NY Times Jane Brody misses the mark



NY Times' health columnist, Jane Brody, recently wrote a bit of fluff for her paper:

"CT Scans of the Heart Come With Trade-Offs


In her report, she says:

Coronary CT scans are being sold directly to the public, and they have found a market in health-conscious people who can afford them. But screening exams can have downsides. They can cause needless worry, and they sometimes reveal other potential conditions that require invasive procedures like biopsies to diagnose.

I soon learned that among the strongest proponents of CT scans of coronary arteries were physicians with financial ties to drug companies that make statins and others connected to imaging centers that would profit directly from widespread CT screenings.



She then goes on to discuss how the Framingham scoring calculation can tell you whether or not you are at low-, intermediate-, or high-risk for heart disease. She therefore concludes that heart scans are therefore irrelevant for the majority of people. She then proceeds to take a statin agent.

This sort of nonsense continues to get published, despite the clear lack of real "digging" for the truth. She clearly fell for the conventional arguments that continue to mis-guide the majority of people, myths like:

--the Framingham scoring system is reliable--Reliable it is NOT; it is susceptible to substantial "misclassification" bias, meaning people who appear low risk can actually be high risk, and people at high risk can actually be low risk. Among the latest studies that question the scoring system is Family history of premature coronary heart disease and coronary artery calcification: Multi-Ethnic Study of Atherosclerosis (MESA). This study pointed out how the Framingham scoring system, which leaves out family history, can cause people classified as low risk to actually have substantial heart scan scores. This is crucial. A heart scan gets beyond the uncertainties and shows with >95% certainty whether or not hidden coronary atherosclerotic plaque is present.

--"Coronary risk" is a dynammic phenomenon, subject to changes in a person's life. What if, for instance, a person smoked for 20 years, quit 10 years ago, lost 30 lbs, dropped their blood pressure as a result of the weight loss, then relied on the Framingham Risk Calculator to determine risk. They would likely be classified as low- risk, since risk factors now appear favorable. This person could easily have a heart scan score of 500, or 700, or 1000, levels that carry a cardiovascular event risk of 5-25% per year, hardly low-risk, because much of their risk accumulated earlier in life and is no longer revealed by an assessment of risk factors.

--There are sources of risk that have nothing to do with Framingham, such as lipoprotein(a), which is often revealed by family history; the presence of small LDL, which co-varies with HDL and triglycerides, but can behave independently also; and, my favorite, deficiency of vitamin D. This would explain part of the 60-70% of people who are typically mis-classified by Framingham.


Where did Ms. Brody get the idea that proponents of heart scans had ties to drug companies? I think she's barking up the wrong tree on that one. Of course, she ends up on a statin drug. For my part, I am a critic of statin drugs. Yes, they play a role, but they are miserably misused and abused by practicing physicians, based on the endless onslaught of drug company-sponsored trials that have served to distort their usefulness.

If I were Ms. Brody, I would be quaking in my shoes, not knowing what my true risk for heart disease was, relying on the--at best--30% reduction in heart attack risk of Lipitor or other statin drug. Ms. Brody: You are not cured, you're simply wearing a superficial Band-Aid. If you want to know your true risk for heart attack, and you want a precise value that you can track over time, the answer is simple: Reject the conventional notion and get a heart scan.

Comments (6) -

  • russb324

    10/9/2007 1:02:00 PM |

    However, John Tierney wrote an interesting column in the same issue of the NY Times in which he expressed skepticism about the AMA's recommendation of low fat diets based on what socialists called a "cascade" effect thus causing a mistaken consensus.  He also favorably cited to Gary Taubes book "Good Calories, Bad Calories" while acknowledging that Mr. Taubes' hypothesis regarding low carb, higher fat diets are only theories as there have not been rigorous scientific studies to prove or debunk these theories.  Article is definitely worth a read:

    http://www.nytimes.com/2007/10/09/science/09tier.html?_r=1&oref=slogin

  • Anonymous

    10/9/2007 7:33:00 PM |

    I've just found your website and I'm extremely interested.  My doctor said my LDL was 565.  I'm starting a study at the cooper institute next month.  But in the meantime I don't want to die of heart disease like my doctor said I would if I don't change my diet.  What diet should I follow?  Is there a site that you recommend with a diet on it that doesn't ask for payment?

