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 have 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, what, six years since I podcasted? That's right. Yeah, got a lot of, a lot of interest. So I think, yeah, let, uh, we did. So, as you heard in 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 disease than high LDL cholesterol, bad cholesterol, take a Statin, and a 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, 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 Harcombe and Dr. Malcolm Kendrick against Associated Newspapers, which is the publisher of the Mail on Sunday. And there were a series of articles published in March of 2019. Uh, 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 "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, um, 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, their data is flawed on statins, it's overemphasized, it's overprescribed, it has risks, and there are other factors that need to be considered that are often being missed. And, you know, it's a more nuanced view that you have. It's not just drugs are bad, you know, food is good, or drugs are bad, and, you know, weak grass is good. It's, it's basically looking at very nuanced science to help unpack what we know and we don't know about cholesterol and cardiovascular risk. So, can you walk us through what happened with that case and what the findings were, and, and, and, um, how you have all been vindicated as a result of the, the legal decision around this, this, uh, 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 thing. You said, um, and first of all, to clarify, Mark, the reason I did not decide, I mean, it was something I thought about, uh, to sue the Mail on Sunday. I think I was at the time, there was a lot going on. My mom had just died. Um, you know, for me, as an activist in a campaign, I made the decision that I'm going to keep talking about this issue and carry on and just take it on the chin. Um, 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 for Zoe and Malcolm because, um, you know, it, these sorts of things, they do have an impact on you. I, I, before I tell you that, 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, and by the way, I have an impeccable track record in terms of my clinical care, getting on with my colleagues. You know, I'm probably an unusual doctor and probably lucky as well, um, because I, 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, um, that's what happened. And then I wasn't able to get a job back in the NHS. I, I, 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, CU I trained in, you know, some of these hospitals and had good relationships with, with cardiologists there who respect my opinion. Um, and it would be the case where, say, in a cardiology department of eight people, if seven of them said, it'd be great, let's have a seam here to do clinics and and work here for a bit, just one of them would object. No chance, you can't get in. And, and it was always, it came back to, when I asked the reason, it was, you know, there have antibodies that have been developed against you because of, because of your statins, essentially. Right. People are allergic to you because of your opinion on statins. Exactly.

But, but also that, so what happened in the case is that, you know, this was a front-page news story. What made the new 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 of State for Health at the time, called Matt Hancock, you may have heard of him, to say that there was no place in the NHS for these sorts of doctors who are spreading misinformation on statins. Now, interestingly, and of course, one of the most extraordinary bits in, 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 imagine a picture of me, Zoe Harcombe, and him. Right. You have your corner in hell all picked out. Oh, exactly right. I mean, it's, I mean, I find it funny, to be honest. I mean, of course, a lot of other people were more upset than I was. In fact, the, the former Queen of England's doctor, um, and the, and the past president of the Royal College of Physicians, 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 this? Is not what you say, blah, blah, blah, right? And I was calming him down, saying, Richard, just, 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 is 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, I'll mention this crucial bit of evidence which is extraordinary and helped, I think, shift the case and win it, um, 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 Trialists Collaboration in Oxford. These are the most powerful, um, 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 dollars from drug companies that manufacture statins or new cholesterol-lowering drugs. Okay.

So, listen, that for, 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, I remember Peter Libby, who you might have heard of, who was basically the editor-in-chief of the main cardiology textbook that all fellows take, called Braunwald's Cardiology. He, he, uh, is, you know, chairman of cardiovascular disease at, at Harvard. And I said, Peter, why don't you study lifestyle interventions for cardiovascular disease versus just studying medication? He says, Mark, I know lifestyle works, but I can't get $5 to study lifestyle. I can get $150 million to study a drug. 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, that, you know, there's, there's an inherent bias in, in a lot of how we think about things in medicine because of, 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, um, Professor John Ioannidis. I, I refer to Stanford. I refer to him as the Steven 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, we've talked about before, I think, which is called "Why Most Published Research Findings Are False." Yeah. 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. That's right. 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, 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 in a way they can understand. We'll get there in a second.

