2000; Out of print
2010
2009
2008
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A selection of my newsletters |
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For
several years I have sent newsletters to people who have shown interest in the
many contradictions of the cholesterol hypothesis and/or the work of our group THINCS,
The International Network of Cholesterol Skeptics. Here comes a selection of these letters. If you want to become a
recipient of my newsletters, please click here. |
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October
2004
About
those who write the guidelines
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How to convert healthy people into patients
You
have probably heard about the new guidelines issued a few months ago by the
National Institutes of Health and according to which “normal” cholesterol
now is considered to be far below the mean value in most populations. Bingo thus
for the drug companies (and the authors of the guidelines). |
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About lowcarb diet and diabetes Recently Heine and coworkers published a review in British Medical Journal about the treatment of type 2 diabetes without mentioning a word about the many succesful low-carbohydrate trials. The strong resistence against these trials is of course due to the cholesterol campaign according to which we shall eat carbohydrates instead of fat, an advice that has been given to diabetic patients as well. Read the many comments to that study in BMJ, including my own (the last one). If you want to read more about the lowcarb diets I can recommend these papers, freeely available on the web: Arora SK, McFarlane SI. The case for low carbohydrate diets in diabetes management.
Ridicule instead of answer As readers of my newsletters or my books know there is no evidence whatsoever that saturated fat has anything to do with atherosclerosis or coronary heart disease. But do you know that there is no evidence either that saturated fat raises the cholesterol concentration in the blood? A recent paper by Krauss and coworkers is a further confir- mation, but their finding, clearly recorded in a table, wasn´t mentioned in the discussion or in the abstract. This is a common observation when researchers come up with results that go counter to the cholesterol paradigm. Therefore I sent a letter to the editor My letter was commented in a vicious editorial by Martijn Katan, one of the most eager proponents of the cholesterol campaign. You can read more about this discussion here. |
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Pfizer fraud Pfizers new cholesterol-lowering drug Torcetrapib was a
failure; instead of lowering the risk of heart disease, it resulted in more
heart attacks, although in addition to lowering LDL cholesterol, it also raised
the "good" HDL. Now
it appears that Merck´s Vytorin is just as bad. Instead of halting the progress
of atherosclerosis the trial directors of ENHANCE noted an increased progress,
although cholesterol was lowered more than ever before. Here is
a
comment in New York Times But there are more curious facts about that trial. Read for instance a comment in The Guardian A
new
article about statin treatment has just been published on the web by our member Sandy
Szwarc. ...and
here are more critical articles published in Bloomberg Businessweeek: Critical
comments have also been aired by Gary
Taubes and Tara
Parker-Pope, both of them in New YorkTimes.
An unsuccesful statin trial In
this week´s issue of The New England Journal of Medicine the report from the
unsuccesful ENHANCE trial was published, almost two years after it had been
terminated. Not unexpectedly, at least for those who have been informed by
THINCS´ members, a further lowering of cholesterol by a non-statin drug did not
improve the angiographic changes of the coronary arteries; on the contrary. Read
Sandy
Szwarc´s report! And another one First, you have probably heard about the new statin trial JUPITER. According to its authors their new super statin drug Crestor may soon eradicate cardiovascular disease. Not so – we are again misled by industry-paid socalled researchers. Here are two excellent comments; the first one by Dr. Michael Eades, the second one from one of our members, science journalist Sandy Szwarc Scary
news. According
to the new guidelines for cholesterol lowering even children should be treated
with statins. Fortunately a host of critical comments have appeared in various
media. Here are two from Tara Parker-Pope, the wise medical reporter on New York
Times:
8-Year-Olds
on Statins? A New Plan Quickly Bites Back …and one from Sandy Szwarc: Is it for real? Cholesterol screening in toddlers and statins from elementary school age? Why the bad things aren´t told Here are some cuttings from an article by New York Times reporter Duff Wilson
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...In
a first-year pharmacology class at Harvard Medical School, Matt Zerden grew wary
as the professor promoted the benefits of cholesterol drugs and seemed to
belittle a student who asked about side effects. Mr. Zerden later discovered
something by searching online that he began sharing with his classmates. The
professor was not only a full-time member of the Harvard Medical faculty, but a
paid consultant to 10 drug companies, including five makers of cholesterol
treatments.
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The statins are better than snake oil It
is often said that statins are good for almost any human disease. The method
used to ‘prove’ that is to compare people on statin treatment with untreated
people. Most people in the latter group have of course low cholesterol, and not
only low, but very low cholesterol, because as you know the upper limit for
normal has been lowered again and again through the years. It is well-known that
low cholesterol is a risk factor for many diseases; to mention only infectious
ones and cancer. What these researchers have shown is therefore that high
cholesterol is beneficial because people in the statin group have had high
cholesterol most of their life.
Recomended reading If
you think that the statin trials have proved that cholesterol lowering is
beneficial I recommend you to read two important books written by people with
inside information about how we are conned by the drug industry. The first one
is “The Truth About the Drug Companies” by Marcia Angell, former
editor-in-chief of New England Journal of Medicine, one of the world’s most
respected medical journals. The other one is “The Trouble With Medical
Journals” by Richard Smith, former editor-in chief of British Medical Journal,
another great and respectable publication. You should also listen to Beatrice Golomb. She is an associate professor of medicine at the University of California, San Diego and has devoted many years studying the side effects of statin treatment. Here is a youtube talk she gave recently entitled Pharma corruption of medical science December
2009 A dietary U-turn Those of you who have followed our work already know that saturated fat isn´t a menace to human health. Recently WHO and FAO published a new report, Fats and Fatty Acids in Human Nutrition. Now, finally, their experts have come up with the same conclusion; go to pages 191 and 239. However, they havern´t changed their recommendations! You can read more about that paper here (from my new book Ignore the Awkward! How the Cholesterol Myths Are Kept Alive) top
The press is awakening The
press is awakening. Here you will find interesting articles from major
newspapers and journals: Statins have been hailed as a miracle cure for cholesterol, but little is known about their side effects. Read also the 140 comments, but beware, they are scary. Melinda Wenner Moyer (Scientific American): It's Not Dementia, It's Your Heart Medication: Cholesterol Drugs and Memory. Why cholesterol drugs might affect memory. Tom
Naughton: Big Fat Fiasco: how the misguided fear of
saturated fat created a nation of obese diabetics. A humourous speech with a serious content. Five parts, on
Youtube
No more fraudulent trials? After
the Vioxx scandal new clinical research regulations have come into force. Trials
that begin enrolment of patients after 1 July 2005 must register before their
start in a recognised trials registry to be considered for publication and they
must be published within 90 days after the ending regardless
of whether the results are positive, negative or inconclusive.
