Thursday, April 18, 2019

Statins have no effect on cholesterol for over 50% of patients

This study is one of the few that looks at the cholesterol/statin correlation directly. And it does so with a substantial sample (N=165,411) so is of considerable interest. As such its conclusions are gloomy for statin use. On half your patients it may do no good at all, assuming that high cholesterol is associated with heart disease.  Given the size of the effect, that conclusion is unlikely to be overturned in subsequent research so needs to be taken seriously in patient treatment decisions henceforth

On the other hand, they found that among the "unprotected" group heart disease incidence was marginally higher.  In those circumstances (where the effect is weak), limitations of the study must be noted: It must be noted that the sample was not a random one.  It was a sample of people who had seen their doctor with some heart problem. And we also should note that the controls for confounding factors were poor -- no demographics!

So with those large reservations, we could say that the present weak results are consistent with previous findings that high levels of cholesterol are problematic for people with pre-existing heart disease only

Sub-optimal cholesterol response to initiation of statins and future risk of cardiovascular disease

Ralph Kwame Akyea et al.


Objective: To assess low-density lipoprotein cholesterol (LDL-C) response in patients after initiation of statins, and future risk of cardiovascular disease (CVD).

Methods: Prospective cohort study of 165 411 primary care patients, from the UK Clinical Practice Research Datalink, who were free of CVD before statin initiation, and had at least one pre-treatment LDL-C within 12 months before, and one post-treatment LDL-C within 24 months after, statin initiation. Based on current national guidelines, <40% reduction in baseline LDL-C within 24 months was classified as a sub-optimal statin response. Cox proportional regression and competing-risks survival regression models were used to determine adjusted hazard ratios (HRs) and sub-HRs for incident CVD outcomes for LDL-C response to statins.

Results: 84 609 (51.2%) patients had a sub-optimal LDL-C response to initiated statin therapy within 24 months. During 1 077 299 person-years of follow-up (median follow-up 6.2 years), there were 22 798 CVD events (12 142 in sub-optimal responders and 10 656 in optimal responders). In sub-optimal responders, compared with optimal responders, the HR for incident CVD was 1.17 (95% CI 1.13 to 1.20) and 1.22 (95% CI 1.19 to 1.25) after adjusting for age and baseline untreated LDL-C. Considering competing risks resulted in lower but similar sub-HRs for both unadjusted (1.13, 95% CI 1.10 to 1.16) and adjusted (1.19, 95% CI 1.16 to 1.23) cumulative incidence function of CVD.

Conclusions: Optimal lowering of LDL-C is not achieved within 2 years in over half of patients in the general population initiated on statin therapy, and these patients will experience significantly increased risk of future CVD.



Trump can’t finish the wall fast enough as apprehensions on southern border top 103,000 in March

By Robert Romano

Apprehensions on the southern border hit 103,492 in March, according to data compiled by U.S. Customs and Border Patrol, the highest in a decade.

In 2018, apprehensions averaged about 43,424 monthly, 34,626 in 2017, 46,114 in 2016, 37,071 in 2015 and 47,436 in 2014. 2019 looks like it will be a record year, as there have already been more apprehensions through March at 422,334 than all of 2017.

Amid the surge, Immigration and Customs Enforcement only has about 52,000 beds to detain people who are apprehended — which guarantees that a good number of those apprehended will have to be released.

There are simply too many people coming, with not enough facilities to accommodate them and not enough judges to process them efficiently. The effect is catch-and-release. And Congress knows it.

Even the limit on beds comes down to deliberate decision-making by Congress, as this was a major sticking point in the discussions on ending the government shutdown. Democrats wanted a harder limit on beds even when faced with the data of how the system was being overwhelmed. Last year, the authorization allowed for an average daily of 40,520, but President Trump has been able to get the actual number up to 49,000 by moving things around. This year, the new baseline was increased to 45,274, which he can ratchet up to 52,000 by moving things around.

As it turns out, Trump was prophetic in requesting additional funds with the migrant surge now occurring. But what Congress has provided is not nearly enough. Not with over 103,000 being apprehended in a single month.

Ultimately, the federal government wouldn’t need so many beds if resources were brought to bear to secure the border entirely. Two years into the Trump administration, unfortunately, and Congress only inluded $1.6 billion from 2018 for replacing existing fencing with new steel barriers and $1.375 billion in 2019 for more steel barriers.

As it is, President Donald Trump had to resort to declaring a national emergency on the border so that military construction funds could be reprogrammed.

