Do Statins REALLY Work? The Data BIG Pharma Doesn't Want You To See

Part of the problem with the statin research is that it's not that they're bad or good. Every drug has a role. It's a tool.

Yeah.

You know, it's like saying, water, is water good or bad? Well, if you drink too much water, you can die of seizures, but you need water to survive. Right. Everything has a role. So, welcome back to the podcast. It seems great to have you back in person here in Austin, Texas, in my new studio.

Yeah, it's so nice to see you again, Mark. I think. Yeah, we did. It's been about six years since.

That's right.

Yeah. Got a lot of. A lot of interest. So I think. Yeah, let's.

We did. So, as you heard from the introduction, it seems an esteemed cardiologist from the UK who's been a vocal critic of a lot of the mainstream ways of thinking about cardiovascular risk, of cardiovascular health, and the use of statins as our primary therapy for reducing cardiovascular disease, which is, after all, the number one killer in the world. We're going to dive deep into the issues around these drugs, around what we need to actually be looking at for cardiovascular disease. And I think your opinion is going to be a little bit jarring for people because it goes against the conventional wisdom, which isn't necessarily always wise.

And I think it's a much more nuanced conversation that people need to be having around cardiovascular season. High LDL cholesterol, bad cholesterol, take a statin. End of story.

Yeah.

Essentially what we all do in medicine, if we're trained in traditional medicine, high cholesterol equals statin. And if statin causes side effects, you can play with a bunch of other drugs like PCSK9 inhibitors. But we're going to start out at the end, which is this lawsuit that was filed by two of your colleagues that you were going to be a part of, but decided not to be for various reasons because you couldn't actually talk about the issues that you care about, which I think has a lot of integrity. But the case was brought by Zoe Harcomb and Dr. Malcolm Kedrick against Associated Newspapers, which is the publisher of the Mail on Sunday. And there were a series of articles published in March of 2019. They were part of a campaign called Fight Fake Health News. This was even before COVID and the whole misinformation. And in these articles, they named the claimants and statin deniers, including you, which isn't actually true. And they accused you, among and your colleagues of spreading misinformation about statins, which they described as Quote, deadly propaganda. The newspaper's article suggested that their statements led people to avoid taking statins, which was a big public health risk. In response to these articles, your colleagues filed a defamation lawsuit arguing that these articles falsely portrayed them as deliberately spreading lies about statins. Now, the High Court has seen multiple legal arguments, particularly around the public interest defense under the Defamation act of 2013 in the UK. But in 2024, just recently, the case was ruled in favor of your colleagues against the newspaper.

So in some ways you've been vindicated by the legal system that what you're raising in terms of concerns about statins, and I'm kind of quoting from you at this point, which is.

Their data is flawed on statins, it's over emphasized, it's over prescribed, it has risks. And there are other factors that need to be considered that are often being missed. And it's a more nuanced view that you have. It's not just drugs are bad, food is good or drugs are bad and wheatgrass is good. It's basically looking at very nuanced science to help unpack what we know and what we don't know about cholesterol and cardiovascular risk. So walk us through what happened with that case and what the findings were.

And.

How you have all been vindicated as a result of the legal decision around this court case that was basically defending you essentially. Not you weren't directly involved in the final suit, but you were kind of part of the whole things.

First of all, to clarify, Mark, the reason I did not decide, I mean, it was something I thought about, to sue the Mail on Sunday. I think I was at the time, there was a lot going on. My mom had just died. You know, for me, as an activist and a campaigner, I made the decision that I'm going to keep talking about this issue and carry on and just take it on the chin. I've been in this situation before, which we'll talk about later. So I decided that I wasn't going to sue them. But I'm so pleased and happy for Zoe and Malcolm because, you know, these sorts of things, they do have an impact on you. Before I tell you what happened in the case specifically because of that newspaper article about a month later, because my hospital was named in the article and obviously they got a bit panicky. I was told that my services were no longer required, so I lost my NHS job. And by the way, I have an impeccable track record in terms of my clinical care getting on with my colleagues. I'm probably an unusual doctor and probably lucky as well, because throughout my whole career, 23 year career as a doctor, I've never had a single patient complaint, which is unusual because, you know, that can happen for any reason, doesn't mean the doctor's done something wrong. So with all of that background, that's what happened. And then I wasn't able to get a job back in the nhs. I applied and got. You got blacklisted, Basically, yeah. And it doesn't mean that all cardiologists were kind of against me, but the situation arises in hospitals, teaching hospitals, and I know a lot of cardiologists in London because I trained in some of these hospitals and had good relationships with cardiologists there who respect my opinion. And it would be the case where, say, in a cardiology department of eight people, if seven of them said, a seat, be great, let's have a seam here to do clinics and work here for a bit, just one of them would object, no chance, you can't get in. And it was always, it came back to when I asked the reason. It was, you know, there are antibodies that have been developed against you because of your statins. Essentially.

Right. People are allergic to you because of your opinion on statins.

Exactly. So. But. But also that. So what happened in the case is that this was a front page news story. What made the news story, and this is the really interesting bit around the evidence of what happened during the case that I submitted, because I was asked to, is that the front page linked article said, essentially got the Secretary for Health at the time called Matt Hancock, you may have heard of him, to say that there is no place in the NHS for these sites of doctors who are spreading misinformation on statins. Now, interestingly, and of course, one of the most extraordinary bits in the actual newspaper, the editorial from the health editor headline was, there is a special place in hell for doctors who say statins don't work.

Okay.

And then imagine a picture of me, Zoe, Arkham and Harcombe, right?

You have your corner in hell all picked out.

Exactly. Right. I mean, I find it funny, to be honest. I mean, of course a lot of other people were more upset than I. I was, in fact the former Queen of England's doctor and the past president, Royal College of Physician Sir Richard Thompson, who I'm friends with. I mean, he called me up and he was so upset, he's like, this is unbelievable. How can they say, yeah, this is not what you say, Blah, blah, right? And I was calming him down and saying, richard, this, you know, we take this as a backhanded compliment. You're over the target. You get one of the most powerful, influential newspapers in the world to go for you like this, you know, and I'm someone that.

And who's their advertisers?

Well, I don't. Well, that's, that's a fair point. But I think ultimately what came out in the case as well, Mark, and there's also, again, I'll mention this crucial bit of evidence which is extraordinary and helped, I think, shift the case and win it, is that the people who were fueling the health editor to write the article and the people who are commenting on it were all connected or part of something called the ctt, the Cholesterol Trialist Collaboration in Oxford. These are the most powerful statin promoters and some of the most powerful doctors in the world in medical research. But again, which wasn't declared is that their institution has received hundreds of millions of, of dollars from drug companies that manufacture statins or new cholesterol lowering drugs. Okay, so listen, I want to double.

Click on that for a sec, just so people understand. We think academic institutions are squeaky clean, they're neutral, they're objective, they're scientific medical schools, researchers. But the truth is that a lot of their funding comes from pharma, who are funding trials that they're executing. And I remember Peter Libby, who you might have heard of, who's basically the editor in chief of the main cardiology textbook that all fellows take, called Bruno's Cardiology.

He is chairman of Cardiovascular disease at Harvard. And I said, peter, why don't you study lifestyle interventions for cardiovascular disease versus just studying medication? He said, mark, I know lifestyle works, but I can't get $5 to study lifestyle. I can get $150 million to study a drug. And that's funding my department, that's funding my staff, that's funding me. And it's the reality of how the system is set up. So you have to understand that, you know, there's, there's inherent bias in a lot of how we think about things in medicine because of the money. If you follow the money, you understand where things are, are driven from.

Yeah, absolutely right, Mark. And that reminds me actually of somebody who I cite quite regularly. Professor John I need this. I refer to Stanford. Yeah, in Stanford. I refer to him as a Stephen Hawking in medicine. He's the most cited medical researcher in the world. He is a professor of medicine and epidemiology and statistics at Stanford. He's a, he's a mathematical genius and he published a paper in 2006 that we've talked about before, I think, which is called why most published research findings are false. And one of the risk factors for false research is this. The greater the financial and other prejudices in a given field, the less likely the research findings are to be true. Think about that. So when you start with statins, you're talking about one of the most lucrative drugs in the history of medicine. It's a trillion dollar industry, number one.

Selling drug in the world.

So start from that kind of overview to try and help explain what's going on and why these sort of, this confusion is happening and where the battle is happening. And then you can make your own decision, who you trust more. But also the most important thing is to try and give people information the way they can. Understand. We'll get there in a second. So what happened in the case? So we have this kind of defamatory attack on us. But what made the story was the Secretary for Health getting involved. Now, Interestingly, one week earlier, just before this new story broke, I was speaking in Parliament about type 2 diabetes reversal and the benefits, for example, of a low carbohydrate real food diet. For that purpose, Matt Hancock had agreed to meet me. He was aware of my work because of another politician who had lost £94 from following my diet plan.

Was he the one who said, you need to have a special place in hell?

