Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The cholesterol debate: Seeking truth where there is no truth

Robert Centor, MD
Conditions
November 25, 2013
Share
Tweet
Share

The New York Times recently had one of their periodic debates: When Medical Experts Disagree.

This debate actually centers on the current cholesterol guidelines, but the problem recurs often. Different experts look at the data and develop differing opinions. We see this with prostate screening, mammography, and treatment decisions.

As one reads the varying opinions in this debate, an understanding of the affect heuristic makes the debate transparent. When we like something, we overestimate the value and underestimate the risks and costs. This explains most conflicts of interest, and importantly conflicts of interest are not just pharmaceutical.

The experts writing the cholesterol guideline are heavily invested in the cholesterol hypothesis. The higher the cholesterol the worse the patient will do. Amazingly, the data made clear that only statins have excellent outcome data, so the panel dropped cholesterol goals for primary prevention and high yield secondary prevention (patients between 40-75 with type II diabetes mellitus or very high LDL cholesterol).

The controversy rests then on primary prevention. The experts like lowering cholesterol. They have accepted the data that statins trump every other drug class, and that other drug classes do not have sufficient outcome data to either add to statins or use alone. They know that primary prevention does decrease cardiac events. Because they like preventing cardiac events, they favor an aggressive approach to primary prevention.

Many other physicians worry about treating very large numbers of patients with a drug that both has significant costs and side effects (mostly muscle pain). These physicians are not as enamored with statins, unless the patient has very clear indications.

As one reads the various debaters, one can understand their contributions as resulting from the affect heuristic. One debater sees the pharmaceutical influence as a major evil — thus blames the pharmaceutical conflicts of interest (while apparently ignoring other conflicts). One debater clearly focuses on drug side effects, and cautions against using any new drugs, unless the new drug has proven major benefits.

Seeking truth where there is no truth will always frustrate physicians and patients. We have to balance risks, costs and benefits, and generally make these estimate with incomplete information. For rarely can we have complete information. We want to worship at the altar of evidence-based medicine, but we still must assess values, and values will always contain a subjective component.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

Prev

Making the decision to be out on a medical school application

November 25, 2013 Kevin 106
…
Next

Doctors who call patients hypochondriacs are committing malpractice

November 25, 2013 Kevin 92
…

Tagged as: Cardiology, Primary Care

Post navigation

< Previous Post
Making the decision to be out on a medical school application
Next Post >
Doctors who call patients hypochondriacs are committing malpractice

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Robert Centor, MD

  • When the problem representation and the illness script do not match

    Robert Centor, MD
  • Think of diagnostic excellence as playing smooth jazz

    Robert Centor, MD
  • When constipation pain was worse than cancer pain

    Robert Centor, MD

More in Conditions

  • What if medicine had an exit interview?

    Lynn McComas, DNP, ANP-C
  • Finding healing in narrative medicine: When words replace silence

    Michele Luckenbaugh
  • Why coaching is not a substitute for psychotherapy

    Maire Daugharty, MD
  • Why doctors stay silent about preventable harm

    Jenny Shields, PhD
  • Why gambling addiction is America’s next health crisis

    Safina Adatia, MD
  • How robotics are reshaping the future of vascular procedures

    David Fischel
  • Most Popular

  • Past Week

    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • In a fractured world, Brian Wilson’s message still heals

      Arthur Lazarus, MD, MBA | Physician
    • Adriana Smith’s story: a medical tragedy under heartbeat laws

      Nicole M. King, MD | Physician
    • How doctors took back control from hospital executives

      Gene Uzawa Dorio, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
  • Recent Posts

    • Adriana Smith’s story: a medical tragedy under heartbeat laws

      Nicole M. King, MD | Physician
    • What if medicine had an exit interview?

      Lynn McComas, DNP, ANP-C | Conditions
    • Why U.S. health care pricing is so confusing—and how to fix it

      Ashish Mandavia, MD | Physician
    • From survival to sovereignty: What 35 years in the ER taught me about identity, mortality, and redemption

      Kenneth Ro, MD | Physician
    • When doctors forget how to examine: the danger of lost clinical skills

      Mike Stillman, MD | Physician
    • When your dream job becomes a nightmare [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • In a fractured world, Brian Wilson’s message still heals

      Arthur Lazarus, MD, MBA | Physician
    • Adriana Smith’s story: a medical tragedy under heartbeat laws

      Nicole M. King, MD | Physician
    • How doctors took back control from hospital executives

      Gene Uzawa Dorio, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
  • Recent Posts

    • Adriana Smith’s story: a medical tragedy under heartbeat laws

      Nicole M. King, MD | Physician
    • What if medicine had an exit interview?

      Lynn McComas, DNP, ANP-C | Conditions
    • Why U.S. health care pricing is so confusing—and how to fix it

      Ashish Mandavia, MD | Physician
    • From survival to sovereignty: What 35 years in the ER taught me about identity, mortality, and redemption

      Kenneth Ro, MD | Physician
    • When doctors forget how to examine: the danger of lost clinical skills

      Mike Stillman, MD | Physician
    • When your dream job becomes a nightmare [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The cholesterol debate: Seeking truth where there is no truth
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...