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Old 08-13-2018, 02:34 PM
 
Location: Wine Country
4,918 posts, read 6,009,103 times
Reputation: 8705

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Quote:
Originally Posted by suzy_q2010 View Post
The public has been educated. It does not listen, which is what reneeh just explained to you. You think if people are just told to fix their diets, they will. They don't.
I think for the last 10 to 20 years at least the general population knows the difference between healthy foods and crappy foods. I also think they know that exercising is good for them. They know when their meals come from drive throughs and they refuse to exercise they are endangering their health. You have to literally be living in an alternate universe to not know these things. We can educate them until our faces turn blue, but it will not change someone's mind to suddenly stop those behaviors and to start a new healthier life. If that were the case we would not be at a 30% obesity rate in this country.

If Good thinks she is somehow stumbled upon some new development in the quest for health that once people hear it they will change their ways, she is now over 50 pages mistaken.

 
Old 08-13-2018, 02:36 PM
 
Location: Central IL
13,854 posts, read 7,457,220 times
Reputation: 32156
Quote:
Originally Posted by Good4Nothin View Post
I have already said here, many times, that there are people whose cholesterol is extremely high because of genetic defects, and they need cholesterol-lowering drugs. They are only a small minority of the population. If I were a doctor with a patient like that, I would give them drugs.

For most other patients, lifestyle will fix the problem. Not just diet -- exercise is extremely important. And it has to be a lot more than 120 minutes a week.

Exercise is being researched a lot, so it can't be all that hard to research.

Instead of the loud drug industry marketing propaganda, we need loud information about lifestyle. People do not have nearly enough awareness. Especially people who don't spend time reading about health, and expect their doctors to tell them everything in a 15 minute appointment.

We desperately need the public to be educated. They learned from the anti-smoking publicity and now smoking has gone way done from where it was. The same can be done for diet and exercise. But the drug industry has too many people brainwashed. That is what we have to fight against.
And you've been told by many that they fully understand the lifestyle changes that could make a difference and were told those things by their doctors. It is you who are deluded in thinking no one understands this oh so mysterious thing about "lifestyle". And that while lifestyle may work for some and may work a little (or a lot) for those "some" that there will ALWAYS be a need for medication. I suspect that only your own very specific ideas on diet and exercise would be acceptable anyway. Perhaps you are more comfortable living in the type of country that controls exactly what you eat and do - in America, we aren't quite there yet so you'll have to accept that and learn that you can only control yourself, not what others do.

I want you to say the words that (even!) people who DON'T have genetic defects should also get drugs. Unfortunately in your eyes that is only because they just won't listen to what you or their doctor (oops - doctors don't talk about lifestyle!) or anyone else says. You want to punish those people for not doing as they are told - mainly because you assume that if they haven't gotten better they can NOT have been doing what they were supposed to. Their failed cholesterol test is due to THEM failing to make lifestyle changes.

You can't possibly know that - and ultimately you don't get to decide whether they deserve to get medication or not. And I thank the L0rd for that - actually, I thank you - I had no idea people who thought like you existed - people who want to decide for others if they get to take a medication or not - if they have tried hard enough to merit getting a prescription. You can live YOUR life, I'll live my life. And no, I don't bow down to doctors or big Pharma - I can read just like you and decide among all the reputable and obviously disreputable sources what action I'll take for my own health. Sorry that makes you so angry.
 
Old 08-13-2018, 02:39 PM
 
3,540 posts, read 996,535 times
Reputation: 2653
Quote:
Originally Posted by reneeh63 View Post
And you've been told by many that they fully understand the lifestyle changes that could make a difference and were told those things by their doctors. It is you who are deluded in thinking no one understands this oh so mysterious thing about "lifestyle". And that while lifestyle may work for some and may work a little (or a lot) for those "some" that there will ALWAYS be a need for medication. I suspect that only your own very specific ideas on diet and exercise would be acceptable anyway. Perhaps you are more comfortable living in the type of country that controls exactly what you eat and do - in America, we aren't quite there yet so you'll have to accept that and learn that you can only control yourself, not what others do.

I want you to say the words that (even!) people who DON'T have genetic defects should also get drugs. Unfortunately in your eyes that is only because they just won't listen to what you or their doctor (oops - doctors don't talk about lifestyle!) or anyone else says. You want to punish those people for not doing as they are told - mainly because you assume that if they haven't gotten better they can NOT have been doing what they were supposed to. Their failed cholesterol test is due to THEM failing to make lifestyle changes.

