COVID Stupid

[Roller]

I agree there is a ton of misinformation about vaccines and pharmaceuticals (and non-pharmaceuticals) which has existed forever but indeed the internet and social media have it made it much worse. And a lack of trust in the healthcare system and healthcare authorities- an absolutely huge problem with many causes.

I would argue healthcare providers have a higher level of ethical obligation to be vaccinated so as not to harm their patients (or become harmed to inhibit their ability to help others, particularly in a pandemic). People in the military agree to give up some of their rights/autonomy in joining.

Again, I believe everyone should be vaccinated who can be vaccinated for the recommended diseases. Vaccines are perhaps the greatest healthcare tool ever created and have radically reshaped history. But if the determining factor for healthcare mandates is what’s best for the greater public, there could be a lot of mandatory healthcare interventions (or lack thereof) you may not be happy with. Would you agree with society locking people inside their homes if they have any communicable disease, until they recovery? What about people with AIDS? The extreme end (for the sake of illustration) of this would be if you’re cost to the healthcare system is greater than your value to society, then you are not worth receiving healthcare. That way more resources can be allocated to others who are “higher value” members of society, as that’s in society’s best interest.

Before COVID and actually still even today I have never heard of people suggesting mandating the flu vaccines, despite the flu being far more deadly in children.

Most people I’ve come across (as someone in healthcare) don’t refuse vaccinations just for the sake of it. Most have (in their perception) legitimate concerns about the safety of vaccines and yes, a lot of these stem from misinformation or misinterpretations or a lack of knowledge. It also comes from a lack of trust- which there are many reasons for, many self-inflicted by the healthcare industry and authorities. If healthcare providers actually have the time and ability to communicate with patients, listen to their concerns, earn their trust, etc, it works wonders in convincing them to reconsider. Unfortunately that time and access for intimate communication and often does not exist in modern healthcare.

I just find it very interesting how polarized this country became about vaccines and yet now the rate of pediatric vaccinations (despite being available for quite some time across all age groups) and bivalent boosters is quite low. The anti-vax demographics have interestingly shuffled around before and during COVID, but now it seems we have hesitancy/ambivalence across much of the population, as seen in statistics.

I do think it’s hard to convince many parents to vaccinate their children when the risk to children is so low. And with some evidence that these vaccines are not great at preventing transmission (a far more complex conversation affected by numerous factors), there is even less incentive to do so. And I suspect that’s why we’re seeing less boosters in adults as well.

I think we have a lot of lessons to learn about public health and especially healthcare communication considering how COVID-19 was handled in this country. I never imagined things could become this political over vaccines. I think it’s vital we understand how public health communication can be improved. Sadly, reflection of what worked and what didn’t during the earlier phases of the pandemic often just turns into political bickering. If the House (republicans) do a COVID investigation it will surely have ulterior motives, be political theater not focused on improving things, and all the findings (including ones that may actually merit) will not be accepted by half the country.

There should be a serious, non-partisan investigation run by a body of actual experts with minimal conflicts of interest (which is extremely difficult in some aspects of this case). We were very lucky COVID wasn’t nearly as bad as it could have been with a relatively low case fatality rate (as opposed to something like Ebola).

I agree with most of that. In my experience, while many healthcare workers who refuse vaccines do so because they're legitimately concerned about risks and benefits, most of their information about the former comes from questionable sources. I sometimes wonder why these folks don't question things when they're advised to take an antibiotic for a bacterial infection or have a rod placed to repair a fracture. When I deal with patients directly, I'm often disappointed they don't ask more, and I try to provide the best information available so they can make a choice.

 

[mac_in_tosh]

I agree with most of that. In my experience, while many healthcare workers who refuse vaccines do so because they're legitimately concerned about risks and benefits, most of their information about the former comes from questionable sources. I sometimes wonder why these folks don't question things when they're advised to take an antibiotic for a bacterial infection or have a rod placed to repair a fracture. When I deal with patients directly, I'm often disappointed they don't ask more, and I try to provide the best information available so they can make a choice.

