The Cholesterol Con--Where Were the Doctors? Part I

After the stock market bubble burst, the New York Times asked: “Where were the analysts? Why didn’t they warn us?”

To be perfectly honest, this was a somewhat disingenuous question. As experienced financial journalists understood all too well, the analysts plugging the high-flying issues of the 1990s were employed by Wall Street firms raking in billions as investors bet their nest eggs on one hot stock after another. It really wasn’t in their employers’ interest for analysts to tell us that their products were wildly over-priced.  When a small investor wades into the financial world, there are two words he needs to keep in mind: “caveat emptor.”

But physicians, I firmly believe, are different from the folks employed by Merrill Lynch. (I don’t mean to knock people who work at ML. I am simply saying that they have a very different job description.)  When consulting with your doctor, you should not have to be wary. You are not a customer; you are a patient. And your physician is a professional who has pledged to put your interests ahead of his or her own.

This brings me to the question I ask in my headline: during the many years of the Cholesterol Con—where were the doctors?  When everyone from the makers of Mazola Corn Oil to the Popes of Cardiology assured us that virtually anyone could ward off heart disease by lowering their cholesterol, why didn’t  more of our doctors raise an eyebrow and warn us : “Actually, that’s not what the research shows” ?

No doubt, you’ve heard about the recent Business Week cover story, “Do Cholesterol Drugs Do Any Good?", which blew the lid off the theory that “statins”-- drugs like Lipitor, Crestor, Mevacor, Zocor and Pravachol -- can cut the odds that you will die of a heart attack by slowing the production of cholesterol in your  body and increasing the liver’s ability to remove L.D.L., or “bad cholesterol,” from your blood.   

It’s true that these drugs can help some people—but not nearly as many as we have been told. Moreover, and this is the kicker, we don’t have any clear evidence that they work by lowering cholesterol.

Although medical research suggests that statins can definitely benefit one group—men under 70 who already have had a heart attack--researchers are no longer convinced that the drugs stave off a second attack by lowering the patient’s cholesterol. The drugs do lower cholesterol, but that is not what helps the patient.

In other words, researchers are questioning the bedrock assumption that high levels of  “bad cholesterol” cause  heart disease.  “Higher LDL levels do help set the stage for heart disease by contributing to the buildup of plaque in arteries. But something else has to happen before people get heart disease,” Dr. Ronald M. Krauss, director of atherosclerosis research at the Oakland Research Institute, told Business Week.  "When you look at patients with heart disease, their cholesterol levels are not that [much] higher than those without heart disease," he added. “Compare countries, for example. Spaniards have LDL levels similar to Americans', but less than half the rate of heart disease. The Swiss have even higher cholesterol levels, but their rates of heart disease are also lower. Australian aborigines have low cholesterol but high rates of heart disease.”

“Current evidence supports ignoring LDL cholesterol altogether," Dr. Rodney A. Hayward, professor of internal medicine at the University of Michigan, told Business Week’s reporter.

In recent years, researchers have begun to suspect that statins help patients, not by lowering cholesterol levels, but by reducing inflammation. If this theory is right, “this seems likely to shunt cholesterol reduction into a small corner of the overall picture of heart disease,” the Guardian reported four years ago. 

And if the key to statins is that they reduce inflammation, it’s worth keeping in mind that this is what other effective heart treatments like aspirin and the omega three fatty acids found in fish oils, garlic  and Vitamin E do—at a much lower cost and with far fewer side effects.

But hold onto your hats, I still haven’t gotten to what is most shocking about the cholesterol story.  What raises my blood pressure is the knowledge that Business Week’s scoop isn’t really “new” news.” With all due respect to Business Week, which showed real courage in putting the story on its cover, and to its author, John Carey, who did a superb job of explaining the medical research, the truth is that medical researchers have been questioning the theory that widespread use of statins to lower cholesterol will  save lives for many years.

You can find the research questioning the benefits of statins in  medical journals like Lancet (2001) and BMJ (2006), as well as in reports from medical conferences (“Tales From the the Other Drug Wars,” 1999). 

Occasionally, doubts popped up in the mainstream press and then disappeared.

Five years ago, veteran healthcare blogger Matthew Holt pointed to a BMJ article suggesting that stains might be no better than aspirin. That same year, Holt raised pointed questions regarding the risk of taking statins, including possible memory loss.”