Reporting from Calexico, Calif., Lt. Gen. Todd T. Semonite, Chief of Engineers and Commanding General of the U.S. Army Corps of Engineers, reported that with existing funding including the emergency funds, about 450 miles of wall will be built: “Around Dec. 2020, the total amount of money we will have put in the ground in the last couple of years will be about 450 miles. That’s probably about $8 billion, in total about 33 projects.”

In the meantime, while the system continues to be flooded, that means a lot of people are simply going to be released. So, President Trump is proposing to release them into sanctuary cities and states that Democrats have declared. The thinking is clear enough.

On Twitter on April 12, Trump stated, “Due to the fact that Democrats are unwilling to change our very dangerous immigration laws, we are indeed, as reported, giving strong considerations to placing Illegal Immigrants in Sanctuary Cities only…The Radical Left always seems to have an Open Borders, Open Arms policy – so this should make them very happy!”

Perhaps when leaders in Congress have to deal with the migrant surge directly in their local communities, instead thinking they can dump them in red states, they will sit down with Trump and finally get down to business to giving the resources the federal government needs to both deter and contain the illegal immigration surge now occurring.

While the President awaits Congressional action, Americans for Limited Government President Rick Manning suggested that human traffickers should be declared terrorist organizations: “The problem is now so severe that the President should simply declare the human trafficking cartels who are profiteering off the illegal immigration surge to be terrorist organizations and treated accordingly. The costs to both the American taxpayer and to those who depend upon our nation’s generous social safety net is unacceptable, but what’s worse is it is now endangering our national security, and those in Mexico who are facilitating the trafficking need to be dealt with the full force of the law.”

A terrorist organization declaration would invoke certain authorities that would allow the Trump administration to cut of the funds traffickers receive via remittances and other means.

Manning is right. Not enough pressure is being put on those making the journey as the resources Congress has provided are insufficient by a several orders of magnitude to deter and prevent the currently seen levels of migration.

The human traffickers realize the border is wide open, and unless something is done, this is crisis is not going to get any better. Something’s got to give.


Old problem, tired old solution: Democrats want to tax millennials to save Social Security

While so-called "Medicare for all" is grabbing the most headlines, a House Ways and Means subcommittee has held four separate hearings on the looming insolvency of another big entitlement program: Social Security. Subcommittee Chairman John Larson, D-Conn., recently released a bill to shore up Social Security’s funding through myriad new tax increases and 200 of his Democratic colleagues have signed on as co-sponsors.

I testified on Wednesday at a hearing where this bill, the Social Security 2100 Act, was the focus. I was invited to offer some remarks on a group that does not get much attention in the conversation regarding Social Security: young people. My comments focused mostly on millennials, because that is the group for which we have data on their working lives, but the broader consequences to the future of the workforce should be explored before plans to hike taxes on workers and employees is viewed as the silver bullet for the program’s sustainability.

The bill would hike the payroll tax 2.4 percentage points, to 14.8%. While almost half of workers do not pay income tax, the payroll tax is the largest tax most workers pay. Increasing it confiscates wealth for workers that could otherwise be used to save and build equity.

This strikes workers at the beginning of their career particularly hard, not just because it deprives them of a longer window for savings, but also because millennial workers are different from other generations in significant ways. For one, they are more likely to start their own business. Over a third of millennials operate a “side hustle” in addition to their full-time job. This means many young people in the workforce today are not only employees, but potential employers as well. But as a sole proprietor, they would be responsible for both the employer and employee sides of the payroll tax hike in these plans, potentially increasing their payroll taxes by thousands of dollars.

The consequences to economic mobility should be obvious: A payroll tax hike makes each hire for an employer more expensive, and data shows that employers will respond by cutting wages. This will diminish income mobility for workers, particularly those at the beginning of their careers. It will put wage increases further out of reach for workers. What’s more, the income exemptions in this bill are not indexed to inflation, meaning they eat up a larger share of employee income over time. This will further erode young people’s earnings opportunities as they move up the income ladder.

Millennials already lag other generations in terms of wealth accumulation. Workers at the beginning of their careers see a higher share of their income go to payroll taxes, and fixed costs of living take up a higher share of their take-home pay. Increasing the payroll tax further diminishes the amount of money they have available to save and create wealth over time, and exacerbates this disparity between what is now the largest living generation in the country and other generations that have come before it. What’s more, data indicates that lower-income households make up for the loss of income by shouldering more debt, undermining opportunity for young workers to amass their own wealth.

