Statins may have caused the financial breakdown, according to (completely unreliable) experts

In addition to all the good press, statins have also taken a number of hits, but a recent article may have reached a new low by blaming statins for the financial breakdown. Here is how the article, Cholesterol Contrarians Question Cult of Statins, begins:

The near-breakdown of the international financial system and the deep recession it helped create has been attributed to many causes….
Now, a Florida physician proposes an alternative explanation. Perhaps many of those supposedly sophisticated speculators who believed the party would never end were acting under the influence of drugs.
Cholesterol-lowering drugs.
“There’s a damn good possibility it’s related!” said Mark Goldstein, who has been observing his patients’ reactions to statins for the past three decades.


The article appears in Miller-McCune, a magazine and website devoted to policy issues and supported by the founders of the academic publisher Sage Publications.

Although the article includes some mainstream perspective, including an email interview with JUPITER’s Paul Ridker, the vast majority of the text, written by “veteran journalist” Tom Jacobs, repeats a litany of statin criticism familiar to anyone who has monitored the field over the years. Although Jacobs acknowledges that “Goldstein’s provocative thesis” is “highly speculative,” he proceeds to repeat all sorts of accusations about statins, with little or no critical perspective or alternative viewpoints.

The article relies heavily on anecdotal evidence. In once case Jacobs cites UCSD researcher Beatric Golomb, who tells about “an emeritus professor at a major university with an IQ of over 180 who lost the ability to read a page” after starting a statin. “Then his wife took him off the statin. For him, it took two years before he experienced full recovery.”

Editorial comment: I confess to an initial reluctance to draw attention to this article, as just mentioning it may help serve to further the agenda of the extremists and nut cases. In my former incarnation as editor of TheHeart.Org one of my least pleasant duties was patrolling the forum section to prevent the monomaniacal anti-cholesterol pit-bulls  from hijacking and destroying the mainstream discussion we wanted to encourage on the site. Recently the same crowd has attempted and been rebuffed in their efforts to infiltrate the blessedly quiet discussion section here. But just ignoring them won’t make them go away. I believe that the mainstream medical community needs to be aware of these sort of attacks and should be prepared to respond appropriately. Finally, the notion that statins caused the financial breakdown is just too funny to ignore.

Comments

  1. Marilyn Mann says:

    Mark Goldstein has co-authored a number of letters to medical journals attempting to link statins to cancer and other bad stuff. His co-authors include Luca Mascitelli, a member of The International Network of Cholesterol Skeptics (www.thincs.org). I suspect that Dr. Goldstein is a member of THINCS but just hasn’t listed himself as such because he is still practicing medicine. Malcolm Kendrick and Uffe Ravnskov are other well-known members of THINCS. For those who haven’t encountered them, members of THINCS promote the idea that cholesterol levels are not causally related to heart disease.

    I personally have had encounters with some of these people, including Kendrick, Ravnskov, and Mascitelli. Ravnskov told me that the association between heart disease and familial hypercholesterolemia was caused not by high LDL but by a tendency to blood-clotting in some people with FH.

    It is, of course, possible to exaggerate the importance of cholesterol levels. LDL is a fairly weak predictor of heart disease. However, there is a lot of biological evidence that LDL is causal. Of course, the association between FH and heart disease is part of the evidence. By contrast, there was a recent study that found that people with genetically-elevated hsCRP do not have a higher incidence of heart disease. That seems to suggest that CRP may simply be a marker of cardiovascular risk rather than a causal factor.

    Members of THINCS do not necessarily totally deny that statins decrease the risk of heart attacks. Rather, they say that statins act solely through pleiotropic effects (i.e., effects unrelated to LDL-lowering). They have to make this assertion to maintain consistency with their belief that cholesterol and heart disease are unrelated.

    The bottom line is that the cholesterol skeptics cherry-pick and distort the evidence to suit their purposes.

    Harriet Hall on the Science-Based Medicine blog has posted on THINCS.

    Sandy Szwarc of the Junkfood Science blog is at least a sympathizer of THINCS. Check out this page on the THINCS website: http://www.thincs.org/news.htm. Also, a member of THINCS told me that she participates in their discussions.

  2. G Wainwright says:

    Statins can be very useful in short term acute phase treatments. In lipidology there is a whole new wave of research on cholesterol-rich lipid rafts in membrane morphology and function. It is beginning to inform clinical understanding of the way statins work at membrane level and it will really inform our understanding of cholesterol reduction in ways we could only dream of a decade ago. I’d be a little cautious in rushing to judgement until the new and direct evidence from lipidology and the newer squalstatins (squalene epoxidase inhibitors) has been more broadly reviewed.

