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Putting More Americans on Medication


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#1    QuiteContrary

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Posted 12 November 2013 - 10:14 PM

I am not interested in arguing the profiteering of pharmaceutical companies, the article claims they won't make much.

I am interested in this "more meds given to more people, more procedures done on more people, more Big Brother type monitoring, and less choice (with repercussions if you opt out)" becoming a growing  trend.

How do you feel about this? Could your physician drop you if you refuse to follow his suggestion to take a statin or other recommendation? Could you loose insurance coverage if you refuse to follow your physicians recommendations? Could a physician who doesn't prescribe enough meds and procedures lose her license?

How far will this go? How much choice should we have over our own bodies?

I understand the concern with health care costs being out of sight. Insurance costs escalating. Loss of work, etc., cost on society. But how far should our lives be managed and homogenized and all of our bodies' "numbers" adhering to some range, to make it less costly on society and possible live a bit longer?

And why can't I chose, without repercussions, whether or not l (possibly?) extend my life by a couple years?

This is just scary to me. And to make it clear I vaccinated all of my children. I get flu shots. I have even gotten boosters for old vaccines I already got as a child but are now recommended for adults to update. I am on one blood pressure medication and an antidepressant and Vitamin D. So I am not asking this from a fear or disdain of Western Medicine perspective.

Although, I believe we need to be our own health advocates and do our research. And not blindly follow something because it came out of a doctor's mouth. Anyone who has dealt with the medical community frequently or for very long, hopefully also comes to realize this.

Here is the article:

http://www.cnn.com/2....html?hpt=hp_t2

Edited by QuiteContrary, 12 November 2013 - 10:19 PM.

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#2    travelnjones

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Posted 12 November 2013 - 10:26 PM

I hate the whole alternative medicine thing and what not.  My medicine allows me to cheat death for a few days a dose, so I am pretty fond of it.  But this is crazy, statins are awful drugs.  My 2nd cousin had serious reactions where it damaged is muscles.  My wife was constantly exhausted, her doc wouldn't even consider that it was the statin based drugs.  I was basically left a single parent when she was on them.  This is bad news and the science needs to be seriously reviewed for veracity.


#3    aquatus1

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Posted 12 November 2013 - 10:38 PM

Much like everything that isn't a hard science, I imagine it will go with the "What would a reasonable person conclude?" standard, as applied by your peers (in extreme cases, 12 of them).

When all is said and done, the greatest consideration is not going about individual desires, but about society as a whole.  You can walk around thinking you are Big Bird for all the federal or state government cares; it is only when your actions affect others that it has to step in.

On the political side, groups like the NRA have a vested interest in pushing for greater power and consequences in the hands of mental health professionals.  Economically, insurance companies would also like to see this occur.  Socially, the idea of a population a little closer to the mean average instead of "high risk neighborhood" would certainly appeal to most parents.


#4    QuiteContrary

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Posted 12 November 2013 - 11:10 PM

View Posttravelnjones, on 12 November 2013 - 10:26 PM, said:

I hate the whole alternative medicine thing and what not.  My medicine allows me to cheat death for a few days a dose, so I am pretty fond of it.  But this is crazy, statins are awful drugs.  My 2nd cousin had serious reactions where it damaged is muscles.  My wife was constantly exhausted, her doc wouldn't even consider that it was the statin based drugs.  I was basically left a single parent when she was on them.  This is bad news and the science needs to be seriously reviewed for veracity.

It affected my mother's back muscles too, and she traveled a weird medical road (almost getting her gallbladder taken out) before her physician admitted it was the statin and took her off of it.

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#5    QuiteContrary

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Posted 12 November 2013 - 11:24 PM

View Postaquatus1, on 12 November 2013 - 10:38 PM, said:

Much like everything that isn't a hard science, I imagine it will go with the "What would a reasonable person conclude?" standard, as applied by your peers (in extreme cases, 12 of them).

When all is said and done, the greatest consideration is not going about individual desires, but about society as a whole.  You can walk around thinking you are Big Bird for all the federal or state government cares; it is only when your actions affect others that it has to step in.

