argue his opinion based on 10 to 15 years of training is wrong based on their 30 minutes on the internet.
My concern is doctors willing to prescribe for me based on statistics, and with NO investigation of me other than at first a visual, shirt still on, and lately annual blood tests. If it was known I had blocked heart blood vessels, it would be different. I think an ultrasonic scan might show this?
PS in the last 50 years, only the AMEs have had me take my shirt off.
And that is a big problem and a real one.
Please don’t take my comments out of context. Nowhere did I say doctors are equivalent to electronics salesmen, which is what you’re inferring. It was in reference to the very real fact that today the consumer, or the patient, is much more informed thanks to the internet. That’s a very big difference.
Surely you are not disagreeing with this?
And that is a big problem and a real one.
I dunno… Many bedside, clinical tests are rather poor and were developed in the 1800s when people were thinner and imaging and blood tests simply didn’t exist. Some are still good, of course, but generally speaking there’s more to be gained from a good history than from examination. They’d be better off teaching basic ultrasound skills than trying to teach medical students how to feel for how big the liver is, for example.
I think GPs are just so incredibly time-pressured that they become very good at working out what they need to do (blood-tests, imaging, nothing) and are cutting out on things that add little value. I would hope that if I went in and said ‘my ear’s sore’ they’d have a look at it but if I said ’I’m well. I do half marathons. Do I need a statin?’ I can see an argument that listening to my heart would probably add little to the debate.
I think an ultrasonic scan might show this?
An ultrasound scan might show if there was already damage to the heart and part of the muscle was thin or not working properly, but to look at the blood vessels you need angiography (fluoroscopy, CT, rarely MRI). Usually that means a significant radiation dose – fine for people who need it but not something you’d inflict willy-nilly on people without good reason.
Endurance athletes are thought to have more predominantly fat-burning muscle fibers (slow twitch) compared to glucose-burning muscle fibers in sprinters/weightlifters (fast twitch). I didn’t know before this morning, but it seems that ‘fast twitch’ muscles are more sensitive to statins – at least in animal models. But to be honest I would be very surprised if you can reliably predict whether or not you will have a bad reaction to statins based on your choice of sport. You could always look at google scholar and see if you can find something and let us know?
Cardiologists and EPs (Emergency practitioners?) have little knowledge
I often think it odd that after 10 years of concentrated study there are few topics about which I know more than the wikipedia article, and given the vagaries of memory I’m often not certain that I’d be more accurate. And yet a good doctor, has a remarkable capacity for rapidly assessing a patient and working out what needs to be done next. Certainly if I were concerned about my heart, I’d want to see a cardiologist. I would probably do some background reading but really, despite a good understanding of medical terminology, I’d want to have their opinion and I’d give it a lot of respect.
If a patient said ‘Statins make me feel sick’ or ‘I so hate taking tablets that I’d rather not take them, even if they’re good for me’ I’d believe and respect them. If a 70 year old said ’I’ve never taken statins but I am convinced statins will not benefit me’ I’d look to the scientific literature. The question is epidemiological and not anything anyone can have a valid opinion on based on individual experience/observation.
I haven’t actually expressed an opinion on statins other than that I would probably take them myself – I’m aware that there is some controversy about their use in people without evidence of vascular disease but it’s not a topic I’m professionally called on to know about in depth so I haven’t followed the intricacies of the arguments.
You’re quite right. I should have added ellipsis to show that it’s the entire section of your text that is banal, and not just the first sentence. (Tricky to ‘quote’ on an iPhone).
And, no, I’m not disagreeing with the statement ‘the patient is much more informed today, thanks to the internet’. 
You drew a parallel of being able to inform oneself via Google etc beyond the level of knowledge of a shop salesman when buying electronic kit, and a consultant cardiologist. This would be comical, were it not also potentially catastrophic to one’s health.
Use all available means to stay informed, of course. Who would argue with that?
AdamFrisch wrote:
9 times out of 10, your layman’s hunch or suspicion of what might be wrong with you is normally correct.
