Awhile back, I bookmarked an online press release about a study of LDL levels among heart-attack victims.  Here’s the headline and opening paragraphs:

Most heart attack patients’ cholesterol levels did not indicate cardiac risk

A new national study has shown that nearly 75 percent of patients hospitalized for a heart attack had cholesterol levels that would indicate they were not at high risk for a cardiovascular event, based on current national cholesterol guidelines.

Specifically, these patients had low-density lipoprotein (LDL) cholesterol levels that met current guidelines, and close to half had LDL levels classified in guidelines as optimal (less than 100 mg/dL).

Holy jumpin’ jiminees! I said to myself.  We’re finally going to dump the stupid “high cholesterol causes heart disease” theory!  If nearly 75 percent of the people who suffer heart attacks have “normal” LDL levels and nearly half have “optimal” LDL levels, then it’s obvious to anyone with a functioning brain that high LDL isn’t the problem.

Then I read the next paragraph:

“Almost 75 percent of heart attack patients fell within recommended targets for LDL cholesterol, demonstrating that the current guidelines may not be low enough to cut heart attack risk in most who could benefit,” said Dr. Gregg C. Fonarow, Eliot Corday Professor of Cardiovascular Medicine and Science at the David Geffen School of Medicine at UCLA and the study’s principal investigator.

I read that paragraph a few times and concluded that UCLA was probably conducting a nationwide experiment with a title something like Behavioral Effects of a Press Release Specifically Designed to Inspire Intelligent People to Bang Their Heads Against The Nearest Immovable Object.

After I stopped banging my head on my desk, I kept reading:

While the risk of cardiovascular events increases substantially with LDL levels above 40-60 mg/dL, current national cholesterol guidelines consider LDL levels less than 100-130 mg/dL acceptable for many individuals. The guidelines are thus not effectively identifying the majority of individuals who will develop fatal and non-fatal cardiovascular events, according to the study’s authors.

Fabulous … so now the truly “safe” level of LDL is being pegged at 40-60.  Once we adopt those guidelines, the vast majority of the population will immediately require statins to meet them — which is probably the point.  An article about the study in USA Today certainly reached that conclusion … Boy, we may have to give statins to millions more people than we originally thought!  Although to be fair, the USA Today article included this quote as well:

But UCLA’s Fonarow, whose study was published in the American Heart Journal, says there’s another possibility. “There are two potential implications,” he says. “Either the threshold of what was set as an ideal LDL was set outrageously high, thus allowing the vast majority of patients to be missed, or LDL isn’t much of a risk factor.  It’s got to be one of the two.”

Unfortunately, the doctor seemed to leaning toward the lower-threshold theory.  I was beyond annoyed, but as the aspirin took effect, the swelling went down, and the mental fog cleared, it occurred to me that I’m missing a golden opportunity here:  Instead of complaining about bad science, I should learn to use it to my advantage.  All I’d have to do is identify the bad-science protocol and use it to build a theory that suits me.  So I thought about the “cholesterol kills!” theory and how it came to dominate medical thinking, then sketched out the basic steps:

  • Identify an association
  • Mistake the association for cause-and-effect and propose a theory
  • Find a bit more weak evidence to support the theory
  • Allow those with a financial interest in the theory to get on board and steer the research
  • Explain away all evidence that the theory is wrong

With this protocol in mind, I am hereby announcing a bold new theory to the scientific world:

THE PRIMARY CAUSE OF HEART DISEASE IS HIGH TAX RATES

Here’s the association we need to get started:  In his book The Cholesterol Myths, Uffe Ranvskov included a chart that plotted municipal tax rates against heart-disease deaths for several cities in Sweden.  I’ve reproduced it below.

My goodness!  The evidence is clear … the higher the tax rate, the higher the rate of heart disease.  Boost the tax rate to 30%, you may as well just grab an Uzi and start spraying bullets into the streets.  Going in the other direction, Ravnskov calculated that if tax rates were lowered to 9.55%, heart disease would be conquered.  Well, I say Dr. Ravnskov was correct, even if he thought he was being funny in a Swedish sort of way. 

I’m only speculating at this point (we’re early in the process, after all), but my guess is that high taxes create stress, the stress produces an overabundance of cortisol, and the cortisol leads to inflammation that damages arteries. But I still need a bit more evidence, so I copied some charts from the American Heart Association site.  Here’s the first one.