  3. Malcolm Kendrick says:

    I think I object to it being implied that I am an extremist, and a nut-case, because I happen to argue against the cholesterol hypothesis. People who hold different views to yourself may be wrong. But insulting them does not move scientific debate forward.

    I am a practising medical doctor. I have had articles on statins published in peer-reviewed medical journals. I give talks at BMA and RCGP supported meetings. I am invited to present at the BMA council. I am a peer-reviewer for the BMA.

    I mention this not to blow my trumpet, but to counter the implication that those who are anti-statin are some form of green-ink writing, scientifically illerate zealot. I am certainly not a monomanical anti-cholesterol pit-bull, as you so kindly put it. (In fact, I am a pro-cholesterol skeptic. It is you who is anti-cholesterol – I believe).

    If you wish to have a reasoned scientific debate on the cholesterol hypothesis, and the use (or over-use) of statins, please contact me at any time. I have yet to lose a debate in this area – with anyone.

    Yours truly

    Dr Malcolm Kendrick MbChB, MRCGP.

  4. In response to Marilyn Mann:

    I believe it is now well accepted that LDL is not as clearly associated with CAD as Oxidized LDL. If it turns out the native LDL doesn’t play any role other than to serve as substrate for oxidation, then those who suggest LDL is not a risk factor have a point.

    Perhaps, rather than lowering LDL levels with statins and hoping for the best, we should turn our therapeutic efforts toward preventing the oxidation of LDL.

    Fortunately, we already have a great deal of insight into the dietary and other lifestyle factors that increase LDL oxidation, and this drug-free, low-cost, side-affect-free intervention presents us with an opportunity to enhance patient health and patient care at no risk.

  5. Marilyn Mann says:

    “If you wish to have a reasoned scientific debate on the cholesterol hypothesis, and the use (or over-use) of statins, please contact me at any time. I have yet to lose a debate in this area – with anyone.”

    Untrue. On May 31, 2007, I was witness to a debate between Dr. Kendrick and David Rind, M.D., of Beth Israel Deaconess hospital that took place in a usenet group called sci.med.cardiology. Here is the link:

    http://groups.google.com/group/sci.med.cardiology/browse_thread/thread/d66da66a00d22e9c/4dfbbcea52113253?q=women+and+statins+a+good+debate&lnk=nl

    Please see my comments here:

  6. Marilyn Mann says:

    Hm, the second link seems to have gotten lost. Here it is:

    http://www.youtube.com/watch?v=-Xrr8MjDJ78

    As for native LDL v. oxidized LDL, I am generally aware of that area of research, but it is unclear to me whether the “oxidized LDL” hypothesis is generally recognized or not. In any case, in order to get oxidization of LDL, you first have to have LDL.

    Whether lifestyle interventions alone should be used in a particular person depends on their level of cardiovascular risk and personal preferences.

  7. Marilyn Mann says:

    Arghh, I guess the link is just not going to show up. It is a link to a YouTube video of a talk by Dr. Kendrick entitled “FH (BMA Leeds).” You can google it.

  8. Marilyn Mann says:

    Oops, I had not intended to post the actual video. In addition, I see that Glyn Wainwright, who posted the video on YouTube, has deleted some of my comments. I call that cowardice. In addition, I seem to be prevented from adding any additional comments. Again, cowardice.

    My comment that was deleted was something along the following lines:

    It is important to remember that words can kill. THINCS is similar to HIV/AIDS denialism, to groups that support intelligent design, doubt global warming, claim that vaccines cause autism, believe that the terrorist attacks of 11 September 2001 were an intelligence-agency plot or deny the Holocaust. All use similar tactics. Inadequate health policies in South Africa motivated by HIV/AIDS denialism have reportedly led to some 330,000 unnecessary AIDS deaths and a spike in infant mortality.

    For a study showing the impressive efficacy of statins in patients with familial hypercholesterolemia, see Versmissen et al., Efficacy of statins in familial hypercholesterolemia: a long term cohort study, BMJ 2008;337:a2423.

    http://www.bmj.com/cgi/content/abstract/337/nov11_1/a2423

    For a study showing the current impossibility of predicting premature heart disease in FH patients, see
    Koeijvoets et al., Complex genetics of monogenic familial hypercholesterolemia, Future Lipidology, October 2006, Vol. 1, No. 5, Pages 527-538.

    http://www.futuremedicine.com/doi/abs/10.2217/17460875.1.5.527

  9. Jeff Cable says:

    Ms Mann, I have appended a recent (but necessarily truncated) neuro-psychological test result for a once healthy middle-aged human female, who had been tested, and found to have a normal total cholesterol value but she was treated with statin therapy by her family medical practitioner; regardless of her cholesterol test values.

