Cholesterol Drugs Could Be Worse Than Cholesterol

I know about statin drugs.  I used to take some of them, various ones, to lower my cholesterol.  Long ago, of course, when I was a VA patient but some sort of a “VA VIP” since I am a physician, good God, and someone had to make sure I was getting the best care that a federal institution could give.

One of the things they did was to tell me we had to do something about my awful cholesterol.  I knew it was not that awful, but they told me I should get a “statin.”  I tried about three or four different ones before I told my doctor never to give me these horrible medications. He told me I was insane, but my cholesterol has lowered considerably since.There are lots of wonderful ways to lower cholesterol (like dancing as much as you can) that do not carry statin risks. The article cited above is not the first one that blows the widespread use of statins out of the water, if someone bothers to listen.  Few do.

There are two really seminal facts to notice about the article cited above: First, it points out that we are talking about research performed by people who are paid by the company that does the research.  Not that this is a special or unusual circumstance. Anybody, I mean anybody, who reads a journal that reports research should make a serious effort to figure out who is paying for the research that they are reading. If you have any doubt that money makes the world go round, consider this one.  When someone is a professor or academic, when such folks meet, a common question is  “are you funded?”  The awarding of grants makes people’s stock go up.  The government claims lack of funds, as does pretty much anyone else, but it is far less credible to me when a drug company claims lack of funds.  It is usually that they are not funding things that do not advance them, or publicize them.

For example, the very last time that I talked to a drug company representative, I asked for samples of over-the-counter vitamins that were made by that same drug company to treat my indigent and grossly malnourished patients, offering even to provide proof that they were vitamin deficient.  Of course, any kind of “insurance” that would cover said patients would never cover such vitamins, and I told the company what wonderful public relations this would be for both staff and patients, to see these patients improve, thanks to a generous gift from this drug company.  I was told in this instance, exactly as I have been told by every drug company representative to whom I have made a similar request, that such would not happen because it simply was not policy.

Second point; this observation, on the questionable validity of statins in presenting coronary artery disease was made by a Frenchman. Music, please.  “Allons enfants de la patrie.” I am reluctant to believe it is a coincidence that this is the same country where my medical education included the skills to do a critical analysis for medical research that blew my Kansas instructors out of the water. Yes, I am Seriously Afraid that a nieve American love of a big “N” (number of experimental subjects) for clinical trials has obscured more subtle levels of analysis of medical research. Even those that are not terribly subtle, like who is paying whom to do the research.

I personally stopped taking statins after the requisite few months necessary, in my view at the time, to determine if they were indeed lowering my low-density (bad) cholesterols and lowering my cholesterol in general.  As a matter of fact, they were raising my live function tests.  My life has been to hell and back, at least part of it from the side effects of this class of cholesterol-lowering drugs.  My only clinical signs was a bit of nausea, probably from my much maligned and overworked liver, although I certainly prefer to think of that particular symptom as indicative of my feelings about the world of prescription drugs in general.  I didn’t think they were, didn’t think the whole thing was worth the trouble, and decided not to stop my statins temporarily, but to said good- bye and good riddance. My blood levels of cholesterol now may not be perfect, but they are pretty darned good, and I have no intention of treating them with prescription drugs.

I have one vivid memory of a general physician with a large practice and an overweight working laborer for whom he had prescribed two such drugs simultaneously.  Although the blood tests looked perfect, the patient had a profound fatigue with muscle aches, which sounded to me like incipient rhabdomyolysis.  Now rhabdomyolysis only happens, they say, to about one in every one thousand people who is taking statin drugs.

Clearly this thing can be deadly; while the treatment is generally simple — just get rid of the darned drugs.  I had trouble convincing the salt-of-the-earth laborer that his doctor was wrong and putting him at risk.  I didn’t get pushy with the poor patient; I talked to his doctor’s physician assistant, who was using a pre-signed prescription pad, was not a pharmacologist to put it mildly, and was the only person I could talk to, since the general physician refused. I shudder now to remember the correspondence which included printouts from drug-interaction websites and discussions with the agonized pharmacist who distributed both the other physician’s prescriptions and mine.

I never knew the final outcome.  I may have accomplished little other than worrying a well-meaning patient.  Still, statin drugs have side effects for a lot of people; more than just me.

For openers, and from the same “about” group of websites that seems to be making at least a passing effort at being objective, there are plenty of ways to lower cholesterol that have nothing to do with drugs.  The “lifestyle” changes are widely reported and rarely implemented, at least in the low socioeconomic groups of people that public agencies seem to consult me to help treat.

I shall not resolve this question right now, except to say that people never follow “exercise prescriptions” (“ten squat thrusts three days weekly”) but may follow their hearts (“find a kind of dance that puts a smile on your face and do it a lot”). People may never follow a food prescription (“eat dried peas and beans”) but may actually try a new recipe that sounds like fun (“go poach a pear.”) Changes wrought in the American diet by putting sugar where it does not belong to increase some addiction or pseudo-addiction to sweet tastes will not be corrected by ponderous and magistral, not to mention unpleasant food directives. Make life fun and good, beautiful and delicious, and then, perhaps, people may eat nicely.

