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walkitoutThis isn’t any kind of organized thing here. I stumbled over this list of the 300 most prescribed medications not too long ago:
https://clincalc.com/DrugStats/Top300Drugs.aspx
I spent a few hours over several sessions looking up sooooo many of them that I didn’t recognize, but drug naming is _sometimes_ helpful. Like, there’s a whole category of drugs for blood lipid management that end in statin, and are collectively referred to as statins.
I have been harshing on statins for a very, very long time, and basically always for the same reason. Statins are recommended for use in a broad population of people to avoid a small number of fatal (or really serious) events. I just don’t like prescribing by the numbers in general, so that’s strike one. Obviously, in order to make the math work in favor of prescribing, the number of fatal (or really serious) events that occur as a result of taking the drug has to be lower than the number of fatal (or really serious) events you are trying to avert. You know how humans work. If you want to sell these drugs — or if you want to Save Everyone From Death By Fixing Every Thing That Can Possibly Kill You (which is delusional, you know that, I know that, but some very smart people do not know that) — you are going to at least experience some temptation to underplay the negative side effects.
Why am I on about this _now_, tho, you might ask?
https://www.vox.com/health/479714/statins-cholesterol-side-effects-study-symptoms
This article is a classic of the But Why Aren’t People Taking These Lifesaving Medications?
See the earlier link above. They fucking well are taking these medications — the author says 92 million people in the United States are taking them as of 2019 (author did not give a date but I clickety clicked and collected it from his link). (This number is actually bullshit, because it’s “had ever taken any” not “were currently taking”, but whatever.) The author further says that only half the people who “should” (by the numbers”) be taking this drug actually are. I clickety clicked THAT link which is an older study, and all the numbers there are considerably lower than 92 million. So EITHER 92 million people really are not taking statins (they aren’t, we know that, duh) OR that half thing is out of date (it is, duh) OR both or this author is overstating the author’s case.
But all that is by-the-numbers, and remember, I don’t LIKE by-the-numbers prescribing. The other part of the author’s argument revolves around how the claimed negative effects of statins on social media, by RFK jr and elsewhere are not compelling reasons not to take statins. Here are words that appear nowhere in this article:
Creatinine kinase
Rhabdomyolysis
Muscle
Muscular
Polypharmacy
Interaction
These are all words that you would expect to appear in a comprehensive discussion of whether or not a person or group of people should be recommended or continued on statin therapy. None of them appear. Instead, there’s a weird screed about fear of kidney problems.
Let me just say, if you blow through that list of shit I mentioned above, kidney problems are next. So blowing off kidney fears and refusing to engage with the actual clinical guidelines of prescribing statins … makes me rethink whether I should be subscribing to vox.
ETA:
Burying the lede: I really and truly only worry about statins because they generically have the effect of discouraging people from exercise (see all that muscle stuff). I don’t say this based on reading articles. I say this because a couple decades ago I, too, was very excited about statins and asking everyone who was on them / had tried them whether it had any kind of noticeable affect on them (important to know when you are prophylactically prescribing across populations). And I kept hearing from all the women that they went off of them because of muscle problems. When you look at the journal articles, it says men report rhabdo more often than women, but I suspect that’s because the women just stopped taking the statins and it didn’t get reported. Newer work on “noncompliance”, “resistance” and “reluctance” is reframing rhabdo as muscle problems, and taking it a lot more seriously, so there’s some reason to think that this will all get better in the next few years in terms of who is prescribed what and for how long and why. Or, you know, this article, like articles saying bariatric surgery is way better than glp-1s, will age poorly.
ETAYA: Oh, right and statins are implicated in increasing insulin resistance. And then there’s that whole statin - glp-1 interaction thing that’s doing way fewer numbers that it probably should be.
https://clincalc.com/DrugStats/Top300Drugs.aspx
I spent a few hours over several sessions looking up sooooo many of them that I didn’t recognize, but drug naming is _sometimes_ helpful. Like, there’s a whole category of drugs for blood lipid management that end in statin, and are collectively referred to as statins.
I have been harshing on statins for a very, very long time, and basically always for the same reason. Statins are recommended for use in a broad population of people to avoid a small number of fatal (or really serious) events. I just don’t like prescribing by the numbers in general, so that’s strike one. Obviously, in order to make the math work in favor of prescribing, the number of fatal (or really serious) events that occur as a result of taking the drug has to be lower than the number of fatal (or really serious) events you are trying to avert. You know how humans work. If you want to sell these drugs — or if you want to Save Everyone From Death By Fixing Every Thing That Can Possibly Kill You (which is delusional, you know that, I know that, but some very smart people do not know that) — you are going to at least experience some temptation to underplay the negative side effects.
Why am I on about this _now_, tho, you might ask?
https://www.vox.com/health/479714/statins-cholesterol-side-effects-study-symptoms
This article is a classic of the But Why Aren’t People Taking These Lifesaving Medications?
See the earlier link above. They fucking well are taking these medications — the author says 92 million people in the United States are taking them as of 2019 (author did not give a date but I clickety clicked and collected it from his link). (This number is actually bullshit, because it’s “had ever taken any” not “were currently taking”, but whatever.) The author further says that only half the people who “should” (by the numbers”) be taking this drug actually are. I clickety clicked THAT link which is an older study, and all the numbers there are considerably lower than 92 million. So EITHER 92 million people really are not taking statins (they aren’t, we know that, duh) OR that half thing is out of date (it is, duh) OR both or this author is overstating the author’s case.
But all that is by-the-numbers, and remember, I don’t LIKE by-the-numbers prescribing. The other part of the author’s argument revolves around how the claimed negative effects of statins on social media, by RFK jr and elsewhere are not compelling reasons not to take statins. Here are words that appear nowhere in this article:
Creatinine kinase
Rhabdomyolysis
Muscle
Muscular
Polypharmacy
Interaction
These are all words that you would expect to appear in a comprehensive discussion of whether or not a person or group of people should be recommended or continued on statin therapy. None of them appear. Instead, there’s a weird screed about fear of kidney problems.
Let me just say, if you blow through that list of shit I mentioned above, kidney problems are next. So blowing off kidney fears and refusing to engage with the actual clinical guidelines of prescribing statins … makes me rethink whether I should be subscribing to vox.
ETA:
Burying the lede: I really and truly only worry about statins because they generically have the effect of discouraging people from exercise (see all that muscle stuff). I don’t say this based on reading articles. I say this because a couple decades ago I, too, was very excited about statins and asking everyone who was on them / had tried them whether it had any kind of noticeable affect on them (important to know when you are prophylactically prescribing across populations). And I kept hearing from all the women that they went off of them because of muscle problems. When you look at the journal articles, it says men report rhabdo more often than women, but I suspect that’s because the women just stopped taking the statins and it didn’t get reported. Newer work on “noncompliance”, “resistance” and “reluctance” is reframing rhabdo as muscle problems, and taking it a lot more seriously, so there’s some reason to think that this will all get better in the next few years in terms of who is prescribed what and for how long and why. Or, you know, this article, like articles saying bariatric surgery is way better than glp-1s, will age poorly.
ETAYA: Oh, right and statins are implicated in increasing insulin resistance. And then there’s that whole statin - glp-1 interaction thing that’s doing way fewer numbers that it probably should be.