on July 12, 2012
Excellent book. Very good. Bravissimo.
Dr. Roberts is a brave woman. I love the unbridled honesty. Made me more convinced that I am surrounded by people that are full of crap. Reps, other docs, administrators, and people in the medical field all seem to have a hidden agenda. This book debunks the myths perpetuated by the pursuit of shareholder profits.
You know what ? I've been doing ALL of that for years so your book only cemented it in my head. I've picked it up from my own research although the drug trial analyses were new info and soberIng. I appreciate the way they are unbiasedly interpreted in this book. I have avoided egg yolks, but I have been reading more that they are ok. Pretty much the only thing I miss is prociutto!
I not only do this for heart health (obviously worked since I recently had a normal cath, despite a horrible family history, almost no HDL, long history of heavy smoking in my youth, and NO STATIN).But I truly believe the very same rules hold for Alzheimer's, which being Apo B 4/4 and a Mom with it, I purportedly have a 90-95% chance of getting. I think statins actually can precipitate it in those that are at risk. Aren't brains made of cholesterol anyway?
I am neither a cardiologist, nor a cholesterol researcher, so I can't nitpick every little detail or perceived inaccuracy, but I am a vegetarian gastroenterologist with an major interest in nutrition, so I agree completely with the dietary focus that Dr. Roberts promotes. The drug companies are well-aware of our need for a pill to make us feel better about our total lack of self-discipline, when it comes to our health.
What we need are more docs/authors, who have the interest (and the guts) to lay the truth on the line.
on May 19, 2012
Barbara Roberts's book, The Truth About Statins makes a good contribution in that it bolsters the credibility of all the critics of Statins when a M.D., who is also a researcher and administrator is critical of existing medical dogma, at least as far as she goes. The main tenet of her book is that use of Statin drugs does little or nothing to extend longevity, Statins have serious side effects, that those using Statins do little to reduce their risk of coronary heart disease ( CHD ) and you can lower your risk more with weight loss, exercise, and the Mediterranean Diet. What she fails to do is to distance herself from the discredited medical dogma that dietary intake of saturated fats leads to hardening of the arteries that leads to CHD.
In chapter one page five she states the dogma that high levels of certain lipoproteins ..." increase the risk of developing plaque in the arteries .... " No where in this book (that I have found ) does she provide evidence for this. She ignores the many autopsy studies that have found no correlations between plaque, hardening of the arteries and levels of cholesterol in the deceased persons blood. She instead draws conclusions of Ansel Keys discredited pseudoscience, where he cherry picked data to try to epidemiological relate heart disease with diet.
In chapter 1 she gives some insight into official guidelines which more or less force doctors to suggest the use of statin drugs without offering alternatives, and tells us how statins lower cholesterol, defines atherosclerosis, angina, risk factors, and indicates people are at a high risk even when using statins for CHD, and lets women know that there is no evidence that taking a statin drug will lower their risk of a heart attack or dying from heart disease.
In chapter 2 she fails to reject the cholesterol hypothesis of CAD, and I would guess doing that would be professional suicide for her. She gives good background for understanding clinical trials and explores the difference between absolute and relative risk reductions and how the reporting of data is manipulated.
What she knows best is Statins serious side effects, or what I think of as the symptoms of the chronic poisoning caused by long term drug use, and these are well presented in chapter 3. She indicates that Statins also have the abilities to combat inflammation, improve the function of the inner lining of arteries, combat oxidation, and decrease the tendency of clots to form. HOWEVER, she gives no hint that there are safe and effective alternatives available to accomplish these functions.
Chapter 4 deals with how women's biology differs from men with regards to Statin use, which I have not read.
Chapter 5 reveals some fuzzy thinking that points out how flawed the clinical trials were to somehow support the hypothesis of a causal relationship among saturated fat ..... and the development of atherosclerosis CVD. Somehow she accepts the contention that saturated fats cause atherosclerosis ( never mentioning the autopsy studies that show no correlation between fat levels in blood and the degree of hardening of the arteries ). She then makes a good point that a healthy diet is the key and recommends the Mediterranean diet as the solution, which it might be for some people, but for the wrong reasons.
