Kerry D Friesen, M.D.

I’ll See You In Health! Stephen Colbert Rebuts Ridiculous Crestor Claim

Posted on 19. Oct, 2009 by Kerry D Friesen, M.D..

Not For Everyone!

OZ: THE LAND OF INFINITE MEDICAL ANSWERS
(THAT DOESN’T EXIST)

What does it mean when Comedy Central becomes the voice of reason in all things medical?

Only that when you get to the Emerald City and pull back the curtain and discover the Wizard of Oz is really the Wizard of Biz and incapable of solving all of your problems (but more than willing to take your money), you have finally reached the realm of medical realism rather than some pharmaceutical fantasy land.

Despite all the media hype and medical experts claiming otherwise, the so-called pleiotropic effects of statins are not sufficient to cure cancer, Alzheimer’s disease, osteoporosis, multiple sclerosis, rheumatoid arthritis, lupus, aortic stenosis, cardiac myocyte hypertrophy or any other “trophy” for that matter.

Off-label applications excluded, all HMG-CoA reductase inhibitors, in other words, “statins” are effective at lowering LDL cholesterol and raising HDL cholesterol (minimally)—but that’s it.

PHARMACEUTICAL FAIRY TALES

The AstraZeneca claims for Crestor however have to do with the inherent anti-inflammatory property of some statins.

Both vascular and neuro-inflammation are in fact critical risk-factors for cardiovascular and neurodegenerative disease. However, to suggest that everyone would benefit from taking Crestor is bad science and crass commerce.

There are better ways to reduce vascular inflammation. Taking a prescription medicine would be last on my list. A diet rich in polyphenols supplemented with multiple natural anti-inflammatory agents, including astaxanthin would be my preference.

In a Wall Street Journal interview, AstraZeneca CEO David Brennan downplayed the commercial impact of the Jupiter study while simultaneously suggesting that analyst’s forecasts were “pretty bullish”.

Given our current economy, where will the estimated 10 billion additional health care dollars come from that it would take to implement the plan, enforce compliance and manage the inevitable adverse drug reactions?

And what if the expected health benefits are never realized?

OUR DIRECT-TO-CONSUMER ADVERTISING IDIOCRACY

Pharmaceutical companies spent an estimated $2.5 billion in 2000 on direct to consumer advertising and more than $4 billion in 2005.

In one year, prescriptions written for the 50 most heavily prescribed drugs increased by a whopping 25 percent compared to just 4 percent for all other drugs combined!

While direct-to-consumer advertising is illegal in Canada,it is nearly impossible to enforce.

Meanwhile here in America, pharmaceutical DTC advertising thrives in a virtually unregulated environment, emboldened by PhRMA, the lobbying group of the US drug industry.

THE PAL PROJECT AND THE “BITTER PILL” AWARDS

It has been left to watchdog groups (see PAL—the Prescription Access Litigation Project), to reign in the ridiculous.

For example, in 2006 both AstraZeneca’s Crestor and Pfizer’s Lipitor, received the coveted “Got Cholesterol?” award, given for “overpromoting expensive brand name statins,”.

A total of 5 of the country’s best selling drugs received “Bitter Pill” awards in 2006 for overly agressive and misleading DTC advertising.

That same year, AstraZeneca received a disciplinary letter from the FDA for a DTC advertising campaign claiming Crestor was more effective than other statins.

STEPHEN COLBERT AND THE COLBERT NATION: IS THE DOCTOR OF FINE ARTS IN?

Forget the Mayo brothers, if you need a sound dose of medical realism and a cheap second opinion, head straight to the office of Dr. Stephen T. Colbert DFA.

He may not have the bedside manner of a country doctor, but he at least has his medical facts right.

And except for Prescott Pharmaceuticals, Big Pharma doesn’t own him.

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Inflammation Overload!

Posted on 25. Jan, 2009 by Kerry D Friesen, M.D..

Remember you heard it here first.

There now exists a formidable body of literature linking cardiovascular disease and neurodegenerative disorders. More than ten years ago I found myself lecturing my patients on the not-so- subtle connection between abdominal obesity; insulin resistance; syndrome-X and endothelial-cell dysfunction. With abdominal obesity, fat is progressively packed around internal organs until it literally takes on a life of it’s own. Adipocyte (fat cell) signalling becomes so strong that it becomes the dominant “endocrine” or hormone secreting organ in the body. In the vernacular, all hormonal “hell” breaks loose.