You can't possibly know that - and ultimately you don't get to decide whether they deserve to get medication or not. And I thank the L0rd for that - actually, I thank you - I had no idea people who thought like you existed - people who want to decide for others if they get to take a medication or not - if they have tried hard enough to merit getting a prescription. You can live YOUR life, I'll live my life. And no, I don't bow down to doctors or big Pharma - I can read just like you and decide among all the reputable and obviously disreputable sources what action I'll take for my own health. Sorry that makes you so angry.
You are crazy. I just said that people should get the correct information.
 
Old 08-13-2018, 03:04 PM
 
Location: Central IL
13,854 posts, read 7,457,220 times
Reputation: 32156
Quote:
Originally Posted by Good4Nothin View Post
I have already said here, many times, that there are people whose cholesterol is extremely high because of genetic defects, and they need cholesterol-lowering drugs. They are only a small minority of the population. If I were a doctor with a patient like that, I would give them drugs.

For most other patients, lifestyle will fix the problem. Not just diet -- exercise is extremely important. And it has to be a lot more than 120 minutes a week.

Exercise is being researched a lot, so it can't be all that hard to research.

Instead of the loud drug industry marketing propaganda, we need loud information about lifestyle. People do not have nearly enough awareness. Especially people who don't spend time reading about health, and expect their doctors to tell them everything in a 15 minute appointment.

We desperately need the public to be educated. They learned from the anti-smoking publicity and now smoking has gone way done from where it was. The same can be done for diet and exercise. But the drug industry has too many people brainwashed. That is what we have to fight against.

Quote:
Originally Posted by Good4Nothin View Post
You are crazy. I just said that people should get the correct information.
But after they've gotten the information and still aren't better...then what what? You've never said what to do for people who don't have a condition due to non-genetic issues who aren't helped by lifestyle change. Do THOSE folks also get medication? What do you do for THEM?
 
Old 08-13-2018, 04:09 PM
 
3,540 posts, read 996,535 times
Reputation: 2653
Quote:
Originally Posted by reneeh63 View Post
But after they've gotten the information and still aren't better...then what what? You've never said what to do for people who don't have a condition due to non-genetic issues who aren't helped by lifestyle change. Do THOSE folks also get medication? What do you do for THEM?
My post wasn't about that, and I didn't express any opinion on setting those policies.

However, you are assuming that statins will save a person's life if they continue bad lifestyle habits. I have not seen good evidence for that.
 
Old 08-13-2018, 05:23 PM
 
Location: Georgia, USA
21,847 posts, read 26,585,579 times
Reputation: 27094
Quote:
Originally Posted by Good4Nothin View Post
You are crazy. I just said that people should get the correct information.
They do.

Quote:
Originally Posted by reneeh63 View Post
But after they've gotten the information and still aren't better...then what what? You've never said what to do for people who don't have a condition due to non-genetic issues who aren't helped by lifestyle change. Do THOSE folks also get medication? What do you do for THEM?
Good4Nothin, please answer this question, because these are the patients who are being placed on statins, because there is evidence that they do reduce the risk of cardiovascular disease (just not as much as you think they should).

Quote:
Originally Posted by Good4Nothin View Post
My post wasn't about that, and I didn't express any opinion on setting those policies.

However, you are assuming that statins will save a person's life if they continue bad lifestyle habits. I have not seen good evidence for that.
You do not get away with refusing to answer that question, because it reflects real life, not the Nirvana that you live in.

What do you tell the person who does not want to cut back on red meat? How about the guy who continues to consume more beer than he should? The couch potato who refuses to exercise?

"Bad lifestyle" is not a risk factor for cardiovascular disease. The effects of it are: hypertension and diabetes, for example. The NNT to benefit people at risk because of hypertension and diabetes is way less than 250 (and I have not forgotten that you have yet to tell us where you got that number).

Death, as I have mentioned before, is the wrong metric. You seem to think non-fatal heart attacks and strokes are totally irrelevant. They are not.
 
Old 08-13-2018, 10:50 PM
 
3,540 posts, read 996,535 times
Reputation: 2653
Quote:
Originally Posted by suzy_q2010 View Post
They do.



Good4Nothin, please answer this question, because these are the patients who are being placed on statins, because there is evidence that they do reduce the risk of cardiovascular disease (just not as much as you think they should).



You do not get away with refusing to answer that question, because it reflects real life, not the Nirvana that you live in.

What do you tell the person who does not want to cut back on red meat? How about the guy who continues to consume more beer than he should? The couch potato who refuses to exercise?

"Bad lifestyle" is not a risk factor for cardiovascular disease. The effects of it are: hypertension and diabetes, for example. The NNT to benefit people at risk because of hypertension and diabetes is way less than 250 (and I have not forgotten that you have yet to tell us where you got that number).

Death, as I have mentioned before, is the wrong metric. You seem to think non-fatal heart attacks and strokes are totally irrelevant. They are not.
Most people don't get the correct information. They get biased and deceptive marketing information from drug companies. News outlets repeat the marketing information without ever questioning it. Medical doctors mostly trust it also.

