Based on money and Materials Our modern life became a big illusion. The Real life and happiness needs 1- Security 2- Health 3- Life essentials (food – shelter etc). The Real life and happiness lie behind a natural life in a clean environment. We are sinking in different types of pollution. The consequences of pollution include: 1- Climate change the Heat melts ice, worsens weather and expands oceans. 2- Human health effects a- Climate changes b- Pollutants. 3- Plants and animals Natural habitats become hostile. Pollution is a Global Problem with no but a Single must be a Global Solution that is Go Green, Reduce CO2 and Stop Pollution

1. Dr. Fathi Neana, MD
Chief of Orthopaedics
Dr. Fakhry & Dr. A. Al-Garzaie Hospital
Saudi Arabia
September, 28 - 2017

2. ‫الن‬ ‫ِي‬‫د‬ْ‫ي‬َ‫أ‬ ْ‫ت‬َ‫ب‬َ‫س‬َ‫ك‬ ‫ا‬َ‫م‬ِ‫ب‬ ِ‫ر‬ْ‫ح‬َ‫ب‬ْ‫ل‬‫ا‬َ‫و‬ ِ‫ر‬َ‫ب‬ْ‫ل‬‫ا‬ ‫ي‬ِ‫ف‬ ُ‫د‬‫ا‬َ‫س‬َ‫ف‬ْ‫ل‬‫ا‬ َ‫ر‬َ‫ه‬َ‫ظ‬ِ‫اس‬‫م‬ُ‫ه‬َ‫ق‬‫ِي‬‫ذ‬ُ‫ي‬ِ‫ل‬‫ل‬َ‫ع‬َ‫ل‬ ‫وا‬ُ‫ل‬ِ‫َم‬‫ع‬ ‫ِي‬‫ذ‬‫ال‬ َ‫ض‬ْ‫ع‬َ‫ب‬ْ‫م‬ُ‫ه‬
َ‫ون‬ُ‫ع‬ ِ‫ج‬ْ‫ر‬َ‫ي‬(41)‫الروم‬
Mischief has appeared on land and sea because of (the meed) that the hands of men have earned, that
(Allah) may give them a taste of some of their deeds: in order that they may turn back (from Evil).
(Quran 30:41)

3. Health
As defined by World Health Organization (WHO).
Health is a "State of complete physical, mental, and
social well being, and not merely the absence of a
disease or infirmity."
Health is a dynamic condition resulting from a body's constant
adjustment and adaptation in response to stresses and changes
in the environment for maintaining an inner equilibrium called
homeostasis.
Read more: http://www.businessdictionary.com/definition/health.html

4. Human Health
Disease
Acute
chronic
Pathogen
Bacteria
viruses
PollutionRisks
Obesity
smoke
Chemicals
Types
Neurotoxines
Carcinogenes
Teratogenes
Endocrine
disruptors
Allergens
Dose – response Duration
Bioaccumulation
Biomagnification
Stockholm convention
LD50

5. PCBs (Polychlorinated biphenyls)
widely deployed as dielectric and coolant fluids in electrical
apparatus, carbonless copy paper and in heat transfer fluids.
Because of their longevity, PCBs are still widely in use
PCBs cause cancer in animals and are human
carcinogenic , teratogenic , endocrine disruptor
(thyroid) , toxic to liver and nervous system
Because of PCBs' environmental toxicity and classification as
a persistent organic pollutant, PCB production was banned by the
United States Congress in 1979 and by the Stockholm Convention
on Persistent Organic Pollutants in 2001
Many rivers and buildings including schools, parks, and other
sites are contaminated with PCBs, and there have been
contaminations of food supplies with the substances.

6. Bioaccumulation and Biomagnification
PCBs Polychlorinated biphenyls

7. Overfishing of small fish (sardines,
anchovy, mackerel and scads)
‫السردين‬ ‫مثل‬ ‫الصغيرة‬ ‫لالسماك‬ ‫الجائر‬ ‫الصيد‬
Living phytoplankton & zooplankton
absorb pollutants like lead, mercury
Small fish consume the loaded living
phytoplankton & zooplankton
Dead phytoplankton & zooplankton
release pollutants in water again

