Last year I spent a couple of months working as a physician in a geriatric hospital, i.e. a hospital that specializes in taking care of elderly people. One thing that struck me particularly was the large number of medications each patient was on. I don’t think it would be much of an exaggeration to say that the average patient had ten or more medications that they were taking on a daily basis.
Is there any life left in the cholesterol hypothesis (a.k.a. the lipid hypothesis)? Is there anything left for serious scientists to cling to or is time for its mouldering corpse to end up on the trash heap of medical history, alongside lobotomy, bloodletting and the theory of the four humors? I was asked this question by a reader of this blog recently, and as it happens, a systematic review was recently published in Evidence Based Medicine (my favorite medical journal, mainly because it is edited by the brilliant Dr. Carl Heneghan) that definitively answers this question, so I thought it would be interesting to go through what the evidence says together.
Several people have contacted me over the last few weeks asking for my opinions on hydroxychloroquine. I’ve invariably answered that I don’t know, since I haven’t looked at the data myself. I felt that it was time to rectify that situation.
Most of us probably take fever lowering drugs, like paracetamol (a.k.a. acetaminophen, tylenol, panadol, alvedon), aspirin, or ibuprofen (a.k.a. advil, motrin, ipren), when we get a high temperature. The technical term for these drugs is antipyretics. After half an hour or so, we start to feel better and maybe don’t have to spend the whole day in bed. But it is well understood among researchers studying the immune system that the fever is in itself an important part of the body’s defence against infection. Our immune system works better at a higher temperature, and many pathogens have trouble replicating at a higher temperature. So, does taking antipyretics increase the risk of a more severe infection, or even of dying? And does it delay recovery?
If you take blood pressure medications you probably have some interest in following your own blood pressure. But what many people don’t know is what target blood pressure they should be aiming for. If your blood pressure after treatment is 140/85, say, is that good or bad?
Ok, it’s a silly question I admit. As any physician, and anyone else who thinks about it for a few seconds knows, there is no such thing as saving lives. You can only postpone death. So a more nuanced question is required: “Do statins postpone death?”. My mother sure thinks they do, since she’s been popping an atorvastatin a day for the last couple of years on her GP’s recommendation. Of course, the question gets more complicated when you consider two things: