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The International Herald Tribune carried two medical reports that
surprised me and that may have also astounded, if not upset, many
others.
The first was an op-ed piece by Gary Taubes with
the title, “What’s cholesterol got to do with it?” in the Feb.
6 issue.
The second appeared on Feb. 8 as a news report
by Gina Kolata under the headline “New study on diabetes is
stunning doctors.”
The cholesterol hypothesis, accepted almost as
dogma in medical circles, was put to question when the results of
the clinical trials of a drug called Vytorin that’s intended to
replace cholesterol-lowering drugs that are currently in use were
released.
Taubes argued that LDL (low density lipoprotein)
cholesterol as a cause of heart attacks has not been tested
rigorously. The assumption that it does is “based on a
longstanding conceptual error” that conflated cholesterol with
lipoprotein, the molecule that carries cholesterol in the
bloodstream.
He accused doctors and medical researchers of
using “circular logic” to evade the question of whether LDL
cholesterol, the so-called bad cholesterol, was really a cause of
heart disease. No research, beginning in the 1950s, has
“generate[d] compelling evidence” that saturated fat in the diet
causes heart disease.
Statin drugs lower LDL cholesterol; therefore,
they prevent heart attacks. This cause and effect relationship,
although unproven, was accepted with such conviction by the US Food
and Drug Administration that it routinely approved drugs
“solely” on the claim that they lowered LDL cholesterol.
The methodology of a clinical trial is arcane.
Laypersons like myself are not competent to comment on its
procedure, let alone its findings. We’ve to accept, almost on
faith, its integrity.
This being said, the questions that we want
answered are: does LDL cholesterol cause heart disease? If it’s
not the primary cause, what is?
The news report by Gina Kolata is equally
startling. Those of us who are Type II diabetics go to extraordinary
lengths to lower our blood sugar. Weight control, regular exercise,
diet, pills to protect the kidney and keep blood pressure below
certain values, daily blood sugar measurement are part of our
routine. The goal—to bring blood glucose down to the lowest
possible level.
It would now seem that this is a dangerous. A
10-year study in the US of “more than 10,000 middle-aged and older
people with Type 2 diabetes, [found that] lowering blood sugar
actually increased their risk of death.”
Kolata was quick to say that lowering blood
sugar was not unhelpful. It protected against kidney
disease, blindness and amputation.
Doctors, as the headline puts it, were stunned.
The president of the American College of Cardiology, Dr. James Dove,
said: “It’s confusing and disturbing. For 50 years, we’ve
talked about getting blood sugar very low. Everything in the
literature would suggest that this is the right thing to do.”
Like the cholesterol hypothesis, the
low-blood-sugar hypothesis was assumed even though it had not been
tested rigorously.
If this finding is more than an statistical
outcome, then obviously more research is needed. However, in the
meantime, Type II diabetics are well-advised to talk to their
endocrinologists and for the endocrinologists to keep abreast of the
research on the subject in order that they might give their patients
the best possible information in the face of uncertainty.
My aim in calling attention to current research
on cholesterol and diabetes is not to alarm nor to encourage
patients to take matters into their own hands but to be scientific
in their outlook. These findings are preliminary; they only indicate
directions for further investigation.
Heart disease and diabetes, according to the
Department of Health (DOH), are now among the leading causes of
death in the Philippines. As a public health issue, the DOH has an
obligation to follow closely the work of researchers in the US and
to issue timely advisories to their constituents.
Both diseases are among the most expensive to
manage. I’ve not been able to get the actual numbers, but my rough
estimate is that we spend almost P10 billion a year for pills alone.
Insurance companies have also to be alert to
these developments. For example, should very low blood sugar be
factored in actuarial tables?
Since the Congress is about to pass the Cheaper
Medicine Bill, shouldn’t we have another look at it to see if it
has the flexibility to respond to possible changes in the management
of and medication for these ailments?
Finally, the mass media have an obligation to
inform the general public without being alarmist or simplistic.
There are public health issues other than SARS, bird flu and
HIV/AIDS that deserve to be covered regularly by newspapers, radio
and television. Heart disease and diabetes are among them.
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