, most problems will be fixed provided the nutrition is adequate.

        Example: we catch a cold, we don’t treat it, it goes away.

      3. abdlomax

        Sure, “most maladies will go away without treatment.” But is there any way to increase the rate? The placebo effect works, and it is “treatment.” Double-blind, my understanding is that it has no effect, but it is not practiced double-blind, and in clinical practice, again if I’m correct, there is an efficacy. I.e., people who are treated do better, statistically, than people not treated (just not in double-blind tests).

        “Treatment,” by the way, would and should include considerations of diet, exercise, all that. It could also include standard medical treatment, but what worries us is treatment of people with strong remedies that have not actually been shown to be without harm, treatment of large numbers of people to reduce “risk factors,” instead of actual causes.

        Taubes covers in Good Calories, Bad Calories, the history of the movement of public medicine toward treating populations rather than individuals. To do that sanely requires much stronger evidence than existed, to be consistent with the Hippocratic Oath of “do no harm.” But who cares about that silly old idea?

      4. chris c

        Apocryphal story of someone who forgot to take his homepathic remedy and died of an overdose . . .yes I’ve heard of vets using homeopathy.

      5. Dr Richi

        Am not a homoeopath or a speaker for them as part of natural medicine, but I know of the mechanisms of why it works (beyond any belief) and even scientists who accidentally proved a mechanism did not want to be associated with homoeopathy, because of the associations with quackery.
        The disproportionate passion in the hatred of homoeopathy is not because of merely a pharma profit threat but because evidence for the informational or consciousness basis of reality brings down the delusional nature of all materialist (pseudo)science. The odd thing is – this happened in the 1920s with physics, but everyone in the other sciences went on as if nothing happened, and physics itself has split into the acknowledged and unacknowledged.
        Hence pseudo-sceptic defenders of materialism have no where to go but to Defamation, Slander, and Libel of those scientists who find evidence of e.g. water memory etc, they are routinely called pseudo-scientist and insane.

  40. Errett

    https://www.sciencedaily.com/releases/2019/02/190213132317.htm

    Off topic again—“We have discovered that sleep helps to regulate the production in the bone marrow of inflammatory cells and the health of blood vessels and that, conversely, sleep disruption breaks down control of inflammatory cell production, leading to more inflammation and more heart disease,” says Filip Swirski, PhD, of the MGH Center for Systems Biology, senior author of the Nature paper. “We also have identified how a hormone in the brain known to control wakefulness controls processes in the bone marrow and protects against cardiovascular disease.”

    Reply
  41. Scottish lady

    A few weeks ago I emailed Science-Based Medicine about this cholesterol denialism.

    https://sciencebasedmedicine.org/the-cholesterol-controversy/

    The article was written by Christopher Labos MD CM MSc FRCPC.

    Here has gone through practically every objection to statins. Here is his conclusion:

    “But all these criticisms belong to a different time. There are studies in humans. We have moved past diet studies for lowering cholesterol. Women are included in studies. There is a mortality benefit. Statins (and other medications) do work by lowering LDL. Statins are now generic. There are alternative to statins if you have side effects. The thing about the cholesterol controversy is that most of it has been settled.

    Some issues remain. Maybe it is better to measure to non-HDL cholesterol or ApoB cholesterol instead of LDL cholesterol. But this is a subtle point, and finding a better way to measure something does not negate the underlying truth that high cholesterol increases the risk of heart disease.

    There was a time when someone could be skeptical about the role of cholesterol in cardiac risk reduction. That time has now passed.”

    Reply
    1. Mr chris

      Dear Scottish lady,
      I personally find your comment á bit thin. You write to á magaziné, a person replied telling you that statin dénialism is old hat and you send it in. What do you expect the blogger and his audience to do? Say to themselves that all is saved and go away? I think you must do better than that.

      Reply
    2. Jerome Savage

      The suggestion is that millions of years of evolution has resulted in the body producing something that is in effect not natural, that is destined to cause the body’s demise prior to reaching its optimum potential life span. That does not make sense in my book.
      Cholestoral, good or bad is there for a reason unless a sudden evolutionary burst has deemed it redundant. That’s unlikely is it not ?

      Reply
    3. Dr. John H

      Scottish lady (aka BigPharmaShill?)
      Well thought out competing viewpoints are always welcome. Name calling puts your credibility to zero.

      Reply
      1. Mr Chris

        Dr John H
        I am always suspicious of people who suddenly arrive on this board with a pat answer to everything, and a slightly misleading justification as to where they got it from.
        Bigpharmashill might be an exaggeration but…..

    4. Don

      To those interested, Dr. Kendrick has entered the fray in the commenting section to this article. Might be fun to watch!

      Reply
      1. AhNotepad

        I have read a few dozen of the comment posts on the sciencebasedmadicine link. They do a lot of bickering there about who meant what by the words they used. The article seems to be generally supporting statins by making statements referring to studies taht they contribute to signifigantly reduced morbidity. I wonder if they would have the same opinion if they used studies done after 2005.

      2. Gary Ogden

        AhNotepad: I looked in vain for the science in that article. Perhaps the author doesn’t understand the nature of science.

      3. David Bailey

        AhNotepad,

        I tried to add a comment there describing my own experience with statins, It appeared for a while and was then deleted. One way to continue to believe in statins is clearly to ignore anyone who reports anything else!

    5. Dr. Malcolm Kendrick Post author

      I think I would be more open to dialogue if people did not use phrases like cholesterol denialism. It is hard to debate with someone when they have cleared decided that you are a denier and therefore, by definition, wrong. Then you quote a blog that begins with… but all these criticism belong to a different time. Which is basically patronising nonsense. As if the ‘deniers’ are stuck in some dimly lit past, and understand nothing of new shiny thinking. Well, here are the conclusions a paper published late last year (by someone who has no connection to myself, or THINCS). The author reviewed the evidence from statin trials done after 2005, when new regulations came in Regrettably, some clinical trials prior to 2004 have been tainted by scandals that led to new clinical trial regulations intended to safeguard patients and lend credibility to subsequent trials. The table summarizes 29 major RCTs of cholesterol reduction reported after the publication of these regulations In my opinion any clinical trial, funding by the pharmaceutical industry, done prior to 2005 should not remain in the evidence base used to create clinical guidelines. Frankly, they cannot be relied upon. I fully realised that this would create an enormous problem. However, the problem we currently have is far greater. Namely, that we cannot rely on the evidence base – particularly the evidence base created when it was still possible to change end-points mid-trial, refuse to publish statistical analyses that were to be used, add different outcome measures whilst the trials was going on, and simply bury studies that were negative.

      The conclusions of this paper were: LDL-C is considered the primary constituent of atherosclerotic plaque. Therefore, it stands to reason that lowering serum LDL-C should prevent cardiovascular disease. Three decades of RCTs, however, have yielded inconsistent and contradictory results. We must acknowledge these anomalies and either modify or reject the lipid hypothesis https://www.amjmed.com/article/S0002-9343(18)30404-2/fulltext

      Last year I co-authored the paper ‘LDL-C does not cause cardiovascular disease: a comprehensive review of the current literature.’ https://www.ncbi.nlm.nih.gov/pubmed/30198808

      According to Taylor & Francis who publish more than a hundred scientific journals, more than 10,000 open access papers were published during the year 2018. Our paper was placed on the top of their list of the ten most downloaded papers. So, the ‘denier’s objections do not belong to a different time. They belong to the present. What belongs to a different time is a the cholesterol hypothesis created over seventy years ago that has not changed, even in the face of directly contradictory evidence. When it was first created no-one even knew there were different type of lipoproteins. Yet, we still talk about cholesterol levels, as though they actually exist – as a thing. It is utter nonsense, and it always was. The epitome of H L Mencken’s dictum ‘”For every complex problem there is an answer that is clear, simple, and wrong”

      As for the ‘fact’ that Christopher Labos went through practically every objection to statins/cholesterol lowering, he failed to mention these studies. The first is ILLUMINATE

      ‘..at 12 months, patients who received torcetrapib showed an unprecedented panel of results, including a’:
      • Mean increase of 72.1% in high-density lipoprotein cholesterol (HDL-C);
      • Mean decrease of 24.9% in LDL-C; and
      • Small mean decrease of 9% in triglycerides compared with baseline
      Here were the results as reported in Medscape. https://www.medscape.com/viewarticle/569609_2
      • A 58% increase in all-cause mortality in the torcetrapib group
      • A 35% increase in hospitalization for angina in the torcetrapib group
      • 464 serious ‘events; in the torcetrapib group vs 373 in the comparator group
      • In the torcetrapib group there was an increased risk of death from both cardiovascular causes (49 vs 35) and non-cardiovascular causes (40 vs 20).

      The other ‘…cetrapibs’ also failed miserably. Here is the report on evacetrapib.

