Author Topic: From CNN, needs skeptical look: One cardiologist's mission to reduce statin use  (Read 817 times)

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Offline mmortal03

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The following article from CNN seems to contradict a few things Steve has said about physician's education and nutrition, among other topics, including pharma, while sprinkling in other points that are accurate. It would be interesting to hear some commentary from SGU and other science based medicine proponents on the various claims being made.

Here's an important excerpt:

Quote
It took more than 80,000 hours of training for me to become a cardiologist. How much of that time was spent on nutrition? Zero.
Treatment guidelines, representing the standard of care, only pay lip service to nutrition. For example, the American Heart Association's latest cholesterol management guideline is 120 pages long. How much of that is devoted to diet? One paragraph. The guideline mostly instructs providers on which patient to put on which drug and at what dose. Children as young as 10, according to the guidelines, can be started on statin medications such as Lipitor and Crestor.
In addition, physicians know only the prescription model. They are taught that the only truly valid proof of efficacy is a clinical trial and that everything else is conjecture. That's why pharma rules, even though the literature is full of data about the health benefits of various foods. Food does not have "dosing data."
Did you know that doctors are monitored according to whether they prescribe medications? If I don't follow the cholesterol guidelines by prescribing statins, insurers will send letters scolding me. If I don't talk to you about the cholesterol-lowering effects of walnuts and oat bran, nobody cares. Physicians even get paid more when a drug is prescribed. A medical encounter that generates a prescription is considered more complex, which qualifies for higher reimbursement. In contrast, if a physician uses some of the very limited time with patients to talk about antioxidants and omega-3 fatty acids, they get nothing more.

Full article: https://www.cnn.com/2019/01/08/health/cardiologist-statin-cholesterol-mission/index.html
« Last Edit: January 08, 2019, 05:04:21 PM by mmortal03 »

Online bachfiend

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The following article from CNN seems to contradict a few things Steve has said about physician's education and nutrition, among other topics, including pharma, while sprinkling in other points that are accurate. It would be interesting to hear some commentary from SGU and other science based medicine proponents on the various claims being made.

Here's an important excerpt:

Quote
It took more than 80,000 hours of training for me to become a cardiologist. How much of that time was spent on nutrition? Zero.
Treatment guidelines, representing the standard of care, only pay lip service to nutrition. For example, the American Heart Association's latest cholesterol management guideline is 120 pages long. How much of that is devoted to diet? One paragraph. The guideline mostly instructs providers on which patient to put on which drug and at what dose. Children as young as 10, according to the guidelines, can be started on statin medications such as Lipitor and Crestor.
In addition, physicians know only the prescription model. They are taught that the only truly valid proof of efficacy is a clinical trial and that everything else is conjecture. That's why pharma rules, even though the literature is full of data about the health benefits of various foods. Food does not have "dosing data."
Did you know that doctors are monitored according to whether they prescribe medications? If I don't follow the cholesterol guidelines by prescribing statins, insurers will send letters scolding me. If I don't talk to you about the cholesterol-lowering effects of walnuts and oat bran, nobody cares. Physicians even get paid more when a drug is prescribed. A medical encounter that generates a prescription is considered more complex, which qualifies for higher reimbursement. In contrast, if a physician uses some of the very limited time with patients to talk about antioxidants and omega-3 fatty acids, they get nothing more.

Full article: https://www.cnn.com/2019/01/08/health/cardiologist-statin-cholesterol-mission/index.html

Well, the actual guidelines are actually about 80 pages long (around 40 pages are references), and there’s actually two paragraphs dealing with diet/lifestyle changes in managing hypercholesterolaemia/metabolic syndrome, with references to sources dealing with the detailed recommendations of diet and lifestyle.

And it’s a little concerning that she’s also got branded foods.  But anyway - the standard American diet (SAD) is terrible, with too much salt, sugar and fat.
« Last Edit: January 09, 2019, 02:18:28 PM by bachfiend »
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Offline Harry Black

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Any doctor I ever spoke to about it (a small number admittedly) has told me that diet and exercise is a step in their best practice for relevant conditions.
How many hours out of the 80,000 were spent on the best ways to work out? Probably not many?
My mother, my dad, my uncle and my grandad all had specific recommendations from doctors regarding specific foods that were causing them problems, foods they should eat to make up deficiencies or just general advice on smaller portions for weight loss. My dad was told to exercise more.
The problem and difficulty with this advice is that at a base level, it takes about a minute to communicate. Just the bare bones simplest version, is statistically very difficult for people to adhere to even if they really want to, so I assume that if a doctor feels they dont want to or won't be able to stick to a consistent lifestyle change, it makes sense to move to the next step in the process.
They cant hypnotise people to stop eating mcdonalds when they are broke and in a hurry, or to get up and walk when its raining.

