Summer in Wisconsin 25. September 2007 William Davis (10) It's been a glorious summer in Wisconsin. For weeks straight, we've enjoyed bright, sunny days with temperatures in the 70s and 80s. Even now, in late September, our windows are wide open and the days are warm and sunny. Yesterday, it was 84 degrees. Yes, it did rain for a stretch of about 10 days in August, but for the most part it has been a wonderfully sunny summer. So it struck Andy as a big surprise when we checked his 25-OH-vitamin D3 blood level: 15 ng/ml--severe deficiency. "I don't get it. I'm outside almost every day. Look at me! How do you think I got this tan?"Indeed, Andy sported a nice dark tan over exposed areas. In fact, Andy was among the dozen or so people this month with deficiencies of this magnitude. Deficiency is not the exception; it is the rule. Of course, if Andy's blood level is at the level of severe deficiency in September, he will only trend lower over the next few weeks and months. He would likely have shown vitamin D blood levels of <10 ng/ml by January--profound deficiency. With deficiency of this severity, Andy has been exposing himself to risk for prostate and colon cancer, diabetes and metabolic syndrome, low HDL, higher triglycerides, higher blood sugars, higher C-reactive protein, osteoporosis, arthritis . . .Correcting the deficiency is easy. But, as you can see, getting sun is not always the answer. Even with an active, outdoor lifestyle and a tan, Andy still remained significantly deficient. Oral replacement with vitamin D3, or cholecalciferol, is an absolute necessity.
Wacky statin effects 23. September 2007 William Davis (18) In general, I try to exhaust possibilities before resorting to the statin drugs. But we still do use them, both in general practice and the Track Your Plaque program. There are indeed a number of ways to reduce, minimize, or eliminate the need for these drugs. For instance, if your LDL is 150 mg/dl but comprised of 90% small particles, then a reduction in wheat and other high-glycemic index foods, weight loss, fish oil, and niacin can yield big drops in LDL. But sometimes we need them. Say LDL is 225 mg/dl and is a mix of large and small. Exercise, weight loss, niacin, oat bran, ground flaxseed, Benecol, etc. and LDL: 198 mg/dl. Alright, that's when statins may be unavoidable. There's also many people who are not as motivated as all of us trying to reverse heart disease. Some just want the easy way out. Statins do indeed provide that option in some people. So in truth, we end up using these drugs fairly regularly. How common are muscle aches and fatigue? In my experience, they are universal . If taken long enough, or if high doses are used, muscle complaints are inevitable. Most of the time, thankfully, they're modest and often relieved with a change in drug or with coenzyme Q10 supplementation. But there's more to statin side effects than muscle aches. Among the wacky effects that I have witnessed with statin drugs:--Insomnia-especially with simvastatin (Zocor and Vytorin). Insomnia can be quite severe, in fact, with difficulty sleeping more than 3-4 hours a night. --Bone aches--I don't know why this happens, unless it's somehow related to muscle aches. I've seen this with all the statins, but more commonly with Crestor.--Memory impairment--a la Dr. Duane Graveline's wacky book, Lipitor: Thief of Memory. I've seen this with Lipitor, though it's uncommon, and less commonly with simvastatin (Zocor, Vytorin).--Diarrhea--More common with Zetia and Vytorin (which contains Zetia), because of the inhibition of bile acid reabsorption. --Migraine headaches--This I certainly do not understand, but the cause-effect relationship is undoubtedly true in an occasional person. --Low libido--In men more than women, though it may be more due to men being more willing to admit to it. --Increased appetite--Rare, though I've seen dramatic instances. --Tinnitus--Ringing in the ears. I've only seen it with Lipitor and Zocor. In their defense (and in general I am no defender of the drug manufacturers), most people do fine with statin drugs, though the majority do eventually require coenzyme Q10 in my experience. By the way, coenzyme Q10 can be an indispensable aid to help tolerate statin agents. I'd love to hear about your wacky experiences.
