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

Susan <nevermind@xxxxxxxxxx> wrote:

> David Rind wrote:

>> I think it's very hard in any individual to know whether a side effect
>> that comes on slowly and resolves slowly is due to a particular
>> medication, so I would keep an open mind about whether in this
>> particular case the statin was responsible for the change in mental
>> ability. People are wonderful at seeing cause and effect where there
>> isn't any, which is why blinded trials are so helpful.

> I certainly understand that this can be true, BUT... I'm one of those
> folks who gets adverse reactions that later, upon use in the larger
> marketplace, turn out to happen to, say, .5% of all drug takers. The
> bad stuff that happens to me gets blown off by most docs (except those
> who know me for a while)as non-existent. I have to decide for myself,
> despite what studies say, what's causing what. I'm the one to live with
> the consequences.

The other problem is the individual one. If a drug is known to cause a
certain side effect in, say, 1% of the population, and you take the
drug, and suffer from the side effect, then stop the drug, and the
side effect ceases, this only suggests that the drug might have caused
the problem. The individual patient, and his doctor, can never know
for certain.

Some people here go on about the certainty of scientific results
compared with the fallibility of an individual jumping to the
conclusion that the drug made them ill. That's true in the trivial
sense that one swallow doesn't make a summer, but ignores the
important point that no amount of large scale statistical trials which
produce probabilities and risk factors can ever do more than make
informed guesses as to the probabilities in an individual case. Where
risk factors are concerned there are no certainties, just
well-informed guesses which could be wrong. The only certainties large
scale statisitcal trials can produce are certainties about the degree
of uncertainty in the probabilities :-)

>> But not being able to be sure that the statin was the cause doesn't make
>> it unreasonable for someone who seems to have had such a side effect to
>> decide that statins aren't worth the risk. Someone else might choose to
>> see whether a hydrophilic statin was better tolerated, and this would be
>> reasonable as well.

> Something Chris didn't mention here, in terms of assessing and
> moderating risk (Chris will correct me if I'm wrong) is that he was an
> undiagnosed diabetic, probably for a good long time.

Being diabetic is a question of passing a certain threshold in
diagnostic parameters, a threshold which doctors adjust every few
years. Whether I might have been an undiagnosed diabetic five years
ago depends on whether we use the diagnostic criteria of five years
ago, of today, or of next year. What there is no doubt about is that
for years before diagnosis I was suffering some of the typical
symptoms of high blood sugar and high insulin levels, and that at the
time of diagnosis I had already suffered some of the typical damage
caused by such levels, such as mild neuropathy in the
extremeties. However, it is known that people who have higher than
normal blood sugar and insulin levels can already be suffering
permament damage due to those levels even when those levels are below
the current diagnostic levels for diabetes.

In other words, I could easily have have suffered the damage I did as
a result of years of being not yet quite diabetic.

I find it very difficult to have any respect for the intellects of
those who argue in support of the current fatuous mess with respect to
the diagnostic criteria for diabetes, the attempted sticking plaster
of pre-diabetes or the "metabolic syndrome", etc..

> Since learning of
> his diabetes, he's taken steps to maintain much better glycemic control,
> and to increase his already impressive activity level. His risks have
> doubtless dropped a great deal at the same time he's stopped the statin,
> making the choice to do without them much less of an issue. His insulin
> resistance, for one, should be greatly reduced.

My doctor wanted to prescribe me a statin as well as blood sugar
testing strips, but agreed to humour me and let me try and see if
intending to take more exercise and controlling my diet would lower
the measurements which increase my risk factors. His worry was the
unimpressive record of people in general in changing good intentions
about diet and exercise into effective permanent practice.

Since I've already had at least one heart attack I'm definitely at
risk. At least one? Twelve years ago a cardiologist told me that
something very frighteningly like a heart attack definitely hadn't
been. His opinion seemed to be strongly influenced by the speed of my
recovery, e.g. two hours after nearly passing out I slowly and
carefully walked up two flights of stairs to see my doctor. Three
years ago another cardiologist told me that not only had I just had a
mild heart attack, but that the previous cardiologist (whose notes he
was reading) had been over-optimistic in suggesting that twelve years
ago I hadn't had one then.

I haven't been able to keep up impressive activity levels. I was
initially over-enthusiastic in exercising and strained a variety of
tendons and joints by developing and using too much muscle strength
too fast. It'll probably take a few more months before they recover to
the point where I can do more than low-level maintenance exercising. I
think my current exercise levels might be impressive in a car driver,
but are probably average for a non-car-owner who gets about using the
old-fahioned legs method and avoids the use of power tools in DIY
house and garden maintenance.

--
Chris Malcolm cam@xxxxxxxxxxxxxxxxxxxx +44 (0)131 651 3445 DoD #205
IPAB, Informatics, JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK
[http://www.dai.ed.ac.uk/homes/cam/]

.

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