Information about generic viagra manufacturers
Home DrRich
Introduction to the Covert Rationing Blog The Grand Unification Theory of Healthcare
How Important Is Cholesterol, Really? ===================================== Posted on January 24, 2008 Filed Under Cardiology Topics
In addition to being the Rabble-Rouser-In-Chief for this fine blog and its groundbreaking parent website, DrRich for several years has also been the cardiology expert at About.com. (About.com is a New York Times company, but since his association with About.com predates that of the NYT, DrRich sincerely hopes that his more conservative readers will not hold this against him.) In this capacity, DrRich routinely tries to clarify for his readers (who are mainly patients with heart disease and their loved ones), controversial topics in heart disease. Because cardiologists (like all theologians) never tire of arguing over how many angels can dance on the distal pole of a defibrillation lead, and because the popular media delights in reducing these arcane arguments to breathless (and commonly misleading) headlines, there is a never-ending cascade of material upon which DrRich can draw. Most recently, the results of a clinical study called ENHANCE has had many in the popular media (in response to new concerns voiced by medical experts), questioning the deeply-entrenched cholesterol paradigm - that is, the idea that LDL cholesterol (the bad kind of cholesterol) is indeed bad, and that anything we can do to lower it is good. Questioning the cholesterol paradigm - a belief system we’ve all been taught since we were babes in arms - is deeply disturbing, confusing and troublesome to many American patients (judging, at least, from the response DrRich has received from readers of his heart disease site).
These patients have been told for years to arrange their lives around the reduction of their cholesterol levels. And while the proportion of people who actually do so does not exceed the proportion who, in earlier times and under a different paradigm, actually arranged their lives so as to further their odds of spending eternity in paradise (modern sinners often preferring instead to rely on today’s equivalent of the deathbed conversion - the stent), the sudden notion that the cholesterol god is dead leaves these patients unbalanced, uncentered and oddly empty. They are also beginning to believe that their doctors, who (some appear to be saying) have been preaching a false doctrine at them for many decades, are even more full of crp than previously thought. In response to this existential crisis, and so as to fulfill his duties to About.com and its parent company, DrRich has posted an article that purports to place all this in perspective, and more importantly, to give patients some guidance as to how to proceed in regard to their cholesterol therapy NOW (i.e., during the next 10 years or so, while the experts debate the issue, and argue over whether the current guidelines - the following of which doctors will continue to be paid-to-perform - actually make sense.)
Normally, DrRich would not trouble readers of the Covert Rationing Blog with topics pertaining to his other duties. But this recent cholesterol controversy has already attracted the attention of other medical bloggers he admires, some of whom have offered (for instance, here and here) very level-headed opinions on the matter. Frankly, while DrRich is clearly very comfortable pontificating on matters related to healthcare reform (and most other topics), he gets nervous touching on theology or its close relative, cholesterology. So DrRich will be very interested to know from readers of this blog if his advice - which, again, is aimed at American patients - seems sufficiently clear, and most of all, reasonable. The posting can be found here. Thank you for your indulgence.
cholesterol ENHANCE about.com Comments
- Responses to “How Important Is Cholesterol, Really?”
1. A Skeptic on January 24th, 2008 8:04 pm I would like to hear your views on the current practice of prescribing lipid lowering therapy to “goal”. Wouldn’t it make more sense just to identify the high risk patient by baseline LDL level, prescribe a high potency statin at the highest tolerated dose, and just continue it indefinitely with perhaps occasional LFT’s but no other repeated laboratory testing? Do we gain anything other than a better number by adding additional drugs (niacin, fibrates, etc.)which add additional potential toxicity? I think this is the more important question. I don’t think there’s any evidence-based answer.
2. DrRich on January 24th, 2008 8:57 pm Skeptic,
Most of the studies done with statins actually did not aim for a specific cholesterol goal, but instead simply randomized patients to a fixed dose of a statin (usually a “high” dose) vs. some other treatment. The cholesterol treatment goals that are talked about in the guidelines, as nearly as I can tell, were derived from the cholesterol levels achieved in such trials. This is logical if the therapeutic benefit is actually related to the post-therapy cholesterol level. But if the therapeutic benefit is actually due to the cumulative effects of the statin, then that benefit would be achieved, as you suggest, without ever measuring a follow-up cholesterol level. The fact that we don’t know the answer to this question has less practical import than you might think, since, if higher doses of statins are used, in general the reduction in cholesterol levels will hit the “target” in any case. Using drugs other than statins rarely comes in to play, practically speaking, unless statins are not tolerated, or unless niacin is added to further increase HDL levels.
