My father developed similar symptoms on statins, which became so severe that he has lost about 70% of his ambulatory function in his legs and will soon need a chair. He's also experienced wasting and fatigue. These symptoms became so severe that his GP finally took him off statins and has now diagnosed him with early onset Parkinsons. Apparently there is evidence emerging of a link between statins and Parkinsons, triggered by the reduction in LDL levels.

Unfortunately hes a very passive and subservient patient and doesn't want to offend the doctor by seeking other treatments or advice. So whatever's going to happen is going to happen.

The horror story by Eades is what I was trying to get at yesterday when talking about the magical bracelet and not taking advantage of someone's desire for health. What in hell has happened to "first, do no harm.". It's as if first, then second, add infinity is milk the sucker (read patient) for everything he's worth, add opiate, repeat, R.I.P.

My wife's doctor dropped her as a patient a fews years ago because my wife refused to fill her statin prescription. We were dumbfounded at the time, but I guess this explains why.

It isn't just statins although they may be one prominent exmple. There are hundreds of drugs, or possibly thousands which either are of uncertain effectiveness, have horrible side effects, or are no better but 30 Times more expensive than medications available over the counter.

Most medical practices in the US have no financial incentive to write prescriptions. This is completely inflammatory and not consistent with the way the vast majority of phsicians in the US get paid. When a phsician writes a prescription and the patient goes to Walgreens to fill it, how does he get paid?

Just because this one physician has some unusual relationship with an insurer and gets paid for "quality measures" doesn't make that a common financial relationship in the US.

In addition, one can question the benefits of statins, but it is also not helpful to exaggerate the side effects. You are equally guilty in the same overreach as those that exaggerate the benefits of statins. Many randomized studies have shown that a minority of patients have significant side effects as compared to placebo.

http://www.ncbi.nlm.nih.gov/pubmed/7968073

No benefit for anyone?

it is also not helpful to exaggerate the side effects. You are equally guilty in the same overreach as those that exaggerate the benefits of statins.

I'm not. I've looked into this because a doctor wanted to put my boyfriend on statins, and I refused to let him. (Boyfriend lets me help with medical decisions since I'm more informed on and connected to the science than he is, by far.)

All drugs have side effects. Statins have many and for most people, do not have an upside.

Go to Dr. Eades' site and search statins: http://www.proteinpower.com/drmike/

I am very familiar with Gary Taubes and Dr. Eades work and agree with them completely. We are not talking about cholesterol here. We are talking about the effect of statins.

We can debate why statins work. Is it because it lowers LDL? (I doubt it) Is it because they lower inflammation? Or is it some other novel mechanism. The point is that statins have been shown to improve survival in middle-aged men with heart disease. Which is alot of people!!!!

I believe you are confusing the effects of people's blood lipids and the effect of a drug and heart attacks. These are two separate issues. This mistake of confusing the diet-heart hypothesis, medication effect, and the lipid-heart hypothesis is now being made by both sides of this debate.

Are too many young people put on statins? Absolutely. Do statins cause side effects? absolutely, but they are rare and easily cured with stopping the drug.

Are statins effective for primary prevention for heart disease? Probably not.

I think you are making a huge leap that doctors are making money prescribing statins unnecessarily and that no one benefits from these drugs. In addition, a vast majority of statin prescriptions today are written for generics and to do not benefit big pharma.

Leave Jason alone, he is right in assuming the government wouldnt lie.

I for one belived the gov when thy said eggs were bad for your health, and I belived them when the gov said they were good, and then bad again, and then good. . . ummmmm

But wait, remember after 9/11 when people were worried about the dust and smoke from the buning debis and we were told there would be no adverse health effects in returning to work? Oh wait.

You know Jason, now that I think about it your stance is fairly stupid

What does the govt have to do with it?

These are guidelines promoted by insurance companies like blue cross, cigna, aetna, humana, etc. Last I checked these are all private corporations.

The question that this blog post tried to raise was do physicians get financially rewarded for prescribing statins? The answer is, except in rare situations, NO.

Are some physicians misinformed about statins? yes

Are they over-prescribed? probably

The more interesting scientific issue is why do statins save lives in middle-aged men with heart disease. What is the effect? If it isn't due to there cholesterol effects, then what is it?

Statins, like any medication, are a weighing between risks and benefits. The short of it is, the higher the cholesterol (in a population) the more heart disease and stroke there is. However note, what has been considered ‘normal’ has been a lowering bar over the decades (in the 60-70s, you were fine as long as you were below 300; 80-90s, you better be below 200s; now we are looking at ridiculous figures lower than 160, or even down to 120, if you are ‘at high risk’). There is good, solid evidence that having high cholesterol (i.e. high LDLs, which tend to accumulate in the muscular layer of the arterial wall) will lead to accumulation of plaques. It absolutely will cause accumulation of cholesterol plaques and large population studies confirm this (especially the autopsy studies after the Vietnam war). This in turn may lead to heart attacks and strokes. Emphasis on may. However, having low cholesterol is also bad since every cell, every nerve fiber in your body is basically based on having cholesterol stuffed in its cellular membrane to function properly. Cholesterol is necessary for normal operation and is there for a very good reason (that is why your liver produces it on a daily basis, and will respond by producing less if you eat more cholesterol).

But this is not to discount the effects of statins in those with higher cholesterol and reducing the incidence of heart attacks and strokes. However, it is not necessarily the lowering of cholesterol that reduces the risk—it is the anti-inflammatory effects. Fun fact: about a third of patients in the ICU who have had a heart attack or stroke will have normal cholesterol levels. This flies in the face of all the talk about lowering cholesterol making things better (an ‘inconvenient truth’ that tends to be forgotten in clinical practice). But what improves outcomes is reducing inflammation.