IT’S ALL ABOUT BALANCE

Resistance is futile. You have become one with your fat cells. The delicate yin and yang balance between your immune system and other major organ systems is lost. The cytotoxic and neurotoxic effects of inflammatory mediators like TNF-alpha; peroxynitrite and IL-6 to name a few, reign supreme. Over time, free-radical formation and the subsequent oxidative damage result in irreversible mitochondrial DNA decay and cell death. If the affected cells reside in your brain, then any one of a multitude of neurodegenerative diseases is possible. If they happen to line the vascular endothelium in your heart, then you are well on you way to your first heart attack.

Most people reading this blog will find themselves in between the two extremes. In this “no-mans land” of disease, doctors euphemistlcally tell patients they have a “touch of sugar” (you have frank diabetes) or their blood pressure is a “little elevated” (you’ve been diagnosed with high blood pressure) or your “good cholesterol” (HDL) is a little low (you are at high-risk for heart disease and diabetes). I could go on…

INTERLEUKIN-6 FYI: FOR YOUR INFLAMMATION

As it turns out, the common denominator in the above scenario is inflammation overload. Nothing, not even the micro-circulation of the brain escapes the damaging effects of IL-6 and tumor-necrosis factor-alpha. Atherosclerosis “hardening of the arteries”, impairs blood flow to the already hypermetabolic brain tissue, as a result underperfused neurons respond with ß-amyloid plaque deposition, acetylcholine signaling defects, oxidative stress and more inflammation.

The only known genetic risk factor for Alzheimer’s disease not surprisingly, is a gene that codes for Apolipoprotein E4. Apolipoprotein E in one of its three isoforms, is responsible for the transport of triglyceride, phospholipid, cholesteryl esters, and cholesterol into cells.

Of the three main isoforms of the apo E allele, apoE3 is most common, followed by apoE4 and lastly apoE2. The lifetime risk for Alzheimer’s disease in someone with apoE3 is about 9%. The lifetime risk for Alzheimer’s in someone with the apoE4 allele is a whopping 29%. If you happen to be homozygous for apoE4 (both alleles on paired chromosomes are apoE4) the lifetime risk for Alzheimer’s sky-rockets to 91% by age 80. Apparently the apoE4 allele is so inefficient at cholesterol metabolism within the brain that sulphated galactocerebroside (sulphatide) levels drop. Sulfatide has everything to do with neuronal plasticity, cell growth and repair in addition to normal signal transduction.

How do you know if you possess the apoE4 allele? While various labs offer this test Berkley Heart Lab is consistently the most reliable.

In addition, the one-time Apo E test will help decide whether or not diet will have an effect on elevated cholesterol levels. If you possess the apoE4 isoform without question diet therapy can have dramatic effect on your LDL-C (bad cholesterol) levels. If you have seen your doctor and were told you had elevated LDL-C and have altered your diet without success, then this test is for you.

Here are the five easy steps I recommend for my patients. In this case, I personally take a double dose of my own medicine.

1. Consider Apolipoprotein E testing (ask your doctor)
2. Adopt the Mediterranean diet
3. Increase Omega-3-FA consumption
4. Decrease Omega-6-FA intake (PUFA in the form of vegetable oil)
5. Dramatically increase your intake of dietary polyphenols† (see list below)

PASS THE POLYPHENOLS PLEASE

To put it another way, make a concerted effort to bathe your body’s biochemical milieu daily in a rich blend of phytochemicals. This is the essence of the “French Paradox”, that is, while the French consume much more saturated fat than their North American counterparts, they also consume far less omega-6-FA’s and far more polyphenols (in the form of red wine primarily), and have much less heart disease to show for it. It is precisely when science flies in the face of convention that you know you’re “gettin’ warm”.

†Food sources rich in polyphenols include onion, apple, green-tea, red wine, red grapes, grape juice, strawberries, raspberries, blueberries, cranberries and walnuts to name a few.

Polyphenols can be classified as non-flavonoids and flavonoids. The flavonoids quercetin and catechins are currently the most extensively studied polyphenols.

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Why I Quit Counting Cholesterol: Confessions Of A Medical Heretic

Posted on 24. Jan, 2009 by Kerry D Friesen, M.D..

Kerry D. Friesen, M.D.

