Medical science will make great progress when it's able to to challenge some of its basic assumptions.
No single person did more damage to the progress of Medical Science than Ancel Keys [1]. Dr. Keys hypothesized that heart disease was caused by the consumption of saturated fats, and recommended that people avoid the consumption of animal fat, in favor of deodorized polyunsaturated vegetable oil.
We now know that partially-hydrogenated oils (such as were used in Crisco, before it was reformulated in the early 2000's) are the real villains. But the grocery store shelves are still lined with 'healthy' Safflower, Soybean, Corn, and Cottonseed oils.
The drug industry has done a lot of damage too. For example, Doctors have spent decades suppressing cholesterol levels, instead of trying to figure out the meaning of high cholesterol levels. Dissidents against the cholesterol hypothesis have been gaining traction in recent years, even among the professional class.
In Anatomy of an Epidemic, [2] Robert Whitaker covers how the pharmaceutical industry conquered the psychiatric profession in the 1980's.
NASA got the guys home safe from Apollo 11 because brilliant and I mean brilliant minds worked together. My uncle was one of them and he's the craziest, yet most intelligent person I've ever known.
Teamwork is different than collaboration. In teamwork intellectual pursuits can achieve great success, but collaboration needs to be tempered, because many times collaboration means just talking and sharing with weaker members, but teamwork is an ability to effectively communicate, form and dissolve efficiently collaborative groups to optimize for results... That's how I've always separated the two words, might not be for everyone that definition.
Also the other great provider of innovation is pressure towards a definable goal, which most organizations lack looking at them as an external, which doesn't mean I'm accurate, but does cause me to question whether this could be an issue that'll need to be addressed. The singular approach had this goal oriented approach build in by its very nature and the collaboration leads to security and it can be difficult to inspire the same degree of engenuity.
Wrote from my mobile, so please consider that before you play wack a mole with my comment.
Statins are an extremely powerful tool for reducing morbidity and mortality. Statins are like vaccines in their ability to attract deniers, but the genetic data are in complete alignment with the clinical trial results.
So says the cardiology fellow… One theory as to why statins have a small degree of influence is that they actually have an anti-inflammatory action. When my father talks with his patients, he finds many of them couldn't tolerate statins' side effects.
Would you say "so says the cryptographer" to circumscribe something that `tptacek says about cryptography?
> One theory as to why statins have a small degree of influence is that they actually have an anti-inflammatory action. When my father talks with his patients, he finds many of them couldn't tolerate statins' side effects.
Given the predictable effects of LDL-cholesterol lowering on MACE and death, invoking beneficial mechanisms of statins beyond LDL-cholesterol lowering (e.g., by anti-inflammatory effects) is not that well supported (or necessary to explain the benefits), but it's not out of the realm of possibility.
>Would you say "so says the cryptographer" to circumscribe something that `tptacek says about cryptography?
If there were differing opinions and results on some computer science subjects by different specialties (cryptography, data science, language design, algorithms, etc), then yes.
> Would you say "so says the cryptographer" to circumscribe something that `tptacek says about cryptography?
The American Heart Association still promotes Ancel Keys' dietary philosophy, so everything they touch is tainted. An appology for The Mistake (promoting vegetable oil) is necessary to begin the process of rebuilding trust.
I subscribe to a medical news email - one of the recent editorials was about needing to re-examine the profession's obsession with cholesterol. When I find the link I'll post again. But basically the gist is that the CETP agents are good at lowering cholesterol levels, but not so good at lowering mortality, so maybe the hypothesis needs to be reconsidered.
Apheresis, HMG-CoA reductase inhibition (statins), PCSK9 inhibition (-cumabs), and NPC1L1 inhibition (ezetimibe) all lead to reduced LDL-C. Statins and ezetimibe lead to reduced MACE and death. The -cumabs should be reporting trial results in the next 12 months, but the genetic data strongly suggests that they will reduce mortality.
