What role cholesterol medication?

A frequent conversation point among my patients, as well as participants in the www.cureality.com program, is "Are cholesterol medications really necessary?"

No, they are not. What IS necessary is to correct all manifest and hidden causes of coronary plaque. Among these causes, in my view, is LDL cholesterol of 60 mg/dl or greater. There are many other causes of coronary plaque--e.g., small LDL particles, unrecognized hypertension, Lp(a), hidden diabetic patterns, etc.--but reducing LDL to 60 mg is still an important part of a plaque-reversing effort.

Insofar as we wish to get LDL to this goal, the statin cholesterol drugs like Lipitor, Zocor, Crestor, etc. may play a role. However, they should only be considered after a full effort dietary program is pursued. Don't follow the American Heart Association's diet unless you want to fail. It's nonsense.

For a more detailed discussion of how to use nutrition and nutritional supplements to reduce LDL cholesterol, go to www.lef.org, the website for the Life Extension Foundation. I wrote an article for their magazine called "Cholesterol and Statin Drugs: Separating Hype from Reality". You'll find the article at http://search.lef.org/cgi-src-bin/MsmGo.exe?grab_id=0&page_id=1295&query=davis%20cholesterol%20natural&hiword=CHOLESTEROLA%20CHOLESTEROLS%20DAVI%20DAVID%20DAVIE%20DAVIES%20DAVIN%20DAVIO%20DAVISON%20DAVISS%20DAVIT%20NATURALBASED%20NATURALES%20NATURALIZED%20NATURALLY%20NATURALS%20NATURE%20NATURES%20cholesterol%20davis%20natural%20.)

Can your plaque-reversal efforts succeed without statin drugs? It depends on your causes. For instance, someone with small LDL and Lp(a) only may do great on our basic program and then add niacin. Unfortunately, another person with a starting LDL cholesterol of 240 mg/dl--sky high--will have more success with these drugs.

Believe me, I am no blind supporter of drug companies and their flagrantly profit-seeking practices which, in my view, are cut-throat, shoving anyone and anything out of their way to increase profits and market share. I share many of Dr. Dave Warnarowski's views on how vicious their tactics can be; see his recent Blog post at http://www.drdavesbest.com/blog/ called "I smell a rat".

Nonetheless, the deep and well-funded research of the pharmaceutical industry does yield some useful tools. You don't have to love the insect exterminator, but if your house is being eaten by termites, his services can be useful. Same thing with these drugs. Useful--not the complete answer, not even close, but nonetheless useful in the right situations. Sometimes antibiotics are necessary, even life saving. That's how cholesterol drugs are, too.

Take it all in the proper perspective. Your goal is not cholesterol reduction, per se, but plaque control, preferably reversal.

Supplement Mania!

Ever hear of "polypharmacy"? That's when someone takes too many medicines. People will have lists of 15-20 prescription medicines, for instance, with crazy interactions and oodles of side-effects.

Well, how about "poly-supplments"? That's when someone takes a large number of nutritional supplements.

Let me tell you about a 45 year old man I met.

In an effort to rid himself of risk for heart disease that he felt was likely shared with his family (brother and father diagnosed with heart attacks in their late 40s), Steve followed a program of nutritional supplementation. You name it, he took it: hawthorne, anti-oxidant mixtures, vitamins C, E, B-complex, saw palmetto, 7-keto DHEA, velvet deer antler, gingko biloba, policosanol, chronium picolinate, green tea, pine bark extract, St. John's Wort, CoEnzyme Q10, papain and other digestive enzymes...He became a distributor for a nutritional supplement company to allow him to afford his own extraordinary program.

To satisfy himself that he had indeed "cured" himself of heart disease, he got himself a CT heart scan. His score: 470, in th 99th percentile. Steve's heart attack risk based on this score was around 10% per year. High risk, no question.

For weeks after his scan, Steve admitted walking around in a daze, not knowing what to do. Years of telling himself that he had effectively dealt with his heart disease risk, now all down the drain.

When we met, I persuaded him that to think that this collection of supplements would reverse heart disease was magical thinking. We trimmed his list down to the essentials and got him on the right track.

Heart disease is controllable and reversible, but not this way. Don't fool yourself into thinking that some collection of supplements will be enough to stamp out your heart disease risk. Just like taking an antibiotic when you don't have an infection achieves nothing, so does taking the wrong supplements.

What does heart scanning mean to you?

CT heart scans can mean different things to different people.