This really just seems like a tack for someone selling something to create a niche for themselves by saying they can give something others cant.
And if he can have a higher success rate at helping people to do the basics then thats cool. Some doctors are probably better at helping people to quit smoking or get vaccinated.

Offline daniel1948

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My doctors, throughout my adult life, have always stressed the importance of diet and exercise. It’s true that none has ever touted specific benefits for specific foods, such as walnuts for cholesterol, but they’ve always told me to eat a healthy balanced diet, and they’ve always encouraged me to exercise.

I cannot remember what my childhood doctors told me because that’s just too long ago. One doctor, when I was around 16 or 17, (circa 1964) prescribed me a really horrid diet pill that is no longer available, called Eskatrol. I wonder if the trope about doctors turning first to pills is perhaps a leftover from the post-WWII era when pharmaceuticals such as antibiotics were providing “miracle” cures and it seemed as though they could solve everything.

I keep hearing the alternative medicine crowd claiming that doctors don’t know or care about nutrition, but in my adult life I have not encountered such a doctor.

Rejecting all drugs out of hand is as dangerous as expecting a drug for every problem, if not more so. Both extremes are bad. But with the exception of that childhood doctor, I’ve never had one who used drugs before seeing if lifestyle improvements were effective. And I’m not even sure about that doctor, because I don’t remember if he told me to exercise and just prescribed the pills when I refused. I hated sports when I was a kid and got very little exercise.
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Offline random poet

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This "news article" is an advertising diguised as an opinion piece that's trying to be mistaken for objective reporting. It's dishonest to the highest degree. She is outright lying about doctors' practices in order to sell her bogus food products, and giving dangerous advice to people to scare them away from life-saving meds. I don't know how much she paid CNN to publish this, but they should be ashamed of themselves.
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Offline Calinthalus

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I take statins, and I just went to my cardiologist last week.  She upped my dose of coreg and said I should try the Mediterranean diet since nothing else has worked yet.  I've been on Lipitor since my heart attack.


It is probably true that if we fully changed our diet that many of us would no longer need statins.  But that's like saying if we would all quit hating on each other all violence would go away.  The U.S. diet needs changing, but it isn't going to happen on anything like a valid timeline.  No amount of a doctor telling you to lose weight is going to cause you to lose weight.  Facts on the ground are that 90% of all attepts to lose weight fail.  Pretending that you can just tell people more diet advice and get rid of statins is Pollyanna at best.
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Offline Harry Black

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When you say the American diet, it sounds like there is one state sponsored diet plan being recommended to everyone and that for some bizarre reason, fast food and soda is part of it.
This obviously is not the case. You may disagree with specifics in what is considered best practice advice right now but when we refer to the diet of a country, its important to remember that we are discussing what they do eat, not what they are told they should eat or would like to eat if they had the willpower.
My diet is what I eat, not the plan I made on January 1st that is going to rat shit.

Offline Calinthalus

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When I say "the American Diet" I'm not referring to it as a plan.  I mean what the average American eats through the course of the year.  There are plenty of Americans that are eating well and healthy, but by and large they are the minority. We, as a society, need to move more people (including myself) towards that goal.  I don't have a solution to this, and I'm not sure anyone at all does.  What I do know is that we've been trying to get people to "eat right and lose weight" for my entire life and it's only gotten worse; therefore saying diet will fix our reliance on statins seems infeasible.
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Offline Harry Black

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When I say "the American Diet" I'm not referring to it as a plan.  I mean what the average American eats through the course of the year.  There are plenty of Americans that are eating well and healthy, but by and large they are the minority. We, as a society, need to move more people (including myself) towards that goal.  I don't have a solution to this, and I'm not sure anyone at all does.  What I do know is that we've been trying to get people to "eat right and lose weight" for my entire life and it's only gotten worse; therefore saying diet will fix our reliance on statins seems infeasible.
Oh I get it. I knew what you meant, I just think its kind of worth pointing out because I dont think everyone sees it that way.

