Comments on: Why They’re Trashing the JUPITER Trial

By: Wagamama

Wagamama — Sun, 02 Oct 2011 23:50:27 +0000

Totally agree with your excellent posting. The Editor of Archives, Dr. Redberg, is clearly auditioning for a prized place on Obama’s Death Panel…..Sorry, I mean IPAB.

By: Grand Rounds From The Shores Of South Africa - Better Health

Grand Rounds From The Shores Of South Africa - Better Health — Wed, 14 Jul 2010 16:00:47 +0000

[...] man i consider a great blog academic, doctor rich wonders about the motives of people trashing the jupiter trial in an otherwise respected [...]

By: Around the Mediverse: July 8, 2010 « The Notwithstanding Blog

Around the Mediverse: July 8, 2010 « The Notwithstanding Blog — Fri, 09 Jul 2010 05:58:42 +0000

[...] doesn’t mean. In a similar vein, Dr. Rich tries to get at the real reason for some of the outcry directed at the results of the recent JUPITER trial (statins for primary prevention in healthy [...]

By: DrRich

DrRich — Tue, 06 Jul 2010 21:59:44 +0000

Praveen, JUPITER reports the relative risk reduction. I have just published a post that offers a reply to your comment, arguing that, in this case at least, it is reasonable to talk about relative rather than absolute risk reduction. I'd be interested to see whether you think I have pulled it off. Rich

By: Praveen

Praveen — Tue, 06 Jul 2010 18:58:42 +0000

Dr. Rich,

Is relative risk reduction the typical standard used when evaluating a drug’s potential benefit? Are the JUPITER trial numbers relative risk reductions or absolute risk reductions? For instance, if a patient has a 0.1% chance of heart attack over the next year, and this is reduced to 0.08% through the use of a drug, is that considered to have lowered risk by 20%?

I can certainly see why a properly run NICE-like organization would want to use absolute risk reduction metrics, and not relative risk reduction metrics. When quantifying the expected value of treatment, and comparing that against cost, absolute numbers are needed.

This is not unlike the recent dust-up related to mammograms – cost effectiveness is determined in no small part by how many patients need to be treated to prevent a single death.

By: Tom

Tom — Tue, 06 Jul 2010 00:47:43 +0000

In fairness to the meta anaysis, they pooled data from previous trials that related to primary prevention, excluding subsets of patients with known CAD. Their point was that pure primary prevention had not been adequately addressed. Statins are likely helpful in primary prevention, it makes sense. Of course, so did steroids in sepsis =).

As for the 4th ‘study’, they truely embarrassed themselves.

By: Chicago Boyz » Blog Archive » A Nexus Between Academic Medicine and Government

Mon, 05 Jul 2010 18:59:21 +0000

[...] the effect of Obamacare on doctors. A couple of interesting statements bring up some comments on an excellent medical blog I [...]

By: Jan Krouwer

Jan Krouwer — Mon, 05 Jul 2010 00:42:03 +0000

If you are Michael A. Smith, M.D., of the following websites and video, then rest assured, I am not interested in a diet dialogue. I was merely pointing out to Dr. Rich that references to hypothetical cavemen are not needed – real modern data are available.

http://www.weight-loss-professional.com/index.html
http://www.innovative-diabetic-diet.com/

By: Michael A. Smith, M.D.

Michael A. Smith, M.D. — Fri, 02 Jul 2010 20:51:15 +0000

Thank you, Jan Krouwer, for sealing my impression that not only do we no longer value critical thinking, we know longer value the ability to judge the merit of our opinions.

You are a credit to our shared future. Behold, entropy and the prattling of the herd!

MAS

By: Jan Krouwer

Jan Krouwer — Fri, 02 Jul 2010 17:58:52 +0000

Regarding the low LDL cholesterol levels in certain populations, in the book, “The China Study” which is a nutritional study of China and the US conducted in the 80s, the average total cholesterol value in some counties in China was 94 mg/dL.

These people did not get cardiovascular disease and also did not die young.