      DREAM LIPID EFFECT HAD NO CLINICAL BENEFIT
      A class of cholesterol drugs once considered a potentially very promising approach to beneficially reset lipid levels instead produced its third flameout in a pivotal clinical endpoints trial with more than 12,000 patients.
      The failure of evacetrapib treatment to produce any clinical benefit despite dramatically elevating serum levels of high-density lipoprotein cholesterol by an average 130% and substantially dropping levels of low-density lipoprotein cholesterol by a mean 37% pretty much spells the end of the cholesterol ester transfer protein (CETP) inhibitors as drug candidates, agreed many experts who heard the disappointing results.
      The findings also added to existing questions about the reliability of elevated HDL cholesterol levels as a marker for better clinical outcomes, and raised new concerns that a similar limitation might also apply to LDL cholesterol. https://www.mdedge.com/ecardiologynews/article/108182/lipid-disorders/accelerate-evacetrapibs-clinical-failure-sinks-lipid

      Oh, did these trials not get mentioned. I wonder why. Primarily because they failed. Secondly because the main results never got fully published I suppose.

      Please don’t tell me. Oh, these agents must have failed because they raised CVD and overall mortality in some way that was not related to LDL lowering. Fine, if you want to use that argument, then I will say that statins reduce the risk of CVD (by a very minimal amount) through mechanisms unrelated to LDL lowering. I presume, however, you would prefer to use the argument both ways round.

      Reply
      1. Don

        I read the comments section. You were basically wallowing in the mud with pigs, Dr. Kendrick. But I wouldn’t say you were wasting your time totally, as it appeared you may have reached the home school lady whose mind was not closed.

    6. David Bailey

      Scottish Lady,

      Despite giving a vague impression of having professional knowledge in this area, you said nothing very specific. Have you read any of Dr Kendrick’s books – which are heavily annotated with references to actual studies. You could debate the evidence right here, but when you talk of ‘denialism’ it makes me thing you don’t have any detailed knowledge to debate this issue of cholesterol, because scientific debate obviously cannot consist of name calling, or even of vague statements about ‘time having passed’.

      Reply
  42. Eric

    Mostly unrelated, except that they want to define new goalposts for statinization for South Asians. Comment section is interesting, too.

    Reply
  43. Soul

    Learned sad news yesterday. An uncle has been told he needs his other hip replaced. The previous hip had been removed a few years ago I believe.

    The uncle is a statin taker. At least he was in the past. Knowing his personality he likely takes a statin still.

    I don’t know if the statin is causing his joint problems. With what I’ve seen with my mother, i wouldn’t bet against the statin being the main cause of his hip pain.

    Reply
    1. David Bailey

      A poster on here called ‘Soul’ had a similar problem with his mother. She had been basically scheduled to have her hip replaced, but he persuaded her to stop her statins for a bit – and she is now walking fine without a hip operation.

      Reply
      1. Soul

        Yep, that’s me, the one and only Soul. It’s a nickname I picked up as a child while a dozen Chinese nationals were visiting the company my father worked for. Dad was supposed to be in charge of entertainment. Instead the Chinese kept falling me around everywhere, talking constantly, and couldn’t pronounce my name. They kept calling me Soul.

        I’m afraid the statin and hip replacement suggestions from the doctor in the family continues. I don’t know for certain what my uncle is going to. He is a believer, or maybe better said less skeptical of, the medical industry similar to mom. I’m guessing he will have the other hip replaced instead of stopping the statin. His vote will be that lower cholesterol levels improve his life

        He’s a former NASA, rules are rules to be followed, engineer I’m afraid. Often a nice guy but he has a tendency to drive everyone nuts. It has me worried that two nephews are studying, or soon to be in one case, in University to become engineers. I don’t know if I can handle more engineers in the family.

        I’m waiting for the news articles saying that statins cure hepatitis C and AIDS with an added bonus of ridding one of flatulence. It’s only a matter of time I’m afraid.

  44. Errett

    https://www.sciencedaily.com/releases/2019/02/190214153040.htm

    Offering compensation can be an important tactic to attract potential participants for enrollment in research studies, but it might come at a cost. A new study conducted by researchers in the Perelman School of Medicine at the University of Pennsylvania found that up to 23 percent of respondents lied about their eligibility to participate in a survey when offered payment, even small amounts.

    Reply
  45. JDPatten

    Bleeding while on a new anticoagulant:
    There is a bit of research on the reversal agent of the Xa inhibitors rivaroxaban (Xarelto) and apixaban (Eliquis). The research is not complete, but it brings up questions.
    Among 354 subjects, 2/3 were intracranial bleeds. The rest were mostly gastrointestinal bleeds.
    Andexanet alfa was administered.
    10% had a thrombotic event. (Ischemic stroke is a thrombotic event.)
    14% died: due to the antidote? Or the original bleed?
    Was the antidote overdosed?
    Were the patients frail and bled spontaneously?
    Was trauma the bleeding cause?
    100 patients went a full month with no anticoagulation. The others?
    The clearance of apixaban is about a day. Was the antidote overused?
    How many of those with a brain bleed then stroked out?
    This is far from a perfect fix.

    Smart presentation and a link:
    https://www.medscape.com/viewarticle/909362
    (You can easily sign up to access medscape.)

    Reply
    1. amie

      Not sure how your comment re anticoags relates to the rest of this post, but as it happens I was thinking about you and wondering how to attract your attention, just yesterday, JDPatten! My H finally went for consultation at the anticoag clinic at hospital re switching from warfarin to one of the novel ones for his AF. ( since TIA in 2013) The nurse practitioner asked why he wanted to switch as he was achieving 100% in keeping within the 2-2 INR goal. I said we were concerned at studies indicating that long term warfarin leads to calcification of arteries (he has been on them over 5 years and is now 70). She didn’t affirm or dispute this, just said there is not enough data yet on the novel ones to say whether or not they cause calcification. I said it was also indicated that INR levels become more unstable with age. She explained this was because of the health factors in older people which affect INR: UTIs, respiratory illnesses etc. She then offered a choice of Xarelto or Eliquis, and based on your comments on the previous thread, I suggested Eliquis had a slight edge regarding risk of bleeding. She claimed that there are no comparative studies between different novel anticoags, only between them and warfarin. In the end, H chose Xarelto purely for convenience of one tab a day compared to Eliquis 2 per day. He starts today, with me wondering whether I have advised him to do the right thing, or to have let sleeping dogs lie and stay on the warfarin.
      She said re no antidote for the novels, it didn’t really matter much, riskwise,
      as the effect of the novels are much quicker onset and quicker withdrawal than warfarin, which lingers for a few days.

      Reply
  46. Leon

    Serious side effects are a very simple warning that something is very wrong with the theory or treatment.
    Only a simpleton will try and deny it.

    Reply
  47. Matthew

    I am sorry to bring up guilt by association but sometimes this is justifiable. You can define a man by the kind of company he keeps.

    This blog is filled with loons and quacks that support Kendrick’s ideas. I have been digging around on various blogs posts going back years on this website. There are anti-vaccine activists that comment here, people that on a regular basis quote from known conspiracy theorists like Joseph Mercola and Gary Null, yet commenters here never call out this kind of quackery they endorse it. There are people that promote unproven cancer cures here, basically any kind of reality denying nonsense is supported. There are alternative medicine proponents here. There was even a lady promoting the disproven ideas of Cleve Backster that plants have consciousness.

    David Bailey that regularly comments here is a paranormal believer and alleged psychic. He is an admin on the Skeptiko paranormal podcast owned by a paranormal nut Alex Tsakiris. Another commenter Abd ul-Rahman Lomax is a known conspiracy theorist and cold fusion pseudoscience nut. Basically this blog attracts proponents of pseudoscience and woo, not any rational individuals. There is virtually no science here, that is why these insane ramblings are almost limited to a blog on the forgotten side of the internet. I did some private emails to seven known cardiologists in the UK, they said Kendrick is on the extreme verge of fringe science and he is not taken seriously by the medical community as they lack evidence, four of them had never heard of him and two of them described him as a “quack”.

    Göran Sjöberg is a metallurgical engineer he has no credentials in medicine and is another one of these low-carb high-fat crackpots. I could go through countless other commenters here but I will leave it there. This website is filled with absolute cranks and a crowd of reality denying anti-science kooks. It amazes me that people actually think they are pro-science here, delusions of grandeur! The place is a NUT-HOUSE. LOL.

    Reply
    1. AhNotepad

      Matthew, and you are qualified to make these assessments because……………..? Or perhaps you are one of those groups of undergrads reading psychology and is looking for a response.

      You should know that in general clinicians have such huge egos that a large bag of salt is handy to have beside you.

      Reply
    2. Martin Back

      I guess Isaac Newton’s studies of alchemy, esoterics, and biblical prophesy disqualify him as a serious scientist in your eyes.