The China Story - from Alice in Wonderland? Have
you been mislead by Colin Campbell? Here is
an
excellent analysis by
our member Stephanie Seneff of his book The China Study. It is sad that this
book has had such great impact on people's dietary habits.
More revelations More
and more people realize that the cholesterol campaign is built on bad or
fraudulent research. Here are a number of recent eye-opening articles: Steven
Lewingston (Washington Post): Ike and the war on meat October
2010 How to get the desired results A colleague of mine asked about my view on an article in Science Daily. Here you can read that ”A new study by researchers at Harvard School of Public Health (HSPH) provides the first conclusive evidence from randomized clinical trials that people who replace saturated fat in their diet with polyunsaturated fat reduce their risk of coronary heart disease” The paper, the main author of which is Dariush Mozaffarian from the Channing Laboratory at Harvard Medical School, is available here. The
article in Science Daily also tells about another recent review co-authored by
Frank B Hu and Ronald M Krauss, two other well-known US scientists. They
concluded that ”there is no significant evidence for concluding that dietary
saturated fat is associated with an increased risk of CHD or CVD.” The
abstract of that paper is available here.
Their
conclusion was explained away by these words: ”Some of these mixed findings
may relate to absence of prior focus on the specific replacement nutrient for
saturated fat.”
How did Mozaffarian and his coworkers reach to their contradictory
conclusion, you may ask. It is particularly curious because Mozaffarian himself
has published
a study that contradicts his new paper.
What he and his coworkers found was that progress of
atherosclerosis was less pronounced the more saturated fat the participants had
eaten. Let me tell you how Mozaffarian succeded with turning around: By including the Finnish Mental Hospital study, a dietary trial that did not satisfy the most elementary requirements for a correctly performed trial. For instance, it was neither controlled, randomised or blind. By excluding two trials where mortality increased in the treatment
groups and a third where no effect was achieved. (You can read more about
these trials in my books) Furthermore, they included the DART trial, where the only group that improved had increased their intake of fish as the only dietary measure. What proponents of polyunsaturated fat forget is also that today,
most of such fat comes from corn, soy and sunflower oil. Here the main type of
polyunsaturated fat is omega-6, and there are numerous papers having shown that
an excess intake of omega-6 polyunsaturated fats has many serious adverse
effects. A humorous talk about serious matters Recently Tom Naughton gave a speech at the local library entitled "Big Fat Fiasco: how the misguided fear of saturated fat created a nation of obese diabetics." Luckily a photographer was there, because it is both funny and serious, and it is now available on Youtube in five parts
Fraud revealed Do you believe in medical science? Do you think that what has been published in the major medical journals reflects the truth and nothing but he truth? Then read this article by John Ioannidis entitled ”Lies, damned lies and medical science” published recently in The Atlantic. Ioannidis has spent his career challenging his peers
by exposing their bad science. Here is a quotation from the article: ”We could
solve much of the wrongness problem, if the world simply stopped
expecting scientists to be right. That’s because being wrong in science is
fine, and even necessary—as long as scientists recognize that they blew it,
report their mistake openly instead of disguising it as a success, and then move
on to the next thing, until they come up with the very occasional genuine
breakthrough.” More
and more journalists have realized that the drug companies aren’t thrustworthy
either. Read for instance this
article by Stephen Adams from
the British newspaper The Telegraph. Good news For
many years Walter Willett, head of the world´s largest dietary study
situated at Harvard, has warned against saturated fat. This is most curious
because none of the many Harvard studies has ever found that those who gorge in
saturated fat are at a higher risk than those who follow the offical guidelines.
How to cover up the bad news You
have probably read about the new report from the
Cochrane Collaboration mentioned in many of the major media recently (for
instance The Telegraph, BBC, Boston Globe, CBC News, LA Times,
and Reuters. The aim of
the Cochrane authors was to assess the effects, both harms and benefits,
of statins in people with no history of CVD. For that purpose they had analysed
randomised controlled trials of statins with minimum duration of one year and
follow-up of six months, a total of 14 including 34272 participants. The authors concluded that ”although reductions in all-cause
mortality, composite endpoints and revascularisations were found with no excess
of adverse events, there was evidence of selective reporting of outcomes,
failure to report adverse events and inclusion of people with cardiovascular
disease. Only limited evidence shed that primary prevention with statins may be
cost effective and improve patient quality of life. Caution should be taken in
prescribing statins for primary prevention among people at low cardiovascular
risk.” As mentioned in the Cochrane report the low number of side effects
is unlikely. To mention only that independent researchers have found that
muscular problems are seen, not in less than 1 percent as reported in all statin
trials, but in about 25 % of those who exercise regularly. But
it is worse than that. As the authors had included only trials with a length of
one year or longer, they have missed the first statin trial, named EXCEL. It included
more than 8,000 healthy individuals (named ‘patients’ in the trial reports,
because of their moderately elevated cholesterol) who received one of four
different doses of lovastatin (Mevacor®) or a placebo. The trial was terminated
already after 48 weeks of treatment. The
reason? Because the authors only wanted to see if the ”patients” tolerated the drug, and they did, at least according to the trial report. In
the abstract you look in vain after the clinical outcome. In the text you can
read that total mortality was 0.2 percent in the control group and about 0.5
percent in the four treatment groups. The total number of deaths was 36, but as
nothing was said about the exact number of participants in each group (they were
”of similar size”), it is impossible to calculate if the higher number of
deaths in the treatment groups was statistically significant or not. However, it
would most likely have become significant had the trial continued. It
is also worth mentioning that whereas all statin trials with a positive outcome
are freely available on the web, this is not the case with EXCEL. Cholesterol and the brain Although members of THINCS since long have warned against the harmful
cerebral effects from cholesterol lowering, few doctors know about it and
nothing is mentioned on the drug labels. Here is a
thorough review about
this issue by Emily Deans, MD, a clinical instructor in psychiatry at Harvard
Medical School. Obesity - a man-made problem More
and more scientists realize that the cholesterol campaign is the greatest
medical scandal of modern time. Here you can listen to a brilliant talk "How
Bad Science and Big Business Created the Obesity Epidemic" by our
member Professor David M Diamond from
the Departments of Psychology and Molecular Pharmacology and Physiology, Center
for Preclinical and Clinical Research on PTSD in Tampere.