Nevertheless, the very next year, the National Cholesterol Education Program at the U.S. National Heart, Lung and Blood Institute issued new recommendations that drastically lowered the threshold for statin therapy. According to its 2004 report, people at a moderately high risk of developing heart disease (with LDL cholesterol levels between 100 and 129 mg/dL) should be offered statins—even if they have no previous history of heart disease. Statin therapy also should be recommended to very high risk patients, the panel said, even if  their LDL levels are as low as 70. NCEP declared that the recommendations applied to both men and women, regardless of age.

The bottom line: NCEP was urging millions of Americans to go on statins.

Not everyone agreed, recalls Merrill Goozner, editor of “GoozNews,” a top-drawer investigative healthcare blog.   In 2004, a few months after the new guidelines came out, a coalition of more than 30 academic physicians and researchers, inspired by Dr. John Abramson (author of Overdosed America: The Broken Promises of American Medicine),  decided to write a letter to the National Heart Lung and Blood Institute (NHLBI).

Goozner, who does research at the Center for Science in the Public Interest, organized the group. The letter “outlined all the evidence, which was there in published clinical trials for anyone who cared to look,” Goozner recalls, and concluded that while statins, “may lower cholesterol in people at low risk and even many sub-groups at moderate risk of a heart attack . . . there was no evidence that the drugs actually saved lives.”

How could this be, if statins lower the risk of heart attack, at least for some people?  Preventing a heart attack does not necessarily mean that a life is saved. In many statin studies that show lower heart attack risk, the same number of patients end up dying, whether they are taking statins or not. “You may have helped the heart, but you haven't helped the patient," says Dr. Beatrice Golomb, an associate professor of medicine at the University of California, San Diego, and  co-author of a 2004 editorial in The Journal of the American College of Cardiology questioning the data on statins. "You still have to look at the impact on the patient overall.” 

“The letter we sent to the NHLBI also called for an independent panel to review the evidence,”  Goozner notes, “since the NLHBI panel that made the recommendations had been dominated by physicians with ties to statin manufacturers.” Indeed, the National Institutes of Health later admitted that eight of the nine experts on the panel had received financing from one or more of the companies that make statins.  (None of the panelists had publicly disclosed their ties to manufacturers when they made their recommendations.)

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

But “this is relative peanuts compared to Dr P. Trey Sunderland III, a senior psychiatric researcher at the NIH, who took $508,500 in fees from Pfizer, Inc. whilst collaborating with them, and endorsing their drug [Lipitor],” says Dr. Malcolm Kendrick, who is a member of The International Network of Cholesterol Skeptics (THINCS)-- a growing group of scientists, physicians, other academicians and science writers from various countries.

Dr. Abramson, who is a clinical instructor at Harvard Medical School, charges that the study that accompanied the updated 2004 guidelines “knowingly misrepresented the results of the clinical trials that they supposedly relied upon to formulate their recommendations.  The problem is that the experts claimed to rely on scientific evidence, but they act as if empowered to ignore the evidence when it is not consistent with their beliefs.”

This is a serious allegation. Keep in mind that statins are the most popular drugs in the history of human medicine. World-wide sales totaled $33 billion in 2007. More than 18 million American now take them.

Nevertheless, “medical research suggests that only about 40 percent to 50 percent of that number are likely to benefit,” says Abramson.  “The other 8 or 9 million are exposed to the risks that come with taking statins –which can include severe muscle pain, memory loss, sexual dysfunction -- and one study shows increased risk of cancer in the elderly-- but there are no studies to show that the drugs will protect these patients against fatal heart attacks.”

Abramson can cite many studies to support his claims. But first, he stresses that statins can help some people.

“Statins  show a clear benefit for one group,” he says: “People under 65 who have already had a heart attack or have diabetes. But even in these very high risk people, about 22 have to be treated for 5 years for one to benefit.”

What about middle-aged people who are not diabetic and have not had a heart attack?  A 2006 study published in the Annals of Internal Medicine that focused on seven trials involving nearly 43,000 middle-aged adults concluded that statin use did not cut their chances of dying from heart disease.

Is there any benefit for this group? “If they are high risk, statins can be beneficial to people under 65 who haven’t had a heart attack, but 50 such men have to be treated for 5 years for one to benefit.” says Abramson. “The other 49 will not be helped.  The problem is that we can't know who is going to be the 50th man,” he adds. And all 50 will be exposed to the side effects.

