OHHHH NO NOT THIS ON STATINS!!!

[J.Lilinoe]

But I'm just wondering why you're so sure that benefits would be dwarfed by "harmful, nasty side effects" in the long run. Have you secretly conducted your own study?

I have seen a family member who was on a statin drug for several years develop those nasty side effects while on the drug. That is all the "study" I need to convince me that taking statins comes with a HUGE cost that far outweighs its benefits.

[ofonorow]

godsilove it is interesting how you focus on these narrow, drug company sponsored studies, and find them convincing? I am trying to understand. I know I have a strong bias that they are contrived, probably falsified, and that so many are run hoping at least one trial will show a clear benefit, etc. But you appear to be convinced that these drugs must have a benefit, even a strong benefit. I know we have discussed this ad naseum, but other than the sheer number of studies run, I see very little evidence that these drugs benefit heart patients.

We all agree that statins lower cholesterol.

But there is a large amount of observational evidence, and one might even say an underlying "theory" (because of the CoQ10 depletion) that these drugs do much more harm than good in heart patients.

Maybe the answer to our study design is to pit vitamin C lysine against statin cholesterol-lowering drugs? That might be a very interesting contest. You seem to think the statin group would fare better, and I would worry about their continued future existence.

[godsilove]

But I'm just wondering why you're so sure that benefits would be dwarfed by "harmful, nasty side effects" in the long run. Have you secretly conducted your own study?

I have seen a family member who was on a statin drug for several years develop those nasty side effects while on the drug. That is all the "study" I need to convince me that taking statins comes with a HUGE cost that far outweighs its benefits.

I'm sorry to hear that. If you don't mind me asking, what side effects did your relative develop? Was it rhabdomyolysis?

I'm not trying to say that statins are perfectly safe - most drugs aren't. But can one patient's experience be extrapolated to all other patients? I don't think so. Even antibiotics can cause serious side effects in a small subset of patients - but nobody would deny that for the most part they do more good than harm. I think whenever contemplating a treatment - be it a drug, surgery, or lifestyle modification - it is important to weigh the risks of treatment with the risk of doing nothing at all. Unfortunately, it's a bit like a crapshoot at times.

[godsilove]

godsilove it is interesting how you focus on these narrow, drug company sponsored studies, and find them convincing? I am trying to understand. I know I have a strong bias that they are contrived, probably falsified, and that so many are run hoping at least one trial will show a clear benefit, etc. But you appear to be convinced that these drugs must have a benefit, even a strong benefit. I know we have discussed this ad naseum, but other than the sheer number of studies run, I see very little evidence that these drugs benefit heart patients.

Any study with an apparent conflict of interest should be approached cautiously, but I see no reason to dismiss them altogether. That would be like throwing the proverbial baby out with the bath water.

Furthermore, there are long term observational studies that have confirmed the results from the large randomized clinical trials of statins. AFAIK, these observational studies are not funded by the drug companies.

We all agree that statins lower cholesterol.

But there is a large amount of observational evidence, and one might even say an underlying "theory" (because of the CoQ10 depletion) that these drugs do much more harm than good in heart patients.

Is there really? We know that statins do have side effects that affect a small proportion of patients - however, given that they are so widely prescribed, this small proportion can seem like a lot. But do these side effects really outweight the benefits on treatment? I'm not asking in terms of a per patient basis - certainly if a patient develops severe myopathy, it may outweigh the benefit of lowering the risk of a myocardial infaction in the future - but when you look at statin use on a population level. The thing about many side effects associated with statin use is that they can resolve after stopping statin use - on the other hand, a fatal MI is not reversible.

One way to look at whether statins are doing more good than harm would be to look at all-cause mortality. I know of a few cohort studies that show a strong association between statin use and a reduction in all-cause mortality.

Statins are not for everyone; but at the same time, they do have a clinical benefit for many patients.

Maybe the answer to our study design is to pit vitamin C lysine against statin cholesterol-lowering drugs? That might be a very interesting contest. You seem to think the statin group would fare better, and I would worry about their continued future existence.

That would be great, and I think would be much better than just having a single arm treated with vitamin C. I would suggest having standard medical therapy (inc. statins, beta-blockers, aspirin, etc as indicated) vs. standard medical therapy + vitamin C/lysine. Or you could just pit vitamin C/lysine alone against standard treatment.

[ofonorow]

I know of a few cohort studies that show a strong association between statin use and a reduction in all-cause mortality.

Then lets focus on these. Can you identify them?

Ideally, the vitamin C/lysine group would be on as few medications as possible, for a wide variety of reasons; most importantly, the dramatic difference between the two groups. But I suppose for the first "study" we'd have to acquiesce to medical requirements.

Do you know of ANY patients who report that they benefited from statins? A single patient? (not counting those with hypercholesterolemia with cholesterol in the 400s or above. No quarrel that statins may help these folks) Surely someone, somewhere must feel better? The placebo affect if nothing else.

You and the medical profession are hanging your hat on the fact that a substance, first derived from plants (lovistatin), and a substance that seems to have evolved to kill its predators (animals which eat it) by lowering the animals CoQ10/Cholesterol, can somehow extend life in human beings. Apparently, this occurs because artificially lowering cholesterol against the natural tendency of the body reduces the chance for heart attack. On the surface, this makes no sense what-so-ever. There is really no clear experimental evidence that high cholesterol causes heart attack.

[godsilove]

I know of a few cohort studies that show a strong association between statin use and a reduction in all-cause mortality.

Then lets focus on these. Can you identify them?

Yes, here are a few...

http://archinte.ama-assn.org/cgi/conten ... type=HWCIT
I've posted this before - it's a retrospective population-based cohort study looking at real-world usage of statins. One limitation of the study is that it is not a prospective, randomized study and so there may be some unidentified residual confounders which either exaggerate or underestimate the benefit of statins. Nonetheless, it has a large sample of patients and it was able to look at prescription data to determine duration of statin therapy (you could argue that just because a prescription was filled, it doesn't mean that the patient was compliant with treatment - but I think in general there would be a pretty strong correlation between number of prescriptions filled and continuity of use). Another advantage of this study is that it looks at fairly long term statin use (mean of 4 years for primary prevention and 5 years for secondary prevention), and found a 45% relative risk reduction for all-cause mortality when comparing highest users of statins vs. the lowest users.

http://www.ncbi.nlm.nih.gov/pubmed/1916 ... d_RVDocSum
This was a prospective cohort study with a 10-year follow-up. They looked at patients who had a normal lipid profile, those with an abnormal lipid profile but untreated, those with an abnormal lipid profile treated with statins, and those with an abnormal lipid profile treated with fibrates. They found that those on statins had an almost 50% lower risk of all-cause mortality compared to untreated dyslipidemic patients. Of course, this is again an observational study so the usual limitations apply. Furthermore, it's not the largest of studies - there were only around 309 patients in the statin arm. Nonetheless, the benefit was statistically significant and is reinforced by other studies.

http://www.ncbi.nlm.nih.gov/pubmed/1849 ... d_RVDocSum
Scottish cohort study with a 10-year followup with almost 3500 patients receiving statins. They found that adherence to statin use was associated with reduced all-cause mortality.

http://www.ncbi.nlm.nih.gov/pubmed/1679 ... d_RVDocSum
Japanese study that followed patients for ~11yrs after PCI, which again finds a reduction in all-cause mortality amongst patients treated with statins. The study is fairly small (575 patients in total) and the possibility of channeling bias exists, given that it was not a randomized study.

http://www.ncbi.nlm.nih.gov/pubmed/1533 ... d_RVDocSum
This was a follow-up study of the Scandinavian Simvastatin Survival Study (4S), which was a randomized, controlled trial. So in total, it was a 10-year followup, but patients in the latter ~5 yrs were all unblinded and were allowed statin treatment. When comparing the group that was initially allocated to receive statins to those who received placebo, the benefits in all-cause mortality were still apparent after ten years. Crossover in this case could have confounded the results.

http://www.ncbi.nlm.nih.gov/pubmed/1197 ... rom=pubmed
Follow-up of a randomized trial for pravastatin also found sustained long-term benefits in terms of mortality.