8. Human health effects
Human health effects can
be due to
1- Climate change
2- Pollutants

9. Human health effects
Top 45 diseases caused by pollution
Air pollution
1. Asthma attacks - chronic
obstructive pulmonary disease –
COPD
2. Weakening of lung function
3. Pulmonary cancer
4. Mesothelioma
5. Pneumonia
6. Bronchitis
7. Emphysema
8. Leukemia
9. Birth defects and immune
system defects
10. Cardiovascular problems
11. Neurobehavioral disorders
12. Liver and other types of cancer
13. Premature death
14. Autism
Water pollution
15. Typhoid
16. Giardiasis
17. Amoebiasis
18. Ascariasis
19. Hookworm
20. Gastroenteritis
21. Diarrhea
22. Encephalitis
23. Stomach cramps and aches
24. Vomiting
25. Hepatitis
26. Respiratory infections
27. Liver damage and even cancer
28. Kidney damage
29. Neurological problems
30. Weak sexual power
31. Thyroid system disorders
32. Malaria
33. Rashes on skin
34. Ear aches
35. Pink eyes
Soil pollution
36. Cancer
37. Brain and Nerve Damage
38. Kidney and Liver Disease
Noise pollution
39. Efficiency decrease of people
40. Lack of concentration
41. Fatigue
42. Abortion
43. Blood Pressure
44. Temporary or permanent deafness
45. Anxiety
Light Pollution
Melatonin
Radioactive contamination
Ionized radiation.
Non ionized radiation (EMFs – Wi-Fi).
Thermal pollution
Pharmaceuticals Drugs
Alcohol, Smoke
Mental - psychological

10. Water Pollution

11. Water Pollution
‫عذبة‬ ‫مياه‬

12. Water Pollution
• Water pollution is the contamination of water bodies
(e.g. lakes, rivers, oceans, aquifers and groundwater).
• Water pollution occurs when pollutants are discharged
directly or indirectly into water bodies without adequate
treatment to remove harmful compounds.
• Water pollution affects plants and organisms living in
these bodies of water.
• In almost all cases the effect is damaging not only to
individual species and populations, but also to the
natural biological communities

13. .Water pollution is a serious issue as it is easily
spread.
Water pollution have a strong impact on the
delicate balance in the natural ecosystem. This will
ultimately impact the humans and other living
organisms.
The effects of water pollution are different and
depend on the chemicals dumped in that
particular location.
The effects of water pollution could be classified
into:
•effects on ecosystem
•effects on animal health
•effects on human health
Effects of Water Pollution

14. Water pollution
15. Typhoid
16. Giardiasis
17. Amoebiasis
18. Ascariasis
19. Hookworm
20. Gastroenteritis
21. Diarrhea
22. Encephalitis
23. Stomach cramps and aches
24. Vomiting
25. Hepatitis
26. Respiratory infections
27. Liver damage and even cancer
28. Kidney damage
29. Neurological problems
30. Weak sexual power
31. Thyroid system disorders
32. Malaria
33. Rashes on skin
34. Ear aches
35. Pink eyes
Human health effects
Top 45 diseases caused by pollution

15. Sources of water
pollution
• Domestic sewage.
• Industrial waste
water.
• Agricultural waste
water.
• Construction site
storm water.
• Urban runoff storm
water.
• Petroleum hydrocarbons
• Plastics
• Pesticides
• Heavy metals
• Sewage
• Radioactive waste
• Thermal effluents
• Pharmaceuticals

16. Water Pollutants
• Detergents
• Chloroform
• Food processing waste, (fats
and grease)
• Insecticides and herbicides.
• Petroleum hydrocarbons,
(gasoline, diesel fuel, jet fuels,
and fuel oil).
• Lubricants (motor oil).
• From storm water runoff.
• Pharmaceuticals

17. Water pollution
15. Typhoid
16. Giardiasis
17. Amoebiasis
18. Ascariasis
19. Hookworm
20. Gastroenteritis
21. Diarrhea
22. Encephalitis
23. Stomach cramps and aches
24. Vomiting
25. Hepatitis
26. Respiratory infections
27. Liver damage and even cancer
28. Kidney damage
29. Neurological problems
30. Weak sexual power
31. Thyroid system disorders
32. Malaria
33. Rashes on skin
34. Ear aches
35. Pink eyes

18. Preventing Water Pollution
• Conserve water by turning off the tap.
• Mind what you throw down your sink or toilet.
• Don’t throw paints and oils in water channels.
• Use environment friendly household products, such as washing
powder, household cleaning agents etc.
• Take great care not to overuse pesticides and fertilizers.
• Don’t throw litter into rivers, lakes or oceans.
• Help clean up any litter you see on beaches or in rivers and
lakes, make sure it is safe to collect the litter and put it in a
nearby dustbin.

