So, much to my surprise when returning to the nutrition forum to find a recipe, this thread was still on the front page! And boy, have you fellas been busy.
First thing’s first, to my pal storey. It’s amusing to me how you have the balls to resort to ad hominem attacks straight off the bat, and then you call ME a prick? As if that weren’t good enough, in the same sentence you call me “laughably unknowledgeable” IN THE FIELD OF MEDICINE?? Listen, I understand that you have your convictions, ill-advised as they may be, but seriously? Do you tell your auto mechanic how to do his job? Do you instruct teachers on how to teach? No? So why are you trying to tell doctors how to do theirs? I think you missed the entire point of what I was saying, strictly because you couldn’t get your mind off the idea that someone could possibly disagree with your feelings on the matter.
A quick aside: unfortunately for you, my own credentials aside, I also have years of published clinical research and results from thousands of physicians backing up what I’ve been saying here. I read the New England Journal of Medicine in its entirety every single week. Believe me, I’m up to date. And you’re going to give me a WebMD article to read to make your point in your disingenuous rant? That is laughable, at best. NOW I’m being smug, but at least I’m not the guy pretending I know better than all of the board certified physicians and researchers of the west.
Now that we have that out of the way, let’s get to the nitty gritty since you clearly chose to ignore the majority of the content of my posts. What you lack in reading comprehension you certainly make up for in righteous indignation, so I’ll hold your hand as we go through this.
First, and I do not know how I can make this more clear to you than I thought I had in my posts: DRUG THERAPY IS A LAST RESORT. DRUG THERAPY IS NEVER THE FIRST ANSWER. DRUG THERAPY IS SOMETHING THAT ONLY BECOMES NECESSARY WHEN PATIENTS REFUSE TO MAKE CHANGES TO THEIR UNHEALTHY LIFESTYLES. When I see someone’s weight and blood sugar creeping up in their chart, I talk to them about managing their weight through diet and exercise, and the consequences of not doing so. Unfortunately, 9 times out of 10, the next time they come in, things have only progressed to a worse state. After a while, to NOT prescribe something would be a dereliction of duty and not fulfilling the standard of care. There are two reasons to do get them on therapy: 1) current research (and personal experience) justifies it and shows the utility to be FAR better than not doing so, and 2) I’m not interested in a lawsuit, which you bet your ass will come from the patients family when the patient dies of a heart attack at 50 DESPITE ignoring medical advice for years on end.
Yeah, if I could follow the patient around 24/7, throw away all of their cigarettes, stop them from drinking so much, force them to eat clean organic food, and exercise, I’d probably make a lot more progress staving off the progression of diabetes, hypertension, hyperlipidemia, and other chronic disease (and, by the way, this ENTIRE discussion is ignoring the existence of IDIOPATHIC disease of UNKNOWN etiology that affects otherwise healthy individuals, for which drug therapy is an especially good option. See my previous post on my own personal health for a tidbit on that). Unfortunately, doing so is absolutely impossible while simultaneously providing care for a large population with a dwindling number of doctors.
Do you get it now? I’m not a pharma rep. I am left with no choice. I’m not a life coach, I’m a doctor.
Moving along, you are correct in your assertion that the link between cardiovascular risk and cholesterol is not a crystal as once thought. That does not, however, immediately invalidate years of experience and better outcomes caused by treating it as such. In fact, if there ever comes a day when we more clearly elucidate the intricacies of coronary artery disease, atherosclerosis, cholesterol, and metabolism (which I expect will be within the next decade, especially as pharmacogenomics rapidly expands), then guess what? The paradigm will shift and we will change the standard of care. Medicine is a fluid field, and if evidence that suggests we should alter treatments arises, then it will be done without hesitation. Until then, however, it would be irresponsible to neglect patients by not treating with a regimen that we have found to be effective.
I never said doctors have all the answers, but with the information they do have, they treat patients as best they can. In fact, alternative therapies, are long as they do not interrupt with the allopathic treatment regimen, can be very, very beneficial to patients. Whether or not this is due to placebo or intrinsic to the respective alternate therapy is up for debate, but plenty of patients find comfort in things like accupuncture. More power to them. They are not, however, a replacement for pharmacotherapy after medical management has failed.
A large portion of your posts harps on side effects of drugs. If you reread what I said, I NEVER made the statement that these drugs are 100% safe or lack side effects. What I did say, and what I will make clear again, is that the trivial side effects that occur in most people FAR, FAR outweigh the risks of not going on therapy. Since you seem fixated on statins, let’s go with those: what would you prefer? Heart attack 10 years earlier OR some mild indisgestion from time to time? In before “Durrrr but I just told you cholesterol isn’t associated with heart attacks!” Unfortunately, CURRENT RESEARCH dictates that it is. Until there’s a large body of evidence to the contrary, to say otherwise is to piss in the face of science. You seem to enjoy that, however, so what else can I say. Speaking of which, while we’re on the topic of science, your one meager attempt at including something remotely technical also fell flat on its face. “they deplete CoQ10 for christ’s sake, so no that wouldn’t be a good long term strategy.” You broadly declare that strictly because it interacts with the P450 system, it can’t possibly a good solution, is patently false. You know what else “depletes P450 (the fact that this terminology is a sweeping generalization notwithstanding)”? Grapefruit juice. Watercress. And, drum roll please, a FAVORITE of naturopaths for treating depression: St. John’s wart. Furthermore, other drugs can upregulate P450. Please tell us, in your infinite wealth of knowledge, would these, then, be a good solution? Or is the inverse of what you said not true? Sorry, I’m still trying to figure all this stuff out 
Finally, the rarer side effects you’ve mentioned. These are true results. There’s no denying it. However, they are extraordinarily rare (rhabdomyolysis, for example, is <0.1%). Even still, we keep an eye out for them: any responsible doctor, for example, will follow serum level CPK in a patient upon commencing statin therapy, to make sure rhabdo does not happen. If the side effects are found to be unbearable, the patient can be switched to other lipid lowering drugs (you do know we have those, right?)
This has gone on long enough, but I want you to understand something. This is important. Medicine has come a long way. Gone are the days of blood letting, of mercury therapy, of lobotomies. Perhaps one day we will add some of our current drug regimens to that list. Believe me, the day that significant research demonstrates there are other, better ways to provide our patients with relief and decrease significant morbidity/mortality better than we already do, they will be investigated and utilized to the fullest. Until then, please stop pretending like you’re the smartest guy in the room because you’ve read some WebMD and a PubMed article or two. The answer is always somewhere in the middle, and the sooner you realize that, the better.
