Well, my doctors are at it again, trying to get me to take statins. So I've been going through what I went through ten years ago, browsing studies and reading Cochrane reviews and getting the lay of the land. American medicine is very aggressive about preventive statins. It's a maddening edge-case, for me: kind of a toss-up. On the one hand, the benefit is clear enough: if you put a thousand at-risk people on statins for five years, you'll prevent some 18 major cardiovascular episodes. But as far as I can tell, no one clearly understands why. The popular narrative of cholesterol "clogging" arteries is not what actually happens. And meanwhile, you've also put 982 people on a serious systemic drug for five years, without measurable benefit. I don't have confidence that these studies (all of which are underwritten by people who -- surprise! -- want to sell statins) are looking really carefully for long-term side-effects. I don't doubt that the research is conscientious, by its own lights. But its lights are not exactly mine. The balance has shifted slightly in favor of the pro-preventive-statins side, in the last ten years, but not much. I'm undecided.
But still, even given all the caveats, my cholesterol is outlandishly high, and probably indicates that I should do something about it. One thing, which I'm already undertaking, is to increase my (quite lame) cardio: I'm gradually going to double my modest daily walking time. The other thing, of course, is my diet.
I have fixed a lot about my diet, in the past four years, but there's two big changes I've left for later: salt and saturated fat. Salt is a project I'm not willing to undertake yet. But I eat a lot of saturated fat at dinner: 100 grams of ground beef, and a densely-packed quarter cup (probably half a cup, unpacked) of ice cream. I have not had much luck tampering with those: I've partly been able to make all the other changes because I still able to look forward to gorging myself on saturated fat at dinner. But I think I'm going to take another, sustained shot at replacing the burger and ice cream with little fishes. Sardines, or herring, or whatever you call them. Little guys towards the bottom of the food chain. It needs to be canned, because no way am I taking on the burden of purchasing, storing, and prepping fresh fish every day. Not happening.
So. I'll have a lot of calories to spend -- upwards of 400 -- if I drop the burger and ice cream. I have a hard time picturing eating 400 calories of sardines. (Truth be told, I have a hard time picturing eating sardines at all) So at least it will be an "all you can eat" situation, which may placate the appetite demons somewhat.
We'll see. It's an experiment. If I can't do it -- if it leads to intolerable cravings and binges -- then I'll just accept that, resume the burger and ice cream, and go on my way: moving one blood lipid marker down is not worth putting the whole project at risk. Maybe I've done as much as I can: if so, that's all right. But I am going to make the attempt. Market day is Monday, so that's when I start.
Having to decide about the statins evoked an odd emotional crisis, which I'm still sorting out. My doctor ordered me to start taking them in a note on my online chart. It was not camouflaged as a suggestion, or a consultation. It was phrased simply as a command. This is a new-ish doctor for me, who is busy and rather rushed, who probably was not bearing in mind, or didn't know, or didn't care, that doctors have ordered me to take statins before and I have said no.
I don't respond well to being ordered, when I think I ought to be consulted. As a white man with and advanced degree and a retirement stash, I'm greatly impressed with my own importance and dignity, and I expect everyone else to be too.
At the same time, I score off the charts on those personality quizzes that assess agreeability. I prefer to avoid conflict. And I'm keenly aware that I want to stay on the good side of my health care people, because they have control of the pharmacopeia. If I'm dying of cancer someday I may want all the opium I can eat, and this is the doctor who will be deciding if I get it. I'm also aware (really I am!) that even thinking this thought wanders over the line into paranoia: I really doubt that many doctors are going to make that decision by pondering whether I was willing to take statins when they told me to.
No, what's really operating here is a reluctance to accept my low status and vulnerability. Where my two options appear to be knuckling under and accepting that I'm powerless old man, hoping not to be stranded on the ice floe, with an ever-growing list of cumulatively debilitating daily medicines to take; or becoming one of those ridiculous superstitiously anti-medical cranks who refuse to go near a hospital when their appendix bursts. Comical, in any case. Nobody retains their dignity in the face of the Western way of doing medicine. Nobody retains their dignity in the face of age, in any case. And isn't it -- supposedly -- my goal to get rid of my dignity? Isn't my dignity precisely and exactly the source of my suffering? I thought abandoning my dignity was my life's project?
The fact is that this decision is trivial. If you did a study with fifty subjects, and a fifty-person control group, you would probably conclude that a) statins have no benefit and b) statins have no side-effects, either. You can't even see these effects in a small study. I may have opinions about the wisdom of setting standards for preventive drugs that result in the majority of the population eventually taking them, but -- that's another question, and not one in which the opinion of an IT guy / massage therapist / occasional poet weighs much.
So that much is clear. The decision is actually unimportant. What is important for me -- apparently -- is how I hold it, which stories I tell myself about it, and what state of mind they leave me in. The story of letting myself get pushed around is not going to be one that -- for instance -- inspires me to have a go at eating little fishes. The story of crotchety, shrill defiance, and insistence on my dignity, in defiance of due authority, may undergird the little fishes project, but it takes me that much further on the road to suspicion and isolation. I'm already further down that road than I want to be.
Anyway. If any of you have helpful hints or suggestions about little fishes, please give them to me! My plan Monday is to plant myself by the canned fish and read labels and just try whatever they've got.