Demon

Cholesterol

Statins to the Rescue? 

Bempedoic Acid: A Newer Useless Cholesterol-Lowering Drug

Pam Popper, President
Wellness Forum Health

Bempedoic acid is one of a new class of non-statin drugs for lowering LDL cholesterol that targets the cholesterol biosynthesis pathway in the liver. The FDA approved it as a treatment for people who are statin-intolerant or who have reached maximum tolerated statin therapy for treatment of high plasma cholesterol. Made by Esperion, the drug is available in two forms. Nexletol is comprised only of bempedoic acid, and Nexlizet is a combination of bempedoic acid and ezetimibe (Zetia). 

Esperion’s website reports that "once-daily therapy was shown in a clinical trial to deliver" 38% reduction in LDL-C compared to placebo.[1] Keep in mind that this is a change in a surrogate marker – which may not have any relationship to meaningful health improvement.

According to an article published in the New England Journal of Medicine, a randomized controlled clinical trial that included 13,970 patients showed that treatment with bempedoic acid was associated with a lower risk of major cardiovascular events – deaths from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization. According to the study, the relative risk reduction for heart attacks in patients taking Nexletol was almost 23%.[2] One could conclude from this overview that this drug is a reasonable alternative to statins and might be even more effective, a good thing since, when used for primary prevention statin drugs reduce the risk of events by less than 2%.

But further analysis, looking at risk reduction in myocardial infarction in absolute terms shows a different picture:

          Nexletol group: 261 MI events in 6992 patients         3.7% risk
          Placebo:           334 MI events in 6978 patients         4.8% risk
          Absolute risk reduction:                                             1.1% reduction
          Relative risk reduction:                                            22.9% reduction

In other words, the drug delivers a statistically significant result that is clinically meaningless to the person who takes it.

Some additional information from the Esperion’s website reinforces the uselessness of this drug:

"Limitations of use for both Nexletol and Nexlezet:

The effect of NEXLETOL and NEXLIZET on cardiovascular morbidity and mortality has not been determined."

"Safety information:

Side effects of Nexletol include hyperuricemia, tendon rupture, upper respiratory infections, muscle spasms, back pain, abdominal pain, bronchitis, pain in the extremities, anemia, and elevated liver enzymes. Many of these are the same side effects that are caused by statin drugs."

Almost no one would agree to take this drug if shown the actual risk reduction and the side effects. Most people might at least consider adopting a low-fat, plant-centered diet if given data showing the incredible health improvement that results. This lack of real informed consent is one of the reasons why people remain so sick, and why the erroneous perception of the lazy American who does not care about health and just wants to take a pill persists. The pill is falsely represented to be safe and effective, and the diet and lifestyle choice is almost never offered.

Reporting the benefit of drugs, supplements, and medical interventions in relative terms is very misleading, and relative risk reduction should not be the metric used in making treatment decisions.
 

---

[1] https://www.nexlizethcp.com/?gclid=Cj0KCQjw_r6hBhDdARIsAMIDhV9YjqqGzkaRcJPyg4wBWia8k7AVD41vBlcEWamNmBOMTDXqJaWnxRMaAid2EALw_wcB

[2] Nissen SE, Lincoff AM. Brennan D et al. "Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients." NEJM 2023 Mar; doi: 10.1056/NEJMoa2215024. Online ahead of print

*****************************************************

DYI:  I'm no medical expert - since COVID so many of these doctors on TV would not be deemed medical experts - be as that may be; an absolute risk from myocardial infarction is only 3.7% that sounds great since the demon cholesterol that - [may not have any relationship to meaningful health improvement] - but when compared to the placebo group only 4.8%!  Simple arithmetic this is only an absolute improvement of 1.1%  

Plus it does make one wonder as these statin drugs do lower bad cholesterol and yet the absolute drop is from 4.8% to 3.7%...Is cholesterol the big bad demon it is made out to be???  Despite both clinical groups having high bad cholesterol only 4.8% of the placebo group had a myocardial infraction event.  

My Lord with all of the talk regarding cholesterol one would think this placebo group would be dropping off like flies!  Then the statin group only drops by 1.1% on an absolute basis further damning the cholesterol narrative.  My opinion - and again I'm no doctor nor some health professional - cholesterol has as much to do with heart disease as EMT's (Emergency Medical Technicians) causing vehicle accidents!