Older adults have little to gain. The drugs don’t help people over 70 even if they have elevated cholesterol levels, according to a report in the Journal of American Cardiology.

Finally, “there is no evidence of any benefit for women who don't already have heart disease or diabetes,” says Abramson.  According to a 2004  article published in the Journal of the American Medical Association which reviewed all trials in which women with high cholesterol had been randomly assigned to take a cholesterol-lowering drug or a placebo, there was no evidence that statins prolonged women's lives or cut their chances of dying of heart disease.

An editorial published in the Journal of the American College of Cardiology came to the same conclusion-- though there does seem to be a risk that women  on statins develop memory loss so severe that their  relatives may begin shopping for a nursing home.

Memory loss that can mimic Alzheimers is the second most common side affect for people taking statins, right after muscle pain, according to researchers at the University of California at San Diego. For a number of years, they have been running a randomized controlled trial examining the effects of statins on thinking, mood, behavior, and quality of life. Separately, the UCSD researchers have been collecting anecdotal experiences of patients, good and bad, on statins.

"We have some compelling cases," Dr. Beatrice Golomb, the study's lead researcher, told the Wall Street Journal. “In one of them, a San Diego woman, Jane Brunzie, was so forgetful that her daughter was investigating Alzheimer's care for her and refused to let her baby-sit for her 9-year-old granddaughter. Then the mother stopped taking a statin. ‘Literally, within eight days, I was back to normal -- it was that dramatic,’ said Mrs. Brunzie, 69 years old.”

According to the Journal, “Doctors put her on different statins three more times. ‘They'd say, “Here, try these samples.” Doctors don't want to give up on it,’ she said.’ Within a few days of starting another one, I'd start losing my words again,’ added Mrs. Brunzie, who has gone back to volunteering at the local elementary school she loves and is trying to bring her cholesterol down with dietary changes instead.”
Returning to Goozner’s story, did the letter his group wrote to the NHLBI in 2004, spark public discussion about the new cholesterol guidelines?   No. “We released the letter to the press, but the mainstream of the national press ignored us,” Goozner recalls.       

In 2008, Goozner is happy to see the statin controversy hit Business Week’s cover-- though he can’t help but wonder, “Where were these guys three years ago? Now, call me a cynic, but why does my perverted mind think to itself as I watch this coverage: Yeah, now we hear, just when the world's best-selling drug [Lipitor] is about to go off patent.” 

I suspect Goozer is right. It would have been much harder to publish this story a few years ago.

But there also was a trigger that probably helped spur the Business Week investigation. Last month, Merck -Schering/Plough released a long-awaited study revealing that Vytorin, an expensive combination of two drugs designed to lower cholesterol, brought no added benefits for patients suffering from heart disease.

The two cholesterol-lowering drugs were Zocor, which is a statin, and, Zetia, which is not. When combined, the two drugs did drive cholesterol levels much lower. But the clinical trial offered no evidence that the two cholesterol-busters were more effective in reducing heart attacks than Zocor alone.  This raises an obvious question: is cutting cholesterol levels really the key to avoiding heart attacks?

The results of the study helped buttress the strong suspicion that insofar as statins like Zocor  do help anyone with heart disease, the beneficial effect has little to do  with lowering cholesterol levels.
Meanwhile, Zocor is now available in a generic form that can be purchased for less than $6 for a 30-day supply. By contrast, the new combination, selling under the brand name Vytorin, was fetching more than $100 for a 30–day supply. In 2006, the drug brought in $1.5 billion with sales climbing 25% in the first half of 2007 to over $2 billion, according to IMS Health.

Naturally, Merck and Schering/Plough, who were marketing Vytorin  in a joint venture,  were shy about reporting the results of the clinical trials. It was only when they were threatened with a Congressional investigation that they made the results public on January 15—more than a year and a half after the clinical trials were completed.

The day after the drug-makers released the news, the American Heart Association rushed to their defense, declaring that the study was too limited to draw conclusions about Vytorin’s ability to reduce heart attacks or deaths compared to Zocor alone. The AHA advised patients not to abruptly stop taking Vytorin without consulting with the doctors who had prescribed it.

The New York Times, to its credit, was quick to respond, noting that “what the [American Heart Association] did not note in its statement  . . .  was that the group receives nearly $2 million a year from Merck/Schering-Plough Pharmaceuticals, the joint venture that markets Vytorin.

