“New vaccine replaces statins?” Not so fast!

News reports suggest new drugs may replace statins. PSCK9 inhibitors are useful, but only along with statins in high risk patients not controlled on statins alone, or for patients who can’t tolerate statins. They’re not about to replace statins. PyMOL rendering of the structure of the PCSK9 protein. Are statins obsolete? Are new drugs more effective and

Most Patients Get No Benefit from Most Drugs

Some people are reluctant to take statins because they don’t benefit the majority of patients who take them. Actually, most drugs don’t benefit most of the patients who take them. Since we have no way of identifying those who will benefit, we are stuck treating the many to benefit the few. Most of these won’t

When Drugs Cost Too Much

Our ability to develop new drugs is fast outstripping our ability to pay for them; some are exorbitantly expensive and not very effective. Funds are limited, and as a society we need to have a serious discussion about how they are to be allocated. How much is it reasonable to pay for a drug? If

Statin Denialism

When Richard Dawkins was asked to justify his belief in the scientific method, he answered, “It works, bitches!”1 When the scientific evidence is compelling, one would have to be willfully perverse to reject it. But some people do; they reject findings that don’t fit with their ideology. We call them denialists. We have climate change

Glucosamine and Chondroitin: Do They Really Work?

Glucosamine and chondroitin are widely used for osteoarthritis pain. My daughter even gives them to her elderly horse. Their popularity is puzzling, since the evidence from scientific studies indicates that they don’t work. Wikipedia has a useful survey of the history, studies, criticisms, and systematic reviews (https://en.wikipedia.org/wiki/Clinical_trials_on_glucosamine_and_chondroitin). It includes a long list of references. I

Testing Testosterone Treatments

Whatever is in this water, it isn’t testosterone Ponce de Leon is said to have been looking for the Fountain of Youth when he explored Florida. That’s only a myth. Now there’s a new myth, that testosterone supplements are a Fountain of Youth for aging men. Men are urged to get their testosterone levels checked if they have

Statin Side Effects

A recent article in The New England Journal of Medicine by Andrew L. Mammen, MD, PhD, reviewed statin-associated myopathies. Reading his article prompted me to revisit the subject of statin side effects. It can no longer be disputed that statins statistically benefit patients who have cardiovascular disease or who are at high risk of cardiovascular disease. But there

Stem Cells and Chiropractic

As good a source of stem cells as any chiropractor. My local newspaper is a constant source of topics to blog about. It regularly features ads for untested dietary supplements and for chiropractors who offer non-chiropractic treatments and don’t identify themselves as chiropractors. Recently, a full-page ad for NW Pain Relief Centers trumpeted “Stem Cell

Chronic Fatigue Syndrome: Rituximab Revisited

Three years ago I wrote about an experimental treatment for chronic fatigue syndrome (CFS): rituximab (brand name Rituxan). I was concerned that doctors who offered it, like Andreas Kogelnik, were jumping the gun by offering it before the evidence was in, and that they might be putting patients at risk. A correspondent who has been following the

Hazards of Herbal Medicine: Lessons Learned from Aristolochia

This “Brief History of Medicine” has been circulating on the Internet: 2000 B.C. — Here, eat this root. 1000 A.D. — That herb is heathen. Here, say this prayer. 1850 A.D. — That prayer is superstition. Here, drink this potion. 1940 A.D. — That potion is snake oil. Here, swallow this pill. 1985 A.D. —