A lot of information on risks may come from questionable sources but on the other hand information about benefits came from drug companies which have not always been known for transparency. Also, they lobbied Congress and were granted relief from any liability so it appears they themselves were not totally confident in their product.

Antibiotics have been around for a long time. The vaccines however were a new type. As such, the long term risks were by definition not known. And I do question if an antibiotic is advised - is it really necessary, what are the possible side effects, etc.

Of course there are whackos out there claiming microchips are in the vaccines so the government can track people. But it seems sometimes that anyone with genuine, thoughtful concerns about the vaccines are lumped into the same category.

 

[Roller]

A lot of information on risks may come from questionable sources but on the other hand information about benefits came from drug companies which have not always been known for transparency. Also, they lobbied Congress and were granted relief from any liability so it appears they themselves were not totally confident in their product.

Antibiotics have been around for a long time. The vaccines however were a new type. As such, the long term risks were by definition not known. And I do question if an antibiotic is advised - is it really necessary, what are the possible side effects, etc.

Of course there are whackos out there claiming microchips are in the vaccines so the government can track people. But it seems sometimes that anyone with genuine, thoughtful concerns about the vaccines are lumped into the same category.

It was impossible to know the long-term effects of the mRNA vaccines in the real world because they were new, even though they'd been in development for years. But most healthcare workers were happy to get the first shots because we were aware of how the vaccines worked and knew we were at risk at work. As well, it was highly unlikely the pharma companies (which I believe have often been unethical in pricing) faked or fudged the raw data they submitted for EUA, since they knew they'd be under intense scrutiny.

It's great that you ask about side effects and such. But, in my experience with patients, I've found many are, if anything, too trusting. The problem is them knowing where to go for free advice. So much of what they get on the Internet is unfiltered, and it's hard to separate the wheat from the chaff. The COVID situation was ripe for abuse, such as grifter docs who continued to push ineffective therapies after they were shown to be useless.

The concern that keeps me up nights is what will happen when the next viral pandemic hits, but with a much higher fatality rate than SARS-CoV-2. There's so much distrust, I fear getting people vaccinated will be even more difficult. We're in the eye of a strengthening hurricane, and now is the time to be developing better defenses such as intranasal vaccines, improved ventilation, and the means to distribute high-quality masks.

 

[mac_in_tosh]

The concern that keeps me up nights is what will happen when the next viral pandemic hits, but with a much higher fatality rate than SARS-CoV-2. There's so much distrust, I fear getting people vaccinated will be even more difficult. We're in the eye of a strengthening hurricane, and now is the time to be developing better defenses such as intranasal vaccines, improved ventilation, and the means to distribute high-quality masks.

Isn't it true that a significant percentage of poor outcomes from exposure to Covid was in people that had existing health issues - obesity, smoking, etc? Perhaps that vulnerability should be better addressed along with new technologies.

 

[Alli]

Right now, my 88-year old mother, my 22 year-old nephew, and my children’s father and step-father all have Covid. Fortunately, as they’ve all had all the boosters they could get, none of them is suffering particularly badly.

 

[AG_PhamD]

I agree with most of that. In my experience, while many healthcare workers who refuse vaccines do so because they're legitimately concerned about risks and benefits, most of their information about the former comes from questionable sources. I sometimes wonder why these folks don't question things when they're advised to take an antibiotic for a bacterial infection or have a rod placed to repair a fracture. When I deal with patients directly, I'm often disappointed they don't ask more, and I try to provide the best information available so they can make a choice.

There’s a lot of healthcare providers out there who lack the training/experience in drug/medical literature analysis to consider the value of the information they are receiving.

People across the board have a tendency with healthcare (including some HCP’s) to seek information from sources that reinforce their pre-conceived biases and fears. And the bad information often isn’t 100% wrong, but it’s also not considered/presented in the proper context. [And it goes both ways, legitimate (key word) information regarding shortcomings with the vaccines or that opposed let’s call it the “master narrative” of COVID were met by some in some cases with radical condemnation. And that’s not a good thing either in the spirit of scientific inquiry.]