  • Dr. Davis

    10/9/2007 8:04:00 PM |

    I'm afraid with hetero- or homozygous hypercholesterolemia (to account for such high LDL's), this information needs to come from your doctor.

    Also, if you are entering a clinical trial at the Coooper Clinic (an excellent facility), they may ask you to follow a specific diet program.

  • Anonymous

    10/9/2007 9:17:00 PM |

    from dan.
    The Framingham scoring system shows
    potential 'risk' (maybe), whereas the CT scan shows the "actual" condition of the heart. I think there is a huge difference between showing a risk and what is real. If you have a gun in your hand you are potentially a murder, that is a long way from murdering someone. One is a possiblity, whereas the CT scan shows was exist - right now.

  • Dr. Davis

    10/9/2007 9:37:00 PM |

    Thanks, Dan.

    I couldn't have said it better myself.

  • Anonymous

    10/20/2007 11:48:00 PM |

    Hello Dr. Davis, and anonymous

    Have you seen the article by Drs James Wright and John Abramson  published in a recent Lancet? Perhaps Dr. Davis will post a summary.





    Anon2

Loading
Vitamin D as a cardiovascular risk factor gains ground

Vitamin D as a cardiovascular risk factor gains ground

If you were reading The Heart Scan Blog back in 2007, or read my Life Extension article on vitamin D deficiency as a cardiovascular risk factor, you already knew that vitamin D deficiency is rampant and adds to cardiovascular risk.

Results of a study from the Intermountain Medical Center Heart Institute in Utah bolster the concept that vitamin D deficiency is a cardiovascular risk factor, vitamin D normalization/supplementation reduces cardiovascular risk.

Science Daily reported:

For the first study, researchers followed two groups of patients for an average of one year each. In the first study group, over 9,400 patients, mostly female, reported low initial vitamin D levels, and had at least one follow up exam during that time period. Researchers found that 47 percent of the patients who increased their levels of vitamin D between the two visits showed a reduced risk for cardiovascular disease.


In the second study, researchers placed over 31,000 patients into three categories based on their levels of vitamin D. The patients in each category who increased their vitamin D levels to 43 nanograms per milliliter of blood or higher had lower rates of death, diabetes, cardiovascular disease, myocardial infarction, heart failure, high blood pressure, depression, and kidney failure. Currently, a level of 30 nanograms per milliliter is considered "normal."


Over the past 4 years, people in our program have been enjoying the extravagant benefits of vitamin D restoration. Cardiovascular benefits are becoming better documented and the bone health, cancer-preventing, insulin-normalizing, mood-adjusting, and anti-inflammatory effects likewise.
Loading
Wheat Belly coming to bookstores!

Wheat Belly coming to bookstores!

Anyone following the conversations on these pages know that I have some very serious concerns about this thing being sold to us called "wheat"--cause it ain't wheat! It is the result of incredible genetics shenanigans inflicted on this plant, mostly in the name of increased yield per acre.



I now classify wheat as "Public Enemy #1," the prime nutritional culprit underlying obesity, heart disease, "cholesterol" abnormalities, hypertension, arthritis, psychiatric illness, and on and on. Once you read the full story, I believe that you will agree: Modern Triticum aestivum, the plant that now serves as the source for virtually all the wheat flour products now consumed--organic, whole grain, multigrain, sprouted . . . it makes no difference--does not belong in the human diet. So many people, searching for solutions for their fatigue, weight gain, leg edema, incurable rashes, joint pain, etc., will find their answers here.