On page 119 to support her contention that the so call Mediterranean diet is superior, she sees fit to bash the late Dr. Atkins, and repeats the half truth that Atkins died of sudden cardiac arrest, never mentioning that Robert Atkins was at the time of this death in a coma caused by him falling on ice and hitting his head. What a cheap shot !
The rest of the book is devoted to the sleazy practices of the drug business, anatomy of the heart, and so called " Heart Healthy Foods and Recipes "
If you are not familiar with the controversy of Statins use, then this is a good book for you. If you want a more scholarly treatment of the controversy of whether cholesterol causes heart disease, I recommend The Great Cholesterol Con by Anthony Colpo. Colpo devotes a chapter to the iron hypothesis of heart disease which is worth the price of the whole book, IMO. For a shorter critique of the lipid theory and unique insights into the dangers of low cholesterol ( people with low cholesterol are more prone to cancer, dementia, and fatal infections ) by a qualified author see Ignore the Awkward.: How the Cholesterol Myths Are Kept Alive by Uffe Ravnskov
on June 15, 2012
"The Truth About Statins" is incredible and a "must read" for EVERYONE -- not just for people on statins (cholesterol-lowering drugs like Lipitor). It was written by Dr. Barbara Roberts, who is on the faculty of Brown University's medical school, and is head of the Women's Cardiac Center at the Miriam Hospital in Rhode Island. Her book is very enlightening and informative, and readable for health professionals, scientists and the lay public alike. Not obvious from the title is the fact that the book is really about much more than just statins. It's also about how clinical trials are done (well and badly); about the often shady connections between drug companies, doctors, scientists, the FDA and medical societies (e.g, the American Heart Association), and the money that changes hands in these interactions; and about how women and men differ re. cardiac disease and responses to cardiac drugs. This is the first book I've had trouble putting down that wasn't a murder mystery!
on June 13, 2012
I saw Dr. Roberts speak in Providence, RI, and heard her on the Diane Rehm's show on NPR recently and was compelled to buy the book, not because I take statins but because I have family members who do, and did not realize the controversy surrounding the use of this drug. The information the book contains regarding the use of statins and the risk/benefits profiles is an eye-opener, especially if you are a woman, where the benefit was much lower. She spells out the dangers for some of cognitive dysfunction, increased risk of diabetes, muscle aches and pains, and covers all the clinical trials to date. Her emphasis on prevention measures and the Mediterranean diet I found to be very helpful for most of us Baby Boomers. This is a very readable and informative book. When people at her talk and on the radio said: "I took myself off statins but am afraid to tell my doctor," I realized there was a problem. This is not something Dr. Roberts recommends, but apparently people are doing it. If high cholesterol levels and heart disease is part of your family history, I would read this book. Also, check out the podcast on NPR.org.
on June 25, 2012
Big Pharma, the FDA and the various medical associations have questionable motives and more questionable integrity and Dr. Roberts did a good job exposing that. But for someone who wrote a book about the lack of transparency and honesty of Big Pharma, the FDA and various medical associations, she should practice more of what she preaches. Two wrongs don't make a right.
Dr. Robert's biases are apparent when she writes about the Mediterranean Diet.
First, Dr. Roberts fails to mention that Ancel Keys had data from twenty two countries, but he only picked the magical seven countries that clearly strengthened his hypothesis. Why she excluded this information from her readers is as `mysterious' as why Ancel Keys only focused on seven countries. A bit of a mixed message here: scrutinize the methodology of statin studies but don't scrutinize the methodology of the Seven Countries study? If she expects others to be transparent, then so should she.
Second, Dr. Roberts continues to perpetuate the myth that Dr. Robert Atkins died from "a massive heart attack". Dr. Atkins died from the complications of head trauma/brain hemorrhage. According to Grant's Atlas of Anatomy, the head and heart are different organs of the human body and located in areas of the human body. Furthermore, according to Guyton and Hall's Textbook of Medical Physiology, the brain and the heart have different functions in the body. To mistake death due to a "massive heart attack" with death due to traumatic brain injury/brain hemmorhage is like mistaking Lovastatin and Penicillin. If she expects others to be truthful, then so should she.
