OT: Newton's Third Law of Medication

[Nick Odell]

I was pleased to read in the Guardian
<https://www.theguardian.com/society/2023/jan/12/new-statins-guidelines-nice-nhs-england>
that as more and more people are being prescribed statins medication,
fewer and fewer people are now dying from heart attacks and strokes.

There's good evidence that giving statins to people who have already
suffered a stroke or heart attack will reduce the likelihood and/or
severity of a subsequent attack and little evidence to show taking
statins causes harm: controlled experiments show as many people who
don't take statins complain of muscle pains as those who do etc etc.
Therefore, they say, statins should be rolled out further. To the next
highest risk percentage of the population, say some newspaper reports;
to anybody who wants them, read other article in other parts of the
press.

A recent briefing paper published by the House of Lords Library
<https://lordslibrary.parliament.uk/mortality-rates-among-men-and-women-impact-of-austerity>
takes a look at life expectancy figures for the UK and reports that
after steadily climbing for decades, life expectancy started to
plateau around 2011 and has actually fallen between 2018 and 2020.
This is a result of government austerity measures, posits the report.

So, at risk of ostracism from the friendly umra community, may I
observe that nobody ever died from austerity just as nobody ever died
from poverty, pollution, homelessness, hunger or inadequate social or
medical care. What they died from were medical conditions which they
had been pushed into or pushed even further into by poverty,
pollution, homelessness, hunger, inadequate social or medical care or
myriad other things.

Where am I going with this? I'm not sure: I'm working it out as I
type. The Newton's Law thing is because I "feel" (not a good work in a
pseudo-scientific rambling, I know) that medication that fixes one
thing will very often put extra strain on other things but we
generally accept that as a trade-off for the treatment in the first
place. For example, my indigestion cure may well place more strain on
my kidneys, my statins will make my liver work differently and might
affect my type-2 diabetes. The aspirin I take for toothache might make
a bleed-out stroke more likely. Etc, etc.

I realise that I'm probably not even comparing compatible data sources
here but I'm a little uneasy about a medical campaign that has been so
successful at reducing deaths from heart attack and stroke which is
working in the context of rising death rates from other causes. Are
the benefits at the centre of this programme actually pushing more
people at the periphery into "premature" deaths from other things?
Would overall life expectancy rise - or at least not fall so fast - if
so many of us didn't take such preventative measures against
cardio-vascular illness? Would it even be moral to think about such a
thing?

I'm sure I'm barking up the wrong tree here but maybe umra can explain
why.

Nick

[Vicky]

On Fri, 20 Jan 2023 16:45:59 +0000, Nick Odell <nicko...@yahoo.ca>
wrote:

I had blood tests a little over 3 months ago to check thyroid ,iron
level and liver and the GP said to try statins. I didn't want to take
them, got the pills, didn't take them and was told another blood test
in 3 months, which was a couple of weeks ago. The tests showed all
normal. No Dr has contacted me to renew the statins, which I didn't
take.

You get test results from our GP by calling the surgery and speaking
to reception. 'You are caller #25 in the queue ..etc. Only saw a
Dr once since before lockdown and that one was on loan from A&E. I'd
been having falls and they called me in that day to check me. Hence
tests for iron etc. I got iron pills and B12 for a while until the
tests said all ok. Our actual GPs work from home, I am sure. Just do
phone consultations.

[Mike McMillan]

May be it is worth considering the following:

The health advisors suggest that we ought to take various medicaments which
it is generally felt, will lengthen our expected lifespan. Over the years,
the suggested medicaments that allow people (on average) to enjoy a longer
life reveal other life affecting diseases or illnesses become more common
among the elderly. More research is carried out (the drugs and pharma
Industry is a very resourceful and wealthy modern day establishment eager
to find treatments for ills we didn’t use to get as we died earlier than at
an age they are likely to manifest themselves. New treatments are developed
to lessen the effects of these undesirable ailments, eventually, they are
approved, adopted and over the years they may then help to lengthen a
person’s average lifespan, (see where this is going?). The one thing that
is unlikely to change with this extension to life expectancy is the support
to allow these fortunate persons to enjoy it. I am thinking in terms of
social care, financial support, mental care - even housing for what by now
must be an ever increasing population which might be seen in a similar
style to a ponsy(sp?) scheme. Unless the vast majority of these ever older
citizens are still able to work, care for themselves (and possible their
aging partners too) and have the financial wherewithal to finance their
lives without ‘house hogging’ the younger generation’s future accommodation
in their ‘twilight years’ (arrrrghhh!). I doubt that society could support
such a change in our social structure. I fear that apart from those who are
very wealthy, this scheme is unlikely to be seen by Mr or Mrs. Average -
possibly best left that way too!