You bring up a great point, which I have often wondered myself. It’s very interesting to hear non-vaccinated people say they don’t need the vaccine because if they get sick, there are treatments available. I have yet to understand why novel treatments are less of a risk- products like antivirals including Paxlovid, monoclonal antibodies, convalescent plasma therapy, etc. Not to mention the very well known risks associated with existing treatments like antibiotics and steroids. And if you compare the body of research on COVID vaccines, it’s probably the most studied pharma product ever- especially in comparison to the novel treatments that were released later.

In my experience consulting patients on this topic, they often have not considered the risks involved with COVID related treatments. Their response usually is that they’re willing to take that gamble- a definite possibility risk by getting the vaccine vs. maybe getting infected and maybe needing treatment. For older and higher risk people this is definitely a bad gamble. It’s a harder argument for younger folks in good health given their risk profile. I think the best argument here is that vaccines appear to make illness less severe and shorten the recovery time. This can be compelling for young people who are often busy with school, work, families, etc.

I just think many people these days don’t have a lot of trust in healthcare. 25%+ of people don’t have PCPs. Healthcare delivery for most people from offices to Telehealth to pharmacies have become essentially the fast-food chain model, pumping patients through as quickly as possible. In such settings it’s difficult for people to build meaningful relationships with their providers. And people turn to the internet for medical advice before their providers (or in leu) which can easily reinforce whatever ideas/concerns they have. The medical industry and public health authorities have not conducted themselves well, so it’s not surprising they are not trusted. And the politicians were able to swoop in and exploit this mistrust for their own benefit, which is unfortunate and really quite sickening (no pun intended) .

 

[AG_PhamD]

A lot of information on risks may come from questionable sources but on the other hand information about benefits came from drug companies which have not always been known for transparency. Also, they lobbied Congress and were granted relief from any liability so it appears they themselves were not totally confident in their product.

Antibiotics have been around for a long time. The vaccines however were a new type. As such, the long term risks were by definition not known. And I do question if an antibiotic is advised - is it really necessary, what are the possible side effects, etc.

Of course there are whackos out there claiming microchips are in the vaccines so the government can track people. But it seems sometimes that anyone with genuine, thoughtful concerns about the vaccines are lumped into the same category.

All vaccine manufactures in the US have “relief from liability”… to an extent. COVID related products have their own program for a number of reasons, but other vaccines fall under Vaccine Injury Compensation Program (VICP). VICP exists to prevent people suing pharmaceutical companies and dissuading manufacturers from producing vaccines. Instead, the government takes over the liability for harms incurred.

As @Roller mentioned, the COVID vaccines were created quickly and could only have limited testing. The clinical trials were shorter than you’d normally prefer, but had many more participants than usual- 10’s of thousands vs usually <3,000. Potential long term effects are rarely found in clinical trials unless there is a reasonable pathway that could be theorized. Given how typical vaccines and mRNA vaccines function, there is no obvious mechanism for longterm risks. Pharmaceuticals undergo phase IV research aka post-marketing studies, where such effects are monitored for. Animal models like rats also are useful as long term side effects can become apparent much faster due to their short lifespan and the timescales often correlate to humans. And while mRNA vaccines are novel as a marketed product, the underlying technologies have been researched for many years.

I should also mention the chances of long term side effects developing sometime far off in the future from a single injection is very different than longterm side effects of taking a drug daily for years on end. These are two very different types of exposure.

I don’t think the lack of trust in the vaccine early on was surprising given many reasons, including a lack of trust in the pharmaceutical industry. But as time passes and 10’s of millions of people receive the product without incident and adverse events are exceedingly rare, that should be interpreted as a good sign the vaccines are safe. But people will often not think about these things in a reasonable way.