The benefits of statins in lowering both all-cause and cardiovascular mortality are also observed through multiple RCTs, and meta-analyses that pool together thousands of patients consistently find a benefit with statin use. Unfortunately, I think a lot of regulars on this forum are too quick to dismiss them as an effective treatment in patients for whom statins are indicated.

Ideally, the vitamin C/lysine group would be on as few medications as possible, for a wide variety of reasons; most importantly, the dramatic difference between the two groups. But I suppose for the first "study" we'd have to acquiesce to medical requirements.

Well, it depends which group of patients you want to include in the study. If it is patients who are at high risk of cardiac events, or who have already had one, I would be concerned about giving them only a treatment that is unproven, i.e. Pauling Therapy, when standard medical treatments have been shown to work.

Do you know of ANY patients who report that they benefited from statins? A single patient? (not counting those with hypercholesterolemia with cholesterol in the 400s or above. No quarrel that statins may help these folks) Surely someone, somewhere must feel better? The placebo affect if nothing else.

Statins are used primarily for prevention, so in light of this your question doesn't make much sense. No single patient is able to rewind the tape of his or her life or fast-forward to see whether statin use has prevented a heart attack or stroke. A patient at high risk of a myocardial infarction could live for many years on statin therapy without having an MI, but how is he or she supposed to know for certain whether its due to statin use or because he or she is an outlier? At the individual level, we are restricted to looking at surrogate markers like total cholesterol and LDL, which have been consistently linked with increased cardiovascular mortality. And when looking at these markers, thousands of patients can attest to their benefits. I'm not sure that many elderly patients who take vitamin D and calcium supplements necessarily "feel better", but evidence clearly shows that there is a benefit in terms of reducing the risk of fractures and falls. So for most patients, it's irrelevant for the most part - the main goal is to prevent cardiovascular events, not to provide symptomatic relief.

You and the medical profession are hanging your hat on the fact that a substance, first derived from plants (lovistatin), and a substance that seems to have evolved to kill its predators (animals which eat it) by lowering the animals CoQ10/Cholesterol, can somehow extend life in human beings. Apparently, this occurs because artificially lowering cholesterol against the natural tendency of the body reduces the chance for heart attack. On the surface, this makes no sense what-so-ever. There is really no clear experimental evidence that high cholesterol causes heart attack.

No, we "hang our hat" on the fact that pre-clinical and clinical studies strongly support their use in patients at high risk of cardiovascular events, and study after study shows a benefit in terms of survival. Unfortunately, a small proportion of patients will experience side effects - but serious side effects are outweighed by the number of heart attacks, strokes and deaths that are prevented by statin use.

By the way, lovastatin is not derived from plants, but from certain strains of fungi and its function is not to prevent predation by animals - so the point you're trying to make (which is irrelevant anyway - "the dose makes the poison" is not a principle exclusive to modern medicine) does not apply.

You also keep saying there is no clear experimental evidence that high cholesterol causes, yet in your post you also seemed to concede that cholesterol-lowering would be of benefit in patients with cholesterol > 400.

[ofonorow]

Working backwards,

Yes, because cholesterol of 400 mg/dl and above is likely abnormal. Medicine is recommending these poisons (statins), or Governments are, for people with cholesterol in the low 200s!

On page 21 of this E-book written by a former Pharmaceutical chemist Shane Ellison, the origin of lovastatin is discussed. See page 21:

http://www.health-fx.net/eBook.pdf

The origin of statin drugs is not a testament to the ingenuity and innovation of drug companies. Despite enjoying an unprecedented surge of momentum in popularity, statins are nothing more than an isolated poison derived from the fungus known as red yeast rice (Monascus purpurus).48

In a natural response to the threat of a predator, red yeast produces the drug known as lovastatin (as well as other chemicals). Utilizing fundamental laboratory research, the discovery and isolation of lovastatin from red yeast rice was paid for by the U.S. government in the 1970s.49 This secured a monopoly of knowledge, allowing for the censorship of the truth behind the wildly popular cholesterol- lowering drugs.

I don't know, I consider a fungus to be plant (not animal)

No, we "hang our hat" on the fact that pre-clinical and clinical studies strongly support their use in patients at high risk of cardiovascular events, and study after study shows a benefit in terms of survival.

These drug-company sponsored statin studies are contrived and funded by manufacturers who stand to make billions, and by doctors whose living is prescribing drugs. If they "strongly" supported their use in patients at high risk of cardiovascular events, why have the drug companies had to run thousands of studies? 400+ on Lipitor alone? I will try to access the "best" studies you have provided, but for example, can you imagine if a vitamin C/lysine study exhibited the same results as the Jupiter Study for Crestor?? Would you prescribe vitamin C/lysine based on those results? (Yes, 1 versus 2 is either a whopping 50% or 100% difference!)

Statins are used primarily for prevention, so in light of this your question doesn't make much sense. No single patient is able to rewind the tape of his or her life or fast-forward to see whether statin use has prevented a heart attack or stroke. A patient at high risk of a myocardial infarction could live for many years on statin therapy without having an MI, but how is he or she supposed to know for certain whether its due to statin use or because he or she is an outlier? At the individual level, we are restricted to looking at surrogate markers like total cholesterol and LDL, which have been consistently linked with increased cardiovascular mortality. And when looking at these markers, thousands of patients can attest to their benefits. I'm not sure that many elderly patients who take vitamin D and calcium supplements necessarily "feel better", but evidence clearly shows that there is a benefit in terms of reducing the risk of fractures and falls. So for most patients, it's irrelevant for the most part - the main goal is to prevent cardiovascular events, not to provide symptomatic relief.

Okay, so the answer is no. Statins do not even exhibit a placebo effect. No one feels better taking statins (and most people feel worse, and fairly quickly as their muscles deteriorate from the loss of CoQ10). I contrast this with vitamin C/lysine, where people experience evidence of better health almost immediately. For example, on high enough dosages, end-stage CVD patients report the cessation of their angina pain, return of normal skin color, lower blood pressure, more blood flow, disappearances of blockages, drop in heart rates, normalization of lipid profiles, increase in both energy and the sense of well being.

Patients who had failed now pass treadmill stress tests without surgery or any other medical intervention. Patients hardly able to walk before the Pauling therapy report that within months of starting the therapy they were able to dig fence post holes and cut down trees. Medical doctors often tell these patients that the reason for the improvement is that new blood vessels have "grown" which increased blood flow to the coronary arteries feeding the heart. Over time, patients become physically fit, feel well and no longer consider themselves heart patients.

Now to go through your list of studies.. I will post the discussion in the clinical studies forum - one topic per study.

[godsilove]

Working backwards,

Yes, because cholesterol of 400 mg/dl and above is likely abnormal. Medicine is recommending these poisons (statins), or Governments are, for people with cholesterol in the low 200s!

So if I understand you correctly, you don't deny that high cholesterol is a risk factor and that cholesterol-lowering interventions would be beneficial. You only disagree as to what should be considered as "high"? This begs the question: how do you determine what should be considered abnormal?

On page 21 of this E-book written by a former Pharmaceutical chemist Shane Ellison, the origin of lovastatin is discussed. See page 21:

http://www.health-fx.net/eBook.pdf

The origin of statin drugs is not a testament to the ingenuity and innovation of drug companies. Despite enjoying an unprecedented surge of momentum in popularity, statins are nothing more than an isolated poison derived from the fungus known as red yeast rice (Monascus purpurus).48

In a natural response to the threat of a predator, red yeast produces the drug known as lovastatin (as well as other chemicals). Utilizing fundamental laboratory research, the discovery and isolation of lovastatin from red yeast rice was paid for by the U.S. government in the 1970s.49 This secured a monopoly of knowledge, allowing for the censorship of the truth behind the wildly popular cholesterol- lowering drugs.

I don't know, I consider a fungus to be plant (not animal)

A fungus is neither a plant nor an animal. In any case, the word "poison" is being used quite liberally here. Penicillin is also a poison, but this characteristic does not negate its life-saving properties when used as an antibiotic. I've been unable to dig up anything in the extensive literature on lovastatin that gives its exact function in Aspergillus terreus, but I doubt it evolved as a defence mechanism against animals. It is more likely that like penicillin, it is a microbicide - or it could have another function altogether. Just because it is a HMG-CoA reductase inhibitor in humans, it does not imply that it evolved to target this enzyme - molecules can have effects on a variety of different proteins. For instance, salicylic acid functions as a plant hormone but it can act on different targets in humans to produce a physiological effect.