On the political side, groups like the NRA have a vested interest in pushing for greater power and consequences in the hands of mental health professionals.  Economically, insurance companies would also like to see this occur.  Socially, the idea of a population a little closer to the mean average instead of "high risk neighborhood" would certainly appeal to most parents.

I am not sure I understand your post. My fault, not yours.

Medicine isn't a hard science? They are making it one it seems to me, thus my OP.

The Greater Good: At what cost and to what limit? This is a slippery, subjective and totalitarian slope, imo.

Alcohol costs us dearly in health care, accidents, crime and auto insurance. How would the majority feel if it were next on the "greater good"  hit list?

Where do we stop? How can you fight the insurance companies who drop you because you refused doctor prescribed treatment? Who would judge your case: Peers? or Members of the medical community?

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#6    aquatus1

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Posted 13 November 2013 - 12:15 AM

View PostQuiteContrary, on 12 November 2013 - 11:24 PM, said:

I am not sure I understand your post. My fault, not yours.

That's the beauty of a discussion forum.  :tu:

Quote

Medicine isn't a hard science? They are making it one it seems to me, thus my OP.

Nonetheless, it is not.  What you see in this article is less medicine as a science and more "patient-wrangling".

Quote

The Greater Good: At what cost and to what limit? This is a slippery, subjective and totalitarian slope, imo.

Hmm...no, not the "Greater Good", with all of the moralistic baggage it carries with it.  Rather, people who are not able to control their actions to the point they harm others are removed until they can.  It is a rather fundamental reason why we live in a society to begin with.

Quote

Alcohol costs us dearly in health care, accidents, crime and auto insurance. How would the majority feel if it were next on the "greater good"  hit list?

It has already been there, and this time in every sense of the "Greater Good" moralistic argument.  Prohibition has been attempted and failed several times throughout history.

That said, I am not sure it is a valid comparison, using a depressant available for mass consumption over the counter for entertainment purposes and comparing it to a situation-specific pharmaceutical prescription for a professionally diagnosed medical condition.

Quote

Where do we stop? How can you fight the insurance companies who drop you because you refused doctor prescribed treatment? Who would judge your case: Peers? or Members of the medical community?

It depends on the fight you are talking about.  You have multiple scenarios up there.  One is insurance vs insured.  The other is doctors vs insurance.  The third is doctors vs patients.


#7    Lilly

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Posted 13 November 2013 - 12:24 AM

With any medications you are supposed to weigh the risks and the benefits. Statin drugs do indeed lower Cholesterol levels, but they can also affect the liver and raise the risk of type 2 diabestes (especially in older females). So if my total Cholesterol was 330 I'd probably consider a Statin...but if my Cholesterol was like 230, no way. Just passing these drugs out to all older people with slightly high levels is not warranted. Also, if someone is having reactions to these drugs they most certainly should be taken off them. There really needs to be a return to common sense and the decisions need to left to the individuals being treated...no one else.

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#8    QuiteContrary

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Posted 13 November 2013 - 01:09 AM

View PostLilly, on 13 November 2013 - 12:24 AM, said:

With any medications you are supposed to weigh the risks and the benefits. Statin drugs do indeed lower Cholesterol levels, but they can also affect the liver and raise the risk of type 2 diabestes (especially in older females). So if my total Cholesterol was 330 I'd probably consider a Statin...but if my Cholesterol was like 230, no way. Just passing these drugs out to all older people with slightly high levels is not warranted. Also, if someone is having reactions to these drugs they most certainly should be taken off them. There really needs to be a return to common sense and the decisions need to left to the individuals being treated...no one else.

Yes, I agree. But the new guidelines say cholesterol over 190 should be prescribed a statin.

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#9    QuiteContrary

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Posted 13 November 2013 - 01:17 AM

View Postaquatus1, on 13 November 2013 - 12:15 AM, said:

That's the beauty of a discussion forum.  :tu:



Nonetheless, it is not.  What you see in this article is less medicine as a science and more "patient-wrangling".



