Cholesterol lowering drugs

Discussion in 'Health and medical' started by Aniram, Feb 10, 2004.

  1. Aniram

    Aniram Guest

    I heard that cholesterol lowering drugs also lower the human immunity, making the person weaker. Is
    this true? Are there websites that discuss about the controversy of these drugs, particularly
    against our immune system? Did the medical groups / drug manufacturers try to hide this fact? Is
    there any scientific reports or papers available that suggest the above? Thanks for info.
     
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  2. "aniram" <[email protected]> wrote...
    > I heard that cholesterol lowering drugs also lower the human immunity, making the person weaker.
    > Is this true? Are there websites that discuss about the controversy of these drugs, particularly
    > against our immune system? Did the medical groups / drug manufacturers try to hide this fact? Is
    > there any scientific reports or papers available that suggest the above? Thanks for info.

    This is the first time I've ever heard of this idea. Statin drugs have been widely used for at least
    a decade and huge numbers of people are currently on them with no apparent adverse effects. I did
    read of a very recent study that links the statin drug Lipitor with memory loss; the link is still
    uncertain, although the brain is composed of large amounts of cholesterol so that a cholesterol-
    lowering drug may indeed have some effect on brain function. As for lowering immunity - statin drugs
    are increasingly being given to AIDS patients because some of the anti-HIV medications cause
    extremely high cholesterol levels as a side-effect in some patients. I think immune-system effects
    would be first noticed among this group, so focus your research there.
     
  3. Basil Fawlty

    Basil Fawlty Guest

    On 10 Feb 2004 11:00:33 -0800, [email protected] (aniram) wrote:

    >I heard that cholesterol lowering drugs also lower the human immunity, making the person weaker. Is
    >this true? Are there websites that discuss about the controversy of these drugs, particularly
    >against our immune system? Did the medical groups / drug manufacturers try to hide this fact? Is
    >there any scientific reports or papers available that suggest the above? Thanks for info.

    Interesting that you shold mention this, as I'm on a statin and have noticed that problem. This is
    the 1st time I've ever heard this connection, but it makes sense to me.
     
  4. Ellis G.

    Ellis G. Guest

    Basil Fawlty wrote:
    >
    > On 10 Feb 2004 11:00:33 -0800, [email protected] (aniram) wrote:
    >
    > >I heard that cholesterol lowering drugs also lower the human immunity, making the person weaker.
    > >Is this true? Are there websites that discuss about the controversy of these drugs, particularly
    > >against our immune system? Did the medical groups / drug manufacturers try to hide this fact? Is
    > >there any scientific reports or papers available that suggest the above? Thanks for info.
    >
    > Interesting that you shold mention this, as I'm on a statin and have noticed that problem. This is
    > the 1st time I've ever heard this connection, but it makes sense to me.

    I also read this recently:

    Subject: Lipitor, Thief of Memory - New Book Date: Mon, 02 Feb 2004 02:39:33 GMT From: "Sharon Hope"
    <[email protected]> Organization: Comcast Online Newsgroups: sci.med.pharmacy

    The new book, "Lipitor, Thief of Memory", is now available. The release is timely, as Wall Street
    Journal reported last week that the cognitive damage from statin drugs is seen in ~ 15% of the
    patients. Many of these people are told they have "early Alzheimer's" when in fact the drug is
    affecting their memory.

    The author, Duane Graveline MD, is a former US Astronaut, US Air Force Flight Surgeon, and MD
    family doctor, retired. His book, "Lipitor, Thief of Memory" is now available from Infinity
    Publishing. Just call
    877/BUY-BOOK or order online at: http://www.buybooksontheweb.com/description.asp?ISBN=0-7414-1881-9

    Book is $17.95 + $4.50 S&H

    If you buy 5 or more, there is a 40% discount. (in case you go in together or want to give some to
    friends, or doctors)

    If you buy 20 or more, the shipping is FREE

    More and more, people on Cholesterol-lowering statin drugs are suffering disabling short-term memory
    loss and multiple episodes of transcient global amnesia. The brand names of the statin class of
    drugs: Lipitor, Mevacor, Pravachol, Zocor, Lescol, Crestor and Baycol, aka atorvastatin,
    cerivastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin; This class of
    drugs is also known as HMG-CoA Reductase Inhibitors, short for 3-Hydroxy-3-Methyl-Glutaryl Coenzyme
    A Reductase.

