You may have read that doctors receive payment or bonuses for prescribing statins, the cholesterol-lowering drugs. I’m a chapter leader in Kauai, and a family physician, so I’m in a good position to fill in some details about how doctors actually get paid more for writing more statin prescriptions. The mechanism is a little cumbersome to describe clearly, but I’ll take a stab at it.
We have a series of “quality measures” that are tracked by the insurance company. One quality measure is the number of mammograms we do on our patients between ages 40 and 69, another is that we send our diabetic patients to the eye doctor once a year for retinal exams. For our patients who carry a diagnosis of “coronary artery disease,” we have to write them a prescription for a cholesterol-lowering drug. If any one doctor doesn’t follow any one of these imperatives, he loses points toward a cash bonus, and the entire group is similarly penalized. As you can imagine, there is lots of peer pressure to prescribe!
Actually, we don’t get our bonus unless the patient goes and buys the drug or gets the test or sees the eye doctor and so on, so it’s not enough just to write the prescription, we have to talk up the drug enough to get them to go out and buy it. Currently, there are only a few means by which a person can be labeled as a patient with coronary artery disease. Having a heart attack is one, and having abnormal results on heart tests (like angiograms) is another. Diabetes is now considered a “coronary artery disease equivalent” and so, in the near future, doctors may be required to get all our patients who have type one or type two diabetes to take their statins, or lose more money.
These HMOs are insurance companies like Blue Cross, which offer their clients (employers and patients) HMO programs. The HMO plan we have is offered by HMSA (Hawaii Medical Something Something). For whatever reason, HMSA wants to offer an HMO program for people, and doctors who participate as providers must comply with the rules of the program and accept payments according to the rules. There are clear benefits to pharmaceutical companies in this structure but no obvious reason why HMSA would want to encourage people to buy expensive drugs that HMSA must pay for. One might speculate that there are some quid-pro-quo relationships between the insurance companies and the pharmaceutical companies, but I have no idea what they are. However the ties are structured, I feel, as do many other scientists, that these kinds of business relationships lead to behaviors that pose real threats to patient care, and to human health in general. Because industrial connections like this fund most research, they distort the scientific process and are far more insidious, invisible, and totalitarianistic than expensive dinners and trips to Hawaii, which are what the media would have us believe is the sum total of the problem.
By the way, the bonus is actually not a bonus at all. This is where it gets Orwellian. We give up a certain percentage of the payment for accepting HMO patients, and we get it all back, in theory, if we meet all of our quality measures. We never do because of computer glitches which continually fail to track our prescribing, testing, and referring patterns accurately. Nobody can explain why we’ve agreed to accept HMO insurance plans, but we seem to feel we have no choice. And we will have less choice before long; Medicare is planning to begin similar programs. Each of these programs takes more money away from the doctors and gives it to middle managers, ensures that drug companies get more money, and that expensive tests of limited value are done more often.
These are some reasons why savvy business people are going into “alternative” medicine where they benefit from cash payments and total autonomy. Several here on Kauai are making millions.
Catherine Shanahan MD
SHOCK IN HOLLAND
Holland has been shocked by a tragedy in which a police officer shot his wife, three sons and then himself, apparently without any reason. These things have happened before, but I can’t help but speculate.
A few months ago I interviewed a statin victim, also a police officer, who told me, that “when they changed me from Zocor to Lipitor, the muscle pain only got worse. And the world turned even blacker than it had been. It got so bad that I took a nail and connected myself to the grid. But I did not succeed. Then the doctor put me on Seroxat as well, for the depression. Man, you cannot guess what happened to my head on that combination. I had this scary urge to take my gun and just shoot everybody.”
This officer told me that policemen in Holland get regular checkups and are talked into a statin as soon as their cholesterol is a little above 200. “Half the service is on a statin,” he told me. “When they get the statin, they start functioning lousy. Then they go on Seroxat and feel dumb.”
Zoutkamp, The Netherlands
The so-called “Mediterranean Diet” is an American fabrication for the simple reason that in Italy—let alone in the entire Mediterranean area—people eat in different ways. Yet there was historically such a thing as an Italian diet. Here is the story: at the end of the 19th century, Italy had just been unified into a brand new nation. At that time Pellegrino Artusi wrote a book of recipes entitled The Science in the Kitchen and the Art of Eating Well. It was a collection of traditional recipes from Tuscany and Emilia-Romagna (concerning food, Emilia is for Italy what Bourgogne is for France) and it became the second bestselling book in Italy (the first being the Bible). It is actually mentioned in a high school text book, History of Italian Literature, and for good reason as it was responsible for the spread of a common language in the middle class of the new nation. It remained the bible of Italian food for the middle class until the 70s-80s, when the lowfat craze kicked in. I remember that as the time when we really started eating pasta and bread.