How to explain away bad results Using
a new technique named strain imaging US researchers have found that statin
treatment decreases myocardial function.
This is not new knowledge, of course; just consult the writings of our
members Alena and Peter Langsjoen. Do we expect official warnings now? |
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You
make the mistake of believing that peer reviewers actually read the papers
they are sent.... Another solution is to create an ad-hoc hypothesis. If you don´t know
what that means, read Tom
Naughton´s explanation! The statins are bystanders only A new problem for the cholesterol campaign has appeared: There is no association between the decrease of heart disease and the use of statins.This has been shown by Swedish researchers who compared the two measures in all Swedish districts. No association! In some districts heart disease went down and statin use increased but in just as many it was the opposite. You can read the paper here to be published in Journal of Negative Results, meaning that very few will take notice, unless of course you tell about it whenever you have the possibility. Again,
this is no surprise for those who have followed the literature with a
critical eye. If you want a detailed explanation why cholesterol is not
the enemy, read this
review by one of our members Stephanie
Seneff. Its title is How Statins Really Work Explains Why They Don't
Really Work.
Alzheimer and low chlesterol Researchers
paid by the drug industry are eager to tell us that people with Alzheimer´s
disease should be prescribed a statin drug. How do they explain that all
the blood lipids are lower in such patients, lower the more advanced the
Alzheimer has progressed? You
can read more about that
here
A funny video Scary statin news, but editors, please keep quiet! Half a year ago I told you about the new Cochrane report the authors of which concluded that the benefit from statin treatment of people without heart disease is questionable. What I didn´t tell about was the results from a report by Hippisley-Cox and Coupland published last spring in British Medical Journal. The reason was that I hadn´t observed it myself at that time. In the QResearch database 368 general practices in England and Wales had supplied data from more than 2 million patients of whom 225,922 were new statin users. By analysing these data Hippisley-Cox and Coupland concluded that whereas the total number of prevented coronary events, almost all of which were non-fatal, was less than 3 per cent, the total number of adverse effects was more than 4 per cent. The adversities were not harmless either, but consisted of acute renal failure, cataract, and serious liver and muscle damage. You may probably ask yourself if statin treatment of healthy people has been stopped after the publication of this scary report. The answer is no. Neither the practicing doctors nor common people know about these figures, possibly because the British report is difficult to understand for people without thorough knowledge about epidemiology and statistics. But what about the experts? Why haven’t they reacted? Are they anxious to loose their research money and their other financial benefits from the drug industry? Together with two highly qualified members of THINCS (Professors Paul J Rosch and Morley C Sutter; see our list of members) I sent a paper to British Medical Journal about this issue. In the paper we showed in many details that the number of adverse effects must have been even higher because liver disease was recorded only if the substance that reflects liver damage was three times higher than the upper limit of normal, and muscle disease was recorded only if the substance that reflects muscle damage was four times higher. In accordance independent researchers have reported that 20-25% of statin-treated people experience muscle pain or weakness. We also pointed out that several types of adversities were not recorded at all. It is well known for instance that diabetes occur in about 0.5% of statin-treated people and that 20% of the male patients become more or less impotent after a few months treatment. Reviews taking all cholesterol-lowering trials together have also shown a significant increase in death from accidents, suicide, or violence, and there are numerous reports about memory loss and other cerebral disturbances. Worst of all is that the risk of cancer has been ignored by all experts although there is much scientific evidence that cholesterol lowering may result in cancer (you can read much more about that in my recent book Ignore the Awkward!). A few days later I received the following message from the editor: |
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Thank you for sending us your paper. We read it with interest but I regret to say that we have decided not to publish it in the BMJ. Although we are sympathetic to the general point that the downsides of statins are underappreciated, we think that we have covered the point enough. Indeed, we published the Hippesley Cox article that you draw heavily upon.
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Dear Dr. Ravnskov, Many thanks for submitting your manuscript to The Lancet. We have considered your manuscript, but our decision is that it would be better placed elsewhere We tried Archives of Internal Medicine, but with the same result: Dear Dr. Ravnskov, Your manuscript has been reviewed by the senior editors of Archives of Internal Medicine. I regret to inform you that its priority rating is not sufficiently high to warrant our considering it further for publication. Based on our initial review, we will not be sending the paper for additional outside editorial review Today millions of healthy people are on statin treatment without knowing about the imbalance between benefits and risks. How should we inform them when the experts and the medical journals don´t? We haven´t given up and we shall try other journals. The problem is however, that few medical journals are able to survive without their income from the drug industry, and editors are therefore reluctant to publish papers like ours. In
Sweden we have succeeded in informing the public by publishing an article
in Dagens Nyheter, the largest and most influential Swedish
newspaper. An
English version is available on the web. Click also on the text
in the upper. right hand corner: Svenska Dagbladet: Debate on reignited. Shuffle the cards and the reader will believe you! Misleading
papers about the benefits of statin treatment published
by research groups from prestigious universities are countless. Here is an
example. In 2003 the results from a large, multinational statin trial named ASCOTT-LLA (Anglo-Scandinavian Cardiac Outcomes Trial—Lipid-Lowering Arm) including 10305 patients, half of whom had received statin treatment. All of them had three risk factors, but none of them had had a heart attack. The trial was planned to continue for five years, but was stopped already after 3.3 years because of its “large reduction in major cardiovascular events”. Fatal and non-fatal myocardial infarction was reduced by 36 %, seemingly an impressive figure. However, the absolute figures were 1.93 % “heart events” in the statin group against 3 % in the untreated control group, thus a difference of only 1.07%. The figure 36% is correct, however, because 1.07 is the difference between 3 and 1.93, and 1.07 is 36 % of 3.The difference in mortality was even lower. 3.6 % died in the statin group against 4.1 % among the untreated. You could also say that the chance of being alive after 3.3 years without statin treatment is 95.9 %, but if you take a statin drug every day you can increase your chance to 96.4 %. You have to consider the risk of adverse effects, however. In the statin group 3.8 % either got diabetes, renal failure or life-threatening heart arrhythmia, against 3.2 % among the untreated. None of these adverse effects had increased with statistical significance, but perhaps they would, had the trial continued for the planned five years. Nothing was said about other adverse effects, although there are many reports about muscle damage, impotency, cancer, bad memory or temper, to mention just a few, and some of them have been reported in much larger number. More about that in my previous newsletter. Now to the amazing news. Eight years after the discontinuation of the trial the outcome of the British participants was analysed. To their surprise the researchers found that among those who had been on statin treatment eight years before, fewer had died from an infectious or respiratory disease compared with the untreated control individuals. Only 1.6% of those, who had been on statin treatment, had died from these diseases against 2.44% among the untreated. The authors were excited, and the news were spread to many newspapers and professional websites; for instance Science Daily, Daily Mail, Pulse, Netdoctor and The Heart to mention a few. The authors had a number of reservations. But what
they didn’t consider was the fact that the number of statin-treated
individuals after these eight years was almost the same in the two groups.
