The Truth about Truth in Medicine

I have read one too many blogs that speak about the “Truth” in one area of medicine or another. As long as such blogs and news reports and even scientific journals perpetuate the notion that in Medicine we have the capacity to know the “Truth” we will continue to have unhappy patients and argumentative doctors. Sadly I have not yet met a man or woman in the sciences who has conversed with god about medical issues (or any other issues, for that matter). Until such time as we actually do find a way to communicate with “the big guy” we must refrain from bolstering our beliefs and contentions into the realm of the absolute. I have stated this before but I believe it requires repeating: Medicine is a process. We are continually learning, creating novel theories and abandoning old beliefs. One day we might be sure of something and the next day we laugh to ourselves as we learn how wrong we were. On a personal note, I spend a great deal of time exploring a variety of health-related issues. My studies often take me to the depths of cell biology and molecular biology. I even find myself immersed in the swamps of genetics. Each time I explore these spheres I gain greater knowledge about that which I am studying. I also reinforce my understanding about how little we (and I) actually know. Even discoveries from our Nobel Laureates become démodé as new Nobel Laureates pave different pathways. This is simply the nature of science and medicine. And it is wonderful. So I implore you to help eradicate the misperception that in Science and Medicine we have access to truth. By so doing, you will help bring a tranquility to the practice of Medicine that will in turn make doctors and patients far more comfortable in their respective roles as teachers and students. We are not and should not be considered members of the clergy.

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Cholesterol and Vascular Disease Part 3: How Tiny LDL Particles Can Cause Such Harm

September is National Cholesterol Education Month. In support of this important educational initiative we are republishing our six part series on cholesterol and the role it plays in cardiovascular disease.

Note: Seventy-one million American adults have high cholesterol, but it is estimated that only one-third of them have the condition under control.

Previously we discussed the relevance of LDL particles, emphasizing their role as the main drivers of vascular disease. We did not, however, discuss how they wreak such havoc upon our blood vessels. Today we will do so.

LDL particles do wonderful things. They transport cholesterol and triglycerides to various parts of our body for fuel, storage, or even to serve as building blocks for other important molecules. They even transport vitamin E to our brains in order to enhance growth and development in infants, and proper brain function in adults. So how can something so good, be so bad? The answer lies in numbers. The aphorism “too much of a good thing can be bad” applies perfectly to LDL particles; they are necessary for a healthy body, but only in small quantities. The numbers most of us possess are so far out of range, they are literally killing us. But how? What happens when these tiny particles make their way beneath the delicate yet vital single cell layer (called the endothelium) that lines our blood vessels? Read More…

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Distortion of Scientific Findings: Here We Go Again!

“Baby’s Blocked Belly Tied to Low Cholesterol” is the headline of today’s Medscape article reporting on a just-released JAMA publication. Contrast this with the article’s actual title, “Plasma Lipids, Genetic Variants Near APOA1, and the Risk of Infantile Hypertrophic Pyloric Stenosis”. Notice a difference? Accurate headlines don’t sell papers, or blogs. Apparently our interest is peaked only by findings or events that have an immediate and preferably negative impact. One would infer from the headline that low cholesterol is bad, causing the “blocked bellies” in babies. In no way does this study actually come to such a conclusion. Instead it reveals that the genes causing pyloric stenosis reside near those controlling certain lipid levels. Both sets of genes can experience changes (polymorphisms) resulting in abnormalities. So, abnormal lipids in these children are more likely the result of being in the wrong place at the wrong time. It is likely that the two disorders occur concurrently not because of causality, but rather misfortune. Low cholesterol is not necessarily causing the pyloric stenosis even if it is associated with the disorder. Similarly, pyloric stenosis is likely not causing the abnormal cholesterol.  The bottom line again; read everything with cautious eyes.

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Preventive Health News

couple bike riding

This week’s roundup of important preventive health and health-related news.

 Visit vitalremedymd.com for preventive health solutions.

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Caution! Always View Clinical Trials with a Healthy Dose of Skepticism

We are barraged by data. In medicine this comes in the form of clinical trials and reviews. In everyday life data from news outlets strike us at every turn. We also have the internet and TV talk shows. Everyone seems to have an opinion about everything. So how do we separate the wheat from the chaff? When it comes to science, this is what I advise.

First, understand that science is not static; it is a process. It is also not black and white; it comes in countless shades of grey. Published studies are attempts to find biologic connections. They are single links in the chain of understanding. They do not stand alone; they always must be viewed in the context of all other clinical trials as well as our understanding of the complexity of human biology. Never though do we gain a hotline to god. Never are we able to say, “this is truth and all else fiction” after the publication of a clinical trial. So if you hear or see someone go to a place of certainty on the basis of a single trial, be very, very skeptical. Even if that individual is a so-called expert. The experts are not gods.

Second, there are levels of importance among the trials; some therefore are “better” than others. Rarely do you hear even the experts on TV speak about this. They typically speak only about the “abstract”, a brief summation at the beginning of every study. This is an area too complex for most clinicians to fully grasp. How then can we expect the lay population to comprehend this nuance?