The Artusi book is the antithesis of what today is called the Mediterranean diet: for instance one recipe for breakfast calls for eggs, butter, anchovies, capers and tuna. Artusi emphasizes the use of animal fat and meat; in fact, the book is a feast of animal food. The book actually starts with a rating of the nutritive power of different kinds of meat, with beef at the top of the list. There is a section about pasta in which Artusi warns children, elderly and pregnant or lactating women from consuming pasta “because it would distract from the consumption of more nutrient-rich foods, as meat or fish. . . “ and cautions, “people with tendency toward obesity” to refrain from consuming it “because every doctor knows that flour has no nutritive power and immediately turns into body fat.”
The most famous Italian products are animal-based: 400 kinds of traditional cheese (most of which are required by state-enforced purity laws to be made from raw milk, like Parmigiano Reggiano) and hundreds of cold cuts (prosciutto crudo, prosciutto cotto, salame, coppa, pancetta, mortadella, to name a few).
During the 1950s (when Ancel Keys visited Italy and initiated the Mediterranean diet myths) a lot of people had a hard time affording meat, especially in the south. But that was certainly not considered something good. In fact most families that could not afford meat would still buy little pieces of it, at least once a week, to feed the kids. My grandpa, who fought in WWII, would tell me sometimes: “Quit complaining about food. You can have meat twice a day, you don’t know how lucky you are. At your age I knew what famine was like.” Elders who went through fascism, war, German occupation, and then saw their towns destroyed by Anglo-American bombings would commonly speak that way to the new generation.
Finally, in a local newspaper from the northern Italian town I’m from, there is a historical page—sort of “the way we were.” A few months ago it published the following documents from its archive: at the beginning of the 1920s, the price of food was increasing. A group of “middle-class housewives” wrote to the authorities asking for the creation of a committee to control the prices. They also wrote down a list of the essential goods whose price should be kept controlled, in order of importance. The most important was “fi rst choice butter.” Then came the “second choice butter.” Then lard. Then olive oil. Then a list of meats and cold cuts. There is no mention of bread or pasta in the list. Very different from the so-called “Mediterranean diet.”
University Park, Pennsylvania
NO BENEFICIAL ROLE
I want you to know how much I’m enjoying my first issue of the WAPF newsletter. I was happy to see, in one of the letters you published, that I’m not the only RD in the organization.
I thought you might be interested in something I read the other day. I am a member of the American Dietetic Association and was doing some catchup reading when the following paragraph caught my eye (from an article on the new Dietary Reference Intakes in the Fall ‘02 “Dietetics in Practice,” a quarterly ADA publication):
“According to the report [from the Institute of Medicine’s Food and Nutrition Board], saturated fat and cholesterol provide no know [sic] beneficial role in preventing chronic diseases and so are not required at any level in the diet. Since completely eliminating saturated fat and cholesterol from the typical American diet would make it difficult to meet other nutritional guidelines, the panel recommended keeping intake as low as possible while maintaining a nutritionally adequate diet.”
Hmmmm. . . I’d like them to take a look at the lipid profile of human milk and tell me again that saturated fat and cholesterol are not required at any level! Or do they believe our nutritional requirements change that dramatically when we wean?
Thanks again for all you do. I can’t tell you how glad I am that I found the WAPF!
This statin craziness gets worse. I’ve a friend with a cholesterol level of 157 who was put on the statin drugs with the intention of getting it down to 120. She immediately got sick and stopped the drugs. Another friend’s 89-year-old mother in reasonable mental health was put on a statin drug a year ago and now has advanced senile dementia. Age or drug? No proof either way, but I’ve got my suspicions.
Thank you for a great article on cholesterol on your website. We are currently dealing with memory loss with my mother-in-law, age 70. She has been on lovastatin (mevacor) for several years and her memory has gotten worse and worse. She went for a battery of tests and the doctor said it was not dementia or Alzheimer’s, but couldn’t relate it to anything else.
I suspected statin drugs from different articles I had stumbled upon. Lo and behold we discovered she was indeed taking lovastatin. We took her off for a few weeks and she seemed better, less in a fog.
Then the doctor treating her memory loss told her to go back on the statins. “If your primary doctor prescribed them, you must need them,” he said. We were fit to be tied. If anyone knew about the tie-in to memory loss and these drugs, it should have been him!
After doing a little research on this doctor we discovered that he had recently received a nice big grant from the pharmaceutical industry to do research on using statins to improve memory in Alzheimer’s patients!
When we visited her primary care doctor, we were able to convince her to take my mother-in-law off statins for two months at least. She did acknowledge the possibility of a tie-in to the memory issues. But then she immediately said, “If that is the case, then we will really be stuck for a new med to lower her cholesterol. It is important to do that.”
Well, after reading numerous articles about how damaging statins are and how little they really do, I must ask, isn’t quality of life better than (so-called) quantity of life, assuming the claims of increased lifespan are true? Is it better for my mother-in-law to go around confused and in a fog than to risk the potential heart issues that these drugs are “supposed” to prevent? All the research I see shows no positive proof to back up those claims, yet this drug is the number one selling drug (and quite expensive, too) in this country. Not to mention the dangers of lowering cholesterol levels too low and damaging other key functions and components of our bodies?
