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That's more like a 4% rise, not a 12% rise. Overstating threefold much?

To be fair, the mathematical blunders only occur in TFA, not in the original report.

(from the referenced paper in the article, page 918 left side):

Women are often older when they present with their first AMI, at an average age of 71.8 years compared with 65 years for men.

(with AMI meaning Acute Myocardial Infarction)

Now, could it be that the shorter long term survival rate has more to do with age than gender?

Also, there is a very interesting graph on the previous page depicting the AMI-related deaths for both sexes, with female deaths due to cardiovascular faults being in sharp decline since 2000. So either something happened around that time that made women less susceptible to dying from a heart attack, or something else took over as the big lady killer.

However it seems to me it's a bit of a logical leap to do something which transiently increases inflammatory markers and then assume that means the subject's chances of getting a specific inflammatory disease are increased. Maybe I'm misunderstanding the paper.

You know what else causes transitory inflammatory response?

Niacin (Nicotinic Acid). A/K/A VITAMIN B3.

https://articles.mercola.com/s...

You know what else causes transitory inflammatory response?

Nitric Oxide. A/K/A "Molecule of the Year" in 1992, and responsible for a Nobel Prize in 1998, for its discovery as an essential ingredient in dozens of life-processes in the body.

http://circ.ahajournals.org/co...

You know what else causes transitory inflammatory response?

Orgams.

'Nuff said!

Some who would start smoking will use ecigs instead. That's bad how?

As for helping you quit, ecigs helped me quit. After a number of years vaping, I found that I just wasn't interested in the nicotine anymore. No drama, no nail biting, no eating the entire refrigerator, nothing. Just no more interest in nicotine.

While you are one of the (rare) "success stories" of people being able to quit using e-cigs, there are much larger issues at stake. E-cigs are being promoted as a safe alternative to tobacco (quoted from article true link here) and were not designed to help people quit, just channel their addiction/dependence onto a new (probably) more profitable platform, that may be slightly more socially acceptable:

"As tobacco usage declined over time in the United States, industries introduced an alternative known as electronic cigarettes (e-cigarettes) claiming they were a healthier alternative to tobacco smoking.3

Since then, the number of e-cigarette users has increased significantly because of the perception that they serve as a healthy substitute to tobacco consumption with minimal or no harm, a lack of usage regulations (although that has now changed), and the appealing nature of these devices, among other reasons."

And it goes on to state that the these products are increasingly used by teenagers:

"Consequently, e-cigarettes became the most commonly used smoking products, especially among youth, with more than a 9-fold increase in usage from 2011 to 2015.5"

The purposed of this article was to illustrate that these products are not benign as most users believe.

That's the part that really hacks them off, I sinned by smoking and they want to see some serious suffering as penance.

No, they are not out to punish anyone, rather they are trying to dispel incorrect claims from a formerly unregulated industry. Please be happy that someone is actually studying the effects so that we can make informed decisions instead of relying on industry propaganda.

Link for the second article referenced here

Fixed the link:
"Ameliorating hypertension and insulin resistance in subjects at increased cardiovascular risk: effects of acetyl-L-carnitine therapy"
https://www.ncbi.nlm.nih.gov/p...

another good article:
"Oral Acetyl-l-Carnitine Therapy and Insulin Resistance"
http://hyper.ahajournals.org/c...