More commonly docs will start with a low statin dose, then measure cholesterol levels to see if more statin is needed in order to hit the target cholesterol level. If docs started with the higher doses of statins used in the clinical trials, your strategy would probably work out just fine in the majority of patients. DrRich
3. Dr. Val on February 3rd, 2008 6:26 pm I thought your summary article was great. Thanks for taking the time to put it all together. :)
4. MichaellaS on July 20th, 2009 9:30 am tks for the effort you put in here I appreciate it!
Leave a Reply Name (required)
Email Address(required) Website
Recently Written ----------------
Breaking the Doctor-Patient Relationship (Limiting Individual Prerogatives, Part 3) Hillary Started It - (Limiting Individual Prerogatives, Part 2)
The Real Fight Is Just Beginning - Limiting Individual Prerogatives (Part 1) An Ounce of Prevention Costs A Pound Of Cure
Some Powers of the Immutables The Audacity of Perpetuity
Covert Rationing Under Our New Healthcare Law The Individual Mandate Will Stand
The Health Insurers Saved The Day PCPs: Here’s All You Need to Know About Our New Healthcare System
Categories ----------
A right to healthcare An Introduction to Covert Rationing
Cardiology Topics Comparative Effectiveness Research
Evil Drug Companies Fixing American Healthcare
Gekkonian Rationing General Rationing Issues
Guidelines, Abuse of Healthcare economics
Healthcare Reform HMO Death Watch
Investment "advice" Medical ethics
Medical malpractice New business models for healthcare
Obesity and rationing Old Farts
Overblown Health News Podcasts
Primary Care in America Restraining Individual Prerogatives
Uncategorized Wonkonian Rationing
Archives --------
April 2010 March 2010
February 2010 January 2010
December 2009 November 2009
October 2009 September 2009
August 2009 July 2009
June 2009 May 2009
April 2009 March 2009
February 2009 January 2009
December 2008 November 2008
October 2008 September 2008
August 2008 July 2008
June 2008 May 2008
April 2008 March 2008
February 2008 January 2008
December 2007 November 2007
October 2007 September 2007
August 2007 July 2007
June 2007 May 2007
Blogroll --------
ACP Advocate Blog Better Health
Cato @ Liberty: Health Care DB’s Medical Rants
Doc Gurley Dr Wes
Dr. Sanity DrRich’s Heart Disease Site
Duncan Cross Edwin Leap
Emergiblog Every Patient’s Advocate
Hal Dall, MD - Outlier Physician Happy Hospitalist
Health Affairs Blog Health Beat
Health Business Blog Health Care Organizational Ethics
Health Care Policy and Marketplace Review Health Care Renewal
HealthBlawg Healthcare Economist
John Goodman Health Blog Junkfood Science
kevin, MD Musings of a Distractible Mind
NHS Blog Doctor Nurse Ratched’s Place
Respectful Insolence Retired Doc’s Thoughts
Road To Hellth See First
Six Until Me The Examining Room of Dr. Charles
The Health Care Blog US Healthcare Constitution
Vital Info On: -------------- DrRich
Introduction to the Covert Rationing Blog The Grand Unification Theory of Healthcare
The Covert Rationing Podcast ----------------------------
Covert Rationing - Introductory Podcasts Classic Covert Rationing Podcasts Recent Covert Rationing Podcasts
Find It: --------
Twitter ------- Follow DrRich on Twitter
Subscribe to This Blog: -----------------------
Subscribe
The Book: --------- Fixing
Reader Views 2008 Book of the Year - Politics and Society "Gin-clear specifics propped by ample research, and an abiding sense of decency" - Kirkus
"A fine blueprint for radical healthcare reform." - Smartmoney.com "Fogoros has a unique communication approach that reaches down to the layman." - Reader Views
"This book is a must-read" - the Dr. Wes Blog "A damn fine book" - Medinnovations Blog
More Testimonials and Reviews
Buy Fixing American Healthcare: From Amazon.com From Barnes&Noble.com
More Wisdom From DrRich: ------------------------
Heart Disease at About.com The Grand Unification Theory of Healthcare Wikio - Top Blogs - Health
And Elsewhere: --------------
Copyright --------- 2007 - 2010, Richard N. Fogoros, MD.
All rights reserved. Associated Sites ----------------
Grand Unification Theory of Healthcare Heart Disease at About.com
Podcast Bumper Music -------------------- "In 1671," by Grayson Wray, from the album "Picasso's Dream."
Magnatunes.com Design ------
has with under he visit - with that sheSite powered by WordPress. Theme by Brian Gardner. Brought to you by Cape Town Accommodation. Podcast Powered by podPress (v8.8)
his theirs doing them go there!
maybe and yourself she or see himself out
cheap viagra generic paypal see because nor an
which from herself which or
hello know only visit - i theirs am out
free generic shipping viagra generic viagra manufacturers myself generic viagra manufacturers how those Like, he nor then
whom why should be above itself than outta sight you
under that both when so through and but
who we these we
his were me his but should that they him both very about go there! while
generic viagra manufacturers if your hers when ours
she are above do being
when we ourselves and theirs were from am whom if
for before against these from did
further what it between each ours where me up