To cite the authors: |
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The crucial question is of course the following: Why did the original treatment group stop taking statins? Could the reason be unpleasant adverse effects? And isn´t it possible that some of those who started statin treatment during these eight years had not yet decided to stop because of unpleasant symptoms? If so, no conclusions can be drawn from these findings. That cholesterol-lowering should prevent infectious diseases is also highly unlikely, because the lipoproteins protect against all kinds of infectious diseases, an issue that I have described in detail in my books.
More brave journalists Now to the good news. Skepticism against the cholesterol campaign is growing. A few days ago medical journalist Lois Roger published a critical article about this issue entitled Big Fat Lies in the Sunday Times. Unfortunately it is not available without paying, but somebody has sent it to a website named Active Low-Carber Forums Another
eloquent journalist and researcher is Roy Moynihan. In the August 15 issue
of BMJ he published a new, critical paper entitled “Surrogates under
scrutiny: fallible correlations, fatal consequences”. Those who have
read my books are of course familiar with the issue. Here are a few
quotations for those who haven´t, as it is not available for
nonsubscribers: |
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…The
benefits of long term preventive therapies like cholesterol lowering drugs
are usually portrayed as relative reductions in risk, but when the risks
are considered in absolute terms, a different picture emerges. For
example, based on a Cochrane review of trials for primary prevention,
there has been recent enthusiasm that for people without a history of
heart disease statins can reduce premature deaths by 17%, coronary heart
disease by 28%, strokes by 22%, and revascularisation by 34%. Yet a close
reading of the tables from that systematic review suggests the estimated
absolute risk reductions with around four to five years of drug taking are
0.5% for death, 1.9% for coronary heart disease, 0.5% for stroke, and 0.7%
for revascularisation. …The magic of numbers may help corporate profits and professional pride, but at what cost to the health of ordinary people who mistake a numerical benefit for a genuine one? Surely it’s time to ask if there might be a healthier new model for medicine based on far less harmful and costly ways to try to reduce human suffering.”
A Swedish revolution
In Sweden there is an increasing understanding that
meat, eggs and dairy products have nothing to do with atherosclerosis or
heart disease. The story began the year 2005. Lars Erik Litsfeldt, a
Swedish lawyer contacted me to tell me about his success with a lowcarb,
high fat (LCHF) diet. A few years earlier he was an overweight diabetic
with heart problems, but after a few days on the LCHF diet his blood sugar
became normal and he could stop his medication, and soon after his body
weight was back to normal. Our discussions about fat and cholesterol
inspired him to wrote a book “Fettskrämd” (Scared by fat). The same year a book was published by Sten Sture
Skaldeman, a journalist, who had almost halved his body weight (141 kg;
311 lb) by eating a LCHF diet. He had followed the usual dietary
recommendations in vain; his body weight increased more and more. When he
got diabetes and heart failure he realised that his life could end very
soon and he therefore decided to eat the food he enjoyed the most, eg. fat
food. To his surprise he noted that week after week he lost weight and all
his ailments disappeared. However, what really created attention was what
happened to Annika Dahlquist, a general practitioner in Northern Sweden.
When she experienced the same benefit on herself from this diet,
she started recommending it to her patients as well. Two local dieticians
accused her for misconduct and reported her to The National Board of
Health and Welfare (Socialstyrelsen) and her chief prohibited her from
giving dietary advice. However, two years later The National Board
acquitted Annika; although her dietary advice went contrary to the
official guidelines, as they wrote, they were supported by science. Annika wrote a book herself, which became a
blockbuster. Today every Swede knows Annika Dahlquiost and her message.
She has appeared in several television shows and she has given numerous
lectures for lay people all over the country
She has been followed by another general practitioner, Andreas
Eenfeldt, who has written a blockbuster book as well and started an LCHF
blog that has become the largest health blog in Sweden. Together with eight colleagues I have backed up the
LCHF movement by criticizing The National Food Administration for giving
unhealthy dietary advices, both in the newspapers and in the Swedish
medical press. Here is an excerpt from my book “Ignore the Awkward!”
about one of our papers, published in Dagens Medicin, a popular medical
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“Recently, the Swedish Food
Administration published a list of seventy-two studies, which they claimed
were in support of their warnings. Together with eleven colleagues I
scrutinized the list and what we found was the following:
Eleven
studies did not concern saturated fat at all. Another contradiction is, that for many years the
consumption of saturated fat has decreased in many countries, while during
the same time period we have seen a steady increase in the incidence of
type 2 diabetes.”