No, that was the editor.

Of the newspaper. So Hancock, Hancock was involved in the story because he had basically said he'd been contacted by the Mail on Sunday and said, there are these doctors saying this. Do you have a. Can you give us a comment? And he gave a generic comment saying there's no place for this misinformation. Right. And that it looked as if he knew who we were. And we were. So I met Matt Hancock a week before I gave him a copy of my book. He was very respectful, very appreciative of what I'm doing and lifestyle and gave my lecture in Parliament, which got a lot of attention, by the way as well, which may have been the reason why they decided to suddenly do this. You know, the new story is like, okay, we're getting something that's challenging our views on cholesterol on low fat diets or whatever. So that was probably the peg because that was getting a lot of attention to then come back and have a go at me and two other people. I think that's probably what happened. That's why it happened at that particular time. So I texted Matt through Twitter DM'd him. Yeah, I was like, Matt, really? And he replied, aseem, I had no idea they were referring to you or Zoe Harcomb. And I was like, okay, this is very interesting. So I kept that. Obviously, when the case then evolved and went to court, the lawyers for Zoe and Malcolm contacted me and I gave them that evidence. And apparently during the case, and Malcolm fed this back to me, Malcolm Kendrick, he said this turned the judge because they put Barney Kalman, who was the health editor on the stand and essentially made him admit that in a way that they had misled Matt Hancock because they hadn't told him. Because if, if Matt knew. Because I'm, I'm a, you know, for all intensive purposes. So probably. So this is what really changed the case. And I think that that is. Yeah, that. Well, it is.

What, so what were you actually saying? And what was Zoe and Dr. Kendrick saying that raised that concern and that why was, why was the Mail on Sunday so vocal about criticizing? What were they coming after?

So this is basically based upon probably both Malcolm and Zoe and my public advocacy on the over prescription of statins, the lack of informed consent, the lack of access to the raw data, which is still an ongoing problem going over a decade or so. So I think because this story and the statin saga had been getting more and more of an airing and Mark, I've been publishing in medical journals on informed consent and a lot of. I've been publishing a lot about the prescription of statins and the conflicts of interest and not knowing the true benefits and harms. Right. Because as you've said already, a lot of the data that we get from drug industry sponsored trials, if not most of it is never independently evaluated. Most people don't know this. Right? Yeah.

And the other thing people don't know Aseem, is that when studies are done, they don't have to be published. So if studies come out that are showing not a positive benefit for a particular drug that has to be submitted to the FDA or whatever the equivalent is in the uk but they don't actually have to be published in a medical journal. So you're not seeing the full spectrum of what the data show. You're just seeing cherry pick data that shows.

Absolutely.

It's massage and twisted. You know, I think was Mark Twain said, there's liars, there's damn liars and they're statisticians.

Yeah.

You know, and so it's part of the problem with the statin research is that it's not that they're bad or Good. Every drug has a role, it's a tool.

Yeah.

You know, it's like saying water, is water good or bad? Well, if you drink too much water, you can die of seizures, but you need water to survive.

Right.

Everything has a role, but how it's used, how frequent it's used, who it's prescribed, how often it's prescribed. The manipulation of the medical system, the manipulation of the scientific research and the lack of transparency about the data, the lack of publication of all the data gives us a warp view of how great these drugs are. And they're the number one class of drugs sold in the world globally.

Absolutely. I mean, it's estimated between 200 million and 1 billion people are prescribed this drug. So it's a big deal. And especially for me as a cardiologist who's primary purpose is to help my patients and also with my special interest, to really understand the root cause of heart disease and how we can reverse it in the population. We hadn't, we hadn't done that. That's how my journey started. I was somebody that believed in statins. I was one of the biggest prescribers. I was giving it in the ER to a patient coming with a heart attack and telling the nurse to give it them in the ER before they've even gone to the cardiac catheter for them to have a stent, and her.

Cardiologist saying she should serve it at McDonald's with your, you know, fries.

I know.

Or have it over the counter. I mean, there, there was in 2021, globally, it was $15 billion spent on statins. It's projected to reach 22 billion by 2032. I mean, this is a staggering amount of money on one drug.

Absolutely.

And it's, it's. So there's a lot at stake here.

100%. 100%. So understanding that there's a barrier to the truth, which is essentially a financial barrier because of the so much at stake, as you say, not just with statins alone, but the cholesterol lowering industry, the low fat food movement, the fear of cholesterol is a trillion dollar industry. Right. So I think people need to understand that. So how have we got here and what is the truth or what is the greater truth? And the reason I say what is the greater truth? This is another myth that we need to bust for people listening to kind of try and get cut through the confusion. The first thing is we have to understand the public needs to know, doctors even need to know. This medicine is not an exact science. Not even close. It's an applied science. It's a science of human beings, it's a social science. It's constantly evolving, right? We were also taught at medical school by the founding father of the evidence based medicine movement. Half of what you learn will turn out to be either outdated or dead wrong within five years of your graduation.

And we can't tell you which half.

You can't say which half. So you have to learn to learn in your own right? But how many doctors have got the time or the skill to try and cut through, you know, all the stuff that they're getting through medical journals, looking at independent evidence and then, you know, being able to try and get to something that a level of information that they can utilize for really benefiting and helping their patients. So it comes down to informed consent. And for me, one thing that, you know, I think it was Mark Twain that said that truth often lies in simplicity. And the most elegant analytical framework we have for teaching and practicing medicine is called the evidence based medicine triad, right? Published in the BMJ in 1996. I love this. It's beautiful. I put it up in my talks. It's one of the first slides. And I say, listen, this is the most important side of my talk. If you get this, you can probably not only understand why our health is going the wrong direction, but you can probably explain most problems in the world as well, right? So what does that mean? Okay, in the middle of the triad, Our role as healthcare practitioners, as doctors, is to improve patient outcomes, manage risks, treat illness, relieve suffering. How do we do that? There are three inputs. Our clinical experience, our knowledge, our intuition as doctors, over many, many years, the best available evidence, on a drug, on a lifestyle, on a surgical intervention, on ordering a test. And last but not least, David Sackett said, taking into consideration individual patient preferences and values, right? That's where the informed consent comes in. So what's the problem? What are the limitations? Why have we not really advanced evidence.

Based on that's really. I just want to double click on that too. Because when we hear evidence based medicine, what it usually is interpreted as is only what the science says, not what the patient is experiencing or what the clinician expert understands from their decades of experience, which are part of the evidence based trial, 100%. And that's really the failure here. And evidence based medicine is held up as this wholly kind of idol in a sense that we, that we bow to, but often we kind of think misinterpret what it means. And I think your explanation is really important because it's not just what the data show, it's also which data and who funded the data and what wasn't studied. And the absence of evidence is in the evidence of absence. So there's a whole bunch of stuff that's going on.

So then you pick up. So then the next stage is, okay, so if you accept this as pretty solid framework for improving patient outcomes, it doesn't take a rocket scientist to figure out that if there's anything wrong with one or all of these, at best you're going to get suboptimal outcomes and at worst you're going to do harm. So in terms of these inputs, Right, So if we just take the best available evidence and I've just said already, John, I need this, okay, Most published research, finding their faults, et cetera, You've got Richard Horton, editor of the Lancet in 2015 writing an editorial saying that possibly half the published literature is simply untrue. It's not just John, I need a saying this. So you've got all these facts. So what happens ultimately is doctors invariably are making clinical decisions for patients on biased, not saying, completely false, biased and corrupted information which invariably will exaggerate the benefit and safety of those drugs. Because that's in the interest of the drug industry who want to get as many people taking them because their only interest is profit. They're not here to give you the best treatment. So once you acknowledge all of that, then for me and as a cardiologist and as an expert who has spent a decade really, I would challenge you.

I think a lot of people, it's like the Truman show, people in the system, it's like the Truman show, they think they're in this perfect world and that they're doing good. And I think they're good people and they're trying to do good. They're not deliberately trying to harm people. But they can't see what they don't see.

Exactly.

Because they're in this sort of almost.

You know, really good point. And actually, you know, the way I would just summarize that is medical knowledge is under commercial control, but most doctors don't know that.

Right? That's right. That's right.

And, and that's what we're trying to sort of get them to think outside the box because again, I 100% agree with you, most healthcare professionals, most doctors genuinely want to help their patients and are well intentioned. And actually, you know, I'm very proud of being a doctor because I think of all the professions, I know things are changing and we have to protect our profession. I think we are people that actually have some of the strongest ethical principles. Right. When it comes to how we, you know, do our jobs. And we have to. And we held in that esteem because of that reason. So for me.

Trying to break out of that conventional paradigm happened because I came to realize that the information that I believed as being gospel truth as a medical student, as a junior doctor, it's published in a medical journal. It's science. Right. Didn't question it. I then came to realize that, hold on a minute, there's a lot more to this. And I used of course, the, you know, the heart disease paradigm to understanding why we hadn't curbed heart disease, even though it was predicted by Nobel prize winners Brown and Goldstein. I think in the late 90s who discovered the LDL receptor was involved in, you know, coronary artery disease. They predicted the end, the eradication of heart disease may completely end by the early 2000s.