Dr Mike Knapton, associate medical director at the British Heart Foundation, said the claims about saturated fat were "unhelpful and misleading".He added: "Decades of research have proved that a diet rich in saturated fat increases 'bad' LDL cholesterol in your blood, which puts you at greater risk of a heart attack or stroke." Knapton states a fact coupled with an assumption. It's a fact that three chain lengths of saturated fat (12, 14, and 16) raise LDL cholesterol somewhat. http://ajcn.nutrition.org/cont... It is also a fact that 18 carbon chain stearic acid, which has no affect on LDL cholesterol levels is the most prominent fatty acid in unstable arterial plaques. http://circgenetics.ahajournal... I mention unstable arterial plaques because of this. "Numerous studies have demonstrated that coronary atherosclerosis affects all eutherian animals with a body mass comparable to or larger than humans, regardless of diet specialization and LDL levels. Surprisingly, in these mammals, lipid accumulations in arterial walls were more common in herbivores than carnivores." https://www.ncbi.nlm.nih.gov/p... So the debate should not be about LDL levels. It should center on what causes plaque build up and what generates unstable plaques. It's peculiar that nobody mentions mercury toxicity. Quite likely mercury toxicity contributed significantly to heart attack risk among middle aged men during the first half of the 20th Century. "Mercury activates phospholipase A2 (PLA-2) which increases the risk for coronary artery and cerebral plaque rupture with MI and CVA. In addition, mercury induces formation of arachidonic acid metabolites such as total prostaglandins, thromboxane B2 and 8 isoprostane in vascular endothelial cells and activates vascular endothelial cell phospholipase D. Even very low levels of chronic mercury exposure promote endothelial dysfunction (ED) as a result of increased inflammation, oxidative stress, immune dysfunction, reduced oxidative defense, reduction in nitric oxide (NO) bioavailability. Many of the cardiovascular consequences of mercury are mitigated by concomitant intake of fish containing omega 3 fatty acids and by the intake of selenium. All of these pathobiological findings will increase the risk of hypertension, CHD, MI, CVD and CVA." https://www.esciencecentral.or... Note the mention of arachidonic acid metabolites. Why it that important? "Arachidonic acid (AA) in the diet can be efficiently absorbed and incorporated into tissue membranes, resulting in an increased production of thromboxane A2 by platelets and increased ex vivo platelet aggregability. Results from previous studies have shown that AA is concentrated in the membrane phospholipids of lean meats." https://www.ncbi.nlm.nih.gov/p... "The highest level of AA in lean meat was in duck (99 mg/100 g), whereas pork fat had the highest concentration for the visible fats (180 mg/100 g). The lean portions of beef and lamb contained the higher levels of n-3 polyunsaturated fatty acids (PUFA) compared with white meats which were high in AA and low in n-3 PUFA. The present data indicate that the visible meat fat can make a contribution to dietary intake of AA, particularly for consumers with high intakes of fat from pork or poultry meat." https://www.ncbi.nlm.nih.gov/p... It is unfortunate that scientists debating the saturated fat issue ignore endocannabinoid system (ECS) research. "We now know that major changes have taken place in the food supply over the last 100years, when food technology and modern agriculture led to enormous production of vegetable oils high in -6 fatty acids, and changed a

This isn't exactly new. Heart tissue is easy to grow and already used for disease modeling. Call me when they make something that is structurally a heart. We've had heart tissue in hydrogels and various other materials since the 1980s and heart tissue on sheets for maybe 20 years for drug testing. The novelty here is that it's on chip and optimal for drug testing?

http://circres.ahajournals.org... [ahajournals.org]

Wait. The official cause of death is listed as Cardiovascular Disease and I'm the one who's reaching? I never said lung cancer didn't contribute to it, just that the official reason is heart failure and saying she died of lung cancer is perpetuating a myth.

There is ample evidence showing smoking increases the risk of Cardiovascular Disease, so it's safe to say that smoking contributed to her death, just not in the manner you described.

I suppose "cardiovascular disease" or "heart failure" don't have the same emotional impact as "lung cancer"...

Dude, don't stop the metoprolol... just avoid combining it with its evil twin. If you rely on /. for medical advice, all I can say is Darwin.

If one follows the links further in, it shows Metoprolol alone increases the QT level in 13% of the patients, 22% when comboded.
http://www.chicagotribune.com/...

A lengthened QT interval is a marker for the potential of ventricular tachyarrhythmias like torsades de pointes and a risk factor for sudden death.
https://en.wikipedia.org/wiki/...