      Reply
    3. AhNotepad

      I presume you consider you support “the science”, possibly even “the settled science”, or maybe the “consensus science”. Well since you mention the anti-vaccine activists that comment here, you will be aware that there has never been a double blind random inert placebo controlled trial for any vaccine. How scientific is that? In 1986 one of the conditions the US government took on the manufacturers liability for vaccine caused damage, was there should be a biannual report about the steps taken to ensure the vaccines were safe. There has never been a report in over 30 years. How scientific is that?

      Reply
    4. Jerome Savage

      Some like yourself DO contest Dr K’s ideas, ideas that are not by any means exclusive to Dr. K. and these contrarian views are published here. But you Matthew, unlike those with a worthwhile but contrararian point to make, are anonymous. But yes, some commentators are suspect, bit like yourself. Censorship I’m sure takes extra time and effort and itself is not always a good thing.

      Reply
    5. Dr. John H

      Malcolm,
      When mean spirited shills post here, do you as the moderator want to delete their comments? Or, do you want us to see what you have to put up with?

      I am very grateful for you and your blog, as you have helped me, my family, and patients a great deal!

      Reply
      1. Dr. Malcolm Kendrick Post author

        It would be easy not to put up the comment in the first place. I think that free speech is an extremely important principle. I have three rules for comments. One, no advertising. Two, no personal insults. Three it has to make some kind of sense. Matthew did breach rule number two. If he wants to stay and try to argue the science – fine. If he simply wishes to insult people, then he probably gets three strikes then your out. At present I am giving him the benefit of the doubt. I also think it is important for readers of this blog to know that kind of stuff that gets said. Some of it does not get through. The most insulting stuff tends to be direct e-mails to me. I have trained myself not to react. In fact it does not bother me in the least. Ad hominem attacks always do more damage to the sender than to the receiver. Even if I do not know who they are – they know who they are, and they know (deep down) that they are corroding their souls.

      2. David Bailey

        As Matthew mentioned, I do help moderate a website devoted to another area where I think conventional science has let us down – so I have to deal with posters not dissimilar to Matthew.

        I realised that those with a hostile attitude (particularly those who triumphantly display information about posters, obtained by underhand means) are not going to improve when shown the evidence – their aim is simply to cause trouble. If one of these idiots enjoys the oxygen of publicity, another two will decide to have a go – things quickly escalate. Until recently, I hardly ever saw posts like Matthew’s on your blog, and I suggest that it is better to nip these things in the bud – because those posts, and all the resultant chatter can quickly drown out the real subject matter – which in this case was a study that purported to show that statins save lives.

        I really value this blog, and it clearly does offer us freedom of speech, but the only aim of people like Matthew is to deny others their freedom of speech by wrecking the place where they meet.

      3. mmec7

        – Agree with David. I also administer a site, so far it is clean of such attacks, but one has to be on one’s toes.

      4. Gary Ogden

        David Bailey: We also must bear in mind that the CDC Foundation funds a multi-billion dollar propaganda campaign on behalf of pharmaceutical interests. They hire “PR” firms to do all sorts of underhanded stuff, such as hiring internet trolls. Whether this Matthew character is one of these we don’t know, and it really doesn’t matter. I have occasionally engaged them in the past, but no longer. They are best simply ignored. Best pay attention to what government is doing right out in the open. This we can do something about. The industry appears to be in near panic mode, with the recent heavy-handed push to statinate everyone who is breathing, and universal forced vaccination without informed consent, which our Congress appears on the verge of mandating. The internet has fortunately allowed the spread of knowledge like never before in human history, and is un-censorable except in outright authoritarian regimes. In Western “democracies” they simply won’t get away with it. Vive le France!

    6. AnnaM

      Oh my, my, my. I am shocked I tell you. Shocked.
      And to think you have spent years here! How very, very odd.
      I wonder if I could get paid to do something like this. I have better punctuation skills.

      Reply
    7. Dr Richi

      Am not sure it is worth any of the wise people here wasting their energies on this transparent psyop bullying. If I could speak on behalf of many of us and as a warning to shills, I would say:

      “You’re too late”
      Many / all here are highly educated people from backgrounds of western medicine and physical science – they are just not controlled and completely closed minded i.e. a real scientist. In the tradition of Francis Bacon and Isaac Newton for a start.

      What this shill pseudosceptic fails to realise is, not only are we better educated, better informed, – but personal experience with actual research, as well as life experience, knowing insiders, whistle-blowers, intelligence etc – you cant unscramble a cliche, and Pandora’s box is in with the recycling. The boat has sailed and you are ranting to no one, on the jetty.

      Just because these cowards literally cant handle the truth, they are hell bent on trying to contain “the people” from knowing the truth too. They wish they had the authority, mystique and charm of a cigarette smoking man, but sorry, you are all just transparently spineless losers, shouting cliches, with no intelligence, no references to anything, no mind and no hope.

      This should motivate any readers here to go further, not be contained – read what the sceptics attack, read the “pseudoscience” trust your own intelligence and instinct about truth – don’t be told.

      Reply
      1. abdlomax

        Underscore. Read what is well-written and especially verifiable (sourced), whether “mainstream” or “pseudoscientific” or “skeptical,” believe none of it, but do the work to feed your intuition with data as close to direct experience as possible, and then trust your informed intuition. Do not “believe” your own conclusions, but do believe your eyes and ears and nose and touch and the other senses, that you see what you see, hear what you hear, and so forth, and trust reality itself, that it will guide you. There is no better way. Do this for your life and you will die happy.

        (Real intuition is what you do, not what you think.)

    8. Bill in Oz

      Then just piss off Mathew. Leave us ‘loons’ and ‘cranks’ to do our thing.
      We are all adults and willing participate in Dr Kendricks Blog with great enthusiasm and joy at the information, knowledge & wisdom shared.

      Now tottle off back to kindergarten !

      Reply
    9. Joyce

      You must really be shaking the tree Malcolm! Why else would the “Nuts” be falling out? Strange isn’t it, whenever someone has a difference of opinion with the Medical/Pharmaceutical ‘brotherhood”, and their disciples, they fall on you like a pack of hyenas! Proves you must have them on the run. Also wondering why a sensible chap like Matthew wastes his valuable time reading/commenting in this “NUT HOUSE” (his words, not mine). Personally I spend quite a bit of time(too much my husband tells me) surfing the wonders of the internet. A lot of trash out there, but if you’re choosie , a myriad of wonderful information. Having had personal experience of the horrors associated with CVD medication, I am exceptionally grateful to find some sanity on this site, compared with the money driven despicable behaviour of the drug companies and the lazy, incompetent and sometimes shameful lack of guts among the medics. By the way Matthew, I also believe in God. Does this mean I will warrant a double dose of abuse in your next vile diatribe? “Shaking all over”, as Elvis would say. lol

      Reply
      1. David Bailey

        Joyce,

        Matthew’s outburst had provoked such a wonderful outpouring of comments – yours included – that it was maybe beneficial that he wrote what he did!

        That is what we have come to – on the one hand, Malcolm’s cool analysis of where various studies and theories have gone wrong, and on the other hand……Matthew! He epitomises the moronic response from conventional science – just ignore all the technical details, and rely on perverted emotional arguments!

        By now, whenever I hear the expression pseudoscience I expect some science that has not been perverted, and faces the facts square on!

    10. abdlomax

      To answer Dr. Kendrick, “matthew” is, high confidence, Darryl L. Smith, the same as Skeptic from Britain, which should be no surprise, and he has written articles attacking the people he mentions. I cover all this and related issues at The ultimate pseudoscience, on my blog. There is also a page about the current RationalWiki incarnation of Smith, John66. Darryl is a troll, obviously. Only a troll would write as he wrote here. He starts with a blatant lie. He is not “sorry,” that is SOP for him, and then his rationalization for claiming “guilt by association” would impeach every blogger who allows free speech, as Dr. Kendrick has proven he does. ‘Nuff said.

      (It is amusing to note that he voluntarily associated himself with this blog, by commenting, like all the other “loons and cranks.” He chose to do that, but Dr. Kendrick does not choose who comments here.)

      Reply
      1. PeteM

        Skeptic from Britain had a name change on Wikipedia just before he quit – he became MatthewManchester1994. Coincidence that another Matthew with the same vocabulary turns up here to rant against loons and quacks? I doubt it…

      2. abdlomax

        There is much stronger evidence than that. I have extensive coverage of Darryl L. Smith and his brother on the blog, and the page on Skeptic of Britain and subpages cover much of the evidence, but not all of it is published yet.

        (my blog:) anglo-pyramidologist/darryl-l-smith/skeptic-from-britain

        His brother, Oliver, is facing a defamation action in the U.K. and it is possible that Darryl will become involved in that. I have filed an action in the United States in a related matter, and Darryl may end up named in that as well.

        This is Darryl also, attacking Dr. Kendrick (and, when I exposed it, me, as expected.)
        2/24/2019,
        3/1/2019, and 3/1/2019

        Smith lies fluently. He created both the articles he cites on RationalWiki, I’ve been researching his activity for over a year, looking back more than six years. His patterns are quite recognizable, and I have additional evidence.