Didn't happen. Still the number one killer in the world. Exactly.

Despite the mass prescription of statins, despite.

It, more and more people are getting heart disease, but less people are dying from it.

Is that accurate? Yes. Correct.

Because we have better management, we can deal with risks.

We can. Three reasons I can tell you, big, low hanging fruit. Why have we got less death rates from heart disease? If you were a smoker, your mortality rate rate increased 50% with smoking reductions played a big role. Emergency treatment in specifically in the acute setting of an acute heart attack. Stenting or thrombolytics, which we used to use. Right.

Clockbuster.

But the third one, which the Bernard Lowen pioneer and cardiologist got the Nobel prize for, was the defibrillator. Right. So what used to happen in Patients would be admitted to hospital with a heart attack and the first 20 to 4, 24 to 48 hours after having a heart attack, you're most vulnerable to having a cardiac arrhythmia that causes you to have a cardiac arrest. Right. And patients would die.

They develop cardiac better at saving people after they've had a problem completely. And that's kind of why there's less deaths.

100% it hasn't. Well, so the next question is people think, oh, must be statins as well. Well, paper in the BMJ a few years ago, looked at millions more people taking statins in Europe over a 10 year period to see was there any reduction in cardiovascular mortality in Europe because millions more people were taking statins. They found there was none. None, zero, no change. But you can actually explain that Mark. Because one way of looking at the statistics, looking at industry sponsored trials, which we've already alluded to, should be taken with a grain of salt because they are best case scenario, they're curated information.

Or a tab of butter maybe.

Well, actually absolutely. Butter would be better. Remind me to come back about a butter story of me being hauled into a medical director's office offers to talk about butter. By the way, when I busted the myth of saturated fat and heart disease. You know, when you look at the data from indispensable trials and you look at the statistics that looks at the average or median increase in life expectancy over five years. Right. In the highest risk groups where there is a greater benefit. The median increase in life expectancy over a five year period in the person that's had a heart attack. Right. And say in their 50s, just over four days now.

So just to back that up for people. So there's two kinds of treatments for cholesterol that are happening. One is we call primary prevention. You've never had a heart attack but your cholesterol is high. Your doctor gives you a drug like a statin.

Yeah.

Then there's secondary prevention. Means you already had an event and it's trying to prevent a second event. And that's what you're just talking about. If you already have had a heart attack and you take a statin, it shows that you only live an extra four days.

Yeah. If you look at the median increase in life expectancy in that group. Another way that we use in medicine when talk about informed consent or I call it ethical, very controversial topic. Ethical evidence based medical practice. Mark. Which means true informed consent. Which means telling patients the numbers needed to treat other absolute individual benefit. And you look at the totality of evidence. I know there are lots of studies we can talk about, but for me it's about what does the totality of evidence tell us. Right. And there's a great website which is independently evaluated by doctors and it goes through peer review in the one of the family physician journals in the US called the nnt.com numbers needed to treat people. Look it up. It's great.

And what that means, everybody is how many people you need to treat with a certain drug to get a benefit.

Yes.

If you have a bladder infection or strep throat and I give you an antibiotic, it's, you know, pretty much 100% like, it's like you need to treat one person to get one person better.

Yeah.

Or maybe if they have a resistant antibiotic, it's two.

Yeah. Or you take paracetamol for a headache. It's like one in two. So it's like two, two people, one will get their headache completely.

But with the statins treat 89 people for five years to prevent one heart attack.

Yeah. So it's actually so. So I know this stuff inside out. So if you've had a heart attack already, let's say the high risk group, you have to treat 83 people over five years for one to have their life saved or life prolonged. Right. Okay. And for preventing a further heart attack, 1 in 39. Now most people around the world, Marco prescribed statins are not in that group. They are in the either low risk.

75%.

Yeah, exactly. Low risk or what we call high risk primary prevention. Now the benefits of a statin over a five year period in that group at best is 1% in preventing a non fatal heart attack, a non disabling stroke. Okay. But without prolonging your life by one day.

So essentially if you, if you've never had a heart attack and you have a high cholesterol and you take a statin.

Yeah.

It won't prevent you from. It won't prevent one single death. It will. May prevent a heart attack.

Yes.

100 people take it one, it'll prevent one heart attack. So 99 people taking it for five years will have no benefit.

Yeah. So this again comes back to now this is just my opinion. It's like, oh, is a Seymour Hochscha just cherry picking statistics here? 2009, Gerd Gigarenza, the director of the Max Planck Institute for Health Literacy in Berlin. This is the same institution that Einstein taught and trained in. Brilliant guy. He wrote in a WHO bullet to 2009 is an ethical imperative for every doctor to understand the difference between absolute risk reduction numbers need a tree and relative risk reduction. And he said to protect patients from unnecessary anxiety and manipulation. So in other words, I paraphrase this. If you have that information. And again, most doctors are not trained this way. Mark, this is a problem. You should use it and tell patients. This is what I do. And a patient comes in, it's like, should I take a statin or not? I say, well let me just. Let me empower you the information. Tell me what you think. Most patients with the 1% thing think, hold on a minute, I don't think that's that great, doc. And then they'll say, well, is there anything else I can do? And of course you and I are empowered with understanding lifestyle. Right. So this is how we should be practicing medicine. But Mark, one quick thing is that I didn't just talk about this, I wrote about it and I even got this in front of every Royal College president in the UK saying that the British Medical Journal, we're doing this campaign against too much medicine. They're talking about informed consent by use of NNTs. We need to dodge a campaign because over prescription is a big problem. We know there's a big problem with side effects. We know that one estimate suggests that prescribed medications is the third most common cause of death after heart disease and cancer globally because of side effects. It didn't take long for me to convince the Royal College president. I was an ambassador for the overall Academy of Royal Colleges at the time and to say that we should have a joint campaign with the bmj. So I then wrote a paper, I was lead author, had the chairman of the General Medical Council, the chairman of the Medical Colleges on that co author paper to say, okay, this is a campaign we can get and change medical education, change postgraduate medical training. And we got that. It's in the media. It was a big news story. BBC all over the news, front page of British newspapers. Campaigns obviously need to be sustained. But what happened is of course if you engage in true informed consent with patients, most patients will choose less treatments. Now who's going to suffer from that? The drug industry? In my view. It's very clear it's not a conspiracy. This is clearly how they do business and this is what they want to do is they want to, they engage in a tactic called opposition fragmentation. Anyone that threatens their for their bottom line, they will do smearing, they will do all these things behind the scenes. There's a whole documented history of it. Oh, I'm a tobacco dinner for a while.

If you google me, you'll find many groups that are attacking me like the American Council on Science and Health which sounds great, but it's actually a front group for Pharma, Big Food and Big Ag that think trans fats, pesticides, smoking and you know, glyphosate are all healthy for you, like okay. And if they become a sounding very, you know, erudite and smart.

So you've experienced them.

Science based medicine, American health and science, Science and health. I mean quack busters, quack watch. I mean I've been there all, all through it and you get it. I totally get it. And I actually, I find a badge of honor, you know it is.

Well no, so actually in a way it is. Although you've got to grow a thick skin, right? Because you know.

One of the lessons in public health advocacy done by. Written a great paper written by Simon Chapman who took on big tobacco in Australia and talks about his 38 year career and taking on big tobacco. He says, as soon as your work threatens an industry or an ideological cabal, because also about this, about mind, it's not just about money, it's about indoctrination in the brain, right? As soon as you work threatens an industry or an ideological cabal, you will be attacked sometimes unrelentingly and viciously. So you have to grow a rhinoceros hide. So for me, what happened after that is there was. I kept pushing this message, but they then behind the scenes were all cultural positions, I think funded by pharma. Some scientists funded by pharma started making complaints to the Academy of Medical Colleges where I was one of their ambassadors for seven years. Right. To say this guy's got his own agenda, he's exploiting people for his own agenda, he's trying to make money off all nonsense. And, and that was so relentless that they. Then in 2018, I got an email from the new chair of the Royal Colleges saying that the campaign that I had started or was that they had took on and instigated, that I was no longer part of that because of stuff that I apparently said publicly on statins, even though everything in the newspapers that was written about statins for me was coming from medical journals. And I was very strong advocate for informed consent. But again, don't confuse me with the facts.

My mind's made up.

Well, exactly. So this is what they do. And of course it does have this personal toll. And then it culminated. Coming back to where we started is that because we were having an effect, mark. And of course you're absolutely doing the same thing. One of my inspirations, right, revolutionaries, Mahatma Gandhi and one of his quotes, which I love is, you know, and he took on the system. I mean he got British colonialists out of India. I mean it almost single handedly. And he says, first they ignore you.

I think Britain was bigger than the pharma companies, you know.