Metoprolol isn't manufactured as a QT adjuster https://en.wikipedia.org/wiki/... in fact advised against it's use for that condition http://circep.ahajournals.org/... (very long read just search for Metoprolol).

Odd or better without, and there are substitutes.

I will admit that after almost half a century of learning that oxygen deprivation kills cells, it's hard to swallow the new theories that cell death doesn't actually occur until the cells are re-exposed to oxygen. It's true though, and new therapies of cardiac arrest survivors, such as induced hypothermia have greatly improved outcomes. Here are a couple of the easier to understand studies:

http://europepmc.org/abstract/...
http://circ.ahajournals.org/co...

It's something that's been known for awhile- there are papers on it going back to the early 1980s, though I'd imagine it may not have been heavily publicized at first due to the American preference at the time for paper-filtered drip coffee. Methods that retain more of the oils or the grounds themselves in the finished coffee, like boiled coffee or French press tend to have much higher concentrations.

This paper and this paper have some more information.

You — and others — seem to have misconstrued my argument to mean, the government simply can not do anything. That's not, what I said. They can do it — just poorly.

it's rare for conservatives to change their minds based on the facts

Is not it a little early in the conversation for ad hominems?

I base this on several years of the Wall Street Journal comments page, until I gave up on them. And I read lots of conservative articles on health care policy. There are conservatives who change their minds based on the facts, but in my experience they are rare. William Buckley is dead. The WSJ editorial page has turned into a Pravda for the conservative wing of the Republican Party. Sic transit gloria mundi.

The military and Veterans Affairs medical centers give some of the best care in the world

Citation needed?

http://www.ncbi.nlm.nih.gov/pubmed/?term=%22Veterans'+Affairs%22

http://www.nejm.org/doi/full/10.1056/NEJMoa1007474

http://www.ncbi.nlm.nih.gov/pubmed/7979780

http://circ.ahajournals.org/content/86/1/121.abstract

http://circ.ahajournals.org/content/93/12/2128.abstract

In case you're not used to reading medical journal articles (and most people aren't), the point of these studies is that they took the medical conditions that they most frequently treated, and were responsible for the most deaths, like heart disease, high blood pressure, and kidney disease, where different doctors treated the same patients different ways, and they did randomized, controlled trials to see which treatments worked at all and which were better. They also did studies of different VA hospitals to see which hospitals had better and worse outcomes. They tried to improve the hospitals with worse outcomes, and if that didn't work, they shut the departments down.

If you go to any major medical conference, and go to the sessions on important diseases, you'll usually hear them talking about the "VA study." That's because in many medical specialties, the VA did the major, best-designed study to find out which treatments work and didn't work. There are a few private non-government organizations, like Kaiser-Permanente and Blue Cross/Blue Shield, who do the same thing, but (not to disparage them), the VA does a lot more of these studies.

The National Institutes of Health also does big studies like that. Of course, with the budget cuts, they can't do as many, and they're being forced right now to decide which important ongoing studies will have to go, as Science and Nature have been reporting.

Everybody who follows medical research knows this. If you say, the government can't do anything well, they'll know that you don't know anything about the reality in this important field.

And as for those complaints about the bad outcomes in VA hospitals -- those are the kind of thing that happen in any hospital. It's easier to find out what happens in the VA hospitals because of their internal accounting and disclosure policies. You'll notice that the story got that information from the government's own review. Try to get that same information from private hospitals. What matters is when doctors who know how to compare hospitals compare large numbers of patients, to see whether there are any statistically significant patterns. When they do that, the VA hospitals usually do well. And when they don't, they find out why and how to change it.

Ronald Reagan got his colon and prostate su

You — and others — seem to have misconstrued my argument to mean, the government simply can not do anything. That's not, what I said. They can do it — just poorly.

it's rare for conservatives to change their minds based on the facts

Is not it a little early in the conversation for ad hominems?

