Franklin Delano Roosevelt had wicked hypertension. When the arteries in his brain finally blew apart, causing a massive stroke and death, his blood pressure had been hovering for months around 300 over 200. As I’ve written previously, Howard Bruenn, the president’s cardiologist, believed strongly in ‘Essential Hypertension’. This is a theory suggesting high blood pressure was necessary—essential—to power blood flow through FDR’s calcified, thickened arteries.
But it’s wrong. Hypertension is not essential, it’s bad and should be treated.
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The Plumbing Theory of coronary disease holds that inserting stents to open blocked and partially blocked arteries will prevent heart attacks and extend life. But other than in the throes of a heart attack, we now know that’s wrong. Such stents are harmful, not helpful.
Virtually every major depression drug prescribed and sold in the past three decades is engineered to correct a ‘chemical imbalance’, serotonin deficiency. That’s because the Serotonin Theory identifies this as the cause of Major Depression. But there is no serotonin deficiency with depression—we now know the theory is wrong.
The Lipid Hypothesis proposes that cholesterol causes coronary disease, and lowering it will prevent coronary events and prolong life. Last week’s post discusses a new study, however, that plainly disproves that theory—again.
Last week I wrote about the Semmelweis Reflex, a tendency to cling to pre-existing beliefs even when data challenges them. While it may be a common and very human reflex, it is deeply anti-scientific. The charge of the academic and the scientist, as Thomas Jefferson once said, is “to follow truth wherever it may lead.”
Physicians, moreover, swear an oath to put patients ahead of their egos, money, and everything else. And yet here we are, in the midst of a Semmelweis Setback, a period during which overwhelming data have debunked a theory of practice, while the practice continues, hurting everyone. We chase cholesterol as a primary means of preventing heart disease; we place millions of pricey stents that can only do harm; we treat depression almost exclusively with serotonin drugs.
To reverse these moral and practical wrongs, we must understand why they’re happening. In that spirit I offer the following well known theory, with a twist:
Follow the money, deprogram the ideology.
Cholesterol lowering, stents, and serotonin drugs are financial blockbusters. Knowing this, however, is not enough. It is true what Upton Sinclair said, “It is difficult to get a man to understand something, when his salary depends on his not understanding it.” But there is more than money at stake. While some physicians gain financially from placing stents, even in socialized systems where physicians don’t gain, stents are rampantly overused. And few make extra money for prescribing statins or Prozac.
Instead, what physicians gain is gumption. Ideologic gumption is an inflated belief in the impact of one’s actions and therefore the theories underlying those actions. To tell a cardiologist cholesterol is meaningless in preventing most heart disease, or stents don’t work, is to challenge their identity. They are true believers, not thieves or con men.
So who slayed Essential Hypertension? FDR and his hapless cardiologist. They didn’t do it on purpose but they shocked the world into seeing something hitherto invisible. FDR’s death deprogrammed the ideology, and forced a reckoning.
Similarly, Joseph Lister and Louis Pasteur elaborated the Germ Theory piercing the ideologic bubble that allowed physicians to deny they themselves were vectors for the infections killing women in childbirth. This too was a reckoning, a slap in the face for doctors who had denied Semmelweis’ data with a vitriol and defensiveness that only comes from a challenge to one’s own identity.
It will likely take a slap for doctors to see cholesterol, serotonin, and stents for what they are. Doctors are good people, overworked, nose to the grindstone, seeing patients and moving mountains. They do not have the time, nor often the training, to read every new study or puzzle through every new theory. They rely on professional guidelines and experts, information sources deeply influenced by money and usually oblivious to their ideologic capture—but that is a subject for another post, when we tackle how to Follow The Money.
Meantime, grassroots work can shift the views of doctors, because there is one group they listen to more than any other: patients. So tell everyone you know, including your doctor, what you’ve learned about cholesterol, and serotonin, and stents. It will take time and gumption of your own, but do them the favor of treating them like scientists.
In other words, pierce their bubble. Do it lovingly, with respect and admiration. But do it.