What does a heart scan mean to you? There are several possibilities:

1) A way of reducing uncertainty in your future.

2) A tool to crystallize your commitment to health.

3) A device to help you track how successful your heart disease prevention program is.

4) A trick to get you in the hospital.

5) A moneymaking tool for unscrupulous physicians hoping to profit from "downstream" testing, particularly heart catheterizations.


Like anything, heart scans can be used for both good and evil. How can you be sure that your heart scan is put to proper use--for your benefit and not someone else's profit?

Simple: Get educated. Understand the issues, be armed with informed questions.

If, for instance, you're a 55-year old female with a heart scan score of 90, active without symptoms, and you're told to have a heart catheterization right off the bat---run the other way. This is bad advice. A heart procedure like catheterization at this score in an asymptomatic woman is very rarely necessary. That decision can only be made after a step-by-step series of decisions are made by a truly interested, unbiased party. (A stress test is almost always required in this situation before the decision can be made to proceed with a catheterization.)

Unfortunately, in 2006, getting unbiased advice from your doctor is still a struggle. That's why we started Track Your Plaque---unbiased information, uncolored by drug or device company support, with an interest in the truth.

Coronary disease is drying up!

I had an interesting conversation with a device representative this morning. He was a sales representative for a major medical manufacturer of stents, defibrillators, and other such devices for heart disease.

Since I'm still involved with hospital heart care and cardiac catheterization laboratories, this representative asked me if I was interested in getting involved with some of the new cardiac devices making it to market over the next year or two. "The coronary market is drying up, what with coated stents and such. We've got to find new profit sources."

Well, doesn't that sum it up? If you haven't already had this epiphany, here it is:

HEART DISEASE IS A PROFITABLE BUSINESS!

Why else can hospitals afford billboards, $10 million dollar annual ad campaigns, etc.? They do it for PROFIT. Likewise, device and drug manufacturers see the tremendous profit in heart disease.

The representative's comments about the market "drying up" simply means that the use of coated stents has cut back on the need for repeat procedures. It does NOT mean that coronary disease is on the way out. On the contrary, for the people and institutions who stand to profit from heart care, there's lots of opportunity.

Track Your Plaque is trying to battle this trend. Heart disease should NOT be profitable. For the vast majority of us, it is a preventable process, much like house fires and dental cavities.

Mammogram for your heart

With the booming popularity of "64-slice CT scans", there's a lot of mis-information about what these tests provide.

These tests are essentially heart scans with added x-ray dye injected to see the insides of the arteries. However, to accomplish this, a large quantity of radiation is required. In addition, the test is not quantitative, that is, it is not a precise measure that can be repeated year after year.

It is okay to have a 64-slice CT coronary angiogram. It is NOT okay to have one every year. That's too much radiation. However, a heart scan can be repeated every year, if necessary, to track progression or regression. Once stabilization (zero change) or reduction is achieved, then you're done (unless your life takes a major change, like a 20 lb weight gain).

The tried-and-true CT heart scan is the gold standard--easy, inexpensive, precise, and repeatable. Not true for 64-slice angiograms.

Is your doctor using "leeches"?

What if you went to your doctor for a problem and he/she promptly placed leeches on your body?

Yeccchhhh! Would you go back? I'd bet that you'd run the other way as fast as your bleeding legs could take you. Outdated health practices like "bleeding" are outdated for good reason.

Then why would you allow your doctor to approach your heart disease prevention program by checking cholesterol and then waiting for symptoms to appear? That miserable approach leads to tragedy and death all too often--ask Bill Clinton! He might as well have had leeches!

Don't allow your doctor's ignorance or disinterest impede your prevention program. Get your coronary plaque measured, then attack it from all sides by knowing all causes, hidden and obvious. That's why Track Your Plaque is such an effective program.

I often wonder why more doctors aren't using this unbelievably powerful approach to deal with heart disease. But when I see colleagues implanting stents, defibrillators, and the like for many thousands of dollars per patient, the answers are obvious. Given a choice of a rational, effective program of prevention that pays the doctor a few hundred dollars for his time, versus $2000 to $10,000 for a procedure, you can see that the temptation is irresistible for many physicians.

