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Old 02-08-2012, 01:12 AM   #61
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Ha - these are documents that may be hammered out by committees, but these documents also protect me and my license in a court of law and in front of my peers. I do not practice medicine to include popular or unpopular evidence in it, just what protects my patients and my license. I know this sounds strange, but that the state of today's medicine we are in.

Like all clinicians, I have a license to protect. Therefore I must practice defensible medicine first.


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These are documents hammered out by committees, which may have members who just like congressmen have their constituencies. The protocols are not the original journal papers, and they may not very faithfully reflect all the evidence, including the unpopular evidence.

The studies are usually easy enough to find, although it takes an excellent medical library to carry paper copies of even all the main journals, and sometimes various journals restrict electronic access to subscribers.

At any rate, the large, randomized clinical studies mostly show some improvement in both all cause mortality, and specifically cardiovascular mortality. But it is small, and given the various side effects and occasional disasters it seems like a rational decision to at least consider sitting out this game.

OTOH, statins are very good at treating LDL numbers, and doctors are very good at focusing on LDL numbers. So it's kind of a marriage made in heaven from that point of view. But to me, this is an example of confusing a variably useful metric with the outcome the patient is interested in-a meaningfully longer, more pleasant life.

Ha
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Old 02-08-2012, 01:13 AM   #62
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See my answer to Ha. It's ok to disagree, ERD50
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Haha's post echoes my sentiments.
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Old 02-08-2012, 04:56 AM   #63
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The more I read, the more confuse I become. What do my numbers really mean? In any case, I don't want my bad cholesterol to go higher and I know I won't want to go on medication for high cholesterol. Someone in the thread asked me to check my triglycerides which is ok standing at 0.9 mmol/L. I guess I need to heed the doctor's advice to limit the high cholesterol food I take. So, here's my action plan:-

Food Intake - (a) take oatmeal with almond flakes/bananas (great suggestion from some of the contributors in this thread). Unfortunately, DH bought 2 large bags of instant oatmeal - so will finish those before I buy the non-instant ones. (b) Include fenugreek in my diet - I have friends who swear that this will work. (c) Cut down (but not eliminate) on red meat (which I love), animal skin, liver, egg yolks, sausages, cheese and similar high cholesterol products. (d) Eat more fish, vegetables, fruits and nuts. (e) Hopefully, very hopefully, eat less carbohydrate.

Exercise - increase my exercise level to ensure my heart gets a good cardiovascular exercise. I already exercise 6 days a week. Now, I will push myself at each exercise session - just bought a new pair of running shoes - it's time to start serious jogging again to replace the usual brisk walk.

My medical report suggests I take my blood test again in 4 months time - wonder whether this is really necessary. Will check with the doctor in due course. Hope all this will work!
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Old 02-08-2012, 06:09 AM   #64
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Sounds good. Also avoid tobacco, drugs, alcohol (the usual culprits). What you write in your post is a good start. Keep us informed and good luck.
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I guess I need to heed the doctor's advice to limit the high cholesterol food I take.
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Old 02-08-2012, 06:10 AM   #65
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DW and I had advanced lipids testing done by the same doctor at the same time in December. We got a call to come to the doctor's office for a consultation. My numbers were good - DW's not so good. She has a better diet than I, but gets less exercise. DW asked the doctor why her numbers were not as good as mine, and the doctor said heredity and amount of cardio. So the doctor put her on Lipofen and told her to do some hard cardio.
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Old 02-08-2012, 06:27 AM   #66
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The more I read, the more confuse I become. What do my numbers really mean? In any case, I don't want my bad cholesterol to go higher and I know I won't want to go on medication for high cholesterol. Someone in the thread asked me to check my triglycerides which is ok standing at 0.9 mmol/L. I guess I need to heed the doctor's advice to limit the high cholesterol food I take. So, here's my action plan:-

Food Intake - (a) take oatmeal with almond flakes/bananas (great suggestion from some of the contributors in this thread). Unfortunately, DH bought 2 large bags of instant oatmeal - so will finish those before I buy the non-instant ones. (b) Include fenugreek in my diet - I have friends who swear that this will work. (c) Cut down (but not eliminate) on red meat (which I love), animal skin, liver, egg yolks, sausages, cheese and similar high cholesterol products. (d) Eat more fish, vegetables, fruits and nuts. (e) Hopefully, very hopefully, eat less carbohydrate.

Exercise - increase my exercise level to ensure my heart gets a good cardiovascular exercise. I already exercise 6 days a week. Now, I will push myself at each exercise session - just bought a new pair of running shoes - it's time to start serious jogging again to replace the usual brisk walk.