Hmm...no, not the "Greater Good", with all of the moralistic baggage it carries with it.  Rather, people who are not able to control their actions to the point they harm others are removed until they can.  It is a rather fundamental reason why we live in a society to begin with.



It has already been there, and this time in every sense of the "Greater Good" moralistic argument.  Prohibition has been attempted and failed several times throughout history.

That said, I am not sure it is a valid comparison, using a depressant available for mass consumption over the counter for entertainment purposes and comparing it to a situation-specific pharmaceutical prescription for a professionally diagnosed medical condition.



It depends on the fight you are talking about.  You have multiple scenarios up there.  One is insurance vs insured.  The other is doctors vs insurance.  The third is doctors vs patients.

I understand now :) . And I realize I confused the "statin" topic with too many scenarios. BUT that is essentially what my OP was meant to get at... Ultimately, where does it end? How much freedom will you give up? I saw this article as a scary stepping stone to who knows what and who knows where.

As far as Prohibition- It is like the food police trying to restrict our food choices to avoid costly (to society) health issues. That is a huge scenario (food restriction laws ) to tackle, yet we are hearing about attempted legislation all the time.

Edited by QuiteContrary, 13 November 2013 - 01:21 AM.

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#10    aquatus1

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Posted 13 November 2013 - 04:37 AM

View PostQuiteContrary, on 13 November 2013 - 01:17 AM, said:

I understand now :) . And I realize I confused the "statin" topic with too many scenarios. BUT that is essentially what my OP was meant to get at... Ultimately, where does it end? How much freedom will you give up? I saw this article as a scary stepping stone to who knows what and who knows where.

A common problem, as I see it, is that people think of Freedom as if it were some finite resource, or something that can be measured on a scale ranging from Totally Free to Absolute Slavery.  The more you think about it, though, the harder it is to reconcile this sort of measurement system with reality.

Where does this range begin?  Was there some period in time when we never had to worry about someone telling us what to do?  How much freedom are you willing to give up begs the question of how much freedom do you actually need;  Is more freedom necessarily better?  If we voluntarily give up a freedom, isn't that our freedom at work?  If we willingly accept slavery, doesn't that mean we have chosen our destiny?

These are the sort of paradoxes on gets when one assumes a priory, that freedom is a fixed point from which we either lose or gain...freedom mass, energy, juice, whatever freedom is measured in.  Why, then, do so many people just automatically think this way?

In large part, the problem lies in confusing the two definitions of "freedom" itself:  Freedom can mean the ability to act, speak, and think, in a manner in which one chooses, and it can also mean a state in which one is not imprisoned or enslaved.  It does not, however, have to mean both things at the same time.  The assumption that it does is what causes the above confusion.

Don't think of this as some kind of scale where we have to decrease the amount of freedom if we wish to increase the amount of security.  That kind of linear thinking leads to little other than internal conflict.  Think of this, rather, as a reformulation.  Society has changed, and so we have to reformulate the social norms to match it.  Freedom is little more than a state of satisfaction with current society.  If some factor makes the society unsatisfactory, and a new law can re-balance it, people will be satisfied again.  This doesn't mean they have made themselves slaves to the new law.  It simply means that their world now includes a new danger, and a new law helps even out that danger.

Quote

As far as Prohibition- It is like the food police trying to restrict our food choices to avoid costly (to society) health issues. That is a huge scenario (food restriction laws ) to tackle, yet we are hearing about attempted legislation all the time.

Except the temperance movement wasn't about health issues.  It was about morality.  You can't mix the two.  They are fundamentally different both in nature and in social acceptance.  To follow the above explanation, Medical issues are physical and objective; they are real and present "danger".  Creating a rule to control it balances out the danger.  Morality issues, on the other hand, are only real to a particular group of people.  Making a rule without a danger to balance it out will make the rule itself a possible danger.

The same thing is happening here.  You are, essentially, wondering if the danger posed by health issues merits a new rule to control it.  If this were merely a medical issue, you would eventually accept it, much the same way you accepted the whole vaccination issue.  However, you feel that there might be a moralistic dilemma in there.  You feel that if the danger presented by the health issue isn't sufficient to merit a new rule, then a new rule would be a danger itself (a "slippery slope" as you put it).


