Another blow to the Statin religion

A study of nearly 3,000 older adults found that giving them statins did not extend their lifespans nor did they get fewer  heart attacks.  Since old people are the high risk group, we have to ask if they do not benefit from statins, who would?

Effect of Statin Treatment vs Usual Care on Primary Cardiovascular Prevention Among Older Adults

Benjamin H. Han et al.

Abstract

Importance:  While statin therapy for primary cardiovascular prevention has been associated with reductions in cardiovascular morbidity, the effect on all-cause mortality has been variable. There is little evidence to guide the use of statins for primary prevention in adults 75 years and older.

Objectives:  To examine statin treatment among adults aged 65 to 74 years and 75 years and older when used for primary prevention in the Lipid-Lowering Trial (LLT) component of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT).

Design, Setting, and Participants:  Post hoc secondary data analyses were conducted of participants 65 years and older without evidence of atherosclerotic cardiovascular disease; 2867 ambulatory adults with hypertension and without baseline atherosclerotic cardiovascular disease were included. The ALLHAT-LLT was conducted from February 1994 to March 2002 at 513 clinical sites.

Interventions:  Pravastatin sodium (40 mg/d) vs usual care (UC).

Main Outcomes and Measures:  The primary outcome in the ALLHAT-LLT was all-cause mortality. Secondary outcomes included cause-specific mortality and nonfatal myocardial infarction or fatal coronary heart disease combined (coronary heart disease events).

Results:  There were 1467 participants (mean [SD] age, 71.3 [5.2] years) in the pravastatin group (48.0% [n = 704] female) and 1400 participants (mean [SD] age, 71.2 [5.2] years) in the UC group (50.8% [n = 711] female). The baseline mean (SD) low-density lipoprotein cholesterol levels were 147.7 (19.8) mg/dL in the pravastatin group and 147.6 (19.4) mg/dL in the UC group; by year 6, the mean (SD) low-density lipoprotein cholesterol levels were 109.1 (35.4) mg/dL in the pravastatin group and 128.8 (27.5) mg/dL in the UC group. At year 6, of the participants assigned to pravastatin, 42 of 253 (16.6%) were not taking any statin; 71.0% in the UC group were not taking any statin.

The hazard ratios for all-cause mortality in the pravastatin group vs the UC group were 1.18 (95% CI, 0.97-1.42; P = .09) for all adults 65 years and older, 1.08 (95% CI, 0.85-1.37; P = .55) for adults aged 65 to 74 years, and 1.34 (95% CI, 0.98-1.84; P = .07) for adults 75 years and older. Coronary heart disease event rates were not significantly different among the groups. In multivariable regression, the results remained nonsignificant, and there was no significant interaction between treatment group and age.

Conclusions and Relevance:  No benefit was found when pravastatin was given for primary prevention to older adults with moderate hyperlipidemia and hypertension, and a nonsignificant direction toward increased all-cause mortality with pravastatin was observed among adults 75 years and older.

JAMA Intern Med. Published online May 22, 2017. doi:10.1001/jamainternmed.2017.1442

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The Best Trump Budget Cuts, Part V: Less Foreign Aid

President Trump’s new budget is getting attacked by politicians and interest groups in Washington. These critics say the budget cuts are too severe and draconian.

My main reaction is to wonder whether these people are illiterate and/or innumerate. After all, even a cursory examination of Trump’s proposal shows that the federal government will expand over the next decade by an average of 3.46 percent every year, considerably faster than inflation.

For what it’s worth, I’m sure most of the critics actually do understand that government will continue growing under Trump’s budget. But they find it politically advantageous to engage in “Washington math,” which is when you get to claim a program is being cut if it doesn’t get a sufficiently large increase. I’m not joking.

That being said, while the overall federal budget will get bigger, there are some very good proposals in the President’s budget to terminate or reduce a few specific programs. I don’t know if the White House is actually serious about any of these ideas, but some of them are very desirable.

* Shutting down the wasteful National Endowment for the Arts.
* Defunding National Public Radio and the Corporation for Public Broadcasting.
* Terminating the scandal-plagued Community Development Block Grant program.
* Block-granting Medicaid and reducing central government funding and control.

Today, let’s add a fifth idea to our list. The Trump budget proposes a substantial reduction in foreign aid (for numbers, see line 18 of this OMB excel file).

I hope these cuts are implemented. In part, I want to save money for American taxpayers, but I’m even more motivated by a desire to help the rest of the world. Simply stated, foreign aid is counterproductive.

The great paradox of government-to-government aid transfers is that they won’t work if recipient nations have bad policy. Yet we also know that nations with good policy don’t need handouts.

In other words, there’s no substitute for free markets and small government. That recipe works wherever it’s tried.

My colleague at the Cato Institute, Marian Tupy, embraces the idea of less foreign aid in a Reason column.

President Donald Trump is said to be considering large cuts to foreign aid. Those cuts cannot come soon enough. And he explains why in the article. Here’s the passage that caught my eye.

Graham Hancock’s 1994 book, The Lords of Poverty: The Power, Prestige, and Corruption of the International Aid Business, is still worth reading. As the author explains, much of foreign aid is used to subsidize opulent lifestyles within the aid establishment. “Only a small portion of [aid money],” Hancock writes, “is ever translated into direct assistance. Thanks to bureaucratic inefficiency, misguided policies, large executive salaries, political corruption, and the self-perpetuating ‘overhead’ of the administrative agencies, much of this tremendous wealth is frittered away.”

The problems are not specific to the United States. Foreign aid also is used as a scam to line the pockets of contractors in the United Kingdom.

