Re: Cholesterol Levels Are Falling, But Red Flags Are Rising


"MEM, MD" <mem2y@xxxxxxxxxxx> wrote in message
news:bd5uk1lc8se3lbpr87q5iimnnib8i67sqi@xxxxxxxxxx
> On 13 Oct 2005 19:18:02 -0700, "fresh~horses"
> <fresh~horses@xxxxxxxxxxxxx> wrote:
>
> >
> >MEM, MD wrote:
> >> On 13 Oct 2005 08:20:08 -0700, James216440@xxxxxxxxx wrote:
> >>
> >> >
> >> >MEM, MD wrote:
> >> >
> >> >> On 12 Oct 2005 15:55:49 -0700, James216440@xxxxxxxxx wrote:
> >> >>
> >> >>
> >> >>
> >> >> >
> >> >> >While on the topic I have been waiting a long time for you to
respond
> >> >> >with more then a wise ass comment about my statement re life
expectancy
> >> >> >gains from statins Jim. You are usually a great deal more
thoughtful
> >> >> >and interested in finding the truth then you seemed to be on this
> >> >> >topic. Ok, I will tell you where my 26 days of life expectancy
came
> >> >> >from. It was from the 4S five year data plus reasonable
extrapolation
> >> >> >based on Helsinki. In 4S people who were basically healthy, except
> >> >> >they had high TC and diagnosed coronary disease, were placed on a
> >> >> >statin. The five year data showed the treated population gained
> >> >> >roughly 26 days of life expectancy. It is hard to give an exact
number
> >> >> >because the authors have not released the raw data so you have to
do
> >> >> >some attempts at integrating the lumped data that they have
released.
> >> >> >But probably anything from 20 days to 35 days would be a reasonable
> >> >> >conclusion to draw for life expectancy gains of the treated
population
> >> >> >vs the untreated control for the total five years of the study.
> >> >> >
> >> >>
> >> >>
> >> >> Hi James,
> >> >> Just had to add my 2 cents about calculating a "mean life expectency
> >> >> gain" from a clinical trial of anything but perhaps terminal cancer:
> >> >> it is interesting and kind of sobering, but it's clinically
> >> >> meaningless.
> >> >>
> >> >> If 1 of every 400 babies died of a terrible disease at birth, should
> >> >> we bother finding a cure? If each baby could expect a life span of
80
> >> >> years, curing the disease would only add an "average" of 9 weeks of
> >> >> life to each person. Not a very impressive benefit when stated that
> >> >> way. Sure, it's an extreme example, but I think it makes my point.
> >> >>
> >> >> Something bothers me about the general theme of most of these
> >> >> discussion, or maybe simply confuses me: why the focused attacks on
> >> >> statins, and seemingly only statins? Yes, they make drug companies
> >> >> obscene amounts of money. Yes they can lead to life-altering side
> >> >> effects, and often health care providers refuse to accept these side
> >> >> effects. But at the least they have shown clear cut benefits to a
> >> >> wide range of patients. But what about coronary stenting? Way less
> >> >> survival benefit (only in very specific senarios), at least as much
> >> >> potential for harm, and making device companies obscene amounts of
> >> >> money. How about the Chickenpox vaccine? My kids were forced to
get
> >> >> it to be allowed to start school, and yet not only is there no
> >> >> survival data to justify this practice, we have no idea how long the
> >> >> vaccine will last, potentially putting my kids at risk of getting
> >> >> chicken pox as adults (a very serious situation).
> >> >>
> >> >> Hopefully someone can answer this- perhaps statin dislikers are just
> >> >> simply more vocal.
> >> >
> >> >It all depends on the cost of saving that one baby in 400 who will die
> >> >at birth without treatment. If the cost is going to be $1,000,000 per
> >> >incident and no real hope of great reduction in cost with experience I
> >> >would submit it is not worth the cost. One human life expectancy is
> >> >simply not worth anyplace close to nearly half a billion dollars.
This
> >> >has been long since decided in most of the world either due to lack of
> >> >resources or rationing in those places that have socialized medicine.
> >> >Only in the US is a question like this ever even asked.
> >> >
> >> >You need to get that cost down to at most a couple million dollars per