According to a recent poll almost 25% of the Swedish population has changes their dietary habits in the LCHF direction and in today´s local newspaper you could read that there is lack of butter in all districts in Sweden. False and dangerous advertisements from Unilever Recently David Jenkins and 16 colleagues published the results from a dietary trial in JAMA (The Journal of the American Medical Association). They had compared the usual low−saturated fat diet with a diet that included plant sterols, soy protein, fibers, and nuts. They succeeded in lowering LDK-cholesterol by about 13% with the plant sterol diet, but only by 3% with the usual low-fat diet. What is a plant sterol, you may ask. Cholesterol is an important constituent of plants as well, although the molecule looks a little different. There are several types of plant cholesterol; together they are named plant sterols. A typical Western diet contains 400-500 mg plant sterols, but little is taken up in the gut. Human and plant cholesterol compete for uptake in the gut. If you eat much plant sterol, your intake of normal cholesterol goes down. This fact got Unilever the idea to add plant sterols to their food products; in the first hand to margarine. The product is named Promise Active in the US, and Flora Pro.active or Becel Pro.active in other countries. And this was also the product that was given to the participants in the plant sterol group. It is correct that cholesterol goes down if we eat much plant sterol, but that doesn’t mean that it is able to prevent heart disease, because no one has ever tested that in a scientific experiment. What happens is that our own cholesterol is exchanged with a foreign type of cholesterol, not only in the blood but also in our cells and cell membranes. Is it really a good idea? Isn’t it likely that the molecular differences between animal and plant sterols have a meaning? I think so, and science is in support of my view. Several studies have shown that even a mild elevation of plant sterols in the blood is a risk factor for heart disease, and the findings in people with a rare inborn disease named sitosterolemia are in accord. These people absorb much more plant sterols than normally and they also become atherosclerotic much earlier in life than normal people. Statin treatment lowers blood cholesterol, but at the same time it raises the level of plant sterols. In the 4S-trial about 25 % of the patients had a mildly elevated level of plant sterols before treatment. In this group statin treatment resulted in a further increase of plant sterols and the number of heart attacks was twice as high compared with the patients with the lowest plant sterol levels. This means that for about 25% of the many millions of people on statin treatment, their risk of heart disease may increase, not decrease. In spite of that, Unilever still advertise their margarine and other food products with high contents of plant sterols: Enjoy heart healthy buttery spread with Promise! I
became upset when I read that paper and I therefore sent a letter to the
editor of JAMA with the following text: Questionable conclusions
from a dietary trial It
is well known that an addition of plant sterols and soybean products to
the diet may lower cholesterol by 10-15%. The findings in the dietary
trial performed by Jenkins et al.(1) are therefore no surprise.
It is questionable, however, if a lowering of cholesterol by dietary means
is equivalent with a lowering of the risk of coronary heart disease (CHD)
because hitherto no unifactorial dietary trial has succeeded in lowering
cardiovascular or total mortality (2,3). What the authors also
ignore is that an increased intake of plant sterols is associated with an
increased cardiovascular risk. In at least four cohort studies a high
intake or a high plasma level of plant sterols were independently
associated with a higher risk of CHD,
and in experiments on mice a dietary supplementation with plant sterol
esters equivalent to a commercial spread induced endothelial dysfunction (4). 1.
Jenkins DJ, Jones PJ, Lamarche B et al. Effect of a Dietary
Portfolio of Cholesterol-Lowering Foods Given at 2 Levels of Intensity of
Dietary Advice on Serum Lipids in Hyperlipidemia: A Randomized Controlled
Trial. JAMA.
2011:306(8),831-839. 2.
Ravnskov U. The questionable role of saturated and polyunsaturated
fatty acids in cardiovascular disease. J
Clin Epidemiol. 1998;51(6):443-460. 3.
Hooper L, Summerbell CD, Higgins JP et al. Dietary fat intake and
prevention of cardiovascular disease: systematic review. BMJ.
2001;322(7289):757-763. 4.
Weingärtner O, Böhm M, Laufs U. Controversial role of plant
sterol esters in the management of hypercholesterolaemia. Eur
Heart J. 2009;30(4):404-409. A
month later I got the following answer from the Editor: Dear Dr. Ravnskov: Thank you for your recent letter to the editor. Unfortunately, because of the many submissions we receive and our space limitations in the Letters section, we are unable to publish your letter in JAMA. After considering the opinions of our editorial staff, we determined your letter did not receive a high enough priority rating for publication in JAMA. We are able to publish only a small fraction of the letters submitted to us each year, which means that published letters must have an extremely high rating. We encourage you to contact the corresponding author of the article, although we cannot guarantee a response. We do appreciate you taking time to write to us and thank you for the opportunity to look at your letter. Sincerely yours, Jody W. Zylke, MD Senior Editor, JAMA Letters
Section Editor I
haven´t contacted the corresponding author of the paper, as suggested by
Dr. Zylke, by the simple reason that nothing would happen. According to
the Conflict of Interest Disclosures ten of the authors were supported
financially by Unilever and several other producers of the food types used
in the trial. Here is for instance Dr. Jenkins´ list: “Dr
Jenkins reported serving on the Scientific Advisory Board of Unilever,
Sanitarium Company, California Strawberry Commission, Loblaw
Supermarket,Herbal Life International, Nutritional Fundamental for Health,
Pacific Health Laboratories, Metagenics, Bayer Consumer Care, Orafti, Dean
Foods, Kellogg’s, Quaker Oats, Procter & Gamble, Coca-Cola, NuVal
Griffin Hospital, Abbott, Pulse Canada, Saskatchewan Pulse Growers, and
Canola Council of Canada; receiving honoraria for scientific advice from
the Almond Board of California, International Tree Nut Council Nutrition
Research and Education Foundation, Barilla, Unilever Canada, Solae,
Oldways, Kellogg’s, Quaker Oats, Procter & Gamble, Coca-Cola, NuVal
Griffin Hospital, Abbott, Canola Council of Canada, Dean Foods, California
Strawberry Commission, Haine Celestial, and Alpro Foundation; being on the
speakers panel for the Almond Board of California; receiving research
grants from Loblaw Brands Ltd, Unilever, Barilla, Almond Board of
California, Solae, Haine Celestial, Sanitarium Company, Orafti,
International Tree Nut Council, and Peanut Institute; and receiving travel
support to meetings from the Almond Board of California, Unilever, Alpro
Foundation, and International Tree Nut Council.” In addition Unilever Research and Development provided the donation of margarines used in the study. Misleading scientists - once again Statins
cure almost everything. This is the message we are told again and again in
the scientific press; at least from researchers supported by the drug
companies. Here is a new example. In European
Heart Journal Peter
S Sever and his coauthors claimed that statin treatment also lower
mortality from infections and respiratory diseases. How did they
come up with this surprising result? It is surprising because as readers
of my books know, the lipoproteins, the carriers of cholesterol, is an
important part of our immune system. If we lower cholesterol, we lower the
lipoproteins as well. Their
argument comes from a large statin experiment called ASCOTT-LLA. This
trial included more than 10,000 patients with hypertension, half of whom
were treated with atorvastatin. The trial was stopped prematurely in 2002
after three years because of the allegedly obtained benefit at that time.