When I return to the saga of the “Cholesterol Con,” in the second installment of this post, I am going take a closer look at the American Heart Association—and others who stood to gain by persuading  Americans of the absolute link between high levels of cholesterol and heart disease. 

It is a story that begins long before Pfizer and other drug makers invented statins. And it explains why so few American doctors stood up and questioned the widespread use of drugs like Lipitor.

The belief that cholesterol causes heart disease wasn’t just a theory. It became a matter of faith, brought to us by a motley group that included food companies advertising margarine and corn oil, the American Heart Association, and doctors who joined the bandwagon. At first the American Medical Association resisted—but soon it too capitulated.  Finally, when the American College of Cardiology signed on, it became very difficult for physicians to speak out.

At that point, anyone who questioned the cholesterol connection could easily be painted as “reckless”—a doctor willing to put thousands of lives at risk by encouraging patients to question what had become the Holy Grail of cardiac care.

Comments

[Alex]

All this is really a concern. I'll just bring up two sons and try to ensure that they eat properly. In order to find the right diet you can always use Google or watch video seminars on youtube.

[Fernando]

Thanks for the information!!!!!!!!!!!

[Kevin Dwyer]

Statins are sheer poison, they destroy pretty much everything good in the body inc. the appetite. Why so many people and doctors have been sold this rubbish I don't know. Surely the alarm bells go off when "statins cure diabetes, statins cure dementia, stains cure pneumonia. When's this going to end. Kd.

[berta]

I try to keep to a healthy way of life and analyze everything I eat. For other people who try to take care of their health and food, this link to a very informative film - http://file.sh/CHOLESTEROL+THE+MODERN+KILLER+CAN+BE+PREVENTED+torrent.html

[Zazu]

My blood cholesterol was well over 300 and came down 100 points because of Simvistatin. Statins are hard on the liver but my liver tests showed just fine and I take the smallest dose. A person taking statins needs to be checked periodically by a doctor and get blood tests regularly.

[LT3Y]

There has been a proliteration of doctors posting to articles such as yours. Whether or not they are doctors is debatable.

Some years ago Monbiot wrote about his investigation into Monsanto putting paid infiltrators on boards where activists shared information about actions. That's also being done by non-agro pharmaceutical companies.

[maggie mahar]

Julia, Janice, LT3Y, RS,

Julia, I do there will be more interdisciplinary work in
medicine exploring mind/body problems--though it has been a long time coming. This is probably because the profit motive has so distorted priorities.

Researchers in the private sector tend to focus on problems that they can hope to solve in a relatively short period of time (a slight variation on a drug we alrady have,for example), package and sell.

We need to put more money into govt research and, most of all, we really need more academic scientists doing research for the sake of expanding knowledge--scientists are not dependent on funding from for-profit companies.

Of course that means that universities would need to reward these scientists (with tenure, respect and enough funding to do their work) even though they weren't bringing in outside money.

As for the blog, most of the issues we focus on are not that technical. Even in the case of cholesterol, this is a subject that many people are interested in and can follow. (The post was picked up by www.alternet.org, a general interest alternative online newspaper that covers a wide range of subjects. There, a 109 people have commented--many of them people who have bad experiences with statins.

On this blog we often have comments from doctors,but the majority are able to express what they know in plain English . . .

LT3Y-- Thanks much. When I
get e-mails from people they are usually people who
have been reading my posts for a long time, here and elsewhere . .

RS and Janice--Someone who
I respect very much is a big fan of chelation. He's an older man (actually fought in WW II)and in very good health, so it certainly doesn't seem to have done him any harm, and he firmly believes it has done him a world of good.

[LT3Y]

I want to thank you for this Maggie. Although I know everything in here and in fact have been part of getting this information into the press, I can't think of another writer who has pulled it together as cogently as you have.

Regarding your post about a doctor contacting you privately: I assume you Googled and did an AMA search on this physician's name? How rare that this professional has time on his hands to read blogs, form intricate character analysis of posters over a period of time, and then privately contact you with a synopsis of his hours and hours of internet study.

Wow. There is no doctor shortage in the U.S.

[RS]

Janice N. Thaxter, I think EDTA chelation is good for ridding the heart of plaque.

[Janice N. Thaxter Ph.D.]

