I always seem to be late writing about calendar events. I do okay with the big ones like Christmas and News Years, but I missed Father’s Day. Perhaps I’m tardy because my column appears once a week. You’d think I’d plan ahead, but I don’t. Maybe it’s because I increasingly live in the present rather than stressing about the future or dwelling on the past.
It may be out of character, but I’ve already begun to think of our fortieth anniversary which Becky and I will celebrate in September. I am blessed to have married well. Becky is for me the measure of goodness which I aspire to, but never quiet achieve. Ancient philosophers spoke of a tertium quid we know as a standard. Becky is my yardstick of virtue and is one of the few people I’ve met who is genuinely good. Perhaps you’ve encountered one of these “saints of the latter day.” Fortunately, she loves me, and her recent observation that I am a good father validates me like nothing else.
Each year at Memorial Day I watch the movie Saving Private Ryan. This cinematic depiction is the closest I will ever come to war. I feel it is my duty to watch and reflect on the sacrifices of those who have won my freedom. The movie did not win the best picture of the year, but it should have. A fluff piece was chosen by the Holly-weird Academy instead. I no longer have any respect for that industry.
There is a scene at the beginning of the movie where the modern day Private Ryan is visiting the military cemetery in Normandy and finds the grave of the leader who saved his life in 1944. Tearfully, Ryan asks his wife if he was a good man and worthy of those who sacrificed their lives that he might live. She reassured the aged soldier that he had been a good father. Sometimes I question myself if I’ve been “good enough.” However, like Private Ryan I am made worthy by those who love and appreciate me. So, happy belated Father’s Day to those who are real men and true fathers.
You’ve heard the homily that hindsight is better than foresight. Perhaps this perspective resonates with us because man can’t predict the future with any certainty. I have an app on my iPhone which links me to the Weather Channel. Unfortunately, our weather man has trouble telling me whether it will rain in an hour or twenty four hours. And yet some of us believe these experts can predict the weather in five, ten or twenty years. At one time there was “consensus” that there were no spots on the sun. Galileo was forced to recount his telescopic observations. Beware of scientific consensus. It is usually politically motivated. General George Patton once observed, “If everyone is thinking alike, then somebody isn’t thinking.”
I’ve been in medicine forty years, time enough to see things come and go. I remember a lecture by an expert on cholesterol when I was chief resident at University Hospital. At the end of an erudite review of cholesterol and cardiovascular disease, the expert recommended draconian dietary fat restrictions and a powder medication that tastes like sand. An old sage on our medical staff asked the expert whether people on the dietary equivalent of “hay” mixed with sand actually lived longer or did it just seem like they did. Perhaps you remember the recommendations of our experts in years past who advised us to choose more carbohydrates and less fatty foods. Unfortunately, this fueled the obesity epidemic and diabetes.
We are now told that margarine is bad. It once was advised in place of butter. Supposedly, the trans-fats which make margarine solid at room temperature produce greater cardiovascular risk. Corn oil, olive oil and butter in moderation are currently recommended. And the ban on coconut oil has even been rescinded. Beware of consensus as dogma.
I’ve written extensively about the major cardiovascular risk factors of smoking, hypertension, elevated cholesterol, early cardiovascular disease in family members and diabetes. Having lived long enough to be relegated to the venerable/sage status, I find it mystifying that the 2013 guidelines of experts no longer consider family history important enough to figure into the decision to use drugs for lowering cholesterol. As a result more and more will be advised to take statins, though 7% will discontinue this effective therapy each year because of side effects, hassle and perhaps expense.
We are fortunate to now have better cholesterol lowering medications than in times past. Statins, like Lipitor, Crestor and simvastatin are the cornerstone of cholesterol treatment after dietary moderation. Aggressive treatment of all risk factors is warranted after a heart attack. However, in the absence of cardiovascular disease the benefit of cholesterol lowering medication is more difficult to measure. This is where one’s family history of early heart disease seems most relevant to me. Blindly putting statins in the nation’s chow, as some experts have argued, seems more like herd management than thoughtful caring for the thoroughbred in a doctor’s “stable.”
It may not interest some, but this internist remains fascinated by the “statin hypothesis” and the “LDL hypothesis.” The LDL sub-fraction of cholesterol is most closely associated with cardiovascular disease. Lowering LDL and total cholesterol with statins reduces cardiovascular risk. However, these potent agents have other properties which doctors call pleiotropic effects. These include, reducing inflammation, improving the function of cells lining blood vessels and antioxidant properties.
A recent study in the NEJM showcased the growing body of knowledge that the LDL hypothesis seems to be gaining consensus and a lower cholesterol level is better, just as a lower blood pressure is better. But beware the old opera cliché that it’s never over “til the fat lady sings.”
A hypothesis is a perspective which science then tests with experiments. If a hypothesis is repeatedly confirmed through testing it may be elevated to a theory as the way things work. With time a theory may be so successful that it becomes a law such as the law of gravity. But even Isaac Newton’s laws of gravity are subject to later consideration, as when Albert Einstein conceived relativity.
History and hind-sight are gifts of discernment. I have found that blind orthodoxy is just that.
