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Three studies presented at the recent American Heart Association annual meeting deserve our attention. The first studied Vytorin (10mg Zetia and 40mg Simvastatin) vs 40mg Simvastatin alone in patients with known coronary artery disease. States the study website: “Vytorin significantly reduced CV outcomes more than Simvastatin alone” in this group. Over 7 years there was a 6% reduction in CV endpoints compared to statins, which is approximately (by our calculations) 3-4 additional people who will benefit out of 1000 who take Vytorin rather than Simvastatin. The study is not yet published or peer reviewed and stands in contrast to virtual every other study that has demonstrated two outcom
What are quality indicators? Essentially Medicare and the ACA are attempting to assure that we doctors practice quality medicine, and they have established means to monitor us through quality indicators. On the surface, that sounds like a very noble cause. But unfortunately, the quest to enforce quality is leading us to just the opposite pole. We have talked about the quest for numerical perfection and how much of a folly that is for older patients. Yet, many quality indicators are focused on numbers: achieving “ideal” blood pressure, measuring and treating cholesterol, measuring and treating bone density, and more. Doctors are rewarded for pursuing the very naïve number chasing that
Who is Ancel Keys? If you ever wondered why we think eggs and shell fish are harmful, why low-fat foods sell so well, why we have become a society obsessed with cholesterol levels, why statins are among the most profitable drugs peddled by our pharmaceutical companies, you just have to look at the work of Ancel Keys. In 1953, after examining data on dietary intake in 22 countries, he published the Seven Countries Study that linked high fat/high cholesterol diets to increased coronary artery disease (CAD). The fact that he eliminated 15 countries from his final paper (countries in which his thesis may well have been contradicted), that his dietary information was imprecise, and that his us
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