Drug companies working on ways to raise cholesterol

I have been awakened from my slumber by an article which has completely floored me.

On discovering, shock horror, that high HDL levels in men confer longevity, the drug companies saw a marketing opportunity (my highlights):

“It’s difficult to change HDL levels,” Barzilai said. Exercise might raise it a few points, but it isn’t a very efficient way to improve, he said. “We need to get a drug eventually.”

Merck and Roche are both working on an HDL raising drug, he told Reuters Health. Pfizer stopped its research into another such drug, torcetrapib, in 2006 because people taking it along with Lipitor in a study had a higher rate of death. – Reuters

Wow. Just wow.

It should also be noted that Total Cholesterol = Triglycerides + LDL + HDL so if HDL goes up, so will the total. And then they will be in a tizzy because the total is too high.

They didn’t bother to mention what the total cholesterol numbers were for these long lived men but I willing to bet they were at levels which would have Merck and Roche screaming for force feeding of statins.

PS: you don’t need drugs to boost your HDL.

NEW YORK (Reuters Health) – Men who reach their 85th birthdays tended to have high levels of good cholesterol while in their 60s, a new study says.

Researchers found that men with the highest good (HDL) cholesterol were 28 percent less likely to die before they reached 85, compared to men in the lowest HDL group.

This paper, published in the American Journal of Cardiology, adds to the evidence that HDL is important for a long life, said Dr. Nir Barzilai, who heads the Institute for Aging Research at Albert Einstein College of Medicine in New York and was not part of the study.

However, “we always have to remember that it’s an association,” and it does not mean that having high HDL increases life span, he told Reuters Health.
About 12 million men suffered from heart disease and stroke in 2006, but high levels of HDL cholesterol may reduce the risks, according to the American Heart Association.

Low levels of HDL, less than 40 milligrams per deciliter (mg/dL) of blood for men, are known to increase the risk of heart disease, according to the heart association.

The researchers, from the Massachusetts Veterans Epidemiology and Research Information Center in Boston, looked at the medical records of about 650 veterans when they were around 65 years old, then grouped them based on HDL levels.

Starting with low levels of 40 mg/dL, they found that for each ten mg/dL increase of HDL, the men were 14 percent less likely to have died by 85. Overall, 375 survived to that age.

Also, fewer of the men with higher HDL were overweight, and they tended not to have more than 2 drinks a day. And fewer of them had heart disease or smoked, compared to the lowest HDL group.

These other factors might have had an effect on survival, Barzilai said. However, the researchers did account for this, and still showed a link between reaching 85 and high HDL levels, he told Reuters Health.
“It’s difficult to change HDL levels,” Barzilai said. Exercise might raise it a few points, but it isn’t a very efficient way to improve, he said. “We need to get a drug eventually.”

Merck and Roche are both working on an HDL raising drug, he told Reuters Health. Pfizer stopped its research into another such drug, torcetrapib, in 2006 because people taking it along with Lipitor in a study had a higher rate of death.

The B-vitamin niacin may raise HDL levels 15 to 35 percent. However, side effects can include liver damage and increased blood sugar, according to the Mayo Clinic.

A three-month supply costs about nine dollars. Niacin is also found in dairy products, lean meats, nuts, eggs and fish.

However, it’s unclear how much raising HDL will prevent heart disease, Barzilai said, so whether drugs might improve people’s health remains to be seen.

The study authors could not be reached by deadline.

SOURCE: http://bit.ly/h8Jty9 The American Journal of Cardiology, online February 4, 2011.


Ideology trumps evidence

Fantastic opinion piece in the NYT:
Believing in Treatments That Don’t Work

Treatment based on ideology is alluring. Surgeries to repair the knee should work. A syrup to reduce cough should help. Calming the straining heart should save lives. But the uncomfortable truth is that many expensive, invasive interventions are of little or no benefit and cause potentially uncomfortable, costly, and dangerous side effects and complications.

The critical question that looms for health care reform is whether patients, doctors and experts are prepared to set aside ideology in the face of data. Can we abide by the evidence when it tells us that antibiotics don’t clear ear infections or help strep throats? Can we stop asking for, and writing, these prescriptions? Can we stop performing, and asking for, knee and back surgeries? Can we handle what the evidence reveals? Are we ready for the truth?