        (I do not call a person a “liar” without strong evidence. People may be wrong without lying)

        It was impersonations that first called my attention to him, a bit over a year ago. He uses many highly reprehensible tactics, getting web sites taken down, the mother of a blogger who had criticized him lost her job, and anyone who interferes with his agenda can look forward to defamation-by-Google. One of my daughters, somewhat of an internet personality, a book author, received an email effectively accusing me of being a pedophile or, at least, defending pedophiles. On the SBM blog, as he has elsewhere, he may induce people to repeat what he feeds them, and then he goes back to RationalWiki and cites the comments as proof. He has done this with mainstream media.

        (Sometimes reporters fail to carefully check information they get, and he is an expert at creating misleading evidence, by cherry-picking and quoting out of context.)

        He threatened me (for exposing the impersonations) and then researched my internet history, which goes back into the 1980s, he did an amazing amount of damage, not so much to me, but to the work of many people.

        He works tirelessly to defame his targets (who are real-name authors) and hides behind hundreds of accounts. Maybe thousands, when his impersonation socks are included. I worked on this case for months before I announced identity. It has been confirmed many times (though some accounts with a small number of edits might be mistakenly identified. Nobody has come forth with plausible evidence that they were not a Smith brother (there were actually two of these trolls, which confused Wikipedia functionaries on more than one occasion. But they are both banned there and in many, many other places, but then they keep creating accounts.

        I very much doubt that he is working for big pharma, and accusations of that can harm the cause of bringing out the truth about cholesterol and statins. Nor is he believed to be a vegetarian, but he created that rumor to attack a critic. He has claimed support from a “major skeptical organization.” The only evidence I have on this, however. comes from an old sock account of his, and from his brother. It is plausible. He strongly attacks anyone who exposes him or who defends his enemies against the lies he spreads about them.

        This is his most recent active regular sock puppet.
        https://rationalwiki.org/wiki/Special:Contributions/John66.

        If anyone wants to know more, there is a link to my blog above, and one may request an email in any comment. I am not hiding. He is.

        Meanwhile, I went to the SBM blog because of the article linked from here. Dr. Kendrick commented on that article, and was promptly attacked by Smith. So I countered that, knowing that he would respond, with that account or another. I really do want to engage with the author of that article on Cholesterol, and I went there for that, not for attacking Smith or defending Kendrick. The author, Labos, is attempting to cover the controversy and answer objections, and that community does include some smart people. I will create a study page, because I would like to collect the best evidence and arguments on all sides. My long-term interest is in science. Real science.

        Like Dr. Kendrick, I also aspire to skepticism, and hew to reality, without believing that I know what is real and what is not.

        Smith makes up allegations by the dozens, and as is commonly true for trolls, answering them can be a waste of time, but, again, if anyone has any questions for me, ask on the blog (instead of creating more distraction here.)

        You can see a list of Dr. Kendrick’s Disqus comments here. One piece of good news out of this: I was introduced to Dr. Kendrick because he was attacked. This is leading to much personal benefit, at least, and I also bought his books (as Kindle editions).

    11. andy

      Hi Matthew
      You seem to have so much self confidence. I would like to know more about your background, age, education, personal experience with health providers, what you believe causes CVD, source of your beliefs, etc..

      Reply
  48. Triumphs

    Dr. Kendrick… Peter of Hyperlipid often points out that everyone has been off on a wild goose chase trying to pin the cause of CVD on lipoproteins. He believes that it’s only the purple spotted small dense LDL that are the culprits! Any thoughts?

    Reply
    1. LA_Bob

      OMG

      I certainly hope this sub-thread is a joke! Peter (Petro Dobromylskyj) is as anti-lipid-hypothesis as anyone.

      Here are a few helpful posts for the curious.

      https://high-fat-nutrition.blogspot.com/2010/03/lipoproteina-and-tissue.html
      https://high-fat-nutrition.blogspot.com/2016/07/arteriosclerosis-6-and-subbotin.html

      “It was obvious, at least as recently as 1964, that arteriosclerosis was a repair process. Possibly a repair process gone wrong, but a repair process never the less.” https://high-fat-nutrition.blogspot.com/search?q=single-vessel

      My favorite: https://high-fat-nutrition.blogspot.com/search/label/Cholesterol%3A%20LDL%20in%20Oslo

      A post where he links to this Kendrick fellow (ever hear of him?) https://high-fat-nutrition.blogspot.com/2015/08/cholesterol-reflectivity-at-400nm.html

      Another post quoting that Kendrick guy: https://high-fat-nutrition.blogspot.com/search/label/Cholesterol%3A%20ASTEROID%20destroys%20lipid%20hypothesis

      And this gem from the comments to http://high-fat-nutrition.blogspot.com/2016/08/glucose-from-fatty-acids-rq-of-0454.html

      Rattus said…

      Peter Attia has recently come out implicating LDL-P as the new villain in heart disease [LDL-C is out]. Thoughts?
      22 Aug 2016, 14:25:00

      Peter said…

      Rattus, people have to blame lipids. Somehow, somewhere, it has to be cholesterol. Personally I KNOW it’s Purple Spotted cholesterol which causes CVD. PS-C is sugar coated.

      Peter
      6 Sep 2016, 04:21:00

      The reference to purple-spotted LDL (NOT purple-spotted small dense LDL) is a jab at the lipid hypothesis. Peter is very snarky!

      Reply
      1. chris c

        I thought it was the sky blue pink cholesterol with polka dots, but perhaps that wasn’t Peter, or maybe that was an earlier hypothesis

        On a similar subject

        Co-existence of insulin resistance and high
        concentrations of circulating oxidized LDL lipids

        http://sci-hub.tw/10.3109/07853890.2015.1043939

        “These findings further illuminate the increased atherosclerosis risk mechanisms characteristic of diabetes and the contributing effect thereon of atherogenic (oxidative) modifications in LDL lipids. “

    2. LA_Bob

      It occurs to me that possibly Dr Kendrick confused Peter of Hyperlipid with Peter Attia, who does seem to follow the lipid hypothesis. I hope that’s the case!

      Reply
      1. abdlomax

        Any written communication is just a collection of symbols with, always I’d say, though there are degrees, more than one possible interpretation. So especially if someone is saying something that seems obviously wrong, look again! Try to find other interpretations that make more sense. Set aside the first reaction for a time, keeping it as a possible interpretation unless you notice clear evidence to the contrary. This is actually how to communicate with skeptics and even pseudoskeptics, and how real skeptics will communicate with people who appear to be uncritical “believers.”

        What do you get when you can see something from more than one point of view at a time?

      2. Gary Ogden

        LA_Bob: I suspect you’re right. I took the Peter at Hyperlipid quote as a joke, the key being the word “purple.” I wish Dr. Attia well, but no longer read him. Too jargonish.

      3. BobM

        Yes, Peter Attia is stuck in the lipid hypothesis. He had Dave Feldman on his show, and Dave could barely get a word in. Then Peter Attia spent multiple shows with Tom Dayspring, a true lipidologist:

        Podcast with Dave Feldman: https://peterattiamd.com/davefeldman/

        To repent at the alter of lipidology, he then spent five (yes, five) podcasts with Tom Dayspring (here’s the first): https://peterattiamd.com/tomdayspring1/

        Petro Dobromylskyj, by contrast, I find to have a unique understanding of biology:

        http://high-fat-nutrition.blogspot.com/

        His series on protons alone is with worth reading (if you can, and I admit a lot of it goes over my head) and some type of award. The protons theory is that PUFAs (polyunsaturated fatty acids) cause fat cells to be insulin sensitive, whereas saturated fat causes fat cells to be insulin resistant. What does this mean? This means that PUFAs (which are in basically any prepared food) cause one to overeat and get fatter. Dr. Eades likes this theory so much he’s called it an alternative theory of obesity (search and you can find his talk).

      4. LA_Bob

        Dr K,

        I’m often guilty of “skimming” and thus sometimes misreading. I just hope Triumphs gets as much joy from exploring Hyperlipid as we all get from reading you.

  49. Dr. John H

    Malcolm,
    Do cholesterol measurements provide any useful insight at all? You and Uffe have shown that there is no known upper limit for LDL and HDL (with your FH study), but what about small dense LDL and triglycerides? I recall Uffe writing about how great triglycerides are, but I tend to think if it is very high, then it means a person is eating too many carbs. But do triglycerides themselves damage the arteries, or are they a marker for something that cause damage, or not important? same with small dense LDL, does measuring it give us any useful information?

