It's actually more complex than that because triglycerides are or should be taken into account, also in ratios.
The whole thing about total cholesterol level dates back some years to when it was decided by NICE and others that the populace would be unable to understand anything more complicated than a single number, even though that single number is pretty much useless.
Then that was extended a bit into "good" and "bad" cholesterol because it was thought that people might just about grasp that and the slides from the Framingham Study would be trotted out.
Nowadays ratios have become considered to be more important, and some effort is being put into raising of HDL levels as well as lowering LDLs.
On Wed, 05 Mar 2008 22:12:07 GMT, geoff had this to say:
This is usually the case with NHS staff, who are noted for job creation.
I'm pretty certain that NHS GP practices are given large cash allowances determined by their supposed 'at risk' patients, so they tend to exaggerate such to maximise their profits.
And then they put the person with high cholesterol onto statins. Which are "so safe they should be added to the water supply" (or some such bollocks), ignoring their capacity to cause rhabdomyolysis and to kill. And don't even bother to measure thyroid hormone levels.
That is what the books say. However, it may be a difference in nomenclature over time, like the Roman pace being the distance between the same foot striking the ground twice and the modern pace being the distance between opposite feet striking the ground.
The young man inside me is rather wondering what he was doing at a great-grandson's christening last year. However, I was taught that the cgs was a derivative of the metric system, better suited to scientific measurements, rather than being a system in its own rights.
My only exposure to it was as a mention in a list of units in an American textbook we used at University.
I was taught that the metric system was introduced by the French Revolutionaries as part of their attempts to do away with all the trappings of the old Monarchy. ISTR there were other, much shorter lived, changes in the same vein. Measuring the distance from the top to the bottom of France took six years and cost a number of surveyors their lives, as someone had decided they should use large white flags to mark their survey points. Unfortunately, a number of local revolutionary committees took exception to men flying the Royalist colours from hill tops.
That is pure urban legend. He proposed a scale of 100 degrees that ran from the freezing point of saturated brine to human blood temperature.
That rather begs the question of how, if he only used one measurement from one person, he knew that blood heat was a reliable fixed point. There is some medical evidence that, due to a large number of low-grade infections being present, 100F is probably the average temperature of a population without access to modern sanitation and hygiene. It seems it is that we have changed, rather than him getting it wrong.
Réaumur is interesting in that his scale only had a single fixed point - the freezing point of pure water. His degrees were determined by being each displaced along the thermometer tube by 1/1000 of the volume of the bulb and tube up to the zero point.
Wikipedia has an interesting piece on Gabriel Moulton which insists that his units were also based on the circumference of the earth and it was for practical reasons he proposed a pendulum of 20.54cm (not a one second pendulum) by todays measurements. I can't resist quoting the final line of the entry:
"By today's measures, his milliare corresponds directly to a nautical mile, and his virga would by definition have been 1.852 m."
1.852 m is as near as damn-it 2 yards. (fraction under an inch more if my calculator is to be relied on).
You certainly went to a better school than me. I was always considered rather good at maths and it was a terrible shock when I first looked at one of my A Level maths papers to see it stuffed full of questions on
2nd order differential equations when I didn't even know what one was, let alone that they were ridiculously easy to solve. One of the reasons why I passed 2 A levels and failed two even though I only sat three. (General Paper was O* level in those days IIRC but I failed that as well).
I didn't say I actually used the the unit. IIRC we always defaulted to poundals but the seemingly ridiculous name for the unit kept it in my mind all these years and while looking up something in an old text book recently I actually came across an example that used slugs.
I had to drop history (and biology) early in order to continue with chemistry (and geography). a choice that didn't do me any good at all. Most of what I now know of history comes from subsequent reading, etc.
I think you may well be right Frank. My GP seems desperate to convince me I am diabetic dispite the lack of any evidence or symptoms. My paramedic daughter reckons they have targets to achieve and since I could be 'at risk' they are trying to treat me for something I might develop.
I reckon statins are the biggest con trick in medical history. The drugs companies must be laughing all the way to the bank. Little if any evidence that they do any good. I discussed this with my quack when he wanted to put me on them.