So, what happened in the case? So we have this kind of defamatory, you know, attack on us. But what made the story was the Secretary of State for Health getting involved. Now, interestingly, one week earlier, just before this news story broke, I was speaking in Parliament about type 2 diabetes reversal and the benefits of, for example, of a low-carbohydrate, you know, real food diet for that purpose. Matt Hancock had agreed to meet me. He had, um, was aware of my work because of another politician who had lost £94 from following my diet plan. This is the one who said, you need to have a special place in hell. Or no, that was the editor of the, of the, of the actual, of the, um, the newspaper. So Hancock, all Hancock was involved in the story because he had basically said he'd been contacted by the Mail on Sunday and said, there were 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 on lifestyle, and gave my lecture in, 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 news story is like, okay, we, we're getting something that's challenging our views on cholesterol, on, 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, 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, Asim, I had no idea they were referring to you or Zoe Harcombe. And I was like, okay, this is very interesting. So I, I kept that. Obviously, when the case then evolved and went to court, the, the lawyers for Zoe and, 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 Corman, who was the health editor, on the stand and essentially made him admit that, you know, that in a way that they had misled Matt Hancock because they hadn't told him, because if Matt had known, cuz I'm, I'm a, you know, in person. So probably. So this is what really changed the case. And I think that that is, yeah, that. Well, it is what it is.

So, what were you actually saying, and what were Zoe and Dr. Kendrick saying that raised that concern? And why was, why was the, the Mail on Sunday so vocal about criticizing you? What, what were they coming after? So this is basically based upon probably both Malcolm and Zoe and my public advocacy on the overprescription 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, Asim, is that 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. No. So you're not seeing the full spectrum of what the data show. You're just seeing cherry-picked data that shows. Absolutely. That's massaged and twisted. You know, I think it was Mark Twain who said, there's liars, there's damn liars, and there's statisticians. Yeah. You know? And so, absolutely. 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 have seizures, but you need water to survive, right? Everything has a role. But how it's used, how frequently 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 warped 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 whose 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 get telling the nurse to give it to them in the ER before they've even gone to the cardiac. For them, I'm a cardiologist saying you should serve it at at McDonald's with your, you know, french fries or have it over the counter. I mean, there was, uh, in 2021, globally, it was $15 billion spent on statins. It's projected to be $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, that there's a barrier to the truth, which is essentially a financial barrier because of, there's 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? Okay. 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. It's 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. We can't tell you 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, in a level of information that they can utilize for really benefiting on 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, 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 slide 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, 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, you know, 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, what are the limitations? Why have we not really, um, advanced evidence?