    Reply
    1. Dr. Malcolm Kendrick Post author

      A high VLDL (triglyceride) level, with a low HDL, is almost always a sign of the metabolic syndrome/insulin resistance (I say, using a term I do not like). If you can reverse the metabolic syndrome (usually by cutting down/out the carbs) then the VLDL will fall and the HDL will rise. At the same time the blood sugar will fall, the insulin level will fall, and many other potentially damaging factors can, and will, normalise. There is a however, a little secret, that I can share with you. VLDL is pro-coagulant, and HDL is anti-coagulant. So, lowering VLDL and raising HDL has benefits – independent of anything else.

      These studies conclusively demonstrate that freshly prepared HDL fractions possess anticoagulant activity. Fractions from Superose 6 columns that contain HDL reproducibly enhance APC:Protein S anticoagulant activity, consistent with the hypothesis that HDL has antithrombotic activity and with the observation that low HDL levels are found in male venous thrombosis patients. Understanding the basis for this activity could lead to novel therapeutic approaches to regulate venous thrombosis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4344393/

      There is a considerable body of evidence supporting an association between hypertriglyceridaemia, a hypercoagulable state and atherothrombosis. https://www.ncbi.nlm.nih.gov/pubmed/16877877

      Reply
      1. Dr. Malcolm Kendrick Post author

        Yes, and I think the general idea that no-one, other than a cardiologist, is allowed to have any view of cardiology, is completely stupid. Science often progresses when those who have expertise in unrelated fields cast different eyes on a problem, giving new insights. If we become too compartmentalised in our thinking we will find it very difficult to move forward.

      2. Jean Humphreys

        From personal experience, I have had the hint of rolled eyes effect when I dare to suggest something that a cardiologist doesn’t believe in. After all he is trained and educated, and I have merely spent twenty two years, twenty four seven, living with the disease, and knowing what my own body is telling me. One of my GPs actually told me that I was the most self aware patient he had ever encountered. I takes a great deal of care and thought to talk a cardiologist into understanding what I need. And he has usually only got a few brief measurements to go by, which add uo to a badly blurred snapshot of the state of me.
        Thank goodness my present GP is wide awake, and believes me. His usual opener is “What do you need me to do today?”

      3. Gary Ogden

        Dr. Kendrick: Thank you for that explanation. I’ve just finished Jason Fung’s “The Diabetes Code,” and I’m attempting to fit this new knowledge into your hypothesis. His explanation is essentially the same as you’ve given here, except without discussing the pro- and anti-coagulant nature of the particles. Would it be fair to say that both dysfunctional HPA-axis and hyperinsulinemia lead to the cascade of damage which results in atheroma formation and subsequent narrowing of the lumen? That both, and especially together, are powerful drivers of CVD?

      4. Dr. John H

        Can you be more specific? Since you have said that small dense LDL doesn’t infiltrate the endothelium, what harm does it cause?

      5. Dr. John H

        Malcolm,

        I thought that you have said all along that small dense LDL is not a risk factor in CVD, because those particles cannot infiltrate the endothelium? Am I missing something, or are there other problems associated with small dense LDL? Thanks!

      6. Dr. Malcolm Kendrick Post author

        Maybe I am not managing to make myself clear. I think small dense LDL is a sign of underlying metabolic problems (usually the metabolic syndrome). They are not, of themselves, causal. At least I am pretty sure that is the case.

      7. BobM

        Dr. John H, I think what Dr. Kendrick means in that your diet might need to be modified if you still are having small dense LDL (as these are markers of “insulin resistance” rather than true markers of heart disease risk). I still have “high” small dense LDL, even after 5+ years of low carb/keto and a lot of fasting. I did a lot of damage to myself in 30+ years of high carb. I have not had a test in a while, though, as (1) I have to pay for them myself, (2) they are expensive, and (3) I’m already doing all I can do via diet, exercise, sleep, and stress reduction. So, knowing I may or may not have “high” dense LDL isn’t going to add any information or cause me to do much if anything different.

  50. Leon

    Göran is mechanical engineer , my son is studying chemical engineering . They will immediately realise something needs to be modified to prevent catastrophic consequences . Engineering , like aviation is based on exact science . What are the official figures for deaths in Europe alone as stated previously for prescription drugs or misdiagnosis by doctors ? As I said in my previous blog , only a simpleton will deny it . We have the written evidence on this blog.

    Reply
  51. Charles Gale

    Matthew

    Through gritted teeth I’ll add my 2 pennies worth…

    I feel your analysis of the personalities and demographics and so on of the commenters/visitors to this website is incomplete.

    You missed out the many here who have been on the cardio-slab in intensive care fighting for their lives.

    Those whose medical records contain comments (arising from their CVD incident) such as:

    (1) “bystander CPR and 25 minutes of CPR by paramedics afterwards” and
    (2) “if patient recovers from this event…”.

    From my records.

    Taking your approach for commenting (i.e. based on no real evidence, subjective, misinterpretation…hmmm, this approach sounds mighty familiar! It’s easy to do too!) I’ll bet:

    (1) you haven’t been through any CVD event and
    (2) your medical records won’t contain comments such as I have quoted.

    But your time will come – no one gets out alive.

    And if or when you do stagger out of hospital, you’ll know where to turn to.

    Here.

    If your statin fogged brain remembers.

    Reply
    1. Jerome Savage

      Sorry Mathew – Gotham city is on & the 16 yr old is riveted. Your dovetailing with this spooky macabre sub undergraduate stuff. Scientific supporting stuff instead please ?

      Reply
  52. Dr Richi

    I too am a crackpot, pseudo-scientist, nutter – and proud.
    If only I had the sanity to inject more aluminium and mercury – those well known nutrients – and a thousand unknown viruses…
    then perhaps I would be smart enough to understand germ theory and intelligent enough to deny evidence as well as a pharmashill.
    Should we oh sciencebasedmedicine experts, inject more or less aluminium?

    If you survive, what a great advert for your employer Merck
    If anyone here still cares about facts, evidence and sharing information – perhaps consider the suppressed film featuring a certain supervisor of mine:


    http://medicalveritas.org/tribute-to-dr-andrew-moulden/

    Reply
    1. Jerome Savage

      “Special place in hell” for some of these conceited pharma profiteers. More doctors need to develop a conscience – real moral backbone. When i see pharma sponsored pens / notepads in a GPs surgery I immediately think, what else is volunteered & has the surgery been unduly influenced in pursuit of mega pharma executive remuneration, market share & shareholders returns. Am so suspicious, that’s my problem !

      Reply
      1. Gary Ogden

        Jerome Savage: The scary thing is that the pharmaceutical industry, at least in the U.S., is the most profitable and powerful, in terms of political clout, industry of all. This would not be a problem if their products were not both mandated and deadly. Vaccines are mandated, and none of them have ever been properly tested for safety; despite the legal requirement conferred upon the FDA 33 years ago, it has done nothing. We well know that properly prescribed drugs kill in excess of 100,000 people each year, and while not legally mandated, many are, in effect, mandated by practice guidelines, which are enforced by medical boards, and promoted by “professional” organizations, such as the AHA, ADA, AAP, and so forth. It is a corrupt, broken system we have. Representative government has ceased to exist. When Medicine works well, it is a wonderful thing, but much of medical education and practice today is so heavily influenced by industry to the detriment of patients, and now the social media companies are actively censoring points of view and factual information which runs counter to the narrative that all is well in this, the best of all possible worlds. On Wednesday both houses of Congress will be holding hearings in response to a few hundred cases of measles, scattered among a population of 330 million. This is a prelude to the removal of all but the almost-impossible-to-get medical exemptions to the full vaccine schedule. Full throttle medical fascism.

      2. goransjoberg2015

        Yes Jerome!

        The medicine business is today (but not twenty years ago!) just one big scam in my eyes – Big Pharma protecting their profits in the most corrupt and criminal elaborated ways, from bribing local GP’s but most of all the “key-note” researchers in order to have their agendas finally approved. As a long time researcher in the natural sciences it hurts me in my heart to se how they drag true science, as I understand it, in the dirt.

        And it stinks! This goes for the research into CVD, Cancer, mental illness and diabetes but not least for non existing science on vaccinations; actually the most ingenious of all medical activities in the name of profits.

        Reading Suzanne Humphries revealing book on this incredibly vaccin quackery, “Dissolving Illusions, was the great eyeopener for me. Not much was then left of this last “medical barricade”.

      3. Jerome Savage

        Gary Ogden I was drawn to this series of studies from my experiences with some so called medical experts & medical authorities. One experience was effectively a joke – at my expense, pathetic stuff indeed. I decided that’s it, the authorities could not b trusted. And on investigation it became obvious that something was wrong. Many people’s negative experiences were so similar to mine, the common thread was statins -stamped & endorsed by the whole medical world.But why would anyone really expect any different? Profit maximising corporations dictate the health perspective. The dollar (or pound) is king, so no different from the banks or arms manufacturers except they need to convince the consumer that they are working for their better health. If it’s more attractive to be seen to be doing the right thing rather than doing the right thing, which way will the corporation go? The profit maximiser has so many financial demands to meet that a moral code is a ridiculous concept, unless a code works to simply get more money in to the coffers. I admit to having no opinion on vaccinations, indeed the media gave me a sense that vaccination opponents were flat earth types. Indeed did my GP not advise me that 30% of all liver failures were as a result of misguided use of herbal remedies. I took my GP’s word, she was not part of the wider pharma conglomerate after all. The Suzanne Humphreys video is however very convincing. She like Dr Kendrick has a compelling argument and both have their homework done.
        However, one thing still puzzles me to an extent. Given the malpractice evident, why in general, are life expencies increasing across the globe ?