I base this on several years of the Wall Street Journal comments page, until I gave up on them. And I read lots of conservative articles on health care policy. There are conservatives who change their minds based on the facts, but in my experience they are rare. William Buckley is dead. The WSJ editorial page has turned into a Pravda for the conservative wing of the Republican Party. Sic transit gloria mundi.

The military and Veterans Affairs medical centers give some of the best care in the world

Citation needed?

http://www.ncbi.nlm.nih.gov/pubmed/?term=%22Veterans'+Affairs%22

http://www.nejm.org/doi/full/10.1056/NEJMoa1007474

http://www.ncbi.nlm.nih.gov/pubmed/7979780

http://circ.ahajournals.org/content/86/1/121.abstract

http://circ.ahajournals.org/content/93/12/2128.abstract

In case you're not used to reading medical journal articles (and most people aren't), the point of these studies is that they took the medical conditions that they most frequently treated, and were responsible for the most deaths, like heart disease, high blood pressure, and kidney disease, where different doctors treated the same patients different ways, and they did randomized, controlled trials to see which treatments worked at all and which were better. They also did studies of different VA hospitals to see which hospitals had better and worse outcomes. They tried to improve the hospitals with worse outcomes, and if that didn't work, they shut the departments down.

If you go to any major medical conference, and go to the sessions on important diseases, you'll usually hear them talking about the "VA study." That's because in many medical specialties, the VA did the major, best-designed study to find out which treatments work and didn't work. There are a few private non-government organizations, like Kaiser-Permanente and Blue Cross/Blue Shield, who do the same thing, but (not to disparage them), the VA does a lot more of these studies.

The National Institutes of Health also does big studies like that. Of course, with the budget cuts, they can't do as many, and they're being forced right now to decide which important ongoing studies will have to go, as Science and Nature have been reporting.

Everybody who follows medical research knows this. If you say, the government can't do anything well, they'll know that you don't know anything about the reality in this important field.

And as for those complaints about the bad outcomes in VA hospitals -- those are the kind of thing that happen in any hospital. It's easier to find out what happens in the VA hospitals because of their internal accounting and disclosure policies. You'll notice that the story got that information from the government's own review. Try to get that same information from private hospitals. What matters is when doctors who know how to compare hospitals compare large numbers of patients, to see whether there are any statistically significant patterns. When they do that, the VA hospitals usually do well. And when they don't, they find out why and how to change it.

Ronald Reagan got his colon and prostate su

http://www.heartattackproof.com/
"A groundbreaking program backed by the irrefutable results from Dr. Esselstyn's 20-year study proving changes in diet and nutrition can actually cure heart disease ... The proof is in the results. The patients in Dr. Esselstyn's initial study came to him with advanced coronary artery disease. Despite the aggressive treatment they received, among them bypasses and angioplasties, 5 of the original group were told by their cardiologists they had less than a year to live. Within months on Dr. Esselstynâ(TM)s program, their cholesterol levels, angina symptoms, and blood flow improved dramatically. Twelve years later 17 compliant patients had no further cardiac events. Adherent patients survived beyond twenty years free of symptoms."

And:
http://www.heartattackproof.com/huffpost.htm
"Beginning in 1985 I initiated a study of seriously ill coronary artery disease patients. Their nutrition became plant based without oil. Their cholesterol levels plummeted. Their angina disappeared. Their weight dropped. I have reported this study at 5 years, 12 years, and 16 years, in the peer reviewed scientific literature and again beyond 20 years in my book Prevent and Reverse Heart Disease. In some of the patients we had follow up angiograms (x-rays) of previously blocked arteries demonstrating striking disease reversal, which is a testament to my often quoted statement âoeThe truth be known coronary artery disease is a toothless paper tiger that need never exist and if it does exist It need never progress.""

So, it's actually those who won't pay attention who are "killing people" in the sense you mentioned. Those people who don't want to look at the evidence, or don't want to work to gather more.