Furthermore, as the old adage goes, the dose makes the poison. Nobody denies that drugs can be toxic; in fact, most substances are - it's just a matter of the dose. Even a vitamin like vitamin A can be lethal at very high doses. Some of the alternate uses of Botox illustrate this point quite well. The botulinum toxin itself is one of the most lethal toxins known to us, but at very minute doses it may be an effective treatment for diabetic neuropathy.

No, we "hang our hat" on the fact that pre-clinical and clinical studies strongly support their use in patients at high risk of cardiovascular events, and study after study shows a benefit in terms of survival.

These drug-company sponsored statin studies are contrived and funded by manufacturers who stand to make billions, and by doctors whose living is prescribing drugs. If they "strongly" supported their use in patients at high risk of cardiovascular events, why have the drug companies had to run thousands of studies? 400+ on Lipitor alone? I will try to access the "best" studies you have provided, but for example, can you imagine if a vitamin C/lysine study exhibited the same results as the Jupiter Study for Crestor?? Would you prescribe vitamin C/lysine based on those results? (Yes, 1 versus 2 is either a whopping 50% or 100% difference!)

[/quote]

I'm not sure why you think doctors have something to gain by prescribing something that doesn't work. Perhaps the argument could apply if they were making a premium on the drugs they prescribed (e.g. IV drugs that they infuse at their clinics), but there is no financial incentive in prescribing a $1 pill over a $0.01 pill. And as I said before, if all industry-sponsored trials were contrived, then negative industry-sponsored studies would be unheard of. You only have to look at any major medical journal to know that this isn't the case.

As to why there are several studies on statins, there are a number of different reasons: (i) there is more than one statin (ii) there are multiple indications for statins (iii) studies need to be replicated, especially smaller ones (iv) there are studies in various sub-populations, etc. For instance, the Jupiter trial was unique from all other statin trials as it looked at a specific patient population and attempted to answer a different question from other trials, i.e. do statins have a benefit in patients with normal cholesterol but high CRP levels.

Statins are used primarily for prevention, so in light of this your question doesn't make much sense. No single patient is able to rewind the tape of his or her life or fast-forward to see whether statin use has prevented a heart attack or stroke. A patient at high risk of a myocardial infarction could live for many years on statin therapy without having an MI, but how is he or she supposed to know for certain whether its due to statin use or because he or she is an outlier? At the individual level, we are restricted to looking at surrogate markers like total cholesterol and LDL, which have been consistently linked with increased cardiovascular mortality. And when looking at these markers, thousands of patients can attest to their benefits. I'm not sure that many elderly patients who take vitamin D and calcium supplements necessarily "feel better", but evidence clearly shows that there is a benefit in terms of reducing the risk of fractures and falls. So for most patients, it's irrelevant for the most part - the main goal is to prevent cardiovascular events, not to provide symptomatic relief.

Okay, so the answer is no. Statins do not even exhibit a placebo effect.

I didn't say that. I'm simply pointing out that your question is essentially a huge red herring. The goal of statin therapy is primarily as a preventitive treatment, not a palliative one. So whether or not a patient "feels better" is not a true indication of how well the treatment is working - especially when you considered that many patients who are on statins are asymptomatic. Many people do not notice the effects of high cholesterol until it's too late. It's similar to treatment for diabetes - most people don't know when they have hyperglycemia, and a treatment that lowers blood sugar will not necessarily make them "feel better". But the long term detrimental effects of uncontrolled blood sugar are well established, and no sensible person would dismiss any therapy that controls blood sugar simply because they do not function as an anodyne.

As to whether they exhibit a placebo effect, virtually all treatments are capable of this.

No one feels better taking statins (and most people feel worse, and fairly quickly as their muscles deteriorate from the loss of CoQ10). I contrast this with vitamin C/lysine, where people experience evidence of better health almost immediately. For example, on high enough dosages, end-stage CVD patients report the cessation of their angina pain, return of normal skin color, lower blood pressure, more blood flow, disappearances of blockages, drop in heart rates, normalization of lipid profiles, increase in both energy and the sense of well being.

How do you know that no one feels better? Most patients taking statins for primary prevention do not have any noticeable symptoms. But certainly, if you are considering patients who already suffer from angina or the like - there are cases of people who notice an improvement after being on statins. And if you're including test scores like normalization of lipid profiles, then statins definitely do work - although I'm not sure why you mention this when people often cannot tell whether their blood lipids are worsening or not. But ultimately, the purpose of statin treatment is to prevent cardiovascular events and death - and several studies show that it does this, while being fairly well tolerated.

Patients who had failed now pass treadmill stress tests without surgery or any other medical intervention. Patients hardly able to walk before the Pauling therapy report that within months of starting the therapy they were able to dig fence post holes and cut down trees. Medical doctors often tell these patients that the reason for the improvement is that new blood vessels have "grown" which increased blood flow to the coronary arteries feeding the heart. Over time, patients become physically fit, feel well and no longer consider themselves heart patients.
[/i].

Then even a small study of the protocol should have no trouble demonstrating these miraculous benefits...

In fact, let's even ignore clinical trials for now. I'm sure that there are at least some doctors out there who are sympthetic to Pauling Therapy, and recommend it to their patients. Why not assemble a consecutive case series and submit the results to a medical journal. It doesn't have to be the NEJM or the Lancet - any decent, peer-reviewed medical journal would do. You wouldn't require a large amount of funding to do this, but it would at least be a baby step towards building its clinical plausibility.

[ofonorow]

Stimulating as usual.

So if I understand you correctly, you don't deny that high cholesterol is a risk factor and that cholesterol-lowering interventions would be beneficial. You only disagree as to what should be considered as "high"? This begs the question: how do you determine what should be considered abnormal?

Ordinary statistical methods can determine abnormality. If the average is 220 mg/dl and the standard deviation is say 80, then it is certainly "safe" to consider 2 standard deviations away from the mean as "abnormal." Ergo, this acceptance of the proposition that statins may help some people refers to relatively small percentage of the population with hypercholesterolemia. And I am not certain that CVD will develop in these cases without elevated Lp(a). I am thinking about the children with hypercholesterolemia Lp(a). These children exhibit all the symptoms of CVD at a very early age, including rapid development of atherosclerosis.

Pauling/Rath helped to identify that particular form of LDL - an LDL with a sticky apo(a) attached, as the primary risk factor in CVD.

Unfortunately, the HMG-CoA Reductase Inhibitors (statins) do not reduce Lp(a), and at least anecdotally, increase Lp(a).

But to your point, agreeing that statins might have a role in rare cases of hyper cholesterolemia, does not mean I admit that high cholesterol causes CVD. (High Lp(a) cholesterol will.)

A fungus is neither a plant nor an animal. In any case, the word "poison" is being used quite liberally here. Penicillin is also a poison, but this characteristic does not negate its life-saving properties when used as an antibiotic. I've been unable to dig up anything in the extensive literature on lovastatin that gives its exact function in Aspergillus terreus, but I doubt it evolved as a defence mechanism against animals. It is more likely that like penicillin, it is a microbicide - or it could have another function altogether. Just because it is a HMG-CoA reductase inhibitor in humans, it does not imply that it evolved to target this enzyme - molecules can have effects on a variety of different proteins. For instance, salicylic acid functions as a plant hormone but it can act on different targets in humans to produce a physiological effect.

Furthermore, as the old adage goes, the dose makes the poison. Nobody denies that drugs can be toxic; in fact, most substances are - it's just a matter of the dose. Even a vitamin like vitamin A can be lethal at very high doses. Some of the alternate uses of Botox illustrate this point quite well. The botulinum toxin itself is one of the most lethal toxins known to us, but at very minute doses it may be an effective treatment for diabetic neuropathy.