Track Your Plaque goes global 21. September 2007 William Davis (3) I don't use this space to toot my horn (at least I don't too often), but we were looking at the listings of our viewers and members. I was surprised to learn that we now have Track Your Plaque followers in 15 different countries around the world!We have members from Europe including England, Ireland, Switzerland, Belgium, and the Czech Republic. We have members from as far away as South Africa, Australia, India, Singapore, Thailand, and China. I see the entire Track Your Plaque process as a grand experiment. Never before in history has a system of health been delivered via a communication medium like the web. The internet provides more interactivity than television, it's more fluid than a book, it's more dynamic and evolves more rapidly than a face-to-face interaction. While we cannot be hands-on over the internet, we can still deliver all the crucial information and, hopefully, the knowledge on how to get it done. Track Your Plaque is part of an even grander experiment: The movement to shift control over health away from the medical system, doctors, and hospitals and back to individuals. When you think about it, the idea that "health" (more acurately sickness) should be managed by people and institutions (e.g., hospitals and insurance companies) outside of the individual is a 20th century concept. I predict that this notion will also become a relic of the 20th century. Someday, we will look back and laugh at the folly of the 20th century style of paternalistic health care. Perhaps it was a necessary step in the sequence to transform health to a better system that returns control to the individual. But it's clearly time for a change. Track Your Plaque is an example of the extraordinary power that can be taken by a lone individual with only minimal assistance of a health care provider. I see Track Your Plaque members who understand heart disease (at least the coronary disease aspect) far better than 95% of my cardiology colleagues, 100% of my internal medicine and family practice colleagues. Physicians maintain a role, but their role has shrunk and receded. They should be facilitators of success in health, educators, a resource to turn to when we need help. It's not that way today. It will be in 50 years. But, right now, we can get started on this wonderfully self-empowering--liberating-- movement by participating in this global experiment known as Track Your Plaque, the program with the goofy name that has the potential to usurp and unravel this enormous institutionalized system of health care the world has created.
Go to your corners 20. September 2007 William Davis (4) There's a heated debate being waged on the Heart Hawk Blog Dr. Melissa Walton-Shirley authored an editorial entitled It Should Be the Right of All Americans to Have Primary Percutaneous-Based Intervention for Acute Coronary Syndrome . Heart Hawk's response: Dr. Walton-Shirley feels the best use of time, talent, and money is to build more cath labs and train more people in how to use them so that IF you have a heart attack, you stand a better chance of being pulled back from the brink of death. Unfortunately, you have to first let people get so sick that they are about to die. My position is to use those same resources to prevent such disasters from happening in the first place. Take your pick. You cannot spend the money twice. I am no stranger to "direct angioplasty," meaning performing immediate coronary angioplasty (with stenting) for heart attack. Since 1990, I have personally performed hundreds, perhaps over a thousand of these procedures, particularly when I was younger and my practice was procedurally-focused. But, after a few years, I quickly recognized the futility of this approach. Yes, you might have aborted a heart attack ,perhaps even saved a life at the brink of death. But wouldn't it have been better to have prevented the entire episode in the first place? In my mind, putting a cath lab on every corner, as Dr. Walton-Shirley suggests, is like having a fire truck on every street to prevent a house from burning down. It's an enormously expensive proposition that provides no incentive to prevent fires. Why not spend the money on preventing the fires? Expanding access to cath lab procedures is putting the fox in the henhouse. Procedures yield money--big money--for hospitals and cardiologists. Guess what happens when you build facilities that exceed the need? Yes--the number of procedures grows, whether or not they were needed.In my view, Dr. Shirley-Walton's opinions are symptomatic of the profit-driven, procedurally-focused quick-fixes that divert money that would be far better spent on effective dissemination of preventive practices.
