Michael Levin: Statins for 8-year-olds and Mayo Clinic's Whole Practice, Integrative Treatment
Written by John Weeks
Michael Levin: Statins for 8-year-olds and Mayo Clinic's Whole Practice, Integrative Treatment
Summary: The big medical news just after Independence Day was that, following new American Academy of Pediatrics recommendations, thousands of children will soon be dependent on statins for cholesterol management. Integrator columnist Michael Levin muses on this news together with a virtually unnoticed whole system, integrative Mayo Clinic study which found that lifestyle, supplements, diet and yoga or Tai chi not only lowered cholesterol but also weight and who knows what other positive outcomes. Are statins parenting replacement therapies?
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Mayo's research provokes Levin's column
Like Integrator columnist Michael Levin and many of you, I received with sadness the widely reported news that a subset of our already increasingly drugged children are about to have another pharmaceutical on their pill trays. Levin, however, also came across a relatively obscure cholesterol study, just published in the Mayo Clinic Proceedings. That study of a whole system integrative, team approach at Mayo Clinic suggests a road toward the light out of this darkening set of dependencies. Levin suggests that Pharma is serving, again, as a personal responsibility replacement therapy. Levin's series of Integrator columns is available by clicking here.
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Mayo Clinic’s Integrative Treatment Study on Cholesterol and Weight
Over-shadowed by Promotion of Statins for
Children
Michael D. Levin, Health Business Strategies
Rather than parents being responsible for guiding their children towards healthy
habits, Pharma comes to the rescue once again. And once again, these new protocols will add to medical costs.
I agree that investing in drugs can be more
cost-effective than paying for diabetes and heart-disease management in the
future. But it is the lack of personal responsibility and abdication of
parental responsibilities in controlling preventable diseases that is
most troubling. Under these recommendations, Junior can watch TV, eat a double-cheeseburger and take
40mg of lovastatin. Isn’t that grand? The “quick fix” mentality strikes
again.
The real news for integrative medicine and cholesterol management wasn’t
covered in the popular media, or even on National Public Radio. Mayo Clinic just published a randomized primary
prevention trial comparing simvastatin versus therapeutic lifestyle changes and
supplements in 74 subjects.
The lifestyle counseling was multi-dimensional and
included weekly 3.5 hour meetings with a cardiologists, dieticians, exercise
physiologists and “several alternative or relaxation practitioners” (yoga, tai chi).
Great study. The supplements used were independently assayed and
well-controlled. Their conclusion?
“Lifestyle changes combined with ingestion
of red yeast rice and fish oil reduced LDL-C in proportions similar to standard
therapy with simvastatin. Pending confirmation in larger trials, this
multifactorial, alternative approach to lipid lowering has promise for a subset
of patients unwilling or unable to take statins.”
No Surprise: The Mayo team reports that lifestyle changes and
supplements were found to be as effective as statins in managing
LDL-cholesterol, and more effective in reducing weight and triglycerides. These
results come as no surprise. Red yeast rice contains small amounts of naturally
occurring statins. Fish oil has been approved as a drug to reduce triglycerides
(and, in the UK and Canada, reduce the risk of second heart attacks).
Question: Should this alternative, multifactorial, whole system approach be reserved
for a small subset of patients, as the authors suggest, or should this be a treatment of
first choice? In our system, economics is going to be a major influencer of the answer to that question.
Levin:
As long as Pharma gives parents
an apparent “easy out,” and
particularly as long as insurance
does not cover integrative, team
approaches, Mom and Dad will
probably
choose the
co-pay over
the toughest and most important
job of them all: parenting.
Economics: The online cost/tablet of simvastatin 20mg ranges from 87
cents to $6.37.
The daily retail cost for the dosages of supplements used in this study is
probably in the range of $2.00–$3.00. The whole practice program also has additional costs for other treatments. Short term economics will drive the answer to that
question, in favor of the drug.
But if we get out of the short term view we have a different picture. Exercise and proper diet and mind-body work would largely eliminate this problem for many people. We would avoid any adverse effects from the statins - and who knows what they might be after long-term use in children. The lifestyle approach can be preventive, long-term, against many costly conditions. If taught to children, these practices for healthy living can be lifetime companions. In a full cost accounting view, the economics may favor Mayo's team-based protocol.
But
as long as Pharma gives parents an apparent “easy out,” and particularly as long as insurers do not cover integrative, team approaches such as that studied at Mayo, Mom and Dad will probably choose the
co-pay over the toughest and most important job of them all: parenting.
And our unsustainable model of medical management is destined to continue until it collapses under its own economic
weight and the burgeoning poundage of John Q. Public.
Michael D. Levin Founder Health Business Strategies 12042 SE Sunnyside Road Clackamas, OR 97015 503-753-3568 (direct) 503-698-7565 (fax)
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Comment: What we need is a President of the United States who will announce that, in the same way we engaged ourselves as a people to place a person on the moon, we are taking on the challenge of finding non-pharmaceutical ways to create health in our children, and our adults. The President needs to use his/her bully-pulpit creatively, as an educator, as mentor, as coach for a Nation gone to pot-belly. The message needs to be that we will not let up until it is done. The message needs to educate us to the myriad ways that ill health harms, and celebrate advances of health where strategies create health.
Short of that or better yet, as part of that - it would be nice if a few employers, government agencies and insurers would show more leadership by exploring, as Levin suggests, what might happen if these whole system, human-based, team-oriented approaches were actively promoted as first strategies to whole populations rather than merely "patients unwilling or unable to take statins" as the Mayo researchers suggest.
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