The British aid contracting industry has more than doubled in value from £540 million in 2012 to £1.34 billion last year. The proportion of every pound of taxpayers’ aid money that is spent on consultants has risen from 12p in 2011 to 22p. …Budget breakdowns showed the public being charged twice the going rate for workers. One contractor on a project had a margin of 141 per cent between staffing costs charged to Dfid and the cost at market rates.

By the way, one study even found that foreign aid undermines democracy.

Foreign aid provides a windfall of resources to recipient countries and may result in the same rent seeking behavior as documented in the “curse of natural resources” literature. …Using data for 108 recipient countries in the period 1960 to 1999, we find that foreign aid has a negative impact on democracy. In particular, if the foreign aid over GDP that a country receives over a period of five years reaches the 75th percentile in the sample, then a 10-point index of democracy is reduced between 0.6 and one point, a large effect.

Last but not least, Professor William Easterly explains in the Washington Post that foreign aid does not fight terrorism.

President Trump’s proposed budget includes steep cuts in foreign assistance. Aid proponents such as Bill Gates are eloquently fighting back. …The counter-terrorism argument for foreign aid after 9/11 indeed succeeded for a long time at increasing and then sustaining the U.S. foreign aid budget. …the link from aid to counter-terrorism never had any evidence behind it. As it became ever less plausible as terrorism continued, it set up aid for a fall. …the evidence for a link from poverty to terrorism never showed up. …studies since 9/11 have consistently shown that terrorists tend to have above-average income and education. Even if there had been a link from poverty to terrorism, the “aid as counter-terrorism” argument also required the assumption that aid has a dramatic effect on the poverty of entire aid-receiving nations. Today’s proponents of aid no longer make the grandiose claims of aid lifting whole societies out of poverty.
Heck, foreign aid keeps societies in poverty by enabling bigger government.

Yet international bureaucracies such as the United Nations keep peddling the discredited notion that developing nations should have more money to finance ever-bigger government.

The bottom line is that people who care about the world’s poor people should be advocating for freedom rather than handouts.

SOURCE  

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Secular Ecclesiology
   
Ecclesiology is the study of the church. That includes the forms of church government, its leadership, how it worships, its relationship to the people of God and even its sacraments. In modern American evangelicalism, ecclesiology is needed more than ever. With fly-by-night churches built around a single charismatic leader, corruption of church leaders, and community churches spreading like Southern kudzu, evangelicals are losing perspective on the role of churches, their relation to churches and the proper oversight of both church leaders and laity. The lack of sound ecclesiology in many Protestant churches is one of the big reasons many conservatives are migrating towards Catholicism and the Greek Orthodox Church.

Meanwhile, on the political Left, a secular ecclesiology is cementing. In an age where members of the Democratic Party could boo the inclusion of God in their platform and Barack Obama could proclaim the state is the only thing to which we all belong, government is replacing God, abortion is becoming the chief sacrament and tax paying is tithing. The Left is sorting out how government will stand in for the church and, like the Spanish Inquisition, the left-wing Torquemadas will burn at the stake any who dissent. Conservatives are the new heretics.

This is on full display with President Trump’s budget. Under Barack Obama, Congress never actually passed a budget. Through a series of continuing resolutions, the Congress just adjusted funding. President Trump wants to actually govern as intended by preparing a budget and submitting it to Congress for passage. He is dealing with several realities inconvenient for left-wing orthodoxy.

The nation’s debt now exceeds $20 trillion. Barack Obama raised the national debt. If Republicans were to give Democrats all the tax increases they ever wanted, there would still be a deficit and the national debt would continue to grow. Interest payments will continue increasing, depleting money for other things.

Something has to be cut. Waste, fraud and abuse along — presuming they could be eradicated — would not close the deficit. Programs must be cut. The left-wing desire to cut the military is an increasingly irresponsible aspiration considering events like the suicide bombing in Manchester, England. Something, though, must be cut.

As secularism takes on the form of religion in this country, one religious tenet is that the more people dependent on government, the better life is. Mick Mulvaney, the Director of the Office of Management and Budget, is challenging that religious tenet. He thinks the appropriate measure for a government program is how many people the government can elevate out of poverty and off government dependence.

Jesus said, “The poor you shall always have with you.” Mick Mulvaney and conservatives believe that means we will always have a class of poor people who must be helped. Secular progressives believe it means we will always have the exact same people poor who will never be elevated out of government dependence. The idea of getting people off welfare and decreasing dependence on government is anathema to people who have come to believe dependence on government is akin to dependence on God.

As a result, there is a newfound hysteria among secular progressives. They are convinced Republicans are going to kill people by consolidating, eliminating and streamlining government programs. If one is convinced greater government means more salvation, a reduction in government means more damnation. This is akin to Christian concerns about saving and losing souls.

Likewise, as abortion becomes the chief sacrament of the Left, letting government cut Planned Parenthood is akin to denying a church of its funding. Conservative areas of the country give more to charity because they have maintained a distinction between charitable aid and government program. Liberal areas of the country are the least charitable because secular ecclesiology has eliminated that distinction and any reduction in funding to any program is an attack on the liberal church.

This leaves us, as a nation, unable to proceed with civility. If one really believes Republicans want to starve old people and throw grandma off the cliff, hysteria and violence are the logical outcome. So too is bankruptcy. The president’s budget is a compassionate budget because it seeks to elevate the poor into the middle class, not keep them dependent. But to the Left, that is heresy.

SOURCE  

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For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated),  a Coral reef compendium and an IQ compendium. (Both updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on THE PSYCHOLOGIST.

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