So little - a case can be made that the improvement is nothing more than statistical noise - for those taking any statin drug will subject themselves to side affects and long term use to permanent harms and possible death.  The risk of harm in my judgement significantly out ways what possible improvement  - and that is debatable - this new statin along with the whole statin group as well.  

I do have a problem with Pam Popper as she thinks that COVID is real and that it came out of a bio-lab in Wuhan China.  I do not know if she is controlled Ops or a misdirected medical expert.  However she does put out excellent info - [so far as I can tell] - regarding anything non COVID.

Till Next Time

DYI         

U.S. Stock Market Leaps to a Higher Valuation! Shiller PE at 36.43 and Scant Dividend Yield at 1.36% EYC Ratio Drops to 0.58!

 Special Update

Ben Graham’s Corner 

DYI:  Up to date estimated 10yr average annual return for stocks – [S&P 500 index fund, generalized growth fund etc.] – held or bought today; go to sleep like Rip Van Winkle waking 10 years from now your return (estimated) will be…Drum Roll Please…NEGATIVE 1.31%!  This is with dividends reinvested.  Go to money chimp and plug in the numbers!

Margin of Safety!

Central Concept of Investment for the purchase of Common Stocks.

"The danger to investors lies in concentrating their purchases in the upper levels of the market..."

Stocks compared to bonds:

Earnings Yield Coverage Ratio - [EYC Ratio]

Lump Sum any amount greater than yearly salary.

PE10  .........36.43
Bond Rate...5.20%

EYC Ratio = 1/PE10 x 100 x 1.1 / Bond Rate

1.75 plus: Safe for large lump sums & DCA

1.30 Plus: Safe for DCA

1.29 or less: Mid-Point - Hold stocks and purchase bonds.

1.00 or less: Sell stocks - Purchase Bonds

Current EYC Ratio: 0.58(rounded)

As of  3-19-24
Updated Monthly

PE10 as report by Multpl.com

Bond Rate is the rate as reported by

Vanguard Long-Term Investment-Grade Fund Investor Shares (VWESX)

DCA is Dollar Cost Averaging.

Lump Sum is any dollar amount greater than one year salary.

Over a ten-year period the typical excess of stock earnings power over bond interest may aggregate 4/3 of the price paid. This figure is sufficient to provide a very real margin of safety--which, under favorable conditions, will prevent or minimize a loss...If the purchases are made at the average level of the market over a span of years, the prices paid should carry with them assurance of an adequate margin of safety.  The danger to investors lies in concentrating their purchases in the upper levels of the market.....

Common Sense Investing:
The Papers of Benjamin Graham
Benjamin Graham

 Debt Deflation

Part II

Today, the finance, insurance, and real estate (FIRE) sector has regained control of government, creating rentier economies. The aim of this postindustrial finance capitalism is the opposite of industrial capitalism as known to nineteenth-century economists:

Seeking wealth primarily by the extraction of economic rent, not industrial capital formation instead it is tax favoritism for real estate, privatization of oil and mineral extraction, banking and infrastructure monopolies add to the cost of living and doing business. Labor is increasingly exploited by bank debt, student debt, and credit card debt while housing and other prices are inflated on credit, leaving less income to spend on goods and services as economies suffer debt deflation.

If you’re looking at how wealth is accumulated, people think of it in the way textbooks describe: as earning income and saving it up to get rich. That’s all most wage earners can do. But that’s not how it happens at the top of the pyramid. Most wealth takes the form of capital gains. They’re inflated on credit, so it’s really asset price inflation that’s financed by debt leverage. Most of the gains end up being paid out as interest, so the bankers – that is, the bank owners and bondholders – end up with most of the rise in wealth.

But to look at academic economics, it’s as if the whole economy is about making things – as if manufacturing hires labor to produce goods and services that everybody gets rich from, by being more productive. Savings are supposed to finance growth, increasing stock prices because profits go up from employing more labor to produce more goods and services.

But that’s not what really happens. Most money is made by financial engineering, not by industrial engineering.

 

It’s made by what the classical economists 

called 

unearned income. 