    Note that WSJ estimates 15% of statin patients are affected by cognitive adverse effects, far
    more than the 2% on the label. Given that there are over 106 million people on statins (per
    Fortune Magazine
    878), each percentage represents over a million people.

    That would put memory loss from statins at about 15 million people, which is horrific if it is to
    the degree of total disability, as it has been in my husband. The statins are being prescribed for
    people in their 30's, 40's and 50's.

    By comparison, according to the website by the Fisher Center for Alzheimer's Research Foundation:
    "Today, it is estimated that about five million* Americans suffer from Alzheimer's disease, and
    about 360,000 people are newly diagnosed every year. Alzheimer's affects about 10 percent of people
    ages 65 and up, and the prevalence doubles roughly every 10 years after age 65. Half of the
    population ages 85 and up may have Alzheimer's.(*Sources: Evans D., International Conference on
    Alzheimer's Disease and Related Disorders, July 22, 2002; Evans et al, The Milbank Quarterly, 1990;
    Brookmeyer et al, American Journal of Public Health, 1998)"

    All screening tests for Alzheimer's should include questions that determine if the patient has been
    taking one of these cholesterol-lowering statin drugs. If the symptoms started after the patient
    started the drug, the possibility that the memory loss is due to the drug must be explored. Be aware
    that discontinuing the drug must be done under a doctor's care, and that memory loss due to the drug
    resolves very slowly, over a period of years if it took that long to develop on the drug, but it
    does resovle.
    -----------

    Ellis Georgantis
     
  5. Anon

    Anon Guest

    On 2004-02-10 14:00:33 -0500, [email protected] (aniram) said:

    > I heard that cholesterol lowering drugs also lower the human immunity, making the person weaker.
    > Is this true?

    There's no scientific evidence of it. I'd say the burden of proof is on the person(s) making
    the claim.
     
  6. Basil Fawlty

    Basil Fawlty Guest

    On Sun, 15 Feb 2004 18:26:21 -0500, "Ellis G."
    <[email protected]> wrote:

    >Subject: Lipitor, Thief of Memory - New Book Date: Mon, 02 Feb 2004 02:39:33 GMT From: "Sharon
    >Hope" <[email protected]> Organization: Comcast Online Newsgroups: sci.med.pharmacy
    >
    >
    >The new book, "Lipitor, Thief of Memory", is now available. The release is timely, as Wall Street
    >Journal reported last week that the cognitive damage from statin drugs is seen in ~ 15% of the
    >patients. Many of these people are told they have "early Alzheimer's" when in fact the drug is
    >affecting their memory.
    >
    >The author, Duane Graveline MD, is a former US Astronaut, US Air Force Flight Surgeon, and MD
    >family doctor, retired. His book, "Lipitor, Thief of Memory" is now available from Infinity
    >Publishing. Just call
    >877/BUY-BOOK or order online at: http://www.buybooksontheweb.com/description.asp?ISBN=0-7414-1881-9
    >
    >Book is $17.95 + $4.50 S&H
    >
    >If you buy 5 or more, there is a 40% discount. (in case you go in together or want to give some to
    >friends, or doctors)
    >
    >If you buy 20 or more, the shipping is FREE
    >
    >More and more, people on Cholesterol-lowering statin drugs are suffering disabling short-term
    >memory loss and multiple episodes of transcient global amnesia. The brand names of the statin class
    >of drugs: Lipitor, Mevacor, Pravachol, Zocor, Lescol, Crestor and Baycol, aka atorvastatin,
    >cerivastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin; This class of
    >drugs is also known as HMG-CoA Reductase Inhibitors, short for 3-Hydroxy-3-Methyl-Glutaryl Coenzyme
    >A Reductase.
    >
    >Note that WSJ estimates 15% of statin patients are affected by cognitive adverse effects, far
    >more than the 2% on the label. Given that there are over 106 million people on statins (per
    >Fortune Magazine
    >2002), each percentage represents over a million people.
    >
    >That would put memory loss from statins at about 15 million people, which is horrific if it is to
    >the degree of total disability, as it has been in my husband. The statins are being prescribed for
    >people in their 30's, 40's and 50's.
    >
    >By comparison, according to the website by the Fisher Center for Alzheimer's Research Foundation:
    >"Today, it is estimated that about five million* Americans suffer from Alzheimer's disease, and
    >about 360,000 people are newly diagnosed every year. Alzheimer's affects about 10 percent of people
    >ages 65 and up, and the prevalence doubles roughly every 10 years after age 65. Half of the
    >population ages 85 and up may have Alzheimer's.(*Sources: Evans D., International Conference on
    >Alzheimer's Disease and Related Disorders, July 22, 2002; Evans et al, The Milbank Quarterly, 1990;
    >Brookmeyer et al, American Journal of Public Health, 1998)"
    >
    >All screening tests for Alzheimer's should include questions that determine if the patient has been
    >taking one of these cholesterol-lowering statin drugs. If the symptoms started after the patient
    >started the drug, the possibility that the memory loss is due to the drug must be explored. Be
    >aware that discontinuing the drug must be done under a doctor's care, and that memory loss due to
    >the drug resolves very slowly, over a period of years if it took that long to develop on the drug,
    >but it does resovle.