Third, Dr. Roberts emphasizes that the Cretan post WWII Diet is the cholesterol lowering Mediterranean Diet. After looking at the recipes and suggested menu she provides, I am puzzled by her anachronistic choice of ingredients and foods. 1% fat yogurt and tofu burgers aren't something Cretans in post-war Greece would have eaten. Neither they would have used the "no-trans fat margarine" listed as an ingredient for the Porcini Mushroom Sauce, Sole Piccata, Lemon Pineapple Muffins and the Macadamia nut cookies. This is especially laughable because FDA allows a product to be labeled "no trans fat" if it contains less that 0.5 grams trans fat per serving size. Perhaps Dr. Roberts is unaware of this labeling regulation or she is hesitant to mention that the solid fats used in traditional cooking are animal fats like lard, butter, beef or lamb tallow, or chicken fat. It's more likely a post-war Cretan would have saved and used the small amounts of animal fats from those infrequent meat meals, than use margarine and vegetable shortening. But then animal fats are not exactly the popular image of "heart healthy". If she expects full disclosure from others, then so should she.
So either Dr. Roberts is a victim of bad editing in possession of a degree of ignorance or Dr. Roberts is a practitioner of misinformation herself. While I would like to think she's a victim of bad editing, I can't overlook her own glaring blunders in an otherwise good book.
In the interest of full disclosure, Barbara Roberts and I attended the same undergraduate college (Barnard) and we've chatted at college reunions. I have always been skeptical of medications and standardized cookie-cutter solutions to medical problems.
So I was delighted to come across a straight-talking, informative book about the dangers of statins as well as warnings about other prescription drugs. I'm not a doctor but I do have a PhD and I know how to read statistics. Doctors hate patients who ask, "Where's the research behind your recommendation?" (If you know one who doesn't, tell me.)
The real challenge will be taking this book to your own doctor. In my experience, doctors are quick to recommend all sorts of tests and to dismiss concerns about medication. One doctor actually told me that I might cut off ten years of my life, although I'm not aware of any research with "ten years of extra life" as an end point.
I was especially appreciative of the discussion about osteoporosis and the bisophosphonates that are casually prescribed to women. As Dr. Roberts says, the most optimistic research shows that the difference between taking the drug and not taking the drug amounts to about 3% - not the 48% touted in media such as the New York Times.
I'm not familiar with the nuances of different dietary recommendations but the recommendations are consistent with what I've seen on nutritional sites. Where do doctors get the idea that eggs are bad for cholesterol? Why do questions about eggs keep appearing on medical questionnaires?
Unfortunately, most doctors are influenced by the propaganda of Big Pharma and by "grading" systems that motivate them to over-diagnose and over-prescribe. We need more books like this one so we can fight for what we really need.
on August 29, 2013
I was looking for a book on statins written by someone with the credentials and wherewithal to provide an unbiased treatment of the subject - one that I could trust. I believe the author, Barbara Roberts, M.D., is such a candidate. She is director of the Women's Cardiac Center at the Miriam Hospital in Providence R.I. In her book, she provides us with the information we need to know to make an informed decision about the use of these drugs. If you are taking statin drugs or plan to, I would highly recommend you read this book. It has an absolute wealth of very important information.
She begins by introducing us to the lingo of the world of cholesterol reduction - metabolic syndrome, LDL, HDL, triglycerides, ASCVD, hard and soft end points, and so on. Tables are provided to list the major risk factors and the risks that determine LDL cholesterol goals. Using these tables and something called the Framingham risk score (she provides a web address for the calculator), one can determine if the established guidelines recommend treatment. What I found interesting was that doctors are basically under obligation to prescribe drugs to a patient if the guidelines indicate - lest they be sued should something happen if nothing were prescribed. Also some doctors may prescribe statins even if the guidelines don't indicate such. Know the guidelines.