You 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 sciences, not what the patient is experiencing or what the clinician expert understands from their decades of experience, which are part of the evidence-based triad. 100%. And that's really the failure here. And evidence-based medicine is held up as this holy 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, your explanation of it is, 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, so then the next stage is, okay, so if you accept this as a, a 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 Ioannidis, okay, most published research findings are false, etc. You know, 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 Ioannidis saying this. So you've got all these flaws. So, so what happens ultimately is doctors invariably are making clinical decisions for patients on biased, I'm 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 I, 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 they're, and I think they're good people, and they, and they're trying to do good. They're not deliberately trying to harm people. Yeah, but, but they don't, they can't see what they don't see. Exactly. Because they're in this sort of almost, you know, really good point, Mark. And actually, um, 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. Right. And, and that's what we're trying to sort of get them to think outside the box. Because again, I, 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're 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 is 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 disease. They predicted the end, the eradication of heart disease, may completely end by the early 2000s. Didn't happen. It's still the number one killer on the planet. Mass prescription of statins, more and more people are getting heart disease, but less people are dying from it. Is that accurate? 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 increased 50%. With smoking reduction has played a big role. Um, emergency treatment, specifically in, in the acute setting of an acute heart attack, stenting or thrombolytics, which you used to use, right, clot busters. But the third one, which, uh, Bernard Lown, pioneer and cardiologist, got the Nobel Prize for, was the defibrillator, right? So what used to happen, patients would be admitted to hospital with a heart attack. In the first 20 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, we're 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, a 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 how can you 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 cab of butter, maybe? Well, yeah, actually, absolutely. Butter would be better. We remind me to come back about a butter story and me being hauled into a medical director's office to talk about butter, by the way, um, when I busted the myth of saturated fat and heart disease. You know, when you look at the data from industry-sponsored 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 a person that's had a heart attack, right, and say, in their 50s, is just over four days. Now. So, wait, just to back that up for people. So there's two kinds of treatments for 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've 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 had a heart attack and you take a Statin, it shows that you're only living 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 I 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 are their 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 to a peer review in the, one of the, um, family physician journals in the US called the NNT.com. Numbers Needed to Treat. People can look it up. It's great. What that means, everybody, is how many people do 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. Or maybe they have a resistant antibiotic, it's two. 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. The staff, you have to treat 89 people for five years to prevent one heart attack. Yeah. So it's actually, so, so I know this stuff inside out. Um, so if you've had a heart attack already, let's take 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, warning 39. Now, most people around the world, Mark, are prescribed statins are not in that group. They are in the either low-risk, 75% right? 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 a life by one day. So essentially, if you, if you've never had a heart attack and you have high cholesterol and you take a Statin, yeah, it won't prevent you from, it won't prevent one single death. It will maybe prevent a heart attack if 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 Statin just cherry-picking statistics here? 2009, Gerd Gigerenzer, the director of the Max Planck Institute in, uh, for Health Literacy in Berlin, okay? This is the same institution that that Einstein taught and trained in. Brilliant guy. He wrote in a WHO book, 2009, "It is an ethical imperative for every doctor to understand the difference between absolute risk reduction, numbers needed to treat, 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 I, a patient comes in, he's like, should I take a Statin or not? I say, well, let me just, let me empower you with 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 an understanding of lifestyle, right? So this is what, 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 campaign because overprescription 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 Royal College presidents. I was an ambassador for the overall Academy of Royal Colleges at the time, and to say, 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 Royal Colleges on that paper, to say, okay, this is a campaign we can get and change medical education, change postgraduate medical education 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. They, 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, um, they, they engage in a tactic called "opposition fragmentation." Anyone that threatens their, their bottom line, they will do smearing, they will do all these things behind the scenes. There's a whole documented history of this. To do what? For 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 agriculture, that think trans fats, pesticides, smoking, and, you know, glyphosate are all healthy for you. And I'm like, okay. And if they, they come up, tell very, you know, air diet and smart. So you've experienced in, right? Mobile science-based medicine on science and health. I mean, quackbusters, quackwatch. I mean, I, I, I've been there, all through it. And you get it. I totally get it. And I actually, I find it 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, um, you know, uh, 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, 'cause it's also about, this is about minds, it's not just about money, it's about indoctrination in the brain, right? As soon as your work threatens an industry or an ideological cabal, you will be attacked, sometimes unrelentingly and viciously. So you have to grow a rhinoceros hide, right? So for me, what happened after that is there was, I kept pushing this, this message. But they then, behind the scenes, Royal College of Physicians, 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, all nonsense. And that, and that was so relentless that they then, um, in 2018, I got an email from the, the new chair of the Royal Colleges saying that the campaign that I had started or was that they had taken on and instigated, that I was no longer part of that because of, of stuff that I apparently said publicly on statins, even though everything the newspapers that was written about statins for me was coming from medical journals, and I was a very strong advocate for informed consent. But again, this, "don't confuse me with the facts, my mind's made up." Well, exactly, exactly. So this is what they do. And of course, it does have its 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, almost single-handedly. And he says, "First they ignore you." I think Britain was bigger than the pharma companies too. 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 over the target, and you're closing to, you're getting closer to winning. But you have to, it's, it's tough. It's tough.