And when we insist on evidenced based healthcare, will our doctors accept it?

Ethical Quandary – Industry Money in Med Schools

Give your doctor a break, he doesn’t know he has been brainwashed:

In a first-year pharmacology class at Harvard Medical School, Matt Zerden grew wary as the professor promoted the benefits of cholesterol drugs and seemed to belittle a student who asked about side effects.

Mr. Zerden later discovered something by searching online that he began sharing with his classmates. The professor was not only a full-time member of the Harvard Medical faculty, but a paid consultant to 10 drug companies, including five makers of cholesterol treatments.

“I felt really violated,” Mr. Zerden, now a fourth-year student, recently recalled. “Here we have 160 open minds trying to learn the basics in a protected space, and the information he was giving wasn’t as pure as I think it should be.”

More – New York Times

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The lady doth protest too much

Criticism may not be agreeable, but it is necessary. It fulfils the same function as pain in the human body. It calls attention to an unhealthy state of things.
    – Winston Churchill


Criticizing Modern Medicine

Critics of modern medicine’s critics are “fed up with the cranks.

According to the wackos, modern medical care kills and injures more people than, well, just about anything. Joe Mercola and Gary Null have very long articles on their websites bemoaning the dangers of medicine versus the safety of woo. They love to make statements like, “It is now evident that the American medical system is the leading cause of death and injury in the US.” – Denialism Blog

Certainly there is a level of shrill that serves to discredit a detractor especially when the claims are broad sweeping statements which cannot be substantiated.

And the critics frustration with medicine’s “lack of vision” can often escalate into accusations of depraved indifference.

But Bill Maher makes it sound like doctors are stalking healthy people in the streets and beating them to death with ball-peen hammers. – Denialism Blog

There are, however, many credible individuals calling for change. For an intro to this world, Dr. William Davis is as good a place to start as any.

Even those on the inside occasionally break the silence and admit that they are just trying to make it through the day like everyone else.

“Do doctors care?” he writes in one of the journal entries he quotes throughout the memoir. “I don’t know. I don’t see a lot of caring”. (…)

From his current perspective as a practicing cardiologist, Jauhar admits, “In some ways, I probably ended up becoming the kind of doctor I never thought I’d be: impatient with alternative hypotheses, … sometimes indifferent (hard-edged, emotionless), occasionally paternalistic.” – Imperfect Heroes, New York Times

Certainly there is a conservative bias amongst the profession to go with what you know and have been taught. Tried and tested almost always trumps new ideas – even when mountains of evidence suggest it is time for a revision. In fairness, it’s hard not to get shrill when it seems some doctors would rather protect their beliefs than your health.

But when he next visited (…) the specialist was astonished to see that the leg had healed. “He asked me, ‘Where’s the ulcer?'” The former army nurse explained that his diabetes was now being managed on a special low-carbohydrate diet, recommended by his GP. “The specialist told me, Oh, we don’t believe in that.” – The Weight of the Evidence

Furthermore, there is plenty of evidence that those in the medical profession don’t always make the best scientists. For the long examination of that, read Good Calories, Bad Calories.

For a quick example, check out: Medicine and Statistics Don’t Mix

Just press the button...

Bottom line? Medicine affects us all. We’re all entitled to a say because, eventually, we will all be patients or we will be recipients of the edicts issued by the profession. And to remain obediently passive when in doubt is akin to participating in a Milgram experiment in which we both administer and receive the shocks.

Of course, the tenor and content of a criticism will determine whether you are heard or whether your opinions are tossed aside with the rest of “the cranks.”

No doubt those holding tight to their world view will always resort to attacking the messenger instead of the message. The key to success is in perseverance over the long run: keep smiling, keep hurling science back and keep the anecdotes coming. Eventually people listen.

Or, you know, die-off.

An important scientific innovation rarely makes its way by gradually winning over and converting its opponents: What does happen is that the opponents gradually die out.
    – Max Planck

Doctor Knows Best

Having a hard time convincing your doctor that modern medicine has had its mistakes? Show them this…

Neatorama has reprinted an excellent collection of medicines that have come and gone.

Is there anything radium can’t do? In the 1920s and early 1930s, companies touted it as a cure-all and put the radioactive element in toothpaste, ear plugs, soap, suppositories, and even contraceptives.

I suspect it was quite effective as a contraceptive.