The great tragedy of science — the slaying of a beautiful hypothesis by an ugly fact.
–Thomas Henry Huxley

At one time or another we have all held certain beliefs that later turn out to be not true at all.  Most are innocent lies like the tooth fairy or Easter bunny and ultimately no major mental paradigm shift is required to adjust to the “new reality”. ?

You can imagine my surprise to discover while still a D.I.T. (doctor-in-training) that I was being fed a daily diet of less-than scientific—-even downright dangerous information.

Apparently magical-mythical thinking was alive and well, even in the halls of academia.

I discovered this by constantly asking the question “why”?”

“Why give blood products– worse yet—–contaminated blood products to hospitalized patients simply because than their blood count is less than 10 mg/dl”
“Why risk life-threatening anaphylactic reactions by giving platelet transfusions to patients with no clinical or laboratory risk for bleeding”
“Why perform bypass surgery for a known metabolic disease (atherosclerosis), i.e. coronary artery bypass surgery, rather than treat the real cause.

I soon realized that medical science was in fact filled to overflowing, with medical myths.

Another often repeated myth is that bed rest speeds the healing process.

It sounds factual enough.

It even appeals to our “sense-of-the-common” (common sense).

Yet an independent review of 39 different studies confirmed that for many medical conditions strict bed rest was at best not helpful and in many cases harmful.

For that reason I jokingly tell all my elderly patients to “get out of bed”.  Then with as somber a face as I can muster I proclaim, “It is a statistical fact that more people die in bed than out of it”.  Therefore “get out of bed!”

We’ll come back to the intentional use and abuse of “statistical facts” later.

This next one may surprise you.

Almost everyone, doctors included, believe that the following tests have all been shown to improve survival in otherwise healthy people:

Chest X-rays in smokers
Liver function tests
Kidney function tests
Blood glucose levels
Total cholesterol levels
Mammography in women over 40
Ultrasound examination of the ovaries
Bone density in women
Resting EKG
Ultrasound examination of the aorta in men over 55
PSA in men over 50

The truth is there are absolutely no convincing scientific studies that justify the widespread use of these tests in patients without symptoms.

These tests are neither sensitive enough nor specific enough to detect disease and improve survival in healthy people.

In other words, they are just not that accurate.

That doesn’t keep doctors from ordering these tests inappropriately or patients from requesting a multitude of tests to “see if there is cancer anywhere in me”.

Like the song says
Still, a man hears what he wants to hear, and disregards the rest.
–Simon & Garfunkle, The Boxer

Remember while medical science may lessen uncertainty, it can never fully remove it since life, by its very nature is fraught with frailty and uncertainty.

Correlation-Causation Confusion

While “mini-myths” such as the ones above are easily dispelled, the myth of major monolithic proportions that concerns this book has now gone global.

Thanks to the ultra-effective “know your number” ad campaign implemented by the National Cholesterol Education Program and coordinated by the United States National Institutes of Health (NIH), the entire industrialized world is now counting their cholesterol.

But to what end?

While numerous studies have confirmed the close correlation between high cholesterol and heart disease, an even greater number now substantiate the more important role of multiple non-traditional risk factors.

To assume that cholesterol is the cause of coronary artery disease simply because people with heart disease happen to have elevated cholesterol is just one more example of correlation-causation confusion!

Scientists, statisticians, and now even the creators of a popular animated sit-com recognize that just because event A occurs before outcome B, event A did not necessarily cause outcome B.

A conversation between Homer and Lisa in season seven of the Simpson’s illustrates just how easily we are deceived by this apparent cause-and-effect relationship.

Here is how it played out——a single bear sighting prompted the worried residents of Springfield to spend millions on a “Bear Patrol”

Homer: Not a bear in sight. The “Bear Patrol” is working like a charm!
Lisa: That’s specious reasoning, Dad.
Homer: [uncomprehendingly] Thanks honey.
Lisa: By your logic, I could claim that this rock keeps tigers away.
Homer: Hmm. How does it work?
Lisa: It doesn’t work. (Pause) It’s just a stupid rock!
Homer: Uh-huh.
Lisa: But I don’t see any tigers around, do you?
Homer: (pause) Lisa, I want to buy your rock.

Pharmaceutical Fairy Tales

Besides correlation-causation confusion, errors in deductive reasoning abound.  You may not know what to call it, but you will certainly recognize it when you “see” it.

