The International Network of Cholesterol Skeptics - medical center information, medical center, health care, disease, medical journal

Wanted to take a moment to introduce readers to a website that had a profound effect on my thinking.  Namely the International Network of Cholesterol Skeptics or THINCS for short.&nbsp Sounds vaguely subversive in an I-spy or Get Smart sort of way, at least to my mind. And certainly it is a subversive website in the best traditions of the word.&nbsp I remember when I first stumbled upon it some few years back and my initial thought was “oh, this ought to be good”, I was expecting out and out malarkey.&nbsp

As someone who has looked at a lot of research on various obscure rare diseases while at FDA I have become fairly good at sniffing out what, I would at least consider, malarkey.  This was a website questioning the universal and enshrined wisdom of elevated cholesterol being bad for you.  I had learned this in medical school and had it reinforced in medical training, my heavens there was the whole body of evidence from the enormous Framingham studies to back up this universally accepted and diligently enforced dogma.  “Oh, this ought to be good.”

As those of you who have followed this website may have observed, I have posted about Dr. Uffe Ravnskov, MD, PhD the founder of THINCS previously.  So one of the first things I noticed with his site and writings was that he was credentialed.  Now again, as someone who has spent a lot of time looking at obscure subjects in disease, I have more than once come to the conclusion that credentialed people are morons, even when not looking in the mirror.

Next though and more troubling is that he made eminent sense.  By this I mean that Dr. Ranskov did something I had never done, namely he had gone back to actually look at the Framingham studies, as well as all the ancillary studies of the time.  I will not try to synopsize his critique or detail his summary of the overwhelming contradictory data, this is an introduction to his position, suffice it to say to my surprise, I found someone far more credentialed than myself, arguing from the published medical literature with very cogent points.

Perhaps it was my memory of my experience as an internal medicine intern, where part of the quality control for my interaction with little old ladies was whether I had asked them whether they were on HRT or hormone replacement therapy, of course it latter came out that HRT had led to tens of thousands of unnecessary deaths of little old ladies from cancer, heart attack and stroke, an initiative in which I unkowingly played my little part.  Perhaps it was, that though in my own backwater of looking at rare disease related therapies at FDA, I could not help but hear of the other oft prescribed or even “blockbuster” drugs recalled after doing untold harm.  Or perhaps it was my experience in looking at potential therapies for rare diseases where I was making, after diligent reading, decisions on diseases which a few short weeks prior had been only a half remebered paragraph from a medical school text.  Whatever, the precise cause, I quickly realized that I needed to take Dr. Ravnskov seriously and learn more of what he was saying. 

One other aspect of his argument impressed me greatly, and that was that he often returned to the end-point of overall mortality.  Again as someone from FDA, I had heard of cancer drugs which perhaps deceased overall tumor size but had no effect on life span (despite their toxicity) and were still approved.  So for someone to go back to the end-point of mortality in their arguments impressed me greatly, I mean there isn’t a much better preventive medicine end-point than death.

And so, for all these reasons, I had to admit that despite an overwhelming and universally promulgated position from med school onwards (not to mention popular culture) I really knew very little about either cholesterol’s role in physiology or the documented evidence for its health effects.&nbsp Again, I don’t have time to go into Dr. Ravnskov’s research in detail in this post, though I do at least plan to review one of his books in the near future, but it was quite an eye-opener to look at this issue critically.&nbsp And really this issue was a good part of the reason I started this rabbit hole journey called the Skeptic’s Health Journal.

I’ll give another reason, seeing as Dr. Ravnskov is qualified, his comments are based from the medical literature and his end-point (elderly people with low cholesterol die more often) is persuasive, this view should have generated vigorous debate and been widely disseminated.

Well not exactly, it is not that these views have been simply ignored, they have been suppressed.  I started this post with a quote from the initial editor of the prestigious English medical journal the Lancet.  If one goes to the THINCS website one can see the numerous and well-thought out critiques of the studies on cholesterol lowering that have been rejected on spurious grounds by journals such as the Lancet.  I will provide one example from the THINCS website, this one rejected by the prestigious Journal of the American Medical Association.

” In a previous letter¹ we requested the IDEAL trial directors to list the number and specific nature of the serious adverse effects that were seen in almost half of their patients. Such a high percentage has not been reported in any previous trial and their reply² that most of the adverse effects were not drug-related is not informative or responsive to our request. Since many significant adverse side effects from drugs are not detected until the post-marketing surveillance process, what criteria were used to classify adverse effects as not being drug related?  As recently reported³ several unanticipated statin side effects have already surfaced.  Given the fact that more than half the world’s adult population could be on perpetual statin therapy based on the latest guidelines, it is imperative that all adverse effects be reported in detail.   We would therefore again request that the authors make this information available so that others can make their own assessment as to whether they might be statin related. 

1. Ravnskov U, Rosch PJ, Sutter MC. High-Dose Statins and the IDEAL Study. JAMA. 2006;295:2476.
2. Pedersen TJ, Faergeman O Kastelein JJP, Olsson AG, Tikkanen MJ, Holme I; Larsen MLL, Bendiksen FS. High-Dose Statins and the IDEAL Study—Reply JAMA. 2006;295:2478-2479.
3. Ravnskov U, Rosch PJ, Sutter MC, Houston MC. Should we lower cholesterol as much as possible? BMJ 2006; 332: 1330-1332

Here is the editor’s answer:

June 13, 2006

Dr. Uffe Ravnskov
Magle Stora Kyrkogata 9
Lund 22350
Sweden

Dear Dr. Ravnskov:

Thank you for your recent letter to the editor. Unfortunately, because of the many submissions we receive and our space limitations in the Letters section, we are unable to publish your letter in JAMA.

After considering the opinions of our editorial staff, we determined your letter did not receive a high enough priority rating for publication in JAMA. We are able to publish only a small fraction of the letters submitted to us each year, which means that published letters must have an extremely high rating.

We encourage you to contact the corresponding author of the article, although we cannot guarantee a response. We do appreciate you taking time to write to us and thank you for the opportunity to look at your letter.

Sincerely yours,

Robert M. Golub, MD
Letters Section Editor, JAMA

It is the uncritiqued “ENHANCE” trial and others like it that now have physicians clammering for such nonsense as statins to be provided with meals at fast food joints.

In days to come perhaps it will be initiatives like the International Network of Choleterol Skeptics that pick up the mantel of the now compromised Lancet.

The Lancet may now be part of the aristocracy of medical journals – but in 1823, it had a distinctly radical slant.

Its very name represented a sharp instrument used to puncture a boil – Wakley saw much of the medical establishment as fundamentally corrupt, tolerating both nepotism and incompetence.

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