So, so essentially, this, this interesting legal case that we started out with has sort of vindicated that you and your colleagues were speaking truth to power. Yeah. Let's get into the details here because everybody's listening going, yeah, well, my doctor checked my cholesterol, and my LDL was high, and they recommended Statin. And like we said, it's the number one prescribed drug in the world. Yeah. Uh, 75% of the prescriptions are for preventing heart attacks if you've never had one. It's called primary prevention. There's very weak data to show that that actually works, especially for women, especially for over a certain age. Yeah. There is benefit for people who've had a heart attack, no doubt. Um, it's not like taking an antibiotic for a strep throat, but there is a benefit. And, and I'd love you to sort of unpack how you came to go from being a trained cardiologist who basically swallowed the gospel, yeah, 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 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 disease might be a little bit misguided? And we'll talk about what the right approach should be later. But I, I kind of want to start with unpacking, unpack the science for us, 'cause, yeah, everybody listening has heard of cholesterol is high, to take a Statin. 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 nine years qualified as a doctor. I was a specialist registrar in my cardiology training. Um, I was seeing more people, this 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, this, if we carry on down this trajectory, the whole healthcare system is going to collapse. We won't be able to even manage people acutely if they are ill. Right. I never thought that would happen. And, and ultimately, that, one of my own, two of my parents, 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, 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, uh, trajectory down the wrong way. Yeah. And I covered a lot of this in my book, "Eat Fat, Get Thin," which we sort of unpacked the whole history of how we got this low-fat craze and led to this high sugar, starch craze that then led to this dramatic rise in obesity, which now, of course, we're treating with another drug, the GLP-1 agonists, and, you know, semaglutide and some of the other ones. 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 and months and years looking at it and looking at different bits of data, I, 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 that. 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, you know, 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 what 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. So, and if LDL cholesterol or total cholesterol isn't that important as a risk factor, how do statins work? But I knew statins had a separate effect to lowering cholesterol, which is their anti-inflammatory and their anticlotting. And I knew this, even, it's well known within cardiology circles. You know, I trained as an interventional cardiologist, and that means key heart surgery, stents, for example. Patient comes in, we didn't even check the cholesterol. Maybe some of the thinking was a lower the better, which we'll come on to as well. So it doesn't matter what their cholesterol is starting from. Um, 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, "The 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, doesn't exercise." Sounds crazy, but as long as your cholesterol is low enough, you're not going to get a heart, 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 2013. So that's how I got down this track, realizing that our obsession with LDL lowering has has been, you looked at the saturated fat literature and you weren't impressed, and the data showed that it didn't seem, both observational data and randomized control 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, and some might even been 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 hypothesis. By the way, you're not alone in this. I mean, there was a major paper published by Dariush Mozaffarian 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 it created such a, you know, um, a lot of headlines and backlash or whatever else, that's when people like Dariush 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, and at the time, I was, I was writing just a, 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 thought, right? And then it all got proven that, you know, what I had written had validity, right? Which was good. But the other aspect of this, if we go back, and you mention cholesterol, so the, is chol, so is high cholesterol a risk factor for heart disease? And is LDL cholesterol a risk factor for heart disease? So you have to go back to square one, right? So these are the framing of studies that, you know, started in Massachusetts in 1948 and went over decades, looking at thousands of people, where a lot of risk factors emerged 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 the, 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 major cardiology journals 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 Coral LD 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 of heart disease, and I believe with everything I know now that to be the case. Okay, let's, 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 Custer, whether it's PCSK9 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, and some diet trials, but many drug industry-sponsored trials. All of the randomized control trials on cholesterol-lowering drugs, statins, PCSK9, blah, blah, blah. Was there a clear relationship as you lowered LDL in low-risk and high-risk patients? Mark, okay, over 30 studies. Yeah. 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 all believe? So does that mean statins? 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 anticlotting. 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 argue, say, let's say there is a weak benefit in lowering LDL. What else is going on? And what else are you ignoring, right? Yeah. What else do statins do? They cause insulin resistance. Say, one in 100 people get type two diabetes because of statins. One in two? One in 100. One in 100. Yeah. One in 100. So about 1 to 2%. But one in 100. Some, some studies say one in 50, right? We'll get type two diabetes because of the statin. Probably reversible, still, but not ideal, right?

If you're on a statin 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 in McDonald's, it's fine. And they, they, and they're getting more and more of a weight, more insulin resistant, they're increasing their cardiovascular risk. They're not told the statin is going to give them a 1% benefit. I'm 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've overemphasized an index on LDL cholesterol and forgotten everything else. Absolutely right. Because there's a drug for it.

What's 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'd be prescribed it. But we don't even diagnose it in most people because we don't have a drug for it. And it's, 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 do you get to come in are measuring insulin, which is, I think, one of the most important things you need to know about your, 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 little A, including something called APO B, which I want to talk to you about, 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 was so interesting to me was actually from, I think, Scotland or Ireland, was where they looked basically at 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. Yeah. Who had a heart attack. Yeah. That, that was really the big driver. Now, there's a subset of people who have familial lipid disorders, you know, inherited genetic lipid disorders. And not those people probably need to be treated more directly. But for the majority of people out there who are obese or have pre-diabetes 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, no, uh, LDL elevations.