Aha!  The evidence is clearly mounting.  The United States had no permanent national income tax until 1913, and as you can see, heart disease was quite rare before then.  But as tax rates climbed for the next several decades, so did heart disease. 

John F. Kennedy cut income tax rates to boost the economy, and according to our chart, heart disease rates dipped soon thereafter … then rose again in the high-tax 1970s … then dipped again soon after Ronald Reagan’s tax cuts … then rose again after George “Read my lips!  No new taxes!” Bush raised taxes … then dipped a bit during Clinton’s term (we may have a paradox here) … then fell sharply around the time George “I’ll cut taxes but spend like crazy anyway” Bush enacted his economic policies.

Now let’s look at the second Heart Association chart, which shows hospital discharges for cardiovascular diseases — including people discharged alive, dead, or status unknown.  (I’m guessing the facilities that couldn’t determine if their patients were alive or dead were V.A. hospitals.)

I think our paradox just went away.  There’s a dip soon after Reagan’s tax cuts, a steady rise during Bush and Clinton — both of whom increased taxes — then a smaller dip that roughly parallels the term of Bush The Younger.  (Hey, his tax cuts weren’t as dramatic as Reagan’s, so that just proves my point.) 

I’m declaring my theory scientifically sound and well supported by the available evidence.

Getting people financially invested in my theory will be a piece of cake.  Roughly half the population votes against higher taxes anyway, and most of the other half only votes for higher rates when they’re told they won’t be the ones paying.  I’m pretty sure that within months after my theory gains some momentum, we’ll see a slew of well-funded studies concluding that we could save hundreds of thousands of lives each year by lowering the top tax rate to 20 percent. 

Eventually the gullible media will be on board as well.  Every April, there will be articles mentioning that there’s a spike in heart attacks during the last week before taxes are due.  The term “artery-clogging alternative minimum tax” will become common. Doctors will aggressively prescribe lower tax rates for patients with known risk factors … such as owning a successful business, living in California, or having at least one close relative named Wesley Snipes.

The trouble will come when the contrary evidence starts rolling in.  Large clinical trials will fail to show that reducing taxes actually reduces heart disease. Dr. Malcolm Kendrick will write a book pointing out that the French pay more in taxes than Americans do, but have lower rates of heart disease, and if you look around the world, there’s no correlation between tax rates and heart disease whatsoever.  A national study will conclude that 72 percent of all heart attack victims are already paying less than 20 percent in taxes.

But I know how to handle those little annoyances:

  • Bury the clinical studies, or label them as “inconclusive.”
  • Pretend the French don’t exist, and refer to them as a “paradox” if anyone brings them up.
  • Conclude that our “optimal” tax rate of 20 percent is still too high and needs to be even lower.

Meanwhile, there will no doubt be a fair number of contrarians who don’t buy my theory and will insist on paying high tax rates despite my warnings.  I’ll tell them the same thing doctors tell me when I refuse to go on a low-fat diet:  Fine, you can ignore me if you choose … but don’t come crying to me when you have a heart attack.

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25 Responses to “LDL Nonsense is Taxing My Sanity”
  1. KD says:

    “I’m declaring my theory scientifically sound and well supported by the available evidence.”

    I know you speak in jest, but I like this theory and I volunteer to participate in a clinical trial wherein my taxes are lowered. Selection bias, what?

    I believe that in order to ensure our data is sound, we need to run the trial for at least 10 years. No, make it 14 years … that way I’ll be 65 when it’s over.

  2. Gerry says:

    Well done nailed it in one, ever thought of a career in medicine or public health?

    As I explain in my official actor/comedian bio, I paid for my entire college education with one joke — the one that begins, “Mom, Dad … I want to be a doctor.” Around my junior year, I decided life would be much more interesting if I spent it working a random series of unrelated jobs.

  3. jabekk says:

    Ha ha. I love the ability of some people to make science completely unscientific. Great way to illustrate this.

    The scientists made science unscientific; I just played along.

  4. Jan says:

    I have I told you that you’re now my hero?

    No, but now that you mention it, I should probably get a cape.

