I don’t understand the weird moral resistance to using effective drugs.
We’re seeing that today with GLP-1 drugs. Amusingly, it’s coming from both the fat and thin crowds. Fat people are opposing them because, it seems, they’ve paid a high cost their whole lives and now people can just not be fat. But thin people also oppose them because they’ve benefited from being thin, in some cases also at high cost, and now people can just be thin with no effort.
I know you’re advancing the arguments of others, and not your own. But I’ll just point out that it’s not “no effort.” I’ve lost 30 pounds over the past 18 months, and I’ve put in quite a bit of effort. As someone remarked in another thread awhile back, “these drugs don’t make losing weight easy, they make it possible.”
Yeah, plus I’m strawmanning the position a little bit, but I think it’s close to being their arguments. In a sense, the thin people have the more valid position. Being thin is a strong fitness signal! Either it means one is naturally fit or that one has the dedication to eat healthier food and exercise. And while it does still require work, the availability of the drugs does weaken the signal. A bit like how artificial diamonds weaken the utility of natural diamonds as a wealth signal.
Of course no one that actually needs the drugs should pay any attention to that. But it is interesting to see play out.
I think there maybe more than one reason. Possible ones, in no particular order:
I probably missed a couple, but that’s what occurs to me off the top of my head.
I started over 27 years ago but I held off from when I should have for a few years then. I still remember what my irrational thought process was: I should be able to do this with diet and exercise and I just have to try harder. It was only when I was marathon training, eating as healthily as I knew how, and thin enough that my front staff was getting asked if I had cancer, that I in my mind “gave up” and went on Lipitor. Which immediately moved me to LDL lower than my HDL. I do think some who start then feel they don’t need to do the nutrition and exercise bit anymore since the medication is doing it. That is a huge mistake.
No distrust. No feeling it made me a sickly person. Just a sense of having failed to meet a personal goal. Again it was not rational.
This is my primary consideration.
I hate to say I am somewhat dubious about some aspects of the American medical system, in which (in at least some cases) pills/procedures are sought/offered as a substitute for healthy lifestyles. For example, I have encountered diabetics who treat their insulin as a magic bullet.
I also am cautious about the potential side effects of longterm drug usage - especially with combinations of meds.
I wish I did not have my suspicions that, in America’s for-profit healthcare world, certain treatments are offered for reasons other than solely what is the appropriate health care for the individual. Sure - I can accept the possibility that if every person of a certain age is prescribed statins, there will be some benefit. But I also realize the certainty that another result will be increased profits for the statin makers. (Probably bad example as statins are so inexpensive.)
I also don’t have any expectation that I’m going to live forever. So if I can tilt things far enough in my favor with healthy habits, I have some irrational philosophical urge against trying to tilt things further in my favor through chemical means.
Add that to the list.
I’ve encountered too many medical people who don’t even suggest lifestyle changes. They just assume you can’t/won’t do it. I saw that with my spouse who, when he inquired at one point if there was any way to reduce how many pills a day he was taking the doctor stated, in a manner that made it clear he had no belief my spouse would do it, that losing 40 pounds might allow for a reduction in medication. At his next check up spouse had lost so much weight the doc freaked out and told him to slow down his weight loss. The ending of this tale is that spouse lost the 40 pounds in a year and kept it off for the rest of his life. But the doc in that case only suggested lifestyle changes after being pushed.
I wish I didn’t have those concerns, either. I worry about “cookie-cutter” medicine, where things are prescribed without considering the whole patient. Or without telling them about alternatives. Or not warning them of side effects or interactions.
For me, I have concerns about both over-prescribing and not wanting to daily medication, in part because I struggle to remember to take it daily.
Since I’m now in my 60’s I was getting heartily tired of expressions of disbelief when I said no, I am not on any daily medication. Usually followed by questions about vitamins and supplements clearly assuming I was in the group that doesn’t realize those count as medications. No and no. Once or twice got a “Are you SURE?”. Yes, very sure. I realize that it is a bit unusual these days to reach that age without a chronic problem requiring something daily but hey, I did it.
Of course, that changed when I was on chemo this summer. I took a LOT of drugs and pills. I managed to juggle it all and in six months only missed a dose of a single med twice. Some days it was 20 or more pills. All needed. So yes, I will take medications when needed.
Now that chemo has ended the onocologist’s office, which is still monitoring me, seems to be puzzled that I’d like to get off the remaining meds I’m still taking. Yes, I’d very much like to return to the “I don’t have to take daily meds” situation because it’s easier for me. I don’t have to remember to take anything. I don’t have to refill scrips. I’m down to just 8 pills a day. I can’t believe I can put a “down” in front of that, it still seems excessive to me but of course 60+ years of NOT needing daily pills colors my perception. Anyhow, the doctor’s office has convinced me I still need them (they said “for at least a month”) as I’m still recovering from side effects but absolutely I’m going to question anyone’s apparent assumption that I will swallow handfuls of pills every day for the rest of my life and question anyone who thinks it bizarre that I don’t meekly accept that.
If a doctor prescribes a statin for me they’re going to have to justify that to me given my cholesterol/lipid numbers. That applies to anything I’m handed and told “for the rest of your life”.