Oh, it was absolutely. I mean America was founded on anti corporate sentiment taking on the British East India Company. Right. It was a, it was a big corporate tyrannical system. And now we've come back to the same problem right now. But what he said was first they ignore you, then they laugh at you, then they fight you, then you win. Yeah. So when you're getting attacked, you're getting, you're over the target and you're closing to you're getting closer to winning, but you have to. It's tough. It's tough.

So essentially, this interesting legal case that we started out with has sort of indicated that you and your colleagues were speaking truth to power.

Yeah.

So let's get into the details here because everybody's listening on. Yeah. Well, my doctor check my cholesterol and my LDL was high and they recommend a statin. And like we said, it's the number one prescribed drug in the world.

Yeah.

75% of the prescriptions are for preventing heart attacks if you've never had one. It's called primary prevention. And there's very weak data to show that that actually works, especially for women, especially if you're over a certain age.

Yeah.

There is benefit for people who've had a heart attack, no doubt. It's not like taking antibiotic for a strep throat. But there is a benefit. And I'd love you to sort of unpack how you came to go from being a trained cardiologist who basically swallowed the gospel to one who understands and has looked at the literature and has come to a different conclusion. Because it's not just that you're anti drug or you're anti medical care, anti the system. You're for the truth and for science and for an objective loop look at the facts. So the question I have is how did you go from being a trained cardiologist who believed in statins, to one who started to question statins, to one who's come to understand that our approach to cardiovascular use might be a little bit misguided? And we'll talk about what the right approach should be later. But I kind of want to start with unpack the science for us because everybody listening has no. Has heard if their cholesterol's high to take a stat.

Sure.

And if statins cause side effects, which they do for a lot of people, probably 20% get some muscle damage or some symptoms or increase the risk of diabetes. You know, we'll talk about that data. There's still. There's still a huge drive in our society for prescribing these and globally.

Yeah, absolutely. So my interest in this came from really looking at the. Initially the obesity epidemic. So 2004, WHO announced it as an epidemic. You know, by 2010, I was in nine years qualified as a doctor. I was specialist registrar in my cardiology training. I was seeing more people just viscerally. I'm very sensitive to.

How to put it, suffering around me, if you like, but also seeing my colleagues under more stress in the system. And I was like, hold on a minute. If we carry on down this trajectory, the whole healthcare system is going to collapse. We want to even manage people acutely if they are ill. Right. I never thought that would happen. And ultimately that one of my, two of my own, two of my parents, both basically died because of failures in the system, because the system's under so much stress. Right. Never predicted that would happen, but that's where I started from. And when I looked into the issue of obesity, you know, I. I concluded that one of the root causes, Mark, if not the main root cause, was this, was this flawed hypothesis that we should have low fat diets to prevent heart disease. Food industry exploited that. Increasing sugar intake, increasing refined carbohydrate intake. It became quite clear there was a clear correlation between that change in guidance in the late 70s in the US and early 80s in the UK when the obesity epidemic started to then, you know, take its trajectory down the wrong way. Yeah.

And I covered a lot of this in my book, Eat Fat Thin.

Yeah.

Which we sort of unpacked the whole history of how we got this low fat craze led to this high sugar starch craze that then led to this dramatic rise in obesity, which now, of course, we're treating with other drugs, the GLP1 agonist and tirzepatide and semaglutide or zempic and mojaro. It's kind of crazy, right? We just kind of flipped it upside down.

Oh, absolutely. So. So when I looked at that and started looking at the data and spending years and months and years looking at it and looking at different bits of data, I was able to put it all together. And I wrote a piece in The BMJ in 2013 called saturated fat is not the Major Issue. Right.

I read it. That's how I first came across.

Yeah. And that got a lot of attention. Right. It was international news and British news and CNN International and whatever. Because obviously, suddenly you've got a cardiologist busting this myth that we think butter has been bad for our cholesterol. But when I did that, okay, so I looked at the data and it was very clear there was no clear association with saturated fat consumption and heart disease. So if that's true, then. And we know saturated fat raises LDL cholesterol, that means LDL cholesterol can't be that important. And if LDL cholesterol or total cholesterol isn't that important as a risk factor, how does statins work? But I knew statins had a separate effect to lowering cholesterol, which is their anti inflammatory and they're anti clotting. And I knew this even it's well known within cardiology circles. You know, I trained as an interventional cardiologist and that means key or heart surgery stents, for example, patient comes in, we didn't even check their cholesterol. Maybe some of the thinking was the lower the better, which we'll come on to as well. So it doesn't matter what their cholesterol. Starting from the lower your cholesterol, the better. In fact, 2011, 2011, a cardiologist, one of the editors, I think of the American Journal of Cardiology, wrote an article which I, I mentioned in my book A Statin Free Life, which was entitled it's the Cholesterol. Stupid. Right? And what did he say in that? He said you can be an obese diabetic smoker that doesn't exercise. Sounds crazy, but as long as your cholesterol is low enough, you're not going to get, you're not going to get heart disease.

That's crazy.

Like really. So okay, I had to unpick that and, and what I, what I also then did moving forward from 23rd. So that's how I got down this track, realizing that our obsession with LDL lowering has been.

So you look at the saturated fat literature and you weren't impressed. And data showed that it didn't seem.

Both observational data and randomized controlled trials, no benefit like in lowering it, no association, nothing. Right, right. And when you look at all the data. So that was the first sort of bit that I was okay, some might.

Even be protective like some of the dairy fat.

Well, we know now, yes, there is, there is some suggestion that dairy fat could be protective. Absolutely. So there's all that. And then coming back to the ldl.

By the way, you're not alone on this. I mean there was a major paper published by Darius Mozafari and from Tufts and others looking at butter and yeah. And actually showing that there really wasn't evidence that it was.

Mark, this is what's interesting. That article I wrote because creates such a, you know, a lot of headlines and backlash or whatever else. That's when people like Darius started looking at this again. So it was all really from the back of that BMJ piece. It all came together. So then everybody's like, you know, I know. And at the time I was I writing just a commentary which was peer reviewed. But I could have got it wrong. I could have. But I was like, you know what, there's enough here for me to provoke the thoughts, right? And then it all get got proven that, you know, what I'd written had validity. Right. Which is good. But the other aspect to this, if we go back and you mentioned cholesterol, so the. So is cholesterol, is high cholesterol a risk factor for heart disease? And is LDL cholesterol risk factor? So you have to go back to square one, right? So these are the Framingham studies that, you know, started in Massachusetts in 1948 and went over decades looking at thousands of people where a lot of risk factors emerge for heart disease, whether it's diabetes, high blood pressure, smoking, for example, now cholesterol and high cholesterol, right? So you go and look back at the Framingham studies and what. And just to summarize it, without complicating the situation too much, William Castelli is a cardiologist and he published, he was a co director of Framingham and in 1996 he published in one of the cardiology major cardiology journeys, a summary of Framingham specifically looking at LDL cholesterol. Let's just, let's just look at ldl because that is the so called bad cholesterol. And he said from Framingham, unless your LDL was above 7.8 millimoles, which by the way, I think in your units is probably 250 or 300. 250, probably. I think maybe we can look it up and calculate. But let's just say for argument's sake, around 250, which is very, very high, by the way, it absolutely had no, it was useless as a predictor for coronary arteries. Ldl, ldl. Now why is that when you correct for triglycerides and hdl, okay, which by the way is a more important predictor of heart disease, LDL loses its significance completely. So then if that's true, and I'm saying that means LDL isn't really a risk factor for heart disease. And I believe with everything I know now that to be the case, okay, let's unpick every part of it. Does lowering LDL cholesterol from diet or drugs, but more specifically drugs, because they're the most potent ways of lowering LDL cholesterol, whether it's PCK9 inhibitors, whether it's statins, whatever. Is there a clear correlation? Is this dogma true that the lower the better? So myself and two cardiologists did a systematic review of the totality of drug industry sponsored trials, by the way, in Some diet trials, but many drug industry sponsored trials. All of the randomized control trials on cholesterol lowering drugs, statins, PCK9, blah blah. Was there a clear relationship as you lowered LDL in low risk and high risk patients, Mark, over 30 studies. Was a relationship with lowering LDL and preventing cardiovascular events? No.

Even in high risk patients?

Even in high risk. It's nonsense. It's nonsense. So the question then is why do we also believe so does that mean. But then I said, well, of course statins have a role. They do have a benefit from the, from the RCT data, which is small because I knew already they're anti inflammatory and anti clotting. So it's nothing in my view. Listen, I could be proven wrong here, but the evidence at the moment looks very clear that there is no consistent relationship. Right. It's definitely not a clear relationship. So if even if it's a weak relationship, Mark, let's just argument's sake, let's say there is a weak benefit in learning ldl. What else is going on and what else are you ignoring? Right? Yeah. What else does statins do? They cause insulin resistance. Say 1 in 100 people get type 2 diabetes because of statins.

One in two?

One in 100.

One in 100?