I agree it’s wrong that microchip conspiracy theorists and everyone else were grouped into the same category and was detrimental. At some point I think for many of the fervent anti-vaxxers this stopped being a medical/scientific/public health issue and became more of a political thing more than anything.

Under the current guidelines the short answer is antibiotics are not recommended except in cases with suspected/confirmed cases of concurrent bacterial pneumonia. Once a bacterial infection is ruled out or cured then antibiotics should be discontinued. Of course, if the patient is on a ventilator then you would provide antibiotic prophylaxis due to the risk of infection associated with ventilators. Secondary bacterial infections with COVID are not that uncommon in severe cases.

 

[AG_PhamD]

It's great that you ask about side effects and such. But, in my experience with patients, I've found many are, if anything, too trusting. The problem is them knowing where to go for free advice. So much of what they get on the Internet is unfiltered, and it's hard to separate the wheat from the chaff. The COVID situation was ripe for abuse, such as grifter docs who continued to push ineffective therapies after they were shown to be useless.

There are definitely those patients who think their interest research has revealed exclusive knowledge that is not know/available to the medical community.

The concern that keeps me up nights is what will happen when the next viral pandemic hits, but with a much higher fatality rate than SARS-CoV-2. There's so much distrust, I fear getting people vaccinated will be even more difficult. We're in the eye of a strengthening hurricane, and now is the time to be developing better defenses such as intranasal vaccines, improved ventilation, and the means to distribute high-quality masks.

Absolutely, me too. Given how this country has handled swine flu and COVID or even baby formula shortages things do not bode well for a future crisis. I don’t think people realize how much worse diseases are out there. And I’m not sure the government or really even the public is willing to seriously reflect on the failures/mistakes the occurred at all levels of society.

Isn't it true that a significant percentage of poor outcomes from exposure to Covid was in people that had existing health issues - obesity, smoking, etc? Perhaps that vulnerability should be better addressed along with new technologies.

Yes, that is true. People with poor health influenced by lifestyle decisions die prematurely at much higher rates regardless of COVID and are a huge burden on the healthcare system in terms of resources and financial costs.

While these are issues that should be addressed by promoting healthy living, it’s not something that will change quickly or easily and could take generations. In the timescale of a pandemic, lifestyle changes probably won’t make much difference. For people who have lived much of their lives making lifestyle choices not conducive with health, changing their behaviors can improve their health but in many cases some degree of irreparable damage has already done.

The argument that more could be done to promote healthy lifestyles is in some regards fair, but there often are a lot of resources out there people are just not aware of. And it’s not like people who smoke, eat poorly, don’t exercise, and/or are obese are not aware these are unhealthy. Ultimately these are a personal choice and require intrinsic motivation to change. Getting a massive percentage of the population to change their behavior and maintain those changes is not an easy task.

 

[mac_in_tosh]

I don’t think the lack of trust in the vaccine early on was surprising given many reasons, including a lack of trust in the pharmaceutical industry. But as time passes and 10’s of millions of people receive the product without incident and adverse events are exceedingly rare, that should be interpreted as a good sign the vaccines are safe. But people will often not think about these things in a reasonable way.

Where can one find a (hopefully simple to follow) source that tracks adverse effects so "exceedingly rare" can be quantified? For example, the incidence of blood clots and loss of platelets.

 

[mac_in_tosh]

I just think many people these days don’t have a lot of trust in healthcare.

Well it's no mystery when t.v. is saturated with commercials for hospitals and drugs with weird names and a long list of side effects (many of which drugs provide a barely statistically significant benefit), when it takes people days to get an appointment with their doctor (weeks if it's a specialist) and then they are seen for a few minutes of perfunctory interaction, all followed by having to wade through a confusing web of insurance claims and payments.

 

[AG_PhamD]

Where can one find a (hopefully simple to follow) source that tracks adverse effects so "exceedingly rare" can be quantified? For example, the incidence of blood clots and loss of platelets.