But assuming that a well-conditioned American, who is hesitant anyway to buy prevention, which may be the world’s hardest sale, wants a pill.  Does it have to be a statin?

There have been a lot of criticisms of statin drugs.  Smaller studies, requiring a critical eye to read the validity, etc.  I myself got photophobia (trouble with bright light vision) with one, so I can believe there could be some ocular effects. My liver function change qualified as “drug induced hepatitis.”  I think the universe made me be the sensitive one to collect these side effects so I could speak to something very important.

These drugs are being given to people who are “at risk,” but who are, however, “healthy.”  They are people who are going through life being family members and working members of society and there is a recommendation being made that risks be treated. That means we need to be presenting advantages and risks and if we were doing so in an appropriate way, people should, with a non-negligible frequency, be refusing these drugs. I doubt many of them are. The usually tough sell of prevention seems to be frighteningly easy when a doctor says “this is your cholesterol and it is much too high and we have to lower it so here is the medicine that does this.”  My wide eyed patients who accept welfare payments and who are scared about being around to see the birth of grandchildren are snapping up statins to help themselves stay alive, without a good handle on risk.

I cannot criticize them too energetically, for I did the same for a while in my life.  I keep getting smarter.  I hope other people do.

Raised cholesterol (and a disproportionate amount of “bad” cholesterol) are so ubiquitous in our society that we can find them in adolescents as well as seniors, in active people who would not otherwise need drugs.  Oh, how many get started on this at a “regular” checkup, with no symptoms.

Here is a quick and dirty list of things that can and do go wrong with statin drugs.  I do have to note that everyone seems to agree that both statins and natural substances that lower cholesterol deplete COQ10, a substance that promotes muscle function. Many mainstream physicians and others (and me) will say no matter what kind of stuff
you are taking to lower cholesterol, taking a little COQ10 (at least 30mg. daily) is helpful. Muscle weakness, whether slight or the extreme, 1 in 1000 rhabdomyolysis, does not sound like a good thing.

But wait, there’s more. This class of drugs can seriously affect–the nervous system. Even this relatively conservative website seems obligated to tell us about the effects on the peripheral nervous system, which are “neuropathy” and the effects on the central nervous system which can be “amnesia.”

Peripheral nerves make our limbs do what we tell them to.  I certainly do not want to play with this group of symptoms.  I have had, what I believe to have been a brief bout of neuropathy of metabolic origin, as has my husband. This is getting more common in the population, probably because of the increased frequency of type II diabetes.  Most folks do get diagnosis by a neurologist.  This can be serious stuff, with pain, legs falling out from under you, so if you have the slightest doubt that you have it, this is adequate reason for a serious workup. Do think about the B vitamins for this; especially about the synthetic Vitamin B1 analogue that is liposoluble; that means, fat soluble. Remember all those cells that surround nerves and make them do what they are supposed to do are fat cells, so it makes sense that this special B1 analogue, Benfotiamine, helps many.

It is far more scary to me that this class of medications can cause cognitive loss or even amnesia.  Cognitive loss for age is something that people in America seem to accept as a diagnostic classification and to have stopped fighting, while I feel that in my life and in the life of anyone I know and care about we must fight this strange and alien notion of a “stupiding up” that is supposed to happen to us as we get older. I live by my wits and am nowhere near ready to retire. I love natural cognitive enhancers and natural preservers of neurons, but despite one recent study that statins may help in this regard, how can I believe that one study, in the mess of reports of not just cognitive loss but amnesia?  And believe me, amnesia is never, but never, as much fun as it is in a soap opera.  People who don’t know who or where they are?  Try being even part of a team taking care of one such person, and learn what frustration is, as I have several times.

Instead, look at the side effects and wonder as I have wondered.  In all research, we are looking for our keys under the streetlight because it is the only place we can.  What if statins are making more people than we know about both weaker muscularly and stupider?  What if our general complaints about our population; getting stupider or weaker or fatter, are more prom prescription drugs than we know?

A pharmacologist who once believed in the system, who once thought scientific objectivity was a real possibility, has come of age. That’s me.

At the very least, healthy people to whom drugs with advantages and risks are being offered for prevention ought at the very least to get honest and real discussions of advantages and risks.  There may be some situations in which are warranted.  I have talked to genetically loaded for heart disease permanent couch potatoes who may be still alive because of them.

I have also talked to people who would be better off, I think, taking up dancing and poaching pears.

As always, the problem is grouping and norming and thinking all patients are the same; overgeneralizing from biased research.

The corollary is the bias.  The person or persons with the money call the research. Me, I schlog through life trying to do the best I can for both myself and my patients, having myself cheated death a couple of times. Wanting desperately to get my patients a decent quality of life instead of the miseries they bring in my office; miseries upon which psychotropic drugs may accomplish little.

Vive la France for producing at least one doctor who can call it like it is.

All our patients should have unbiased data, and the opportunity to call their lives like they are.