When niacin doesn't work 20. September 2007 William Davis (7) Dan had the usual collection of metabolic syndrome lipoprotein abnormalities: low HDL of 28 mg/dl, triglycerides 280 mg/dl, 90% of his LDL particles were small. Along with elimination of wheat and junk foods, exercise, and fish oil, I asked Dan to add niacin. I usually ask people to buy SloNiacin and begin at 500 mg per day with dinner, increased to 1000 mg per day at dinner after 4 weeks. Dan came back several months later. His lab results: HDL 40 mg/dl, triglycerides 76 mg/dl. (We didn't repeat the full lipoprotein analysis, so no small LDL value was available.) Better, though still some room for improvement. I urged Dan to stick to his program, lose some more weight off his 260 lb frame, exercise, be strict about the wheat products. Dan returned another few months later. Lab results: HDL 29 mg/dl, triglycerides 130 mg/dl. Dan had lost another 8 lbs and was reasonably compliant with his diet. What's going on here? Why would he backtrack on HDL and triglycerides despite sticking to his program? I asked Dan where he purchased his niacin. "I got it from Sam's Club. The pharmacist said to try this 'no-flush' kind so the hot flush wouldn't bother me."Aha! It's no wonder. "No-flush" niacin, or inositol hexaniacinate, is an outright scam. It has virtually no effect on lipids or lipoproteins in humans. It's therefore no surprise that, by replacing real niacin with the no-flush variety, Dan's blood patterns began to revert back to their original state.Let me be straight on this: No-flush niacin is a scam. It does not work: it does not raise HDL, reduce triglycerides, nor reduce small LDL. It's expensive, too, far more expensive than the real thing. It has no business being sold by stores like Sam's Club or your health food store. SloNiacin (Upsher Smith) has become our preferred preparation. (I obtain no compensation of any sort for saying so.) We buy it at Walgreen's.
Niacin and blood sugar 19. September 2007 William Davis (14) We've been engaging in a conversation on the Track Your Plaque Forum on whether niacin raises blood sugar. Yes, it does. In the vast majority of instances, however, the rise is trivial and without consequence. Typically, someone will start with a borderline elevated blood sugar of, say, 108 mg/dl. Niacin, 1000 mg per day, then raises blood sugar to 112 mg/dl. This small increase does not oblige any specific action, nor does it pose any excess risk. Blood sugars in the normal range of <100 mg/dl tend not to show this effect. Higher blood sugars, e.g., 130 mg/dl, may show a more exagerrated effect but it is also rarely of great consequence. People who take medications for adult type II diabetes, or people with childhood-onset, type I diabetes wil All posts by william-davis Toggle navigation Home Blog Home Archive Join Now Log in Dr. Reinhold Vieth on vitamin D 5. February 2007 William Davis (4) A Track Your Plaque member brough the following webcast to our attention: Prospects for Vitamin D Nutrition which can be found at http://tinyurl.com/f93vlDespite the painfully dull title, the webcast is the best summary of data on the health benefits on vitamin D that I've seen. The presenter is Dr. Reinhold Vieth, who is among the handful of worldwide authorities on vitamin D. In 1999, Dr. Vieth authored the first review to concisely and persuasively argue that vitamin D nutrition was woefully neglected and that its potential for health was enormous. (See Vieth R, Am J Clin Nutr 1999 May;69(5):842-856 at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=10232622&query_hl=1&itool=pubmed_DocSum.) I predict that, after viewing Dr. Vieth's hour-long discussion, you will be as convinced as I am that vitamin D is crucial for health. Unfortunately, Dr. Vieth doesn't delve into the conversation about the potential effects on heart disease, since his audience was primary interested in multiple sclerosis, a disease for which vitamin D replacement promises to have enormous possibilities. Even in 2007, the data suggesting that vitamin D has heart benefits is circumstantial. Nonetheless, from our experience, I am thoroughly convinced that, with replacement to blood levels of vitamin D to 50 ng/ml, heart scan scores drop more readily and faster. If you view Dr. Vieth's wonderful webcast, keep in mind that when he discusses vitamin D blood levels, he's using units of nmol/l, rather than ng/ml. To convert nmol/l to ng/ml, divided by 2.5. For example, 125 nmol/l is the same as 50 ng/ml (125/2.5 = 50). Vitamin D on Good Morning America 1. February 2007 William Davis (9) Positive comments about vitamin D made it to a discussion on Good Morning America today about the new and exciting developments in nutrition and "functional foods".I'm thrilled that the media is conducting these conversations. It sure is making my job easier, not having to persuade patients that taking vitamin D is truly and hugely beneficial for health. I still have to struggle with my colleagues, who tell patients to stop the "poisonous" doses we use.But I worry that many of the details behind vitamin D don't quite make it to the media conversation. These are crucial, make-it-or-break-it issues, such as:--Vitamin D must be vitamin D3 or cholecalciferol, not D2 or ergocalciferol. D2 is virtually worthless. Little or none is converted to the active D3, despite the fact that D2 is the form often added to some foods. --Vitamin D3 supplements must be oil-based capsules, or gelcaps. Tablets are so poorly or erratically absorbed that it's simply not worth the effort. (We get ours from the Vitamin Shoppe.)