#11    QuiteContrary

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Posted 13 November 2013 - 10:13 PM

View Postaquatus1, on 13 November 2013 - 04:37 AM, said:

A common problem, as I see it, is that people think of Freedom as if it were some finite resource, or something that can be measured on a scale ranging from Totally Free to Absolute Slavery.  The more you think about it, though, the harder it is to reconcile this sort of measurement system with reality.

Where does this range begin?  Was there some period in time when we never had to worry about someone telling us what to do?  How much freedom are you willing to give up begs the question of how much freedom do you actually need;  Is more freedom necessarily better?  If we voluntarily give up a freedom, isn't that our freedom at work?  If we willingly accept slavery, doesn't that mean we have chosen our destiny?

These are the sort of paradoxes on gets when one assumes a priory, that freedom is a fixed point from which we either lose or gain...freedom mass, energy, juice, whatever freedom is measured in.  Why, then, do so many people just automatically think this way?

In large part, the problem lies in confusing the two definitions of "freedom" itself:  Freedom can mean the ability to act, speak, and think, in a manner in which one chooses, and it can also mean a state in which one is not imprisoned or enslaved.  It does not, however, have to mean both things at the same time.  The assumption that it does is what causes the above confusion.

Don't think of this as some kind of scale where we have to decrease the amount of freedom if we wish to increase the amount of security.  That kind of linear thinking leads to little other than internal conflict.  Think of this, rather, as a reformulation.  Society has changed, and so we have to reformulate the social norms to match it.  Freedom is little more than a state of satisfaction with current society.  If some factor makes the society unsatisfactory, and a new law can re-balance it, people will be satisfied again.  This doesn't mean they have made themselves slaves to the new law.  It simply means that their world now includes a new danger, and a new law helps even out that danger.



Except the temperance movement wasn't about health issues.  It was about morality.  You can't mix the two.  They are fundamentally different both in nature and in social acceptance.  To follow the above explanation, Medical issues are physical and objective; they are real and present "danger".  Creating a rule to control it balances out the danger.  Morality issues, on the other hand, are only real to a particular group of people.  Making a rule without a danger to balance it out will make the rule itself a possible danger.

The same thing is happening here.  You are, essentially, wondering if the danger posed by health issues merits a new rule to control it.  If this were merely a medical issue, you would eventually accept it, much the same way you accepted the whole vaccination issue.  However, you feel that there might be a moralistic dilemma in there.  You feel that if the danger presented by the health issue isn't sufficient to merit a new rule, then a new rule would be a danger itself (a "slippery slope" as you put it).

The individual has had their freedom restricted or regulated ever since there were two or more humans living side by side, would be my guess.

Even if a part of the ebb and flow of society that we all then adjust to over time, that doesn't mean this has never come at too high a price for a society as a whole, or a gender, or a race, or special interest group, etc. And all with absolutes, even "science" to convince the populace and to back up the restrictions.

For me, this is an important issue. And the last thing I want to do is roll over and take any restrictions as they come because someone in power tells me it is best for society as a whole. Otherwise, why have elected officials and voting in general? Or think for myself.

And restrictions/laws/consequences, no matter how much data and science seem to back them up, can still be at the mercy of profit, power, control, the sqeakiest wheel, a party agenda, etc.

That is the problem. We are a society, yes, but we are composed of individuals, and when you tell everyone to behave and do the same, not everyone will accept A (a statin) just because they've accepted B (vaccinations) and D (flu shots) or accept E just because they've accepted F and G. And that is as it should be.

Prohibition may have been thought of as a moral issue in the past, but it can easily be argued as a health and cost and safety issue today, just as trans fats or statins or vaccinations or seatbelt laws or DUI checkpoints etc.

Edited by QuiteContrary, 13 November 2013 - 10:15 PM.

