Saturday, June 16, 2012

Too Good To Be True

Cliches get a bad rap for being worn out and unserviceable. Upon reflection, however, they are oftentimes brimming with common sense and wisdom. For example,"If it seems too good to be true, it probably is."

This cliche came to mind recently when I was reading an article published in The Lancet, a prestigious English medical journal, which suggested that even patients at low risk for cardiovascular disease would benefit from taking statins (a class of cholesterol lowering medicines), resulting in lives saved, and a significant reduction in heart attacks and strokes. 

Until this report, a risk of 20% or higher, defined by a standard measuring device, was the point at which statins, with ringing endorsements from the cognoscenti, were recommended. 

Now, the Lancet research suggests that anyone with a risk of 10% or greater is likely to benefit too.

What the authors of the paper are telling us is that individuals previously thought to be low risk are now thought to be candidates for statins.

With a wave of the wand, the total number of high risk, vulnerable individuals greatly increases, making it appear that cardiovascular disease is more rampant than ever.

Enter the treat everyone, 'put it in the water' school, trumpeting a message that thrives on the simple (and misguided) notion that we are all the same and benefit from the same management and treatments. 

Not too many years ago, followers of this same 'school' informed us that all women on estrogens needed to be on progesterones too. That idea turned out to be categorically false and based on flawed research.

They also issued warnings of late about the dangers of vitamin D deficiency, which they unassailably believed to be a big factor in everything from diabetes to depression to cancer to multiple sclerosis. As a result, no visit to the doctor was complete without a prescription for vitamin D.  Game on.

Enthusiasm for vitamin D supplementation,this latest edition of the fountain of youth, turned out to be uncontainable once the genie was let out of the bottle. Not surprisingly, the lower limits of normal have progressively decreased, drawing more and more people into the vitamin deficient category. 

And thanks to the idea that you can't get too much of a good thing dosages began to rise steadily.

As it turns out, the entire vitamin D epoch was the result of belief masquerading as fact, overlooking a fundamental quality of biology - its variability.  

Variability is the coin of the realm, promoting strength and sustainability in both plants and animals.

For example it's preferable that a garden have multiple strains of plants since a single strain would be much more vulnerable to blight, mutations and even extinction. That's why nature abhors sameness.

Humans are vulnerable to sameness too.  What happens, for example, if an unexpected, and severe, toxicity to, say, statins develops among a population where the drug is unnecessarily used by  large numbers of people? 

So when experts joke about placing a drug (not fluorides)in the drinking water, you can
be pretty sure that canonization of the treatment along with a pharmaceutical jihad are afoot,  unwisely exhorting everyone to dance to the same tune.

It is almost never the case (with the exception of toothbrushing) that everyone should do the same thing.

When a single approach is universally promoted, know that the idea defies common sense and the variability of nature.

Above all, dust off and brandish that trusty cliche - if something appears too good to be true, it probably is.