19. Treating Polluted Water
• Suspended, solid particles
and inorganic material can
be removed by the use of
filters.
• Use of biological filters and processes can naturally
degrade the organic waste material.
• After above two steps chemical additives are supplied
to get rid of any left-over impurities.

20. Soil Pollution

21. Soil pollution
36. Cancer
37. Brain and Nerve Damage
38. Kidney and Liver Disease
Human health effects
Top 45 diseases caused by pollution

22. Soil Pollution
Soil contamination or soil pollution is caused by the presence of xenobiotic
(human-made) chemicals or other alteration in the natural soil
environment.
It is typically caused by
• Industrial activity.
• Agricultural chemicals.
• Improper disposal of waste.
Contaminating Chemicals
• Total petroleum hydrocarbons (TPH).
• Polynuclear aromatic hydrocarbons (PAHs).
• Pesticides and fertilizers
• Lead and Other heavy metals.
• Pharmaceuticals

23. •Direct contact with the polluted soil may cause
cancer including leukemia
•Lead in soil is especially hazardous for young
children and retards brain growth
•Mercury increases the risk of damage to the
kidney
•Polluted land causes neuro muscular blockage
•It may depress the central nervous system of the
human body
•It also causes headaches, nausea, fatigue, eye
irritation and skin rash
Effects of land pollution on human life

24. How to control soil pollution?

25. How to control soil pollution?
• Limit the use of fertilizers and pesticides
• Biological control methods awareness and implementation
• The grazing must be controlled and
• Forest management should be done properly
• The afforestation and reforestation must take place
• Proper preventive methods like shields should be used in areas of
wind erosion and wind breaks
• Treating wastes of industries.
• Treating nuclear waste.
• Proper disposing of plastics, electronics and other garbage
materials by recycling

26. Pharmaceutical Pollution

27. Hazard of Pharmaceutical drugs
Iatrogenic pollutants
1- Environmental effects
Water – Soil pollution
2- Human health effects

28. Number of pharmaceuticals detected in surface water,
groundwater, tap water and/or drinking water
Top 10 pharmaceuticals and the number of countries
in which they have been found in the aquatic
environment
Top 10 pharmaceuticals and the
number of countries in which they
have been found in the aquatic
environment
Diclofenac
CarbamazepineI
Ibuprofen
Sulfamethoxazole
Naproxen
Estrone
17-β-Estradiol
17-α-Ethinylestradiol
Trimethoprim
Paracetamol
05101520253035404550
Source: IWW 2014
Pharmaceuticals in the environment: a growing problem
The Pharmaceutical Journal 19 FEB 2015 By Brian Owens

29. Pharmaceuticals human health effects
Conventional Medicine Is The
Leading Cause Of Death In The US
Conventional Medical stream is the Leading Cause of
Death in USA
Pharmaceutical Drugs is the 4th Leading Cause of
Death USA’s
Iatrogenic death rate in the US (death caused by doctors
and/or medical treatments) is 783,936 a year.
That’s 84,059 more deaths than those caused by heart
disease in 2001 and 230,865 more deaths than those
caused by cancer.
Over a decade, the scientists predict that iatrogenic
deaths will total about 7.8 million, “more than all the
casualties from all the wars fought by the US
throughout its entire history,”
The Nutrition Institute of America funded an independent review of “government-approved” medicine that was
published in 2006. Professors Gary Null and Dorothy Smith, along with doctors Carolyn Dean, Martin Feldman and
Debora Rasio titled the report “Death by Medicine.”
The researchers found that America’s leading cause of death isn’t heart disease or cancer: its conventional medicine.

30. Russell Blaylock, M.D
100,000 Americans die each year from side effects of pharmaceutical
drugs as prescribed by their doctors?
*You might believe that heart disease and cancer are the leading
killers in this country
According to statistical research published by the Life Extension
Foundation,
Our conventional American medical system causes an astronomical
783,936 deaths per year.
*That makes mainstream medicine the actual leading cause of
death and injury in the United States.
The Big Drug Lie!
Russell Blaylock, M.D., practiced conventional medicine as a board-certified neurosurgeon for nearly 30 years. After watching both his
parents die from neurodegenerative disorders that could not be helped by mainstream treatment, he began to research safe and
effective natural cures.