Yes, I agree that all modern medical treatments are basically poisons and that much skill and training is required to administer them. (In fact, the blood thinners are all commercial rat poisons. I am hard pressed to think of a drug that isn't a poison.) The point of orthomolecular medicine is the recognition, thank you Linus Pauling, that most disease can be treated by high-dosages of supplements that are "well known" to the human body, molecules already required for life. Since this discussion focuses on statins, lets compare the statin approach with the high-dose vitamin C approach.

Exhibit A - Both Lower Cholesterol, One is toxic the other isn't

Both substances have been clinically shown to lower cholesterol, although the extensive vitamin C experiments show that vitamin C tends to "regulate" cholesterol to 180 mg/dl (in other words, if cholesterol is lower than this, it will tend to elevate it.)

Exhibit B - Statins deplete CoQ10, Vitamin C is required for its production.

The fact that statins inhibit the body's production of CoQ10 (and lower circulating levels of CoQ10) was discovered almost immediately, and the Merck patent was filed which proves it. Canada requires this warning in drugs ads, the US FDA does not.

Vitamin C does not inhibit CoQ10 production, and is even one of the myriad of nutrients required for the body to produce this energy-giving substance.

Exhibit C - Theory vs. No theory

Statins are aimed at correcting the symptom of CVD - elevated cholesterol, without any cogent theory of the reason why, or real experimental evidence that they do much good. Vitamin C has not been studied, however, the rationale behind vitamin C is based on a complete "unified theory" formulated by one of the world's leading scientists. At the heart of the theory is the mechanical force caused by the heart beat. The arterial lesions form in arteries exposed to this force, when collagen supplies dwindle (usually due to insufficient vitamin C in the diet.)

We can continue the comparison, and then ask the question. Why wouldn't any rational and sane person (or doctor) first try vitamin C (with no known toxicity) before resorting to a drug that we all admit is poisonous in some dosage?

I'm not sure why you think doctors have something to gain by prescribing something that doesn't work. Perhaps the argument could apply if they were making a premium on the drugs they prescribed (e.g. IV drugs that they infuse at their clinics), but there is no financial incentive in prescribing a $1 pill over a $0.01 pill. And as I said before, if all industry-sponsored trials were contrived, then negative industry-sponsored studies would be unheard of. You only have to look at any major medical journal to know that this isn't the case.

No one claims that ALL industry-sponsored trials are contrived, but since we know (if you believe the New York Times (probably from honest FDA insiders)) that more than 200 drugs have been approved on the basis of "fraudulent" studies, we know that not all studies are valid. I am not smart enough to which ones are solid, so I personally dismiss all industry-sponsored studies.

But are you serious about doctors not gaining by prescribing something that doesn't work? Doctors (and pharmaceuticals) only gain when their treatments don't work. (Of course people must believe that the treatments are based on legit studies for this to operate over the long run, but if they cured people, they would no longer be patients.)

The problem with the current system is that there is an incentive to make people sick. In my book I propose an alternative - a Universal scheme where doctors are paid - no matter what, on the basis of the number of patients under their care. In this scenario, the doctors benefits from patient health - not sickness. Not that I think it will ever happen, Pharmcos are too powerful, but it illustrates the problem with the current system that rewards sickness, not health.

There is a story in a vitamin C book of a doctor who learned about vitamin C, advised patients to take it for various conditions, and the doctor never saw the patients again. Not good for business.

As to why there are several studies on statins, there are a number of different reasons: (i) there is more than one statin (ii) there are multiple indications for statins (iii) studies need to be replicated, especially smaller ones (iv) there are studies in various sub-populations, etc. For instance, the Jupiter trial was unique from all other statin trials as it looked at a specific patient population and attempted to answer a different question from other trials, i.e. do statins have a benefit in patients with normal cholesterol but high CRP levels.

Several? There are more than 400 for Lipitor alone! There must be literally thousands conducted for all the statins. To my mind, there are that many because no trial has produced the results the manufactures are hoping for. They know that sooner or later, by chance, a study is bound to show a beneficial effect. And it is apparently soothing to patients to hear that hundreds of studies have been run. To me, it is a huge red flag.

The goal of statin therapy is primarily as a preventitive treatment, not a palliative one. .. Many people do not notice the effects of high cholesterol until it's too late.

I submit that your statement, if accurate, proves that statins do not provide a palliative treatment option, ergo these thousands of studies have not shown much of any value of statins for the treatment of CVD. The problem with prevention is that it is hard to prove (or disprove). I go back to the argument that given vitamin C or a "poison" that is going to weaken my muscles and possibly lead to heart failure, I would prefer to prevent CVD with low-cost vitamin C.

How do you know that no one feels better? Most patients taking statins for primary prevention do not have any noticeable symptoms. But certainly, if you are considering patients who already suffer from angina or the like - there are cases of people who notice an improvement after being on statins. And if you're including test scores like normalization of lipid profiles, then statins definitely do work - although I'm not sure why you mention this when people often cannot tell whether their blood lipids are worsening or not. But ultimately, the purpose of statin treatment is to prevent cardiovascular events and death - and several studies show that it does this, while being fairly well tolerated.

Maybe my bias is created because the people who contact us do so because cardiology has failed them. That is why I was asking you for examples of patients happy to be on and satisfied with statins. I have not met anyone in that category. However, I suspect that most people trust their doctors, and take their medication daily, even in the face of sleep deprivation, muscle pains, depression, temporary transient amnesia, etc.

Re Treadmill...

Then even a small study of the protocol should have no trouble demonstrating these miraculous benefits...

Yes, and I provided such an example found in JAMA in another thread.

RANDOMIZED, DOUBLE-BLIND CONTROLLED TRIAL IN HUMANS FOUND STATISTICALLY SIGNIFICANT 60-SECOND TREADMILL EXERCISE IMPROVEMENTS IN 5000 MG VITAMIN C GROUPS [Chelation Therapy for Ischemic Heart Disease: A Randomized Controlled Trial, Knudtson, et. al. JAMA, Jan 23/30, 2002 - Vol 287, No 4. Pp 481-486]

Examine the data, (not the authors conclusions that this was a "placebo effect." It was a "placebo" effect, because it was the effect of vitamin C and magnesium, but not in the meaning of the phrase as intended.)

In fact, let's even ignore clinical trials for now. I'm sure that there are at least some doctors out there who are sympathetic to Pauling Therapy, and recommend it to their patients. Why not assemble a consecutive case series and submit the results to a medical journal. It doesn't have to be the NEJM or the Lancet - any decent, peer-reviewed medical journal would do. You wouldn't require a large amount of funding to do this, but it would at least be a baby step towards building its clinical plausibility.

This idea sounds plausible, but it ignores reality. The reality is that any alternative doctor can be brought before his or her state medical board for the flimsiest of reasons. History is replete with such "attacks" of unorthodox medicine. After World War II, in the USA, the "community standard of practice" was adopted. Doctors that follow the accepted practices are protected from law suits, even if the treatment kills people, so long as all doctors in the community do it. However, any doctor who does not follow the accepted community standard of practice risks law suits.

I have been told that it will require lawyers dying of heart disease, to bring suits against their doctors following the standard to court in every community. They would have to sue on the basis that there exists medical literature supporting a different treatment. Too bad, as we know, there is no medical literature on the Pauling-therapy, having been completely ignored by modern medicine.

So you find me a way to "protect" the doctors and I can provide a considerable number of doctors who use and do recommend the Pauling-therapy to their patients. (The best way is to run studies and get them published, which puts us back to square one.)

[J.Lilinoe]

I'm sorry to hear that. If you don't mind me asking, what side effects did your relative develop? Was it rhabdomyolysis?

I'm not trying to say that statins are perfectly safe - most drugs aren't. But can one patient's experience be extrapolated to all other patients? I don't think so. Even antibiotics can cause serious side effects in a small subset of patients - but nobody would deny that for the most part they do more good than harm. I think whenever contemplating a treatment - be it a drug, surgery, or lifestyle modification - it is important to weigh the risks of treatment with the risk of doing nothing at all. Unfortunately, it's a bit like a crapshoot at times.

rhabdomyoysis? try congestive heart failure, Alzheimer's and barely able to walk. Since you love statins so much, I hope you are taking them too. And don't preach to me about how these drugs do more good than harm when the drug companies are famous for manipulating their findings and using the media and doctors to spread their LIES. The TRUTH is that NASTY cholesterol lowering drugs like LIPITOR and CRESTOR ARE HARMFUL to anyone who takes it.