    Thanks for this post, I hadn't heard of it causing memory lose, also something me and the family
    have noticed.
     
  7. "Basil Fawlty" <[email protected]> wrote...
    > Thanks for this post, I hadn't heard of it causing memory lose, also something me and the family
    > have noticed.

    The memory-loss connection was just reported by the media a week or two ago. So far, only Lipitor
    has been connected to it. They aren't sure, but they suspect it has something to do with the fact
    that the brain contains large amounts of cholesterol, cholesterol being essential for proper neural
    functioning. They believe that Lipitor may be reducing the brain's cholesterol, thus interfering
    with proper functioning and causing the memory loss. Further studies are being conducted to see if
    the loss is caused by the other statin drugs.

    Both my parents are on statins, my mother takes Lipitor and my father takes Mevachor. Sometimes I do
    wonder if they're getting Alzheimers, as they seem to forget lots of things. A TV show will come on
    and I'll remark that we just watched the same exact episode a few weeks ago and my father insists he
    hasn't seen it. I'll recite the entire plot and sometimes he will recall having seen it. But they
    are also getting old (61), so it may be natural memory loss. But even if it is statin- related, you
    have to weigh the memory loss with the drugs' benefits. My father was a ticking time bomb for a
    heart attack due to his high cholesterol level, now his doctor proclaims him to be in relatively
    perfect health in that respect. Same for my mother. And their diets still suck (meat, cheese,
    grease, etc., just like mine).
     
  8. Anon

    Anon Guest

    On 2004-02-19 14:10:13 -0500, "Charles Manson"
    <[email protected]> said:

    > "Basil Fawlty" <[email protected]> wrote...
    >> Thanks for this post, I hadn't heard of it causing memory lose, also something me and the family
    >> have noticed.

    Lots of people have memory impairment (and have had long before statins even existed), but thanks to
    cardiovascular disease (our nation's number one killer), many people die long before they become
    demented. Thanks to statins and reduced cardiovascular mortality and morbidity, more people may
    outlive heart disease long enough to become demented. I'd hardly fault the statin for that. There
    are way too many other variables in the equation to easily prove cause and effect.
     
  9. Zee

    Zee Guest

    "Charles Manson" <[email protected]> wrote in message news:<[email protected]>...
    > "Basil Fawlty" <[email protected]> wrote...
    > > Thanks for this post, I hadn't heard of it causing memory lose, also something me and the family
    > > have noticed.
    >
    > The memory-loss connection was just reported by the media a week or two ago. So far, only Lipitor
    > has been connected to it. They aren't sure, but they suspect it has something to do with the fact
    > that the brain contains large amounts of cholesterol, cholesterol being essential for proper
    > neural functioning. They believe that Lipitor may be reducing the brain's cholesterol, thus
    > interfering with proper functioning and causing the memory loss. Further studies are being
    > conducted to see if the loss is caused by the other statin drugs.
    >
    > Both my parents are on statins, my mother takes Lipitor and my father takes Mevachor. Sometimes I
    > do wonder if they're getting Alzheimers, as they seem to forget lots of things. A TV show will
    > come on and I'll remark that we just watched the same exact episode a few weeks ago and my father
    > insists he hasn't seen it. I'll recite the entire plot and sometimes he will recall having seen
    > it. But they are also getting old (61), so it may be natural memory loss. But even if it is statin-
    > related, you have to weigh the memory loss with the drugs' benefits. My father was a ticking time
    > bomb for a heart attack due to his high cholesterol level, now his doctor proclaims him to be in
    > relatively perfect health in that respect. Same for my mother. And their diets still suck (meat,
    > cheese, grease, etc., just like mine).