All in the family--What to do if there's heart disease in your family

What should you do if a close relative of yours is diagnosed with coronary disease?
This question came up recently with a patient of mine. The patient--a strapping, 47 year old businessman who looked the absolute picture of health--was undergoing bypass surgery. Although I'd met him for the purposes of plaque reversal, he was already having symptoms and his stress test was flagrantly abnormal, all discovered after a heart scan score of 765. On the day after the patient's bypass, the patient's brother came to me. Understandably concerned about his own health, he asked what he should do. The answer: get a heart scan.
Measure the disease with the easiest test available. If his heart scan score is zero, great--he's at exceptionally low (near zero) risk for heart attack. A modest program of long-term prevention is all that's necessary. What if his score is like his brother, should he get in line for his bypass? No, absolutely not! But he will need two things: 1) a stress test to ascertain whether or not he's safe (60% likelihood a stress test would be normal), and 2) an effort to determine how the heck he got so much plaque. (We favor lipoprotein testing, of course, for greatest diagnostic certainty.)
Message: Learn from the lessons your own family provides. Don't let this valuable information go to waste.
Fire your stockbroker, fire your doctor

Fire your stockbroker, fire your doctor

Is it yet time to fire your doctor?

I advocate a model of self-directed health, a style of healthcare in which individuals have the right to direct his or her own healthcare with only the occasional assistance of a physician or healthcare provider.

Healthcare would not be the first industry that converted to such a self-directed model. Remember travel agents? Only 15 years ago, making travel plans meant calling your travel agent to book your arrangements. This was a flawed system, because they worked on commission, thereby impairing incentive to search for the best prices. You were, in effect, at their mercy.

The investment industry is another such example, though on a larger scale.

Up until the 1980s, individual investment was managed by a stockbroker or other money manager. Stockbrokers, analysts, and investment houses commanded the flow of investment in stocks, options, futures, commodities, etc. Individuals lacked access to the methods and knowledge that allowed them to manage their own portfolios. Individuals had no choice but to engage the services of a professional investor. This was also a flawed system. Like travel agents, stockbrokers worked on commission. We've all heard horror stories in which stockbrokers churned accounts, making thousands of dollars in commissions while their clients' portfolios shrunk.

That has all changed.

Today, the process has largely converted to discount brokers and online services used by individuals trading and managing their own portfolios. Stockbrokers and investment houses continue, of course, but are competing for a shrinking piece of the individual investment market. Independent investors now have access to investment tools that didn’t even exist 20 years ago. Companies like E-Trade and Ameritrade now command annual revenues of approximately $2 billion each.

Travel agents, stockbrokers . . . is healthcare next? Can we convert from the paternalistic, “I’m-the-doctor, you’re the patient” relationship to what in which you self-direct your own healthcare and turn to the healthcare system only in unique situations?

I believe that the same revolution that shook the investment industry in the 1980s will seize healthcare in the future. In fact, the transition to self-directed health will dwarf its investing counterpart. It will ripple more broadly through the fabric of American life. Health is a more complicated “product,” with more complex modes of delivery, and more varied levels of need than the investment industry.

I predict that the emergence of health directed by the individual, just as the emergence of self-directed investment, will dominate in the coming years.

While I hope you've already fired your stockbroker, and I doubt that anyone on the internet still uses a travel agent, I wouldn't yet fire your doctor altogether. But I believe that we are approaching a time in which you should begin to take control over your own health and begin to reduce reliance on doctors, drugs, and hospitals.

Comments (10) -

  • Jenny

    4/11/2009 3:04:00 PM |

    The problem with the concept of "self-directed health" is how ignorant most people are about health in the general population. The online community is self-selected and we are extremely well read and aware.

    But I have friends and even family who have medical conditions but know nothing about physiology and  have no interest in learning about it.

    My belief is that most people don't develop an interest in self-directed medicine until, like myself, they or a family member have been seriously hurt by a doctor they trusted. Until that happens most people will trust their doctors.  Sadly, for many of them the "seriously hurt" translates into "Unnecessary first and fatal heart attack."

  • Anonymous

    4/11/2009 3:19:00 PM |

    I would love to utilize the "a la carte" menu of healthcare model... in fact in many ways I already do.

    Hopefully the next thing to go will be the horrified looks... as if I am endangering my health by directing my care, for asking for tests or services when they are needed, for refusing to be a drug company research subject or pawn, and for being as informed about my body and about medicine as I can be.

    Yes, it is definitely time... but this model only works for those who are informed, aware and proactive.  Those who are too timid, or intellectually challenged, or lazy to direct their own care, will prefer the status quo.

    madcook

  • Anonymous

    4/11/2009 3:26:00 PM |

    I agree with your assessment. Unfortunately, there are many who believe that a national health care bureaucracy is the "answer." If this comes to pass, we will all be paying twice for our care: once for the bloated and ineffective system (just look at our public schools) and once for our self-directed care.