--
Toodle Pip, Mike McMillan

[John Ashby]

Your pseudo-scientific rambling put me in mind of this:

https://www.bbc.co.uk/iplayer/episode/m0017wzq/horizon-2022-making-sense-of-cancer-with-hannah-fry

Professor Hannah Fry trying to make sense of her own experience of
cancer treatment and the emotional versus rational arguments around it.

john

[BrritSki]

On 20/01/2023 16:45, Nick Odell wrote:

> I was pleased to read in the Guardian
> <https://www.theguardian.com/society/2023/jan/12/new-statins-guidelines-nice-nhs-england>
> that as more and more people are being prescribed statins medication,
> fewer and fewer people are now dying from heart attacks and strokes.
>
> There's good evidence that giving statins to people who have already
> suffered a stroke or heart attack will reduce the likelihood and/or
> severity of a subsequent attack and little evidence to show taking
> statins causes harm: controlled experiments show as many people who
> don't take statins complain of muscle pains as those who do etc etc.
> Therefore, they say, statins should be rolled out further. To the next
> highest risk percentage of the population, say some newspaper reports;
> to anybody who wants them, read other article in other parts of the
> press.
>

Not sure what the answer to yr ? is, but a couple of other data points

1. I was prescribed them recently but noticed signs of impaired liver
function immediately and so stopped.

2. Then I read an article with the following info. regarding why we have
excess deaths this year:

There can be little doubt that blocking access to, say, cancer screening
and treatment will have disastrous consequences – one of the many
legacies of lockdowns. But how did Professor Whitty and his team
conclude that excess cardiovascular mortality was due to a lack of
statins and antihypertensives?

Primary care is where the bulk of statins and antihypertensives are
prescribed, but did the prescriptions of such drugs change during the
pandemic?

Not according to Open Prescribing, which is based on monthly NHS
prescribing data.


Another aspect that needs to be considered when looking at whether a
lack of statins could have caused a sudden increase in cardiovascular
deaths is the length of time of exposure to the drugs.

A large meta-analysis of the effects of statin use in primary prevention
compared to placebo reported a number-needed-to-treat (NNT) of 138
people with statins for five years to prevent one death, 49 to prevent
one cardiovascular disease (CVD) event, and 155 to prevent one stroke.

The figures for secondary prevention (in those who have known heart
disease or a history of stroke) are better, as you would expect: NNT of
83 for one death after five years of exposure to a statin.

The five years do not fit the introduction of restrictions in March
2020, nor is there any evidence that lipid regulating and
antihypertensive drugs were prescribed less in the last three years
based on the NHS’s data.

There is evidence of a fundamental change in working practice and
primary care delivery during the three periods of restrictions. Six
measures recovered to pre-pandemic levels within a year, asthma and COPD
(pulmonary disease) reviews recovered by August 2021, and blood pressure
monitoring and cardiovascular disease risk assessment had a sustained
drop in activity up to December 2021.

However, a sustained drop in monitoring is unlikely to be the reason for
the increase in excess deaths. In 2017 we did a systematic review of the
effect of global cardiovascular risk assessment in adults. We found its
use did not translate into reductions in CVD morbidity or mortality.

So what might be the cause? The British Heart Foundation considers
“severe ambulance delays, inaccessible care and ever-growing waiting
lists are contributing to heart patients dying needlessly”.


While the data from the Office for Health Improvement and Disparities
report an excess of cardiovascular disease mortality, the ‘independent’
report produced by the U.K. Government does not attempt to understand
what is causing the excess mortality from CVD.

In the last year, there has been an excess of 21,841 deaths with CVD
mentioned on the death certificate. Our analysis suggests it isn’t a
fall in drug treatment, and the drop in CVD risk monitoring can’t
account for it, given the lack of evidence of an effect.

Given all its resources, the Government could and should do better to
get to the bottom of what is driving the excess in cardiovascular
deaths. We’ll keep digging.

Dr. Carl Heneghan is the Oxford Professor of Evidence Based Medicine and
Dr. Tom Jefferson is an epidemiologist based in Rome who works with
Professor Heneghan on the Cochrane Collaboration. This article was first
published on their Substack blog, Trust The Evidence, which you can
subscribe to here.