    Yes the memory problem is probably lipitor. No high cholesterol is not a cause of heart disease in
    and of itself. Sorry but 61 is getting older, true, but so is 37. Think how many active heads of
    corporations, governments, countries and high performance athletes are
    60. I am 61, my cholesterol is almost 12, in the British system (500 American system) and I have NO
    heart disease. However, I did suffer muscle pain, wasting and atrophy, memory and language loss,
    transient global amnesia, learning difficulties, pancreatitis, joint pain and injuries, vision
    damage and more--all from which I have only partly recovered. I still have no cardiovascular
    disease. All the members of my family have very high cholesterol. There is no reason to take a
    drug for something you MIGHT get. If that were the case, you'd be taking hundreds of medications
    daily. Read here:

    The Cholesterol Myths http://www.ravnskov.nu/cholesterol.htm

    And go to sci.med.cardiology and follow the discussions on lipitor and other statins.

    Cheers B'adant
     
  10. Anon

    Anon Guest

    On 2004-02-19 18:21:27 -0500, [email protected] (Zee) said:

    > "Charles Manson" <[email protected]> wrote in message news:<jP2dnbkYY9Dbl6jdRVn-
    > [email protected]>...

    > There is no reason to take a drug for something you MIGHT get. If that were the case, you'd be
    > taking hundreds of medications daily.

    You're right, Chuck. You could stop smoking, eat a balanced, healthy diet, exercise regularly,
    maintain a healthy body weight, etc. Even so, some of these "healthy" folks would still have
    *preventable* heart attacks. And how many people do you know who are *really* doing all of the
    above? There are reasons why our life expectancy is increasing, and believe me...it's not because
    people are taking better care of themselves.
     
  11. "Zee" <[email protected]> wrote...
    > Yes the memory problem is probably lipitor. No high cholesterol is not a cause of heart disease in
    > and of itself. Sorry but 61 is getting older, true, but so is 37. Think how many active heads of
    > corporations, governments, countries and high performance athletes are
    > 60. I am 61, my cholesterol is almost 12, in the British system (500 American system) and I have
    > NO heart disease. However, I did suffer muscle pain, wasting and atrophy, memory and language
    > loss, transient global amnesia, learning difficulties, pancreatitis, joint pain and injuries,
    > vision damage and more--all from which I have only partly recovered. I still have no
    > cardiovascular disease. All the members of my family have very high cholesterol. There is no
    > reason to take a drug for something you MIGHT get. If that were the case, you'd be taking
    > hundreds of medications daily. Read here:

    The cholesterol, "bad cholesterol," is not the actual cause of heart attacks, it simply contributes
    to them by encouraging the buildup of plaque in the arteries. Your level of 500 sounds very
    dangerous, I can't believe you're not on statins.

    Something in the news a month or two ago was an experiment where they fed a solution of synthetic
    "good" cholesterol intravenously for a period of 5 weeks and the study participants actually
    experienced a small, but significant, in arterial plaque deposits.

    I think newer drugs will soon be developed that will reduce bad cholesterol, increase good
    cholesterol, and also remove existing plaque from artery walls; all without the negative side-
    effects including memory loss.

    I expect to need Lipitor in the near future, if not already. I had a blood test last year but didn't
    go in for the results, although the nurse who called me suggested that the cholesterol and
    triglyceride numbers were extremely high. As I have no health insurance, I need to consider the $40
    or so per month the Lipitor costs (and that's if I split high-dose tablets), and also the cost of
    doctor's visits and the regular blood tests.
     
  12. Anon

    Anon Guest

    On 2004-02-19 18:57:01 -0500, "Charles Manson"
    <[email protected]> said:

    > As I have no health insurance, I need to consider the $40 or so per month the Lipitor costs
    > (and that's if I split high-dose tablets), and also the cost of doctor's visits and the regular
    > blood tests.