--The dose should be sufficient to eliminate the phenemena of deficiency, which is around 50 ng/ml. I take 6000 units per day. Dr. John Cannell of www.vitamindcouncil.com takes 5000 units per day. I give my wife 2000 units per day (she's not as deficient as I was), each of my kids 1000 units per day, except for my 180 lb. 15 year old who takes 2000 units. I fear that, when people hear that vitamin D packs fabulous effects for health, they will take a 400 unit tablet--nothing will happen. They will not obtain the benefits such as reduction of blood pressure and blood sugar; increased bone density, reduction of arthritis, dramatic reduction in risk for fractures; reduction in risk for colon, prostate, and breast cancer; reduction in risk for multiple sclerosis; reduction in inflammatory processes such as those evidenced by C-reactive protein; and facilitation of reduction of heart scan score. Would you bet your life on chelation? 31. January 2007 William Davis (1) Hugh's heart scan score was 1751, an awful score. Recall that, at this level of scoring, Hugh's heart attack and death risk is 25% per year. Obviously, serious efforts need to be taken. In this situation, much as I despise drug companies and what they represent and their heavy-handed ways, I'm more inclined to resort directly to prescription agents, as well as our nutritional supplements and other strategies. The price of dilly-dallying could be his death. Hugh and his wife asked about chelation. Now, there are five studies I'm aware of that have tried to examine the value of chelation. None showed any measurable benefit, though all were rather weak in design and small in number of participants. One study, for instance, looked at whether anginal chest pains were provoked any later after chelation. Another looked at whether calf claudication, or calf cramping while walking due to artery blockages in the leg arteries, was delayed on treadmill testing after chelation. No benefit was observed: no delay in provocation of angina, no delay in provocation of claudication. However, the adherents of chelation have been vehement enough that the NIH has funded a large, multi-center study to settle the question once and for all. Best I can tell, the study has not been contaminated by any drug company involvement. It is meant to be an unbiased, objective study of whether chelation has any value. My personal experience in patients who underwent chelation is that, despite spending hundreds or thousands of dollars, plaque grew at the expected rate--no effect at all. None of this constitutes proof of efficacy nor proof of lack of efficacy. We will need to await the NIH trial to have better information. Should Hugh bet his life on chelation? I advised him strongly against it. At this point, the only reason I can see to pursue chelation would be faith--that is, expectation based not on fact, but on hope. The powerful forces preserving the status quo 31. January 2007 William Davis (1) An interesting quote from the book, Critical Condition: How health care in American became big business--and bad medicine: Politics and ProfitsTo protect its interests and expand its influence, the health care industrial complex has done what all successful special interests do: It's become a big donor and a high-powered lobby in Washington. In the last fifteen years, HMOs, insurers, pharmacuetical companies, hospital corporations, physicians, and other segments of the industry contributed $479 million to political campaigns--more than the energy industry ($315 million), commercial banks ($133 million), and big tobacco ($52 million). More telling is how much the health care industry spends on lobbying. It invests more than any other industry except one, according to the nonpartiisan Center for Responsive Politics. From 1997 to 2000, the most recent year for which complete data is available, the industry spent $734 million lobbying Congress and the executive branch. Only the finance, insurance, and real estate lobby exceeded that amount in the same period, with a ttoal of $823 million. In contrast, the defense industry spent $211 million--less than one-third of the health care expenditure. These telling statistics indicate just how vigorously profit-seeking forces in heart care are trying to preserve the status quo. Hospitals want to protect their valuable procedure-driven enterprise, the pharmaceutical industry wants to protect its enormous though little-known niche of procedure-based medications (like $1200 a dose ReoPro), and the medical device industry wants to maintain the multi-billion dollar-generating machine aided and abetted by the FDA's 501k rule (that makes entry to market a breeze). The current procedure based formula for heart disease profits so many and they are desperate to preserve it. Resistance to the deep-pocketed efforts of industry and hospitals will come from people like you and me, trying to propagate a better way. Remember: hospital procedures for coronary disease represent the failure of prevention. They are not--any longer--successes in and of themselves. Read a scathing insight into some of these practices by reading investigative journalists' Donald Barlett and James Steele's book, Critical Condition. I found their descriptions painfully accurate. (But don't get too angry! Remember: only optimists reverse their plaque! We need to turn the conversation in a positive direction, not just in this Blog or the Track Your Plaque website, but nationwide.) One of the new missions for the www.cureality.com website is to help you understand just how powerful, insidious, shrewd, and pervasive the efforts to maintain the current system truly are. Do stents prevent reversal? 