[godsilove]

I'm sorry to hear that. If you don't mind me asking, what side effects did your relative develop? Was it rhabdomyolysis?

I'm not trying to say that statins are perfectly safe - most drugs aren't. But can one patient's experience be extrapolated to all other patients? I don't think so. Even antibiotics can cause serious side effects in a small subset of patients - but nobody would deny that for the most part they do more good than harm. I think whenever contemplating a treatment - be it a drug, surgery, or lifestyle modification - it is important to weigh the risks of treatment with the risk of doing nothing at all. Unfortunately, it's a bit like a crapshoot at times.

rhabdomyoysis? try congestive heart failure, Alzheimer's and barely able to walk. Since you love statins so much, I hope you are taking them too. And don't preach to me about how these drugs do more good than harm when the drug companies are famous for manipulating their findings and using the media and doctors to spread their LIES. The TRUTH is that NASTY cholesterol lowering drugs like LIPITOR and CRESTOR ARE HARMFUL to anyone who takes it.

Fortunately, I am young and still at very low risk of cardiovascular disease. I'm trying to be careful with my lifestyle choices, but should my cholesterol reach a level where it is uncontrollable and puts me at risk, I would discuss taking statins with my primary care physician. But if I can avoid having to take them, then that's the ideal scenario for me - I'm not in "love" with statins anymore than I "love" bypass surgeries or defibrillators.

Once again, I'm sorry that your relative had a bad experience with statins, but I respectfully disagree that they are harmful to EVERYONE.

[godsilove]

Stimulating as usual.

So if I understand you correctly, you don't deny that high cholesterol is a risk factor and that cholesterol-lowering interventions would be beneficial. You only disagree as to what should be considered as "high"? This begs the question: how do you determine what should be considered abnormal?

Ordinary statistical methods can determine abnormality. If the average is 220 mg/dl and the standard deviation is say 80, then it is certainly "safe" to consider 2 standard deviations away from the mean as "abnormal." Ergo, this acceptance of the proposition that statins may help some people refers to relatively small percentage of the population with hypercholesterolemia. And I am not certain that CVD will develop in these cases without elevated Lp(a). I am thinking about the children with hypercholesterolemia Lp(a). These children exhibit all the symptoms of CVD at a very early age, including rapid development of atherosclerosis.

Pauling/Rath helped to identify that particular form of LDL - an LDL with a sticky apo(a) attached, as the primary risk factor in CVD.

Unfortunately, the HMG-CoA Reductase Inhibitors (statins) do not reduce Lp(a), and at least anecdotally, increase Lp(a).

But to your point, agreeing that statins might have a role in rare cases of hyper cholesterolemia, does not mean I admit that high cholesterol causes CVD. (High Lp(a) cholesterol will.)

I agree that high Lp(a) may also be a risk factor, but I don't understand why you deny that high LDL-cholesterol is also a risk factor.

A fungus is neither a plant nor an animal. In any case, the word "poison" is being used quite liberally here. Penicillin is also a poison, but this characteristic does not negate its life-saving properties when used as an antibiotic. I've been unable to dig up anything in the extensive literature on lovastatin that gives its exact function in Aspergillus terreus, but I doubt it evolved as a defence mechanism against animals. It is more likely that like penicillin, it is a microbicide - or it could have another function altogether. Just because it is a HMG-CoA reductase inhibitor in humans, it does not imply that it evolved to target this enzyme - molecules can have effects on a variety of different proteins. For instance, salicylic acid functions as a plant hormone but it can act on different targets in humans to produce a physiological effect.

Furthermore, as the old adage goes, the dose makes the poison. Nobody denies that drugs can be toxic; in fact, most substances are - it's just a matter of the dose. Even a vitamin like vitamin A can be lethal at very high doses. Some of the alternate uses of Botox illustrate this point quite well. The botulinum toxin itself is one of the most lethal toxins known to us, but at very minute doses it may be an effective treatment for diabetic neuropathy.

Yes, I agree that all modern medical treatments are basically poisons and that much skill and training is required to administer them. (In fact, the blood thinners are all commercial rat poisons. I am hard pressed to think of a drug that isn't a poison.)

[/QUOTE]

Virtually all substances are potentially toxic if administered at high doses. Some substances just happen to have a narrower therapeutic index than others. Even water can be toxic in excess, although water intoxication is very rare. I think there's a blurred line between what you call orthomolecular and toximolecular. Substances that are recognized by the body, e.g. urea, vitamin A, niacin, etc can all have side effects.

The point of orthomolecular medicine is the recognition, thank you Linus Pauling, that most disease can be treated by high-dosages of supplements that are "well known" to the human body, molecules already required for life.

Based on what evidence?

Suppose I told you that an extract from a plant found in E. Africa could cure every disease, and that the earliest humans would use this plant as a panacea. Humans evolved in this environment and so the active ingredients are in some sense "well known" to the body. Suppose I also told you that there were case reports and anecdotes of this extract curing a variety of illnesses. Would you take my word for it? Let's also suppose I have THREE Nobel Prizes.

As far as I'm concerned, science is the best tool at our disposal for figuring out what works and what doesn't. So wherever possible, any claim - no matter how plausible - should be investigated using this tool. As far as I'm aware, there are relatively few rigorous studies showing that micronutrients can cure a disease, given the number of diseases that afflict us. For the diseases where micronutrients have been shown to have a preventitive or curative role, they are prescribed by mainstream practitioners.

On the surface, the orthomolecular theory is very appealing - almost too good to be true. It offers interventions with minimal toxicity and promises miraculous efficacy. Yet for some reason, very few studies exist that show this to be the case. And I think the premise is also flawed because it is essentially a false dichotomy. Vitamins and essential minerals aren't the only substances that the body recognizes. We consume all sorts of substances in our diet (and have done so for millenia), and our body for the most part "recognizes" such substances. For instance, the body recognizes cyanide in small quantities and even has enzymes that can convert it into less harmful substances that are excreted. But even though cyanide is a substance the body essentially recognizes, I wouldn't be surprised if it wasn't classifed as being "orthomolecular".

Since this discussion focuses on statins, lets compare the statin approach with the high-dose vitamin C approach.

Exhibit A - Both Lower Cholesterol, One is toxic the other isn't

Both substances have been clinically shown to lower cholesterol, although the extensive vitamin C experiments show that vitamin C tends to "regulate" cholesterol to 180 mg/dl (in other words, if cholesterol is lower than this, it will tend to elevate it.)

But by how much does vitamin C reduce cholesterol? Fenofibrates also reduce cholesterol, but are much less effective that statins - which is why only studies with the latter were able to show substantial benefits. If vitamin C could be shown to reduce cholesterol as well as statins, I would become a strong advocate for it.

Exhibit B - Statins deplete CoQ10, Vitamin C is required for its production.

The fact that statins inhibit the body's production of CoQ10 (and lower circulating levels of CoQ10) was discovered almost immediately, and the Merck patent was filed which proves it. Canada requires this warning in drugs ads, the US FDA does not.

Vitamin C does not inhibit CoQ10 production, and is even one of the myriad of nutrients required for the body to produce this energy-giving substance.

Fair enough, but this is inconsequential unless vitamin C actually works as well as or better than statins in preventing CV disease.

Exhibit C - Theory vs. No theory

Statins are aimed at correcting the symptom of CVD - elevated cholesterol, without any cogent theory of the reason why, or real experimental evidence that they do much good. Vitamin C has not been studied, however, the rationale behind vitamin C is based on a complete "unified theory" formulated by one of the world's leading scientists. At the heart of the theory is the mechanical force caused by the heart beat. The arterial lesions form in arteries exposed to this force, when collagen supplies dwindle (usually due to insufficient vitamin C in the diet.)

Not true, and I think we partially covered some of this in previous threads. There is a huge body of research that supports a mechanism for how LDL contributes towards atherotic plaques. On the other hand, how many studies have Pauling and Rath conducted to test their theory?

