Another Big Fat Fail For The Lipid Hypothesis by Tom Naughton

Bacterial pneumonia, once a leading killer of the old and the very young, is caused by (duh) bacteria.  If you kill the bacteria, the pneumonia goes away.  It doesn’t really matter how you kill the bacteria, either.  If a patient is allergic to one drug that kills the bacteria, a doctor can prescribe a different drug that kills the bacteria and – bingo! – the pneumonia goes away. Why?

BECAUSE THE PNEUMONIA IS CAUSED BY THE BACTERIA, FOR PETE’S SAKE!  

And how do we know that?

BECAUSE IF WE KILL THE BACTERIA, THE PNEUMONIA GOES AWAY, FOR PETE’S SAKE!

Okay, but let’s suppose we kill the bacteria we believe causes the pneumonia, but the pneumonia remains and the patient dies.  And let’s suppose this happens with multiple patients.  Then what would we conclude?

IF KILLING THE BACTERIA DOESN’T MAKE THE PNEUMONIA GO AWAY, THEN THE PNEUMONIA ISN’T CAUSED BY THE BACTERIA, FOR PETE’S SAKE!  WHAT ARE YOU, AN IDIOT?

No, I’m just pointing out some basic logic here.  If we kill the bacteria but the pneumonia remains, we have to conclude that while a bacterial infection may be associated with pneumonia, it isn’t the cause.  That’s what we’d expect any honest scientist to say.

But strangely, this basic logic seems to escape researchers when a cholesterol-lowering drug fails to prevent heart attacks.

It is a drug that reduces levels of LDL cholesterol, the dangerous kind, as much as statins do. And it more than doubles levels of HDL cholesterol, the good kind, which is linked to protection from heart disease.

That’s the Lipid Hypothesis in a nutshell: LDL is dangerous.  It causes heart disease — just like that nasty bacteria causes bacterial pneumonia.  HDL, meanwhile, protects against heart disease.

As a result, heart experts had high hopes for it as an alternative for the many patients who cannot or will not take statins.

Everybody sing: “Oh, we’ve got hiiiigh hopes.  Yes, we’ve got hiiiigh hopes …”

But these specialists were stunned by the results of a study of 12,000 patients, announced on Sunday at the American College of Cardiology’s annual meeting: There was no benefit from taking the drug, evacetrapib.

No benefit?  But LDL causes heart disease!  Did the drug fail to lower the LDL that causes heart disease?

Participants taking the drug saw their LDL levels fall to an average of 55 milligrams per deciliter from 84. Their HDL levels rose to an average of 104 milligram per deciliter from 46.

Well now, that is an amazing improvement in lipids.  The American Heart Association would be delighted with those numbers … although strangely, I can’t find recommended LDL levels on the AHA site anymore.  Perhaps they hired the former KGB artists who used to make people disappear from official photos once they became an embarrassment to the Kremlin.  Anyway …

Yet 256 participants had heart attacks, compared with 255 patients in the group who were taking a placebo.

In other words, no difference.  A total fail.

“We had an agent that seemed to do all the right things,” said Dr. Stephen J. Nicholls, the study’s principal investigator and the deputy director of the South Australian Health and Medical Research Institute in Adelaide.

Yup.  If high cholesterol – and specifically high LDL – causes heart disease, then you did indeed have an agent that seemed to do all the right things.

“It’s the most mind-boggling question. How can a drug that lowers something that is associated with benefit not show any benefit?” he said, referring to the 37 percent drop in LDL levels with the drug.

Boy, that’s a real head-scratcher.  Let me think for a minute … uh … uh … perhaps the fact that two things are associated doesn’t mean one is causing the other?  I seem to recall a good scientist or two saying as much.

The entire article can be read here.

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