31. 1- Why many FDA-approved prescription drugs Later
pulled from the market?
2- Why many drugs is prohibited inside the
manufacturing country and still in use in other
countries?
3- Why the true long term frustrating side effects is
not mentioned in the drug information provided by
industry funded trials!
According to the FDA, a "drug is removed from the market when its risks outweigh its
benefits. A drug is usually taken off the market because of safety issues with the drug
that cannot be corrected, such as when it is discovered that the drug can cause
serious side effects that were not known at the time of approval.“
The FDA also takes into account the number of people taking a drug being
considered for removal so as to not harm those patients.

32. Vioxx (Rofecoxib)
Use: NSAID (pain relief)
Manufacturer: Merck
Cause for recall:
increased risk of heart attack and stroke; linked
to about 27,785 heart attacks or sudden
cardiac deaths between May 20, 1999 and
2003
Ads for Vioxx features Olympic gold medalists
Dorothy Hamill and Bruce Jenner. Vioxx was
prescribed to more than 20 million people.
on the market for
5.3 YEARS
May 20, 1999 to Sep. 30, 2004
Baycol (Cerivastatin)
Use: Cholesterol reduction
Manufacturer: Bayer A.G.
Cause for recall:
rhabdomyolysis (breakdown of muscle fibers that
results in myoglobin being released into the
bloodstream) which led to kidney failure; 52 deaths
(31 in the US) worldwide; 385 nonfatal cases with
most requiring hospitalization; 12 of the deaths
were related to taking this drug in combination
with gemfibrozil (Lopid)
on the market for
3 YEARS
1998 to Aug. 2001
Very big List of withdrawn
drugs

33. Bayer
(Cerivastatin)
Baycol or Lipobay
Rhabdomyolysis
Muscle Pain
Social Withdrawal
Weakness
Cancer
Muscle Problems
Tiredness
GI Problems
Leg Pain
Kidney Failure
Baycol (Lipobay) vs. Lipitor
Pfizer
(Atorvastatin Calcium)
Lipitor
Muscle Pain
Tiredness
Weight Loss
Weakness
Depression
Weight Gain
Cramping
Joint Pain
Leg Pain
Headaches
cerivastatin , lovastatin, pravastatin, simvastatin, atorvastatin, and fluvastatin

34. Disappointing frustrating long term results
By the most widely spread and popular drugs world over
Ibuprufen (NSAIDs)
a popular domestic and over the counter analgesic and
antipyretic
for adults and children
Ibuprofen has been rated as the safest conventional NSAID
Bisphosphonates (Bone anti resorptive)
Statins (Cholesterol lowering)
The top 50 prescription drugs filled in the U.S.
Jun 16, 2016 | Consumers, Drugs, Healthcare
Professionals, Industry News |
1- Atorvastatin Calcium(generic of Lipitor)

35. The effects of NSAIDs on types I, II, and III collagen
metabolism in a rat osteoarthritis model
Rheumatology International
August 2012, Volume 32, Issue 8, pp 2401–2405| Cite as
Ibufenac
(Ibuprofen)
Withdrawn
1968
UK
Hepatotoxicity,
jaundice. [3]
The generic Ibuprofen is manufactured by 62 companies. has 138 Brands of Generics
of Ibuprofen listed. New generics are constantly being updated.
For what it is prescribed ?
Ibuprofen and Indomethacin are Chondrodestructives
by harming of Collagen metabolism in OA treatment.
Celecoxib, Diclofenc (1977), Aspirin are safer
Rheumatology International
August 2012, Volume 32, Issue 8, pp 2401–2405| Cite as
The effects of NSAIDs on types I, II, and III collagen metabolism in a rat osteoarthritis model

36. Bisphosphonates
Bone anti resorptive agent
For what it is prescribed ?

37. Bisphosphonates
What is our aim
Bone BMD
or
Fracture risk

38. RA , Osteoporosis
On Bisphosphonates

39. SHORT-TERM
UPPER GIT ADVERSE EFFECTS
ACUTE PHASE REACTION
SEVERE MUSCULOSKELETAL PAIN
HYPOCALCEMIA
ESOPHAGEAL CANCER WITH ORAL FORM
OCULAR INFLAMMATION
LONG -TERM
OSTEONECROSIS OF THE JAW
ATRIAL FIBRILLATION
SEVERE SUPPRESSION OF BONE TURNOVER
SUBTROCHANTERIC FEMORAL FRACTURES
Adverse effects of bisphosphonate therapy