Yeah. One in 100. So about 1 to 2%. But 1 in 100. Some, some studies say 1 in 50. Right. We'll get type 2 diabetes because of the statin. Probably reversible still, but not ideal. Right. If you're on a stand drug. The second thing is look at the whole patient coming in. We have the illusion of protection. We have patients I used to see coming in and they thought my cholesterol is low, I can go and eat at McDonald's, it's fine. And they, and they're getting more and more overweight, more insulin resistant, they're increasing their cardiovascular risk. They're not told the statin is going to give them a 1% benefit. That is more likely than not, they're not going to benefit. So you could imagine that concept, that the overall net effect of the way that statins are prescribed and the dogma around them in my view has been negative and has actually been one of the main reasons why we have got this pandemic of chronic disease.

Because we over emphasize an index on LDL cholesterol and forgotten everything else.

Absolutely right.

Because there's a drug for it. It was interesting to me if there was a drug for insulin resistance that worked really well and we have metformin, but it's and it fixed insulin resistance. You know, everybody be prescribing it, but we don't even diagnose it in most people because we don't have a drug for it.

Exactly.

And it's stunning to me that, you know, I was talking to the lab director at Quest Laboratories. I said, what percent of your tests you get to come in are measuring insulin? Which is, I think, one of the most important things you need to know about your biomarkers. And he was like, less than 1%. And it's part of why I co founded this company, Function Health, to really look at a deep biomarker set around cardiometabolic risk factors, including insulin, including lp, including something called apob, which I want to talk to you about.

Yeah.

Not just your total ldl, hdl, and triglyceride levels, but also particle number, particle size, inflammation markers, all the things that are often missed, but that are much better at giving you a holistic picture of your cardiovascular risk. And then you know where to intervene. And in one of the studies that it was so interesting to me was actually from, I think Scotland or Ireland was where they looked, basically a series of patients who came into an emergency room with a heart attack, and they did glucose tolerance tests on everybody who came in with a heart attack, and they found that two thirds either had diabetes or pre diabetes who had a heart attack. That that was really the big driver. Now, there's a subset of people have familial lipid disorders, you know, inherited genetic lipid disorders. And those people probably need to be treated more directly. But for the majority of people out there who are obese or have prediabetes or metabolic dysfunction, which is basically in America, 93% of Americans, that's what's driving probably most of the heart disease. Not 100% butter or saturated fat or LDL elevations.

Well, something else to throw into the picture. You can make the argument, okay, Dr. Malhotra, you're saying there's no consistent relationship. There may be a benefit. Why not just lower your LDL? Okay, so 2016, and the reason we did this, me and a number of international scientists looked at, we decided a systematic review of observational data looking at people over 60. Was there a relationship with LDL cholesterol and heart disease? And the reason we did this, by the way, is another thing that was interesting from framing, which wasn't well publicized, is that when after people hit 50 years old, as their cholesterol dropped, their mortality increased. So we thought, okay, is there something. Because for it to be a risk Factor for heart disease. It should be consistent really across all age groups in both sexes. Right. For mortality. Yeah. But even for heart disease as well. Right, That's a good point. So we looked at. Was there first of all any association if you're over 60, with LDL cholesterol and heart disease? Right. We found none. Okay, interesting. But what was surprising was there was an inverse association with LDL cholesterol and all cause mortality. In other words, statistically, if you're over 60, the higher LDL, the less likely you are to die. So what's the reasoning for that? Well, something that's been forgotten or missed or not discussed. Cholesterol is, has a very vital role in many functions in the body, including, you know, brain, the brain hormone production, but also the immune system. And it's likely that that's where the protective benefit comes because older people are more vulnerable to dying from infections. And we also know there is an association, I'll use this word, an association. Right. Can't say it's definitely causal between low cholesterol and cancer. Again, it's probably related to the immune system.

Yeah, I mean, I think, I think.

Which is very interesting.

This data though is, and I'll just push back a little bit is it's, it's observational data. And the data like from the Hawaii study show that, you know, the, you were older and you had higher cholesterol, you know, you're more likely to live longer than if your cholesterol is lower.

Yeah.

But it may be because the people had low cholesterol are malnourished, have cancer and other reasons.

So let me push back on that. So we, we counted for that and we found. Actually no, when you, you count like time lag, you go back five or 10 years. No, it's not, it's not that does happen, but it, no, it's. Independently it does seem to be an issue.

Okay, so you sort of looked at all the data and you came up with this very kind of contrary opinion, which is that LDL isn't all. It's cranked up to me that statins work a little, but not for the reasons we think, meaning they lower inflammation and they may have other properties that may beneficial. We don't even know. We call this pleiotropic effects. They for example, they induce nitric oxide synthase which dilates your blood vessels and reduce inflammation and helps your body lining of your blood vessels. All that's protective. And so it may be stabilizes plaque. It may help in those ways, but it may not be the LDL lowering effect. In fact, Paul Rittger from Harvard, I remember he published a trial, I think it was the Jupiter trial where they showed that if you, if you had a high LDL but didn't have any inflammation, you didn't have that significant a risk of having heart disease. But if you had interesting, a high level of inflammation, high ldl, you had a much higher risk. So it was the inflammation that was really driving the heart disease. And that was really the seminal paper was in the New England Journal of medicine over 20 years ago. I remember reading it by Paul Richard and his crew that really laid out how heart disease is not a plumbing problem, it's an immune problem, 100%.

It's a chronic inflammatory process exacerbated by metabolic risk factors or insulin resistance. And I wrote metabolic risk factors.

By that you mean problems your blood sugar and insulin, insulin resistance and prediabetes 100%.

And actually we published an editorial with two cardiologists I did in British on sports medicine in 2017, which was a very long title but it got a lot of publicity and more than a million downloads which was Saturated fat does not clog the arteries. Coronary artery disease is a chronic inflammatory condition which can be effectively managed with lifestyle changes. That was the title of this thing. But it's all there, people. It's free access. People look it up and read it. But we talk that we've overdone the thing. And it wasn't just Dr. Malhotra, his opinion being controversial. The two, my two co authors were both editors of medical journals and cardiologists. Luis Redberg, editor of Jamaican of Medicine and Pascal Meyer, editor of bmj.

Why is this not getting more play? Why? Why is still the dogma and the orthodoxy that if you have a high ldl you take a statin.

Do you want my honest answer, Mark?

Yeah. I mean, not all. I mean I know doctors are usually very good hearted, sure. Very smart, well intentioned, don't want to hurt their patients, try to do what's in the best interest of their patients and follow the science. So why are they not hearing about this?

Okay, so let's go to the root cause of the problem. Even in society day, what's the big issue in health? We have commercial distortions of the scientific evidence. Who is behind that? And who has more power and control over medical education, medical training, the media than ever before? Big corporations, in this case big pharma. And the level of this control and power, Mark, has got to a level where it can be very easily and rationally, not in an inflammatory way or overplaying it as being tyrannical. What also happens with these big corporations in the way they exert their power, is that they want to avoid conflict. They want to avoid the truth coming out. So there's a debate and discussion because ultimately people like myself, like you, who are obsessed with the truth, who want to get it out to help patients, when we speak and act from a place of, of integrity and truth, it has a very powerful resonance with people and it can very quickly destroy all these other dogmas that people have created because of that power that the truth has. They want that conflict to remain latent, to remain hidden so that, you know, Noam Chomsky says the general public doesn't know what's happening and they don't even know that they don't know.

That's right.

Right. So a lot of these doctors, and I agree, are well intentioned, but they don't. They're living, you know, in many ways they're living, they're climbing up the wrong wall to success when it comes to helping patients because it's a drug companies that are really calling the shots. So we are under a situation of tyranny. And the reason I call it tyrannical is because there are doctors that know this, Mark. There are a few doctors that kind of know this, but then they're less, they're afraid to speak out. And only a minority of the doctors that know what's going on will then speak out.

And it's hard. I mean, listen, you know, I practice medicine. I've seen patients. You're busy. Like I literally had to slack myself in a room, you know, download every paper on this, read it carefully myself, synthesize it all, try to make sense of it. And it's still confusing. And I wrote a whole book about it. I'll call you Fat Get Thin. And I think it's still hard. So the average doctor doesn't have time to kind of do that. They kind of take it face value, what they get taught in their training and they try to look at the evidence as best they can, but also they're looking at sort of biased evidence.

Completely. Absolutely. And then of course, there's a psychological side of it as well, because as human beings, you know, they say changing one's mind is one of the most emotionally traumatic things a human being can go through. Right. And that's where you need humility. Right. John Kenneth Calbraith, the Canadian American economist, said, faced with the choice between changing one's mind and proving there's no reason to do so. Almost everybody gets busy on the proof. Yeah. So for the medical profession we need to have also more humility. I mean one of the interesting, like there's a great, There's a great YouTube channel called After School which I watch a few times. It's brilliant. It goes through like ancient wisdom and philosophy and psychology and it says one of their titles. You should look this up, Mark, you'll love it. Why do intelligent people believe stupid things?

