First a disclaimer: I’m a psychiatrist, not a cardiologist, but I’ve followed with personal interest the discussions about calculating cardiac risk and indications for statin treatment.  Risk is an interesting word, because risk is about populations; it loses the individual. And it seems that statin treatment has taken on a bit of stigma -- something we’re used to in psychiatry -- now you can eat your cake and have low cholesterol, ...

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I rather doubt you need me to bring the roiling statin debate to your attention, given its prominence in scientific circles and mass media alike. In essence, a new set of guidelines for the use of lipid-lowering drugs to prevent heart disease was issued with considerable fanfare and then set off a firestorm of controversy. The old approach relied heavily on levels of LDL cholesterol, while the new approach ...

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We can now add vitamin B12 deficiency to the growing list of risks of long term use of the proton pump inhibitors (PPIs). The New York Times had an article outlining the evidence that prolonged use of both proton pump inhibitors (PPIs) like Prilosec, Protonix, Prevacid and others, as well as the less potent H2 blockers like Zantac and Pepcid, can lead to vitamin B12 deficiency.  This is in addition to ...

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Let’s say you were inventing a new flea powder, called Flea-B-Gone. To test it and manufacture it, you’d need a whole mess of fleas. As everyone knows, kangaroo fleas are hardy and docile, so you open up a kangaroo farm to grow your fleas. You treat the kangaroos well, and other than itchiness, they don’t have much to complain about as you scrape off their fleas to make your Flea-B-Gone. ...

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As I was watching CNN news recently, I noted in the headlines different ways Obamacare is failing.  Current problems discussed were the customers’ sticker shock of high deductible plans (up to $12,700 for families), the president blaming the insurance companies for having substandard plans, and the people blaming the president for losing their current insurance. One patient even complained, “My new health care plan tripled in price, and now, it is ...

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A version of column was published in USA Today on November 20, 2013. I once diagnosed a patient with high cholesterol, and prescribed him a medicine commonly known as a statin.   When I saw him months later for follow-up, he admitted that he didn’t fill the prescription. “I took red yeast rice capsules instead,” he said. When I asked him why, he told me that he was wary of statins’ long list of side effects ...

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New guidelines from the American College of Cardiology and the American Heart Association on the assessment of cardiovascular risk and the manipulation of cholesterol levels to mitigate that risk have certainly been in the news. The guidelines appropriately use high quality evidence to abandon old untested or unproven paradigms such as treatment to LDL targets and manipulation of non-HDL cholesterol as a secondary goal. In many ways, the new guidelines ...

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I just returned from the annual American Heart Association meeting where I heard distinguished cardiologists and researchers from around the world present the latest in cardiovascular disease. Yet, amidst all the late-breaking clinical trial presentations and ask-the-expert sessions, what I didn't hear were the speakers' financial conflicts of interest. Don't get me wrong -- the AHA mandates that all speakers present a disclosure slide at the beginning of every talk, and this rule was ...

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There has been much discussion recently, by journalists and health professionals, on the new guidelines for the treatment of blood cholesterol put forward by the American Heart Association (AHA) and the American College of Cardiology (ACC).    Critics have raised concerns the revised guidelines will increase the number of healthy people who take statin drugs by 70 percent, that treatment thresholds are too low and that some guideline writers have links ...

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Ever get confused over the names of medicines? I do. There’s Zantac and Xanax. Zanaflex and Zaleplon. But Zanaflex is also known as tizanidine. Tizanidine functions very differently than Zantac and its other name, ranitidine, even though they sound alike. Every drug has (at least) two names -- one proprietary, and one generic. Proprietary names are created to sound catchy by the original manufacturer, almost always under a patent. The generic names are more like chemical ...

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