I had 3 heart attacks in Dec. all atypical. A 99% blockage was found and I now have a stent VAD. I had no symptons, high total Cholesteral, high Triglycerides. I am a diet freak and health nut, love exercise. I refused statins due to the side effects, I am a 75 y/o female, no smoking, no drinking, no drugs. HOWEVER!!!! I AM TOTALLY CONVINCED MY PROBLEMS STARTED WITH THE REMOVAL OF MY GALL BLADDER FEB 2005. Prior to this my angiogram showed 0% placqing. After this surgery I still experience daily pain in the liver area. January 2007 showed 50% blockage in the LV and in December 2007 99+% blockage resulting in my new stent (which I am not thrilled about and suffered w drug reaction (pain & inability to breathe) for about 6 weeks. HAS ANY RESEARCH BEEN DONE IN THIS AREA? I BELIEVE TOO MANY GALL BLADDERS ARE REMOVED WHEN THE SITUATION COULD BE RESOLVED WITH SOME KIND OF NATURAL FORM OF TREATMENT. We are to quick to accept meds and diagnosis from MD's and although I trust my body more than the MD's, I dropped my guard and went along with the surgery I did not want. Stupid? Yes, and now I also have diabetes, heart disease and gross placqing in my left brain. WE NEED RESEARCH ON REDUCING PLACQ. Dr. T

[DodgyOne]

I think my heart disease is not a result of my colesterol or diet or fitness as they are all resonable for a 50 yr old. I think it is because of the stress of 30 yrs of marriage to a nagging selfish woman combined with as many years of a nagging selfish boss. Mens hearts failing them out of fear is the simple explanation.

[Julia]

As one who uses a statin, I guess it
is reasonable to share my observations and opinions.

I have had high cholesterol since I was in my early 30's. I am now almost 55 years old. it took a while to find a medication my body would/could tolerate. After several years I changed Docs, and the new doc took me off the statin. I could not afford to take what she wanted to replace it with so I went without for about 5 years. In those five years I could actually feel the change in my body as the cholesterol began to build up again. After we thought I had a heart attack in 2004 (I didn't) my doc agreed to put me back on what I knew would at least "help"...

Ok...now here is the catch. Had I known in my early 30s what was happening inside my body, as a result of an internal/unconscious stress response due to early (interpersonal) childhood trauma, causing a "fight/flight/freeze" over-production of cortizol (in simple terms -cholesterol ), I wouldn't have waited 20 plus years to deal with the internal stuff (treating the stress disorder, and learning natural ways to allow my body to "unfurl" from its "frozen" place) instead of just treating "symptoms" and covering up all the stuff one needs to "uncover" and go through, to change internal the relationship/response.

So...what do I mean by all this? I agree that there is a big gap in the information we get. For example medical doctors treat high cholesterol, and psychiatrists treat "stress disorders". Most/many docs aren't even trained to connect the biochemical/neuro-biological dots.

I am not sure it is anyone's "fault" though. We don't live in a society which embraces an interdisciplinary/intersubjective approach to much. In one corner, science may be busy looking at a problem, and in the other corner, religion (for example) may be looking at the same problem, but, typically, they aren't talking to one another, and they aren't often delving into each other's methodologies for obtaining information. In many instances, as some people here have pointed out, it simply is not encouraged.

Things can change, though, and in some cases they are. Some very influential MDs have shifted their focus to the study of psychology and the human brain. The combination has the potential to create a very powerful voice in this very industry.

Although Marilyn (sorry if I didn't spell your name correctly) may have been a little personally impassioned when she first wrote, I feel that at the heart of her comments she has a point. Opinions are wonderful and we all need to have an avenue for being more able to both articulate and to "hear" about new information, without the jargon that higher education tends to bring to (especially a subject like this --- so a blog like this is perfect.

Ultimately, though, I am not sure those bigger, stronger, voices which/who are needed to be the driving force behind the kind of change that is being proposed here, will do more than "glance" at material that doesn't provide sufficient references which can be used to propel the forward motion of this kind of argument.

This is not to say I didn't enjoy the blog, and the comments, or that I don't agree with the nature of its general purpose. I just caught myself wondering if it can manage to do both things.. provide a place of congenial conversation for the average-person and also be the vehicle for moving healthcare out of it's currently entrenched position? Might there be a way to bridge that gap?

Thanks for the good read and the opportunity to share a bit.

