Originally Posted by
Carbonfiberboy
It's discouraging to me how charlatans have convinced the American public to distrust science, whatever the field: economics, health care, climate, education, etc., etc., and in some cases have amassed considerable wealth by this practice.
Yes, if my LDL were over 190 I certainly would take a statin. I know several people who've been on statins, some for decades, with no ill effect, still in perfect health. In fact I'm going to discuss statins with a retinologist next week to see if it might help my very early macular degeneration.
No, I do not distrust science. But I have learned not to take it as gospel.
And, I did not get my cynicism from internet charlatans, it was from listening to physicians and scientists debate the science and its validity.
The new calculator is an example: As soon as it was released, I tested it against the Framingham calculator (that has been the gold standard for over 10 years) and found that it ran 50-75% high. Both calculators are based on science -- but yet they provide very different answers to the same question. But yet the new one was accepted by the scientific and medical communities... Until a couple days later when 2 researchers came up with same conclusion that I had and, at that point, Leaders in the medical community started to back away from it ask for further review...
Another recent example is the study (I forget the name of it) that "proved that HDL is not beneficial". What they did was to treat patients already on a statin with niacin. Their HDL went up -- but they still died just as fast. Many believed that disproved the HDL hypothesis. Some other, more thoughtful persons realized that raising HDL when LDL is already low does not do much good. So, the trial, although scientific, had a bad design and really did not prove or disprove much of anything.
Both observational trials and RCTs merely supply data. Sometimes the data is good and sometimes it isn't. But even if it is good data, then you have to rely on the interpretation and analysis of the data -- which can also be flawed.
In short, RCTs are one of the TOOLS of science -- but they are not, in themselves, science.
I do not distrust scientific research -- but I have learned to take it as a guide rather than a gospel and to give it the "stink test" and compare it to other research in the same area before I accept it. In fact, one of the first things I do when a new study has been released is to read the physician's comments about it. Very often I hear that it was a flawed study or flawed analysis.
As for the AHA guidelines (both old and new): there are simply too many unanswered questions about those guidelines for me to take it as any more than one group's opinion -- even if it is considered to be the "gold standard".