Mr. Secretary, Reclassify the Statin | Hacker News Reader

Mr. Secretary, Reclassify the Statin

alexkesin.com

20 pointspaulpauper14 comments

Ways to present LDL-C and statins benefits vary widely, the graph in the article present statins and reduction of LDL-C as a god send.

However some very large study show a seemingly different story, eg:

https://pmc.ncbi.nlm.nih.gov/articles/PMC9798292/

"Association between low-density lipoprotein cholesterol and cardiovascular mortality in statin non-users: a prospective cohort study in 14.9 million Korean adults"

Figure 1 shows a hazard ratio higher for both lower LDL-C and higher LDL-C level, with a large flat part of the curve in between.

Curious if someone has an explanation

My layman take is that like the oil in your car, there is a minimum value you need to be above, and a maximum value you need to stay below. Statin is for treating people that are above the max, so that they drop within acceptable range. Not for lowering the cholesterol to be a slow as possible

This decision only makes sense it saves more lives than the number of lives that will be lost because of it.

It seems to me like it should totally be possible to do the math here and figure it out. Compute the lives saved and compute as many of the lives that will be lost. For instance, statins are a risk to pre-diabetics, and to children, and to etc...

There better be a very large difference. That's the bottom-line argument that I would have attempted to make.

Here are some discussions about OTC'ng statins from NIH.

    https://pubmed.ncbi.nlm.nih.gov/16516588/
    https://pmc.ncbi.nlm.nih.gov/articles/PMC8109468/
    https://pmc.ncbi.nlm.nih.gov/articles/PMC8109854/

While reading them, feel free to wonder if budgetarily carpet-bombing NIH is in our national interest.

Skimming, I started out willing to go with them, but then they lost me with:

> 2. Safety so boring it is practically soporific

> Serious muscle injury from statins occurs in <0.1% of users; hepatotoxicity is an order of magnitude rarer. For context, you’re free to purchase orlistat—a drug whose calling card is oily rectal incontinence—straight from Amazon’s shelves. If we are letting consumers gamble their underwear for a few pounds lost, we can surely trust them with the pill that costs pennies and saves hearts.

Are they saying that there will be many serious muscle injuries if this prescription drug goes OTC, but an already-OTC drug has a potty-humor side effect, therefore... through the power of dismissive levity-logic, we can just chuckle and stop thinking, and it's that same human capacity for rational thought that ensures that a OTC medication with dangerous side effects will be used only judiciously-- Sorry, I don't follow?

A family member experienced the muscle wasting side effects of statins. They didn’t even need them but they were overweight so their doctor thought it was a good idea to put them on statins. Took months to figure out what was wrong and it changed their life permanently damaging their mobility. Whenever they change doctors even though they don’t have cholesterol problems they still have to fight to be kept off of statins because they are overweight.

Statins are wonder drugs for those who need them. There’s absolutely no reason individuals should be deciding for themselves if they need them though. Bloodwork is required at a minimum to determine if they are needed. They are not NSAIDs.

For the record, OTC NSAIDs like ibuprofen are not too safe either. They can and do easily cause stomach and intestinal ulceration. The point is that statins are not much more dangerous. Odds are that your family member was taking a more powerful statin and in a higher dose.

Sorry your family member had to go through that. I think you have an important message, and it looks like comments here are getting drive-by downvotes.

In a blatant act of topic hijacking, I'd like to suggest another rethinking. Where is the wisdom in having Law Enforcement (DEA) make medical decisions (Drug Scheduling) for an entire nation?

This is a critical medical responsibility. It seems profoundly foolish to place it with an entity that 1) is wholly unqualified and 2) has its funding dependent on locking medicine behind that schedule.

Yeah this is rather blatant topic hijacking because statins aren't scheduled under the Controlled Substances Act. The OTC vs prescription question for statins doesn't involve the DEA at all.

Actually the D.E.A. is directly involved in all prescriptions and prescriber activities.

https://en.wikipedia.org/wiki/Drug_Enforcement_Administratio...

Every US prescriber such as a physician or NP must be registered with the DEA and obtain a registration number. This number is provided on all their prescription pads, and it's a number required by the [also DEA-registered] pharmacy to authenticate all prescription requests, controlled substance or not.

You are correct. I am being poor steward of online etiquette. I will do somewhat better in the future.

This shows a fundamental lack of understanding of the current process. One could argue about risk-reward tradeoffs for statins, but showing weird science graphs and double blind study arguments is useless. If you want to save lives, think like a tiktok influencer!

Where's the grift? Who is your target audience? How will they make money?

Yes, it's so cringy reading a naive appeal written by someone who seemingly thinks helping our society or even just the values of open reason have anything to do with the goals of the current administration.

The loudly proclaimed surface policies are trolling for whatever draws the most attention - hence the recycling of so many disparate longstanding criticisms into an overarching wholesale condemnation. And the real policy is driven by whatever enables them to loot, steal, and otherwise enrich themselves by taking bribes for enabling corporate totalitarianism.

I guess it's not really different than people who still think the Republican party represents a strong America, or the widespread continued use of "conservative" as a lazy synonym while the actual agenda is the complete opposite of conservatism. But still like, you aren't an elderly person glued to a nursing home TV all day. You're online so much as to even have a blog. You should know better.

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