And the answer is.

And well, because.

Our intelligence evolved not for seeking objective truth, but more about belonging to a tribe, you know, for personal gain, whatever else. So what is, what do we need to break out of that? There are two characteristics in the human being that are most important for you to think outside the box and be willing to change your mind and not being afraid of it. One is humility and the other one is curiosity. So it ultimately comes down to character. And we've got a system over the years that has become more and more corporatized. Right. You have in America suddenly, you know, and I consider this my, honestly, I'm, I'm, you know, I, I consider America my second home. So I have a lot of love for America and the American people because I have relatives here and I've been here a lot. But you have now the highest health care expenditure in the developed world, over $4 trillion with the worst health outcomes. Oops.

Right.

So what's happened is because of all of this situation around corporate capture, so the counter, of course from a philosophical point of view is that living a life in darkness has no meaning. Yeah. And we need to get people out of this darkness so understand the root of the problem and then we can.

Then start making things think about. You have to take time to think and learn. I mean, John F. Kennedy said we enjoy the comfort of opinion without the discomfort of thought. And I think it's hard to kind of sort through it all. I mean I found it very hard. You know, I just sort of reflect back on some of the data that I uncovered as I was sort of researching this. And it was just one very large study showing that it was, I think 231,000 people in 541 hospitals that had had a heart attack. And it was looked at over a six year period. And they looked at cholesterol lipid levels for everybody. They found that 75% of people who had a heart attack had quote, a normal LDL under 130, which is what's considered normal. 50% had higher optimal levels, under 100. 17% had super optimal levels under 70. But what they did found was really interesting and again it confirms this whole metabolic hypothesis of heart disease that it's really related to mostly insulin resistance, that.

Those with low HDL and high triglycerides, which goes along with small dense cholesterol particles, were much at a higher risk of having a heart attack. And so in fact the average HDL in that group was 39, which should be ideally over 50. And the average triglycerides was 160, should be probably under 100, ideally under 70. And it didn't really seem that LDL was really the driver. It was the triglyceride to HDL ratio. It was the triglycerides in the hdl and it was what is what we generally call an atherogenic. Yeah, lipid profile, which is not just about the total number of cholesterol or the LDL number, it's about the quality of your cholesterol, which is the size and number of the particles. And the smaller dense particles are the ones that are more putting you at risk. And those are the ones that are caused by sugar and starch, not fat. Fat. Fat actually improves the size of your lipid particles.

Yeah, no, fascinating and it makes sense but also interesting. Something else that I came across in the last few years which you'll find fascinating, Mark, and I don't know if you know this, David diamond, who's a cholesterol researcher, published a paper, I can't remember which journal it was in very recently and they looked at the primary prevention randomized control trials done by obviously by the drug companies and secondary prevention trials and subgroup analysis found. So these are people with statins who had neither either were high risk of a heart attack or had a heart attack in the patients in the trials that had normal triglycerides and hdl, no benefit at all from statins. Think about that.

So if your triglycerides and Asia were.

Good, even people who've had a heart attack, there was no benefit from the statin at all. Which fits with what you just said.

And it's kind of interesting because you know, you get the benefit in some ways of inflammation protection, but you also get increased insulin resistance.

You do. And of course we haven't talked about side effects. And that's another issue. Right. So if you look at, you know, to try and explain why there's no reduction in cardiovascular mortality, even if we expect accept a four day increase over five years in high risk patients, one of my explanations is this. In the real world, at least 50% of patients prescribed statins, even in high risk groups, will stop taking it within a couple of years. And when you do surveys, most of them say they felt they got side effects. Muscle fatigue, muscle pain, brain fog, erectile dysfunction. And how prevalent, That's a big. Well, how prevalent is that? And you look at the data and it's mixed. But anything from, in my experience, anything from 20 to 50% of patients at some point, I've had patients who took statins for 20 years and didn't get side effects for 20 years and then they got side effects and it gets better when you stop. So they're very prevalent. I wouldn't say they were serious or life threatening. But, you know, the question I ask the patient always, does this interfere with your quality of life? Right. And it's very simple, you know that as a person, it's a very subjective answer, yes or no. If it does, we need to do something about it because, listen, we're all going to die at some point. What we want to live our lives in the best health we can for as long as possible. Right? That's the, in many ways that's probably more important than our longevity, right, Is having good quality of life. So that is something that I address with patients as well.

So you're going to sort of see them in the argument and argue the other side. How would you argue against yourself for this? Because, you know, I've had these conversations with cardiologists, with experts, and they're like, listen, the data is just so strong about statins and there's no question that they lower risk and there's no question their benefit. And yes, there are side effects. It can cause mitochondrial injury, it can cause muscle pain, it can cause insulin resistance, but the trade off is worth the risk. And data is so prevalent and so strong and so clear that we should all be taking stats.

I think the arguments to be made on interpretations of the evidence, trust in the evidence and different bits of evidence. So all I can say, Mark, for me, is that we all have our biases. And you could argue that I have a bias because I have an obsession with lifestyle and I'm a foodie. And I started cooking when I was 16. I was taught by my dad. And, you know, one of the reasons I got annoyed or pissed off in the hospital and got into this whole, my campaigning started about hospital and just, you know, why are we giving junk food to patients? Because I also, as a doctor was like, frustrated. I can't get any healthy food anywhere. So that could be my bias. Fine, but. And I accept that one of the things I do myself and I think the reason I've been through a process where I've had to change my mind several times on saturated fat, on sugar, on low fat diets, on statin prescriptions, on cholesterol, on something more recent and more controversial, which we're not talking about, is you have to have an element of humility. But when I do that, my analysis myself, I try and counter my own arguments and then try and find a way of a nuance. I can't really see a strong counterargument. And I'm not saying this from a place of hubris because. Okay, let me give you one argument. So if, and this is a hypothetical, if statins didn't have side effects or they were almost non existent, I could actually say put them in the water supply. Because even if, you know, there is a concept in medicine, you got to treat the many to benefit a few. So let's just say that they save lives in, I don't know, on average say 1 in 300 people are going to live longer because of statins. Right.

It's a public health.

Yeah. For public health. So you know, put in the water supply, you know, give to 3 billion people. We're going to have, you know, you're going to save 1 in 300 of those 3 billion, you know, whatever that is A lot of people. It's a lot of people. It's, it's, it's tens of millions of people, at least not hundreds of millions. So you could make that case. But that isn't true though. That's just simply not true.

Yeah, if there were no side effects.

So, so, so I am very for, you know, and that, and that is an argument that has been put forward.

And the issue about there's marginal benefit.

Yeah, but I'm saying that if you, it's a, it's a public health intervention that doesn't have any downside. But, but if it doesn't have any downside, that's fine, then go for it, put it in the water supply. But unfortunately it does and that, that's simply just not true. So therefore you then have to then talk about, you know, and some of the doctors come from a mindset, Mark, where they don't even, they, and this is a different school of thought, but I don't agree with it. It's not about agreement. I mean, okay, maybe say it's my opinion is that they think that There should be an old school paternalistic practice of medicine. Doctor knows best patient, do what I say. That's right.

I'm not working so good anymore.

I'm about, I'm about shared decision making. I'm about explaining patients the way that, you know, that empowers them, that it's a more equal relationship, you know, and that's fine. That's a philosophy. Maybe it's a philosophical disagreement, but that's the stance I'm going to take and I'm prepared to die on that hill.

I think that's right. I mean, I think, you know.

We.

Have to sort of look at this at a high level. Like any tool, there is a use for statins, there's a use for the PCSK9 inhibitors, there's a use for the new CTP drugs that are coming out. There are people who benefit. And I don't think it's heterogeneous. And I think we have to sort of. And I've noticed this as sort of, as a doctor who's been doing this for 40 years, not everybody's the same. Saturated fat is fine for most people, but not for some people.

Yeah, right.

Sugar can be tolerated more by some people, but not by others. I just came back from Utah and was in the Native American reservation, the Navajo reservation. It was just staggering to see the amount of obesity. And when you look at, you know, 150 years ago, there wasn't a single overweight Native American, period. And why, it's because the metabolically, genetically they're different. So I think I'd love to sort of explore who might benefit from these drugs because there's a class of people, we refer to them as lean mass hyper responders, where people like you and I maybe who are athletic, who are fit, who may actually have a adverse response to increased saturated fat in the diet, or who might have a family history of lipid disorders and actually have some genetic issues, which I do in my family. So how do you sort of handle those cases?

So I deal with those actually quite regularly. So, interestingly, about the saturated fat, I think you're right, Mark. There are definitely a subgroup of people who have more who have very high saturated fat intake. Actually it does affect their insulin resistance or make their triglycerides go up. And in fact, there was a paper done by, I think his name's Ronald Kraft, if I'm not wrong.

Ron Krause.

Ron Kraus. Sorry, Krause. You're right. And he showed and he showed there was an abnormal effect on lipids if your saturated fat consumption in this, obviously, certain groups of people was more than 18% of your total calories.