Well, something else to throw into the picture, right? So you could 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. Yeah. So we thought, okay, is there something, you know, because for it to be a risk factor for heart disease, it should be consistent, really, across all age groups and both sexes, right? Mortality for mortality? Yeah. But even for heart disease as well, right? You, 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 has a very vital role in many functions in the body, including, you know, the brain, hormone production, but also the immune system. Mhm. 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 this data though, is, I'll just push back a little bit. Is it, it's observational data. And the data like from the Hawaii study show that, you know, you're older and you had higher cholesterol, you're more likely to live longer than if your cholesterol is lower. But it may be because the people had low cholesterol are malnourishing to have cancer and other reasons. So let me push back on that. So we, we accounted for that and we found actually, no, when you, you account, like time lag, you go back five or 10 years, no, it's not, it's not that. That does happen, but 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 cracked up to be, that statins work a little, but not for the reasons we think. I mean, they lower inflammation and they may have other properties that may beneficially, we don't even know. We call these pleiotropic effects. They, for example, they induce nitric oxide synthase, which dilates your blood vessels and reduces inflammation and helps your blinding of your blood vessels. All that's protective. And so it may stabilize plaque, it may help in those ways, but it may not be the LDL lowering effect. In fact, Paul Ridker from Harvard, I remember he published trials, I think it was the JUPITER trial, where they showed that 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, interestingly, 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 in the New England Journal of Medicine over 20 years ago, I remember reading it by Paul Ridker 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 with your blood sugar and insulin resistance and pre-diabetes? 100%. Uh, and actually, we published an editorial with two cardiologists. I did the British Journal of 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, um, saturated fat does not clog the arteries. Chronic 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's opinion being controversial. The two, my two co-authors were both editors of medical journals and cardiologists, Lee Ridker, editor of J Medicine, and Pascal Meier, editor of BMJ Open.

So why, why, why is this not getting more play? Why is still the dogma and the orthodoxy that if you have a high LDL, you take a statin? Do, 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, why are they not hearing about this?

Okay, so let's go to the root cause of the problem. Even in society today, what's, what's the big issue in health? We have commercial distortions of the scientific evidence. Who's 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, what, what also happens with these big corporations in the way they exert their power is that they want to avoid conflict. Right? 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 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 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. It's hard. I mean, listen, you know, I practice medicine, I'm seeing patients, you're busy. Like, I literally had to lock 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, you know, called E-get-then. 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 at 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 it sort of biased evidence. It is published completely. Absolutely.

And then, of course, there's the psychological side of it as well. Because as human beings, you know, they say changing one's mind is one of the most, you know, emotionally traumatic things a human being can go through. And that's where you need humility. Right? John Kenneth Galbraith, the Canadian-American economist, said, "Face 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 what for the medical profession? We need to have also more humility. I mean, one of the interesting, like, there's, 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, 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, sadly, you know, and I consider this my, honestly, I'm, I'm, uh, you know, 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 healthcare expenditure in the developed world, over $4 trillion, with the worst health outcomes. Oops. Right? So, so, so what's happened is, you know, because of all of this situation around corporate capture. So, you know, the, the counter, of course, from a philosophical point of view, is that living a life in darkness has no meaning. And we need to get people out of the, of this darkness to understand the root of the problem. And then we can then start, you 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 that it was, I think, 231,000 people and 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 optimal levels, yeah, under 100. 17% had had super optimal levels under 70. But what they did find was really interesting, and again, it confirms this whole metabolic hypothesis of heart disease, that it's really related to mostly insulin resistance. That that the, that those with low HDL and high triglycerides, which goes along with small dense cholesterol particles, were much at higher risk of having a heart attack. And so, in fact, the average HDL in that group was 39, which is ideally over 50. And the average triglyceride was 160, should be probably under 100, ideally under 70. And it didn't really seem that that LDL was really the driver. It was the triglyceride HDL ratio. It was the triglyceride 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, 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, uh, putting you at risk. And those are the ones that are caused by sugar and starch, not fat. In fact, fat actually improves the size of your lipid particles. Yeah.