My medical report suggests I take my blood test again in 4 months time - wonder whether this is really necessary. Will check with the doctor in due course. Hope all this will work!
Start with (e).
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Old 02-08-2012, 06:38 AM   #67
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More and more, I'm becoming convinced that this is a religious dispute. Those that subscribe to the cholesterol hypothesis and those of the low carb persuasion are just practicing different religions. Neither is likely to convince the other to cross over to the dark side (although it happens).

This is probably my final post on the topic, because I really don't see the value in further discussion of it.

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Old 02-08-2012, 07:01 AM   #68
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I agree. There is one side that understands, interprets, accepts and applies medical science. The other side does not. And it's ok - part of my job is to educate my patients too...
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More and more, I'm becoming convinced that this is a religious dispute.
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Old 02-08-2012, 07:44 AM   #69
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Very interesting thread. It tells me one thing--people are thinking about their health. I take a statin myself to keep my LDL as close to 100 as I can get. However, I recently dropped my dosage to 40mg/day instead of the 80 I was taking. Going for a blood test next week to see how the numbers stack up. I have read too many articles lately about the damage statins can do the muscles and that article said to stay from the 80mg simvastatin. So I'm trying it.

I used to play golf with a cardiologist who told me there are 5 things that contribute to heart trouble. Genetics, obesity, high blood pressure, smoking and cholestrol. Genetics is #1 by a big margin. If you have good genes but also one of the other factors, no problem. Good genes and two of the other factors, be concerned. Good genes and three of the other factors you are in trouble and need to be under the care of a cardiologist.
You can't do anything about the genes but you can control all the others. It's up to you.

That was 20 years ago. Studies and information and drugs now make it easier to control the variables.
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Old 02-08-2012, 08:01 AM   #70
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these documents also protect me and my license in a court of law and in front of my peers. I do not practice medicine to include popular or unpopular evidence in it, just what protects my patients and my license. I know this sounds strange, but that the state of today's medicine we are in.

Like all clinicians, I have a license to protect. Therefore I must practice defensible medicine first.
Quote:
There is one side that understands, interprets, accepts and applies medical science. The other side does not.
Assuming you actually understand, interpret and accept "medical science" correctly, how can you apply it to your patients situation? What we learn today will not show its face in the conventional wisdom (and your treatment protocols) for many years. In the interim, your patients suffer.
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Old 02-08-2012, 08:05 AM   #71
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Originally Posted by obgyn65 View Post
these documents also protect me and my license in a court of law and in front of my peers. I do not practice medicine to include popular or unpopular evidence in it, just what protects my patients and my license. I know this sounds strange, but that the state of today's medicine we are in.

Like all clinicians, I have a license to protect. Therefore I must practice defensible medicine first.
Sometimes you frighten me.
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Old 02-08-2012, 09:31 AM   #72
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It's too bad some people here don't seem to have a good enough relationship with their doctors that they can't ask them to explain exactly why something is prescribed and what the alternatives would be and why the alternatives might or might not be better/equal/worse. DH has such a relationship with his doctor and is on statins (his MD doctor, a department head at a major teaching hospital also "prescribes" things like saw palmetto and practices acupuncture). Would DH ever not follow his doc's directions? No.
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Old 02-08-2012, 09:35 AM   #73
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Ha - these are documents that may be hammered out by committees, but these documents also protect me and my license in a court of law and in front of my peers. I do not practice medicine to include popular or unpopular evidence in it, just what protects my patients and my license. I know this sounds strange, but that the state of today's medicine we are in.

Like all clinicians, I have a license to protect. Therefore I must practice defensible medicine first.
I completely understand what you are saying. It has much to do with the point I was trying to make. There are constraints on a doctor's freely derived opinions of evidence. You can't get picked off if you are in the middle of the herd. That is one reason why it may be naive to believe that doctor always knows best, at least as judged by what he says which as you point out might be different from his unfettered judgment.

Like ERD50 says, it's a mess.

Ha
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Old 02-08-2012, 09:55 AM   #74
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Quote:
Originally Posted by obgyn65
Ha - these are documents that may be hammered out by committees, but these documents also protect me and my license in a court of law and in front of my peers. I do not practice medicine to include popular or unpopular evidence in it, just what protects my patients and my license. I know this sounds strange, but that the state of today's medicine we are in.

Like all clinicians, I have a license to protect. Therefore I must practice defensible medicine first.
This, for me, explains why good doctors can give bad advice. I've heard many say that the doctor may feel that the conventional wisdom is wrong, but he/she still follows it because not doing so would put him/her at risk of a lawsuit. Thanks for the direct confirmation. Wow.
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Old 02-08-2012, 10:01 AM   #75
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Originally Posted by braumeister
More and more, I'm becoming convinced that this is a religious dispute. Those that subscribe to the cholesterol hypothesis and those of the low carb persuasion are just practicing different religions. Neither is likely to convince the other to cross over to the dark side (although it happens).