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#12    White Unicorn

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Posted 13 November 2013 - 10:59 PM

View PostLilly, on 13 November 2013 - 12:24 AM, said:

With any medications you are supposed to weigh the risks and the benefits. Statin drugs do indeed lower Cholesterol levels, but they can also affect the liver and raise the risk of type 2 diabestes (especially in older females). So if my total Cholesterol was 330 I'd probably consider a Statin...but if my Cholesterol was like 230, no way. Just passing these drugs out to all older people with slightly high levels is not warranted. Also, if someone is having reactions to these drugs they most certainly should be taken off them. There really needs to be a return to common sense and the decisions need to left to the individuals being treated...no one else.

Agree. We are individuals and no one medicine works the same for everyone. What's risky to one isn't another. My pet peeve in the system is the wellness programs seem to insist on statin to your doctor even if you react to them! Years ago I had high blood pressure and chloestrol.  I stopped the blood pressure meds when it went normal and gee it stayed normal. My chloestreol went really low from 300 to 140-150 and I felt sick and had borderline diabetes and muscle reactions and even rashes with some types. Lost my gall bladder too. Later I was in a NIH program and they said, stop the statin after they saw my genetic makeup. My levels only elavated to 170-190 at the most in the years that followed, but the wellness program insisted on trying new statins on me or he wasn't being a good doctor more or less. Reacted and he took me off, I'm at still 170-180.

Moral of the story is,  I think they are great if your levels are sky rocketing and at risk, but what makes every body in preventive health care think they should be a normal long term preventative drug? Antibiotics are great when your really sick but you don't make them routine or long term for generally healthy people or animals. You see where there got us!


#13    aquatus1

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Posted 14 November 2013 - 12:25 AM

View PostQuiteContrary, on 13 November 2013 - 10:13 PM, said:

The individual has had their freedom restricted or regulated ever since there were two or more humans living side by side, would be my guess.

Correct.  We see then, that "freedom" is not an absolute term; It depends not on a vague set of prefixed points, but rather on an overall level of satisfaction with the life that one is living.

Quote

Even if a part of the ebb and flow of society that we all then adjust to over time, that doesn't mean this has never come at too high a price for a society as a whole, or a gender, or a race, or special interest group, etc. And all with absolutes, even "science" to convince the populace and to back up the restrictions.

Can you give us an example of a scientific absolute that resulted in a restriction that came at too high a price?

Quote

For me, this is an important issue. And the last thing I want to do is roll over and take any restrictions as they come because someone in power tells me it is best for society as a whole. Otherwise, why have elected officials and voting in general? Or think for myself.

Freedom is a very important issue to everyone.  That is not in question.  The question is whether this is a situation in which freedom is actually an issue. or whether this is a reasonable rule.

Quote

And restrictions/laws/consequences, no matter how much data and science seem to back them up, can still be at the mercy of profit, power, control, the sqeakiest wheel, a party agenda, etc.

More than agreed.  U.S. prisons are bloated with people who would never have even been considered for jail time prior to the privatization of the prison system.  Indeed, I suspect many who would never have progressed further down the criminal path were more encouraged by their time behind bars, rather than veered off.

Again, that is why we discuss.  Knowing no more than what has been presented, I suspect this has less to do with freedom, or even medicine, and more to do with doctors finally paying attention to the long-neglected field of psychology in order to get their patients to take their medication.

Quote

That is the problem. We are a society, yes, but we are composed of individuals, and when you tell everyone to behave and do the same, not everyone will accept A (a statin) just because they've accepted B (vaccinations) and D (flu shots) or accept E just because they've accepted F and G. And that is as it should be.

Agreed.  Rule the masses, persuade the individuals.

Quote

Prohibition may have been thought of as a moral issue in the past, but it can easily be argued as a health and cost and safety issue today, just as trans fats or statins or vaccinations or seatbelt laws or DUI checkpoints etc.

True.  That said...

For some inexplicable reason, tobacco and alcohol have a place in the human condition that far exceeds that of pretty much any foreign substance we regularly ingest into our bodies.  While I am willing to argue the OP of this thread with different medical examples, the role of tobacco and alcohol in our society could take up an entire thread of its own, and I think would be too unwieldy to put on the table here.