His rather limp reply was that they wouldn't do me any harm. Apart from wasting NHS resource of course.
My paramedic daughter has never attended a cardiac patient who wasn't on statins.
Indeed. There is large bunce to be had here and negotiation can be made. This time last year (getting towards the end of the financial year) I was able to agree with my GP an increase in test strip prescription to an appropriate level in exchange for agreeing to have a couple of tests done before the end of March.
Rhabdomyolysis through statins is fairly rare and tends to be linked to certain ones. Nonetheless, liver and kidney function tests in addition to thyroid tests should be done. Needless to say, the NHS only offers the cheaper of the thyroid tests unless one pushes the point, if necessary with the PCT. Alternatively, being friendly to the phlebotomist is a help in order to get more boxes ticked on the computer. Insisting on getting the printed results (not just the tell patient normal remark) is important too.
Our NHS lab simply will not do anything but TSH to begin with. fT4 follows if and only if the TSH is very low. It doesn't matter how many boxes are ticked (by doctor, phlebotomist or patient :-) ) - they do not get done. (A very long story is associated with my partner being authorised to get fT4/fT3 by special and exceptional permission.) And yes, numbers and reference ranges are vital.
Unfortunately, hypothyroidism tends to increase cholesterol levels which makes sufferers prime candidates for being prescribed statins. Rhabdomyolysis is considerably more likely in hypothyroid sufferers given statins (and yes, specific ones are worse than others). The problems do seem to occur because of ignorant doctors prescribing statins without checking and is made more likely by the number of people who are hypothyroid but don't know it/haven't been diagnosed.
Some are, although many products have become generics.
It's a fairly generic response to a fairly wide range of situations. There are several lifestyle alternatves to many of the causes of hypercholesterolaemia that are as effective as statins.
Generic statins are cheap so this is a non issue. The funding path between our pockets and the point of delivery of healthcare is the actual waste of resource, which is why the NHS as currently arranged should receive major surgery.
That's not a strong argument. All of these things are based on risk factor. If a particular therapy reduces risk for a given age and medical condition group, then anothe way to look at it is that for the same probability, the age at which it equalises becomes extended.
Said a different way, if the therapy results in patients having the same probability of a CVE at age 75 that they would have had at age 60 then it is probably worthwhile, especially if the dependency on long trm care is reduced.
One can't make a deduction that statins or any other therapy aren't worthwhile based on what the ambulance service collects. An alternatie conclusion that also fits is that such patients have been effectively identified by their PCP and had a statin prescribed. That may have been rather later than would have been useful to make a large difference to outcome in some cases, but may well have done in others. That conclusion can only be drawn from a large study population over many years, not from an ambulance log book.
The measurements are easy enough to make and completely standardised by NICE.
It's a DIY job with a blood glucose meter and two measurements of fasting blood glucose of > 7mmol/ml.
There are various other impairment conditions such as insulin resistance, impaired glucose tolerance, syndrome X etc. which don't quite meet those criteria. An initial identification of these can be made using the above equipment and a bottle of Lucozade.
Having said that, it's becoming increasingly clear that diabetes does not fit into the previously neatly defined type 1 and type 2 categories. There is a lot of research in this area.
It isn't at all desirable to wait until there are symptoms, because frankly they are not pleasant. If you are in a questionmark range, I'd ask for a referal or second opinion. For a lot of people, treatment can be a choice between lifestyle changes and popping a white pill. Doctors also know that most patients would prefer the latter, and the white pills are very cheap indeed.
Either way, I would look past the targets nonsense and look at number one, and not wait until there are symptoms that are not reversible.
There are targets for diabetic care and bunce for it, that is true. Even the NHS manages a half respectable job in some areas, although would prefer to organise a 3-6 monthly test of how treatment is working as opposed to the means for patients to manage themselves on a daily basis. That's a cost issue pure and simple.
Even worse is that there are substantial differences between what is considered normal between one country and another in the area of thyroid hormones.
I've just been having that precise discussion with the local PCT and had additional testing agreed. Threat of escalation was required. I don't have time to be a squeaky wheel.
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