This is a contribution from members of THINCS,
The International Network of Cholesterol Skeptics


In a JAMA paper (ref 1) Stamler and Neaton publish a number of false statements in support of the cholesterol campaign. Here is our comment to his paper. The editor's response follows.

On The Unimportance of MRFIT and Relative Risk
Stamler and Neaton's insinuation that increased serum cholesterol causes a continuous, graded increase in coronary heart disease (CHD)1 continues to confuse risk markers, which are merely statistical associations, with risk factors that have a causal contribution.2 Their recommendation that dietary fat intake and serum cholesterol should be lowered as much as possible in everyone are also refuted by numerous studies published since their MRFIT paper.2,3 High cholesterol is not a risk factor for women, diabetics, CHD patients, senior citizens (in whom ninety percent of all cardiovascular deaths occur), and is associated with reduced mortality in the elderly because of its protective effects.4

No mention was made of HDL, diastolic BP, blood sugar vs. "reported diabetes", or how "excess deaths attributable to serum cholesterol levels 180 mg/dL or greater" were "estimated". The strong, linear relationship in the original MRFIT paper became trivial and non-linear after exclusion of the smokers,5 Werkö has enumerated other questionable and inconsistent study reports, such as the variation in number of screeenies from 316,099 to 361,266 and the dubious likelihood that all could have been tracked after 6-12 years.6 

1. Stamler J, Neaton JD. The Multiple Risk Factor Intervention Trial (MRFIT) importance then and now. JAMA 2008;300(11):1343-1345.
2. Rosch PJ. Cholesterol does not cause coronary heart disease in contrast to stress. Scand Cardiovasc J. 2008 Aug;42(4):244-9.
3. Ravnskov U, Rosch PJ, Houston MC. Should we lower cholesterol as much as possible? BMJ 2006;332:1330-1332.
4. Ravnskov U. Should medical science ignore the past? BMJ 2008;337:a1681.

5. Shaten BJ, Kuller LH, Neaton JD.
Association between baseline risk factors, cigarette smoking, and CHD mortality after 10.5 years. MRFIT Research Group. Prev Med 1991 ;20:655-9.
6. Werkö L. Analysis of the MRFIT screenees: a methodological study. J Intern Med 1995; 237:507-18.

Paul J. Rosch, MD, FACP
President, The American Institute of Stress
Clinical Professor of Medicine and Psychiatry
New York Medical College

Uffe Ravnskov, MD, PhD
Independent Researcher, Lund, Sweden

And here comes the editor´s usual response:

Dear Dr. 

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,

Robert M. Golub, MD
Letters Section Editor, JAMA

Other unpublished contributions by members of THINCS