Knowledge Reveals Profound Ignorance: the Hallmark of Medicine

I’ve said this many times before, Medicine Is a process, one that replaces old ideas with new understanding. HDL offers a perfect example. We all know HDL to be “the good cholesterol”. Simple, correct? HDL is the cholesterol that protects us from heart attacks and strokes; that’s its job. Low HDL implies risk while high HDL, protection. Enter the science of the past decade. Everything has changed. We’ve discovered that raising HDL in patients already on statin medications does not (as we previously believed) necessarily equal risk reduction. Far more profound than this realization is the fact that HDL is NOT “the good cholesterol”. Yes, it is a carrier of cholesterol, and yes it helps reduce the risk of heart attack, but NO it is NOT cholesterol.

It turns out that HDL is an extraordinarily complex structure with many phases of life and many forms and functions. HDL can be a disc and it can be a sphere. It can be very large or very small. Its surface can carry over 200 different types of fats and about 200 various forms of proteins. And, specific combinations of these fats and proteins will imbue the HDL particle with specific functions. HDL particles can help us fight infections, carry vitamins and nutrients throughout our bodies, protect LDL particles from oxidation, and shuttle proteins around the body to be given to more needy recipients. The list goes on. HDL is amazing. And the more amazing we know it to be the more we must admit how little we understand HDL. So if HDL is so complex, imagine how intricate our entire bodies are. The bottom line, please be patient with your doctor. He or she is trying desperately to understand and work with an ever-expanding field of information. Please understand that what may seem to be mistakes in science are often simply the byproducts of growth and development. We all aspire to the same goal, the expansion of health and reduction of illness. We really are all on the same team.

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