27. January 2007 William Davis (3) I've seen this phenomenon several times now: A highly-motivated Track Your Plaque participant with a stent in one artery will do all the right things--lose weight, achieve 60:60:60 in basic lipids, identify and correct hidden lipoprotein disorders, take fish oil, correct vitamin D, etc.Follow-up heart scan shows dramatic reduction in scoring in the two arteries without stents--30% per artery. But the artery with the stent will show marked increase in scoring above and/or below the stent. (It's impossible to tell what happens in or around the stent itself from a calcium scoring standpoint, since steel looks just like calcium on a CT heart scan.) In other words, there is marked plaque growth in the vicinity of the stent, despite the fact that dramatic reversal of atherosclerosis has occurred in other arteries without stents. Should we take this to mean that a stent destroys the opportunity for atherosclerotic plaque reversal in the stented artery? I don't know, but I fear this may be true. What dangers does this different sort of plaque pose? Is it the result of the injury imposed at time of stent implantation, some modification of flow or biologic responses as a result of the presence of the stent? These are all unanswered questions. But I believe that it is yet another suggestive piece of evidence that the best stent is no stent at all. At what score should I have a heart cath? 25. January 2007 William Davis (0) This question comes up frequently: At what specific heart scan score should a heart catheterization be performed? In other words, is there a specific cut-off that automatically triggers a need for catheterization? In my view, there is no such score. We can't say, for instance, that everybody with a score above 1000 should have a catheterization. It is true that the higher your score, the greater the likelihood of a plaque blocking flow. A score of 1000 carries an approximately 25-30% likelihood of reduced blood flow sufficient to consider a stent or bypass. This can nearly always be settled with a stress test. Recall that, despite their pitfalls for uncovering hidden heart disease in the first place, stress tests are useful as gauges of coronary blood flow. But even a score of 1000 carries a 70-75% likelihood that a procedure will not be necesary. This is too high to justify doing heart catheterizations willy-nilly. Unfortunately, some my colleagues will say that any heart scan score justifies a heart cath. I believe this is absolutely, unquestionably, and inexcusably wrong. More often than not, this attitude is borne out of ignorance, laziness, or a desire for profit. Does every lump or bump justify surgery, radiation, and chemotherapy on the chance it could represent cancer? Of course not. There is indeed a time and place for these things, but judgment is involved. In my view, no heart scan score should autmatically prompt a major heart procedure like heart catheterization in a person without symptoms. Niacin makes NY Times 24. January 2007 William Davis (0) In the wake of the crash and burn of Pfizer's torcetrapib, media attention has turned up the miracles of . . .good old niacin. The NY Times carried a well-written
Dr. Reinhold Vieth on vitamin D 5. February 2007 William Davis (4) A Track Your Plaque member brough the following webcast to our attention: Prospects for Vitamin D Nutrition which can be found at http://tinyurl.com/f93vlDespite the painfully dull title, the webcast is the best summary of data on the health benefits on vitamin D that I've seen. The presenter is Dr. Reinhold Vieth, who is among the handful of worldwide authorities on vitamin D. In 1999, Dr. Vieth authored the first review to concisely and persuasively argue that vitamin D nutrition was woefully neglected and that its potential for health was enormous. (See Vieth R, Am J Clin Nutr 1999 May;69(5):842-856 at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=10232622&query_hl=1&itool=pubmed_DocSum.) I predict that, after viewing Dr. Vieth's hour-long discussion, you will be as convinced as I am that vitamin D is crucial for health. Unfortunately, Dr. Vieth doesn't delve into the conversation about the potential effects on heart disease, since his audience was primary interested in multiple sclerosis, a disease for which vitamin D replacement promises to have enormous possibilities. Even in 2007, the data suggesting that vitamin D has heart benefits is circumstantial. Nonetheless, from our experience, I am thoroughly convinced that, with replacement to blood levels of vitamin D to 50 ng/ml, heart scan scores drop more readily and faster. If you view Dr. Vieth's wonderful webcast, keep in mind that when he discusses vitamin D blood levels, he's using units of nmol/l, rather than ng/ml. To convert nmol/l to ng/ml, divided by 2.5. For example, 125 nmol/l is the same as 50 ng/ml (125/2.5 = 50).