    Consider Mevacor (lovastatin), now available in generic form, and generally less expensive than
    Lipitor. Also, ask your doctor if you would qualify for a drug company (in Lipitor's case, Pfizer)
    patient assistance program. I'm sure your doctor will work with you on the lab costs if necessary.
    It's not really all that costly anyway. An ALT (the typical liver function test used to monitor
    statins) costs around $20, and you'd only need it every six months or so if you're on a stable
    statin dose.
     
  13. Zee

    Zee Guest

    anon <[email protected]> wrote in message news:<2004021521150675249%[email protected]>...
    > On 2004-02-10 14:00:33 -0500, [email protected] (aniram) said:
    >
    > > I heard that cholesterol lowering drugs also lower the human immunity, making the person weaker.
    > > Is this true?
    >
    > There's no scientific evidence of it. I'd say the burden of proof is on the person(s) making
    > the claim.

    Anon said: There's no scientific evidence of it.

    Are you sure of that? There are several studies looking at their use as immunosuppressants in organ
    transplants.

    This is just one of 60 citations I found on Pub Med looking statins in the context of their possible
    role as immunosuppressants. B'adant

    Minerva Urol Nefrol. 2003 Jun;55(2):111-9. Related Articles, Links

    Acute renal allograft rejections, a role for statins?

    Holdaas H, Jardine A.

    Department of Medicine, National Hospital, Oslo, Norway. [email protected]

    Acute rejection of kidney allografts during the first months following transplantation is one of the
    most important risk factor for long-term graft failure. Some small open studies have indicated that
    3-hydroxy-3-methylglutaryl coenzyme A (HMG-Co-A), statins, might act as immunosuppressive agents,
    and reduce acute rejection rates. Moreover, the use of statin in transplant recipients is quite
    common, despite no data from prospective large multi-centre studies are available to demonstrate any
    beneficial effect for acute rejections or long-term cardiovascular protection in this population. In
    this overview, recent clinical and experimental data will be provided for assessing statins as
    immunosuppressive agents. Although in vitro studies have provided a theoretical basis for the use of
    statins as immunosuppressive agents, more recent clinical placebo controlled studies have failed to
    confirm the initial optimism of this effect of statins.

    Publication Types: Review Review, Tutorial

    PMID: 12847415 [PubMed - indexed for MEDLINE]
     
  14. Zee

    Zee Guest

    "Charles Manson" <[email protected]he666club.com> wrote in message news:<[email protected]>...
    > "Zee" <[email protected]> wrote...
    > > Yes the memory problem is probably lipitor. No high cholesterol is not a cause of heart disease
    > > in and of itself. Sorry but 61 is getting older, true, but so is 37. Think how many active heads
    > > of corporations, governments, countries and high performance athletes are
    > > 60. I am 61, my cholesterol is almost 12, in the British system (500 American system) and I have
    > > NO heart disease. However, I did suffer muscle pain, wasting and atrophy, memory and
    > > language loss, transient global amnesia, learning difficulties, pancreatitis, joint pain and
    > > injuries, vision damage and more--all from which I have only partly recovered. I still have
    > > no cardiovascular disease. All the members of my family have very high cholesterol. There is
    > > no reason to take a drug for something you MIGHT get. If that were the case, you'd be taking
    > > hundreds of medications daily. Read here:
    >
    > The cholesterol, "bad cholesterol," is not the actual cause of heart attacks, it simply
    > contributes to them by encouraging the buildup of plaque in the arteries. Your level of 500 sounds
    > very dangerous, I can't believe you're not on statins.
    >
    > Something in the news a month or two ago was an experiment where they fed a solution of synthetic
    > "good" cholesterol intravenously for a period of 5 weeks and the study participants actually
    > experienced a small, but significant, in arterial plaque deposits.
    >
    > I think newer drugs will soon be developed that will reduce bad cholesterol, increase good
    > cholesterol, and also remove existing plaque from artery walls; all without the negative side-
    > effects including memory loss.
    >
    > I expect to need Lipitor in the near future, if not already. I had a blood test last year but
    > didn't go in for the results, although the nurse who called me suggested that the cholesterol and
    > triglyceride numbers were extremely high. As I have no health insurance, I need to consider the
    > $40 or so per month the Lipitor costs (and that's if I split high-dose tablets), and also the cost
    > of doctor's visits and the regular blood tests.

