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Comment by Qem | Hacker News Reader

So it appears oat fibers are just quite effective natural bile acid sequestrants[1]. That makes me wonder why don't we use this class of locally-acting compounds as first line cholesterol lowering treatment, instead going straight for the "bazooka" of systemic acting statins that have lots of side-effects, even affecting personality[2].

[1] https://en.wikipedia.org/wiki/Bile_acid_sequestrant

[2] https://www.bbc.com/future/article/20200108-the-medications-...

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Patient compliance is notoriously fickle, especially when it comes to changing one's lifestyle (diet).

Synthetic, stronger versions are available, as cholestyramine, colestipol or colesevalam, that can be taken as medicines, instead of demanding large changes to diet.

Because medication is more effective. Side effects from statins are relatively uncommon and generally mild, so it wouldn’t be ethical to use lifestyle as a first-line treatment in place of, say, a combination of low dose statin and pcsk9 inhibitors.

However many clinicians do take a “let’s sort out the problem as quickly as possible with medication, and if you want to try lifestyle and back off (or even stop entirely) the meds and see how your cholesterol is afterwards, we can do that.”

This seems like a good balance to me.

Wait isn’t this the other way around?

In reality lifestyle modifications are more conservative than using a medication so lifestyle modification would be first line from an ethical perspective.

In reality though it does seem like statins are used first line by many clinicians. But ethically speaking conservative interventions like lifestyle modification in terms of changing diet and exercise should be used prior to medicating a young otherwise healthy person.

In other groups such as when someone has had a recent heart attack of course the thought process is different. Such people should be immediately placed on a statin.

No, because we have a huge body of evidence pointing to both the safety and efficacy of lipid lowering medications. We know that as far as LDL-c goes, the lower the better, so since we have safe drugs that lower more effectively than lifestyle interventions, these are the first line option in most cases.

This isn’t true in the slightest.

Lifestyle is more effective and has less side effects.

Lifestyle is the first line of treatment, with meds being a later line of action.

What’s the evidence that lifestyle intervention is more effective than combination medication therapy?

My guess is something like, because there aren't patents on food.

There's no financial incentive for the healthcare industry to promote a healthy lifestyle.

Doctors and public health organizations literally have dietary and physical activity guidelines.

True, it is more complicated.

For one, there could be some financial incentives mixed in in that health insurance companies would want their people to be healthier so they don't pay out as much, but it's not that simple for them either - the health industry as a whole profits more if there is more treatment ergo more health problems. If health care was cheap or less needed the insurers themselves would make less.

More importantly, there can be other than financial incentives mixed in for doctors and public health organizations to encourage health. Doctors for example take an oath and I think often genuinely want their people to be healthy. Public health organizations may be more murky but there's definitely a financial and otherwise incentive for the government itself minus those corrupted by the health industry, to want people to have less health problems.

The problem is entirely about patients refusing to do what they know is good for them if it takes any self-discipline, so doctors resort to medication.

You can't force them to have healthy lifestyles.

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