[Julia]

As one who uses a statin, I guess it
is reasonable to share my observations and opinions.

I have had high cholesterol since I was in my early 30's. I am now almost 55 years old. it took a while to find a medication my body would/could tolerate. After several years I changed Docs, and the new doc took me off the statin. I could not afford to take what she wanted to replace it with so I went without for about 5 years. In those five years I could actually feel the change in my body as the cholesterol began to build up again. After we thought I had a heart attack in 2004 (I didn't) my doc agreed to put me back on what I knew would at least "help"...

Ok...now here is the catch. Had I known in my early 30s what was happening inside my body, as a result of an internal/unconscious stress response due to early (interpersonal) childhood trauma, causing a "fight/flight/freeze" over-production of cortizol (in simple terms -cholesterol ), I wouldn't have waited 20 plus years to deal with the internal stuff (treating the stress disorder, and learning natural ways to allow my body to "unfurl" from its "frozen" place) instead of just treating "symptoms" and covering up all the stuff one needs to "uncover" and go through, to change internal the relationship/response.

So...what do I mean by all this? I agree that there is a big gap in the information we get. For example medical doctors treat high cholesterol, and psychiatrists treat "stress disorders". Most/many docs aren't even trained to connect the biochemical/neuro-biological dots.

I am not sure it is anyone's "fault" though. We don't live in a society which embraces an interdisciplinary/intersubjective approach to much. In one corner, science may be busy looking at a problem, and in the other corner, religion (for example) may be looking at the same problem, but, typically, they aren't talking to one another, and they aren't often delving into each other's methodologies for obtaining information. In many instances, as some people here have pointed out, it simply is not encouraged.

Things can change, though, and in some cases they are. Some very influential MDs have shifted their focus to the study of psychology and the human brain. The combination has the potential to create a very powerful voice in this very industry.

Although Marilyn (sorry if I didn't spell your name correctly) may have been a little personally impassioned when she first wrote, I feel that at the heart of her comments she has a point. Opinions are wonderful and we all need to have an avenue for being more able to both articulate and to "hear" about new information, without the jargon that higher education tends to bring to (especially a subject like this --- so a blog like this is perfect.

Ultimately, though, I am not sure those bigger, stronger, voices which/who are needed to be the driving force behind the kind of change that is being proposed here, will do more than "glance" at material that doesn't provide sufficient references which can be used to propel the forward motion of this kind of argument.

This is not to say I didn't enjoy the blog, and the comments, or that I don't agree with the nature of its general purpose. I just caught myself wondering if it can manage to do both things.. provide a place of congenial conversation for the average-person and also be the vehicle for moving healthcare out of it's currently entrenched position? Might there be a way to bridge that gap?

Thanks for the good read and the opportunity to share a bit.

[Julia]

As one who uses a statin, I guess it
is reasonable to share my observations and opinions.

I have had high cholesterol since I was in my early 30's. I am now almost 55 years old. it took a while to find a medication my body would/could tolerate. After several years I changed Docs, and the new doc took me off the statin. I could not afford to take what she wanted to replace it with so I went without for about 5 years. In those five years I could actually feel the change in my body as the cholesterol began to build up again. After we thought I had a heart attack in 2004 (I didn't) my doc agreed to put me back on what I knew would at least "help"...

Ok...now here is the catch. Had I known in my early 30s what was happening inside my body, as a result of an internal/unconscious stress response due to early (interpersonal) childhood trauma, causing a "fight/flight/freeze" over-production of cortizol (in simple terms -cholesterol ), I wouldn't have waited 20 plus years to deal with the internal stuff (treating the stress disorder, and learning natural ways to allow my body to "unfurl" from its "frozen" place) instead of just treating "symptoms" and covering up all the stuff one needs to "uncover" and go through, to change internal the relationship/response.

So...what do I mean by all this? I agree that there is a big gap in the information we get. For example medical doctors treat high cholesterol, and psychiatrists treat "stress disorders". Most/many docs aren't even trained to connect the biochemical/neuro-biological dots.

I am not sure it is anyone's "fault" though. We don't live in a society which embraces an interdisciplinary/intersubjective approach to much. In one corner, science may be busy looking at a problem, and in the other corner, religion (for example) may be looking at the same problem, but, typically, they aren't talking to one another, and they aren't often delving into each other's methodologies for obtaining information. In many instances, as some people here have pointed out, it simply is not encouraged.

