Think about this. Medical science has advanced as much as telephone science. Fifty years ago, phone communication was clunky and expensive. There was a long distance fee for calling someone in the next county. Now you can communicate with anyone, anywhere in the world almost instantly and easily for a relatively small monthly fee. And the phone does all kinds of other things. One of the most amazing is GPS navigation. You can use your phone to navigate from your home to a place 4 states away. Over 20 satellites provide your real-time position on a map and you receive voice instructions. The hard science that makes all that happen is fantastic. Medical science has advanced at least that fast but most of us don’t receive the full benefit because it is even more complicated. It is difficult for laymen to understand what to do. The information is so confusing. This site exists to help you overcome that.
Bestermann writes excellent information such as given here. He has done an excellent job of giving the exact relevant numbers. The problem with much of randomized controlled studies/RCT = double blind placebo controlled crossover studies is that they are now tainted by researchers who have an agenda to make a point (which will contribute to their being rewarded with future research funding as well as popularity in the professional community). This was widely apparent during the coronavirus pandemic. But it also applies to cardiovascular research. Bestermann's discussion here is ethical and correct and to be believed. Yet there is always progress and that usually comes with a price. For instance the newest aldosterone blocker, Kerendia is better than spironolactone and eplerenone. Combining an Ozempic GLP-1 type medication with a Jardiance SGLT2 type medication gives (both are much more expensive) much better glucose control then metformin as well as vastly reduced risk of heart attack and stroke. Edarbi is a better/more effective and much more expensive ARB than losartan. Chlorthalidone is a better diuretic to lower blood pressure than is hydrochlorothiazide (HCTZ). Much of the price of these new medications is related to governmental requirements for the research which are USUALLY/unnecessarily excessive and incredibly costly to adhere to, thereby affecting the price of the medication when it is released. Bestermann continues to shine thru this fog. H. Robert Silverstein, MD, FACC
Thanks Dr. Silverstein. You have made my day with your kind comment. Patients can achieve much better outcomes at reduced expense using the protocol that I described, but you are correct that we should be able to do even better with the new tools as you describe. I would still use metformin first and add the others if required. I believe we could perform even better vs usual care with the medicines that you describe.
Bestermann writes excellent information such as given here. He has done an excellent job of giving the exact relevant numbers. The problem with much of randomized controlled studies/RCT = double blind placebo controlled crossover studies is that they are now tainted by researchers who have an agenda to make a point (which will contribute to their being rewarded with future research funding as well as popularity in the professional community). This was widely apparent during the coronavirus pandemic. But it also applies to cardiovascular research. Bestermann's discussion here is ethical and correct and to be believed. Yet there is always progress and that usually comes with a price. For instance the newest aldosterone blocker, Kerendia is better than spironolactone and eplerenone. Combining an Ozempic GLP-1 type medication with a Jardiance SGLT2 type medication gives (both are much more expensive) much better glucose control then metformin as well as vastly reduced risk of heart attack and stroke. Edarbi is a better/more effective and much more expensive ARB than losartan. Chlorthalidone is a better diuretic to lower blood pressure than is hydrochlorothiazide (HCTZ). Much of the price of these new medications is related to governmental requirements for the research which are USUALLY/unnecessarily excessive and incredibly costly to adhere to, thereby affecting the price of the medication when it is released. Bestermann continues to shine thru this fog. H. Robert Silverstein, MD, FACC
Thanks Dr. Silverstein. You have made my day with your kind comment. Patients can achieve much better outcomes at reduced expense using the protocol that I described, but you are correct that we should be able to do even better with the new tools as you describe. I would still use metformin first and add the others if required. I believe we could perform even better vs usual care with the medicines that you describe.