#14    lightly

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Posted 14 November 2013 - 01:38 AM

View PostQuiteContrary, on 13 November 2013 - 01:09 AM, said:

Yes, I agree. But the new guidelines say cholesterol over 190 should be prescribed a statin.

   i have to wonder about the validity of  "new guidelines"    ..  what was an acceptable range of blood pressure   ,etc,   is  no longer acceptable.   It just seems like way too many people are being prescribed drugs for what are described as    Borderline    conditions, instead of being urged to Immediately change the diet and lifestyle  choices that are usually the cause of the problem .

  I'm shocked to see how many people are being  Prescribed  mood altering drugs.    They help some people,  but i've seen them make people act really weird  .. Much worse  than the  minor depression or anxiety or whatever they were  experiencing .

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#15    Copasetic

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Posted 16 November 2013 - 12:21 AM

View PostLilly, on 13 November 2013 - 12:24 AM, said:

With any medications you are supposed to weigh the risks and the benefits. Statin drugs do indeed lower Cholesterol levels, but they can also affect the liver and raise the risk of type 2 diabestes (especially in older females). So if my total Cholesterol was 330 I'd probably consider a Statin...but if my Cholesterol was like 230, no way. Just passing these drugs out to all older people with slightly high levels is not warranted. Also, if someone is having reactions to these drugs they most certainly should be taken off them. There really needs to be a return to common sense and the decisions need to left to the individuals being treated...no one else.

230 is a borderline total cholesterol number and in itself wouldn't warrent statin therapy. Above 240 mg/dl your 10 year risk for coronary associated mortality doubles that of someone the same age and gender as you who's total cholesterol is below 200. In reality the likelihood you need a statin isn't based on your total cholesterol though. What's more important that your docotor looks as is your LDL cholesterol (specifically your LDL-C) which is your "bad" cholesterol. Probably even more important than that is the ratio of your HDL cholesterol ("good" cholesterol) to your LDL cholesterol.

This is still only part of the story. When assessing risk we actually look at many other factors than just your HDL and LDL. Specifically CVD risk factors like; gender (males >44, females >54), diabetes, CHD in first degree relatives, previous history of MI/CAD/angina/PTCA/CABG, smoking and hypertension. We can calculate risk based on the Framingham risk score (hard science numbers @ aquatus :tsu: ).



View PostQuiteContrary, on 13 November 2013 - 01:09 AM, said:

Yes, I agree. But the new guidelines say cholesterol over 190 should be prescribed a statin.

Well not quite. You need to specify what type of cholesterol we are talking about. LDL-C levels above 190 are what the guidelines are talking about and 190 for your LDL is high! Real high! There is a significant increase in cardiovascular assoicated mortality in people with cholesterol above 190 and this is particularly high in people who have high cholesterol levels at young ages (because of their genetics, not just a life time of crappy eating).

The guideline actually reads however;
"In patients with LDL ≥190 mg/dL, provide a high-intensity statin unless contraindicated or not tolerated.".

The key there being if the patient doesn't tolerate the medication, they shouldn't be on it (actually your physician should try a different statin, because very few people have class-reactive side effects, its normally statin specific--which means those patients that need to be on statins still potentially can).

Every 39 mg/dl reduction in LDL-C, below 190 mg/dl correlates to about a 20% reduction in cardiovascular associated risk mortality. That is big time results, especially given that CAD leads all-cause mortality in the US.

Statins also have other benefits outside of lowering LDL levels (which means less LDL deposition in endothelium), they stabilize plaques. Stable plaques are happy plaques and less likely to end up rupturing. Which means the patient is less likely to end up on my cath table at 2 in the morning and having me trying to reperfuse areas of their heart.

Statins are good drugs, but like all drugs have side effect profiles and their benefit must be weighed against their cost (like all drugs). Probably 99% of my CAD, high risk for CAD and NSTEMI/STEMI patients are good candidates for statins. The majority of those tolerate a statin (note; not every statin, but at least 1 in the class) well.





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