USA Today piece on LDL/statins

[tweaked17]

What do you think? I know we have a lot of strong opinions on cholesterol/statins here on the boards.

http://www.usatoday.com/news/health/...lesterol_N.htm

Some selections:

"Taken together, doctors say, the studies suggest that accepted notions of normal LDL are wrong ? and that current treatment guidelines miss at least half of those who should be getting a statin."

"JUPITER suggests that millions more older people ? as many as 11 million, Yale researcher Erica Spatz reported this month ? should be getting statins. That would bring the total to about 45 million people, or 80% of all men older than 50 and all women older than 60."

'"Either the threshold of what was set as an ideal LDL was set outrageously high, thus allowing the vast majority of patients to be missed, or LDL isn't much of a risk factor. It's got to be one of the two."'

". . .the study supports the wisdom of a push to drive LDL even lower, in many cases down to 70 mg/dl. " - HAH! Jesus...

[Dr. Horse]

LOL, more like "USA Yesterday"...

Anyway, when those studies hit the news a few months ago, millions of people asked their doctors to check their CRP. It made some waves.

[justfyi]

LOL, more like "USA Yesterday"...

OHHHH SNAPPPPPPP

Sounds like the medical industry and doctors are schemin' just to stack alil' more paper

[SDC77]

The sad thing is that there are people who actually believe that the goal of doctors is to keep the population sick. I hear it and read it all of the time. What the f*ck is wrong with you people? To think that someone will sweat through med school, work their fingers to the bone on zero sleep through residency, be available at times 24/7 for their patients..... truly wants said patients to be sick and then die only after they've milked them for every last penny of insurance money? You idiotic oxygen thieves.

[Dr. Horse]

The sad thing is that there are people who actually believe that the goal of doctors is to keep the population sick. I hear it and read it all of the time. What the f*ck is wrong with you people? To think that someone will sweat through med school, work their fingers to the bone on zero sleep through residency, be available at times 24/7 for their patients..... truly wants said patients to be sick and then die only after they've milked them for every last penny of insurance money? You idiotic oxygen thieves.

But how do you really feel about it?

[tweaked17]

LOL, more like "USA Yesterday"...

..those studies hit the news a few months ago

I guess I missed the memo. I was traveling and interviewing on top of 20 credits, so I'm not surprised. "News to me!"

But how do you really feel about it?

LMAO


Scott, you are justified, but don't kid yourself - there are scumbag doctors. There are also doctors, just like people, who don't know any better or are ignorant to certain things.

That said, I think there are a lot of people out there who enjoy a general mistrust towards the medical profession when the majority of doctors I have met/work with really don't deserve any of that.

People also don't understand the profession because there's little transparency. Where I live (and I suppose, were most people live for that matter), most OB/GYNs work at least 3 months out of the year before they can break even with their malpractice insurance costs. That's before putting a single dime in their pocket/savings. (I don't want this to become a discussion, I was just giving an example of what many don't know/consider)

Many people criticize the amount of tests doctors run or the fact that most are quick to get you on meds or immunize your kids, but when you live in fear of being sued for the big bucks, you practice defensive medicine.

[PTN_old]

OHHHH SNAPPPPPPP

Sounds like the medical industry and doctors are schemin' just to stack alil' more paper

i lol'd

[LactoseTolerant]

The sad thing is that there are people who actually believe that the goal of doctors is to keep the population sick.

Let's be honest here. The livelihood of a lot of people depend on other people being/getting sick. If viral illnesses disappeared from the planet tomorrow, I'd be out of a job the day after.

That's not to say that there's a concerted conspiracy here.

[reefpicker]

The sad thing is that there are people who actually believe that the goal of doctors is to keep the population sick. I hear it and read it all of the time. What the f*ck is wrong with you people? To think that someone will sweat through med school, work their fingers to the bone on zero sleep through residency, be available at times 24/7 for their patients..... truly wants said patients to be sick and then die only after they've milked them for every last penny of insurance money? You idiotic oxygen thieves.