This is probably my final post on the topic, because I really don't see the value in further discussion of it.

That is exactly right. As Martha once pointed out, once someone has taken a position, arguments against it simply harden his views.

I often ask myself whether this is the case for me. However (1) I used to be very anti-low-carb pro whole grains and (2) I would much rather believe what most people believe. Being a low carber can be very inconvenient.
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Old 02-08-2012, 10:12 AM   #76
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I would much rather believe what most people believe. Being a low carber can be very inconvenient.
Once gary Taubes made this very point. Someone asked him what was the most difficult aspect of low-carbing. Social conflicts he answered. Dinner parties are very trying, you make kind of a bother of yourself, and people think you are a food faddist maniac.

Also, when others order a beer at a sports bar, I am drinking whiskey.

Travel? Doable, but not easy.

Ha
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Old 02-08-2012, 12:42 PM   #77
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I agree. There is one side that understands, interprets, accepts and applies medical science. The other side does not. And it's ok - part of my job is to educate my patients too...
I'm not sure whether you are serious or not, but I remember an aha moment when I was in graduate school. At a seminar, an MD was presenting his idea for the design of an experiment. It was terrible, and the scientists tore him to shreds.

I realized then that MDs don't necessarily know anything more about science than engineers or artists. It's not surprising, because their training is quite different from that of a scientist's. They aren't necessarily trained in the scientific method, hypothesis testing, statistics, experiment design and interpretation, etc.
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Old 02-08-2012, 01:11 PM   #78
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See my answer to Ha. It's ok to disagree, ERD50
Are we disagreeing about anything? I didn't think so. I thought we were just discussing how anyone would know that the 'accepted protocols' actually reflect the best practices for the patient.

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Ha - these are documents that may be hammered out by committees, but these documents also protect me and my license in a court of law and in front of my peers. I do not practice medicine to include popular or unpopular evidence in it, just what protects my patients and my license. I know this sounds strange, but that the state of today's medicine we are in.

Like all clinicians, I have a license to protect. Therefore I must practice defensible medicine first.
Mostly echoing haha again here, but it does not sound strange to me. I understand that you have a licence to protect, and as a boss of mine often said (when I was being my usual stubborn self) - '"Sometimes it's better to be wrong together, than to be right all alone" (and I bet he thought I wasn't listening!).

But it doesn't answer the question. It sounds like you are saying that I shouldn't question my Doctor on this, he/she will follow the 'party line', and I should just go along blindly. Sorry, I'm not wired that way. Personally, I think it is a little sad that someone who puts forth all the time and effort on the education it requires to become a Doctor, seems so unwilling to use that intelligence and gained knowledge to question the status quo.

I suppose this is the same as an electrician/carpenter who must follow building codes on the job, even though he may know with certainty when an alternative may be just as good/safe or even better than the published code. But somehow, I don't think of Doctors on the same level as electricians/carpenters. Maybe I should?

I guess you are saying - that is left up to the researches, and the General Practitioner just does as they are told? But this still seems odd, because not every Doctor has the same opinions on treatments.

More to the point of the OP, I guess I'm still confused as to whether Statins merely 'improve the numbers', or if there is a clear association with better outcomes for the patient.

-ERD50
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Old 02-08-2012, 01:11 PM   #79
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That is exactly right. As Martha once pointed out, once someone has taken a position, arguments against it simply harden his views.

I often ask myself whether this is the case for me. However (1) I used to be very anti-low-carb pro whole grains and (2) I would much rather believe what most people believe. Being a low carber can be very inconvenient.
While I have a viewpoint and probably wont move too far from it at this point, that doesnt mean I am not opposed to listening and learning info about various others such as low carb. Presonally, I am not at the point of being proved right or wrong yet concerning diet. I know at this point in time of my life, I am unwilling to change. I enjoy carbs and will continue to eat them, but I have modified the intake of them. Food is still an enjoyable hobby to me. As long as I am in good health, I will continue to tweek around the edges. I was hoping for a transition in old age from " eating, then seek entertainment" to "eating for entertainment", but it probably isnt going to happen if I want a lengthy, healthy retirement.
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Old 02-08-2012, 01:24 PM   #80
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Sometimes you frighten me.
I also found it somewhat disturbing. I will definitely keep looking out for myself!

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It sounds like you are saying that I shouldn't question my Doctor on this, he/she will follow the 'party line', and I should just go along blindly. Sorry, I'm not wired that way. Personally, I think it is a little sad that someone who puts forth all the time and effort on the education it requires to become a Doctor, seems so unwilling to use that intelligence and gained knowledge to question the status quo.
Agreed.
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