> >> >life expectancy to be economically sensible. Statins are not there by
> >> >a long ways, particularly in primary postponement. They are there in
> >> >accute postponement I suspect.
> >> >
> >> >I hate to see you leave the group. Am I a statin hater? I guess in
> >> >your eyes I am. All they did was force my early retirement and cause
> >> >what look to be life long impairments. Fortunately I was an astue
> >> >investor and make a hell of a lot of money off my investments and
could
> >> >afford to retire very young and not have to ever worry about finances.
> >> >Understanding math and statistics do have financial benefits also.
> >> >Many are not so lucky and skilled as I was. But I would still be
> >> >willing and happy to take them for 30 days if I had a MI. And I would
> >> >suggest to any friend or relative they do the same. This makes me a
> >> >statin hater? I simply will not follow gods (your) advice so I am
> >> >below your consideration. Typical god complex from the medical
> >> >profession. I submit you need to do some personal soul searching and
> >> >return to reality. But you are a doctor so I know it aint going to
> >> >happen. Your training placed you well above the rest of us lowly
> >> >mortals. Your job is to belittle anyone who does not agree with your
> >> >high opinion of yourself. A lot like Chung.
> >>
> >> OK, I'm back in on this one. James, I don't recall ever giving you any
> >> advice. Nor have I ever told you, Sharon, or any patient that you or
> >> they are (wrong, misinformed, stupid, etc) for not wishing to take
> >> statins and for being resentful of their experience. I've never once
> >> told a patient "Your symptoms aren't due to statins." I always inform
> >> patients of potential side effects of statins when they are initiated,
> >> regardless of whether they ask or not. I try to distill the evidence
> >> supporting a particular patient's risk-benefit ratio for this and
> >> every class of drug and include that in the discussion. Please please
> >> please don't suggest I have a "god complex." That is prejudiced,
> >> silly, and sounds like a scene from ER.
> >>
> >> In any case, back to my interest in joining this group, discussion of
> >> studies and data, both positive and negative- FYI per our discussion
> >> above, if it only cost $1,000,000 to save an infant, and his expected
> >> lifespan is 80 years, that comes to $12,500 per life year saved- any
> >> health system would JUMP at a chance to pay for something like that.
> >>
> >> Also FYI (cuz I like this kind of data), comparative costs/life year
> >> saved (from a variety of US and British analyses, I can forward
> >> references if you like):
> >>
> >> Aspirin after MI: $95
> >> Plavix after MI: $6318
> >> Statin (after MI/ACS) $8250
> >> Statin (primary prevention- $23940
> >> Defibrillator (MADIT II- primary prevention) $33192
> >
> >
> >The aspirin is cheapest. Is it equally efffective? Or was that not
> >something shown.
> >
> >Zee
> >(aspirin user--no cardiovascular disease--TC 9.7)
>
> If you're asking is aspirin equally effective to plavix, the 2 were
> looked at head to head in the CAPRIE trial. A very complex trial with
> complex endpoints, but my opinion is that asa bore out as just as good
> as plavix. There were fewer events on plavix in the group with
> cardiovascular disease, but most of these were peripheral vascular
> events, which doesn't make much sense to me. For primary prevention
> plavix hasn't been studied compared to aspirin to the best of my
> knowledge.
>
> No question, if you want to be on one primary preventative medicine
> for CV disease, Women's Health Study be damned, I'd do 81 mg of
> aspirin.

I don't want to point any fingers here but aspirin and plavix resistance
studies after coronary events are in progress.
Not to mention that aspirin has a lot of complications in those who can not
tolerate it with a history of ulcers. People have died on aspirin and they
have never had any previous symptoms. They bled out at inopportune times out
in the remote areas away from hospitals.


.

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