  5. Bruce says:

    For the French “paradox”, just add into the theory, after much debate and rancor, that smoking AND drinking wine is cholesterol lowering. Maybe come out where you are not sure if it is one or the other or both. Then say more research is needed. Get the funds from the government so you can save the children. Then call me and we will research the bejesus out of France. Foie gras perhaps? Speaking French maybe? Let’s go to Belgium too. Maybe beer and or cigarettes?

    If we can get funding for that research trip, I’m on board.

  6. Brian says:

    As a taxpayer, count me in. Do you think it might help if I just decide not to pay my taxes this year? Just thinking about it makes me feel better. Paradox or not, it works for me. Now, where to hide… Is the name Michael Jacobson already taken?

    That’s a good thought. Just skip sending in that check and when the IRS comes knocking, we’ll call it “alternative medicine.”

  7. Dan says:

    We need to keep the tax hypothesis alive. If it results in lower taxes, it’s worth it, even if it is bad science. That may be the ONLY way to lower taxes. :)

    I’m fighting the lunacy by refusing to take statins for LDL around 130. Since 70% of heart attack patients have an LDL less than 130, I’d say I’m pretty well off.

    They are already pushing LDL targets to unnaturally low levels and pushing them to even more unnaturally low levels will ensure that everyone is on statins, which is, no doubt, big pharma’s goal.

    A doctor in the UK has proposed putting statins in the drinking water — and he wasn’t joking.

  8. djinn says:

    Doctor Naughton, once again your analysis is far superior to that of the scientific community at large.
    The only reason I can think of for this effect is that you are a professional comedian and scientists as a group are only gifted amateures.

    Well, I once had a German plastics engineer attempt to explain why a bit in my standup act wasn’t actually funny, even though it routinely generated a big laugh, so fair is fair. (German plastics engineers are, of course, reknowned for their sense of humor.)

  9. jerome says:

    Re Dan’s comment:

    I can’t help wondering if all those amateur comedians – I mean scientists – have noticed that overall risk of mortality rises rapidly below reasonable levels of chloresterol. Of course that’s irrelevant to a statinator; when you die, it’s less likely to be from CVD, which is what’s important. (that, and statin sales)

    They actually have a rationalization for that one: high cholesterol causes heart disease, you see, but low cholesterol is associated with disease only because (drum roll, now) the diseases lower your cholesterol.

  10. Tracee says:

    All roads lead to statins I guess. The cholesterol theory is just a floating turd that can’t be flushed. I like your tax theory, it really is more plausible.

    And my prescription — lower tax rates — produces very few unwanted side effects.

  11. Phyllis Mueller says:

    There’s also the piece on The People’s Pharmacy website about statins raising blood sugar. Oops! Here’s the link:

    http://www.peoplespharmacy.com/2010/03/01/listen-to-patients-when-it-comes-to-statin-side-effects/

    The same site has a wealth of information (from readers’ comments) about other statin side effects, including ALS syndrome. Some of the stories are heartbreaking.

    Just what we need: more people with elevated blood sugar. The more I read, the more I’m convinced statins are a horror show.

  12. Katy says:

    Oh, yeah, lower is better (NOT!). I think what the statinators are doing is criminal.

    http://www.neurology.org/cgi/eletters/71/5/344

    “The Framingham Heart study found that those with high cholesterol—defined as 240-380 mg/dL [6.1-9.7 mmol/L]—had significantly better cognition scores than those with lower levels of 150-199 mg/dL (3.85-5.1 mmol/L; P <0.01 for group test scores). [3]”

    “Cholesterol is vital to memory and the aging brain [4] and the message the authors convey may promote non evidence-based drug use. At an age where cognitive decline, low cholesterol, and heart failure become major health issues, a recent observational study found 2.6 times the in-hospital mortality from heart failure in those with lowest cholesterol, an effect that became highly significant among statin users. [5]”

    If you get seriously ill, you’d better hope your cholesterol isn’t too low.

  13. Richard Tamesis says:

    Excellent article pointing out how prevalent bad science and medical researchers who pretend to be scientists are in supposedly premier academic centers such as UCLA! I’ll definitely be curious to see what the CHD rates are for 2009 and 2010 and see if your plausible hypothesis predicts the trend correctly.

    We’ll see what happens when the rates go up.

