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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