      4. Gary Ogden

        Jerome Savage: I have not looked at the World figures of late, but in the U.S. life expectancy has dropped three straight years (2016-2018). Why they haven’t blamed this on Trump or global warming is a mystery. What I have read lays the blame on opioids. In the Philippines it has been dropping, too. Now you’ve piqued my curiosity, and I’m going to look at the figures. Seems at some point we’ll reach a biological maximum, like with height, and this will no longer rise much.

      5. David Bailey

        Jerome,

        If you want to assess the scale of the statin scandal for your self, and you are approximately 60 or older, you can do as I did – a direct study.

        Take a walk on the hills, or go for some kind of organised exercise venue. Nowadays there are always a few of us oldsters, so it is easy to chat to others. Inevitably people talk about odd problems they have encountered that made exercise more difficult.

        Just mention statins and hear what comes out. I’d say that at least half report some problem that they or someone they know had encountered. For example, the other day, I was cycling and got talking with a magnificently fit 81-year old, who was cycling at about my pace despite being 12 years older. To my amazement, he said he had had a heart attack, so I mentioned statins. He laughed and said that yes, he had been prescribed them, but rarely took them because they gave him muscle cramps!

        Any doctor of about our age could try the same experiment, quite anonymously. I think many would find the result extremely thought provoking.

      6. Sasha

        I think the healthspans are definitely being affected by polypharmacy, food and lifestyle changes, etc.

      7. chris c

        Not only that but the suffering goes on for years for too many people. I accept that medicine has done some spectacular things with acute illnesses but the chronic stuff seems to be increasing and I strongly suspect the polypharmacy doesn’t help much. It may improve one thing over here while damaging several other things over there. Most folks past middle age are on the typical bunch of old fart pills, as was I before I wised up.

      8. Jerome Savage

        David Bailey
        I do take to the hills. Unfortunately I broke my ankle coming down Slieve Foye just above the ancient seaside town of Carlingford on 13th January last. Recovering well, great treatment by the surgeon with a plate & pins. That’s the good side of medicine (tho the anti inflammatories disturbed my sleep) Now, did my ankle break easily? Is that because i am prescribed steroids, with bone weakens effect . Steroids I take due to auto immune syndrome. And guess what has been identified as a cause of A.I. , in a small % of cases ? Yes, good old statins ! But cases are few & far between we are told, might say i am one of the unlucky ones. Good news is I got airlifted by Rescue 116, another very worthwhile & professional outfit, 1st time in a helicopter!

      9. Jerome Savage

        Confirmed- by hard nosed actuaries.
        https://news.sky.com/story/a-lot-of-people-in-the-city-are-getting-very-excited-about-death-11665682
        Extract “does not appear to be a temporary phenomenon. The Institute and Faculty of Actuaries, which calculates life expectancy for the industry, says it first saw evidence of falling life expectancy in 2010-11.

        It reported last week that it now expects a man aged 65 can expect to live to 86 years and nine months – down from its previous estimate of 87 years and four months. A 65-year old woman is now expected to live until she is 89 years and two months, down from 89 years and seven months previously.
        These reductions in life expectancies are the biggest the institute has ever made”
        Well there you go !

      10. Frederica Huxley

        I wonder what the comparable figures are for the US, given the opioid crisis, poverty and appalling neo-natal death rate?

  53. David Bailey

    Malcolm,

    I have often wondered if HDL, LDL, VLDL, etc are discrete entities (perhaps each with an specific composition, like molecules), or do they represent different fractions after blood centrifugation, and so could be subdivided ad nauseam?

    Reply
    1. Dr. Malcolm Kendrick Post author

      They can be subdivided ad-nauseam. We also have IDLs half way between a VLDL and an LDL. There are small dense LDLs and light and bouyant etc. I read a paper outlining 36 different forms of HDL.

      Reply
    2. goransjoberg2015

      As far as I remember it was the physicist John Gofman

      https://en.wikipedia.org/wiki/John_Gofman

      who first, around 1950, with his ultra centrifuge showed how the lipoproteins in the blood could be divided into a number of different density fractions.

      He tried unsuccessfully to get the medical community interested but. He finally got tired of these ignorant people who could not handle this kind of equipment and turned his back to them. BTW the nobel laureate Linus Pauling had the same experience 30 yeas later when he tried to get medicine interested in true science.

      Medicine today is about religion – not science – an actually elaborated quackery in my eyes.

      Reply
  54. Aileen

    Dr Kendrick, I hope you will agree that this is relevant.

    Professor Chris Exley of Keele University has spent many years studying the role of aluminium in living beings. In recent years his research has led him to consider the safety of aluminium adjuvants in vaccines, as well as the role of aluminium in neurodegenerative conditions such as Alzheimer’s and multiple sclerosis.

    This isn’t the sort of work the more conventional grant-awarding bodies want to encourage. Funding has become increasingly difficult and is now on the verge of drying up completely; his group now has less than six months to find £100,000.

    A crowdfunding appeal was launched independently yesterday in the hope of raising at least some of the money to allow Professor Exley and his colleagues to continue their vital work. Encouragingly, it has already raised over £1,000.

    If anyone is interested, the link to the appeal can be found at https://www.gofundme.com/aluminium-and-silicon-research. There are also lots of videos on YouTube outlining Professor Exley’s work.

    Reply
      1. AhNotepad

        Worth helping IMO since the government appears to want to fund mainly pseudo science, and proper science has to sort itself out.

        Today the Biased Broadcasting Conspiracists (BBC) today had another article about the measles outbreaks and their being mainly caused by antivaxxers posting on facebook. Fortunately according to their guest, from a nursing college, the social media are trying to limit the spread of the posts.

      2. Jerome Savage

        AHN
        Had measles as an 11 year old. Over it in a few days. Had worse – no big deal.

      3. Dr Richi

        If anyone couldn’t decode the hints – I was a student of Prof Exley – hopefully I was more subtle in promoting his research.
        What I did not say (because perhaps Malcolm talked about it in “the real cause of heart disease part ninety seven thousand and forty two” which I havent found yet) is that I was working on an Aluminium (and metals) and heart disease link recently and wanted to post a short comment on the hypothesis.

        “It was suspected that” cheap tobacco starts off full of aluminium cadmium and lead, as a starter – perhaps (translation – almost assuredly) from the biggest supplier China. This is made into cigarettes that are full of strange organic chemicals, even some of those here: https://en.wikipedia.org/wiki/List_of_additives_in_cigarettes

        I would hypothesise that additives and metal contribute to the mechanisms in CHD – i.e. blocking receptors for LDLcholestrol to enter the cell plus paralysing the glycoprotein fibre on the endothelium – the initial phase of destroying the “exclusion zone”* of blood matrix – which keeps the artery frictionless, almost, like a maglev train.
        Incidentally sunlight helps move the blood through capillaries because more than one scientist seemed to prove that the heart alone can not push red blood cells down the tiniest tubes – and of course – the Lymph system has no pump.

        *People not familiar with this idea might want to watch a lecture by my friend Dr Jerry Pollack and buy the Fourth Phase of Water, which is almost as funny as Malcolm’s books and at least as relevant to modern biology.

        Am sure that the exclusion zone effect is more than related to the little fibres of the glycocalyx which are surely collapsed by reactive metals, e.g. aluminium :
        “However, the glycocalyx can be easily damaged and is extremely vulnerable to insultsfrom a variety of sources, including inflammation, trauma, haemorrhagic shock, hypovolemia and ischaemia-reperfusion. Damage to the glycocalyx commonly precedes further damage to the vascular endothelium.” From the abstract of *Schöttet al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine*

        Am sure people here know Stephanie Seneff – and we havent forgotten her work on the cholesterol sulphate, as well as glyphosate and aluminium. I think this paper has a large implication for the subject of this page:
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4202242/
        That’s my piece of silver for now, on that. No pun intended

    1. Gary Ogden

      Aileen: Professor Exley deserves our full support. Governments and academic institutions will not support basic science which in any way threatens the profit streams of industry. Were I rich I would have no end to good work I would support financially, among them his.

      Reply
      1. Aileen

        Gary, I agree absolutely. What particularly worries me about this is that if Prof Exley can’t find the funding he has said his lab will close down and all the equipment and expertise associated with it will be lost. So even if the opportunity for larger scale work or collaboration were to arise in the future, it would not then be possible to take advantage of it.