In actual practice seldom do you see a patient who has symptoms that are ascribable to a slowly clogging vessel that becomes blocked off. Most patients will have no symptoms until something happens, that something being a vessel which suddenly decides to clot off (please forgive this gross simplification—but in fact we really don’t know much more than that). Inflammation is intimately tied to vessels clotting off and cholesterol plaques are very, very pro-inflammatory. Having high (and I mean actually high, as in above 300 levels, cholesterol makes this more likely but having normal, or even low, levels of cholesterol don’t save you either). This is why statins help people more after they have a heart attack/stroke. But again with confounding variables: are statins helping reducing inflammation in general or just helping out people who are very ‘pro-inflammatory’ that tend to have high cholesterol?

But to the story and the fallacy of ‘algorithm-based’ medicine. In order to force these ‘standards’ down the doctor’s throat perverse incentives are introduced: if you follow the current ‘evidence-based’ standards you will get paid more. The algorithm is very straightforward: cholesterol high = statins; increase dose until cholesterol in ‘normal’ range. In reality, this is not a concern for a physician and our paycheck. The incentive is a small increase in pay (especially with Medicaid or Medicare, as in you don’t notice it in your monthly check). However, the disincentive is a large deduction in (or complete removal of) pay since you are no longer following ‘the standard’ (whither that standard is logical or not).

I don't know where this rumor began.

Medicare or Medicaid do NOT pay physicians for treating high cholesterol or prescribing statins.

The only bonus physicians get from Medicare is for having an electronic medical record. This was part of the stimulus bill.

Physicians in the US in most practices get paid fee-for-service. They get paid for office visits, procedures, interpreting x-rays, etc. They have no financial incentive to prescribe anything!!!

The only providers that do get paid for administering drugs are oncologists who give chemotherapy.

Jason, you are missing something. If everything most people need was either avaiable over the counter or a pharamacist could prescribe it, how many fewer doctor and hospital visits would there be per year?

Also when you are prescribed a drug that has possible dangerous side effects, who is the person who can not only require you to make several office visits per year to get your prescription renewed and of course, also order all the lab work you need to make sure the perscription drug is not damaging your liver and is, of course, lowering your cholesterol? Thats right, the same person who has been granted a government monopoly, also known as a medical license to provide you care.

It is in every physicians best interest to have you in that office as often as possible. That is how they make money. Whether or not they get a kickback on the drugs is actually immaterial. The pharmaceutical companies wine and dine these guys, and gives out free samples to try and insure that the physician picks their name brand product instead of telling a patient to lose weight, lose the cigarettes, and park the freakin car.

Maybe a dead thread but...

Some medicaid/care pilot programs do offer up minor financial incentives (and I do mean minor, but may add up if you do the same thing with all your patients). I don't participate in those programs so I don't know what the incentive is but have heard things like an increase in the office visit pay. But when you are getting paid $52 for 25 minutes and they 'add' $2-3 this is a token economy rather than a blatant incentive; however, if you do this to 200, 300, 500 patients then you may actually see a difference...of a hundred dollars a month after you pay for everything else Medicaid/care underpays for. HOWEVER, the perverse negative incentive is they won't pay you at all if they don't like how you have 'treated' a patient (to whatever standard of 'treated' they decide is 'standard').

I am very concerned. Both my mother and grandma are on statin's... and are dealing with things that could be side effects. I just spoke to my mom,,, and guess what? She didn't want to listen. She thinks if a doc prescribes something.. well then that doc knows better... OMY! Very annoying to hear her say this....

TO: Amy Alkon, et al
RE: On Statins

Heh. My GP gave me statins some years ago because of his concern for my cholesterol. Some months later I noticed I:

[1] Was much more tired than I used to be.
[2] Couldn't work-out on a regular basis, as I used to.
[3] Couldn't write computer code anymore.
[4] Began forgetting the names of common household items and friends.
[5] Began speaking like Yoda....

If Yoda in Force so strong, how come Yoda, in proper order, words cannot put.

I gave up on the statins. Took me YEARS to get back to the point I could write computer code again.

I've mentioned this to a number of others and they—not being into writing computer code—mentioned that they've experienced similar circumstances.

Now....I don't claim to be some sort of Jedi-master, let alone of the Unix 'school', BUT having a degree in microbe—with an emphasis on pathogens—I can recognize a pattern of behavior amongst a certain group, e.g., people on statins.

There's something VERY WRONG going on with this business and I suspect that the vaunted American Medical Industry is very much aware of it, but won't tell US about it.

Welcome to the world of 'conspiracy theory'.....

Regards,

Chuck(le)
P.S. What does this have to do with that discussion down-the-hall from here regarding medical practices and whether or not the practitioners are telling US the truth? Eh?

P.PS. I LOVE the phrase "all-cause mortality".....

....as the emphasis of the vaunted American Medical Industry's claim that statins are 'good' for you.

Why is it that such think that just being merely 'alive' is 'good', if you're in a nearly vegetative state?

9/11/2001 a day when terrorists wanted to send us a message. 9/11/2010 i unfriended Osama Bin Laden on facebook. WE WON!

I am 76, and healthy! Always had a somewhat "elevated cholesterol" for the past X number of years since the "cholesterol watch" kicked in. My Dr's consistently recommended statins. I consistently declined. I am glad I did. My cholesterol is still the same. My heart is in great shape. If I kick the bucket, it will not be for lack of having taken statins. It will be because I will have kicked the bucket even if I had taken statins. Big pharma is powerful, there is a lot of money involved, and money has unmatched persuasive power, AT ALL LEVELS. Take care of YOURSELVES.