But, it is indeed very profitable to kill people via misleading them that heart surgery will help much (as two of my family members suffered through and then died shortly afterwards for a personal anecdote). As Dr. Fuhrman points out, cardiac interventions are a major hospital profit center. Doctors made $100K or more (in insurance) from my family, but did not have to attend the funerals caused by their bad advice, and neither did they have to experience first-hand the physical or mental suffering their interventions caused.

Note that Fuhrman's, Orish's, Esselstyn's and McDougal's approaches are all better than the "Mediterranean diet" as much as that does indeed help:
http://circ.ahajournals.org/content/103/13/1823.full
"Diet is a cornerstone of cardiovascular disease (CVD) prevention and treatment efforts. Step I and Step II diets are widely recommended as the first line of CVD intervention.1 At the core of this dietary guidance are the recommendations to decrease saturated fat and cholesterol and to consume more fruits, vegetables, and whole grain products. Information from an extensive database, especially regarding saturated fat, indicates that these diets significantly lower blood cholesterol levels, a major risk factor for CVD. Consequently, it is beyond debate that these diets reduce CVD risk. ..."

But what these MDs I mention go beyond is showing how you can not just prevent but *reverse* clogged arteries in the heart with diet.

So, if you had heart disease right now (which you probably do if you are like most older US Americans an eat a Standard American Diet), which would you rather have:
* a painful operation, months of recovery, and then six years of generally crappy quality of life eating the same old junk doing various restricted activities, or:
* making a major change to what you eat, which in six weeks tastes as good overall as what you ate before, and then, quite possibly, living twenty years in great health doing lots of physical activity?

See also:
"How to escape The Pleasure Trap!"

...so this research is misguided in that sense. See: http://www.drfuhrman.com/library/PCI_angioplasty_article.aspx

The link to Dr. Fuhrman's web site says:

The findings indicated that there was no evidence that angioplasty and stent placement for coronary artery disease resulted in fewer heart attacks or deaths when compared to patients with the same level of disease who were not treated in this manner.

That's true, but irrelevant. As the Lancet reported in 2009, angioplasty and stent placement doesn't reduce deaths. Cardiologists don't use it to reduce death any more. They use it to reduce angina (pain). Of course there are unscrupulous doctors who do unnecessary surgery. Just as there are unscrupulous doctors who sell people overpriced, unnecessary vitamins and supplements, as Fuhrman is doing.

However, coronary artery bypass, which bypasses the occluded coronary arteries with grafts from arteries and veins, does reduce death. It extends life by about 6 years in one study that I read, but it depends on the patient population. One of the issues is that medical treatment (diuretics, ACE inhibitors, alpha-blockers, statins, etc.) has gotten so good that the advantage of surgery over best medical treatment has gotten smaller.

Here's one study.

http://circ.ahajournals.org/content/112/9_suppl/I-371.full
Surgery for Coronary Artery Disease: Comparing Long-Term Survival of Patients With Multivessel Coronary Disease After CABG or PCI
Circulation. 2005; 112: I-371-I-376 doi: 10.1161/

Adjusted long-term survival for patients with 3-vessel disease was better after CABG than PCI (HR, 0.60; P<0.01) but not for patients with 2-vessel disease (HR, 0.98; P=0.77).

Conclusions— In contemporary practice, survival for patients with 3-vessel coronary disease is better after CABG than PCI, an observation that patients and physicians should carefully consider when deciding on a revascularization strategy.

Dr. Fuhrman (selectively) quotes The Lancet to argue that angioplasty and stents don't work.

Where are the published studies in major peer-reviewed journals to show that Dr. Fuhrman's diet treatment works? I don't think there are any.

There are studies published in in JAMA and NEJM of randomized trials of various dietary interventions, like the Atkins diet and traditional Greek diets, and some of them have good results, but nowhere near what Fuhrman is claiming.

Conclusion
Come to your own conclusion.

