Why I refuse cholesterol checks

All this worry about cholesterol makes me crazy. Our livers manufacture cholesterol for a reason. Most importantly, as far as I’m concerned, is that cholesterol is a major component of our brains and other parts of our nervous systems. I don't think it's a good idea to be messing with your body's natural processes--which is exactly what cholesterol-lowering drugs do. 

Statins work by interrupting the chain of events by which our livers produce cholesterol. Because of this interruption, other substances, such as co-enzyme CoQ10 are also thwarted.  CoQ10 is a cellular nutrient critical for maintaining the integrity of membranes for nerve conduction and muscle function. Depletion of CoQ10 and other substances that make up the chain result in a variety of side effects, the most common of which is muscle weakness and cramps. Many people also report problems with memory, depression and irritability, headaches, joint and abdominal pain, and tingling and numbness of extremities. The most serious and potentially fatal effect is rhabdomyolysis, in which muscle fibers break down and release their contents into the bloodstream.

I get particularly upset when cholesterol-lowering drugs are prescribed to old ladies, for whom the drugs have never proven beneficial (in fact high cholesterol is protective in older women). I know of two older women on Lipitor who have fallen and broken bones. Another, the mother of a friend, lost her ability to walk. She died not long after. As recounted in the memoir of her heart attack, Martha Weinman Lear reports, “…I had been started on a high-cholesterol pill, which had caused me, and apparently millions of other users, to have severe leg cramps, and which had not, as was now clear, kept me from the absurdity of my new condition.” These women should never have been prescribed the drugs, particularly since the drugs have not been shown to benefit anyone over 65 or women of any age, as revealed by an analysis of evidence from drug trials. 

The incidence of falls among older people has steadily increased. The number of people over 65 who were treated in emergency departments for injuries from falls has increased 50 percent over a decade. I’d be willing to bet that cholesterol-lowering drugs are a major culprit in that increase.

The primary beneficiaries of cholesterol-lowering drugs are the pharmaceutical companies, as I will discuss in my next post.

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It's not helping our health

Over-testing, over-medicating and over-diagnosing people—turning them into patients in need of treatment—has not improved the health of Americans. The Department of Health and Human Service’s program, called “Healthy People 2010,” reported that, between 1999 to 2002, healthy life expectancy (the number of years Americans live free of disease) had fallen from 48.7 to 47.5 years. People have gotten sicker. On top of that, unnecessary tests add an estimated $150 billion each year to the health care budget.

Americans spend more than $2.5 trillion on health. Are we getting our money’s worth? Hardly. The United States ranks forty-fifth in life expectancy, behind Bosnia and Jordan. We also rank near last in infant mortality compared with other developed countries. And, according to the Commonwealth Fund, a health care research group, we rank last place in health care quality, access, and efficiency among major industrialized countries.

What’s more, areas of the country that have the most doctors also have the most per capita utilization of doctors’ services and testing. (In one New Jersey hospital, Medicare beneficiaries will see on average seventeen physicians and receive more than fifty physician visits during the last six months of their lives.) But here’s the thing: health care expenditures don’t translate into better outcomes. In fact, health outcomes in the highest-spending regions of the country may be worse, mostly because of the negative results of hospital stays.

It’s true that the average lifespan of people in the US has, since 1900, lengthened by greater than 30 years. But, according to the U.S. Centers for Disease Control, most of this gain (25 years) is attributable to advances in public health, such as sanitation. Of the remaining five years’ increased longevity, 18 or 19 months is attributable to preventive care, such as immunizations and blood pressure checks; and the final 44 to 45 months is attributable to medical care for illness, such as heart attacks, trauma, and cancer treatment.  Remember, this longevity increase is for the entire 20^th century.