We can continue the comparison, and then ask the question. Why wouldn't any rational and sane person (or doctor) first try vitamin C (with no known toxicity) before resorting to a drug that we all admit is poisonous in some dosage?

Any sane person would choose vitamin C if it were shown to work. We can lament all the hurdles facing vitamin C research, but it still doesn't change the fact that very few rigorous studies exist showing that vitamin C will work better than standard treatments in humans.

As a glimmer of hope, there is a study being conducted by Dr. Joseph Vita of Boston University - it is looking at endothelial dysfunction as a primary endpoint, if I recall correctly, and one arm will receive Lipitor and the other will receive vitamin C (albeit 500 mg). Dr. Vita conducted a randomized trial of vitamin C a few years ago which showed it could lower blood pressure, although unfortunately I don't think the results have been replicated by other investigators. If the Foundation is looking to approach vitamin C-friendly researchers, I think he might be one.

I'm not sure why you think doctors have something to gain by prescribing something that doesn't work. Perhaps the argument could apply if they were making a premium on the drugs they prescribed (e.g. IV drugs that they infuse at their clinics), but there is no financial incentive in prescribing a $1 pill over a $0.01 pill. And as I said before, if all industry-sponsored trials were contrived, then negative industry-sponsored studies would be unheard of. You only have to look at any major medical journal to know that this isn't the case.

No one claims that ALL industry-sponsored trials are contrived, but since we know (if you believe the New York Times (probably from honest FDA insiders)) that more than 200 drugs have been approved on the basis of "fraudulent" studies, we know that not all studies are valid. I am not smart enough to which ones are solid, so I personally dismiss all industry-sponsored studies.

But are you serious about doctors not gaining by prescribing something that doesn't work? Doctors (and pharmaceuticals) only gain when their treatments don't work. (Of course people must believe that the treatments are based on legit studies for this to operate over the long run, but if they cured people, they would no longer be patients.)

I don't buy it - doctors are humans too, and have families and friends who suffer the same diseases as their patients. If they knew of a way to magically cure diseases, why would they withold it? I think its wishful thinking to assume that there exists a simple cure for virtually every disease, but that big pharma and big medicine are suppressing it.

As to why there are several studies on statins, there are a number of different reasons: (i) there is more than one statin (ii) there are multiple indications for statins (iii) studies need to be replicated, especially smaller ones (iv) there are studies in various sub-populations, etc. For instance, the Jupiter trial was unique from all other statin trials as it looked at a specific patient population and attempted to answer a different question from other trials, i.e. do statins have a benefit in patients with normal cholesterol but high CRP levels.

[color=#0000BF]Several? There are more than 400 for Lipitor alone! There must be literally thousands conducted for all the statins. To my mind, there are that many because no trial has produced the results the manufactures are hoping for. They know that sooner or later, by chance, a study is bound to show a beneficial effect. And it is apparently soothing to patients to hear that hundreds of studies have been run. To me, it is a huge red flag.

Well - take a look for yourself. Over 300 studies on Lipitor alone are listed in the clinicaltrials.gov database. I had a quick look, and there are studies for all sorts of illnesses - many don't seem to have anything to do with cholesterol, but may involve inflammation. If you can find more than two studies that are almost exactly the same in terms of patient population and design, then that would definitely be suspicious. But the reason a variety of trials have been are are being conducted is because of the various indications, different populations, permutations of combinations with other agents, and head-to-head trials with various other agents.

Let me just say though that the "over 400 studies with Lipitor" does involve a bit of marketing BS. While it is not strictly false, it can be misleading to patients who might be under the impression that all these studies were done for heart disease.

The goal of statin therapy is primarily as a preventitive treatment, not a palliative one. .. Many people do not notice the effects of high cholesterol until it's too late.

I submit that your statement, if accurate, proves that statins do not provide a palliative treatment option, ergo these thousands of studies have not shown much of any value of statins for the treatment of CVD. The problem with prevention is that it is hard to prove (or disprove). I go back to the argument that given vitamin C or a "poison" that is going to weaken my muscles and possibly lead to heart failure, I would prefer to prevent CVD with low-cost vitamin C.

How do you know that no one feels better? Most patients taking statins for primary prevention do not have any noticeable symptoms. But certainly, if you are considering patients who already suffer from angina or the like - there are cases of people who notice an improvement after being on statins. And if you're including test scores like normalization of lipid profiles, then statins definitely do work - although I'm not sure why you mention this when people often cannot tell whether their blood lipids are worsening or not. But ultimately, the purpose of statin treatment is to prevent cardiovascular events and death - and several studies show that it does this, while being fairly well tolerated.

Maybe my bias is created because the people who contact us do so because cardiology has failed them. That is why I was asking you for examples of patients happy to be on and satisfied with statins. I have not met anyone in that category. However, I suspect that most people trust their doctors, and take their medication daily, even in the face of sleep deprivation, muscle pains, depression, temporary transient amnesia, etc.

I agree that your opinion might be shaped because of a sort of "channeling bias", i.e. people who turn to "alternative" medicine often do so because they feel that mainstream practitioners have failed them.

Re Treadmill...

Then even a small study of the protocol should have no trouble demonstrating these miraculous benefits...

Yes, and I provided such an example found in JAMA in another thread.

RANDOMIZED, DOUBLE-BLIND CONTROLLED TRIAL IN HUMANS FOUND STATISTICALLY SIGNIFICANT 60-SECOND TREADMILL EXERCISE IMPROVEMENTS IN 5000 MG VITAMIN C GROUPS [Chelation Therapy for Ischemic Heart Disease: A Randomized Controlled Trial, Knudtson, et. al. JAMA, Jan 23/30, 2002 - Vol 287, No 4. Pp 481-486]

Examine the data, (not the authors conclusions that this was a "placebo effect." It was a "placebo" effect, because it was the effect of vitamin C and magnesium, but not in the meaning of the phrase as intended.)

In fact, let's even ignore clinical trials for now. I'm sure that there are at least some doctors out there who are sympathetic to Pauling Therapy, and recommend it to their patients. Why not assemble a consecutive case series and submit the results to a medical journal. It doesn't have to be the NEJM or the Lancet - any decent, peer-reviewed medical journal would do. You wouldn't require a large amount of funding to do this, but it would at least be a baby step towards building its clinical plausibility.

This idea sounds plausible, but it ignores reality. The reality is that any alternative doctor can be brought before his or her state medical board for the flimsiest of reasons. History is replete with such "attacks" of unorthodox medicine. After World War II, in the USA, the "community standard of practice" was adopted. Doctors that follow the accepted practices are protected from law suits, even if the treatment kills people, so long as all doctors in the community do it. However, any doctor who does not follow the accepted community standard of practice risks law suits.

I have been told that it will require lawyers dying of heart disease, to bring suits against their doctors following the standard to court in every community. They would have to sue on the basis that there exists medical literature supporting a different treatment. Too bad, as we know, there is no medical literature on the Pauling-therapy, having been completely ignored by modern medicine.

So you find me a way to "protect" the doctors and I can provide a considerable number of doctors who use and do recommend the Pauling-therapy to their patients. (The best way is to run studies and get them published, which puts us back to square one.)

[/QUOTE]

Gotta run...so I'll follow this up at a later juncture...

[ofonorow]

I agree that high Lp(a) may also be a risk factor, but I don't understand why you deny that high LDL-cholesterol is also a risk factor.

Because it isn't. (If you can find evidence that children with hypercholesterolemia - with low to normal Lp(a) - exhibit advanced signs of CVD, that would be solid evidence in your favor.) To repeat, researchers at Framingham and elsewhere, who "reevaluated" their findings by separating Lp(a) from LDL found a significant difference/increased risk w/r to Lp(a). The mistake before taking Lp(a) into account, was lumping Lp(a) (which is an LDL) in to the risk group. You can separate it. Unfortunately, statins do not lower Lp(a).

Based on what evidence?

Suppose I told you that an extract from a plant found in E. Africa could cure every disease, and that the earliest humans would use this plant as a panacea. Humans evolved in this environment and so the active ingredients are in some sense "well known" to the body. Suppose I also told you that there were case reports and anecdotes of this extract curing a variety of illnesses. Would you take my word for it? Let's also suppose I have THREE Nobel Prizes.