80% of bank loans are to the real estate sector.

The more loans banks make to the real estate sector, the more their credit bids up real estate prices. People think that real estate goes up because population growth and people getting richer to afford paying more. But that’s not really why housing prices are rising. The value of a home or commercial office building is worth whatever a bank is willing to lend against it. As banks loosen their lending standards, they lend more and more. The result is debt pyramiding – and this is true not only for real estate, but for the economy as a whole.

But the FIRE sector’s rent and interest are the first things you have to pay out of your paycheck. That’s more real – in the sense of being most pressing – than goods and services. So when a family gets its paycheck, the taxes and the bank debts credit card debt they owe, and either their rent or their mortgage payment, often are automatically taken out of their check or bank account right off the top. Out of what remains, the average American wage earner only has maybe 25 to 30% of their income available to actually spend on the goods and services they produce.

So there’s a diversion of this income to pay the FIRE sector – a sector that classical economists hoped to minimize. They wanted to get rid of the rentier class. They wanted to nationalize the land, or at least tax away its rent. They wanted the government to be the public creditor, or at least for banks to make productive loans, not finance corporate share buybacks, corporate takeovers, or lend just to inflate real estate prices and make home buyers take on higher and higher debt levels in order to obtain housing.

Today, families entering the labor force are going to have to spend all their life working off the debt they need to take on in order to get an education to get a job, as well the debt they need to buy a car to drive to the job, and the mortgage debt for the house they need to live in to avoid rents going up and up. They have to spend all their life merely to pay their creditors, not to live better with more goods and services. Unlike serfdom, today’s workers can live wherever they want. But wherever they live, they have to produce value not only for their employers but also for the bankers.

These bankers (and bondholders) are the main exploiters today. So finance capitalism is overwhelming industrial capitalism. Instead of industrial capitalism evolving into socialism as was expected, it is retrogressing back to neo-serfdom and neo-feudalism. This is mainly because of the inability to bring debt within the industrial capitalist system to evolve into a socialist economy. That is what neoliberalism is sponsoring by financialization and privatization: the inability to make debt productive.

The economic textbooks […] depict a parallel universe backed by Orwellian euphemistic economics to make people think that somehow they’re going to get rich by borrowing money to buy a home that may rise further in price. The dream is to be a Donald Trump in miniature, to make money on the home as a real estate investment. Make money in the stock market by turning their money over to financial managers like Citibank, Goldman Sachs, or other companies that have paid tens of billions in fines for financial fraud.

 Till Next Time

DYI

 Grinding Down Into Deflation: The National Debt Disaster No One Is Talking About

By Brandon Smith and originally published at Birch Gold Group

The process of stagflation is difficult to track because there are multiple paths that it can take, many of them largely dependent on the whims of the central bank and its policy decisions. All we can really do is look back at the limited number of historic  examples and guess at what will happen next. In the 1970s, stagflation nearly crushed the country with inflation rising by 7% to over 14% per year for a decade while the general public eventually faced high unemployment.

When I hear Zennials complain about being born into the “worst economy ever,” I have to laugh because they really have no clue. The 1970s was FAR worse in terms of erosion of buying power as well as overall poverty. If you look at film footage and photos of urban areas from LA to NY to Philadelphia during that time, many parts of these cities looked like bombed out war zones. The country was truly on the edge of disaster.

DYI:  When I was a young back in the late 1960's my Dad made a trip with us kids into Cleveland Ohio - [I grew up in Willoughby, Ohio (east of Cleveland)] - and drove through parts of the city that looked like it was destroyed by WWII B-17 bombers.     

In the early 1980s, the Federal Reserve jacked interest rates up to over 20% – This stopped the inflation crisis but triggered a deflationary plunge that would sit like a giant boulder on the chest of the American consumer and small business owners for years to come. My own grandfather lost millions in his trucking and freight company during the rate spike; many people lost their businesses and homes.

In other words, as bad as the situation is now, we haven’t seen anything yet. Of course, we are quickly moving towards similar conditions and there is one thing we have today that the 1970s didn’t: A massive snowballing national debt.

