Janknitz wrote:
Prescribing statins to anyone with a total cholesterol of over 200 and/or an LDL of over 100 has become the "standard of care". Doctors fear getting sued if they don't prescribe statin drugs and a patient later has a cardiovascular event.
DTSM replied: This is absolutely false! If your total cholesterol exceeds 200, the standard practice is to recommend control through diet and exercise. The use of statins or any other medication is not the first line of treatment.
I did not pull those statements out of a hat. Listen to this podcast where Mary Vernon, MD, explains the pressure on physicians to prescribe statins:
http://www.askthelowcarbexperts.com/201 ... ry-vernon/
At about 8:01 she says “Insurance companies actually pay physicians to prescribe certain medications.” She goes on to explain that insurers use the types and numbers of prescriptions a doctor prescribes as a measure of that physician’s quality of care. So if you have a diagnosis like diabetes, the insurance company expects to see statins prescribed, regardless of HDL/triglyceride levels (or lifestyle modifications). She explains that when a physician fails to prescribe the expected number of statins then his quality of care is deemed to be inferior (insurers may look at the number of boxes checked off on a quality-assessment questionnaire rather than looking at actual outcomes). Some doctors may be very successful at getting patients to make lifestyle changes and improve their diabetes and cholesterol that way, but if they don’t check off that statin box, they are not considered to be giving quality care.
Note question after question on that podcast from people who have very good HDL, Triglycerides, and even heart scan scores, but physicians STILL want to put them on statins. I know so many people who are pressured by their physicians to go on statins because their total cholesterol is over 200 or LDL’s are over 100, regardless of any other factor. It’s a reality.
Other doctors have spoken about the pressure to prescribe statins and the potential liability they face if someone for whom they did not prescribe a statin has a cardiovascular event.
And it’s not just statins. Dr. William Davis has said that cardiologists who are successful at getting patients to adopt effective lifestyle changes may be denied financial bonuses by hospitals or their own group practices because their numbers of interventional procedures decline.
My sense (opinion here, not statement of fact) is that insurers, hospitals and others don’t really believe in “lifestyle changes”, and neither do many physicians. Why? Because they keep giving the same lifestyle advice (eat less—in particular a low calorie, low fat diet—and move more) and this advice doesn’t work in the long term for the vast majority of patients. Isn’t that the definition of insanity—doing the same thing over and over again and expecting different results?
For this reason, many physicians will give lip service to the lifestyle changes at the very same moment they are writing out the statin prescription. Physicians seem to either believe that most patients are too lazy and stupid to adopt these lifestyle changes, or—if they are willing to admit the standard lifestyle recommendations don’t work in the long term—are perplexed as to why not. Only a treasured few look beyond the conventional advice to find out why these standard lifestyle recommendations don’t work long term and to learn what does. Gary Taubes wrote an excellent piece in this week’s Newsweek magazine about this very topic.
We’ve all seen careless doctors and DME’s on this board in their approach to treating sleep apnea. Here we advocate that people educate themselves and monitor their own care. That should extend to other areas of healthcare as well. If you are a doctor you sound like a doctor who does much more than simply pulling out a prescription pad, and that’s a great thing. We can only wish that more doctors are like that.