Things can change, though, and in some cases they are. Some very influential MDs have shifted their focus to the study of psychology and the human brain. The combination has the potential to create a very powerful voice in this very industry.

Although Marilyn (sorry if I didn't spell your name correctly) may have been a little personally impassioned when she first wrote, I feel that at the heart of her comments she has a point. Opinions are wonderful and we all need to have an avenue for being more able to both articulate and to "hear" about new information, without the jargon that higher education tends to bring to (especially a subject like this --- so a blog like this is perfect.

Ultimately, though, I am not sure those bigger, stronger, voices which/who are needed to be the driving force behind the kind of change that is being proposed here, will do more than "glance" at material that doesn't provide sufficient references which can be used to propel the forward motion of this kind of argument.

This is not to say I didn't enjoy the blog, and the comments, or that I don't agree with the nature of its general purpose. I just caught myself wondering if it can manage to do both things.. provide a place of congenial conversation for the average-person and also be the vehicle for moving healthcare out of it's currently entrenched position? Might there be a way to bridge that gap?

Thanks for the good read and the opportunity to share a bit.

[Maggie Mahar]

Terry--
Thanks for the head's up on RSS--
I e-mailed the person who oversees our computer system and this was her reply:

"I just took a look at Health Beat and all of the feeds are working correctly-- I verified Firefox in PC/Mac; Internet Explorer on PC; and Safari in Mac.
So, right now, everything is working fine with a variety of browsers and on both macs and pcs."

Is it working for you now?

[ralphie]

So, do any of you doctors ever step back and think about these things, and wonder if they arent being done on purpose?

This is 2008, so where are all these 'advances'?

Why are we sicker now than in the 70s?

Maybe your foundations and authorities dont have the same goals as the goals they advertise?

[Terry]

None of your RSS feeds appear to work.

[maggie mahar]

Marilyn--

I agree--I think our problem was mainly a matter of style. You're accustomed to a differnt kind of blog.

But I really hope you keep commenting here. You
clearly are very knowledgable and care passionately about healthcare.

These are the commenters I most value. It's just that commenting here tends to be less of a
"fast and furious argument," and more of a conversatoin designed to bring everyone
in while in coming to a betternunderstanding of our health care system and what we need to do to fix it.

I'm a former college teacher, and so I tend to think of a good blog as a good seminar. It's an interactive learning experience. Ideally, commenters talk across the table to each other--not just to me. And they're interested in helping each other navigate a very, very difficult topic--how we can improve health care in America.

I truly do hope that we hear from you again.

[Marilyn Mann]

Maggie,

I think this may be more a question of style than anything else. I'm used to posting on usenet groups, like sci.med.cardiology, where people routinely post abstracts and where the discussion is fast and furious.

If I ever post on your blog again, I'll keep your helpful hints in mind.

Also, I'm an lawyer, and you know how obnoxious lawyers are!

Best regards,

Marilyn

[Gregory D. Pawelski]

Maybe most of the people reading this blog "are not" doctors and don't like to see discussions get bogged down in detail.

I certainly don't like the concept of having anyone make a pronouncement as to what constitutes "truth." Medical science is no different than any other type of science. Truth is generally an imperfect work in progress. Evidence-based medicine is an attempt to fix "truth" in concrete, in many cases ossifying what should more properly be a work in progress.

I believe Maggie would not want to turn this into a Jerry Springer-style blog. What do attacks and detours have to do with the subject being discussed?

If someone thinks they have information on the subject being discussed, they should post that information and leave attacks in the drawer.

I personally read this blog because of the more civil nature of discourse. I feel it is patently unfair for someone to attack anyone else's thoughtful opinions or information which may not meet with the personal opinions of someone else.

The most interesting discussion is the honest difference of opinion.

[maggie mahar]

Marilyn--

First, I'm very sorry about your daughter, and am glad to know Marilyn isn't a pseudonymn.

I don't mind when people
disagree with me. I do mind when they try to derail or stop the discussion and this is what the other reader (who I don't know personally, just on this blog) was complaining about.

Listing a string of journals articles isn't helpful. Most people don't have the time (or the access) to look them all up. If you had read this blog for a while, you would know that when people cite evidence they explain--in clear English, free of jargon, that everyone can understand. They explain any technical terms. They provide a URL so that someone who does want to look at the article can do so.