I conclude that Fuhrman is a huckster, making misleading and probably false claims. If people drop their standard medical treatment in favor of his diets, he's killing people.

http://circ.ahajournals.org/content/112/17/e285/T1.expansion.html

Note the elevated waist requirement doesn't even factor in height:

Elevated waist circumference*
102 cm (40 inches) in men
88 cm (35 inches) in women

Hard to consider that an accurate proxy for a fat accumulation problem of obesity.

http://circ.ahajournals.org/content/109/21/2655.full http://www.sciencedaily.com/releases/2012/06/120605121700.htm Have I got a case yet ?

A better one, ya. I appreciate the links.
Though I'd still be curious to know if CO2 is the relevant cause. These links discuss airborne pollutants, like particulates. And that's a case less people are prone to question.

http://circ.ahajournals.org/content/109/21/2655.full
http://www.sciencedaily.com/releases/2012/06/120605121700.htm

Have I got a case yet ?

I'd like to know how many people die on the roads, or from accidents related to cannabis, though.

Do we also take into account the fact that cannabis (much like other drugs) can be a trigger for a number of mental and cardiac problems, or should we just suppress that information because it doesn't fit in nicely with our views?

No, we're learning what genes seem to indicate a greater potential for certain personality and mental problems.

The other poster is correct. We do not truly understand how DNA and personality interact and screwing with it, with our small knowledge of the human genome, may not turn out all peaches and cream.

We may have mapped the human genome, but we have not decoded it.

As it stands, IVF is mainly used to treat what can be termed as genetically inferior people to achieve reproduction (which would otherwise be denied to them from there own inferior genes). They pass on these inferior genes through IVF. We have not figured out how to give these parents a child with non-defective genes - i.e. their children will probably have the same reproductive problems. Now, this transfers to healthy babies too - we don't know how to make them better than average.

The oldest IVF baby is about 34 years old (born 1978). We don't currently know what long term effects IVF will have on humans. We do know it doesn't look good by indicators from other animals. Studies like this point to these same problems being inherited by humans: http://circ.ahajournals.org/content/125/15/1890.abstract

IVF is a highly flawed technology. First we need to solve the IVF problem. Then decode the human genome. Then we can go making better humans.

Of course, adults shouldn't be interested in fixing unborn babies. Adults should be interested in gene therapy for adults. The real versus a potential.

This work hs been going on in an adacent lab for a while now.... very promising to hear results like that.

  http://m.circres.ahajournals.org/content/107/9/1042.full

The fat, carbohydrate, and cholesterol theories of atherosclerosis are all BULLSHIT. Atherosclerosis is caused by chronic INFLAMMATION of the arteries.

Make sure that country is not Canada lest you run a greater risk of mortality from your heart problems. You might as well cross the UK off your list as well.

If the stuff you're pushing worked the way you say it would, the doctor would be recommending it.

However, as it turns out, the research on whether or not magnesium helps with high blood pressure is inconclusive; this article seems to have a reasonable layman's summary of what's going on. Therefore, the doctor cannot in good conscience recommend that the guy take magnesium pills, as they may or may not work (for the same reason why doctors can't prescribe placebos, despite their occasional effectiveness).

Furthermore, look at the "Should I take oral magnesium supplements" and "What are good dietary sources of magnesium" sections - dietary magnesium supplements just don't work, you need to get it as part of your food. What food contains magnesium? Healthy food. What part of the doctor's recommendation are you leaving out? A diet change. No doctor would just prescribe blood pressure pills without also including a dietary intervention, that's only treating the symptoms without treating the underlying problem. This is actually something alt-med people love to accuse doctors of, probably because everyone just hears "pills" but doesn't pay attention to the "and here's how you should improve your diet, and some exercises you can do" bit. Either you or your friend didn't pay attention to the part where the doctor recommended lifestyle changes, because he certainly did (and if he didn't, he is being remiss in his care).