Unusual for cholesterol modification agents, some of the CETP drugs (which were designed around their HDL-C raising properties but do lower LDL-C) increased MACE, while others had neutral effect, so there is something about CETP that we have yet to understand.
I would estimate that the cholesterol fetish has about 2 more years before it begins to slide into irrelevance, and the field begins to refocus on the causes behind the symptom.
The article is about Billionaires trying new approaches to medical research. My point was that more progress could be made by re-examining old assumptions.
> So says the cardiology fellow…
For the record, I was traveling when I wrote this and my later comments. If I'd had a keyboard, and had spent more time drafting, I might've said things differently.
I wanted to point out that the carbocation has a vested interest in promoting statins. I note that carbocation never responded to the substance of my comments: that an old science-mistake that has never been officially corrected contributes to many people's health problems. That inflammation -- caused by the consumption of partially hydrogenated oils and Omega-6 PUFA oils -- is a primary consideration for heart problems, moreso even than cholesterol lab #'s.
In summary, I apologize for being short and less-than-courteous yesterday. It was a combination of not having a keyboard for my followup posts, and responding to someone whose initial post was entirely dismissive of the 'dissidents' complaints about the drugs that [s]he apparently thinks highly of.
I don't have a vested interest in promoting statins: I have no financial stake in companies that produce them, and my job as a cardiologist would still exist if statins were proven to be harmful. I do think that your views about statins are wrong on the scientific merits. There is a preponderance of evidence that supports their use as not only safe, but also effective (though costly if you don't select your population at all).
Your views on inflammation aren't right or wrong; they're speculative. Some evidence can be interpreted as supporting the inflammation hypothesis (JUPITER trial), other evidence suggests that much of what we measure as a sign of inflammation has no direct impact on CAD (see the CRP Mendelian randomization). So, this is still an active area of research.
I'm probably in the category of people they might be prescribed to - 52, year male, bit overweight, otherwise healthy, but I'm kind of a believer in if it ain't broken don't fix it and so will risk it.
The "cholesterol hypothesis" is kind of a different thing.
With a mean follow-up of 3.7 years, it should surprise nobody that no significant differences could be shown. The study quality is low, because the follow up is so short, which likely explains the low-impact journal for publication. Even then, the point estimate is 0.9 and the confidence interval barely overlaps 1, suggesting that after longer follow-up, even this analysis would come in line with essentially every other study which shows benefit.
In higher-risk groups in the same timeline (this time, 5 years)[1][2], or in other analyses such as the Cochrane analysis [3], statin use for LDL-cholesterol lowering is demonstrated to be effective even on those same short timescales for reduction in mortality. Whether it's cost-effective to do this at scale is not clear.
Don't oversimplify. You understand the difference between treating a symptom vs treating a cause. In a complicated biological system there are long chains of correlated events, and throwing a drug at one part of a chain should only be considered an attempt at understanding and controlling the process.
No single person did more damage to the progress of Medical Science than Ancel Keys [1]. Dr. Keys hypothesized that heart disease was caused by the consumption of saturated fats, and recommended that people avoid the consumption of animal fat, in favor of deodorized polyunsaturated vegetable oil.
We now know that partially-hydrogenated oils (such as were used in Crisco, before it was reformulated in the early 2000's) are the real villains. But the grocery store shelves are still lined with 'healthy' Safflower, Soybean, Corn, and Cottonseed oils.
[1] https://en.wikipedia.org/wiki/Ancel_Keys#Seven_Countries_Stu...
The drug industry has done a lot of damage too. For example, Doctors have spent decades suppressing cholesterol levels, instead of trying to figure out the meaning of high cholesterol levels. Dissidents against the cholesterol hypothesis have been gaining traction in recent years, even among the professional class.
In Anatomy of an Epidemic, [2] Robert Whitaker covers how the pharmaceutical industry conquered the psychiatric profession in the 1980's.
[2] http://robertwhitaker.org/robertwhitaker.org/Anatomy%20of%20...