[BrritSki]

On 20/01/2023 18:42, BrritSki wrote:
> On 20/01/2023 16:45, Nick Odell wrote:
>> I was pleased to read in the Guardian
>> <https://www.theguardian.com/society/2023/jan/12/new-statins-guidelines-nice-nhs-england>
>> that as more and more people are being prescribed statins medication,
>> fewer and fewer people are now dying from heart attacks and strokes.
>>
>> There's good evidence that giving statins to people who have already
>> suffered a stroke or heart attack will reduce the likelihood and/or
>> severity of a subsequent attack and little evidence to show taking
>> statins causes harm: controlled experiments show as many people who
>> don't take statins complain of muscle pains as those who do etc etc.
>> Therefore, they say, statins should be rolled out further. To the next
>> highest risk percentage of the population, say some newspaper reports;
>> to anybody who wants them, read other article in other parts of the
>> press.
>>
> Not sure what the answer to yr ? is, but a couple of other data points
>

And a 3rd from the Times house doctor...

At least half of adults in the UK could soon be eligible for a daily
statin, according to new guidance from the National Institute for Health
and Care Excellence. The draft guidelines, which will be finalised in
May, propose lowering the threshold for eligibility (see below) so that
it encompasses the vast majority over 50 (as well as anyone else who is
keen). It will include me, but while I am open to the idea, I am in no
rush to join the eight million or so already taking statins. Here’s why.

First, the move is more of a public health measure than a personal one.
Statins are cheap, while treating cardiovascular disease (CVD) such as
strokes and heart attacks is very expensive. Nice estimates the
healthcare cost of CVD in England alone at £7.4 billion a year, yet the
annual bill for the 70 million prescriptions for statins is a tiny
fraction of the bill (1.4 per cent, at about £100 million a year).

So if prescribing cholesterol-lowering drugs to more people creates even
a small dent in the number of strokes and heart attacks then it is
likely to pay for itself many times over. And the protective effects are
indeed small, at least for otherwise healthy people looking to delay
their first heart attack or stroke (primary prevention). At the
threshold for offering statins to this group — a 10 per cent risk over
the next decade (see below) — Nice believes that 40 strokes and heart
attacks could be prevented for every 1,000 people who take them for ten
years.

So instead of the NHS having to treat 100 people with CVD, it only has
to treat 60. A great result for the NHS and the lucky 40, but not so
good for the 960 who didn’t benefit, either because they didn’t really
need one or because it didn’t work and they ran into trouble anyway.

The maths is less convincing the lower you go. Let’s assume you have a 5
per cent risk. At this level Nice estimates that 1,000 people would have
to take a statin for a decade to prevent 20 heart attacks and strokes
(reducing the total toll from 50 to 30). Once again, great if you are
one of those 20 who dodged a bullet, but not so clever for the remaining
980. And the lower the threshold the less the benefit.

ADVERTISEMENT
Risk calculators, such as the QRISK3 favoured by Nice, are designed to
help decision-making, but while they are constantly being tweaked to
reflect the latest data and improve accuracy, they remain comparatively
crude tools.

They may be good at predicting what is going to happen to a group of
people like you, but they cannot say what your future holds. Or, to put
it another way, they can be accurate at predicting the number of heart
attacks and strokes in a group with similar characteristics (age, blood
pressure, cholesterol level etc), but useless when it comes to
identifying which members of that cohort will develop them.

● Extending statins to millions more patients
● Hand out statins on demand, NHS told

QRISK3 does have another useful facility. It compares you to your peers
to give a comparative heart age (mine is 62) that, rather than
encouraging pill-taking, can be used to promote healthy change where
possible. If your heart age comes out higher than your chronological
one, try adjusting your weight, blood pressure, cholesterol levels and
smoking habits (if you do) in the calculator to see what impact it has.
And start with dietary and lifestyle changes first if concerned. These
tend to be far more effective than statins and you can always add in the
drugs later.

Another concern is that medication is a double-edged sword, and there
are potential risks that come with any benefits. Statins have a poor
reputation when it comes to side-effects. However, in practice they are
often far better tolerated than many other commonly used drugs, with the
most recent trials suggesting the incidence of common complaints such as
stiff muscles doesn’t actually differ much from placebo.

Yet if millions of people take them, even rare side-effects such as
muscle damage and liver inflammation will rear their heads. And they do,
but the vast majority of people I look after on the standard primary
prevention regimen (20mg atorvastatin daily) tend to be fine.