Third, and probably most important of all, every trial comes with flaws. Sometimes these imperfections entirely devalue the trial’s results; other times they simply raise cause for concern. Regardless, to do a trial justice, one must read it with a fine tooth comb. In fact, when I really need to understand a particular study I spend four or five hours reading and critiquing it. Imagine that; four or five hours for a single trial. How then can I treat patients, teach, write, and still have time to read the many thousands of trials published annually. I can’t.

In sum, be cautious. Do not jump to conclusions when a study is published. Do not panic. Do not stop your medications or supplements until you’ve had the opportunity to discuss the findings thoroughly with your doctor. Always be circumspect and vigilant when learning about a clinical trial. Always maintain a very healthy skepticism. I guess in the final analysis the truth is that you can’t always believe what you read or hear. Competing interests often get in the way of truth. And the truth with clinical trials is that they are not at all about “the truth”. They are simply small cogs in the wheels of discovery.

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USDA Names 2015 Dietary Guidelines Advisory Committee

farmer's marketThe U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius and U.S. Department of Agriculture (USDA) Secretary Tom Vilsack have announced the appointment of 15 nationally recognized experts to serve on the 2015 Dietary Guidelines Advisory Committee. The Committee’s recommendations and rationale will serve as a basis for the eighth edition of the Dietary Guidelines for Americans.

Every five years, the Dietary Guidelines for Americans are updated and published jointly by HHS and USDA. The administrative responsibility for leading the process alternates between Departments. The Office of Disease Prevention and Health Promotion at HHS is the administrative lead for the 2015 process.

Dr. Thomas Brenna, the President elect of ISSFAL (International Society for the Study of Fatty Acids and Lipids) is among the 15 renowned experts appointed to the 2015 Dietary Guidelines Advisory Committee.

Of special note: Dr. Brenna has been invited to speak at the American Society of Preventive Cardiology’s Second Annual Southeastern Conference “CDV Prevention for Women” event, which is being held in collaboration with Boca Raton Hospital in Boca Raton, FL July 12 – 13th. I’ll be chairing the event which will be held at the Boca Raton Resort & Club.  I’m also proud to serve as the treasury of ISSFAL.

Please read more about preventive cardiology at www.preventivecardiologyinc.com.

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40 Year Old Woman’s Heart Attack Attributed to Familial Hypercholesterolemia

A recent story featured on Good Morning America and ABC News relates the story of Blair Wenter, a 44-year-old mother diagnosed with familial hypercholesterolemia — a genetic cholesterol disorder that starts at birth, an issue that was amplified by the fact that genetic testing revealed Blair’s son Christian also had the condition. Blair – at the time a 40-year-old ranch photographer from Frisco, Texas, thought she was too healthy and active to have a heart attack.

Wenter, a lively speaker at last year’s Boca Raton Regional Hospital (BRRH) sponsored ASPC meeting stated, “When you see a 128-pound, 5-foot 4-inch woman in stilettos, doctors think it’s a hormone issue”. “I was riding horses, chasing children, swimming — I live a very active life. I ran a 10K the week of my heart attack.” Sadly Wenter’s story is not unique.

As is the case with many people stricken with FH, Blair was unaware she had the condition. Familial Hypercholesterolemia, is a genetic cholesterol disorder that leads to premature vascular disease. In the most severe circumstances, very young children can experience life-threatening heart attacks and strokes. Typically however, the disease does not wreak havoc until people reach their 40s and 50s. FH is not as rare as you might imagine. It occurs in one out of every 500 people, but in some populations – like French Canadians and South African Ashkenazi Jews – the number can be as high as one in 67! To make matters worse, the disorder often goes undetected.

In an attempt to thwart the dire consequences of FH, organizations like the FH Foundation, the National Lipid Association and the American Society for Preventive Cardiology are working hard to raise awareness. This Tuesday February 26th at BRRH I will be giving Grand Rounds on FH. Because of her dedication to the FH cause, Katherine Wilemon, the founder and president of the FH Foundation (and an FH patient herself) will be flying in from California to join me. These organizations – and I personally – encourage you to speak to your doctor to see whether you harbor this silent threat. If you do, don’t be afraid; treatment is available for you and your family.

Remember, as a genetic disease FH can impact all members of your immediate and even extended family. Consequently all relatives of a single FH patient should be screened with simple cholesterol tests. Please don’t procrastinate. See your doctor soon to be sure you do not have FH.. These organizations – and I personally – encourage you to speak to your doctor to see whether you harbor this silent threat. If you do, don’t be afraid; treatment is available for you and your family. Remember, as a genetic disease FH can impact all members of your immediate and even extended family. Consequently all relatives of a single FH patient should be screened with simple cholesterol tests. Please don’t procrastinate. See your doctor soon to be sure you do not have FH.

For more information on FH treatment alternatives, including LDL-Apheresis, visit Preventive Cardiology Inc.

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