For example, cholesterol drug ads claim a 25% reduction in heart attack risk.

But before you fill your prescription, always ask yourself,

25% of what?

A 25% reduction means nothing unless you know your personal odds of a heart attack!

Here is another way of looking at it.   Utilizing the Framingham Risk calculator you discover you have a 2% chance of having a heart attack in the next ten years.
The 25% reduction from drug therapy will decrease your risk by

0.25 x 0.02 = 0.005 ———>   2% – 0.5% = 1.5%

A whopping one-half of one percent.

Not much to get excited about.

Keep in mind that a one-half of one-percent reduction in risk comes at the expense of taking that medicine with all its potential for harm for the rest of your life.

Thanks to a never-ending prime-time stream of pharmaceutical fairy tales, you may “Know Your Number” but do you know your vascular biology?

Measuring blood markers of inflammation and calculating oxidative stress levels is every bit as important as knowing your blood pressure and bank account number.

If you still think that the skin is the largest organ in the body, get ready for a database update.

The vascular endothelium—the trillions of cells that line our blood vessels is without question the largest organ in our bodies.  Turn to Chapter __ It’s a Vascular Adventure for how we managed to miss the obvious!

While the quantity of cholesterol present in our bodies may be helpful—quality is clearly more important.

By now almost everyone has heard of so-called ‘good’ (HDL) and ‘bad’ (LDL) cholesterol.

But did you know that there are seven different sub-types of LDL and five different sub-types of HDL?

Only two of the five sub-types of HDL cholesterol are actually “good” and three of the seven sub-types of LDL cholesterol are so damaging to our endothelial cells (see Chapter 7 Pssst! What’s Your Particle Size?) that our  risk for heart disease increases more three-fold!

In reality, new studies exploring the real cause of atherosclerosis and heart disease , reveal a complex, sub-cellular environment of lipid (fat) particles, non-fat metabolic trash (such as homocysteine) and chemical messengers such as nitric oxide, inflammatory mediators, antioxidants and free radicals—-all involved in the delicate balance of maintaining vascular health.
While traditional risk-factors such as cigarette smoking, hypertension, diabetes, and obesity remain important, new data emphasize how chronic low-grade inflammation compounded by a genetic predisposition to premature heart disease contribute to the pathogenesis (cause) of atherosclerosis (hardening of the arteries).

In addition, risk rises exponentially as traditional risk factors are combined with newer risks.
Sometimes it takes turning everything completely upside down in order to get it right.
While so much attention has been focused on the problem, (read LDL cholesterol and the medical-pharmaceutical-industrial complex) a token amount of research has been directed toward the solution—HDL.
Helping you understand HDL and how it reverses heart disease is one of the focal points of this blog.

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Heart Disease: It Doesn’t Have To Happen

Posted on 24. Jan, 2009 by Kerry D Friesen, M.D..

Neurocardiology Comes Of Age

YOU SAY YOU WANT A REVOLUTION?
Once in a great while new scientific information arises that revolutionizes a field of medicine.

THE FRAMINGHAM HEART STUDY

In 1948 in Framingham Massachusetts, 5127 men and women were enrolled in a study that has continued on to the present day. More recently, under the direction of William Castelli, M.D. , Medical Director from 1979 until 1995, careful analysis of the scientific information obtained confirmed the relationship between elevated cholesterol levels and coronary artery (heart) disease.

Since that time, numerous studies have reaffirmed that relationship.

That data, while invaluable, tells only part of a more complex story.

Almost daily, new studies into the cause of atherosclerosis , reveal a complex, sub-cellular environment of fat particles,  metabolic” trash” and inflammatory mediators—-all capable of disrupting the delicate balance required to maintain vascular health.  While traditional risk-factors such as cigarette smoking, hypertension, diabetes and obesity remain important, new data emphasizes the role of inflammation, genetic make-up, low HDL-cholesterol and small-dense LDL cholesterol.

In addition, risk rises as traditional risk factors are combined with newer risks and all of this is just the beginning.

Every 32 seconds someone in North America suffers a heart-attack and despite all that modern medicine has to offer, one-third of those will still die.

Women, by the way, are no exception.

In fact, more women than men die of heart attacks every day.

A better understanding of non-traditional risk factors can change that.

This blog is can help you do it!

To borrow a quote,
“May you live long and prosper”

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