Another interesting thing was the results of six secondary prevention trials (where patients have cardiovascular disease - CVD) and three primary prevention trials (where patients have no signs of CVD). You will find that what is called "absolute risk reduction" was only 7 percent in the secondary trials and only 1 to 2 percent in the primary trials. Compare this to the "relative risk reduction," which is usually quoted in the literature, of 30 percent and 37 to 44 percent respectively. Basically this is saying, in absolute terms, that your risk of a hard end point (think heart attack, stroke) is not all that much improved by taking cholesterol drugs according to these trials. Caution: never stop taking medication without consulting your doctor first, no matter what you read.
On the positive side, Roberts shows that statins do lower LDL, combat inflammation, improve the function of the inner lining of arteries, and reduce blood clot tendency. Some people need these drugs for sure. But there are serious side effects to consider. Roberts devotes an entire chapter to the common side effects. Some that she discusses are: unmasking of previously undiagnosed conditions, rhabdomyolysis, tendon damage, joint problems, effects on liver, effects on nervous system, nerve damage, risk of cancer, risk of diabetes, and more. Her research has showed that "the authors of statin studies and their sponsors in Big Pharma tend to hype the benefits and downplay the harm." The waters are further muddied by the billions of dollars of profit at stake. With so much money on the line, it is hard not to believe that the information we receive will be biased.
In the chapter on gender differences and statin use, Roberts reveals the results of various large studies that studied statin use in men and women. One major trial was the JUPITER trial; it was touted as the first primary prevention trial to show stain benefit in women - or did it really? Dr. Roberts shows us some of the major deficits or anomalies in this trial. If I had the space here, I would describe them because what I read is absolutely incredible. This is a must read. Her final opinion: "The results of the JUPITER trial support concerns that commercially sponsored clinical trials are at risk of poor quality and bias." Looking at the studies carried out, it appears that for women, statins may reduce the risk of future recurrence of cardiovascular events, but for women under sixty-five with no established cardiovascular issues, there is zero evidence.
In chapter 9, Roberts discusses the clinical research and "science" used to support stain use. She sums up the results of eleven primary prevention trials and three secondary trials. The results are very enlightening. It appears that the absolute risk reduction is puny in the primary prevention trials, but there appears to be a statistically significant reduction in absolute risk in those with existing cardiovascular disease. Even then we are talking only a few percent. What was interesting was that Big Pharma publishes the relative risk reduction when discussing the benefits of the drugs, such as heart attack prevention (this produces more impressive numbers), but chooses to use absolute risk reduction values when reporting the adverse effects of the drugs (this produces the appearance of less risk).
Should you be on statin drugs? I believe this is a decision between you and your doctor, but I would recommend including the knowledge contained in this book. It can be a lifesaver.
on February 20, 2015
The initial part of the book is good, however the author then veers off into giving dietary advice in which she vilifies the consumption of saturated fats.
It's ironic that she does this, given the fact that there isn't a shred of evidence that this is bad for the heart or causes atherosclerosis! She criticizes other physicians for believing in the efficacy of statins without evidence, then does the same thing herself with regard to the totally discredited diet-heart hypothesis!
A much better book is The Great Cholesterol Con by Kendrick, another MD, who actually does have an open mind and has looked at the evidence in an unbiased fashion.
Dr. Roberts is stuck in between conventional garbage cardiology and a more enlightened approach. Hopefully one day she'll wake up and revise this book. Until then I can't recommend it.
on July 4, 2015
Anyone who is taking statins should read this book. My own experience was that most physicians are convinced that these drugs are safe. They are not. In fact the whole concept of cholesterol being the major cause of plaque in the arteries may be wrong. But read the information for yourself. Even if you believe the concept the decrease in risk is so low that it doesn't seem worth the myopathy, reflux, brain fog, increase risk of diabetes and whatever other side effect result from tampering with a major physiologic process. Its all about money, power, and influence folks.
on June 17, 2012
I have not yet read this book, but I heard the Doctor on the Diane Rehm radio show. Very interesting. I am so glad to finally start hearing doctors acknowledge the cognitive side effects of statins. A few years ago my doctor prescribed statin for me because I had borderline high cholesterol. When I complained to him about the side effects (having trouble thinking and verbalizing) he didn't have much to say. I now have a new doctor. And I also have a very different perspective on statins. I would like to see statins (and all other drugs) used much more conservatively.