A Statin Nation. Dr Malcolm Kendrick
the cult doctrines. Access to outside information or perspectives is forbidden, and any questioning is swiftly met with threats of ostracism and expulsion.
Once sufficiently indoctrinated, the recruits are coerced into several years of working long, mind-numbing hours of labor at penury ‘wages’ – ostensibly for the good of the cult, while the poohbahs at the top enjoy riches and lavish lifestyles.
Oh wait. Wrong cult. That’s the ‘medical school/internships programs’ cult.
Never mind. My bad.
Cheers!
And a very powerful cult it is too.
Anyway, where was I? Oh yes, explaining that medicine is heading towards an extreme place that is in danger of damaging us all. Health is not the lowering of numbers on a blood test, nor endless scanning and screening in a desperate attempt to find perfect health. It is a very different thing indeed. Positive mental attitude, for one.
In fact, the WHO, in its very first meeting, stated that health is ‘a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.’ Absolutely true. Most of which has very little to do with the medical profession.
I would also argue that almost all of what we now call ‘preventive medicine’ has nothing to do with prevention at all. Detecting high blood pressure, for example, is not prevention. It is just finding a problem at an early stage. Cancer screening, again, is not prevention. It is just finding the problem at an early stage. Screening is not preventing.
Moreover, lowering blood pressure is doing nothing for the underlying disease process. You are just lowering a measurement that may or may not be very helpful. Indeed, some anti-hypertensives have been found to lower blood pressure very effectively, yet increase the risk of CVD death.7
The same phenomenon of simply lowering numbers has also been found in the world of diabetes. The ACCORD Study, using multiple interventions to lower the blood sugar in people with diabetes, as far as possible, found that this had no effect on CV mortality, but significantly increased overall mortality (overall mortality = the risk of dying of anything): ‘As compared with standard therapy, the use of intensive therapy to target normal glycated hemoglobin levels for 3.5 years increased mortality and did not significantly reduce major cardiovascular events. These findings identify a previously unrecognised harm of intensive glucose lowering in high-risk patients with type 2 diabetes.’8
More recently, the findings of ACCORD were confirmed by another study that made exactly the same point. Namely, that the more you lower the blood sugar level with drugs, the greater risk of death. Insulin was fingered as the most damaged drug of all. ‘The pattern of mortality risk across levels of HbA1c (long term measure of blood sugar levels) differed by glucose-lowering regimen. Lower HbA1c was associated with increased mortality risk compared with moderate control.’9
Finding things that are ‘wrong’ and then attempting to batter them back down to ‘normal’ does not necessarily end well. Instead, we have been fitted to what I call the ‘Procrustean bed of medicine’.
‘In the Greek myth, Procrustes was a son of Poseidon with a stronghold on Mount Korydallos at Erineus, on the sacred way between Athens and Eleusis. There he had a bed, in which he invited every passer-by to spend the night, and where he set to work on them with his smith’s hammer, to stretch them to fit. In later tellings, if the guest proved too tall, Procrustes would amputate the excess length; nobody ever fitted the bed exactly – so they died.’10
Clever people those Greeks.
I believe that we need to move away from defining more and more people as ill, then chopping or stretching things back to ‘normal’. Instead we need to move towards ‘a state of complete physical, mental, and social well-being’.
I cannot cover everything, but I want to try to help people understand CVD. I will outline the current ideas and explain as well as I can, in some detail, where these ideas have gone wrong, and will sign off by trying to outline the most important things that you can do to maintain good CV health. But before getting into the guts of the matter, I must add that I am not attacking conventional Western medicine. This has been, in many ways, a spectacular success with hip replacements, antibiotics, anesthetics, the treatment of major trauma and the prevention of many diseases that have been a scourge of humanity for millennia. Smallpox, syphilis, polio. Dentistry, new heart valves, painkillers, orthopaedic surgery … I could go on and on.
However, in CVD prevention, medicine has grabbed the wrong end of the stick and then rushed off, with grim determination, in the wrong direction. I intend to change things round, then the experts can rush back madly from whence they came and head off in the right, damned direction. No offence, guys. Well, not much.
Notes
1. http://www.telegraph.co.uk/news/2017/11/15/half-over-65s-take-least-five-drugs-day/
2. http://www.medscape.com/viewarticle/881689#vp_3
3. http://www.dietsdontwork.co.uk/sweden-rejects-low-fat
4. https://www.theguardian.com/society/2016/jan/08/tough-drinking-guidelines-not-scaremongering-says-chief-medical-officer
5. https://www.spectator.co.uk/2009/07/to-become-an-extremist-hang-around-with-people-you-agree-with/
6. Meador, C., ‘The Last Well Person’, NEJM, 10 February 1994, pp. 400-1
7. http://www.medscape.com/viewarticle/460474_5
8. ACCORD – Action to Control Cardiovascular Risk in Type II Diabetes; the study is at http://www.nejm.org/doi/full/10.1056/NEJMoa0802743#t=abstract
9. ‘The impact of differing glucose lowering regimens on the pattern of association between glucose control and survival’, 2018: http://onlinelibrary.wiley.com/doi/10.1111/dom.13155/epdf
10. https://en.wikipedia.org/wiki/Procrustes