Don’t get me started on the grapefruit arguments - I like grapefruit. I have too many dietary restrictions already. Yes, it pisses me off when some medical person says “people your age should just stay away from it, it’s safer and less work.” Screw you if you don’t want to do the work of looking up whether or not what you’re proposing is incompatible with something in my diet. If you won’t do that for one thing how can I trust you’re checking for this interaction of medications and drugs (which extends beyond grapefruit) for anything else?
This is the feeling I get from my friends I mentioned. They seem to suggest I am not trying hard enough, and since trying real hard worked for them, it would work for me, if I tried harder. I, too, was running a lot, doing half-marathons, riding my bike, doing strenuous exercise 4-5 days a week. I had cut out most dairy and red meat from my diet and amplified veggies. But still, my Dr was not satisfied with my cholesterol levels. After going on a low dose statin things got to where they need to be, with no side effects and low/no cost. Why wouldn’t I take a statin? But, it seems there is this thinking that I failed. And yeah, I am still active today.
I just tried to dig for how often lifestyle change are effective for moving lipid numbers enough.
Found this.
Maybe there is more recent and bigger studies, dunno, but modest results at best.
Relative to the Western diet, the TLC/Step 2 diet resulted in 11% and 7% lower LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C), respectively, with no significant change in TG levels or total cholesterol-HDL-C ratio.
11% would not have been enough for me, and especially coupled with HDL dropping too.
Lifestyle should be emphasized because it does so much more than hitting these numbers, but the odds of it alone getting most of us to desired levels is maybe not great.
Well, I was trying to write something up, but it was coming across as insulting in a way that wasn’t intended. So I’ll just say that while I get that other people have various psychological reasons for declining effective drugs (anything of the form of “I know it’s irrational, but…”), I just don’t personally understand them. It’s not a factor that’s ever affected me, so I find it impossible to internalize.
The practical reasons I get. I mean, I don’t have a doctor because it’s a total pain. Hence I wish I could get statins OTC. And then do my own cholesterol monitoring, as I have been for the past year.
I sure understand that, having too many annoying food restrictions already and I also love grapefruits and grapefruit juice. I was on several statins for several years and scrupulously avoided grapefruit, no small sacrifice for me. My Family Practice doc changed me (for night time leg cramp reasons) to pravastatin and that one is just fine with grapefruit. It is also a cheap generic so no extra cost, unless your drug plan makes you try simvastatin first, to save them .13 cents a month. If that happens, just use GoodRx to pay out of pocket for pravastatin and avoid that hassle. It’s only a couple of dollars a month through GoodRx. Here’s a Harvard Medical School newsletter with a chart showing the ok/not ok with grapefruit statins.
I was on statins for about two years and my doctor never mentioned the grapefruit issue. (I like grapefruit, but it wasn’t a daily part of my diet or anything.) I read here about the problem and stopped. I going to ask my doctor about it, because I would like to resume occasional grapefruit consumption. (it’s also my preferred mimosa mixer)
I am NOT giving advice for anyone else but I never bothered to worry. It seemed to me to be a pharmacologist’s worry but from a practical clinical POV, why should I care if sometimes my blood level is like I took two pills in one day every so often instead of just one? Maybe if I was prone to side effects I’d care.
Check out that Harvard newsletter and see if the statin you’re taking requires avoiding grapefruit. You can ask your doctor to switch you to one that co-exists well with grapefruit before your next refill so you can get back to your mimosas 
.
Actually, a pharmacist is more likely to have been the one to tell you about yea or nay on grapefruit and they usually put a warning sticker on the pill bottle. Pharmacists go to school for umpty-nine rigorous years and know so much detail about how to get the best out of your meds and also how to avoid the worst customized to you and your health profile. Drs know what meds work for what conditions and the right dosages but not necessarily the finer points of IRL use like pharmacists do. Use your pharmacist, have a relationship with them to get the best out of your meds, it’s a waste not too.
This article tends to agree with you, although you should note that the effect could be like taking nearly four pills at once in the case of some statins.
You could theoretically drive the level of medication high enough to damage your liver, or cause muscle damage that can lead to kidney failure.
It’s not just an issue with statins, either. Grapefruit and grapefruit juice can affect all kinds of medications, including blood pressure medications and cancer drugs.
And the effect on the relevant enzyme from grapefruit can last up to 72 hours (which was news to me).
Per the Wikipedia article:
Seems like a big risk to take for some grapefruit juice.
https://www.fda.gov/consumers/consumer-updates/grapefruit-juice-and-some-drugs-dont-mix
I’m on a very lose dose. Probably not an issue. I’ll check with the doc.
I just have them without the juice. Seems to be working okay.
I’m on 20 mg daily of atorvastatin (Lipitor). 80 mg is used by some safely with infrequent incidence of muscle pain. I eat grapefruit on occasion, not daily. The safety profile is such that the theoretical risk is not a concern to me. For this medication at this dose. True if I was at a very high dose regimen, or on other meds with less of a safety margin, I would conclude otherwise.
Me too. Per the article I linked to above, the effective increase on atorvastatin was only 80% (an effective dose of 1.8 times the normal dose).
They conclude that this is not serious, and that grapefruit is not contraindicated for people taking statins, which is not at all what I would have expected to find when looking this up earlier today.
While they note that there is an increased risk of muscle damage, they contend this is offset by the increased reduction in cholesterol observed due to the larger effective dose.
Corrected link for my last post. Here is the article.
Yeah, I was off grapefruit for six months of chemo. Eating something that makes the chemo hang out in you 2-3 times longer than normal would be extremely bad.