There are studies into this- Data is collected by both the manufacturer, health authority reporting mechanisms (such as the CDC’s VAERS in the US), and independent research via clinical trials and by searching/analyzing patient health databases (ie correlating health records of patients suffering X condition and filtering out those who had recently had vaccinations).

Well it's no mystery when t.v. is saturated with commercials for hospitals and drugs with weird names and a long list of side effects (many of which drugs provide a barely statistically significant benefit), when it takes people days to get an appointment with their doctor (weeks if it's a specialist) and then they are seen for a few minutes of perfunctory interaction, all followed by having to wade through a confusing web of insurance claims and payments.

There are certainly some drugs with marginal effectiveness and have been cases of “surrogate markers” (aka indirect metrics) being used to evaluate a drugs efficacy that don’t actually end up correlating to the desired outcome. A classic example, correlating lowering cholesterol with reduction of cardiac events (heart attack, stroke, etc). Some cholesterol lowering agents have been found to have no effect on cardiac events while Statins are very effective. But oftentimes surrogate markers are used because it’s only reasonable or ethical way of doing things. Such studies can be found on the. NIH’s PubMed and other databases like OVID or medical journals (preferably of high impact rating) who review such articles for publishing (NJM, Nature, Lancet, etc).

Drugs that are marginally effective often have no alternative- take for instance Alzheimer’s drugs. Their effects are minimal but there’s otherwise no alternative. There’s also a problem where uninformed journalists or people see’s a study and due to a lack of understanding of statistics and medical context underestimate the effect.

By law drug companies have to report all the side effects in their marketing, including extremely rare side effects that may/may not be related to the drug or ones that occur at the same or less rate as the placebo in placebo controlled studies. Frankly, I don’t think direct-to-consumer marketing of pharmaceuticals should exist if only for the immense cost, amongst other issues.

I would say the more common issue are new drugs that are released that provide no real benefit among existing, cheaper options. Or they’re just combinations of existing drugs that cost 10x as much. Manufacturer clinical trials are intentionally designed to make their drug look superior- such as comparing it to a drug known to already be inferior compared to other alternatives.

Unfortunately the modern healthcare system is not designed to provide good access or communication between providers and patients. The media has a long track record too of reporting on studies of anything science related and not properly understanding them themselves, thus providing an incorrect translation to the public. I am not a physicist but even I knew had enough limited understanding of the concepts involved to know the reporting on the DOE “fusion breakthrough” was far less significant than the news made it out to be. But this is what happens when you have a media financially (ergo existentially) reliant on clickbait headlines.

 

[mac_in_tosh]

There are studies into this- Data is collected by both the manufacturer, health authority reporting mechanisms (such as the CDC’s VAERS in the US), and independent research via clinical trials and by searching/analyzing patient health databases (ie correlating health records of patients suffering X condition and filtering out those who had recently had vaccinations).

Is there a central location for this data that would be accessible to non specialists?

 

[mac_in_tosh]

There are certainly some drugs with marginal effectiveness and have been cases of “surrogate markers” (aka indirect metrics) being used to evaluate a drugs efficacy that don’t actually end up correlating to the desired outcome. A classic example, correlating lowering cholesterol with reduction of cardiac events (heart attack, stroke, etc). Some cholesterol lowering agents have been found to have no effect on cardiac events while Statins are very effective.

Interesting that you bring up statins as examples of drugs with more than marginal benefit as I had looked into this a while back. The following chart from the American Heart Association touts the benefit of adding a statin to blood pressure meds for reducing heart attacks, strokes and heart-related deaths. I believe it is based on the HOPE-3 study that involved 12,705 people at least 55 years old. Over a six year period, some received blood pressure meds, some a statin, some both and some placebos.

On the one hand, it could be argued that statin + bp meds reduce heart related incidents by 28% (1.4/5). That's the typical relative benefit that gets quoted. The results show, however, that in every group of 100 people taking those meds over a 6 year period, there is about 1 fewer person with an incident compared to placebo (3.6 vs. 5). That's great for that one person, but (from other sources) 2% will have common side effects including cold symptoms, digestive problems, weakness, dizziness, etc. Some more serious side effects have also been reported for vulnerable groups. It would seem better if doctors prescribed, and people followed, more effective lifestyle changes. I know, not easy.