You never explained why you think reporting risk reduction in relative terms is not deceptive. It can make a tiny benefit seem huge. There is no context, no way to make sense of it.

I have seen various NNTs for various risk levels. I got the 250 number from an article you linked, somewhere buried in this thread. But I have seen similar NNTs elsewhere.

I have read, and have posted here, various NNTs for various endpoints, not just death. Often, they have found no mortality reduction at all for low risk people. And the CVD NNT is usually very high for low risk people.

I don't know what should be told to people who refuse to improve their lifestyle. I think most of the time it's because they believe the drugs will protect them, so why bother. Changing your lifestyle takes effort, taking a pill is easy. They should be told that the pill only has a small chance of protecting them, and that if they don't improve their lifestyle they may have a short life, or become disabled, even with the pills.

I think most will listen to accurate information, and get motivated to make changes.

Are there people who are incredibly stubborn, who will not listen to important health information? Millions of people still smoke, in spite of knowing the risks. But cigarette addiction is very hard to break, and a lot of them would like to quit but simply can't.

In the case of exercise, it is hard to get started when you have gone for decades without it. People just need to be convinced it's important, and should be reassured that they will get used to it. But, as I keep saying, the official recommendation of 120 minutes per week is not enough.

With nutrition, it's important that patients get current information. And there is plenty of controversy about what diet is best, and maybe it isn't the same for everyone. But there is agreement that refined carbohydrates and processed food are bad. Not everyone knows this, many probably don't. The American diet is pretty much based on refined carbohydrates.

Medical doctors don't have time to educate patients about lifestyle. But this education can come from anywhere. We know it's possible, because anti-smoking advertisements worked. We are getting too much pro-drug information, and seldom hearing the other side.

The messages from the drug companies need to be balanced by other more scientific and accurate messages. Medical doctors should learn about relative vs absolute risk reduction. It's so easy to find articles in medical journals and on general news websites shouting about 45% reductions in heart disease thanks to drugs. This is a marketing strategy, it is not scientific, and it misleads people, and it even misleads doctors.
 
Old 08-13-2018, 11:01 PM
 
Location: Georgia, USA
21,847 posts, read 26,585,579 times
Reputation: 27094
Quote:
Originally Posted by Good4Nothin View Post
Most people don't get the correct information. They get biased and deceptive marketing information from drug companies. News outlets repeat the marketing information without ever questioning it. Medical doctors mostly trust it also.

You never explained why you think reporting risk reduction in relative terms is not deceptive. It can make a tiny benefit seem huge. There is no context, no way to make sense of it.

I have seen various NNTs for various risk levels. I got the 250 number from an article you linked, somewhere buried in this thread. But I have seen similar NNTs elsewhere.

I have read, and have posted here, various NNTs for various endpoints, not just death. Often, they have found no mortality reduction at all for low risk people. And the CVD NNT is usually very high for low risk people.

I don't know what should be told to people who refuse to improve their lifestyle. I think most of the time it's because they believe the drugs will protect them, so why bother. Changing your lifestyle takes effort, taking a pill is easy. They should be told that the pill only has a small chance of protecting them, and that if they don't improve their lifestyle they may have a short life, or become disabled, even with the pills.

I think most will listen to accurate information, and get motivated to make changes.

Are there people who are incredibly stubborn, who will not listen to important health information? Millions of people still smoke, in spite of knowing the risks. But cigarette addiction is very hard to break, and a lot of them would like to quit but simply can't.

In the case of exercise, it is hard to get started when you have gone for decades without it. People just need to be convinced it's important, and should be reassured that they will get used to it. But, as I keep saying, the official recommendation of 120 minutes per week is not enough.

With nutrition, it's important that patients get current information. And there is plenty of controversy about what diet is best, and maybe it isn't the same for everyone. But there is agreement that refined carbohydrates and processed food are bad. Not everyone knows this, many probably don't. The American diet is pretty much based on refined carbohydrates.

Medical doctors don't have time to educate patients about lifestyle. But this education can come from anywhere. We know it's possible, because anti-smoking advertisements worked. We are getting too much pro-drug information, and seldom hearing the other side.

The messages from the drug companies need to be balanced by other more scientific and accurate messages. Medical doctors should learn about relative vs absolute risk reduction. It's so easy to find articles in medical journals and on general news websites shouting about 45% reductions in heart disease thanks to drugs. This is a marketing strategy, it is not scientific, and it misleads people, and it even misleads doctors.
The relative risk reduction varies with the magnitude of the original risk, which has to be calculated for each individual patient. A 20% reduction for someone with a ten-year risk of a major cardiovascular adverse event of 30% is huge in absolute terms.