Right.

It's still very, very high. But again, that. You're absolutely right. That might happen with a certain subgroup of people. I've seen, for example, a patient on a carnivore diet who actually had something like that. And when they reduce their saturated fat intake, their lipid profile got better. That's all they changed. So I agree with you. There are going to be a subset of people. What do you do with fh? The people with the familiar hyperlipidemia. So let's just lay it out for people, right?

And I think there's more than just that one subtype. There's many different types of genetic lipid disorders. Of course, I think we're just starting.

To figure out there are. But, you know, you talk about apob and lipoprotein little A, which are all these other extra markers of risk that are added in basic teaching in medical school, certainly what I teach medical students and junior doctors. Right. Don't organize a test unless it's going to change your management plan. Right? Because what's the point? So you create. Unless there's anxiety, for example, for some people. Now, I get it, people may want to know, and if that's what they want to know, that's fine. But, you know, and we'll come on to management as well, if you're not going to add in a statin or whatever else. And okay, maybe those people need to be more extreme in the lifestyle. Maybe that's a reason to do it. Saying you need to be like, instead of meditating for 30 minutes a day, I want you to meditate for an hour. Right? No, fine. I mean, maybe that's the best we're going to offer them, right? To keep the wrist down. So we've got to just be a little bit careful about how we. About ordering these tests and then. But thinking a little bit more about, okay, is it going to change anything? And am I just going to give this patient unnecessary extra anxiety? And I'm. Listen, I'm a doctor. Doctors are the worst patients I probably have, probably because my dad was the same. I have moments of being a hypochondriac and I know on the receiving end, like, you know, tests that are done that didn't need to be done. And now I'm like, okay, what does this mean? And you're going down a rabbit hole. So we've got to think about that as well, right? In terms of if you haven't got a clear solution, then don't order the test. I'm not saying don't do the test, but I just want us to think about that a little bit.

It's true. We learned that in medicine. I'm not sure I have the same view because I think that the more data you have, the better you can make sense of what's going on. And I think there's a movement towards this deep phenomics. I've had Jeremy Nicholson in my podcast, Leroy Hood on my podcast, and they're about more data and dense dynamic data, clouds of information from your biomarkers, your metabolome, your microbiome, your genome, your transcriptome that all teach you about the sort of subtle changes that may not represent a disease today, or they don't have a drug treatment today, but that if you left untended, would ultimately lead to a disease.

Or, but may not.

Or may not, but, but I'd rather know if my insulin is going up over 10 way before I get diabetes.

No, I agree. So 100%, I agree. There are definitely certain. Yeah. So I think there's a nuance there. Again, there are certain things where we know, okay, there's a very likely benefit here of you getting your insulin down, etc. I think some of the other biomarkers is still in a certain, you know, area. But again, Mark, you said that, okay, you're a guy, and this is if I was having a conversation with you and is your preference of values. You want the data, that's your preference and values. I want to know more and more and more, and that's fine, Mark, I'm going to help you and let's do all these tests for you. Somebody else comes in, you know, and then suddenly they come back. And the thing is, I see this, this is what happens with the whole cholesterol hypothesis, right? I've got patients coming to me for second opinion. As a cardiologist, I do, you know, international consults and virtual and whatever else all around the world. And they, and I talk to them and I just start to tell me what's been going on. And they're, they've been living in absolute fear of death for months. And some of them break down in tears when I just say to them, listen, I've just done a cardiovascular risk here. Your LDL cholesterol is so called high, but it's not an issue and you're fine and your risk is only 2%. And you can just see a sigh of relief and say, doctor, thank God, I've been going on thinking that I'm. That's again, misuse, not good use of maybe numbers or statistics. I mean, going on thinking that I've got, In the next five years, there's an 80% chance I'm going to die of a heart attack. I'm like, no, it's 2% in 10 years. Right, right. So. So there's also that as well. So I just think we just to think a little bit carefully on it. But coming back to FH, FH affects familial hyperlipidemia, genetically, very high cholesterol. Okay. 50% of men and 70% of women. Right. With FH untreated, big numbers will not develop premature heart disease. But 30% of women will. And 50%, which is a lot, will get even before maybe 50 or 60 will get heart disease. So I did actually a review paper with a number of international scientists as well, and we published it in BMJ, evidence based medicine. And we thought, okay, that's interesting. 50% of men with FH, familial hyperlipidemia, very high LDL, don't get heart disease and 50% do. Is there anything we can find that's different between them that highlights the subgroup? Like what is the difference between them? First thing, was it the ldl? Is the LDL higher in those ones that get heart disease versus the ones that don't? No difference at all. Ah, that's interesting. It can't be the ldl. Then what is it? Well, we found, and this is Mark, you're going to like this. One of the lipoprotein little A was higher than the one that got heart disease. So FH you should look at like definitely that gives them a high risk. But what's most promising and interesting is when you correct for insulin resistance. Yeah, right. Their level of risk of heart disease for FH patients almost comes back to someone who's completely healthy. It's only slightly higher. So what were the two markers? Normal waist circumference and low insulin. Yeah. Now how do you get there? Diet. Right. Cutting out the sugar, processed foods, refined carbs.

That's right.

And it rapidly. So this is amazing. So I can. So what I do with those patients is I go through that with them. Now, if I think they're actually the high lipoprotein and they're probably at high risk, I say, listen, the statin benefit is there, it's small, but why don't we do a halfway house? High dose statins are more likely to give you side Effects. Let's do a lot of statin. Let's do the lifestyle. The lifestyle is most important for you. And I go really hard on that with them, including the diet, the exercise and actually the, the one that I think isn't discussed enough. And you know, it comes out in my, my documentary film which is called first do. No Farm. P H A R M not farm.

All right, how do you, how do you find that?

We. It's released online at the moment and you can download it for $10. And it's. The website is nofarmfilm.com and the reviews have been, you know, pretty extraordinary.

No Farm.

No Farm film dot com.

P H A R M. P H.

A R M. Okay, yeah, yeah, yeah. No farmfilm.com. we screened it in, in the Lesser Square Odeon in London, which is the most famous cinema in the world. 790 people came. It was invite only, but celebrities, really good feedback. Screened it to Doctors Integrated Mental Health conference in Washington D.C. really amazing feedback there. And so far, you know, we're getting reviews that are giving it sort of 9.7 out of 10, which is great. I'm proud of that. But most importantly, Mark, it is a. It is, in my view, this film uncovers.

Literally how we have got this pandemic of chronic disease, both with big pharma and big food capturing. We've got, you know, medical knowledge, we've got very credible experts formed the bmj. We go into some dark stuff in there, just how many people have been killed by research fraud. But we also give people hope with the lifestyle stuff. And one of the most interesting things I discovered in the, in the film or in my own research is that for me, pushing the boundaries on heart disease is also the next phase is can you reverse the blockages of coronary artery disease. And the only. There's not a lot of research out there. We know, of course, Dean Ornish did his trial many years ago, but the reversal was very, very, you know, listen, at least very recent stabilized coronary disease. But it was like 1 or 2% in terms of the blockages. Cardiologists in India for 20 years has been reversing heart disease to the level where, you know, one of his papers that he published showed a 20% reduction within two to two years of the.

Of the narrowing of the artery.

70% became 50, 50 became 30. So he did it through this healthy lifestyle program. It was. There were devout Hindus, hundreds of patients, right? High fiber, vegetarian diet because they were Devout Hindus. Fine two 30 minute brisk walks a day. Okay. And then something called Raj Yoga meditation. And when he did a deep dive analysis into what caused a reversal, the only independent factor for reversal of heart disease was 40 minutes of Raj Yoga meditation a day. So I went to India and I thought, let me just. Is this true? Is this real? Let me look at the angiograms on myself. I trained in this stuff. I know this stuff inside out. It was unbelievable what I was seeing. I was seeing those patients. I've seen the angiogram reports. There was clear reversal in some patients. It was a complete 100% occlusion that then opened up.

Wow.

Right. So I think it's because you've turned down the chronic inflammation by getting on top of the stress. But it wasn't just about breathwork and meditation. This comes into something that we are dealing with right now in society, which is a crisis of morality. Okay. It was a spiritual transformation. These people changed their mindset. They became less materialistic, they became more spiritual. They how thought how to reduce their anger. They were, you know, he got them into the ashram with their wives, for example, the men, and vice versa, to talk about why were they getting more angry. Like, how is your relationship, what's going on with your work? It was a real spiritual transformation that reduced probably the stress. And I think that probably has a scientific basis because we know chronic stress increases chronic low grade inflammation. We've talked about heart disease being a chronic inflammatory process. You turn down the inflammation and the body can heal. The body has a capacity to heal itself.

So kind of in wrapping up, you know, kind of what I'm hearing is statins have a role, but they're not all they're cracked up to be.

Yeah, Just, just know, are they right for you? Are you being told the absolute benefit is. And then what do you think? Like, you know, do you want to take it or not?