And here’s a sweetener you probably haven’t thought of:

Ancient Romans used lead in everything from paint to dishware to plumbing, despite warnings from Caesar’s engineers. Actually, Romans loved the stuff so much that they added lead acetate to wine as a sweetener.

Sadly, I’ve had no success at determining the carb content of lead acetate.

Bariatric Surgery has Nothing on this Hack

If you thought stomach stapling was too extreme for the treatment of obesity, then this will really yank your chain.

Doctors in Toronto have experimented on a morbidly obese man by implanting electrodes into his brain to stimulate appetite suppression. One has to assume that you are quite desperate to hack your brain for results.

The interesting outcome, however, was that the doctors discovered that the electrical current to the hypothalamus resulted in “turning up the brain volume” such that memory and ability to learn was greatly enhanced. There was no mention of whether the patient’s appetite was affected. Research clearly took a happy turn and they didn’t look back.

New brain anyone?


On Brainsuckers and Googlers

I read this article some time ago but there is something about it that keeps bugging me:

When the Patient Is a Googler

A woman walks into a doctor’s office with a knee problem. She is looking for a specialist to help sort it out. She dominates the conversation, she is distrustful and she has clearly done a lot of research on the topic. She’s also Googled him personally. The whole while she’s in the doctor’s office, her 4 year old son makes a huge mess and acts up providing an unpleasant backdrop to what he finds an already stressful scenario.

The doctor refers to her as a “brainsucker” and “queen of Googlers.” He feels a bit invaded by her Googling his personal life. He is clearly offended by the distrust he senses from her because, after all, he’s there to help. He also has little time for anything but the obvious medical diagnosis and cure which involves one to two surgeries and many months of recovery. The thought of going through this with her is more than he can bear.

So he lets her carry on for a while until he finds the right moment to get a word in then recommends another doctor. Bye Bye Mrs. Smarty-Pants.


It’s absolutely right that people should, when they have the option, choose to avoid people they know will cause them stress. She’s part of the 20% of the world that will cause him 80% of his work. She’s intense and he’s looking for an easier doctor-patient relationship. He wants someone who will let him get on with the job. And off course, he wants someone who will defer to his expertise.

But I can also empathise with this woman’s distrust. Perhaps she has suffered doctors who, as a first option, want to get their patients under the knife for some quality billable hours instead of exploring non-invasive and less expensive options. Maybe being the “brainsucker” that she is, she’s found that some physicians don’t keep up with the latest developments and technology and are unaware of some new alternative treatments. How would the likes of Jimmy Moore and co have fared only following the gospel of the experts?

About a year back I saw a great video by one such “brainsucker” by the name of Jerry Brunetti who had been diagnosed with non-Hodgkin’s Lymphoma. Jerry did his homework then went to see the specialist. The specialist said the only route to health was an expensive course of chemo therapy which would have lots of debilitating side effects and only a 60% chance of surviving 2 years. Jerry tried to discuss his research but was told in no uncertain terms that he was foolish to question the established truth with its appointed guardians.

Jerry walked out on the experts and proceeded to cure himself using his own application of the info he had gathered.

OK an anecdote is not statistical proof. But I guess when a doctor finds the distrustful brainsuckers walking into his office, he could do better than to write them off as a new-age pain in the ass.

Because if he does, then perhaps the distrust isn’t misplaced after all. Perhaps the very refusal to listen is what ultimately causes the divide.

Exercise Pill on the Way?

By giving ordinary adult mice a drug – a synthetic designed to mimic fat – Salk Institute scientist Dr. Ronald M. Evans is now able to chemically switch on PPAR-d, the master regulator that controls the ability of cells to burn fat. Even when the mice are not active, turning on the chemical switch activates the same fat-burning process that occurs during exercise. The resulting shift in energy balance (calories in, calories burned) makes the mice resistant to weight gain on a high fat diet.

The Salk Institute scientist who earlier discovered that enhancing the function of a single protein produced a mouse with an innate resistance to weight gain and the ability to run a mile without stopping, has found new evidence that this protein and a related protein play central roles in the body’s complex journey to obesity and offer a new and specific metabolic approach to the treatment of obesity related disease such as Syndrome X (insulin resistance, hyperlipidemia and atherosclerosis).

Via | Marathon Mouse Keeps on Running