Hats off to the NEJM in  bucking the trend, publishing free online a Sounding Board against releasing a (Merck) statin for over-the-counter purchase – see article


Dr Tinetti highlights the  accumulating insidious long term risks of statins- the latest being  haemorrhagic stroke and lung damage; and as Jacobson’s Mayo Clinic proceedings review the same month says, al least 5% ie 1:20 patients REPORT muscle pain and fatigue, if not also depression, impotence, liver-kidney problems etc. see Mayo Clinic.


As Mary Tinetti says, and has been stressed for over a decade by eg the Sheffield group, there has never been evidence that statins give safe overall benefit- major reduction in cardiovascular risk – UNLESS  the patient already has serious lipidemia with existing ischaemic disease ie 10year risk exceeding about 2% per year.


The simple reason is that in practice, statins do nothing for the underlying CAUSE of  common atheroma-  lipidemia –  which is the metabolic syndrome  X  (MBSx ) of overweight- insulin resistance – type 2 diabetes,  from excess calorie and fat intake,  from stress (cortisol) and from lack of  physical exercise (which statins aggravate).


Except in rare cases of severe hypercholesterolemia (genetic  or irreversible liver/renal disease), cholesterol per se is not a significant risk factor since it is a vital substrate for our metabolism. Statins thus do absolutely nothing for  the mountain of non-cardiovascular morbidity and mortality, from infections, overweight, arthritis and depression to cancer.


The agents which the vast majority of  us need- those becoming overweight ie heading into MBSx – are not wannabe synthetics like statins but  those that lower  excessive clotting and insulin resistance,  reverse fat gain  and hepatic steatosis, and thus ENERGISE muscles ie exercise – the 80-year old metformin or it’s parent herb galega,, minerals,  vitamins, fish oil, fibre, fenugreek,  cinnamon, garlic; ginger, gymnema; ribose, coleus, CoQ10, carnitine, acetylcysteine, and where appropriate with (relative) deficiency), physiological systemic human sex-hormone replacement (depot testosterone, estradiol). 


Any healthcare provider who fails to enforce such simple holistic low-cost primary prevention early (which halves all-cause disease and deaths, adds decades to health and thus vastly reduces the cost and disability-dependence burden)   should be disciplined for negligence. Disease  certainly pays the Disease industry,  shareholders, Governments , Academia and Regulators – but not the individual- for whom Only Prevention Pays.


 If any prescription drug warrants release to over-the-counter status it is METFORMIN, given that no serious adverse effect has EVER occurred  with sensible use   and instruction (ie self dose titration to tolerance) in  trials of either PRIMARY prevention of diabetes and overweight, or even SECONDARY therapy eg  in polycystic ovary syndrome – infertility- pregnancy, or the 20 year  UKPDS  United Kingdom trial  in type 2 diabetics.


The same cannot be said for eg sugar, alcohol or smoking  tobacco, which  – since they are the greatest  marketed insidious killers universally on sale – should be heavily scheduled regulated drugs if not (in the case of smoking tobacco) banned.


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