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The Cardiometabolic Risk Working Group: Another Coven Practising Drug-Induced Magical Thinking

Posted by Colin Rose on April 14, 2011

The latest issue of the Canadian Journal of Cardiology, published by the Canadian Cardiovascular Society (CCS), both of which are largely funded by the drug industry has shamelessly published a “Position Statement by the Cardiometabolic Risk Working Group” (see highlights below). We have previously blogged about the American “Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults” and the Canadian “Working Group on Hypercholesterolemia and Other Dyslipidemias”. Now that the ability of “cholesterol” to induce terror in doctors and patients has become a little worn and less profitable, drug dealers have invented a new disease, “cardiometabolic risk” with which to terrorize asymptomatic people into demanding even more drugs and doctors into prescribing them. Many of the members of the previous covens have migrated to the new one.

These medical covens take it upon themselves to dictate to the rest of the medical profession what drugs should be prescribed to prevent diseases of lifestyle in the otherwise “normal” population, so-called primary prevention. How are these covens assembled and what gives them the authority to establish norms for other doctors? This paper reveals in stunning clarity the answers to these questions. As we can see from the Acknowledgements and Disclosures sections, most of the authors of this Position Statement have many long-term financial relations with many drug dealers. Of the ten members of the executive committee of the Cardiometabolic Risk Working Group, nine have multiple financial relations with drug dealers and of the whole Working Group 19 out of 21 have similar relations. Clearly, drug dealers have distributed tens, if not hundreds, of millions of dollars to these doctors, justified under various guises, to facilitate a culture of drug dependency. Drug dealers choose members of  the Working Group, pay them to be “authors”, pay a medical writer to compose the Position Statement and get it published in a journal which would not exist without the financial support of the same drug dealers. Why am I not impressed and why would any other doctor follow the advice of this coven? But most family physicians and many cardiologists treat this sort of statement, endorsed by presumably unassailable organizations like the CCS, as revealed truth by a mysterious higher authority in possession of occult knowledge that must be accepted or suffer ostracism by one’s colleagues. Of course it doesn’t hurt that a 30-second drug prescription for numerical symptoms of junk food addiction is much easier that spending many unpaid hours reducing the addiction, the only real way to prevent its consequences.

Here is an example of the occult numerological incantations of the Working Group. Compare this with the occult number philosophy of Agrippa based on the pentacle below.

Optimize lipid levels. In patients with cardiometabolic risk with a moderate or high Framingham Risk Score, treatment should be initiated with a statin to reduce low-density lipoprotein cholesterol (LDL-C) by at least 50% and to 2.0 mmol/L. Apo B levels are a better measurement of lipid-related risk in these patients, and the target level for treatment is 0.8 g/L in high-risk and moderate-risk individuals. There is a large residual risk for patients at high risk for CVD, despite LDL-C reduction with high-dose statins. Many patients with cardio- metabolic risk may also have an acquired combined hyperlipidemia, associated with increased triglycerides (TGs), a modest increase in LDL-C, and low high-density lipoprotein cholesterol (HDL-C). LDL particle numbers are increased, as reflected by the increased levels of apo B100. Beyond LDL-C lowering, strategies that might reduce the residual risk include reducing the total cholesterol (TC) to HDL-C ratio, high-sensitivity C-reactive protein, and TG, although there are no clinical trial data to date to support such strategies. In the patient with diabetes, glycemic control optimization and health behaviour modification should be attempted prior to the addition of another agent, such as a fibrate. In the Action to Control Cardiovascular Risk in Diabetes trial the addition of fenofibrate to simvastatin in patients with type 2 diabetes failed to show any reduction of CV events, although there may have been benefit in the subset of individuals with high TG/low HDL-C.

The deliberations of the Cardiometabolic Risk Working Group have much in common with pagan covens with occult rituals and symbols like the pentacle which when worn will drive out evil numbers such as “cholesterol”. Expensive statins for “cholesterol” and ARBs for high blood pressure are the new pentacle. The significance of the pentacle, as described by Heinrich Cornelius Agrippa in his Three Books of Occult Philosophy, makes as much sense as the Position Statement of the Working Group.  “A Pentangle also, as with the vertue of the number five hath a very great command over evil spirits, so by its lineature, by which it hath within five obtuse angles, and without five acutes, five double triangles by which it is surrounded. The interior pentangle containes in it great mysteries, which also is so to be enquired after, and understood; of the other figures, viz. triangle, quadrangle, sexangle, septangle, octangle, and the rest, of which many, as they are made of many and divers intersections…

When one manages to decode the occult numerology of the Statement one can see that the goal of the Working Group is to have every overweight junk-food addict in Canada, the typical “high-risk” patient, on some combination of pills for “high” blood pressure and “high” cholesterol. The “targets” for blood pressure and cholesterol are set low and arbitrarily to guarantee that most of the Canadian population would be on some drug. The drug dealers can be assured that doctors will prescribe the newest, most expensive patented drug rather than a cheaper generic alternative because they have already spend hundreds of millions of dollars in advertising the advantages of the patented drugs. This is called clever marketing but it has nothing to do with the health of the population. The consequences of self-destructive lifestyles will not be lessened by any number of drugs which will have the unintended consequence of worsening those lifestyles when people are convinced they can continue those lifestyles with impunity under the “protection” of drugs that make the numerical symptoms of those lifestyles look better. While the Position Statement gives lip service to the necessity of “health behaviour interventions” it insists also on the necessity of “vascular protective measures”, code for expensive drug prescription.