Next week: Why I refuse to have my cholesterol checked.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Forget your annual physical

You probably have your annual physical because you think it might prevent you from becoming ill. I did that for a while too, then quit about 12 years ago. I like my local doc just fine, but I didn't see any value in the checkups, and we would end up arguing about my cholesterol. I’m not worried about my cholesterol, even though it’s “high” by some standards. I also don’t believe in cholesterol-lowering drugs (more about that later). So I’ve not had my cholesterol checked for 12 years. My doctor’s final words to me were, “Call me if you ever get sick.”   

To bolster my anti-annual-checkups stance, I can cite the recommendations of the “Choosing Wisely” campaign of the Society of General Internal Medicine. One of the recommendations is: “Don’t perform routine general health checks for asymptomatic adults” (people who feel fine). Regularly scheduled general health checks, according to this group of doctors, “have not shown to be effective in reducing morbidity, mortality or hospitalization, while creating a potential for harm from unnecessary testing” [italics mine]. This conclusion was the result of studies that included nine trials of 155,899 patients. So, according to this medical organization, by refusing my annual physical, I’m doing the right thing. (You can Google “Choosing Wisely” for more information.)

Annual checkups, which are promoted by physicians and requested by patients, are one of the two most common reasons people visited their health care providers in the US and Canada (2009). Dr. Gilbert Welch, author of Overdiagnosed, tells us that American medicine is “expanding relentlessly.” A major reason for this expansion is an increasing tendency to make diagnoses. In fact, Welch calls our current situation an “epidemic of diagnoses.” Conventional wisdom would have you believe that finding problems early saves lives—that you can fix small problems before they become big problems. But these “small problems” are likely to be little abnormalities that would never bother us. What’s more, getting a diagnosis of high cholesterol or hypertension, for example, turns you into a sick person. And more diagnoses leads to excessive treatment for problems that aren't bothersome at all. (“Over-diagnosis” by the way, refers to diagnosing a supposed “condition” that will never cause symptoms or death.)

Update: Right after I posted this, my son Glenn sent me an op-ed piece from The New York Times with essentially the same message. It's written by an oncologist. I recommend it.

Update II: My granddaughter Maggie sent me this piece that she heard on NPR with the same message.

Next week I'll show that all of this medical treatment is not helping our health.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

I Just Say No

About twelve years ago, I decided to quit having annual checkups or screenings of any sort. I also refuse prescription medications. Many in the medical profession agree with this stance, but I don’t know any ordinary older people like me who practice it.

I also don’t get sick. The last time I had the flu was 50 years ago. (I realize this is mostly dumb luck. I could drop dead tomorrow.) As long as I’m feeling fine, I will stick with this no checkup/no meds program. This blog explains my reasoning as well as scientific evidence to support my stance.

Don’t get me wrong. I’m grateful to have medical care when I need it, as when I split my kneecap in half. The doc put it back together and the knee works fine. I'm also absolutely in favor of childhood immunization! So I’m not against medical practice per se. I’m simply against unnecessary—and potentially harmful—meds, tests, and procedures. 

I should note that I’m seventy-nine years old. According to Medicare data, half of all beneficiaries over sixty-five have at least three chronic conditions. Twenty-one percent have five or more! I have none. That's partly because of luck, of course, but also because I refuse to be diagnosed with high cholesterol or hypertension or what have you. Let me also assure you that I’m not some miracle of nature. I feel and look my age and have aches and pains aplenty.

Oddly, even though I try to steer clear of the medical system, I read lots of books about medicine. For example, one of my favorites is Overdiagnosed: Making People Sick in the Pursuit of Health, by Dr. H. Gilbert Welch. Welch is a professor of Medicine at the Dartmouth Institute for Health Policy and Clinical Research. Another good book is The Truth About the Drug Companies: How They Deceive Us and What to Do About It, by Dr. Marcia Angell, former editor in chief of The New England Journal of Medicine.

So, in this blog, I’m going to share the bits from the books that I think are important to know. Save you the trouble of reading them. Plus I’ll share some of my personal experiences, if anybody cares.

In next week's post, I’ll discuss why you don't need an annual checkup. 

For a list of blog topics, click the Topics tab.