How do lowly consumers go about getting their voices heard to help prevent millions more from being damaged by these awful drugs? When did doctors in this country become legal drug pushers, turning healthy adults into pill-popping patients? When a patient identifies a side effect to a drug, why isn’t it reported? I find it hard to believe that all the people who claim memory loss and amnesia, as well as muscle and other problems, with these drugs are just making it up.
Editor’s Response: The best way for consumers to avoid being damaged by statin drugs is to “just say no.” Only when large numbers of patients begin voting with their feet will the power of the pharmaceutical industry start to wane. Our role at the Weston A. Price Foundation is to provide the information patients need to find the courage to refuse statin drugs. For proof that “high cholesterol” is a new and invented disease, read on.
I have in front of me a copy of my mother’s cholesterol report taken in 1996. The established parameter for normal cholesterol is listed at 150-300. She typically runs around 270 and had experienced a lot of pressure to go on statins; she fortunately has enough confidence to “just say no.”
She had been on a very lowfat diet for years and was never able to lower her cholesterol levels very much. She now suffers from lung problems. Fortunately she has become an avid consumer of raw milk, raw milk kefir, eggs and other nutrient-dense foods. Thank you for your research and all your posts on this subject.
A CANDIDATE FOR STATINS?
I’ve been a WAPF adherent for about a year. A few weeks ago I started having frequent heart palpitations. Naturally, I was frightened. Although I wanted to find out what was wrong, I was also afraid to visit my doctor for fear they’d want to check my cholesterol, and heaven forbid anything be out of line or they’d try to put me on medication. But with my mother’s recent heart attack looming over me, and since the palpitations weren’t going away, I made an appointment. My doctor did as thorough an in-office exam as possible, checking for all sorts of things. He also ordered the dreaded lipids panel. After getting the EKG results, he told me that he could detect nothing wrong with my heart function, although if the palpitations continued we could consult a specialist. I felt enormously relieved to know I wasn’t going to keel over from heart failure anytime soon, and hoped that my blood chemistries would also be reassuring. Wouldn’t you know, right away my palpitations decreased in frequency, and over the next few days almost disappeared! I gave the matter some thought and realized that I had been under quite a bit of stress, with many demands on my time.
Then I got the call from the doctor’s office. My labs looked fine, except for my LDL-cholesterol, which was “sky high” at 188, and could I come in soon to discuss treatment? I spent a week’s worth of my son’s naptimes on the computer, looking for information that could assuage my fear.
Today I returned to my doctor’s; I was so anxious that on the way there I gave myself a running pep talk. I thought perhaps I was just paranoid, and that surely he wouldn’t prescribe statins to an otherwise healthy 34-year-old woman. Guess what? Apparently no one is a bad candidate for drugs nowadays, because I came away with a prescription for simvastin! (Don’t worry, there’s no way I’m going to take the stuff.) It seems that even though my HDL is outstanding at 84, my triglycerides are fine at 99, my risk ratio is a perfectly acceptable 3.5, my other labs were totally normal, and I have absolutely no signs of heart disease (other than the now-resolved palpitations), I simply cannot continue with such high LDL. He admitted that my cholesterol had nothing to do with the palpitations, and even that my risk ratio and HDL are good, but kept saying that my LDL had to come down, preferably under 100.
But what really blew my mind was when I told him that I was very concerned about starting meds right now, since my husband and I are currently trying for another child. I thought he’d surely agree to postpone any treatment, but instead he said to go ahead and start the meds, and then quit once I became pregnant! He then told me that not taking medication during the pregnancy and breastfeeding period wouldn’t be a big deal, since it wasn’t like I was going to have a heart attack right now. So if it’s no big deal, then why risk my taking them during early pregnancy??
VANISHED TINS OF FAT
Now in my 80s, I have eaten butter all my life, not just a little smear, but I have plastered that so-called yellow poison on my bread, my toast, mashed potatoes, you name it, I have always applied it with a heavy hand. And I will not buy meat unless it has fat on it. My blood pressure is normal and I am as active and mentally alert as someone in their 50s.
Back in the 1940s, the doctors told my great grandmother not to eat fat—they were doing it even then. “But I like fat,” she said, as she sliced through rolled roast of beef. She ignored them and lived to an advanced age.
When I was young, fat was never wasted. Drippings from the roast were kept in one tin and fat from the bacon in another. They were later used for frying, smeared on bread and for making suet puddings and many other delicious edibles. We did not use oils, except for cod liver oil. We drank full fat milk and in my farming days, we would not consider butchering and dressing a thin animal. And we spread additional fat across the roast before it went in the oven.
A motto to live by: listen to your body, not the dietitians. Enjoy your food and don’t be afraid of fat. It’s not going to kill you. And keep those tins of fat on hand!
Geoffrey C. Morell
SATURATED FAT MIRACLE
I saw your website and I want to briefly tell you about my wife. She has had autistic symptoms all her life, and for the last two years, Addison symptoms so serious she was a semi-invalid and very depressed. She is now cured (since last August). She is happy, works hard, no symptoms, no medication, all her lifelong autism symptoms are gone as well! It was truly a miracle. By accident and out of desperation she tried a diet extremely high in saturated fat. That was all. In three days she was a new person! I think someone should get the word out about this.