Offline jt512

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I take statins, and I just went to my cardiologist last week.  She upped my dose of coreg and said I should try the Mediterranean diet since nothing else has worked yet.  I've been on Lipitor since my heart attack.


It is probably true that if we fully changed our diet that many of us would no longer need statins.  But that's like saying if we would all quit hating on each other all violence would go away.  The U.S. diet needs changing, but it isn't going to happen on anything like a valid timeline.  No amount of a doctor telling you to lose weight is going to cause you to lose weight.  Facts on the ground are that 90% of all attepts to lose weight fail.  Pretending that you can just tell people more diet advice and get rid of statins is Pollyanna at best.

You can eat whatever you like.  The choice is yours
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Offline Ah.hell

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I will add one more to the, "every doctor I've talked to about high blood pressure and cholesterol has recommended diet and exercise before drugs" brigade.

The problem is, I hate exercise and love to eat like a 13 year old. 

Online bachfiend

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I will add one more to the, "every doctor I've talked to about high blood pressure and cholesterol has recommended diet and exercise before drugs" brigade.

The problem is, I hate exercise and love to eat like a 13 year old.

I know people don’t like anecdotes, but my (successful) strategy is to eat only after exercise (I exercise to eat, not eat to exercise), so if I don’t do my daily ‘fix’ of exercise I don’t get to eat.  And I restrict my caloric intake each day to a limited number of hours, say 3 pm to 7 pm, outside of which I don’t eat and fall for the temptation of fast food restaurants.  Or high calorie/low nutrition snacks.

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Offline Ah.hell

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I will add one more to the, "every doctor I've talked to about high blood pressure and cholesterol has recommended diet and exercise before drugs" brigade.

The problem is, I hate exercise and love to eat like a 13 year old.

I know people don’t like anecdotes, but my (successful) strategy is to eat only after exercise (I exercise to eat, not eat to exercise), so if I don’t do my daily ‘fix’ of exercise I don’t get to eat.  And I restrict my caloric intake each day to a limited number of hours, say 3 pm to 7 pm, outside of which I don’t eat and fall for the temptation of fast food restaurants.  Or high calorie/low nutrition snacks.
I think there is decent evidence that most weight loss diets work by just making people pay attention to what they eat and restricting calories as a result. 

I should also ad, my doctor's have generally told me to stop drinking so much.  They've always been full of good advice I don't listen too. 

Online bachfiend

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I will add one more to the, "every doctor I've talked to about high blood pressure and cholesterol has recommended diet and exercise before drugs" brigade.

The problem is, I hate exercise and love to eat like a 13 year old.

I know people don’t like anecdotes, but my (successful) strategy is to eat only after exercise (I exercise to eat, not eat to exercise), so if I don’t do my daily ‘fix’ of exercise I don’t get to eat.  And I restrict my caloric intake each day to a limited number of hours, say 3 pm to 7 pm, outside of which I don’t eat and fall for the temptation of fast food restaurants.  Or high calorie/low nutrition snacks.
I think there is decent evidence that most weight loss diets work by just making people pay attention to what they eat and restricting calories as a result. 

I should also ad, my doctor's have generally told me to stop drinking so much.  They've always been full of good advice I don't listen too.

Yes, that’s right.  Most people become overweight or obese because of a lifetime of bad habits, such as ‘snacking’ or drinking high calorie drinks at all hours.  Losing weight involves getting rid of the bad habits, and hopefully acquiring good habits.  The larger the change in your lifestyle, the more radical the elimination of the bad habits.

I’m pretty certain that intermittent fasting (which is what I do) works in this way.  I’ve only got an hour to eat my day’s calories, so I better be sure I’m getting good quality food.
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Offline lonely moa

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It is absolutely true that medical schools in the developed countries give little or no dietary education to student doctors; not sure how many physicians one needs to hear that from to know that is true.

The well read average human can do reading and testing one oneself and work out something beneficial.  The NNT for statins, BTW, is not encouraging for use by humans without established heart disease, IMHO.

"Pull the goalie", Malcolm Gladwell.

 

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