Actually, I think that you have to keep in mind two things:

1) When a patient is sick, they expect the doctor to give them something, i.e. a prescription

2) Physicians get so much information from the pharmaceutical companies... They are always pushing for the "new" drug or the "latest" treatment. Oh, and to add insult to injury, a lot of new drugs are promoted on TV (so not only the physicians get the information, but also uneducated patients too!)

I think these two factors, compounded together and regardless of the well-intention of the physicians, are part of the growing epidemic of our overreliance on drugs to cure things that maybe could be cured with diet, lifestyle, and natural drugs...

One alarming situation is the number of general practice physicians prescribing anti-depressants to patients without any real and concrete diagnosis of depression.

[bdulany]

Let's be honest here. The livelihood of a lot of people depend on other people being/getting sick. If viral illnesses disappeared from the planet tomorrow, I'd be out of a job the day after.

That's not to say that there's a concerted conspiracy here.

doubt it. if viral illnesses disappeared, there are tons of others problems people need help in. We are not intelligently designed.

[bdulany]

Actually, I think that you have to keep in mind two things:

1) When a patient is sick, they expect the doctor to give them something, i.e. a prescription

2) Physicians get so much information from the pharmaceutical companies... They are always pushing for the "new" drug or the "latest" treatment. Oh, and to add insult to injury, a lot of new drugs are promoted on TV (so not only the physicians get the information, but also uneducated patients too!)

I think these two factors, compounded together and regardless of the well-intention of the physicians, are part of the growing epidemic of our overreliance on drugs to cure things that maybe could be cured with diet, lifestyle, and natural drugs...

One alarming situation is the number of general practice physicians prescribing anti-depressants to patients without any real and concrete diagnosis of depression.

Not a lot of doctors get sucked into the 'new' drugs from the hot pharm rep, unless of course it is suppose to be some novel treatment. As for our reliance on drugs, patients don't want to do the work. E.g., pts come in with 'diet and exercise didn't work' and request phentermine, it isn't something the docs are pushing. Same for the depression cases. Ppl are actually coming in with symptoms of depression and need it.

Anyway, I cannot deal with family or internal medicine. It is full of ppl with diabetes, hypertension, obesity and crazy ppl.

[LactoseTolerant]

doubt it. if viral illnesses disappeared, there are tons of others problems people need help in. We are not intelligently designed.

Er, what are you talking about? If viruses were wiped out, the business of detecting and curing viruses would be wiped out also. How hard is that to understand?

[LactoseTolerant]

Not a lot of doctors get sucked into the 'new' drugs from the hot pharm rep, unless of course it is suppose to be some novel treatment. As for our reliance on drugs, patients don't want to do the work. E.g., pts come in with 'diet and exercise didn't work' and request phentermine, it isn't something the docs are pushing. Same for the depression cases. Ppl are actually coming in with symptoms of depression and need it.

Anyway, I cannot deal with family or internal medicine. It is full of ppl with diabetes, hypertension, obesity and crazy ppl.

You don't know much.

[Dr. Horse]

Er, what are you talking about? If viruses were wiped out, the business of detecting and curing viruses would be wiped out also. How hard is that to understand?

I think what he's saying is that just because you cure one illness doesn't mean that people still won't get sick from something else. People won't live forever; cure one process and another will kill you. Still plenty to go around for the medical profession.

It's like misguided notion that if you could stop all cigarette smoking that you would somehow magically eliminate so much disease and healthcare cost. Sure, you'd reduce the rate of COPD and lung CA, but those people will just die of something else. It actually costs LESS healthcare dollars to take care of a smoker than a non-smoker, because they don't live as long.

[reefpicker]

It actually costs LESS healthcare dollars to take care of a smoker than a non-smoker, because they don't live as long.

Whether intentional or not I literally LOLed at that.

patients don't want to do the work. E.g., pts come in with 'diet and exercise didn't work' and request phentermine, it isn't something the docs are pushing. Same for the depression cases. Ppl are actually coming in with symptoms of depression and need it.