No, fascinating. And it makes sense. But also, interestingly, 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, statins, who had either, either were high risk of 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 triglyceride in ratio were good, even people who had a heart attack, there was no benefit from the statin at all. Which, 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 even 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 accept a 4-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 why is? 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 prevent? 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 then got side effects for 20 years, and then they got side effects, and it gets better when you stop the statin. 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 a 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 is to live our lives in the best health we can for as long as possible, right? That's the most, in many ways, that's probably more important than longevity, right? Is having good quality of life. So that is something that I address with patients as well.

So if you're going to sort of seal 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 so strong about statins. And yeah, 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 the data is so prevalent and so strong and so clear that we should all be taking statins. I think, I think, you know, 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, um, one of the reasons I got annoyed or pissed off in the hospital and got into this whole my campaigning started about hospital and J, 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, um, and I accept that. One of the things I do myself, and I think you, the reason I've been through a process why 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 nuance. I can't really see a strong counterargument. And I'm not saying this from a place of hubris. Because, okay, let me get, 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's a concept in medicine, you've got to treat the many to benefit a few. Let's just say that they save lives in, I don't know, on average, say, one 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 three billion people, you're going to have, you're going to save one in 300 of those three billion, you know, whatever that is, it's a lot of people. It's a lot of people. It's, it's tens of millions of people at least, not hundreds of millions. So, um, 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 because 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's simply just not true. So therefore, you 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. Not working so good anymore. I'm about, I'm about shared decision-making. I'm about explaining to patients in a way that, you know, empowers them, that it's a more equal relationship. You know, and that, that's fine. That's a philosophical disagreement, but that's a 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, we, 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. I think we have to sort of, and I've noticed this as, as sort of as a doctor's been doing this for 40 years, not everybody's the same. Saturated fat is fine for most people, but not for some people. 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 and why? It's because the metabolically, they're genetically, they're different. So I think, I think, you know, 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 an adverse response to increased saturated fat in the diet, or who might have a history of lipid disorders and actually have some genetic issues, which I do in my family. So how, how do you sort of handle those?

So, 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 is Ronald Krauss, if I'm not wrong. Ron Krauss. Ron Krauss, sorry. Krauss. 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? Which is still very, very high. But again, that you're absolutely right, that might happen with 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, when they reduced 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 familial hypercholesterolemia?

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 that I think we're just starting to figure out there are. But, you know, you talk about APO 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. MH. Because what's the point? So you create unnecessary anxiety. For example, for some people, I get it. People may want to know. And if that's what they want to know, that's fine. But, you know, the, and we 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 what the best we're going to offer them, right? To keep their risk down. So we've got to just be a little bit careful about how we about ordering these tests. And then, but, 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, uh, partly 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 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 that 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 on my podcast. They were, I had him on my podcast. And they're about more data, and dense dynamic data clouds of information from your biomarkers, your metabolomics, 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 I'd rather know if my insulin is going up over 10 years 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, um, area. But again, Mark, you've said that, okay, you're a guy, and this is, if I was having a conversation with you, and this is your preference and values, you want the data. That's your preference and values. I want to know more and more and more. And that's fine. 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 a 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, 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 then, that's again, misuse, not good use of maybe numbers or statistics. I've been going on thinking that I've got in the next five years, an 80% chance I'm going to die of a heart attack. I'm like, no, it's 2% in 10 years, 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, familial hypercholesterolemia, 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 review paper with 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 hypercholesterolemia, 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 was 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 in the ones who developed heart disease. So FH, you should look at lipoprotein A, definitely. That gives them a high risk. But what's most promising and interesting is when you correct for insulin resistance, yeah, right. It, or 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, 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 A 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 low-dose 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 one that I think isn't discussed enough, and, you know, it comes out in my documentary film, um, which is called "Do No Harm." Not FM, oh. And how do you, how do you find that? Um, we, it's released online at the moment, and you can download it for $10. Um, and it's, the website is do no harm film.com. And the reviews have been, you know, pretty extraordinary. No harm? No harm film.com. P-A-R-M. P-A-R-M. Okay. Yeah, yeah. No harm film.com. We screened it in, in the Lyceum, 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' integrative mental health conference in Washington DC, really amazing feedback. 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've got this pandemic of chronic disease, both with big pharma and big food capturing with, got, you know, medical knowledge. We've got very credible experts from 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 film, or in my own research, is that for me, pushing the boundaries on heart disease is also the next phase. Can you reverse the blockages of coronary 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 least, it stabilized cardiovascular disease. But it was like one or 2% in terms of the blockages. Cardiology 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 22 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 a, there were devout Hindus, hundreds of patients, right? High fiber vegetarian diet because they were devout Hindus. Is 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 was seeing the angiogram reports. There was clear reversal in some patients. There 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, um, a crisis of morality. Okay? It was a spiritual transformation. These people changed their mindset. They became less materialistic. They became more spiritual. They learned 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, 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 sift and sifted through the statistics to show the benefit. Yeah. 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 three to two percent, right? It's 1%. Yeah. 1%. And, you know, there are, there are flaws in the ways in which a lot of these studies are done. So could you, some of the big data that you kind of critiqued, can you sort of unpack that a little bit? Because I think we didn't dive deep enough into that. I want people to 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, who control how the trials are designed and 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 run-in trial. And for six weeks, for example, in 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 that's probably one of the reasons they're massively underreported the side effects. It's, 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, right? The system is fraudulent.