    Thanks for spreading the news.

  • Brock Cusick

    4/11/2009 6:15:00 PM |

    Speaking as someone in the "Investment Adviser" business, I can say with great certainty that Ameritrade and Charles Schwab can give people the ability to make stock trades cheaply, but they cannot help them (much) make trades wisely.  Main Street Joe has gained incredible ability, but expertise lags considerably.

    Most importantly, expertise will ALWAYS be lacking because (if Joe is doing his job) he spends most of his learning time on his real job, whether that's carpentry, plumbing, doctoring, or whatever. The guy who looks at stocks professionally will always have a better feel for the market and what makes a good stock.

    The solution isn't to fire the investment adviser (aka, the expert), but to change the incentives. Get rid of the commission. Fee-based advisers (who take a fee determined by the total assets under management) have the same incentive as the investor - to grow the value of the portfolio.


    ----

    We can make an analogy to Doctors. If the General Practitioner acted more like a Health Adviser who got paid only when you get healthy (rather than get paid when they sell you a medication or procedure) I bet we'd see radical improvement in care. There would probably also have to be payments in the event that the patient refuses to comply with taking his vitamins or stop eating bad things.

  • Lena

    4/12/2009 1:20:00 AM |

    I'd love for this to hurry up and be the case. My current GP always seems "concerned" if I try to take a detailed interest in my own health, as if I am a hypochondriac. I'm quite good at reading body language and am not a paranoia-prone person, so I don't think I'm misreading the situation. She got upset when I brought in some information relevant to my case because it had come from the internet. It wasn't even anonymous, dubious information, it was a guideline authored by two eminent professors in the subject which was widely linked to by medical professionals. But because it came from the internet it was somehow invalid.

    There will be some doctors that will fight tooth and nail before they give up their paternalistic doctor-is-god ways.

  • Dr. William Davis

    4/12/2009 1:11:00 PM |

    Good thoughts, all.

    The fact that we are even having this conversation online is testimony to the fact that self-directed health is ALREADY happening. It is not some sci-fi figment of imagination. It is happening, it will happen, it will grow.

    Granted, "only" 5-10% of the population (15-30 million) will, in the next 30 years, participate. That should not stop one of the most exciting, revolutionary steps in healthcare to develop.

  • Trinkwasser

    4/12/2009 2:29:00 PM |

    Fully agreed! Yes there are a lot of cranks on the internet but equally there are a lot of people pointing and yelling "Crank!"

    This does NOT happen with your GP who might actually know very little about your specific condition, and that knowledge may be 50 years out of date. Sadly this is likely to be the case if he (or you) inform yourself from some of the woefully inadequate "professional" sites.

    Many doctors are first class, as are many other sources of health information. Increasingly we are seeing first class patients also! Teamwork is the best plan, my GP has pointed me to information I didn't otherwise know, and I've returned the compliment.

  • Kris

    4/12/2009 6:51:00 PM |

    it reminds me of speed limits on our Highways. where many people can safely drive at 100 miles an hour but not every one is capable of doing it. Therefore speed limits needed where majority is expected to drive safely. The concept of "self directed health" runs in to the same danger. even though i my self, treated my misery by self educating after years of appointments with doctors and not only suffering physically but also paying big price socially and economically. It is  important to change the selection process of these so called doctors before an individual is allowed in to a medical school. the selection should be based on not only academic achievements but a real personality for community service without ego should be a major criteria. A doctor's inability to treat patient accurately effects our social life and community at large. i still believe that more doctors are sick themselves and therefore are blinded by the false ego. Most don't have the stomach to Liston to their patients. general public shouldn't have to waist their time learning "self directed health treatments". we have a system in place and there are people being trained to take care of the society. it is the selection and training of these individuals which needs an over haul which will require some major alligators/licensing authorities  in the medical system to be shaken.
    However, since internet is a useful tool for learning and millions are already using it for self diagnoses, The medical language (studies and trials findings)posted on the internet should be in plain English so that misunderstanding can be reduced for general public.

  • Anonymous

    5/4/2009 3:53:00 AM |

    Emancipated Patients and a New Kind of Doctor

    http://www.metzelf.info/articles/emancipated.html

  • Jessica

    5/6/2009 9:27:00 PM |

    Our medical director (and Vitamin D proponent) calls this concept "Medical Self Reliance."

    Sounds...empowering!

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