First, depression can be treated with both drugs and psychotherapy. In fact, depression is a symptom, and just prescribing anti-depressant without knowledge of an underlying disease or psychoevaluation is irresponsible. For example, a patient could be depressed because he/she has a hormonal imbalance, or the patient could have been sexually abused. In both cases, treating the underlying problem and not the symptom is the best course of action. Hence, why I abhor the accepted practice of GPs prescribing anti-depressant. It is stupid. GPs lack the training to treat depression. Forgive my bluntness, but I am very passionate about how we have been mishandling mental health issues in this country. And this is one of many areas where we have shown a lack of understanding of these diseases.

As for the your other comment about patients lazyness, if the physician gives up, so will the patient. The system is broken at both ends, not one end.

I agree that in the end it is the job of the physician to keep the patient alive, and that such burden should not be taken lightly. I can empathize with them in that regard. But on the other hand, they have the upper hand. They have the knowledge and experience, and if they believe that adherance to a diet or exercise regime is better than the drugs, they should really push for the former.

[Blindead]

Apparently I had crazy irrational depression as a kid and was one of the few with a medical problem in my brain. They actually found out about it when I got diagnosed with OCD much later (ofc after giving me meds lawl). I have no idea what it was, apparently when you're like 12 you don't need to know what's wrong with you, lawl.

[Phosphate bond]

Anyway, when those studies hit the news a few months ago, millions of people asked their doctors to check their CRP. It made some waves.

Can't high CRP be a sign of insulin resistance or possibly impending insulin resistance?

I know that IL-6 secreted from adipocytes secondarily to hyperinsulinemia (among other things) stimulates CRP production in the liver.

Hypoxia also stimulates IL-6 secretion transiently but I don't think that is the major factor here.

[Dr. Horse]

Whether intentional or not I literally LOLed at that.

I'm not getting the joke.

[Phosphate bond]

I think what he's saying is that just because you cure one illness doesn't mean that people still won't get sick from something else. People won't live forever; cure one process and another will kill you. Still plenty to go around for the medical profession.

Yep.

Even if a person could eliminate all dietary contributors and lifestyle factors there would still be genetics, age and environmental problems to deal with.

P.S. The part about people dying sooner (from smoking) costing less money is interesting. That tells me that improving quality of life for old people sounds like high yield area to work on (considering these people most likely have a lot of productive contribution/wisdom left in them too)

[reefpicker]

I'm not getting the joke.

I guess I found it funny in a dark way, how nonchalant you are about the possibility of these people dying earlier and how if they do die early, it is better for the rest of us, as they are one less drag on the health care system.

Of course, I say that, but I do understand smoking is an addiction that is often hard to overcome... My partner smokes, and I am not very happy about it... I know it is hard to quit, but I think smoking is stupid... It is like being served death in a plate, and just slowly helping yourself to a full serving of it...

[gsolo]

Many people criticize the amount of tests doctors run or the fact that most are quick to get you on meds or immunize your kids, but when you live in fear of being sued for the big bucks, you practice defensive medicine.

what is "defensive medicine" ?

[Dr. Horse]

I guess I found it funny in a dark way, how nonchalant you are about the possibility of these people dying earlier and how if they do die early, it is better for the rest of us, as they are one less drag on the health care system.

Just stating a fact is all. One that most people are actually surprised to learn.

[tweaked17]

improving quality of life for old people sounds like high yield area to work on (considering these people most likely have a lot of productive contribution/wisdom left in them too)

Most of my professors really push this idea in the public health program I'm in. They are cognizant of an "aging America"

they are one less drag on the health care system.

If I may quote Nas: "The world could use one less man."

what is "defensive medicine" ?

Are you familiar with the acronym CYA?

Essentially, it's the overuse of diagnostic tests and treatments/medications when they're unnecessary or uncalled for. Doctors are constantly practicing with the threat of malpractice looming overhead. They get sued all the time, and most of the time it amounts to nothing, but to avoid a massive/damaging suit, doctors will do a bunch of unnecessary **** just so you can't claim they were being negligent or that they "missed something" - a good example is an EM physician giving a chest x-ray to everyone who walks into his ED with a cough.

This (including the issue of malpractice) is one of the #1 answers to the question "Why do Americans pay so much for health care?"