Wheat Belly: Lose the wheat, lose the weight and find your path back to health will be on bookstore shelves including Barnes and Noble August 30, 2011 or is available for preorder here at Amazon. Wheat Belly will also be available as a downloadable Kindle book and as unabridged audio CDs.

You can also follow the Wheat Belly conversations on my Wheat Belly Blog. One of my recent posts discusses the herbicide-resistant semi-dwarf wheat strain, Clearfield, that is now making its way to more and more supermarket shelves.

You'll also find more conversation on the Wheat Belly Facebook pages.

Comments (18) -

  • Jana Miller

    7/31/2011 5:47:19 PM |

    Congratulations...thanks for all you do to educate and inform us about wheat!!
    all the best,
    jana

  • BJ

    7/31/2011 5:55:00 PM |

    The date of the book arrival must be incorrect?  2001?
    I am anxious to read this one!

  • Lori

    7/31/2011 6:05:42 PM |

    I've pre-ordered Wheat Belly and look forward to reading it.

    I'm enjoying my second summer free of hay fever--coincidentally, the first summer was right after I eliminated wheat from my diet. Hurray!

  • Princess Dieter

    7/31/2011 6:39:26 PM |

    Will it be a Nook book? I love my Nook! And I've got Mercola's No Grain diet, some Primal/Paleo books on there already. Would love to have yours, too. Thanks.

  • Princess Dieter

    7/31/2011 6:40:47 PM |

    OMG, I just read Lori's comment, and realize that I've been less asthmatic/allergenic this summer since ditching wheat/gluten. I've been able to scale back (stop Nasonex and cut back on inhaled steroid dosage, even) .  August-September is the worse, runny-nose-wise, so I'll get to observe and see. Hm.

  • Diana

    8/1/2011 12:34:08 AM |

    Congrats on the book! Can't wait to read it!
    Continuing on a comment above, I too have had no seasonal allergies since doing a diet which is wheat-free. Have you ever covered this topic in your blog, or could you in the future?

  • Might-o'chondri-AL

    8/1/2011 9:52:09 AM |

    7 times Sunday/Monday tried to get  just 2 sentence post about ApoE4  in previous thread and got "Server Error", so testing again in this tread ... this lousy server did this before with me.

  • Might-o'chondri-AL

    8/1/2011 10:04:44 AM |

    Anyone still checking this thread want me to continue with some ApoE4 comments here ? I went back to try previous thread and still got "server error" there. I  ask for interest because I myself don't always follow  new thread comments section  - and maybe those with ApoE4 interest are not reading here now.

  • Might-o'chondri-AL

    8/1/2011 5:39:19 PM |

    Just tried to use "reply" box of  Dr. K.'s comment on previous ApoE4 thread  to contribute and got "Server Error";
    let's see if I am still welcomed on this thread by the server....

  • Melinda

    8/1/2011 8:13:42 PM |

    Might-o'chondri-al,

    Yes, I would be interested in your replies about ApoE4.  I always read your comments around the web and like many, I wish you had your own blog so I wouldn't miss any of your output.

  • Might-o'chonri-AL

    8/2/2011 12:57:19 AM |

    Hi Melinda,
    Please copy and post this in previous thread for ApoE4 ... .
    Continuation about ApoE4:
    % of ApoE4 messes dynamic inside tissue cell so that ApoB turns to use Scavenger Receptors to try to start cascade which gets signal transducer (Specificity Protein 1) to up-regulate the cell membrane transporter protein ( ABCA1, ATP binding cassette transporter A1) that puts excess cholesterol out from that cell.   I believe this is where Doc Davis' stated ApoB irregularities  add to the problem with ApoE4 (since normal human ApoE3  works all by itself to get that signal transducer to bind to ABCA1 to work shucking cholesterol) . When cholesterol gets to build up inside the cell the large LDL can acetylate and form  excessive "droplets" in that cell's cytoplasm; while the small LDL can oxidize from CuSO4- and load up inside that cell's lysosome.