In the treatment group 3.58% had died; in the untreated group 4.13%. After
that the treated participants decided for themselves whether they wanted
to continue the treatment or not, and the untreated were offered
treatment. About a third in the first group stopped or had already stopped
treatment, and more
than half of the others started. Eight years later more had died from
infections and pulmonary diseases in the control group. But
how could they know whether the difference was due to statin treatment? As
I wrote in
a letter to the journal:
It is not too farfetched to assume that those who stopped the treatment,
did it because of unpleasant adverse effects, and that many of those, who
had started it, not yet had recognized that possible adverse effects were
caused by the treatment. The
analyses were supported by an unrestricted grant from Pfizer and two of
the authors, including Peter Sever, had served as consultants or received
travel expenses, or payment for speaking at meetings, or funding for
research from one or more pharmaceutical companies that market
blood-pressure-lowering or lipid-lowering drugs, including Pfizer for
ASCOT. If
you want more information about the many misleading ways we are informed
about the statins, read this
paper by
Stephanie Seneff. Stephanie is a senior scientist at Massachusetts
Institute of Technology (MIT) and a member of THINCS And if you think that the lipid guidelines are written by independent researchers, please read this article by Larry Husten. Recently, the Danish government committed an act of extreme folly: They taxed saturated fat, ostensibly ‘to prevent obesity’. And in so doing, they got it disastrously wrong. Why? Because saturated fat is not only not fattening; it is actually one of the best slimming agents. If you understand the Scandinavian languages, you can read why that is a bad idea in my chronicle in Berlingske Tidende, one of the major Danish newspapers. (You can get an approximate translation using Google´s language tool). To prevent similar mistakes by other governments Members of THINCS are just now preparing a similar paper in seven different languages to be sent to newspapers in other countries. We are not too optimistic because articles critical to the cholesterol campaign are rarely accepted for publication. How to cheat with complicated calculations The
New England Journal of Medicine recently published the
results of the SATURN trial.
It was designed to study the effect of atorvastatin (Lipitor) vs.
rosuvastatin (Crestor) on the volume of atheroma in a coronary artery. It
was hoped that the volume would be reduced, demonstrating that high dose
statins can decrease the burden of atherosclerosis. Initially
1578 patients were selected for the trial, but after a run-in period of 2
weeks where they were treated with half-maximal doses of either
atorvastatin or rosuvastatin, 193 patients were excluded. The rest were
treated either with 80 mg atorvastatin or 40 mg rosuvastatin. After 2
years of treatment a further 346 patients had disappeared. Before
and after the trial the patients underwent intravascular ultrasonography
to measure the lumen diameter and the total diameter of a coronary artery.
Subtracting the lumen area from the total area of the artery is thought to
reflect the total atheroma volume, (represented as the percentage atheroma
volume). The primary endpoint was to measure the reduction in percent
atheroma volume After
the treatment the lumen had increased on average by 0.99 % in the
atorvastatin group, and by 1.22 % in the rosuvastatin group, and the per
cent atheroma volume (eg. the area of the arterial wall) had decreased by
1.1 % and 1.3 % respectively.
TAVnormalized
= Σ (EEMarea − lumen area x median
no. of
no.
of images in pullback images in cohort
Anyway, the critical measure was the difference between the inner and
outer area of the artery. Unfortunately, there is no evidence that the
figure from this calculation reflects atheroma volume. For example,
vascular dilation will increase the inner diameter, without having any
effect on the thickness of the arterial wall. But this would result in an
apparent decrease in atheroma volume. To further understand what I mean,
read the following section from my book Fat
and Cholesterol are GOOD for You! The
anguish of angiography
In short, the degree of arterial dilation is a massive and uncontrolled
variable in the SATURN study. This problem could have been solved if the
investigators had included a placebo group (a group of patients who
unknowingly received an ineffective pill). However, “It was not
considered ethically possible to measure disease progression in
placebo-treated patients”, as they wrote. There were other major problems with this study.
The issue of drug related adverse events is extremely important. This was
virtually dismissed within the paper. “Both agents had acceptable
side-effect profiles”. Can this be true. A more detailed review of
adverse events reveals that “new proteinuria”, defined as an excretion
of more than twice the amount of protein in the urine during the
follow-up, in 1.7 and 3.8 %, respectively in the two groups. An increase
in proteinuria is a measure of progressive damage to the kidneys. This
trial only lasted two years, so we don´t know what would have happened in
the longer term. Equally it was stated that less than two per cent
had laboratory signs of liver damage. However, liver damage was only
recorded if the laboratory signs were at least three times higher than the
upper limit of the normal range. And whilst less than two per cent had
muscular damage, this was only reported if the laboratory signs were at
least five times higher than the upper limit of the normal value. What do
you think will happen with the liver and muscles of patients whose
laboratory signs were “only” twice or four times higher, respectively? In the end a further 22 % of the patients had
disappeared. The reasons were said to be preference of patient (7.7% and
7.8 %), adverse effects (7% and 6.5 %), loss to follow-up (1.3% and 2.9 %)
and noncompliance (2.3% and 1.9 %). What they meant with “preference of
patient” I don´t know, but I am confident that “non-compliance” and
perhaps also “loss to follow-up” represent those who could not
tolerate the medication. Thus, whilst the authors claimed that ‘both
agents had acceptable side effect profiles,’ the reality is that 12%
could not tolerate these agents at the start of the study, and another 23
% dropped out – most likely to due to intolerable adverse events. My summary of the SATURN study would be that it
used a primary end point that has never been properly validated, and can
be affected by a host of confounding variables e.g. stress . This
variability could only have been controlled for by including a placebo
arm, which was not done. Therefore, the result is rendered meaningless. More importantly, it would appear that the burden
of adverse events from using high doses of statin drugs is unacceptably
high. It is likely that more than a third of patients will be unable to
tolerate 80 mg Atrovastatin, or 40 mg of Simvastatin. All of this
suffering in order to have an uncertain effect on a surrogate end-point,
which may or may not mean anything. |
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Dr.