        I wonder how often this sort of situation occurs unnoticed when people stray into areas which happen to threaten the status quo.

        And our government is still trying to ignore the consequences and implications of Camelford. No wonder they would prefer Prof Exley to shut up shop. Oh, but presumably that makes me a conspiracy theorist.

    2. Dr Richi

      As well as Exley and Humphries, I’ve been for a long time a “fan” of Richard Deth, who like Chris Exley was just doing his research, minding his own business and accidentally proving a mechanism for how extremely toxic metals might cause damage if you are stupid enough to inject them into children.
      Does anyone know who he is? I remember reading many years ago about his mechanism* of how heavy metals cause specific neurological disorders, otherwise known as autism.

      He has a subtle mocking sense of humour, as demonstrated in the opening sentence.

      Molecular Aspects of Thimerosal-induced Autism

      Summary from Richard Deth’s paper:
      “The developmental disorder autism has both genetic and environmental origins, and its forty-fold increase during the past two decades reflects an increased role for environmental factors. It has been proposed that increased use of vaccines containing the ethylmercury derivative thimerasol is the major contributing factor. Published research from my laboratory has revealed that thimerosal is an exceptionally potent inhibitor of biochemical pathways that transfer single carbon atoms between molecules. These “methylation” pathways are critically involved in several important functions including the regulation of gene expression and the molecular mechanism of attention. Recent studies from my lab indicate that thimerosal exerts its toxic effect on methylation by interfering with formation of the active form of vitamin B12, also known as cobalamin. Dietary B12 must be converted to methylB12 (methylcobalamin) in order to assist in the transfer of single-carbon methyl groups from the folic acid pathway by the enzyme known as methionine synthase. By reducing methylB12 formation, thimerosal inhibits this enzyme and thereby interferes with methylation events. Autistic children have abnormal plasma levels of methylation-related metabolites and exhibit higher frequencies of genetic mutations that affect this pathway. These genetic risk factors make them less able to detoxify thimerosal and also increase their sensitivity to its mechanism of toxicity. In many cases, autism can be effectively treated by the administration of methylB12 along with other agents that augment methylation capacity. Taken together, these facts indicate that increased exposure to thimerosal has combined with genetic risk factors in a sensitive subpopulation to cause the recent rise in autism.”

      I just found this paper, while trying to sort an unorganised mess of academic papers apparently backed-up to a home computer from a phone (for those into synchronicity – the date was the 4th March 2018)
      These links might help anyone get to know who this great scientist is:

      https://www.ageofautism.com/2011/01/news-northeastern-presents-dr-richard-deth-on-chilling-research-into-vaccine-autism-link.html
      https://pharmapps.nova.edu/profile.cfm?BioID=rdeth
      https://www.youtube.com/watch?v=z1L84EQ9S5k [3,369 views – does anyone believe this could be true when various insiders have pointed out certain subjects are censored, or hidden from youtube, google and those antisocial media pages, sometimes by fake view counts or not appearing in search results]

      For those of us just following science in a rather distant remote sort of way – without reference to the influence (is there a polite word for mind control?) of the mainstream media, none of Deth, Humphries, Exley’s or the “suicided” Andrew Moulden’s etc work comes as a surprise.
      What is important about Prof Deth is that he isnt talking about vague risk, statistics and correlation but simply pure mechanism – should be undeniable to anyone who would care to understand it.
      Perhaps fellows here also have backgrounds in grounded organic chemistry and biochemistry too? This is what we need (and perhaps have had for decades) in the arena of so called “heart disease” which is surely the prototype field of pseudomedicine – an area forever contaminated with talk about relative risk – and other dead giveaway trigger words for “hiding the truth in statistics and probabilistic doublespeak” meaning “the population are too dumb to understand or ever find out that this disease has a simple known mechanism”.

      Am sorry for Malcolm, that he has to pander to these criminals by using their language and terms.

      Reply
  55. AnnaM

    I think that the increase in life expectancy has already peaked and will drop very sharply fairly soon. There are too many assaults on health, and the children aren’t very healthy any more. You can’t have an obesity and diabetes epidemic and increasing lifespans. The old people of today and yesterday grew up and reached adulthood in a very different world. A healthy youth and modern medicine to patch up a few problems in their older years.

    Reply
  56. Joyce

    Every person I talk to regarding Statins repeats the same mantra…aches, pains, etc.etc.(won’t go into the boring repetitive details.) Some have refused to continue their statination, others are afraid to stop because they think they’ll die or the doctor will get cross with them! With me it was being hospitalised after 5 weeks on 80Mg of Atorvastin with liver function tests showing 1300 instead of approx 56(whatever that all meant I didn’t know), but the dark brown urine/yellow eyes was a clue I understood!) The short story is I was told by the Cardiac Nurse to stop the Statins, and admitted to hospital for tests. At the end of that day was “offered” an MRI scan(5 weeks after having a metal stent inserted! (Swiftly declined,) and a gallbladder removal! I declined both on the day and went home being in no pain whatsoever. I was of course told to resume the 80mgs of Atorvastin, which I did! Next morning, on talking to the Cardiac Nurse, I was told “no, no, stop the Statins! Strange advice when we are talking about THE “wonder drug” is it not? I stopped again, and low and behold over the next few weeks (blood tests every couple of days) I was “normal once again”. Then I was told the consultant wanted me to resume the Atorvastin with 10mg, working slowly up to the magic 80mgs over time. My “No way”, was not accepted(truly). I literally had to agree to do this to be signed off from the hospital into the care of my G.P. I then told him I wasn’t taking a statin. Ok he said, it’s up to you. That was four years ago, and incidently, I still have my gallbladder intact! Sorry it’s taken so long to get to the point I wanted to make, which is this….The severe reaction I had to Atorvastin was clearly denied, put down to something else I had never suffered from before or since, and dismissed. Never reported, never part of any statistics. Since then, I have paid meticulous notice when discussing with anyone I know taking statins, as to the reaction they get from medics regarding the side effects most of them are suffering, and none of them have ever been told to stop, or that it’s possibly causing their problems. Therefore it must follow that no one has their side effects reported to any register(yellow card or other). They simply don’t happen it seems. No wonder this Miracle, Wonder Drug is not questioned by the trusting general public. Here endothelial the lesson…if you’re still awake lol.

    Reply
    1. abdlomax

      Thanks for telling your story, clearly and well. A problem with statin studies could be that a patient taking statins is suffering from a side effect, but does not identity it as due to the statin. If the study is well-designed, it would still measure side effects, regardless of how severe the patient thinks they are. Aches and pains can normally come upon us, and they don’t have a label on them that clearly states what caused them. I like “all-cause mortality” as a measure of drug effectiveness and safety, because it’s objective. There is still the “healthy complier” problem, that can easily introduce bias, and the authors of the subject study were aware of that, but their compensating measure was not powerful. because compliance with one drug does not necessarily correlate well with compliance with another.

      Non-compliance may well be a result of unconscious aversion, the body does that. We don’t necessarily know why we don’t want to do something. There is also, of course, the nocebo effect. However, instead of taking the opportunity to address their own poor communication, too many (i.e., the mainstream?) blame the patients and critics, and pretend that the issues are already “closed,” when it is obvious that continued “cholesterol” or “statin denialism” is not a resolved issue, not with a true scientific consensus. “Denialists” and “quacks” and “cranks” and “die-hards” are not, ever, scientific arguments.

      One the other hand, neither is “Big Pharma shill.” There is a natural reluctance to trust studies funded by pharmaceutical companies, and eternal vigilance is the price of liberty, but until we have solid and reliable public funding of research, and a public demanding it, we need to be careful about pharma funded studies, but not toss them in the trash without thorough analysis, better than “I see a problem with this study, therefore bogus). Clearly studying them and describing them accurately will ultimately win the day, and the year, and the century.

      It takes time to overcome an information cascade.

      Reply
    1. andy

      Hi Soul, thanks for posting sad tale of Dr. Aseem Malhotra’s mother. This is relevant to me since I have now achieved the life expectancy milestone (79). The question is why do people get sick and die as they get older and what can be done to increase their heathspan?

      One explanation could be that a young person’s immune system can cope with eating inflammatory foods. These foods would be stuff that their ancestors were not evolved to consume. The big culprits could be wheat, seed oil, and high carbs. With advanced age the immune system becomes compromised and sickness follows.

      Reply
  57. Eyrie

    As one who worked in the meteorology/atmospheric/environmental science field decades ago with some residual professional interest I have been closely following the I see uncomfortable parallels between the man made global warming/climate change conjecture and the debate on lipids and statins etc. The same words are even used to describe us skeptics.
    A couple of points: western governments are facing a severe state funded pension crisis and have no interest in old people living longer once retired. You’ll find you need to push to get treatment other than “take these pills and go away”. Not comfortable.
    Follow the money – always.
    Lastly for a bit of light relief, did you know that vegan/vegetarian are old Australian aboriginal words meaning ” bad hunter” 🙂

    Reply
    1. AhNotepad

      Eyrie, interesting comment, I notice the same thing. The proponents of the fake arguments drop quickly into personal attack or insults when you question their arguments.