Currently, the US national debt is $33.8 trillion and has a 120% debt-to-GDP ratio. In a single month (October) the US added over $600 billion to the debt, and at the current pace the total official debt will hit over $41 trillion in one year. The speed of this accumulation is frightening. To put this in perspective, the Obama Administration and the Federal Reserve added around $9 trillion to the debt in 8 years during the corporate bailouts. Under Joe Biden, this is set to happen in a little over 1 year.

As I have noted in the past, the US economy has stacked so much fiat and so much debt that any deviation in interest rates is going cause huge ripple effects. We don’t even need to hit the 20% interest rates of the early 1980s – A constant rate of near 6% is enough to cause debt to skyrocket. Then there is the problem of “compounding interest.” The US government is borrowing money to make interest payments, but it also borrows to roll over the principal payments, and it borrows still more to fund the general spending which is in excess of taxes collected (deficit spending).

Eventually the avalanche of debt will stall inflation but it will also pop multiple asset bubbles cross numerous market sectors and trigger a deflationary crisis. We are already seeing this trend with a crash in manufacturing as well as frozen wages. We are seeing it in the freight industry, with layoffs and bankruptcies piling up in a shocking downturn indicating impending recession. Not to mention US home sales have plunged to a 13 year low as prices continue to rise.

These are all red flags of an impending deflation event that WILL lead to large scale job losses, likely within the next year. It would seem the magic of COVID stimulus measures is finally fading away and we are beginning to see the real economy underneath.

All the negative news has led to a spike in stock markets recently. Why? Because bad news is good news for equities. The expectation among investors is that the Fed is poised to cut rates or return swiftly to QE. This is not going to happen, at least not anytime soon. The Fed, I believe, wants a crash. After addicting markets to easy money for over a decade, the central bankers know EXACTLY what will happen as they continue to cut off the drug supply.

DYI:  The S&P 500 currently being propelled upward by the top 5 tech stocks with Nvidia doing the brunt of the heavy lifting.  This is not symptomatic of a healthy bull market it is the telltale sign of an exhausted bull readying itself to turn into a full fledge bear market.

I suspect we are about to see a major change in the behavior of the economy going into 2024. The stagflation phase is nearly over. The discussion around dinner tables across America will turn to the exploding national debt, and debt in general. The big debate will once again turn to this: 

Will the Fed keep rates steady, risking deflationary implosion and debt default, or, will they cut rates, return to stimulus to pay the debt and risk double digit inflation?

DYI:  Stocks are clearly in a bubble with the S&P 500 sky high Shiller PE at 34.29 with a scant dividend yield of only 1.38!  Stocks held today or bought today on a wholesale basis, such as an S&P500 index fund or generalized growth fund so prevalent in 401k's the future estimated - [go to sleep like Rip Van Winkle waking ten years from now] - average annual return is...drum roll please...negative 0.71%.  This is simple math all done by plugging in the numbers at money chimp.

Till Next Time

DYI    

DYI:  Very little change from last month despite all of the cheerleading for AI as the new market upward propulsion system - [a bit of sarcasm].  Stock remain at nose bleed valuations with estimated 10yr future average annual returns - [buy or hold stocks go to sleep like Rip Van Winkle awake in 10yrs] - has now dipped into negative 0.71%!

Long term bonds over the past months with interest rates rising have value as shown by my model portfolio with 22% allocated.  Long term bonds rates are trading close to their long term mean average going back to 1871.

Gold whether physical or in the form of mining companies remains our stand out value with the model portfolio at the maximum of 50%!  Please not that the Gold to Silver Ratio at 91 to 1 screaming silver is far better value than gold.

Cash - [short term notes and bills] is now a standout after being in the dog house due to the Fed's years of sub atomic low interest rate policy.     

Updated Monthly

AGGRESSIVE PORTFOLIO - ACTIVE ALLOCATION - 3/1/24

Active Allocation Bands (excluding cash) 0% to 50%

28% - Cash -Short Term Bond Index - VBIRX

50% -Gold- Global Capital Cycles Fund - VGPMX **

 22% -Lt. Bonds- Long Term Bond Index - VBLTX

 0% -Stocks- Total Stock Market Index - VTSAX

[See Disclaimer]

** Vanguard's Global Capital Cycles Fund maintains 25%+ in precious metal equities the remainder are domestic or international companies they believe will perform well during times of world wide stress or economic declines.  