So why recommend blood pressure pills in the first place, if the real treatment is going to be a change in diet and exercise? Because high blood pressure is a danger now, while diet and exercise will cure the problem later (if at all - to be quite honest, few people manage to make permanent healthy lifestyle changes. It's really sad, but that's the way it is). Ideally, your friend would start taking the blood pressure pills immediately, then start in on changing his diet and getting more exercise and eventually wean himself off the pills once his blood pressure gets to a normal level.

As for potassium bicarbonate, the Cigna page on it says that you should tell your doctor if you have high blood pressure and intend to take it, as there may be side effects. The only study on its effects that I could find was this one, which had positive results but was little more than a pilot study (14 people). Further research is needed before a doctor can really recommend supplementation with potassium bicarbonate (especially when just eating more fruits and vegetables already has a significant effect, which is probably why there's been little research in this area - there's no need to recommend expensive supplements when the patient can just eat better).

There is something I don't understand in your post, though: you say that taking these alternative supplements is good, because it deprives the pharmaceutical complex of years of income (despite the fact that ideally you'd stop taking the blood pressure pills at some point) - but as your alternative, you recommend taking magnesium and potassium bicarbonate supplements. Do those poof into existence from thin air? No, they're sold by the "supplemental" complex - and you're recommending giving them years of income for treating high blood pressure, despite (again) the fact that the real treatment lies in a lifestyle change. You're basically saying "don't buy stuff that we know works from those guys, buy stuff that may or may not work from these other guys".

I wonder who is treating the symptoms here, and not addressing the causes?

If you take a look at the paper, which is online and not paywalled, it's obvious junk science. They claim a correlation between mortality and sitting, and the abstract states that the variables they controlled for were "age, sex, waist circumference, and exercise." Well, watching eight hours a day of TV is probably negatively correlated with a lot of other variables, including general health, education, income, intelligence, and employment. And I would guess that mortality is probably also strongly negatively correlated with general health (duh), education, income, intelligence, and employment. On the second page of the paper, they say that they surveyed the participants for "demographic attributes" including education, but note that education is *not* listed in the abstract as one of the variables they controlled for. Look at table 1, and they show a clear anticorrelation between education and television viewing. On p. 387 they talk about how they tried to minimize the effect of the anticorrelations involving general health, but their method is pretty crude.

To provide a URL, it's a bit cleaner to use:

http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.109.894824v1

Here is the papirus: http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.109.894824v1

I'm not too convinced here. Besides the obvious Duh! factor in TFP, I feel there's much more to the story and until lots and lots of follow-up studies are done I'm not convinced. Hell, these dudes are saying that you can be lean and mean (totally fit) and still have a much higher chance of death if you rest watching the F'n TV. And the numbers are STAGGERING.

I think it was Carl Sagan that used to say "Extraordinary claims require extraordinary evidence"; correct me if I'm wrong; but one study in a journal with an obvious bias just isn't enough to scare me. Now if you'll excuse me I'll watch that rerun of last tango in paris.

Ack - this issue was "patched" in the 80's. Please keep up with technology improvements. See the section entitled "Common Misconceptions About Pacemakers" at http://circ.ahajournals.org/cgi/content/full/105/18/2136 Circulation is one of the main Cardiology Journals Dr. Kenneth Ellenbogen has authored one of the basic textbooks on cardiac pacing. He is one of the authorities in this business.

My partner was an ICU nurse and used continuous flow VADs (Ventricular Assist Device) for years.

Here's an article from 2000: http://circ.ahajournals.org/cgi/content/abstract/circulationaha;101/4/356

There is some controversy about continuous flow, but the notion is that most of the body experiences nearly continuous flow, anyway.