No. And your initial post I read before your edit used even more alarming language.
David, enjoy blindingly putting your life in the hand of an overworked expert that might have interests that are very closely aligned with the pharmaceutical company that invited him and his family to a “conference” in the Bahamas, all mod cons. I’ll stay a little more skeptical and double check stuff. Each to their own.
Speaking of the UK, and having known some people who worked in the pharmaceutical advertising business at the time, the Bahamas stuff ended here some 20 to 30 years ago. It was indeed true then that the annual advertising industry spend c. 1980 was some k per GP!
The problem is that exhaustive diagnosis is very expensive so the NHS does a lot of stuff on a statistical basis. So if eg you are hypothyroid they will stick you on say 125mcg and if you end up climbing the side of your house you will presumably come back to see the GP. Retest at 2 or 6 months… This is ok for way over 90% of the population who simply don’t care about their health until something falls apart. A friend once had bleeding from a certain orifice which could have been some pretty terminal thing. It turned out nothing serious. He had loads of tests including PSA but when I asked him about them, he said the GP told him he was good and he knew nothing. That’s the 90%…
So the other 10% or whatever get progressively desperate and hit the internet, which is full of “support” forums full of fake specialists, among some good stuff. But you need to have a good education in research methods (ie a good sense for bullsh*t) to make use of that resource.
In simple terms, the name of the game is to get past the GP ASAP and see a really good specialist. That might take 12 weeks, or as little as a few hrs if you pay say 300 quid and go private. The local hospital (Royal Sussex) has two switchboards and you choose 
I dont know anything about statins but would not take them, or any other regular drug, without more work, which would cost probably a few k…
Adam, you wrote "
David, enjoy blindingly putting your life in the hand of an overworked expert that might have interests that are very closely aligned with the pharmaceutical company that invited him and his family to a “conference” in the Bahamas, all mod cons. I’ll stay a little more skeptical and double check stuff. Each to their own."
may well hold true in the US – in the Netherlands and possibly other countries this sort of entertainment is banned. Even trrating a cardiologist to a dinner is strictly regulated.
Somewhat tangential to the discussion on statins, but the US now has something called the “opioid epidemic”, caused by very liberal prescriptions of opioid pain killers. Here is one report which I simply couldn’t believe when I first read it:
http://edition.cnn.com/2016/08/25/health/us-surgeon-general-letter-doctors-opioid-use/
The way the pharmaceutical industry has convinced doctors that opioids weren’t addictive and they should liberally prescribe them is mind-boggling. They used a “letter to the editors” to Harvard Medical Review by some doctor as evidence that “less than one percent of patients on opioid pain killers developed an addiction” and presented it as a fact, as if it came from serious peer reviewed scientific study published in that reputable journal. But it wasn’t, and now they have this (quote from the CNN article above):
From 1999 to 2014, more than 165,000 people in the United States died from overdoses related to opioid pain medications, according to the Centers for Disease Control and Prevention.
While some of those bought their drugs on the streets, many did not. In 2012, health care providers wrote 259 million prescriptions for opioid pain medication — enough for every adult in the United States to have a bottle of pills, according to the CDC.
Or, if you prefer to have it summarized bluntly, you can watch this:
I really wouldn’t put blind trust in your doctor, but rather look for some general guidelines that many countries edit which are regularly updated based on the latest scientific evidence. Not that that would always be unbiased itself or flawless, but it is usually the best that you can get. Then you at least have a general guideline against which you can check your doctor’s actions.
Another factor in the USA is ‘league tables’ where patients rate their doctors. The easiest way to get a good rating is to give patients what they want, the easiest way to get a bad rating is not to give patients what they want. The patients who are most satisfied with their doctors are apparently more likely to die, and their doctors’ reluctance to refuse opiates is likely to be part of the reason why.
http://www.medscape.com/viewarticle/863405
http://www.theatlantic.com/health/archive/2015/04/the-problem-with-satisfied-patients/390684/
Or search ‘Fenton patient satisfaction’ on google scholar.