 This blog site is not a registered financial advisor, broker or securities dealer and The Dividend Yield Investor is not responsible for what you do with your money.

This site strives for the highest standards of accuracy; however ERRORS AND OMISSIONS ARE ACCEPTED!

The Dividend Yield Investor is a blog site for entertainment and educational purposes ONLY.

The Dividend Yield Investor shall not be held liable for any loss and/or damages from the information herein.

Use this site at your own risk.

PAST PERFORMANCE IS NO GUARANTEE OF FUTURE RESULTS.

Margin of Safety!

Central Concept of Investment for the purchase of Common Stocks.

"The danger to investors lies in concentrating their purchases in the upper levels of the market..."

Stocks compared to bonds:

Earnings Yield Coverage Ratio - [EYC Ratio]

Lump Sum any amount greater than yearly salary.

PE10  .........34.30
Bond Rate...5.20%

EYC Ratio = 1/PE10 x 100 x 1.1 / Bond Rate

1.75 plus: Safe for large lump sums & DCA

1.30 Plus: Safe for DCA

1.29 or less: Mid-Point - Hold stocks and purchase bonds.

1.00 or less: Sell stocks - Purchase Bonds

Current EYC Ratio: 0.62(rounded)

As of  3-1-24
Updated Monthly

PE10 as report by Multpl.com

Bond Rate is the rate as reported by

Vanguard Long-Term Investment-Grade Fund Investor Shares (VWESX)

DCA is Dollar Cost Averaging.

Lump Sum is any dollar amount greater than one year salary.

Over a ten-year period the typical excess of stock earnings power over bond interest may aggregate 4/3 of the price paid. This figure is sufficient to provide a very real margin of safety--which, under favorable conditions, will prevent or minimize a loss...If the purchases are made at the average level of the market over a span of years, the prices paid should carry with them assurance of an adequate margin of safety.  The danger to investors lies in concentrating their purchases in the upper levels of the market.....

Common Sense Investing:
The Papers of Benjamin Graham
Benjamin Graham

%
Stocks & Bonds

Allocation Formula

3-1-24
Updated Monthly

% Allocation = 100 x (Current PE10 – Avg. PE10 / 4)  /  (Avg.PE10 x 2 – Avg. PE10 / 2)]

Formula's answer determines bond allocation.

Current PE10.....34.30

Avg. PE10...........17.09

% Stock Allocation     0% (rounded)
% Bond Allocation  100% (rounded) 

Logic behind this approach:

--As the stock market becomes more expensive, a conservative investor's stock allocation should go down. The rationale recognizes the reduced expected future returns for stocks, and the increasing risk. 

--The formula acknowledges the increased likelihood of the market falling from current levels based on historical valuation levels and regression to the mean, rather than from volatility. Many agree this is the key to value investing.  

Please note there is controversy regarding the divisor (Avg. PE10).  The average since 1881 as reported by Multpl.com is 16.70.  However, Larry Swedroe and others believe that using a revised Shiller P/E mean of 19.6 , the number since 1960 ( a 53-year period), reflects more modern accounting procedures.

DYI adheres to the long view where over time the legacy (prior 1959) values will be absorbed into the average.  Also it can be said with just as much vigor the last 25 years corporate America has been noted for accounting irregularities.  So....If you use the higher or lower number, or average them, you'll be within the guide posts of value.

Please note:  I changed the formula when the Shiller PE10 is trading at it's mean - stocks and bonds will be at 50% - 50% representing Ben Graham's Defensive investor starting point; only deviating from that norm as valuations rise or fall.        

  

DYI

This blog site is not a registered financial advisor, broker or securities dealer and The Dividend Yield Investor is not responsible for what you do with your money.

This site strives for the highest standards of accuracy; however ERRORS AND OMISSIONS ARE ACCEPTED!

The Dividend Yield Investor is a blog site for entertainment and educational purposes ONLY.

The Dividend Yield Investor shall not be held liable for any loss and/or damages from the information herein.

Use this site at your own risk.

PAST PERFORMANCE IS NO GUARANTEE OF FUTURE RESULTS.

The Formula.

A value based allocation strategy

February 19, 2010 by John Kingham