Canada is currently in the middle of a federal election campaign in which the most important issue for voters is “health care”. All parties are promising to increase “health care” spending by 6% a year indefinitely. With an inflation rate of only 2%, a PhD in mathematics is not required to see that in the not too distant future “health care” will consume the entire tax revenue of federal and provincial governments. The increase in “health care” spending is driven by the sort of activities represented by this Position Statement but no candidate dares to mention drug-induced magical thinking in their campaign speeches or platforms. The electorate loves its addictions and demands infinite “health care” to provide the mirage of protection from the consequences of those addictions and any candidate who points out the obvious absurdity of this belief is dead electoral meat.

How can we exorcise the myths promoted by these venal covens? There at two excellent drug review publications written by authors with absolutely no connection to drug dealers that should be required reading for every doctor: Prescrire, a French publication available in English, which is expensive but is the gold standard in independent thinking about drugs and the Drug and Therapeutics Bulletin of Navarre, a Spanish publication, available in English, which is free but covers a limited range of drugs. A recent excellent article from the latter, “Magical numbers in pharmacological prevention of cardiovascular disease and fractures: a critical appraisal“, analyzed in detail the occult numerology of the drug-funded covens’ pontifications on “primary prevention” and concludes,

A considerable part of the pharmacological recommendations to prevent cardiovascular events and fractures in healthy persons lack any solid justification. No clear efficacy, nor the size of the effect of these agents or a clear balance between risk and benefit make the intervention clinically and socially worthwhile. The “therapeutic targets” and the “operative definition” of disease or risk factor that include instruments or tables to calculate risk are new gateways to unnecessary medicalization. In the context of modern medicine, immersed in conflicts of interest, the physician is obliged to interpret the results of trials and the recommendations from guidelines and consensus at a critical distance, and to place emphasis on the development of clinical prudence as a desired skill.

In other words a truly professional doctor will ignore any advice from the drug dealer funded covens and use his or her own best judgement.

Lawrence A. Leiter, David H. Fitchett, Richard E. Gilbert, Milan Gupta, G. B. John Mancini, Philip A. McFarlane, Robert Ross, Hwee Teoh, Subodh Verma,  Sonia Anand, Kathryn Camelon, Chi-Ming Chow, Jafna L. Cox, Jean-Pierre Després, Jacques Genest, Stewart B. Harris, David C. W. Lau, Richard Lewanczuk, Peter P. Liu, Eva M. Lonn, MD, Ruth McPherson, Paul Poirier, Shafiq Qaadri, Rémi Rabasa-Lhoret, Simon W. Rabkin, Arya M. Sharma, Andrew W. Steele, James A. Stone, Jean-Claude Tardif, Sheldon Tobe, Ehud Ur

Posted in Canada, cardiology, cholesterol, cme, continuing medical education, diabetes, diabetes, Type 2, diet, drug marketing, drugs, election, ethics, health care, junk food, medical terrorism, obesity, professionalism, statins | 5 Comments »

MUHC Endorses Pfizer’s Products

Posted by Colin Rose on April 9, 2010

Lipitor.ca

This is a back lit box on the first floor of the Montreal General Hospital, the “mountain campus” of the MUHC. This is how the McGill University Health Centre is caring for your health. Obviously Pfizer expects that the “professionels de la santé” at the MUHC would highly recommend Pfizer’s products and obviously the MUHC administration expects that they would. How many $millions is Pfizer paying the MUHC for this priceless endorsement of its products which directly benefit those “professionels de la santé?” What would happen to any of the “professionels de la santé” who gave “précieux conseils” that Lipitor was useless in the vast majority of people for whom it is prescribed as described in our blog page on statins? Do true professionals associate with organizations that take money from the profits of companies selling the products they recommend? In Quebec our taxes are about to increase dramatically to pay for a “health contribution” a lot of which will go to paying for expensive, mostly useless drugs like Lipitor. That’s good business if you are running a hospital but not if you are really caring for health. If you would like to protest this highly unprofessional behaviour  phone Rebecca Burns (MUHC media) at (514) 934-1934 Ext. 71443 or  email Dr. Arthur Porter, CEO of the MUHC.