And that you have critiques of the way the research was done and how the studies sort of sort and sifted through the statistics to show the benefit, how it's reported as relative risk versus absolute risk. So if you get a risk reduction from 3% to 2%, that's a 30% risk reduction. Sounds great, but it's really a 3 to 2%, right?

It's 1%.

Yeah, 1%. And you know, there are flaws in the ways in which a lot of these studies are done. So could you sort of, for some of the big data that you kind of critique, can you sort of unpack that a little bit? Because I think we didn't dive deep Enough into that I want people understand this is not just sort of a heretical opinion, but this is after looking at the way these studies were designed, the way they were done, what the data actually show.

So, so when they do the randomized trials where you're trying to compare two groups which are the same and you're trying to get show a benefit of an intervention, what's reported in the results often underestimates, massively underreports the side effects. Because what the drug companies do control how the trials are designed, how they're conducted. Think about that. They're only interested in profit, not looking after you. So they will try and design the trials to maximize ultimately the sales of the drugs. They have what we call a pre randomization run in phase where they get these volunteers who are interested in being in the trial. And for six weeks, for example, one of the trials, the heart protection study, a third of the patients, thousands of patients were removed before the trial began because of so called non compliance. In other words, they got side effects. So imagine they take the people out with side effects at the beginning and then they only start the trial once they've taken the people out with side effects who get them early on and then report and then. So that's probably one of the reasons they're massively underreported, the side effects. I'm sorry, Mark, you know, it's fraud. I'm sorry, it's fraud. And let me be definitive about how I describe that. What's the definition of fraud? Deliberate deception in order to make money. I'm sorry, that's the way I interpret it. This is fraud. The system is fraudulent.

Some of the independent studies also show benefit.

Yeah, well the independent studies that have been done have shown very little benefit. But I agree that I think there is a small benefit. But the question then is you also look at the side effects issue and the independent studies have never been able to get hold of the raw data as well on statins, a totality of evidence around statins. The raw data has never been independently evaluated for side effects. So we still don't know the true side effects.

Well, in other words, what we know is what's published, not what it's actually been tracked. Because pharmaceutical companies don't have to release that data. And they hold it.

They hold it. And then you think the regulators are going to be able to ask for it and look for it? They rarely do that.

Well, they have it but they don't publish it, which is interesting to me. The FDA does this because if you probably dig far enough and deep enough. You can find it online or through the FDA databases. But it's not in the literature because they're not published. But the pharmaceutical company has to report all that data before a drug is approved. They can't cherry pick what they provide the fda, but it's not published. And the FDA doesn't do a good job of saying, hey, yeah, this is what they published. But you know, all this other stuff shows that it really didn't work that way.

Well, what they often give the fda, Mark, is curated information from tens of thousands of pages of clinical study reports on patients in the trial. So the FDA normally doesn't go and then reanalyze it. They just trust what the drug industry, the summary results. And then the other issue is of course the financial conflicts of interest. 65% of the funding of the FDA in the US comes from Big Pharma. 86% of the funding in the UK of the MHRA comes from big Pharma. They don't want to bite the hand that feeds them. So there's a huge confidence.

Why? It seemed that the American College of Cardiology and the American Heart association still recommends statins for people with high LDL for primary prevention. Meaning if you've never had a heart attack, which is 75% of the prescriptions, you know, is it because they're captured too?

I think it's a combination of factors, but yes, I think at the root of it is flawed science, dogma and money. And then even if people know there's an issue, they're afraid to speak out because they're worried about their jobs. But if we're all doing this collectively, it's going to be a complete part of my language shit show for healthcare. And that's why we are where we are in America right now. So it's time to. You know, I think I love this phrase. I know this is not a political podcast and it shouldn't be, but you know, a good friend of mine and good friend of yours is Robert Kennedy Jr. And I love the fact that he's come out with this make America healthy again. I think we should all get behind that.

Yeah, it's been co opted unfortunately and.

You can't trump campaign, but. Well, no, but you can't make America healthy again until you remove commercial distortions of the scientific evidence. And that unless that is addressed head on, we're not going anywhere.

Okay, I want to say that again. Commercial distortions of the scientific evidence.

Unless you correct that, you won't Fix health.

There's actually a paper, I'm going to link to it in the show Notes called the Commercial Determinants of Health, talking about the data on how multinational corporations like pharma, food and ag companies subvert public health and privatized profits. And it's a WHO report that's sort of partly published, but also coming out much, much bigger report. And it's going to be interesting when that hits because, you know, we talk about the social determinants of health, but this is really how, how the industry is driving it. And just. The American Heart association alone receives $192 million a year from food and pharma companies.

Right. Crazy. Mind blowing.

It's mind blowing.

How can we, how can we trust that they're being independent with their information? Come on. I mean, it's. People need to just, you know, wake up, wake up.

And you're not telling everybody who's on a statin to stop it. You're not telling them anybody.

Just get better informed.

Get better informed.

Yeah.

Read the data. I wrote an article years ago called what I Got Wrong, what I Got Right, which goes through a lot of this data. It was published about eight years ago, but still, I think there's more and more data coming out all the time. And I think they can check your books. Where do they learn more about your work and what you're doing?

Yeah.

How do they understand?

Very quickly on that. I love the fact you've brought up commercial determinants of health. So there's a definition in public health, because I talk about this as well. So just so people understand what that means. Strategies and approaches adopted by the private sector to promote products and choices that are detrimental to health. That's the definition of commercial determinants of health.

Yeah.

I have evolved that and in fact referenced in the Lancet because Richard Horton, the editor, came to one of my lectures and I've said that the way that drug companies, big corporations, conduct business, not individuals within it, I'm not pointing individuals who work for them as legal entities, the way they conduct their business as actually fulfills the criteria for psychopath.

No, but this comes from Robert Hare.

Amoral, not immoral. Right.

Forensics. Yeah. Forensic psychologist Robert Hare, behind the original DSM criteria of psychopathy, defined them in the book Corporation. He said, so what does that mean? Callous, unconcerned for the safety of others, incapacity to experience guilt, repeated lying and conning others for profit. So there's another one to throw in there. Maybe next time for it. Now Psychopathic determinants of health is my new term. Right. So this is what the root of the problem. Right. And of course downstream effects. We know what's going on. So yeah, people can. I've got a website, draseem.com I think, to be honest, if they want to get an overview of this, it's a 1 hour 50 minutes. It's an educational tool. Please go and download first. Do no farm from nofarmfilm.com and if you want to read about statins in particular, but we cover this in the film a little bit, the whole drama of statins, which is quite interesting. My third book is called, called A Statin Free Life. And I think that really breaks down all the cholesterol stuff and the statin stuff and the lifestyle stuff as well.

Yeah. So in summary, you're not anti science or anti drug or anti pharma. You're just for pro health. Real health.

Real health.

I'm pro ethical evidence based medical practice. There you go.

So it's really been an amazing conversation. I could talk to you for hours. Unfortunately, we have stuff to do. And I encourage people to dig deep into the scientific work you published, which is where I first came across your work in the British Medical Journal, or BMJ as they call it now, and your books, your films. And you're kind of a tireless advocate for a contrary opinion that is really advocating for a better approach to understanding nutrition health and making informed choices as opposed to just swallowing hook, lung and sinker. The dogma that we're all taught in this society, which is that the only path to success in medicine is through pharma. And I am not anti pharma. I prescribe drugs regularly. However, I want to prescribe the right treatment for the problem. And because all we have in our toolkit as physicians is a prescription pad, that's all we know how to use. Where diet and lifestyle work far better and are far more effective at achieving the same or even better results than drugs. And if there was a drug that could, you know, instantly reverse diabetes or fix insulin resistance or prevent.

With no side effects.

With no side effects. Yeah, I would do it. But, you know, I, I've never seen anything work as well as food when applied in the right dose.

Yeah.

The right medicine.

Yeah.

And for the right duration.

100.

And I think people don't understand that about food. It's not like, oh, food is medicine. It's kind of like hippie dippy term.

Yeah.

It's actually very precise. Just like you need to know, know the drug. You need to know the pharmacology. You need to know the dose, you need to know the frequency. You need to know the duration of a drug that you're prescribing for a particular condition. You need to know the same about food. That's how nuanced and detailed it is. Because food is full of tens of thousands of molecules that regulate every single aspect of your biology. And understanding how to leverage that tool for healing is profound.

100 and mark. And another point before we finish is that you know, which you've just raised is that these pills for chronic disease rarely improve your quality of life. They may affect a blood marker, they may reduce your risk to some degree in the long term, but lifestyle changes come without side effects, by and large, and they improve your quality of life.

Well, there are a lot of side effects. You feel better, you have more energy, you sleep better, a better sex drive, less depression, you know, so all the side effects are.

Good point, fair point. Positive side effects.

Well, thanks again for being on the Doctor's pharmacy, and we'll see you next time. And keep up the good work, man.

Thank you, Mark. Lovely to see you.