    Again, I don't know why you would take a harmful medication for something you *might* get. There is
    no evidence that statins have any benefit for protection of cardiovascular disease. If you already
    have cardiovascular diseasse there is a slight protection, perhaps. The studies that show benefit
    are by and large industry (pharmaceutical company) funded.

    Dr. Malcolm Kendrick discussing lipids, cholesterol and heart disease.
    http://www.redflagsweekly.com/kendrick/2004_feb17.html

    Therapeutics Initiative, an epidemiology group out of the University of British Columbia medical
    school, funded by the British Columbia Ministry of Health (not industry funding) says NO benefit to
    taking statins for prevention. http://www.ti.ubc.ca/pages/letter48.htm

    I disagree with you about my cholesterol level. It is not dangerous. What is dangerous is pushing
    medication on people who are not ill. Dangerous medication, which causes illness. Search here on the
    Health Canada adverse drug reaction database for Lipitor, and see what happened to approximately 450
    people who took this drug in Canada between 1997-2003. That is 450 people who reported an adverse
    reaction. Health Canada estimates fewer than 10 per cent do so. Researchers who study health policy
    estimate it is less than 1 per cent. That means several thousand Canadians were injured by Lipitor
    alone. Lipitor is only one of the statins. Canada has a small population relative to the United
    States, or Britain, or Europe. Extrapolate...

    http://www.cbc.ca/news/adr/database/

    B'adant
     
  15. Zee

    Zee Guest

    anon <[email protected]> wrote in message news:<2004021521150675249%[email protected]>...
    > On 2004-02-10 14:00:33 -0500, [email protected] (aniram) said:
    >
    > > I heard that cholesterol lowering drugs also lower the human immunity, making the person weaker.
    > > Is this true?
    >
    > There's no scientific evidence of it. I'd say the burden of proof is on the person(s) making
    > the claim.

    Anon said: There's no scientific evidence of it. Part two....

    And another example of a type of study looking at statins as immunomodulator, which may be the
    explanation for their action in cardiovascular disease. These studies show this is indeed being
    looked at. I would say yes, statins do look as though they are immunosuppressants with possible
    practical application for that....which would be novel, since their ownly present role as
    immunosuppressant is to cause grave disability and death. B'adant

    J Am Soc Nephrol. 2002 Jun;13(6):1673-81. Related Articles, Links

    Immunomodulatory effects of statins: mechanisms and potential impact on arteriosclerosis.

    Palinski W, Tsimikas S.

    Department of Medicine 0682, University of California San Diego, La Jolla, California 92093-0682,
    USA. [email protected]

    Clinical trials with statins have demonstrated a marked reduction of cardiovascular mortality.
    However, it remains controversial whether these clinical benefits stem from powerful cholesterol-
    lowering effects of statins or whether they are due in part to their cholesterol-independent effects
    on vascular function, plaque growth, plaque rupture, or thrombosis. The identification of several
    mechanisms through which statins decrease the recruitment of monocytes and T cells into the arterial
    wall and inhibit T cell activation and proliferation in vitro have prompted speculations that
    immunomodulatory effects of statins may be beneficial in recipients of organ transplants.
    Hypercholesterolemia is frequent in these patients, and delayed-type hypersensitivity reactions in
    the arterial walls of the graft may be compounded by chronic inflammation associated with
    conventional atherogenesis. To assess the potential clinical relevance of immunomodulatory effects
    of statins, the role of the immune system in atherogenesis and the effects of statins in vitro in
    experimental models and in clinical trials will be reviewed. It is concluded that despite solid in
    vitro evidence, clinical evidence for an independent immunosuppressive effect of statins in organ
    transplant patients is presently insufficient; however, further investigation of their in vivo
    occurrence and clinical relevance is warranted.

    Publication Types: Review Review, Tutorial

    PMID: 12039998 [PubMed - indexed for MEDLINE]
     
  16. Anon

    Anon Guest

    On 2004-02-19 23:54:38 -0500, [email protected] (Zee) said:

    > Are you sure of that? There are several studies looking at their use as immunosuppressants in
    > organ transplants.

    And not a one that proves anything. Lots of studies "look at" lots of things without proving them.
    If you can't read the medical literature critically, you shouldn't be reading it at all.
     
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