As far as I'm concerned, science is the best tool at our disposal for figuring out what works and what doesn't. So wherever possible, any claim - no matter how plausible - should be investigated using this tool. As far as I'm aware, there are relatively few rigorous studies showing that micronutrients can cure a disease, given the number of diseases that afflict us. For the diseases where micronutrients have been shown to have a preventitive or curative role, they are prescribed by mainstream practitioners.

On the surface, the orthomolecular theory is very appealing - almost too good to be true. It offers interventions with minimal toxicity and promises miraculous efficacy. Yet for some reason, very few studies exist that show this to be the case. And I think the premise is also flawed because it is essentially a false dichotomy. Vitamins and essential minerals aren't the only substances that the body recognizes. We consume all sorts of substances in our diet (and have done so for millenia), and our body for the most part "recognizes" such substances. For instance, the body recognizes cyanide in small quantities and even has enzymes that can convert it into less harmful substances that are excreted. But even though cyanide is a substance the body essentially recognizes, I wouldn't be surprised if it wasn't classifed as being "orthomolecular".

Well, if your hypothetical substance had over 80,000 studies and papers published since the early 1900s, I would certainly take it seriously. (Only aspirin (prostaglandins) have more papers published than vitamin C - of course you wouldn't know that using today's libraries and databases. Again, thank you Linus Pauling. I agree with you about science, unfortunately, medical science is more politics than real science lately. )

You say orthomolecular medicine is "almost too good to be true", yet you are willing to accept that fact that poison after poison, in rather small amounts, can have miraculous effects on the human body? Which one of us is more off base?

But I would also take your substance seriously if I could read a substantial number of case reports, and spoke with enough people.

If vitamin C could be shown to reduce cholesterol as well as statins, I would become a strong advocate for it.

Well, it does work better, (in my opinion because it regulates cholesterol in a range) but cholesterol-lowering is a side effect of the body becoming healthier. There is no evidence that lowering cholesterol, per se, has any health benefits - other than the contrived studies funded by drug companies.

Vitamin C dosage is important, and yes far less statin is required than vitamin C for the cholesterol-lowering effect.

Fair enough, but this [CoQ10 depletiong] is inconsequential unless vitamin C actually works as well as or better than statins in preventing CV disease.

Inconsequential???!! The incidence of heart failure (heart transplant) has at least tripled since statins have been introduced, and the epidemic correlates with the dosage. The higher the dosage, the more likely is heart failure. You keep stressing prevention. I do not claim vitamin C prevents the disease, because how could we prove it? (I'm sure it does, but our reports are with very ill persons.) We have been dealing with end-stage, serious CVD, people with constant pain who have trouble walking across the room, and usually people whose doctor has told them there is little else that can be done. You admit that statins are not helpful for these patients. These are the people who experience relief in two weeks, or less, and many paint their houses in a month. These are the people that medical professionals can and should encourage to try Pauling's therapy, and see the miracle for themselves. Why don't they? What have doctors got to lose if there is nothing else to try?

There is a huge body of research that supports a mechanism for how LDL contributes towards atherotic plaques.

?? This is an interesting statement, because the Brown/Goldstein Nobel prize identified the mechanism by which lesions form in arteries - from the Lysine Binding Sites - and these "receptors" occur on Lp(a) molecules, not ordinary LDL! This fact has been brushed under the rug, but you can find a lot of research that has explored the mechanism by which plaques form in arteries. It revolves around "kringles" on apo(a) ... Anyway, the error in the "huge body of research" is lumping the sticky and atherogenic Lp(a) with LDL. I am interested in ANY evidence that LDL (without Lp(a)) has any risk what-so-ever.

Any sane person would choose vitamin C if it were shown to work. We can lament all the hurdles facing vitamin C research, but it still doesn't change the fact that very few rigorous studies exist showing that vitamin C will work better than standard treatments in humans.

We know of Dr. Vita (I hope he is tenured. There is a story of the head of the Harvard cardiology department at Harvard Medical school who was forced to resign after trying to pursue the Pauling/Rath theory. I can look it up if it matters.) Again, if medicine runs out of options, cannot control the pain, what possible reason is there at that point to not try vitamin C and lysine? If you must wait for the outcome of a study (which is of course ridiculous in the case of vitamin C and lysine which are completely nontoxic) then you (medicine) is under the control of those who can fund such studies, the patients be damned.

I don't buy it - doctors are humans too, and have families and friends who suffer the same diseases as their patients. If they knew of a way to magically cure diseases, why would they withhold it? I think its wishful thinking to assume that there exists a simple cure for virtually every disease, but that big pharma and big medicine are suppressing it.

In my opinion, this is your best argument to date! However, I have been to school and have received the nutrition "training" doctors in the USA receive. I have written elsewhere about this obvious "brainwashing." It is absurd to believe that Big Pharma can be controlling medicine in this manner - until you realize there would be no Big Pharma if the truth won out.

I agree that your opinion might be shaped because of a sort of "channeling bias", i.e. people who turn to "alternative" medicine often do so because they feel that mainstream practitioners have failed them.

I don't know if you are aware, but JAMA commissioned researchers at Stanford to examine why people select Alternative Medicine. (There were something like 400 million visits to Alternative doctors that year, while 350 to regular doctors.) The results were surprising - at least to the researchers; the number one claim was that alternative treatments worked! So yes, mainstream poison therapy often fails, but the "absurd" alternatives seem to work! This was published in JAMA and I can look it up if you would like.

[godsilove]

I agree that high Lp(a) may also be a risk factor, but I don't understand why you deny that high LDL-cholesterol is also a risk factor.

Because it isn't. (If you can find evidence that children with hypercholesterolemia - with low to normal Lp(a) - exhibit advanced signs of CVD, that would be solid evidence in your favor.) To repeat, researchers at Framingham and elsewhere, who "reevaluated" their findings by separating Lp(a) from LDL found a significant difference/increased risk w/r to Lp(a). The mistake before taking Lp(a) into account, was lumping Lp(a) (which is an LDL) in to the risk group. You can separate it. Unfortunately, statins do not lower Lp(a).

Again, I don't disagree that Lp(a) is a risk factor. However, the evidence does show that high LDL and high Lp(a) carry an additive risk. For instance, see this epidemiological study (using the cohort from the Women's Health Study), which was published in JAMA a few years ago. They found that high levels of Lp(a) do increase cardiovascular risk, but only in patients with higher than average LDL-cholesterol, not in those with below average cholesterol.

I don't know if there are studies in people with primary hypercholesterolemia where they do a similar analysis - it would definitely be interesting to see. In any case, do you deny that statins have a benefit in these patients?

By the way, are you positive that statins do not lower Lp(a)?

Based on what evidence?

Suppose I told you that an extract from a plant found in E. Africa could cure every disease, and that the earliest humans would use this plant as a panacea. Humans evolved in this environment and so the active ingredients are in some sense "well known" to the body. Suppose I also told you that there were case reports and anecdotes of this extract curing a variety of illnesses. Would you take my word for it? Let's also suppose I have THREE Nobel Prizes.

As far as I'm concerned, science is the best tool at our disposal for figuring out what works and what doesn't. So wherever possible, any claim - no matter how plausible - should be investigated using this tool. As far as I'm aware, there are relatively few rigorous studies showing that micronutrients can cure a disease, given the number of diseases that afflict us. For the diseases where micronutrients have been shown to have a preventitive or curative role, they are prescribed by mainstream practitioners.

On the surface, the orthomolecular theory is very appealing - almost too good to be true. It offers interventions with minimal toxicity and promises miraculous efficacy. Yet for some reason, very few studies exist that show this to be the case. And I think the premise is also flawed because it is essentially a false dichotomy. Vitamins and essential minerals aren't the only substances that the body recognizes. We consume all sorts of substances in our diet (and have done so for millenia), and our body for the most part "recognizes" such substances. For instance, the body recognizes cyanide in small quantities and even has enzymes that can convert it into less harmful substances that are excreted. But even though cyanide is a substance the body essentially recognizes, I wouldn't be surprised if it wasn't classifed as being "orthomolecular".