41. Cell Metabolism
Volume 23, Issue 3, Pages 479-491
March 2016)
Ligand Activation of ERRα by
Cholesterol Mediates Statin and
Bisphosphonate Effects
Bisphosphonates
Statins

42. ERRa is the oldest orphan nuclear receptor. Combining affinity chromatography with tissue lipidomics,
Wei et al. identify cholesterol as an endogenous ERRa agonist.
ERRa mediates the effects of cholesterol on osteoclasts, macrophages, and myocytes, as well as the pharmacological effects of statins and bisphosphonates on bone
resorption and skeletal remodeling.
Cell Metabolism
Volume 23, Issue 3, Pages 479-491 March 2016)
Ligand Activation of ERRα by Cholesterol Mediates Statin and Bisphosphonate Effects
Cholesterol is a Ligand for estrogen-related
receptors (ERRα)
1- Increase Osteoclastogenesis
Bone resorption
2- Reduce macrophage cytokines Anti
inflammatory
3- Increase myogenesis
Repair, regeneration
4- Reduce myotoxicity
Rhabdomyolysis

43. Harumi Okuyama
Professor Harumi Okuyama
Nagoya City University, Japan
Harumi Okuyama graduated from the University of Tokyo, Graduate School of Pharmaceutical Sciences, PhD
degree granted in 1968. Served as Professor of biochemistry at Nagoya City University and at Kinjo Gakuin
University, Japan and as a visiting professor at Baylor College of Medicine, University of Illinois at Chicago, USA,
Dalian Medical University, Dalian University, China and Toyama University, Japan. Major interest is lipid
nutritional biochemistry. The first president of the Japan Society for Lipid Nutrition.
* Data recorded August 21, 2016.
Expert commentary
Few cardiology specialists around the world have accepted that there is no clinical evidence for ‘the lower, the
better hypothesis’.
The majority of clinicians still appear to accept the results of meta-analysis of reports, including those published
before 2004 when new penal regulations on the clinical trials came into effect in the EU, that is, statins are effective
in lowering LDL-C levels and thereby preventing CHD incidence.
Our group and others [2–4] only adopt the conclusions of papers reported after 2004 by scientists essentially free
of conflict of interest that statins are ineffective in preventing CHD.
Severe and often irreversible adverse effects of statins and their pharmacological mechanisms have been discussed
in this study, indicating that the applicability of statins should be severely restricted.
Clinicians should not rely on drug information provided by industry-funded trials, or should they trust study
abstracts of clinical publications, which frequently do not provide the full picture and present many deceptions.
Nondrug company-funded sources of information are likely to be much more useful and less biased.

44. Statins Stimulate Atherosclerosis and Heart Failure:
Pharmacological Mechanisms
Expert Review of Clinical Pharmacology
March 2015; Vol. 8; No. 2; pp. 189–199 - Published online: 06 Feb 2015.
Harumi Okuyama, Peter H Langsjoen, Tomohito Hamazaki, Yoichi Ogushi, Rokuro Hama, Tetsuyuki
Kobayashi, Hajime Uchino
Abstract
In contrast to the current belief that cholesterol reduction with statins decreases atherosclerosis,
We present a perspective that statins may cause coronary artery calcification and can function as mitochondrial
toxins that impair muscle function in the heart and blood vessels through the depletion of coenzyme Q10 and ‘heme
A’, and thereby ATP generation.
Statins inhibit the synthesis of vitamin K2, the cofactor for matrix Gla-protein activation, which in turn protects
arteries from calcification.
Statins inhibit the biosynthesis of selenium containing proteins, one of which is glutathione peroxidase serving to
suppress peroxidative stress. An impairment of selenoprotein biosynthesis may be a factor in congestive heart
failure, reminiscent of the dilated cardiomyopathies seen with selenium deficiency.
Thus, the epidemic of heart failure and atherosclerosis that plagues the modern world may paradoxically be
aggravated by the pervasive use of statin drugs.
We propose that current statin treatment guidelines be critically reevaluated.
Keywords: atherosclerosis, ATP generation, coenzyme Q10, heart failure, mitochondrial
toxin, selenoprotein, statin, statin cardiomyopathy, vitamin K2

45. Dr. Dwight Lundell's
Confession
a heart surgeon with 25 years experience,
having done more than 5,000 open-heart
surgeries ->> Life style change
the human body cannot process, nor was it
designed to consume, foods packed with
sugars and soaked in omega-6 oils.“
." That's because the low-fat, high-simple-carb
diet is actively destroying the walls of our
blood vessels by causing chronic
inflammation
We add lack of exercise and stress.