The workforce today looks different than the workforce of different generations — this is a feature, not a flaw, of the American system. As our economy evolves, however, so too must our public policy. For many millennials who entered the workforce during the recession, the recent economic expansion has been their first opportunity to grow in their careers and build wealth. Proposals that would force this cohort to shoulder new tax burdens threaten to undermine this progress. While Congress has enhanced private savings opportunities to the widespread benefit of workers, it has yet to tackle the looming fiscal insecurity of government spending. Congress should consider bipartisan methods of meeting this challenge without simply redistributing the burden to future generations.



The Trump jobs miracle

If you want one number that encapsulates the enormity of the economic turnaround under Donald Trump it is this: Today in America so far this year there have been between 7.1 million and 7.6 million unfilled jobs. This number is larger than the entire population of the state of Indiana. That is how powerful and relentless the hiring spree has been under Trump policies.

Today, there are just over 6 million Americans who are “unemployed.” This means that even if every person in America looking for a job took a job (and had the skills to fill them), we would still have more than 1 million jobs that would not be filled. That’s the University of Michigan football stadium filled 10 times. That’s a lot of jobs.

Add to that the latest Labor Department numbers that the number of people signing up for unemployment benefits and it adds up to a glorious and irrefutable reality.

This is the best labor market for workers in 50 years.

Maybe ever.

This tight labor market is exactly what those of us on the Trump team hoped for when we designed the tax reform bill, the deregulation policies and other policy changes designed to allow American businesses to grow and prosper. The competition for workers explains why average wages in America have risen by 3.2 percent over the last year in an environment of little or no inflation. Add to that the average tax reduction of between $1,500 and $2,000 for the typical middle class family and it is no wonder that 71 percent of workers feel good about the economic direction of the nation, as a recent CNN poll found. Before the election of 2016 only about half that number of Americans rated the economy as good or great.

For the first time in a long time, Americans’ real take home pay is expanding. It feels good. People are spending because they have more money in their wallets and they are confident in their financial future. What a change from the malaise of the last decade, when almost every poll showed that jobs and the economy were the biggest worry of Americans.

The tight labor market and boost in wages are inextricably linked. Target just announced a new “minimum wage” of $13 an hour. That wage is headed to $15 an hour in 18 months. Is this because of a government minimum wage law? No. The company said it had to pay more to recrult and retain the best workers. There is nothing more empowering for middle class workers than having employers compete for their services.

Target isn’t the only company handing out big raises in the Trump era. Walmart is up to $11 an hour, and Amazon just recently went to $15 an hour for starting workers. Don’t forget to add to bonuses of up to $2,000, and paid vacations and other enticements.

Even as businesses are investing more in capital equipment — like machinery, computers, robotics, trucks and forklifts — they are hiring more workers at a brisk pace. Remember the worry that the Internet and robots were going to destroy all the jobs and America would be one long unemployment line? It’s not happening.

So now the worry is America is running out of workers. Not really. As wages rise, more working-age Americans who aren’t currently looking for a job will snatch them up. There are at least 10 million Americans who could be in the labor force if the offer to get off the sidelines is enticing enough.

The irony of all this is that at the very moment that the left wants to institute a “guaranteed livable income” for every American, President Trump is doing that and more by making sure that every last American who wants one can get a job.



Comey assumes jester role in spygate tragedy

Top secret surveillance is spying.

Americans for Limited Government President Rick Manning today issued the following statement blasting former FBI Director James Comey’s contention that “the FBI and the Department of Justice conduct court-ordered electronic surveillance… I have never thought of that as spying”:

“James Comey’s latest embarrassing declaration that top secret surveillance of American citizens’ phone calls, emails, texts and other communications in a counterintelligence probe is not spying ranks right up with Bill Clinton’s parsing of the meaning of the word is. Comey signed the Foreign Intelligence Surveillance Act warrants to spy against the Trump campaign. In Washington, D.C., lies are excused if couched in the right flowery verbage. Comey cannot possibly believe that engaging in electronic surveillance largely based on documentation from politically weaponized spies, which he says was ‘selacious and unverified,’ as well as using human intelligence resources to observe and attempt to infiltrate the Trump campaign in the midst of a counterintelligence investigation is not spying.

“Comey’s Hamlet-like musings reflect more on his attempt to rerwrite history and restore his tattered personal legacy. If this tragedy is ever honestly written, Comey has cemented his role as the fool rather than the hero he portrays himself as.”



Feel the hate

Bella Abzug (1920 – 1998) was a bane of American conservatives for many years in the late 20th century. It was a relief when she died.  She was an aggressive feminist and all-round far-leftist with a very loud and abusive mouth


For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCHPOLITICAL 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.

Email me  here (Hotmail address). My Home Pages are here (Academic) or  here (Pictorial) or  here  (Personal)


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