Still, I won’t be rushing to discuss statins with my GP because,
frankly, she has got much better things to do at the moment than shaving
a few per cent off the ten-year cardiovascular risk of a slim, fit
middle-aged chap. One to mention next time I speak to her, which
hopefully won’t be too soon. Until then, it’s physician, heal thyself.

You can read more about the proposed changes in the draft guidance from
Nice at nice.org.uk.

[Nick Odell]

On Fri, 20 Jan 2023 18:24:00 +0000, John Ashby <johna...@yahoo.com>
wrote:

Ah.... In the UK I'm contractually obliged not to use the iPlayer and
down here it seems it's a rights issue so I won't be able to watch
that, I'm afraid. The programme notes are interesting though. The
medicalisation of everything is another little hobby-horse of mine and
when I think about it, that little screed of mine ^^^up there^^^ is on
a similar track.

Thanks John,

Nick

[Penny]

On Fri, 20 Jan 2023 16:45:59 +0000, Nick Odell <nicko...@yahoo.ca> a
gribouillé dans la poussière...

>I was pleased to read in the Guardian
><https://www.theguardian.com/society/2023/jan/12/new-statins-guidelines-nice-nhs-england>
>that as more and more people are being prescribed statins medication,
>fewer and fewer people are now dying from heart attacks and strokes.
>
>There's good evidence that giving statins to people who have already
>suffered a stroke or heart attack will reduce the likelihood and/or
>severity of a subsequent attack and little evidence to show taking
>statins causes harm: controlled experiments show as many people who
>don't take statins complain of muscle pains as those who do etc etc.
>Therefore, they say, statins should be rolled out further. To the next
>highest risk percentage of the population, say some newspaper reports;
>to anybody who wants them, read other article in other parts of the
>press.

Way back in 2007 (or possibly earlier), Tony Blair's government declared
that everyone should be taking statins. This decision was based upon the
results of trials on the drug done by the manufacturer which, to my
somewhat faulty memory, were very similar to those quoted this week.

Ray and I both took them for a brief period. We both woke every morning in
pain. It made me cry. Ray had a dig around t'internet and found articles
about the poorly run drugs trial (too few participants) and anecdotal
evidence of the very painful result of taking the pills. We stopped taking
them, the pain stopped.

Around that time, there was a 30 minute programme on Radio 4, explaining
the drug company had presented wildly misleading results based upon a very
small number of participants. It also spoke of the pain suffered by many
taking the pills, and generally denounced them as a bad thing. I taped the
programme, then leant it to a sceptical friend - I never got it back.

Here we are again - what's changed?
Very little, I suspect.
The drugs are cheap, they make big claims, the government feels the need to
make a big gesture to persuade people they are doing 'the right thing' on a
health issue.
Bzzz! Repetition.

>A recent briefing paper published by the House of Lords Library
><https://lordslibrary.parliament.uk/mortality-rates-among-men-and-women-impact-of-austerity>
>takes a look at life expectancy figures for the UK and reports that
>after steadily climbing for decades, life expectancy started to
>plateau around 2011 and has actually fallen between 2018 and 2020.
>This is a result of government austerity measures, posits the report.

...

>Where am I going with this? I'm not sure: I'm working it out as I
>type. The Newton's Law thing is because I "feel" (not a good work in a
>pseudo-scientific rambling, I know) that medication that fixes one
>thing will very often put extra strain on other things but we
>generally accept that as a trade-off for the treatment in the first
>place.

Makes sense to me.

Death and taxes.

My father, in his nineties, on return from yet another brief hospital stay,
complained he and his wife had looked after themselves too well.
He warned me against getting old, it just means more bits don't work
properly.
--
Penny
Annoyed by The Archers since 1959

[Nick Odell]

On Fri, 20 Jan 2023 18:55:38 +0000, BrritSki
<rtilbury...@gmail.com> wrote:

>On 20/01/2023 18:42, BrritSki wrote:

Thanks Britters. Interesting posts, both of them. From deep inside my
own personal philosophical silo it's not always obvious that other,
better informed people might be having the same discussions elsewhere.
Finding the right search terms would be a good start. Lots more
reading to do....

Nick

[Vicky]

On Sat, 21 Jan 2023 16:57:19 +0000, Nick Odell <nicko...@yahoo.ca>
wrote:

https://twitter.com/maryannedemasi/status/1616262064808558592?s=66&t=Q42fnHAHvh2VhZ-bNZxEeA