    Meanwhile % of  ApoE4 doesn't just dock with tissue cell LDL receptors and so the macrophage scavenger receptors pick up too much cholesterol laden ApoB/ApoE lipo-protein carrier molecules. Once in the macrophage the same problem of oxidized LDL piling up  in lysosome and acetylated LDL burdening cytoplasm occurs; and for that matter, in macrophages,  it is down to ApoB to get  the signal transducer going if any cholesterol is to be put out by cell membrane transporter protein ABCA1.  This is the recipe for  risky pro-atherogenic  "foam cell" formation; while the individual genetics of ApoE, ApoB, assorted receptor types, signal transducer and transport protein all make it hard to predict how ApoE4 plays out.

    Dr. Kruse broaches ApoE4 in alzheimers and this is in large part because ApoE4 causes the brain neurons to  get less than optimal cholesterol from the brain's astrocytes. It is ApoA1 working in HDL complex that controls the astrocyte cholesterol balance and when there is inflammation there is a risk of ApoA1 mis-folding to  foster amyloid aggregations.  Low intact ApoA1 and ApoE4 together increase the risk factor for cognitive problems and dementia several fold.

    Diabetics with ApoE4 have that % of ApoE4 as an  additional  limitation;  however,  irregardless of  the ApoE iso-form diabetic dementia risk arises from their glucose loads impairing kidney tubules, and thus fostering the uremic environment that stymies ApoA1 bio-synthesis. The normal role of ApoA1 is to bind to the transport protein which secures cholesterol into a safe bond with HDL; so low ApoA1 from any factor will  challenge the brain neuron over time. I suggest there are individuals whose age impaired kidneys contribute to senile dementia from impairing ApoA1 levels being made and also possibly speeding up the normal 4-6 days kidney elimination of ApoA1 ; and  so Patri's comment on limitation of high protein intake is relevant due to it's demand on aging  kidneys.

  • Dr. William Davis

    8/2/2011 1:58:16 AM |

    Oooops! Too many zeros and too few ones!
    Yes, indeed, 2011. Thanks, BJ.

  • Dr. William Davis

    8/2/2011 1:59:11 AM |

    Hi, Lori-
    I personally experienced the very same effect.
    I remember days in which my eyes were swollen shut, sinuses achingly closed, wheezing. All now a distant memory!

  • Dr. William Davis

    8/2/2011 2:00:39 AM |

    Yes, great idea, Diana. I'll cover that topic, though likely more appropriate for the Wheat Belly Blog.
    I will likely mirror this post in both blogs. It affects a LOT of people.

  • Dr. William Davis

    8/2/2011 2:02:19 AM |

    Hi, Might--
    Sorry for all the posting struggles. I'm still working with working out the kinks.
    The changes here are occuring with some back room changes in database software, etc., that is making for more than the usual headaches.
    Please don't give up in frustration. Your comments are truly valued.

  • MJ Klein

    8/2/2011 2:07:31 AM |

    is this primarily a US problem?

  • Might-o'chonri-AL

    8/2/2011 5:25:41 AM |

    Hi MJ,
    ApoE4 =  14-19% Germans & Finns and  7-12% Italians & French
    ApoE3 = +/- 60% of people
    ApoE2 = 3-4% Japanese, Finns & Nigerians and 2-4 % Mexican Americans & American Indians

  • Stella

    11/11/2011 10:55:36 AM |

    Just wondered if you were aware that for several days now (all this week, for sure) Amazon UK has been displaying the following message on the Wheat Belly page:

    "Item Under Review
    This product is not currently offered by Amazon.co.uk because a customer recently told us that the item he or she received was not as described.
    We are working to resolve this as quickly as possible. In the meantime, you may still find this product available from other sellers on this page."

    Maybe they were expecting bagel recipes? There is no explanation, and the three accompanying reader reviews are all 5*

Loading