  14. Howard says:

    Hmm, seems the hammer just isn’t working. Let’s use the pile driver and see if that eliminates the headache.

    When your head falls off, the statinators will declare it a successful treatment.

  15. Lynda says:

    Just when I think I’ve read it all, you scare the bejesus out of me!! I’ve always considered myself to have good common sense and a logical mind. It beggars belief that so much inaccurate information abounds in the world. This is seriously like when people said the world was flat! Because something is said often enough it is obviously true! I have started my own one-woman crusade to help all of my online overweight blogger friends.

    My partner and I are doing this by example and I have converted a few to the new way of thinking and eating. I just listened to the Jimmy Moore’s podcast about the book “Suicide by Sugar” and was shocked by that. How on earth does fat get the bad rap and sugar (aka, corn syrup and about 50 other names) get off virtually scott free?

    Well done too on the “high tax causes high cholesterol” – I thoroughly enjoyed that :)

    Gary Taubes began the investigative work that eventually led to “Good Calories, Bad Calories” after he wrote a book about cold fusion titled “Bad Science,” and a friend in the nutrition field told him the really bad science was in health and nutrition. His friend was right.

  16. Richard Tamesis says:

    Can I use your article for a journal club that I’m holding next month with ophthalmology residents? I want to show them a great example of critical thinking and how to recognize garbage in medical literature when they see it.

    I’d be honored, thanks.

  17. Lazar says:

    Props for this great article

    I am propped.

  18. Alex says:

    Maybe the European secret is lower stress levels, not so much the diet. Although their habit of eating more slowly also helps to reduce the inflammatory response, compared to our American habit of gobbling down our food in 10 minutes.

    That’s what Dr. Malcolm Kendrick believes as well; stress has quite a bit to do with heart disease.

  19. Todd says:

    Had I submitted conclusions as counter to the results and illogical as these tenured, published, chair-holding professors at top-level colleges, I never would have made it out of any of the lab sections of my 200 level coursework on the way to a B.Sc.

    I think my college physics professor would’ve smacked me over the head if I’d explained away the results like these people do.

  20. Richard Tamesis says:

    My only quibble with your hypothesis is that you failed to include the favorite word of lousy researchers, which is “suggest” as in “Our data SUGGESTS that high tax rates are highly associated with higher heart disease rates.” Without that magic word in your article, people reading your article won’t take you seriously.

    Good point. I appreciate the suggestion.

  21. jerome says:

    Tom, I’ve been mulling over the scientists’ claim that disease lowers
    chloresterol. Obviously, good health is hazardous to your chloreserol
    levels! Which explains how statins lower LDL – they make you sick!
    But wouldn’t a typhoid injection work as well?

    And it would be cheaper.

  22. Angel says:

    To Brian and anyone else considering not paying their taxes:

    You might lower your heart disease risk, but you’d be dead anyway because your significant other would kill you.

    However, from a scientific point of view, this would not be a problem if Tom chooses to ignore all-cause mortality. Just be sure to get your blood sample sent in to the lab before your spouse finds out what you’ve done.

    I’m taking a tip from the statin-makers: I’ll simply report a lower number of heart-disease deaths, without bothering to mention that more people in my treatment group died of other causes.

  23. Todd says:

    Speaking of bad science..

    I’d call this tripe, but it’s an insult to perfectly good food!

    “Fat turns off hormones that regulate our appetite and bodyweight”

    http://ca.lifestyle.yahoo.com/health-fitness/articles/archive/rogers-macleans/blame-your-brain-2009-12-18

    Fat ramps up our appetites? That’s just stupid. Who the heck ever eats 20 eggs? Interesting example, too: strip loin, loaded baked potato, cheesecake. Then when you overeat, they blame the fat, not the starch and sugar.

  24. Dan says:

    With your libertarian bent, you might enjoy this article by Chris Masterjohn, if you haven’t already seen it.

    “Why the State Hates Cholesterol.”

    http://nutrition-and-physical-regeneration.com/blog/182/government/why-the-state-hates-cholesterol/

    Brilliant! Wish I’d written it myself.

  25. Walter B says:

    Masterjohn’s article is no longer at the above address but is at

    http://www.lewrockwell.com/orig6/masterjohn1.html

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