If you do not know where you got the 250 number, stop using it.

Statins are not given to low risk people. That is what the risk calculator is used for. How many examples of that do I have to show you? Statins are not offered to low risk people. The NNT is low for high risk people, you know, those who should consider using a statin.

It would be great if you could just tell people to improve their lifestyle and they would do it. Some will and some won't. You still have not said what a doctor should do if lifestyle changes do not work (and for some who diligently apply them they do not) or if the patient refuses to make the changes. Your approach seems to be, "Sorry, no pill for you."

You say, "I think most of the time it's because they believe the drugs will protect them, so why bother."

That is not what their doctor tells them.


You say, "I think most will listen to accurate information, and get motivated to make changes."

One in four do not even make those changes after a heart attack or stroke:

https://www.stltoday.com/lifestyles/health-med-fit/percent-do-not-change-bad-health-habits-after-heart-attack/article_f30164af-2368-5cf5-8bdc-3f641a7607b8.html

One of the people quoted does say the problem is education, but the article goes on to describe a lot of effort put into education.


You say, "But, as I keep saying, the official recommendation of 120 minutes per week is not enough."

How do you know that? Do you have a source? This is a prime example of your trying to couch your personal opinion as a fact.

From the link above:

"While the American Heart Association recommends walking for 30 minutes a day five times a week [that's 150 minutes, not 120], the SSM cardiologist encourages his patients to begin with walking three days a week."

I guarantee that trying to get a sedentary person to start exercising an hour a day five or six days a week is going to go over like a lead balloon. Some working people with families to take care of will find that very hard to do, and a patient who has known heart disease needs a graded, supervised exercise program.

You say, "With nutrition, it's important that patients get current information."

That is why doctors refer patients to nutritionists, with a prescription for the diet they want the patient to be on. No, the doctor is not going to sit down and plan meals with you, but he will refer you to someone who will.

You say, "This is a marketing strategy, it is not scientific, and it misleads people, and it even misleads doctors."

Doctors are not dummies. They have to communicate with people at all levels of education and intellectual ability. Understanding risk is hard, as this very thread demonstrates. The bottom line is that the risk has to be estimated for the individual patient, diet and exercise are the foundation of the risk reduction strategy, statins are not offered as an alternative to lifestyle changes but to augment them, and there are people who do not have familial hyperlipidemia who benefit from them. The greater the individual's risk, the greater the benefit.

Last edited by suzy_q2010; 08-14-2018 at 12:17 AM..
 
Old 08-13-2018, 11:36 PM
 
3,540 posts, read 996,535 times
Reputation: 2653
Quote:
Originally Posted by suzy_q2010 View Post
They do. They refer them to nutritionists and recommend exercise. It is up to the patient to implement the recommendations. Many don't.
Well I think there have to be reasons, and I tried to explain what some reasons might be. I don't think people are generally stupid and irresponsible. I think they are misinformed about drugs. You have no response to that. Medical doctors have been misinformed also, so how can they educate their patients correctly?

There is a very strong message, originating with the drug industry but echoing all through our society, that statins drugs are highly effective and extremely safe. You obviously believe that yourself. But the message is biased, as I keep saying. And you have no response to that.
 
Old 08-14-2018, 05:31 AM
 
3,241 posts, read 1,309,384 times
Reputation: 6492
Quote:
Originally Posted by Good4Nothin View Post
Well I think there have to be reasons, and I tried to explain what some reasons might be. I don't think people are generally stupid and irresponsible. I think they are misinformed about drugs. You have no response to that. Medical doctors have been misinformed also, so how can they educate their patients correctly?

There is a very strong message, originating with the drug industry but echoing all through our society, that statins drugs are highly effective and extremely safe. You obviously believe that yourself. But the message is biased, as I keep saying. And you have no response to that.
Doctors do tell their patients to diet and exercise, every single day. I review medical records daily as part of my job and whenever a patient has a diagnosis like diabetes, high blood pressure, or high cholesterol, they are ALWAYS recommended to improve their diet and exercise unless they have some sort of injury or physical limitation that prevents them from engaging in any sort of physical exertion. In many cases, the doctor will still try to work with them to find alternatives that can help them be active, like suggest aquatherapy/swimming if walking is a problem. I have seen people go off statins because they have a bad reaction to them. They will recommend people go to PT, go see dietitians, and try a variety of other methods to help people be more active.

There is no benefit to the drug companies at this point. You can get generic statins for free or at very low cost at many large grocery store chains. On the other hand, PT is NOT free and is often insanely expensive. Yes, if people could exercise more easily, that would be great, but we have yet to come up with a program that provides free or low cost PT and other therapies that make exercising easy for people who have physical limitations who need to learn how to do it without pain.
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