Vitamin D on Good Morning America 1. February 2007 William Davis (9) Positive comments about vitamin D made it to a discussion on Good Morning America today about the new and exciting developments in nutrition and "functional foods".I'm thrilled that the media is conducting these conversations. It sure is making my job easier, not having to persuade patients that taking vitamin D is truly and hugely beneficial for health. I still have to struggle with my colleagues, who tell patients to stop the "poisonous" doses we use.But I worry that many of the details behind vitamin D don't quite make it to the media conversation. These are crucial, make-it-or-break-it issues, such as:--Vitamin D must be vitamin D3 or cholecalciferol, not D2 or ergocalciferol. D2 is virtually worthless. Little or none is converted to the active D3, despite the fact that D2 is the form often added to some foods. --Vitamin D3 supplements must be oil-based capsules, or gelcaps. Tablets are so poorly or erratically absorbed that it's simply not worth the effort. (We get ours from the Vitamin Shoppe.)--The dose should be sufficient to eliminate the phenemena of deficiency, which is around 50 ng/ml. I take 6000 units per day. Dr. John Cannell of www.vitamindcouncil.com takes 5000 units per day. I give my wife 2000 units per day (she's not as deficient as I was), each of my kids 1000 units per day, except for my 180 lb. 15 year old who takes 2000 units. I fear that, when people hear that vitamin D packs fabulous effects for health, they will take a 400 unit tablet--nothing will happen. They will not obtain the benefits such as reduction of blood pressure and blood sugar; increased bone density, reduction of arthritis, dramatic reduction in risk for fractures; reduction in risk for colon, prostate, and breast cancer; reduction in risk for multiple sclerosis; reduction in inflammatory processes such as those evidenced by C-reactive protein; and facilitation of reduction of heart scan score.
Would you bet your life on chelation? 31. January 2007 William Davis (1) Hugh's heart scan score was 1751, an awful score. Recall that, at this level of scoring, Hugh's heart attack and death risk is 25% per year. Obviously, serious efforts need to be taken. In this situation, much as I despise drug companies and what they represent and their heavy-handed ways, I'm more inclined to resort directly to prescription agents, as well as our nutritional supplements and other strategies. The price of dilly-dallying could be his death. Hugh and his wife asked about chelation. Now, there are five studies I'm aware of that have tried to examine the value of chelation. None showed any measurable benefit, though all were rather weak in design and small in number of participants. One study, for instance, looked at whether anginal chest pains were provoked any later after chelation. Another looked at whether calf claudication, or calf cramping while walking due to artery blockages in the leg arteries, was delayed on treadmill testing after chelation. No benefit was observed: no delay in provocation of angina, no delay in provocation of claudication. However, the adherents of chelation have been vehement enough that the NIH has funded a large, multi-center study to settle the question once and for all. Best I can tell, the study has not been contaminated by any drug company involvement. It is meant to be an unbiased, objective study of whether chelation has any value. My personal experience in patients who underwent chelation is that, despite spending hundreds or thousands of dollars, plaque grew at the expected rate--no effect at all. None of this constitutes proof of efficacy nor proof of lack of efficacy. We will need to await the NIH trial to have better information. Should Hugh bet his life on chelation? I advised him strongly against it. At this point, the only reason I can see to pursue chelation would be faith--that is, expectation based not on fact, but on hope.
