OT: Elizabeth Holmes guilty

[Randal7]

Thanks for the answer.
First, not seeing a cardiologist in PA. I'm simply asking if I want to order labs directly from a place such as TrueHealthLabs.com or another one of the places you can go direct, but they specify certain tests (e.g., apoB) cannot be collected in NJ for testing. However, I can take that same form and drive over to PA and get my blood drawn. I'm not breaking any laws. It's the same draw whether it is LDL ( fairly useless metric these days) or apoB. It's what happens to that blood in the test.

I have extremely high cholesterol, but my last CAC (calcium) test and CCTA soft plaque of heart/arteries showed zero calcium and plaque. Some people have low LDL and high apoB. Doctors that are up to date with the latest science (which is now more than 10 or 15 years old) know to order apoB. But you would be amazed at the number of family doctors and cardiologist that a) don't know what apoB is or means; b) never order it for their patients to get a closer look a patient's lipid profile; c) refuse to order it if the patient asks. It is ridiculous. A family member had extremely high apoB after ordering the test and the primary care doctor said nothing about it.

I hate being that patient that has to rely on "Dr. Google", but apoB should be ordered for every patient as part of a lipid panel.

As far as coverage, you are correct. It is not covered. It costs $35. NJ BCBS deems it "experimental" and refuses to pay for it. But they will pay for a lifelong prescription of a statin that a patient may not even need. FFS is our health system broken.

Sorry for the rant. While Twitter is not always a reliable source, Dr. Thomas Dayspring (RU alum!) is one of the foremost lipidologists in the world. Here is a tweet, with a link to a study in The Lancet. Dr. Sniderman from Canada is another proponent of apoB testing, and so are numerous other MDs. Sorry for the long rant. I need to get my blood pressure checked.

https://pubmed.ncbi.nlm.nih.gov/31642874/

Super interesting. Thanks for the explanation. I confess, I know nothing about ApoB as a prognostic marker of cardiovascular risk. The ones I think of are your traditional measures plus hsCRP (as an inflammatory bio marker) and the Framingham offspring study has some pretty compelling data on LDL particle size (ie very low density lipoprotein being the most likely to penetrate the Endothelium and build up vascular wall plaque)

Anyway, with all that said, I’m not sure why you are able to order ApoB in Pennsylvania and not NJ. My last guess is that, sometimes, there are state by state rules on what consumers can order or buy themselves. Diagnostic Manufacturers have to do consumer perception studies to ensure that the consumer understands the results they are viewing because they could make health related decisions based on a misunderstanding of the data. A good example is the Owlet device, which is a baby wearable that got pulled from the market because there was a concern parents were misinterpreting the results. That could be it. That’s all I got

 

[Knight Shift]

Super interesting. Thanks for the explanation. I confess, I know nothing about ApoB as a prognostic marker of cardiovascular risk. The ones I think of are your traditional measures plus hsCRP (as an inflammatory bio marker) and the Framingham offspring study has some pretty compelling data on LDL particle size (ie very low density lipoprotein being the most likely to penetrate the Endothelium and build up vascular wall plaque)

Anyway, with all that said, I’m not sure why you are able to order ApoB in Pennsylvania and not NJ. My last guess is that, sometimes, there are state by state rules on what consumers can order or buy themselves. Diagnostic Manufacturers have to do consumer perception studies to ensure that the consumer understands the results they are viewing because they could make health related decisions based on a misunderstanding of the data. A good example is the Owlet device, which is a baby wearable that got pulled from the market because there was a concern parents were misinterpreting the results. That could be it. That’s all I got

Thanks for that info. I'm aware of hsCRP (mine is extremely low) and LDL particle size (none of my docs care about it-I'm seeing a cardiologist who only looks at LDL (refuses to look at apoB), a board certified lipidologist who looks at everything and is ordering more tests, and I switched family doctors, and they are very amenable to me asking for tests that I pay for out of pocket-great group of docs I have!).

The frustrating thing is the seemingly instinctive and first reflex of most docs to prescribe a statin if LDL is high. Rarely a look at inflammation (hsCRP and other markers like LpPLA-2), a discussion on diet (consumption of processes carbs, high fat, red meat, etc)---just---here's a script for a statin.

Anyway, with all things, like Sy Syms used to say about suits- an educated consumer is our best customer. It pays to do your own research and trust, but verify what you doctor tells you and prescribes.

Thanks again.

BTW, bringing this back to Elizabeth Holmes, she told me not to worry, I will be fine.

 

[Randal7]

Thanks for that info. I'm aware of hsCRP (mine is extremely low) and LDL particle size (none of my docs care about it-I'm seeing a cardiologist who only looks at LDL (refuses to look at apoB), a board certified lipidologist who looks at everything and is ordering more tests, and I switched family doctors, and they are very amenable to me asking for tests that I pay for out of pocket-great group of docs I have!).