Well, if your hypothetical substance had over 80,000 studies and papers published since the early 1900s, I would certainly take it seriously. (Only aspirin (prostaglandins) have more papers published than vitamin C - of course you wouldn't know that using today's libraries and databases. Again, thank you Linus Pauling. I agree with you about science, unfortunately, medical science is more politics than real science lately. )

Okay, let's suppose that the hypothetical substance had over 80,000 studies since the early 1900s, but that most of these were in lab animals or cell cultures, and that relatively few were in humans.

Out of the 80,000 studies done on Vitamin C, how may rigorous studies show a substantial benefit in treating heart disease?

You say orthomolecular medicine is "almost too good to be true", yet you are willing to accept that fact that poison after poison, in rather small amounts, can have miraculous effects on the human body? Which one of us is more off base?

I don't look at substances as being "orthomolecular" or "toximolecular", because it creates a false dilemma. Substances regarded as orthomolecular can also be poisonous, and substances which fit the definition (as I understand it) are also potentially poisonous. As far as miraculous effects are concerned, I don't know of any intervention that is considered a cure-all. I wouldn't consider the benefit of statins for prevention of heart disease to be "miraculous" even as a figure of speech.

But I would also take your substance seriously if I could read a substantial number of case reports, and spoke with enough people.

How many people would be enough?

If vitamin C could be shown to reduce cholesterol as well as statins, I would become a strong advocate for it.

[color=#4000BF]Well, it does work better, (in my opinion because it regulates cholesterol in a range) but cholesterol-lowering is a side effect of the body becoming healthier. There is no evidence that lowering cholesterol, per se, has any health benefits - other than the contrived studies funded by drug companies.

Vitamin C dosage is important, and yes far less statin is required than vitamin C for the cholesterol-lowering effect.

As I've pointed out before, there are studies that are not industry-supported, and there are others jointly supported by public funding agencies.

If your opinion is more than just that, that would be fantastic. I would seriously become a fan of vitamin C if studies showed that it was as good as or better than statins in terms of lowering cholesterol, or even better, reducing cardiovascular events.

Fair enough, but this [CoQ10 depletiong] is inconsequential unless vitamin C actually works as well as or better than statins in preventing CV disease.

Inconsequential???!! The incidence of heart failure (heart transplant) has at least tripled since statins have been introduced, and the epidemic correlates with the dosage. The higher the dosage, the more likely is heart failure.

Inconsequential, unless vitamin C can be shown to work as effectively. To me, that's the important part of the equation that is missing - convincing scientific evidence that vitamin C works as you claim it does. If there were such evidence available, I agree that it would be a no-brainer - the cheaper, safer alternative would be preferred.

As far as heart failure is concerned, what kinds of studies are you referring to? It wouldn't be surprising if non-randomized studies showed a correlation between higher dose of statin use and heart failure, since it doesn't imply causation. In fact, it would probably be expected considering patients who are prescribed higher doses of statins are likely to be sicker and probably at higher risk to begin with. If you know of any randomized studies which eliminate this inherent bias, that would lend more strength to your claim that statins lead to heart failure.

You keep stressing prevention. I do not claim vitamin C prevents the disease, because how could we prove it? (I'm sure it does, but our reports are with very ill persons.) We have been dealing with end-stage, serious CVD, people with constant pain who have trouble walking across the room, and usually people whose doctor has told them there is little else that can be done.

How do we "prove" it? Randomized controlled trials, of course. It's the same way it was shown that vitamin D and calcium supplementation prevents fractures in elderly patients.

Likewise, it vitamin C does in fact prevent cardiovascular disease we would be able to see that in any rigorous and well-designed study that randomizes people to receive either vitamin C or something else, and following them over a long period of time.

You admit that statins are not helpful for these patients.

I do? I don't recall saying that - I said that statins won't necessarily make people feel better in the same way analgesics do. That's not how statins work.

These are the people who experience relief in two weeks, or less, and many paint their houses in a month. These are the people that medical professionals can and should encourage to try Pauling's therapy, and see the miracle for themselves. Why don't they? What have doctors got to lose if there is nothing else to try?

Again, why aren't alternative doctors pushing for even small, pilot clinical trials in such patients who are refractory to standard treatments? Many clinical trials for a variety of illnesses investigate experimental treatments in such patients.

There are currently studies being done for things like acupuncture and homeopathy. Are you telling me that Big Medicine condones these trials, yet will want nothing to do with Vitamin C?

There is a huge body of research that supports a mechanism for how LDL contributes towards atherotic plaques.

?? This is an interesting statement, because the Brown/Goldstein Nobel prize identified the mechanism by which lesions form in arteries - from the Lysine Binding Sites - and these "receptors" occur on Lp(a) molecules, not ordinary LDL! This fact has been brushed under the rug, but you can find a lot of research that has explored the mechanism by which plaques form in arteries. It revolves around "kringles" on apo(a) ... Anyway, the error in the "huge body of research" is lumping the sticky and atherogenic Lp(a) with LDL. I am interested in ANY evidence that LDL (without Lp(a)) has any risk what-so-ever.

See above - the JAMA study shows that LDL carries a risk independent of Lp(a).

What "receptors" on Lp(a) molecules are you referring to? Brown and Goldstein's research focused on LDL-receptors on cells, and they showed that a dearth of these receptors due to a genetic mutation is what results in high cholesterol in people with primary hypercholesterolemia. This research helped to establish a role for statins in lowering cholesterol by increasing the number of LDL-receptors expressed by cells.

Any sane person would choose vitamin C if it were shown to work. We can lament all the hurdles facing vitamin C research, but it still doesn't change the fact that very few rigorous studies exist showing that vitamin C will work better than standard treatments in humans.

We know of Dr. Vita (I hope he is tenured. There is a story of the head of the Harvard cardiology department at Harvard Medical school who was forced to resign after trying to pursue the Pauling/Rath theory. I can look it up if it matters.) Again, if medicine runs out of options, cannot control the pain, what possible reason is there at that point to not try vitamin C and lysine? If you must wait for the outcome of a study (which is of course ridiculous in the case of vitamin C and lysine which are completely nontoxic) then you (medicine) is under the control of those who can fund such studies, the patients be damned.

If there are other options, then that's a different story. But people come on this forum saying they have just been prescribed a statin by their doctor, and you advise them to come off it. I don't think that's always justified.

I don't buy it - doctors are humans too, and have families and friends who suffer the same diseases as their patients. If they knew of a way to magically cure diseases, why would they withhold it? I think its wishful thinking to assume that there exists a simple cure for virtually every disease, but that big pharma and big medicine are suppressing it.

In my opinion, this is your best argument to date! However, I have been to school and have received the nutrition "training" doctors in the USA receive. I have written elsewhere about this obvious "brainwashing." It is absurd to believe that Big Pharma can be controlling medicine in this manner - until you realize there would be no Big Pharma if the truth won out.

What "truth"?

It seems as though you're arguing that disease is a complete fabrication of pharmaceutical companies, even though sickness has afflicted our species for much longer than they've been around.

I agree that your opinion might be shaped because of a sort of "channeling bias", i.e. people who turn to "alternative" medicine often do so because they feel that mainstream practitioners have failed them.

I don't know if you are aware, but JAMA commissioned researchers at Stanford to examine why people select Alternative Medicine. (There were something like 400 million visits to Alternative doctors that year, while 350 to regular doctors.) The results were surprising - at least to the researchers; the number one claim was that alternative treatments worked! So yes, mainstream poison therapy often fails, but the "absurd" alternatives seem to work! This was published in JAMA and I can look it up if you would like.

[/QUOTE]

This reminds me of a newsstory I read recently about use of complementary therapies in the UK - they did a survey with cancer patients and found that only about 20% used complementary therapies - much lower than surveys done in the US. I think part of the discrepancy could be explained by the fact that many people are uninsured in the US, whereas in the UK patients have fewer concerns about being able to afford mainstream treatment.

By the way, is this the study you are referring to:
http://www.ncbi.nlm.nih.gov/pubmed/9605899
I don't see anything in the conclusion about patients using alternative therapies because they necessarily work.

[ofonorow]