Nicholls reports receiving consulting fees from Roche, Esperion,
Merck,
Omthera, Sanofi-Aventis, and Boehringer Ingelheim, serving as an unpaid
consultant for Abbott, Pfizer, LipoScience, Novo Nordisk, AtheroNova, and
CSL Behring, receiving grant support from Eli Lilly, AstraZeneca,
Novartis, Anthera, LipoScience, Roche, and Resverlogix and lecture fees
from AstraZeneca and Roche; |
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Should children lower their cholesterol??? There are more miserable news. Recently an expert
panel appointed by the National Heart, Lung and Blood Institute and
endorsed by the American Academy of Pediatrics has published new
guidelines according to which every child in the United States
should be tested for high cholesterol between ages nine and 11 so steps
can be taken to prevent heart disease later on. Such crazy thoughts have been aired several times
in the past. In a letter to
The Lancet (published on January 1, 2000; a good start of the new
millennium). I tried to explain why this is a most dangerous idea, but
obviously the letter made no impact.
December 2011 In many western countries
more and more get cancer although at the same time more and more people
stop smoking, one of the most cancer provoking factors. Members of
Skeptics think that the reason is the increasing use of cholesterol
lowering drugs. Those who promote such treatment argue that no analysis of
the statin trials have shown any association and some even claim that the
statins protect against cancer. There are many ways to
cover up the fact that lowering cholesterol may lead to cancer, but there
are also numerous observations that point to low cholesterol as the
villain. But how can low
cholesterol lead to cancer? This is a good question, and there is an
answer. Because the liporoteins partake in the immune defense system, and
because many cancers are caused by virus or bacteria. Together with two members of THINCS, Kilmer McCully, the discoverer of the association between homocysteine and atherosclerosis, and Paul Rosch, President of the American Institute of Stress, I have tried to present the facts around this issue. The paper has finally been published in Quarterly Journal of Medicine Before that, we sent the paper to six different medical journals (not at the same time of course), all of which rejected it. Here are their arguments |
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CA: A Cancer
Journal for Clinicians:
Cancer:
JAMA:
Journal of the National Cancer Institute: I am sorry that we shall not be able to use the above-titled manuscript. After careful evaluation, the Editorial Board did not accord it a priority sufficient for further consideration.
Scandinavian Cardiovascular
Journal: Read our
paper yourself and tell me if the paper is not "of broad
enough interest" or if it is "polemic in style" or
if "its priority rating is not sufficiently high" What I have told you here is no exception. Many of our members including myself can tell you about how difficult it is to publish papers that goes counter to conventional wisdom. On oe of our websites you can find many examples of rejected papers and commensw. Statin treatment and infections Several
researchers have claimed that statin treatment prevents infections.
Recently a Dutch group published an
analysis of the statin trials
where the authors had reported the number of infections. Not unexpectedly
they didn´t find any difference between the statin groups and the
controls (those who got an ineffective placebo pill). In
an editorial
in the same issue of British Medical Journal, where the Dutch report was
published, Beatrice Golomb commented the study. It was certainly not
expected either because, as she wrote, a number of relevant factors may
distort the results. One of them is the fact that among 632 statin trials,
only eleven reported the number of infections, and ”most authors
declined to provide the omitted information when approached”. “The
best evidence, she concluded, “is that statins should not be used to
forestall infection or its consequences.” There
is even evidence of the opposite. As mentioned, and as Golomb also pointed
out, low cholesterol is a risk factor for infection, and as we have a
plausible mechanism to propose, we send a letter to British Medical
Journal, now published as a Rapid
Response. Most Rapid Responses are available on the web ony. If you sympathize with our letter, you are most welcome to vote (on the right hand side of the letter). Many positive votes may possibly increase its chance to become published in the paper version as well. January 2012
In my
November
newsletter I
told you about the misleading SATURN trial. Together with two of our
members, Paul Rosch, Professor of Medicine and Psychiatry at New York
Medical College and President of The American Institute of Stress, and
Stephanie Seneff, Principal Research Scientist at MIT, I sent the
following letter to New England Journal of Medicine:
A few days later I got the following letter from the journal:
It is of course embarrassing that the editors accepted the SATURN report
for publishing in one of the world´s most respected medical journals, but
shouldn´t they have the guts to admit their mistake? Or has even this
journal become dependent on the money from the drug companies? They have
lots of them; take a look for instance at the short
movie with three of our members as actors. How to meet criticism
A few months ago Jan Pedersen and coworkers,
all of them strong supporters of the diet-heart idea, published an
editorial in British Journal of Nutrition entitled The
importance of reducing SFA to limit CHD. Pedersen
and his co-workers published a
response
to
our letter without answering any of our objections (To read their
response, click on the blue field in the upper right corner). Their answer
is almost identical with a response I got a few years ago from Martijn
Katan, one of Pedersen´s co-workers. You can read my letter and Katan´s
response on
Michael Eades blog
together with Michaels comments. An
interview with me
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Diabetics - don´t eat statins! It
is well established that patients with diabetes run a greater risk of
developing cardiovascular diseases. In Sweden and in most other countries
cholesterol-lowering treatment is therefore prescribed routinely to all
diabetics, whether their cholesterol is high or low and failure to do so
is seen as professional misconduct. But there are a number of observations
that should have stopped this habit long ago. First,
at least fourteen studies have shown that high cholesterol is not a risk
factor for patients with diabetes. If you are in doubt, go to chapter 4 in
my book “Ignore the Awkward!, there you will find the references to
these studies. The reason is probably the fact that high cholesterol may
protect against infections, a common problem for diabetic patients. As
readers of my books know, there is strong evidence that the lipoproteins
are able to bind and inactivate all kinds of bacteria and virus. You can
read more about that in a
paper
that I published together with Kilmer McCully. A
critical and well-informed reader may possibly say that the small effect from statin treatment is not due to cholesterol lowering, but
to their other effects, and this is true. If so, statin
treatment perhaps may benefit a diabetic in other ways. But here comes the
next warning: Statin treatment may cause diabetes! What happens with those who already have diabetes when they start statin
treatment? We don’t know because nobody has analysed this question.
