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Don't Hurry Your Death
Death: Part 3
Low cholesterol increases the total numbers of deaths in the middle-aged
Children and the elderly have both been shown to have higher death rate with low cholesterol levels. That leaves the middle aged. Amongst men in their forties there does seem to be a correlation between high cholesterol and greater coronary death rates. But here again we find that total mortality is highest in men whose blood cholesterol is lowest ? less than 4.8 mmol/l (185 mg/dL). These deaths are largely due to cancers and other non-cardiovascular causes.[i] In this age group, while the lowest total mortality was seen between 4.8 mmol/l and 5.4 mmol/L (185?208 mg/dL), it rose only slightly as cholesterol concentrations rose above 5.4 but was considerably higher below 4.8.
In 1993 Dr M G Dunnigan wrote that both primary and secondary trials showed a significant number of excess deaths from non-cardiac causes: cancer, violence and suicide. He also pointed out that in a meta-analysis of 35 randomised controlled trials (RCTs) had little relevance to the non-symptomatic person under 65.
'Without definite data on all-cause mortality and with current unresolved concerns about excess deaths from non-cardiac causes in RCTs, decisions to embark on lifelong lipid lowering drug treatment in most patients with primary hypercholesterolaemia depend on the doctor's interpretation of available evidence. As in other situations in which certainty is illusory, this varies from evangelical enthusiasm for lowering lipid concentrations to therapeutic nihilism.'[ii]
How physicians are fooled
So, with all this information apparently at their fingertips, you might wonder why there is such widespread acceptance of the cholesterol myth in the medical world, and why it is that doctors insist that everyone should have exactly the same cholesterol level. You might also wonder if their oath to 'first do no harm' means anything any more.
The reason is relatively simple to explain. Firstly, there are some 30,000 medical journals published and no doctor can be expected to read all of them. Secondly, wherever heart disease is mentioned in conjunction with cholesterol, out of the many studies that have been published only a mere handful of the supportive studies are quoted.[iii] Those that don't support the myth are rarely mentioned.
This preferential citation has skewed the facts. In addition, pharmaceutical companies who sell cholesterol-lowering drugs produce many publications which broadcast the cholesterol lowering myth to millions. Dr Jerome P Kassirer, a former editor of the New England Journal of Medicine told readers of The Washington Post that major publications such as Lipid Letter, Lipids Online, and Lipid Management are all financed by the makers of cholesterol-lowering drugs.[iv] These publications which warn relentlessly of the (false) dangers of cholesterol reach millions of medical doctors; they are designed, of course, to persuade doctors to prescribe their cholesterol lowering drugs. So it isn't really surprising that overworked professionals continue to teach us that cholesterol is dangerous and pharmaceutical companies aggressively push their cholesterol lowering drugs.
Conclusion
Dr A E Dugdale of the Cherbourg Hospital, St Lucia, Queensland, Australia, looked at the costs and benefits of cholesterol-lowering using 1984 Australian mortality statistics.[v] What he discovered was that the main effect of cholesterol lowering 'is to alter the cause of death'. 'When the lowest quintile of cholesterol levels is compared with the highest, the proportion of deaths from heart disease is almost halved, but the proportion from malignancies is almost doubled.' He concluded that:'A decrease in serum cholesterol of a population by 10%, even if this were possible, would be expensive in money and manpower. The benefits would be small and perhaps not liked by the subjects. We all die and . . . heart disease may be preferable to cancer.'It's a sobering thought.
References
[i]. Wannamethee G, Shaper AG, Whincup PH, Walker M. Low serum total cholesterol concentrations and mortality in middle aged British men. BMJ 1995; 311: 409-13
[ii]. Dunnigan M G. The problem with cholesterol: No light at the end of this tunnel? BMJ 1993; 306: 1355-6.
[iii]. Ravnskov U. Cholesterol lowering trials in coronary heart disease: frequency of citation and outcome. BMJ 1992; 305: 15-19.
[iv]. Kassirer, Jerome P. Why Should We Swallow What These Studies Say? The Washington Post. 1 August 2004; B03.
[v]. Dugdale A E. Serum cholesterol and mortality rates. Lancet 1987; i: 155-6
Last updated 1 August 2008
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