I think the bottom line here is that almost all the people taking statins will not have any adverse effects but nor will they get any heart related benefit. A small % will benefit, but a similar number of people will have adverse effects to various degrees.

 

[AG_PhamD]

Interesting that you bring up statins as examples of drugs with more than marginal benefit as I had looked into this a while back. The following chart from the American Heart Association touts the benefit of adding a statin to blood pressure meds for reducing heart attacks, strokes and heart-related deaths. I believe it is based on the HOPE-3 study that involved 12,705 people at least 55 years old. Over a six year period, some received blood pressure meds, some a statin, some both and some placebos.

View attachment 20715

On the one hand, it could be argued that statin + bp meds reduce heart related incidents by 28% (1.4/5). That's the typical relative benefit that gets quoted. The results show, however, that in every group of 100 people taking those meds over a 6 year period, there is about 1 fewer person with an incident compared to placebo (3.6 vs. 5). That's great for that one person, but (from other sources) 2% will have common side effects including cold symptoms, digestive problems, weakness, dizziness, etc. Some more serious side effects have also been reported for vulnerable groups. It would seem better if doctors prescribed, and people followed, more effective lifestyle changes. I know, not easy.

I think the bottom line here is that almost all the people taking statins will not have any adverse effects but nor will they get any heart related benefit. A small % will benefit, but a similar number of people will have adverse effects to various degrees.

The risk reduction is actually 25%ish PER 1mmol reduction in LDL (24-28% depending on who you ask). You can generally assume around 1.8mmol reduction using high intensity statins. It’s also worth noting that since statins reduce plaque formation and stabilize existing the plaque and there is earlier they are started the more beneficial they are, so looking at a 6 year timescale doesn’t exactly represent the full benefit. An easier way of assessing benefit is NNT, number needed to treat, meaning how many people must be treated to prevent one bad outcome. NNT for heart attack is generally cited around 60 for statins over 5 years. For more severely affected patients, it’s as low as 30 over 5 years.

The side effect profiles vary slightly between drugs, but generally are well tolerated drugs. Dizziness is usually more associated with blood pressure meds. And the side effects the do occur are usually tolerable or manageable. Some side effects will subside with time. The most common side effect is muscle pain which is not uncommon in older people to begin with and most typically happens at high doses.

In terms of major problems, they can increase blood glucose with can lead to diabetes- but this is exclusively seems to only really affect and occurs at 0.2% people already at risk of diabetes. Another risk is rhabdomyolysis which can cause kidney damage, but is pretty easily detectable and only occurs 1.5 in 100,000 with statins overall and some are more likely than others.

I would argue reducing your risk of stroke or heart attack where the outcome is possibly death or permanent disability (not to mention other ischemic cardiovascular problems), the possibility of having mild side effects is well worth it. And most people have no issues.

Generally speaking the people more likely to have side effects are taking higher intensity statins, meaning they have a higher risk of cardiac events. Dosing is based off a risk factor calculation.

If one takes statins and simply cannot tolerate them- any drug at any dose, to the point where it’s a quality of life issue, that is certainly it’s own situation. And in that case patients and providers can decide what’s best for them.

 

[AG_PhamD]

Is there a central location for this data that would be accessible to non specialists?

PubMed is a good repository for many studies that occur. Not all are available for free viewing though. All of the studies are available to anyone, but you have to pay to access some of them (unless you’re affiliated with an institution like hospital or school that has subscriptions to various databases and journals).

In terms of a place that might collect such studies and translate them into vernacular, I’m not aware of such a resource.

One solution is to look for meta-analyses which independently analyze a bunch of studies on the same topic, filter out the bad ones, and combine the data to summarize findings (incl telling you what evidence is lacking). The Cochrane Library is a highly reputable organization that does this and I believe all their reports are freely available.