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March 2012 Recently a new report has been published from the famous Channing Laboratory at Harvard. Here, a number of researchers headed by Walter Willett have studied the dietary habits for many years in more than 100,000 men and women. Again and again they have warned us against saturated fat, although none of their many studies have found that heart patients have eaten more of such fat than have other people. However, as I told you in my December Newsletter Willett has changed his mind This time the message, published in Archives of Internal Medicine, is that you will shorten your life if you eat too much unprocessed read meat. Two population groups, the Health Professionals Study that included 37698 men, and the Nurses’ Health Study that included 83644 women, were followed for 22 and 28 years, respectively. At the start and every 4 year they filled in a dietary questionnaire. At follow-up almost 24,000 had died. The authors divided the participants into five parts (quintiles) after their intake of read meat. The first quintile included those who had eaten the least, and the fifth those who had eaten the most. Fromthemfiguresmgiven in the tables it is possible to calculate the mortality in each group. The pattern was similar in both groups, but for simplicity I give you the figures for the Health Professionals´ Study only. Here 1.23 per cent had died each year in the first quintile; and 1.29 per cent in the fifth quintile. Thus, during the 22 years the total mortality in these two groups was 27.1 and 28.4 per cent, respectively. But it was only 21.8 per cent in the third quintile! So, what shall we do? If we eat too much, the risk increases, but so it does if we eat too little. How can we know whether we eat too much or too little? However, there were many factors that could have skewed the result. For instance, those with the lowest intake were more physically active, fewer smoked, they ate more fruits, vegetables and fish, and fewer had diabetes and high blood pressure compared with the other groups. These life style factors were particularly bad in the fifth quintile. But as mentioned, the risk of dying was about the same in all groups. You could also say that even if you smoke, eat too little fruits, vegetables and fish, and even if you have diabetes or high blood pressure, then you may live almost as long as people with a healthier lifestyle if you gorge in unprocessed read meat. The authors concluded otherwise, however, because their statistician has made some serious errors. After having corrected for the uneven distribution of the various factors, they found that the risk of dying was lowest in the first quintile and it increased step by step from the first to the fifth quintile. Their conclusion was that if you consume less than 42 gram unprocessed meat per day, you could lower your risk to die the next 22-28 years by about 8 per cent. It is not possible to know the exact mortality after their corrections, because it is expressed in a statistical term called hazard risk. But let us assume that the risk after the corrections was 30 per cent for those with the highest intake and 27.6 per cent for those with the lowest. These figures are of a similar magnitude as those that we can calculate ourselves from the original figures. The difference between 30 and 27.6 is 2.4, meaning that you can only lower your risk of dying by 2.4 per cent. Then how can they conclude that we can lower it by 8 per cent? Because 2.4 is 8 per cent of 30. There are more curious data. The body weight of the participants was pretty normal in all groups. To be precise, BMI varied between 24.7 and 26.0. But whereas the high-consumers on average ate about 2200 calories per day, the low-consumers ate only 1659. In the Nurses’ Health Study, where BMI varied between 23.9 and 24.7 the high-consumers ate 2030 calories and the low-consumers only only 1202! These figures are of course highly unlikely. People who have eaten only 1202 calories per day for 28 years cannot have the same body weight as people who have eaten 2030 calories per day. Thus, the statistician must have made some serious miscalculations. But let us assume that the figures are correct. Should we really bother? Let me calculate it in another way. If you eat as much unprocessed read meat as you like, your chance to be alive after 22 years is about 70 per cent, but if you avoid it as much as possible you can increase your chance to 73 per cent at most. But again, this is true only if the data published by Hu and his coworkers are correct, and this is very unlikely. You can learn more about this paper by reading a detailed comment by one of our members Zoë Harcombe. She also asked Frank Hu, if he could explain the curious result. Here is his answer: Thanks for your interest in our paper. Unfortunately, the crude mortality rate is misleading because the mean age in the first quintile (Q1) was older than other quintiles. Therefore, the crude mortality rate in the first quintile would be artificially higher than other quintiles. In this analysis, age was a stronger confounding factor than other lifestyle factors. Hope this helps. Frank Hu This answer is nonsense of course, because there were only minor differences in age between the five quintiles. In HPFS it varied between 52.2 and 53.8, and in NHS between 45.3 and 47.3 years. For instance, compare these small differences with the fact that in the fifth quintile there were almost three times more smokers than in the first; and only 17 percent were physically active against 27 percent in the first. Professor David Diamond, another member of THINCS, sent him a letter as well, but hitherto Frank Hu hasn´t answered him. Do you become fat by eating fat? A last question: Do you suffer from obesity? Then listen to this brilliant lecture by Zoë Harcombe.
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"New" statin side effects Those
of you, who have read our member Duane
Graveline´s book ”Thief of Memory” know that bad memory is one of
the many serious side effects from statin treatment. According to Dr
Graveline thousands of reports about cognitive problems that have occurred
during statin treatment and have disappeared after its discontinuation,
have been sent to FDA since the introduction of these drugs. A few months
ago FDA finally have officially admitted in a New
safety alert that such problems may occur. You can read more about
that in several newspapers, for instance NY
Times, Edmonton
Journal and Boston
Globe You may probably ask, how come that it took more than ten years? Let me cite a few words from Marcia Angell´s book ”The Truth About the Drug Companies. How They Deceive Us and What to Do About It”. Marcia Angell is the former editor in chief of The New England Journal of Medicine. ”Congress also put the FDA on the pharmaceutical industry´s payroll . . . Fees . . . soon accounted for about half the budget of the agency´s drug evaluation center. That makes the FDA dependent on an industry it regulates.” (page 208)
”The FDA is subject to industry pressures through its eighteen standing advisory committees on drug approvals. These committees, which consist of outside experts in various subspecialities, are charged with reviewing new drug applications and making recommendations to the agency about approval. The FDA almost always takes their advice. Many members of these committees have financial connections to interested companies . . . Members of FDA advisory committees are said to command unusually high consulting fees from drug companies.” (pages 210-211). More and more are realizing the dangers of statin treatment. Here is a warning from Sylvia Booth Hubbard, NewsMax Media (Peter Langsjoen, who is mentioned in the article, is a member of THINCS). And here is a scary video from an insider , who has worked for 15 years in the drug industry. In a previous newsletter I told you about statins and the risk of cancer. Our article about this issue has now been published in the paper version of Quarterly Journal of Medicine. Kim Greenhouse from a Los Angeles Radio named ”It´s Rainmaking Time” interiewed me recently. You can listen to it here.
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Note: If you want to receive my newsletters, click here If
you are not familiar with the scientific language used here and there in the
above, You can read about most of the issues taken up in the above in a more
popular way in my books. In the most recent one I have also described how it has
been possible to seduce a whole world for many decades by ignoring all
conflicting observations; by twisting and exaggerating trivial findings; by
citing studies with opposing results in a way to make them look supportive; and
by ignoring or scorning the work of critical scientists. Here they are, together with the Swedish, Danish, Finnish, German, Polish and Dutch variants: |
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