Don't, some of the independent studies also show benefit? Um, 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 a 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 effect. What we know is what's published, not what's actually been tracked. Because pharmaceutical companies don't have to release that data. And they hold it. They hold it. And then, then the regulators, you think the regulators are going to be able to ask for it and look for it? They rarely do that. And well, they have it, but they don't publish it, which is which is interesting to me. The FDA does this because, you know, if you probably dig far enough and deep enough, you can find it online or through the FDA databases. Yeah. 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. Yeah. They can't cherry-pick what they provide the FDA. But it's not published. So, 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 of 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 conflict 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.

Explain why it seems that the American College of Cardiology and the American Heart Association still recommend 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 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, pardon my language, a show for healthcare. And that's why we are where we are in America right now. So it's time to, you know, you know, I think, um, 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 by the 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 privatize profits. And it's a WHO report that's sort of partly published, but also coming out as a 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 the industry is driving it. And, you know, just the American Heart Association alone receives $192 million a year from food and pharma companies. Crazy. Mind-blowing. It's mind-blowing. And how can we, how can we trust 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. Let's get better informed. Get better informed. Yeah. Read the data. I wrote an article years ago called "Fat: 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? How do they understand? Dig a little bit more. Just very quickly on that. Just 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, IES and approaches adopted by the private sector to promote products and choices that are detrimental to health. That's the definition of commercial deter of health. I have evolved that. And in fact, um, referencing the Lancet, because Richard Horton, the editor, came to one of my lectures, and I've said that the, the way that, and uh, drug companies, big corporations conduct business, not individuals within. I'm not pointing individuals that work for them, as legal entities, the way they conduct their business actually fulfills the criteria for psychopath.

Some concern. No, but but this this comes from Robert. Immoral, not immoral, right. Imoral. Yeah. Forensic psychologist Robert Hare, behind the original DSM criteria for psychopathy, defined them in the book Corporation. He said, so what does that mean? Callous concern 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. Psychopathic determinance 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, um, I've got a website, dr.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. Um, please go and download First Do No Harm from noharmfilm.com. Um, and if you want to read about statins in particular, but we we cover this in the film a little bit, the whole drama of statins, which is quite interesting. Um, my third book is 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 summer, you're not anti-science or anti-drug or anti-pharma. You're just for pro-health, real, real health. I'm pro. I'm pro ethical, evidence-based medical practice. There you go. So it's, uh, really been an amazing conversation. I could talk to you for hours. Unfortunately, we have stuff to do. And, uh, 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, uh, 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 and making informed choices as opposed to just swallowing hook, line, 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 and I am not anti-pharma. I prescribe drugs regularly. However, I want to prescribe the right treatment for the problem. Yes. And because all we have in our toolkit as physicians is a prescription pad. That's all we know how to use. Yeah. Or diet and lifestyle work far better and are far more effective at achieving the same or even better results than 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, I would do it. But 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 some like hippie-dippy term. Yeah. It's actually very precise. Just like you need to 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%.

Uh, and and and Mark, and another point before we finish is that, you know, you, which You've just raised, is that these HS 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. Uh, you feel better, you have more energy, you sleep better, better sex drive, less depression. You know, so all the side effects are good ones. Fad point. Fad point. Fad 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. MK. Lovely to see you.