46. Combating Heart Disease: Statins, Supplements, Stem Cells,
Hyperbaric Oxygen?
By Donald W. Miller, Jr., MD
July 14, 2016
Prescribing statins is a multibillion-dollar business.
Pfizer’s Lipitor went on sale in 1997 and became the best-
selling drug in the history of prescription pharmaceuticals.
Sales surpassed $125 billion during the life of its patent.
Crestor is now the top-selling statin. It generated $5.2 billion
in revenue in 2013.
These drugs are very effective in lowering cholesterol.
Lipitor, 40-80 mg a day, and Crestor, 20-40 mg, can drop
LDL-cholesterol levels >50 percent.
Nevertheless, the prevalence of heart disease has not dropped with the
advent of these cholesterol-lowing statin drugs.

47. The Money Game or Gain
1- Change a number, or definition create a patient
A lot of money can be made from healthy people who believe they are sick
The social construction of illness is being replaced by the corporate construction of disease.
Ray Moynihan, journalist, Iona Heath, general practitioner, David Henry, professor of clinical pharmacology. BMJ
2002;324:886-891
Change a number, or definition create a patient
The number of people with at least one of four major medical conditions has
increased dramatically in the past decade because of changes in the definitions
of disease.
"The new definitions ultimately label 75% of the adult U.S.
population as diseased,"
according to calculations by two Dartmouth Medical School researchers.
Suddenly sick: A special report by Susan Kelleher and Duff Wilson · June 26 - June 30, 2005
http://seattletimes.nwsource.com/news/health/suddenlysick/sickdefinitions26.html

48. Diagnosis Old Definition New definition People
under
Old
People
under
New
% increase Year
Diabetes Fasting Sugar
> 140mg/dl
Fasting
> 126mg/dl
11.7 M 1.7 M 14% 1997
Hypertension BP > 160/100 BP> 140/90 38.7 M 13.5 M 35% 1997
Cholesterol > 250mg/dl > 200mg/dl 49.5 M 42.6 M 86% 1998
Obesity
(BMI)
BMI> 27kg/m² BMI> 25kg/m² 70.6 M 30.5 M 43% 1998
Pre
hypertension
Nil 120/80 to
139/89
Nil 45 M - 2003
New definitions, Change a number create a patient
Source: “Changing Disease Definitions: Implications for Disease Prevalence,”
Dr. Lisa Schwartz and Steven Woloshin, Effective Clinical Practice, March/April 1999.

49. The double standard
1- Absolute Risk (True)
To minimize the side effects
2- Relative Risk (Myth)
To magnify the benefit
The Money Game or Gain
2- Absolute Risk (True) vs. Relative Risk (Myth)
َ‫ين‬ِ‫ف‬ِ‫ف‬َ‫ط‬ُ‫م‬ْ‫ل‬ِ‫ل‬ ٌ‫ل‬ْ‫ي‬َ‫و‬(1)َ‫ع‬ ‫وا‬ُ‫ل‬‫ا‬َ‫ت‬ْ‫ك‬‫ا‬ ‫ا‬َ‫ذ‬ِ‫إ‬ َ‫ِين‬‫ذ‬‫ال‬‫ى‬َ‫ل‬
َ‫ون‬ُ‫ف‬ ْ‫و‬َ‫ت‬ْ‫س‬َ‫ي‬ ِ‫اس‬‫الن‬(2)ْ‫م‬ُ‫ه‬‫و‬ُ‫ن‬َ‫ز‬‫و‬ ‫و‬َ‫أ‬ ْ‫م‬ُ‫ه‬‫و‬ُ‫ل‬‫َا‬‫ك‬ ‫ا‬َ‫ذ‬ِ‫إ‬َ‫و‬
َ‫ون‬ُ‫ر‬ِ‫س‬ْ‫خ‬ُ‫ي‬(3)
‫المطففين‬ ‫سورة‬
Woe to those that deal in fraud,
Those who, when they have to
receive by measure from men,
exact full measure,
But when they have to give by
measure or weight to men, give
less than due.
Al – Mutaffifin

50. Drugs. 2004;64 Suppl 2:43-60.
Prevention of coronary and stroke events with atorvastatin in hypertensive patients
who have average or lower-than-average cholesterol concentrations, in the Anglo-
Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm (ASCOT-LLA): a
multicentre randomised controlled trial.
Sever PS1, Dahlöf B, Poulter NR, Wedel H, Beevers G, Caulfield M, Collins R, Kjeldsen
SE, Kristinsson A, McInnes GT, Mehlsen J, Nieminen M, O'Brien E, Ostergren J; ASCOT
Investigators.
Figure 2. Relative risk of 36 percent with actual
absolute risk in the Lipitor study.