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Update, April 16, 2010

It seems the MUHC administration felt some heat. One week after posting this blog, the Pfizer ad had been removed. They reacted so fast that they had no replacement and had to leave only an embarrassing blank light box.

Thanks to all those who took the time to register their opinion of this example of grossly unprofessional behaviour.

One hopes that in the future McGill and the MUHC will think twice about prostituting themselves to the drug dealers.

MGH-Box

Posted in cholesterol, drug marketing, drugs, ethics, professionalism, statins | Tagged: , , , | 2 Comments »

“When diet doesn’t work”

Posted by Colin Rose on September 21, 2009

Here is a graphic illustration of the concept of moral hazard as applied to the drug treatment of lifestyle diseases.

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Reprinted from AdWatch

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Many studies confirm that doctors’ behaviour can be influenced by drug advertising, but many of them are unaware of this.
Not only the advertising text, but also the images play an important part.
For example, see the above image in the Lescol advertisement published in the April 2008 issue of Rivista SIMG (Journal of the Italian Society of General Practitioners).

Lescol (fluvastatin sodium) is one of the statin class of drugs used to treat of high cholesterol when diet and other lifestyle changes don’t work.
The Summary of Product Characteristics states “for best results in lowering cholesterol, it is important that you closely follow the diet suggested by your doctor”.

What kind of advice could the doctor have given the two people on the beach?

They seem to be really happy and relaxed. The pastel colours, the calm sea and the blue sky in the background convey the impression that all is going well and no changes are needed.

The designer must have been influenced by the Colombian painter Fernando Botero, famous for his fat men and women, who generally emanate a sense of calmness and satisfaction.

What I can understand, as a doctor, after looking at this image?
“It doesn’t matter what I advise my patients to eat; it isn’t worth them trying to change their lifestyle behaviours.
Only the pill can make the difference!”

Posted in atherosclerosis, cardiology, cholesterol, diet, drug marketing, drugs, food, junk food, moral hazard, statins | Tagged: , , | Leave a Comment »

FREE LUNCHES COME AT A PRICE

Posted by Colin Rose on September 12, 2009

No professional should take any benefits from any industry for which s/he makes recommendations to clients. Medical licensing bodies should de-license any doctor who does so.


FREE LUNCHES COME AT A PRICE
ALEX ROSLIN SPECIAL TO THE GAZETTE
The Gazette
12 Sep 2009

Adam Hofmann is used to getting teased about his lunch. It’s not because his mom gave him something uncool to eat. It’s because he paid for it. Hofmann is a doctor and fifth-year medical resident at McGill University. Lunchtime is often when residents…read more…

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Drug Dealers Fund Doctors’ Education

Posted by Colin Rose on September 10, 2009

Here is a classic example of Big Pharma controlling what doctors get to hear during “continuing medical education”. Big Pharma pays big money to have their logos appear below that of McGill, a presumed institute of higher learning that is tacitly approving of their drugs and the methods they use to promote them.

There is always the meaningless disclaimer about how the grants are “unrestricted”. Just try inviting a speaker who is at all critical of Big Pharma and see how fast the grant disappears.

How much does the McGill Faculty of Medicine receive? How much of the money goes into undergraduate education? Is the money also influencing what gets taught to medical students?

Write to the Dean of the Faculty of Medicine, Richard Levin,  and try to get his answers. Lots of luck.

McGill-Refresher-Course-Drugs

Posted in cme, continuing medical education, drug marketing, professionalism | Tagged: , , , , , , , , , , , | Leave a Comment »

Drug costs have ballooned in Quebec

Posted by Colin Rose on April 18, 2009

Why am I not surprised? In Quebec, doctors are paid by drug dealers to prescribe drugs.

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Drug costs have ballooned in Quebec
AARON DERFEL GAZETTE HEALTH REPORTER
The Gazette
17 Apr 2009

Quebec spends far more on prescription drugs than any other province or territory in Canada – a factor that’s to blame for spiralling healthcare costs, a new study reveals. More disturbing, Quebec has gone from spending the least of any province on…read more…

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OBSTAT-Doctors being paid to push drug study

Posted by Colin Rose on April 3, 2009

“Dr. LeLorier reports having served as a paid speaker or consultant for the following manufacturers of statins: Merck Frosst Canada, Pfizer Canada, AstraZeneca, and Bristol-Myers Squibb.” Why would anyone take any advice on statins from him?


Doctors being paid to push drug study
BY TOM BLACKWELL
National Post
03 Apr 2009

Quebec doctors are being offered $100 for every new patient they put on cholesterollowering statin drugs as part of a major, federally subsidized study that is raising questions about the influence of the pharmaceutical industry on health…read more…

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Drug Marketing by “Study”

Posted by Colin Rose on December 13, 2008

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Posted in atherosclerosis, cardiology, cholesterol, drug marketing, professionalism, statins | Tagged: , , , , , , , , , , | Leave a Comment »