The fact that I was the only person on the thread who responded to your comments should tell you something.

As for the truth of what I have said here, and what Business Week printed,-- as you know there are doctors who agree with the Business Week article. And there are doctors who agree with my post. (See, for example, www.Kevinmd.com, which lists it as one of the best health posts of the week.)

Finally, on this blog we try to avoid hostility and saracasm. ( You wrote: "What a ridiculous, condescending comment. You make unsupported statements and then decline to cite any evidence for fear of confusing people. I find that insulting. . .
The fact is, you didn't do enough research before you wrote your post, and it shows. Better luck next time."

In fact, I have done a great deal of research on this topic--and asked a doctor who specializes in this area of reserach to fact-check the post before I put it up.

[maggie mahar]

Marilyn--

First, I'm very sorry about your daughter, and am glad to know Marilyn isn't a pseudonymn.

I don't mind when people
disagree with me. I do mind when they try to derail or stop the discussion and this is what the other reader (who I don't know personally, just on this blog) was complaining about.

Listing a string of journals articles isn't helpful. Most people don't have the time (or the access) to look them all up. If you had read this blog for a while, you would know that when people cite evidence they explain--in clear English, free of jargon, that everyone can understand. They explain any technical terms. They provide a URL so that someone who does want to look at the article can do so.

The fact that I was the only person on the thread who responded to your comments should tell you something.

As for the truth of what I have said here, and what Business Week printed,-- as you know there are doctors who agree with the Business Week article. And there are doctors who agree with my post. (See, for example, www.Kevinmd.com, which lists it as one of the best health posts of the week.)

Finally, on this blog we try to avoid hostility and saracasm. ( You wrote: "What a ridiculous, condescending comment. You make unsupported statements and then decline to cite any evidence for fear of confusing people. I find that insulting. . .
The fact is, you didn't do enough research before you wrote your post, and it shows. Better luck next time."

In fact, I have done a great deal of research on this topic--and asked a doctor who specializes in this area of reserach to fact-check the post before I put it up.

[Marilyn Mann]

I just want to add that I am curious about what your friend thinks my political leanings are. I'm a liberal democrat. This is my first time reading your blog, so I'm not even familiar with your political views.

I'm no apologist for the drug industry, if that is what he/you are thinking.

I am not familiar with the "Quackwatch people" he is referring to so I can't comment on that. If "Quackwatch" is an organization, I am not a member of it.

I would be curious to know what the pseudonyms are that he attributes to me. I am wondering whether those other posts are mine or not.

[Marilyn Mann]

Marilyn Mann is not a pseudonym. It is my real name.

Maybe I feel strongly about this subject because my daughter has heterozygous familial hypercholesterolemia and would be at risk of an early death if it weren't for statins.

My husband has also been told he is at high risk of a heart attack. He is also on a statin.

I agreed with you that statins are overprescribed for primary prevention. But because I dared to disagree with some of the other things you said, you accuse me of "fundamentalism" or of pursuing a "diatribe." I respectfully disagree.

If you post something on the internet, and open it up for comments, you have to be ready for people to disagree with you. If that offends you, then you are in the wrong business.

Please ask your friend to contact me directly to discuss the situation. My e-mail is mannm@comcast.net. My phone numbers are (202) 551-6813 and (301) 520-5488. I would be glad to discuss the matter with him at his convenience.

Have a good evening.

[Maggie Mahar]

Marilyn--

I have had a complaint from a reader (who, as it happens, is a doctor) about your comments.

Apparently, he has spotted you on other blogs--using other pseudonymns.

He said that he recognized you by your style when you "unloaded a deluge of meaningless references when she cannot cobble together in a cohesive and persuasive original content based upon logic and the issue at hand. Then she has to use bully tactics and unjustified discrediting."

The goal seems to be to undermine the blog--perhaps for political reasons. . He concludes by saying:
"Trying to read someone slicing and dicing and dissecting every sentence you write is borig. The point by point, line by line, tit for tat rebuttal style is indeed fundamentalism, with the guiding principle of Quackwatch people."

This is what I was getting at when I said that I didn't want to get bogged down in a "Here's my journal article which says the opposite of your journal article" war of words.

Rather than contributing to the thread, you are interrupting it with a diabtribe that is not interesting (or even comprehensible) to most readers.

Please refrain from this style in the future.