51. Combating Heart Disease:
Statins, Supplements, Stem
Cells, Hyperbaric Oxygen?
By Donald W. Miller, Jr., MD
July 14, 2016

52. Lipitor
• Reduction of
risk of heart
attack
• people who
take statins get
diabetes
Absolute Risk
• 1.1 % *
• (1.9% - 3%)
• 6% **
• 8% - 2%
Relative Risk
• 36%
• (1.1% ÷ 3%)
• 75 %
• (6% ÷ 8%)
*1.9 % of people taking Lipitor suffered a heart attack Compared to 3% of the placebo
group
Absolute risk 3%-1.9%= 1.1%
Relative risk” reduction, calculated this way: 3 – 1.9 = 1.1 and 1.1 divided by 3 = 36%.
** 8% of people who take statins get diabetes, compared with 2% in the placebo group.
Absolute risk 8%-2%= 6%
Relative risk: 8 – 2 = 6 and 6 divided by 8 equals 75%.

53. The Diabetes World Summit
2016
Bayer, the maker of one-time rival statin
Baycol, paid $1 billion in 2005 to settle
about 3,000 cases alleging the drug caused
rhabdomyolysis, a disease that breaks
down muscle tissue. Baycol was pulled
from the market in 2001 after being linked
to 31 deaths.
Pfizer confronts surge of lawsuits
over Lipitor
Published 6:43 AM ET Fri, 8 Aug
2014Reuters
Pharmaceutical giant Pfizer is facing a
mounting wave of lawsuits by women who
allege that the company knew about
possible serious side effects of its
blockbuster anti-cholesterol drug Lipitor
but never properly warned the public.
In the past five months, a Reuters review of
federal court filings shows, lawsuits by U.S.
women who say that taking Lipitor gave
them type-2 diabetes have shot up from 56
to almost 1,000.
In your relentless quest to lower your cholesterol,
you may be giving yourself diabetes. The statins
offset the cholesterol you make, not eat.
Statins block endogenous cholesterol
production in the liver, they force liver to ‘spit
out’ the glucose that comes from eating
sugary, starchy foods.
Normally, your liver would turn that PB & J sandwich
into cholesterol but instead, the glucose gets pushed
back into your bloodstream.
I recommend reducing cholesterol with diet,
exercise and healthy EFAs (essential fatty acids
like fish oil, chia seed oil, etc.). sugar levels.

54. Patients on five or more drugs :
1- About 20% of adult
2- 30 % to 70 % of elderly over 65y
3- Up to 90% In nursing homes and
other residential facilities
Recent study of polypharmacy
89% of patients interested in
stopping a medication if their
physician agreed
Common Classes of medications that are good
candidates for deprescribing include
●Anti-anxiety medications known as benzodiazepines,
which can contribute to cognitive impairment, delirium, falls (and
related injuries), breathing problems and motor-vehicle
accidents.
●Atypical antipsychotics ,taert ot desu nefto era hcihw
atinemed ,ylredle eht ni ,dna sisohcysp.
●Anti-cholesterol statins, which can cause muscle
problems, cognitive impairment and a higher risk of diabetes.
Statins also have a high risk for interaction with other medications
and certain foods. Given that the benefits of statins are long term,
they are not needed for elderly patients.
●Tricyclic antidepressants ,which are used for depression
and dementia. These are not recommended in the elderly but are
often used nonetheless, causing side effects or harms that can
include low blood pressure (which contributes to falls and
fractures), heart arrhythmias and other disturbances, delirium,
difficulty urinating, dry mouth and constipation.
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●Proton pump inhibitors ,
Mishori is a professor of family medicine and the director of the Health and Media Fellowship in the Department of Family Medicine at
Georgetown University School of Medicine.
Polypharmacy
The name given to prescribing patients five or more
medications at the same time