Generic statins and limiting blood tests are a horrible way to save money....

Today's Post: Thursday, 5-26-2011

There was an article with the best methods to save money from several different kinds of doctors. TIME ran the story with the title, “Advice From Doctors: Top 5 Ways to Lower Costs and Improve Care.”

The top 5 from Family Medicine, Internal Medicine, and Pediatrics all made sense but two, using generic statins and limiting blood tests.

(Those were the two listed from Internal Medicine not already in the Family Medicine list.)

1. Why not use the generic statins?

The generic form of Lipitor does cost less than prescribing Lipitor for example.

So why is it a dreadful idea?

It presumes that prescribing any statin to people with high LDL cholesterol is a good idea.

It is NOT. And, its both more expensive and less effective than better choices. It also causes increased costs to treat the side effects of the statins.

So, it’s a dreadful example of how NOT to save money in health care!

The problem with that is that there are more effective ways to lower LDL cholesterol and to prevent heart attacks than taking statin drugs. They are also usually cheaper!

We now know what lifestyles cause heart disease and in some detail. If those things are reversed, the chances of heart attacks and the level of LDL and the small particle LDL that causes heart disease drop far more.

People who eat or drink a LOT of sweets tend to lower their HDL and sharply increase their triglycerides. That causes not just an increase in LDL, it causes an increase in the small particle LDL that causes heart disease. (Eating refined grain foods instead of some whole grain foods, some vegetables, and some beans has much the same effect.) Why give ANY drug to someone who still eats this way? It’s like holding off a tsunami with a thimble. It’s a waste of money.

People who eat a lot of foods that contain hydrogenated oils and transfats, research has found, get an increase in the small particle LDL that causes heart disease. That’s why it’s gradually being banned. Why give ANY drug to someone who still eats this stuff? It’s like holding off a tsunami with a thimble. It’s a waste of money.

People who exercise most days of the week decrease their levels of small particle LDL that causes heart disease. If they do some vigorous exercise each week as part of their exercise and keep doing it for several years, the effect gets stronger. (Exercise also tends to prevent type 2 diabetes. And, type 2 diabetes dramatically increases the risk of heart attacks.)

Note that intense exertion in unfit people or people who have heart disease can trigger heart attacks. But with that exception, exercise tends to prevent heart disease and heart attacks. (Gradual build up of intensity and keeping intense exertion brief can solve that problem.)

True, some people are too disabled to exercise. And, some have such hard lives they can’t fit it in. But they can learn to avoid the things that cause heart disease. Unless the people who can exercise do so or begin to, why give ANY drug to them? It’s like holding off a tsunami with a thimble. It’s a waste of money.

People who smoke or who voluntarily expose themselves to second hand tobacco smoke are suicidal or very uninformed. Tobacco smoke lowers HDL and makes what’s left less effective at clearing your arteries. A cyanide like chemical in the smoke damages the lining in your arteries and causes a large jump in chronic inflammation which causes heart disease too. Every exposure to tobacco smoke has these effects.

We also recently found out that tobacco smoke triggers heart attacks in people who might otherwise have avoided them!

And, unlike cancer which does spare some smokers, these effects harm all smokers.

Why give a cholesterol reducing drug to a smoker? It’s like holding off a tsunami with a thimble. It’s a waste of money.

On top of that, there are three inexpensive and effective ways to lower LDL. Each has other documented health benefits. None with one exception has the side effects of statin drugs.

Eating foods such as vegetables, beans, oatmeal, and apples that are high in soluble fiber reduces LDL cholesterol.

Taking sterol supplements lowers LDL cholesterol and is far cheaper and safer than statin drugs.

And taking some niacin after meals and some inositol hexaniacinate not only lowers LDL; but it increases HDL and lowers triglycerides. Since it has been tested to lower death rates, it very likely lowers the small particle LDL that causes heart disease.

The Berkeley Heart Lab did research finding that only one genetic subgroup was more protected by statins than niacin or protected much at all. No prescription for a statin, generic or otherwise, should be given to someone who hasn’t tested to be in this subgroup! It’s a waste of money! Statins, they found are quite ineffective protection for everyone else.

(A recent study finding that adding high dose niacin to the treatment of people with significant heart disease and who already were taking very high doses of statins found that the niacin added no extra protection.

Niacin was not tested INSTEAD of statins. That might have had a different result entirely.

Nor was their any mention of getting the people studied to avoid tobacco smoke, sugary foods and drinks, or trans fats. Testing something that might prevent heart attacks on people who still do these things is like betting on a horse race where your candidate has to tow an anchor!

Between not testing niacin by itself, not adding it to lifestyle changes, and waiting until the people may have had too much damage to help them much, this was a very, very poor test!)

Lastly, people who take statins often cost money to treat the side effects. Only using them when actually desirable saves money.

Lipitor, I just read causes insomnia. So, if a sleep inducing drug is used that cost must be added.

Statins often cause neuropathy. If that’s treated with tests or drugs that cost must be added.

I’ve read that statins tend to cause or worsen heart failure, particularly if they are not taken with the ubiquinol form of CoQ10. And treating heart failure is hugely expensive!

Yes – IF statins are used, the generic is cheaper. But NOT using statins can save a LOT more money!

2. Why not limit blood tests?

Because there are three uses for them and only cutting back on their use in one of the three areas saves money.

But, I know from direct experience with my own doctor at Kaiser, if you tell a doctor to limit tests, he or she will limit all three uses!

If you treat someone for something where it’s 90% likely you have the right diagnosis, you can use blood tests right then to check for causes in the other
10%. But unless the symptoms are life threatening, it WILL save money to only test if the patient fails to improve by treating the most likely cause.

That’s the use that does save money!

But, because my wife and I were tested with fasting glucose and HBA1C tests while we seemed completely healthy, I was able to avoid getting type 2 diabetes; and my wife caught hers at an early enough level to not need to take drugs for it or risk much damage from it.

Had we not been tested when we were, our medical costs could easily been dramatically higher! When such diagnostic tests are used routinely in healthy adults, health care costs go DOWN not up!

So cutting tests in this use to save money will backfire to the tenth power! It is a VERY, VERY bad idea!

The third use of blood tests is to allow people who make the lifestyle changes to get feedback on their progress.

When you can and they can see their markers going in the right direction, it helps enormously to help them keep up their hard work.

And, if their markers stay the same or get worse, it lets them see they need more effort or better methods.

It’s just like driving a car on the freeway. It works better and is safer if you can see where you are going!

And, it’s a use it is penny wise and twenty dollar bill foolish to cut out!