The frustrating thing is the seemingly instinctive and first reflex of most docs to prescribe a statin if LDL is high. Rarely a look at inflammation (hsCRP and other markers like LpPLA-2), a discussion on diet (consumption of processes carbs, high fat, red meat, etc)---just---here's a script for a statin.

Anyway, with all things, like Sy Syms used to say about suits- an educated consumer is our best customer. It pays to do your own research and trust, but verify what you doctor tells you and prescribes.

Thanks again.

BTW, bringing this back to Elizabeth Holmes, she told me not to worry, I will be fine.

An educated consumer is very important, no doubt. You are doing the right thing when it comes to your health. Do the research yourself.

The major reason why docs prescribe statins is because of the plaque stabilization effects. If you look at Pfizer’s MIRACLE study of Lipitor you’ll see they dosed Lipitor post heart attack basically on the cath lab table and that stabilized plaque and substantially reduced secondary events. So there’s a lot of data that suggests there is some kind of pleiotropic effect of statin use that lowers primary risk and also secondary recurrent risk of cardiac events, and it’s disentangled from the LDL magnitude of lowering argument. It’s got something to do with the lumen and/or metabolic system. Nothing else comes close (yet) from ab outcomes perspective.

 

[Rutgers85_rivals]

What was this thread about again?

 

[Randal7]

What was this thread about again?

I think about Elizabeth Holmes cardiovascular risk

 

[RUTGERS95]

zelinsky stealing 400mm per reliable sources and CIA and admin know it. anyone care? lol

 

[Knight Shift]

An educated consumer is very important, no doubt. You are doing the right thing when it comes to your health. Do the research yourself.

The major reason why docs prescribe statins is because of the plaque stabilization effects. If you look at Pfizer’s MIRACLE study of Lipitor you’ll see they dosed Lipitor post heart attack basically on the cath lab table and that stabilized plaque and substantially reduced secondary events. So there’s a lot of data that suggests there is some kind of pleiotropic effect of statin use that lowers primary risk and also secondary recurrent risk of cardiac events, and it’s disentangled from the LDL magnitude of lowering argument. It’s got something to do with the lumen and/or metabolic system. Nothing else comes close (yet) from ab outcomes perspective.

I have seen those studies. There are aspects of statins that are concerning for some people like me. People who are insulin resistant can be pushed into diabetes. There is also the muscle soreness/myalgia side effect. Apparently, the issues may be from only the higher dose statins. I am looking at other cholesterol lowering options, but will not rule out a statin. There are a lot of statin deniers/haters out there, and they are not all wrong, but they can really muddy the waters if their messaging is not clear. But I have seen the plaque stabilization studies, and that makes sense for people who have had a heart attack.

Deniers aside, there is a movement of doctors, including some prominent cardiologists at Johns Hopkins who want to stratify risk for patients that have a zero calcium score and/or a clear CCTA showing no plaque. There is a counterargument to that in the analogy that a person who smokes should not stop at the first sign of lung cancer. But there is also a class of people with very high cholesterol (not necessarily familial (FH)) that do not get atherosclerosis.

The problem is that most family docs do not dig in and/or have the time to the stratification. My current family doc does that. He uses the MESA risk calculator, which uses hsCRP, LDL, HDL, CAC score (I think) before prescribing a statin or other therapy.

Sorry for the thread hijack here-- it's all @Randal7 's fault for posting his expertise in blood testing, and I could not control myself.

Back to Elizabeth Holmes, I wonder how much her Stanford background (she dropped out) and her purported good looks were a factor in snookering investors.

 

[mildone_rivals]

What was this thread about again?

Pretty sure it‘s about hookers and blow.

 

[rureadyforsomefootball]

Pretty sure it‘s about hookers and blow.

So now we are talking Hunter?

 

[rureadyforsomefootball]

I don't know why you hate this country so much.
Also, IMO Joe Biden has done a damn good job as president. Especially when you consider what he inherited from what lots of people are saying was the worst president this country has ever had.
Lock the treasonous Putin-lover up.

Hate this country hardly. I hate the fact you blame everything on one person and fail to see anything that this current President has done wrong. "IMO Joe Biden has done a damn good job as president", is comical, Racheal Madcow and MSNBC would be so proud. We are doomed as a country with this idiocy.

 

[Kbee3]

Hate this country hardly. I hate the fact you blame everything on one person and fail to see anything that this current President has done wrong. "IMO Joe Biden has done a damn good job as president", is comical, Racheal Madcow and MSNBC would be so proud. We are doomed as a country with this idiocy.

Still with the hatred.
And I blame more than one person. But it's clear who the number one douchebag has been.
Cheetolini...the friggin traitor.
BTW, I'm still trying to find out if the Secret Service is gonna be with him in the cell when they finally lock his *** up.