      Reply
    2. Sasha

      Pushing people into poly pharmacy will more likely make them into chronic consumers of health services, rather than kill them. The so called pension crisis is a chimera since governments can print money indefinitely.

      Reply
  58. Ed Carter

    In the US, Medicare helps pay for cardiac care with the Ornish Center and Pritikin resorts, which emphasize a low fat, plant based diet plus exercise and stress reduction (in my understanding). Is there not clear, verifiable evidence to support such a government subsidy?
    What would you suggest to avoid a second heart attack, if not these dietary and lifestyle strategies?

    Reply
  59. SteveH

    Not one but TWO articles in the Mail today about the “statin deniers” (sic) peddling their fake news. One is a particularly egregious hatchet job on several named individuals – including our own Dr. K!

    Reply
    1. abdlomax

      The two articles are actually one, the second one appears as an extension of the main article, but can be accessed separately (which is then misleading, because the second refers to the first, but doesn’t link to it. Sloppy editing. The first is The deadly propaganda of the statin deniers: The drugs DO protect you from heart attacks but as this devastating investigation reveals thousands are refusing them, and it is the one with detail on Dr. Kendrick, and the second, I have reviewed on the blog, his language: Special Place in Hell. It is an old Muslim joke — or reality — that when one person says that another will burn in hell, (and the Arabic actually uses the present perfect, more literally, “is burning in the Fire”), one of them is. (or both!).

      This idiot — or shill, if anyone writing about this topic is being paid, it could be him, and drug advertising is common in the Mail — doesn’t believe in Hell and his “Hell denialism” will not protect him from the consequences of his actions. Perhaps it is like the placebo effect, you don’t have to believe in it for it to work.

      I have yet to write a review of the main article. However, just from the title, this article is definitely statin propaganda, overpromising benefit. Statins may have ( consider it controversial still) some protective effect, but it is weak at best. I would not consider something “protective” if it reduces risk by a third, say. I would not be confident that taking statins will prevent me from having a heart attack, because most heart attacks will happen anyway, and the evidence on all-cause death, that statins do not significantly reduce it, indicates that something is off, and we need to know, and we will not learn it through blaming “statin denialists” for “misleading the public,” which is, all on its own, rejecting statins, and the whole sequence of “scientific advice” on fat, cholesterol, heart disease, and statins, has led to a massive lack of confidence on the part of many.

      It is like anti-vaxx, in fact. Instead of clearly addressing the problems in vaccine safety testing, and the difficult issues where public policy is concerned, the pro-vaxx propaganda becomes hysterical, increasing polarization and stiffening opposition. My opinion is that vaccines have saved millions of lives, but there is a cost, and there are major civil liberties issues, not eliminated by hysteria. There are abusive parents, and I have dealt extensively with child protective services in California and Massachusetts, and generally trust them, but, like anyone, they can make mistakes. This is life on Planet Earth. Forcing people backfires and causes harm. Educating them with understanding and patience can save lives.

      The most amazing part of “Special Place in Hell” is his patient example, which shows little except the stupidity of ignoring a problem, even after having a heart attack and a stent put in, changing nothing about lifestyle (as far as we know), being put on statins, experiencing a common statin side-effect, and he writes his physician to tell him he is stopping and gets no response, no “Come in and see me, let’s talk about it.” Silence.

      This is not an indictment of statin skeptics, it is an indictment of that doctor and the medical system! Do these idiots think that buzz about statins and big pharma conspiracy is going to go away by attacking skeptical researchers? No, the opposite. Sure, some will believe what they read. In the Mail, which has a horrible reputation for accuracy. There are people here who believe the lurid stories in the supermarket-rack magazines. There is little way to protect people from their own entrenched ignorance and denial.

      My prognosis for that 49-year-old with his second heart attack is poor, unless someone actually takes an interest and sets him on a true recovery course. Taking some pills is far less important than many other treatment modalities.

      This is the real tragedy: he never did really trust his physician. Because he had a negative outcome, instead of taking responsibility for his lack of attention to his own very serious problem, he simply dropped the connection and the statins, and stuck his head in the sand. Maybe it will all go away, but I have heart disease in my family, and if I think about it, it makes me afraid, so I will simply stop thinking about it, I won’t actually research it, I will listen to the radio and interpret the messages the way I want, and years later, it all fell back on him, and his doctor is encouraging him to blame the radio and the “denialists.”?

      Many of us do not have time to do our own research, but somehow find time to watch that game on TV or other non-essentials. Is our health important? The question gets asked over and over, “whom should we trust,” and people are looking for a generic answer, which, increasingly people are rejecting, “Trust your physician, trust the government, trust the charities, even though they are drug-company supported, trust the drug companies,” and, as well, “trust the authors who write well and seem to be smart.” It is all an attempt to avoid the work of actually meeting people, interacting with them, and this does start with your doctor. (I call it work, but it is actually fun, but many of us are averse, isolated, don’t know how to create positive conversations, and are afraid of it.)

      If we have chosen our doctor, we will sanely do this because the doctor impresses us, not just with his knowledge, I would hope, but with his or her humanity and humility. Does the person listen, or do they rush you through the exam so they can get to the next patient? That can happen with anyone who is busy, but is that routine, is a caring connection established, and, if not, do we keep looking for a physician who will actually listen to us and give us advice we can verify and follow or ask questions about?

      I have done that work and have physicians who support my researching my own condition, because I know my actual state and what is happening with my body, at least in certain ways, better than any physician, but I can also err, like anyone else. Together, we can optimize decision-making, but is the full involvement of patient participation in health decisions being supported?

      If “statin denialism” is so dangerous, where are the clear reviews that are unbiased, free of possibly improper influence, verifiable, and not full of logical errors, easily seen with a little study?

      When I look at what is presented of those, they are nearly all partisan, setting up straw-man arguments to reject, etc. The conclusions do not fairly represent what one will find in real science: admissions of ignorance, recognition of the need for more research if conclusions must be validated, etc.

      For the general public, as we really are, not as we “should” be, access to this must be easy, and consensus process must not be by a group selected for agreement, it becomes circular. Dissent must be fully heard. It’s known how to do all this, but it is rare that it is actually done, because people — including some scientists — want to convince others they are right, which is the opposite of science. It is politics and polemic and it divides people.

      Reply
      1. Chris Morriss

        Not just one, but two articles of doubtful veracity and shoddy journalism on two days. I don’t just smell a rat, my nose is overloaded with a veritable plague of them.

      2. AhNotepad

        abdlomax, to respond to your mention of vaccines https://docs.google.com/document/d/1N5ePF6XPR5LmLGTjiBMpD5JfFJAm6JYJ68OyV5GJySw/mobilebasic#! is a 213 page document with a lot of the vaccine history. I have read some of it but not all. I question vaccines having saved millions of lives. 1) you only alter the end date, 2) I think it has been demonstrated a particular vaccine may have prevented children dying from the associated disease, but they die from something else instead, and the number of deaths is greater in the vaccinated population than the non-vaccinated.

        An example of a problem was the Urabi mumps vaccine developed in Japan. This was found to cause aseptic mengitis. It was then added to other vaccines to make an MMR vaccine. This was not used in the US, but it was used in Canada.
        Once the problem was highlighted the vaccine was withdrawn in Feb 1988 in Quebec.
        It was then marketed as Trivirex.
        In June 1988 it was relabeled as Pluserix.
        In July 1988 it was withdrawn in Ontario.
        In July 1988 it was licensed for use in the UK.

        Post marketing surveillance should have been done after it was suggested to Smith Kline Beecham / Smith Kline French to establish the safety, but the research was never done.

        This is an example of ignorance, or evil intent. You choose

      1. mmec7

        LA Bob – Thanks for that. Goodness knows how that happened, as was a time ago I was looking at snake venom – my nephew had a small lab. Can’t back-track either to correct the link. So, again, my thanks.
        Statins in Variant Angina seems just another thrust by pharma to push these drugs. There is quite a group of us with this problem, last thing we want is a goodly number of of the group in a stew over statins – and all the repercussions. Sickening. Heigh-Ho.

      2. mmec7

        Thank you LA_Bob – It was good of you to check this out. Looks like the answer, no doubt as I was hitting the keys – though I copy and paste, but…must be more careful.

  60. Joyce

    Disgraceful article in the Mail, by a newspaper hack with a degree in fashion! Obviously well qualified to deliver the multiple character assassinations! Daily Mail and your fashion graduate, hang your heads in shame. At least take the time to read the papers produced by these people before dismissing them as quacks. Maybe reading wasn’t on the curriculum on that course?

    Reply

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