The New Normal

Physicians often use abnormal values to diagnose diseases. We often start treatments aimed at making vital signs and lab tests normal. We feel better when we do this. But is it really the best thing for our patients?

We will explore the role of normal in this weeks class (much more than body temperature!) This week we are going to look in detail at changes in cholesterol and the current guidelines that call for prescribing cholesterol lowering medications to more than 50% of the (male) population over the age of 40. Is that a good idea? Perhaps. Perhaps not. We will also look at the enthusiasm of drug companies in developing anti-inflammatory medications for sepsis, including drugs like statins.

In The Lancet, Terblanche wrote: “Sepsis occurs when the immune system responds to a localised infection at a systemic level, thereby causing tissue damage and organ dysfunction. Statins have proven health benefits in many diseases involving vascular inflammation and injury. Recent animal data suggest that the administration of a statin before a sepsis-inducing insult reduces morbidity and improves survival. The immunomodulatory and anti-inflammatory effects of statins, collectively referred to as pleiotropic effects, lend biological plausibility to such findings. Limited human data hint at reduced mortality rates in bacteraemic patients, and a reduced risk of sepsis in patients with bacterial infections concurrently taking statins. These lines of evidence point to a potential new treatment and prevention modality for sepsis. The stage is set for randomised controlled clinical trials that will determine whether statins represent a safe and beneficial treatment in critically ill, septic patients and whether statins are effective at preventing sepsis in high-risk clinical settings.”

Statins have been described as a wonder drug. They lower cholesterol and reduce the risk of heart attacks, according to clinical trials. Statins also have anti-inflammatory effects. Some researchers have been excited to use statins for diseases like sepsis.

As described in the magazine Time:

“Dr. David Agus, professor of medicine at the University of Southern California Keck School of Medicine, recommends that everyone over 40 should discuss statins with their doctor, even if they haven’t had heart problems or are at increased risk for heart disease or diabetes. He says that inflammation is driving a number of aging-related conditions, both in the body and brain, and since studies have shown that statins are a powerful way to dampen the inflammatory response, more people might be living longer if they take advantage of statins. ”

Your assignment: You are working for a health agency that is advocating for more widespread adoption of statins. The idea is that they are so good at reducing mortality (from heart attacks) that we should prescribe them to all adults.  Your manager is asking you to devise a public health advertising campaign to promote use of statins in all adults. Is this a good idea? Are you going to proceed with this project? Why or why not.

Reading 1New Guidelines for Cholesterol Treatments Represent Huge Change

Reading 2 Statins for cardiovascular disease (this article is kind of long. You may skim, but read the abstract and conclusions carefully)

Reading 3 Should people at low risk of cardiovascular disease take a statin?

Reading 4 Smoke Detector Principle -Nesse

Optional additional reading: Statins for sepsis

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