tag:blogger.com,1999:blog-18943510.post4683288709730311641..comments2023-08-21T02:57:37.362-05:00Comments on Dr. Wes: With Prevention, The Sky's the LimitDrWeshttp://www.blogger.com/profile/17438019699222125477noreply@blogger.comBlogger13125tag:blogger.com,1999:blog-18943510.post-36456540745304406782008-11-13T04:26:00.000-06:002008-11-13T04:26:00.000-06:00Nice post.I still think "cholesterol" is one of th...Nice post.<BR/><BR/>I still think "cholesterol" is one of the biggest scams ever in the history of modern medicine, right up there with "bleeding" patients of their bad blood.<BR/><BR/>I seem to recall that nearly half of all heart attacks happen to people with normal LDL/HDL levels.<BR/><BR/>C-RP and triglycerides make a lot more sense as warning signals, although as I understand it they are Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-33459301148888082072008-11-11T15:15:00.000-06:002008-11-11T15:15:00.000-06:00I'm not sure I agree with some of your numbers, so...I'm not sure I agree with some of your numbers, so I re-crunched them <A HREF="http://dinosaurmusings.blogspot.com/2008/11/prevention-myths.html" REL="nofollow">here</A>.#1 Dinosaurhttps://www.blogger.com/profile/01357845504444464397noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-41797282064349007602008-11-11T11:06:00.000-06:002008-11-11T11:06:00.000-06:00Just curious, but how much does an average admissi...<I>Just curious, but how much does an average admission for one of the 'cardiac events' run these days? I'm assuming a fair number end up in the unit which isn't cheap .....</I><BR/><BR/>Ever heard about NNT? Sure admissions aren't cheap, but admitting 1 person may still be cheaper than treating many, don't you think?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-49820853718802813382008-11-11T08:55:00.000-06:002008-11-11T08:55:00.000-06:00Just curious, but how much does an average admissi...Just curious, but how much does an average admission for one of the 'cardiac events' run these days? I'm assuming a fair number end up in the unit which isn't cheap .....Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-89089973327905789902008-11-11T08:36:00.000-06:002008-11-11T08:36:00.000-06:00anon 10:00 CST-I'm guessing the DSMB (not the comp...anon 10:00 CST-<BR/><BR/>I'm guessing the DSMB (not the company) stopped the trial early because the interventional arm had a 50% lower cardiac event rate. It is unethical to continue an RCT when one arm is clearly superior to another. <BR/><BR/>The whole basis of human subject participation in clinical research is (right or wrong) informed consent. At the time subjects were consented, there was Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-7186908610618950122008-11-11T07:10:00.000-06:002008-11-11T07:10:00.000-06:00They stopped a 5 year trial, 3 years early.Hmmmmmm...They stopped a 5 year trial, 3 years early.<BR/><BR/>Hmmmmmmmm. Wonder why?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-44518770130068175682008-11-10T22:01:00.000-06:002008-11-10T22:01:00.000-06:00Brilliant post.Brilliant post.Margaret Polaneczky, MD (aka TBTAM)https://www.blogger.com/profile/16555722791007332247noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-46080427044568022052008-11-10T18:23:00.000-06:002008-11-10T18:23:00.000-06:00dr wes,don't forget all the extra dr visits for al...dr wes,<BR/><BR/>don't forget all the extra dr visits for all that prescribing. and testing. and counseling. and dealing with dose changes. and side effects. <BR/><BR/>(and making visits that would have already happened anyway more complex and thus more expensive.)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-81914794582330052102008-11-10T13:31:00.000-06:002008-11-10T13:31:00.000-06:00Wonder where the cost would come out if you use a ...Wonder where the cost would come out if you use a generic statin and skip the CRP test (which is so nonspecific as to be valueless) and just aim for a lower target LDL. I think the patients ended up with a mean LDL level of 55 mg/dL which is very low, so maybe it suggests that the current targets are too high.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-82188818209473447852008-11-10T13:10:00.000-06:002008-11-10T13:10:00.000-06:00anony 12:18 - Point well-taken. Irrespective, the...anony 12:18 - <BR/>Point well-taken. Irrespective, the numbers are astromonical and well beyond Jupiter...DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-43014858870542272232008-11-10T12:18:00.000-06:002008-11-10T12:18:00.000-06:00Hard to imagine the potential risk pool being 6-10...Hard to imagine the potential risk pool being 6-10 billion people since there are only 6 billion or so people in the entire world. So the final value of $51 trillion is wrong tremendously but the cost per event prevented of $213,000 is correct. Whcih greatly exceeds the generally accepted price limits. Especially since this is cardiac events, not cardiac deaths or all-cause mortality.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-3581203656775405582008-11-10T12:14:00.000-06:002008-11-10T12:14:00.000-06:00kick me if i'm wrong, but I think you're off by a ...kick me if i'm wrong, but I think you're off by a factor of 1000. The at risk population should be 6-30 *million*.<BR/>That puts the cost at 51 Billion. Still a tidy sum, but at least its within the AIG range :)Yonihttps://www.blogger.com/profile/03621328288673602086noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-13795125597593301092008-11-10T10:57:00.000-06:002008-11-10T10:57:00.000-06:00Thanks for doing the math. Helps put things in pe...Thanks for doing the math. Helps put things in perspective.rlbateshttps://www.blogger.com/profile/15236331355857884458noreply@blogger.com