 

[mac_in_tosh]

An easier way of assessing benefit is NNT, number needed to treat, meaning how many people must be treated to prevent one bad outcome. NNT for heart attack is generally cited around 60 for statins over 5 years. For more severely affected patients, it’s as low as 30 over 5 years.

So assuming a daily dose, each of the 60 or 30 people will be taking 365 x 5 = 1,825 pills (twice that if the statin is combined with a bp med) so that one of them will avoid a bad outcome? I'm not sure how that is interpreted as statins having more than a marginal benefit.

I assume the NNT would be much lower for lifestyle changes, which would be cheaper and avoid the side effects.

In terms of major problems, they can increase blood glucose with can lead to diabetes- but this is exclusively seems to only really affect and occurs at 0.2% people already at risk of diabetes.

That's 0.2% for each year a person is on statins, right?

 

[ronntaylor]

Mango Supreme whacko pushed against COVID vaccines and protocols

https://mobile.twitter.com/marclamonthill/status/1612649635277078528

Diamond —of the right-wing, Trump- loving duo Diamond and Silk— has died. In late November, she was hospitalized due to COVID-19. The duo was fired by Fox News a couple years ago for spreading misinformation about COVID-19 and vaccines. You cannot script this stuff.

 

[Yoused]

Mango Supreme whacko pushed against COVID vaccines and protocols

https://mobile.twitter.com/marclamonthill/status/1612649635277078528

You left out the best part,

Contributions towards Preserving Diamond’s Legacy are only being accepted at the following link: give…

Start the grift while the body is still warm.

 

[AG_PhamD]

So assuming a daily dose, each of the 60 or 30 people will be taking 365 x 5 = 1,825 pills (twice that if the statin is combined with a bp med) so that one of them will avoid a bad outcome? I'm not sure how that is interpreted as statins having more than a marginal benefit.

I assume the NNT would be much lower for lifestyle changes, which would be cheaper and avoid the side effects.

That's 0.2% for each year a person is on statins, right?

I’m not sure what the number of pills has to do with anything. I would say a 1 in 60 difference is quite significant if you consider the tens of millions of people at risk and the consequences at hand.

0.2% of all people, but also consider most people with pre-diabetes will be on statins. As I mentioned, the population affected is almost exclusively those already teetering on the edge of diabetes. I say “almost”because nothing is definite in medicine, but people without diabetes or pre-diabetes can control their blood sugar so it doesn’t seem likely they would have a problem. I’ve never seen a non-diabetic person get diabetes from a statin.

I would always suggest lifestyle (ie diet, exercise, smoking cessation, etc) modifications in leu of medication any day. The reality is most people are not able/willing to make such changes. Our society would definitely be better off if people made better choices.

On the other hand, it’s worth noting there are some people make the right choices their entire life and still have problems.

Depending upon what health issue we are talking about, some of the damage may already be done regardless of lifestyle changes. In the case of atherosclerosis, lifestyle modification can help, but lifestyle modification + medication is most effective compared to either option alone.

I am very much a believer in less is more when it comes to medication. As a clinical pharmacologist in a hospital I actually do more de-prescribing and medication consolidation than prescribing. And when consulting patients I always recommended non-pharmacological interventions.

Ultimately it’s up to the individual what they want to do with their lifestyle and medication treatment, regardless of the risks not receiving the treatment. If you chose to go against widely accepted medical advice, that’s your right and everyone else has to accept that.

 

[Roller]

You left out the best part,


Start the grift while the body is still warm.

And here's another one:

QAnon influencer who spread conspiracy theories and misinformation about COVID-19 dies after contracting the virus

"I'm exhausted and I have no, I'm very, very weak. I have no strength. I haven't eaten in four days," Cirsten Weldon said in one of her final videos.

www.businessinsider.com

Her followers' response: threaten the medical professionals who tried to save her.