The powerful forces preserving the status quo 31. January 2007 William Davis (1) An interesting quote from the book, Critical Condition: How health care in American became big business--and bad medicine: Politics and ProfitsTo protect its interests and expand its influence, the health care industrial complex has done what all successful special interests do: It's become a big donor and a high-powered lobby in Washington. In the last fifteen years, HMOs, insurers, pharmacuetical companies, hospital corporations, physicians, and other segments of the industry contributed $479 million to political campaigns--more than the energy industry ($315 million), commercial banks ($133 million), and big tobacco ($52 million). More telling is how much the health care industry spends on lobbying. It invests more than any other industry except one, according to the nonpartiisan Center for Responsive Politics. From 1997 to 2000, the most recent year for which complete data is available, the industry spent $734 million lobbying Congress and the executive branch. Only the finance, insurance, and real estate lobby exceeded that amount in the same period, with a ttoal of $823 million. In contrast, the defense industry spent $211 million--less than one-third of the health care expenditure. These telling statistics indicate just how vigorously profit-seeking forces in heart care are trying to preserve the status quo. Hospitals want to protect their valuable procedure-driven enterprise, the pharmaceutical industry wants to protect its enormous though little-known niche of procedure-based medications (like $1200 a dose ReoPro), and the medical device industry wants to maintain the multi-billion dollar-generating machine aided and abetted by the FDA's 501k rule (that makes entry to market a breeze). The current procedure based formula for heart disease profits so many and they are desperate to preserve it. Resistance to the deep-pocketed efforts of industry and hospitals will come from people like you and me, trying to propagate a better way. Remember: hospital procedures for coronary disease represent the failure of prevention. They are not--any longer--successes in and of themselves. Read a scathing insight into some of these practices by reading investigative journalists' Donald Barlett and James Steele's book, Critical Condition. I found their descriptions painfully accurate. (But don't get too angry! Remember: only optimists reverse their plaque! We need to turn the conversation in a positive direction, not just in this Blog or the Track Your Plaque website, but nationwide.) One of the new missions for the www.cureality.com website is to help you understand just how powerful, insidious, shrewd, and pervasive the efforts to maintain the current system truly are.
Do stents prevent reversal? 27. January 2007 William Davis (3) I've seen this phenomenon several times now: A highly-motivated Track Your Plaque participant with a stent in one artery will do all the right things--lose weight, achieve 60:60:60 in basic lipids, identify and correct hidden lipoprotein disorders, take fish oil, correct vitamin D, etc.Follow-up heart scan shows dramatic reduction in scoring in the two arteries without stents--30% per artery. But the artery with the stent will show marked increase in scoring above and/or below the stent. (It's impossible to tell what happens in or around the stent itself from a calcium scoring standpoint, since steel looks just like calcium on a CT heart scan.) In other words, there is marked plaque growth in the vicinity of the stent, despite the fact that dramatic reversal of atherosclerosis has occurred in other arteries without stents. Should we take this to mean that a stent destroys the opportunity for atherosclerotic plaque reversal in the stented artery? I don't know, but I fear this may be true. What dangers does this different sort of plaque pose? Is it the result of the injury imposed at time of stent implantation, some modification of flow or biologic responses as a result of the presence of the stent? These are all unanswered questions. But I believe that it is yet another suggestive piece of evidence that the best stent is no stent at all.
At what score should I have a heart cath? 25. January 2007 William Davis (0) This question comes up frequently: At what specific heart scan score should a heart catheterization be performed? In other words, is there a specific cut-off that automatically triggers a need for catheterization? In my view, there is no such score. We can't say, for instance, that everybody with a score above 1000 should have a catheterization. It is true that the higher your score, the greater the likelihood of a plaque blocking flow. A score of 1000 carries an approximately 25-30% likelihood of reduced blood flow sufficient to consider a stent or bypass. This can nearly always be settled with a stress test. Recall that, despite their pitfalls for uncovering hidden heart disease in the first place, stress tests are useful as gauges of coronary blood flow. But even a score of 1000 carries a 70-75% likelihood that a procedure will not be necesary. This is too high to justify doing heart catheterizations willy-nilly. Unfortunately, some my colleagues will say that any heart scan score justifies a heart cath. I believe this is absolutely, unquestionably, and inexcusably wrong. More often than not, this attitude is borne out of ignorance, laziness, or a desire for profit. Does every lump or bump justify surgery, radiation, and chemotherapy on the chance it could represent cancer? Of course not. There is indeed a time and place for these things, but judgment is involved. In my view, no heart scan score should autmatically prompt a major heart procedure like heart catheterization in a person without symptoms.
Niacin makes NY Times 24. January 2007 William Davis (0) In the wake of the crash and burn of Pfizer's torcetrapib, media attention has turned up the miracles of . . .good old niacin. The NY Times carried a well-written