[Dr. Horse]

wow strong MCAT

Congrats.

So, do tell... What's the score and where do you want to go/do?

[Notorious BIG]

The sad thing is that there are people who actually believe that the goal of doctors is to keep the population sick. I hear it and read it all of the time. What the f*ck is wrong with you people? To think that someone will sweat through med school, work their fingers to the bone on zero sleep through residency, be available at times 24/7 for their patients..... truly wants said patients to be sick and then die only after they've milked them for every last penny of insurance money? You idiotic oxygen thieves.

My dad is a doctor and whats sad is that he tells me he often meets will very stupid doctors. This pacific doctor would prescribe omoxyelin (spelling?) regardless of your condition, LOL.

Feeling sick? Can i interest you in some omoxyelin?

[Dr. Horse]

pacific doctor

Sounds like a nice guy.

[tweaked17]

Congrats.

So, do tell... What's the score and where do you want to go/do?

Well, my MCAT day could be a topic of its own. That was actually intended to reflect how damn hard the test was, not how great my score was!

But, all things considered (10 days after my last final [my fault], construction above the test room, workers tripping the fire alarm during Verbal Reasoning), I was very happy with a 34R.

Needless to say, the pre-meds (you know how we are) at my test site were FURIOUS because we all lost time. I had a similar test day experience with Thompson-Prometric when they administered my personal training cert, so I knew what to expect from their staff/customer service. Never again.

Right now, I'm trying to decide between Temple and SUNY Downstate (for those interested, a 34R + 3.88 were good enough this time 'round). However, there are one or two wild cards I haven't yet heard from that could displace one or both of those schools as top choices.

As far as what I want to do - it will probably wind up being a subspecialty of IM (gastro, endo, cardio, etc.). I don't think I'm a cutter and know I don't want to go into psych or peds, but I also don't know many doctors who didn't change their mind ~4 times in med school

[Dr. Horse]

Well, my MCAT day could be a topic of its own. That was actually intended to reflect how damn hard the test was, not how great my score was!

But, all things considered (10 days after my last final [my fault], construction above the test room, workers tripping the fire alarm during Verbal Reasoning), I was very happy with a 34R.

Needless to say, the pre-meds (you know how we are) at my test site were FURIOUS because we all lost time. I had a similar test day experience with Thompson-Prometric when they administered my personal training cert, so I knew what to expect from their staff/customer service. Never again.

Right now, I'm trying to decide between Temple and SUNY Downstate (for those interested, a 34R + 3.88 were good enough this time 'round). However, there are one or two wild cards I haven't yet heard from that could displace one or both of those schools as top choices.

As far as what I want to do - it will probably wind up being a subspecialty of IM (gastro, endo, cardio, etc.). I don't think I'm a cutter and know I don't want to go into psych or peds, but I also don't know many doctors who didn't change their mind ~4 times in med school

Wow, sounds like a stressful day. I'm surprised they didn't reschedule the test since test time was lost. Fire alarm- priceless!

And a 34 is nothing to sneeze at- that's a good solid score, and good enough to get you in anywhere if the rest of your application is right. Believe me, MCAT is not the be-all end-all. I learned the hard way that a high score does not cover for all past sins (i.e. lower GPA). You GPA is very impressive and carries a lot of weight, assuming you go to a decent school.

Good luck with everything. Med school is a great time- try to go in with an open mind. Remember you'll probably be practicing your chosen field for about 30yrs. Pick something that makes you happy.

[tweaked17]

Wow, sounds like a stressful day. I'm surprised they didn't reschedule the test since test time was lost. Fire alarm- priceless!

And a 34 is nothing to sneeze at- that's a good solid score, and good enough to get you in anywhere if the rest of your application is right. Believe me, MCAT is not the be-all end-all.

In retrospect, not only did I have a great story to tell on interviews, and a 34 isn't bad at all - but on test day (and in the weeks/months following) scoring below your typical range in one of your strongest sections is not fun! I wrote an angry (but appropriate) letter to the AAMC and got a nice response outlining the situation, which they urged me to forward to schools I was applying to.