    Optimal Intellectual Level: 110 ~ 119 (high average range)

    Intellectual functions:-
    Verbal comprehension: 97 (average)
    Perceptual Organisation Index: 87 (low average)
    Working memory index: 100 (average)
    Processing speed index: 75 (borderline)

    Memory functions:-
    Auditory immediate index: 75 (borderline)]
    Delayed index: 67 (very low level)

    Response bias:- 70% of normal. The person is functioning at an impaired level over a range of tests.

    Ms Mann, Instead of you giving the erroneous impression that statins are implicitly wonderful, why don’t you actually discuss the scientific studies that implicate statins in a range of adverse events, from the merely tiresome all the way up to the inconveniently fatal? It would be preferable to your pretending that evidence to the contrary does not exist.

    Cowardice is rather like beauty… it is in the eye of the beholder. Instead of the repeating the tired and worn rubric, about the wonders of statins, you should be addressing the well-documented occurrence of adverse reactions to statins, such as: neuropathies, myopathies, mood changes, ALS-like sequelae, memory loss and severe cognitive difficulties. While you are about it, pray tell us all about the mevalonate metabolic pathway inhibition of dolichols, prenylated proteins, ubiquinone and heme a and then explain how the inhibition of those processes has no effect on human physiology.

    Perhaps you would also care to discuss statin-mediated damage to cells or maybe you would care to discuss the role of cholesterol in the brain and the effect on neurological tissue, when cholesterol production is inhibited. It would be a welcome change from your denigration of Drs Goldstein, Kendrick, Mascitelli and Ravnskov. Sadly, I don’t expect you will cease and desist from continuing with this unseemly smear campaign. It would appear to be the case that much ‘clinical research’, is little more than a tawdry advertorial for the pharmaceutical industry. qv JUPITER , Kastelein et al.

    What about telling us what happened during the Atorvastatin/Torcetrapib trial conducted by Pfizer? I don’t hear you discussing that well-hidden disaster yet you do seem to be on the lookout for shoddy science. Pfizer were forced to halt the clinical trail by the DSMB, because of the unexplained and unexpected increase in mortality.

    Yes, Ms Mann, well you may rail against the the cowardice of any person who is very clearly interested in seeing an honest scientific debate… and obviously someone saw the need for removing your inflammatory and emotional tirade, which had no place in a proper scientific debate. Holocaust denial? Disgusting conduct! Since when did any scientist stoop so low… in what appears, to me, to be a determined effort to crawl in the gutter? You have a lot in common with Kastelein, whom I can recall using a similar tactic in an effort to stifle scientific debate and smear the name and reputation of one particular scientist.

    When you feel like being honest with yourself, then and only then, there will be a proper scientific debate to be had. Until such a time arrives, perhaps you would be kind enough to vacate your pulpit, for your occupancy only serves to discredit you.

  10. Melchior Meijer says:

    To compare scientists who doubt a causal relationship between LDL and coronary heart disease with Holocaust deniers is extremely rude, uncivilized and unscientific. There are many highly credited scientists in Israel, who don’t express their serious doubts about the cholesterol hypothesis because opinions like those expressed by Mrs Mann remind them of something sinister. Unless Mrs Mann is suffering from hysteria or a comparable mental illness, she should apologize. The etiology and pathogenesis of atherosclerosis and CHD are academic questions and should be discussed by using arguments, not religious warfare.

    Those who stubbornly cling to rapidly collapsing paradigms, traditionally have a tendency to play the man, in stead of the ball. When Dr Uffe Ravnskov (http://en.wikipedia.org/wiki/Uffe_Ravnskov) recently eplained his views on Dutch television, Drs John Kastelein and Martijn Katan reacted by spreading irrelevant slander, in stead of attacking the man’s plausible arguments.

    One would almost suspect that these otherwise intelligent people (they were at least smart enough to make it through university) are inhibiting their HMG Co A reductase.

    Melchior Meijer
    Medical journalist, The Netherlands.

  11. Malcolm Kendrick says:

    Dear Marilyn Mann,

    You appear to insist, and persist, in using highly defamatory and insulting language. This makes any debate impossible.

    Unless you are willing to moderate your language, then do not expect me to respond.

    Regards

    Dr Malcolm Kendrick MbChB MRCGP

    P.S. I do not consider posting one comment on a website to be a ‘debate.’

  12. Marilyn Mann says:

    So sue me :).

    Anyone who is interested in learning more about denialism might want to look at the following wikipedia page:

    http://en.wikipedia.org/wiki/Denialism

    In addition, Seth Kalichman has recently written a book on HIV/AIDS denialism, referenced here:

    http://scienceblogs.com/denialism/2009/05/denying_aids_-_a_book_by_seth.php

  13. Jeff Cable says:

    “So sue me”

    Is this what you think scientific debate comprises?

    Words fail me.

  14. This debate is now over, at least on CardioBrief. All future messages will be deleted ASAP.

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