Implanted continuous flow notes from April: http://www.ncbi.nlm.nih.gov/pubmed/19324130

And another from 2008 implying that pulseless does not matter:
http://www.ncbi.nlm.nih.gov/pubmed/18442710?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed

1. I don't know why you insist on calling his moral considerations "misplaced." He stood on them. He said he would. Good for him. I'm glad he was honest enough with himself to actually say when he thought a human was, in fact, a human life.
2. You appear to be suggesting that the U.S. is the only place that really good research can happen. As far as I know, many countries have allowed embryonic stem cell research and not a whole lot has come out of the research in terms of medicinal uses. Either all other countries stink at research, or there is some truth in the idea that embryonic stem cell research isn't all that it is hyped to be.

Yes, hype. That is what I call promises of very great gain with no real evidence of said great gain. It's marketing, advertising, and hype. Do embryonic stem cells have medical potential? I don't know. I don't think many people know, if any. I do know there have been cases of stem cells (offhand, not sure if they are all adult or not) being rejected by the host. If that's a major issue, then embryonic stem cells wouldn't have much use outside of trying to heal the embryo they were taking from.

Short summary: it seems like adult stem cells are ahead in the race and have a significant advantage, medically: you can get them from the patient, you don't have to worry about someone else's stem cells being rejected by the host.

Once you've got the PDF, go to page 7 of the document (page 1087 in the printed journal). Right hand column, second paragraph reads:

It is reasonable to assume that persons with relatively high daily energy expenditures would be less likely to gain weight over time, compared with those who have low energy expenditures. So far, data to support this hypothesis are not particularly compelling ...

In other words, there are no good scientific studies that prove that exercise leads to weight loss.

Of course, exercise is good for you. But it won't help you lose weight.

So there. The big authorities (who surprisingly enough show scientific integrity) have said it.

Ah, you're right I should have read the actual paper. The fact remains though, that similar treatments are being performed on humans in countries with less stringent standards which makes mouse studies somewhat less exciting but, of course important.

Triple my bodymass in grams of protein is 726.75 grams of protein.

Sorry. 2.5x the "high protein" diet.

Back to your enumerated points (I'm focusing on your ridiculously-off-the-charts-high-protein/low carb/low fat diet)

Do you have Inuit genetics? Whoops.
Do you eat large amounts of seal blubber and other fats like the Inuit? Whoops.
Do you eat the mere ~100 grams of protein and ~200 grams of carbohydrate that the Inuit eat per day? Whoops.
Do you have Maasai genetics? Whoops.
Do you eat the very high-fat diet of the Maasai -- so high fat that a common treat for kids is fat boiled in water? Whoops.
Do you have Bantu genetics? Whoops.
"Northern" and "Southern" indians are not technical terms. Whoops. Did you mean to refer to a particular study or were you pulling that out of a hat?
Do you have any native american genetics from any group? Whoops.
Are you of the mistaken notion that people of different genetic makeups process foods the same? Big whoops. (ever heard of "lactose intolerance"? "Lactose tolerance" is an evolutionary adaptation developed in cultures whose diet included dairy. Cultures adapt to their native diets)
Have there been a ridiculously large number of studies on the negative effects of saturated fats? Whoops.

My average training week includes 30mins of weight lifting upon waking, 1hour of training for lunch, and 1 hour of weights/football/throwing everyday for 4 weeks.

That's it? You eat 600 grams of protein per day and that's all you do? For God's sake!

Look, you're free to destroy your body against the recommendations of all major medical organizations who've commented on high protein diets (and by "high protein", they're typically talking about 1g/lb, not 2.5g/lb). But don't try and pretend that it's somehow natural or good for you.

Cocaine is actually one of the safer stimulants out there (compared to its main rivals, crack and meth, which emerged due to cocaine's astronomical price thanks to prohibition).

Well, not having read the study I can not comment on its significance; however, there is far more to blood transfusion dangers than NO depletion.

Lets get to some significant points: NO is produced locally at the tissues that need it.

• AHA
• jbc
• If u need more

RBC fragility is likely more significant than the effects of one vasodilator

Multiple unnecessary (or necessary) transfusions may lead to iron overload similar to that found in people with hemachromatosis

TRALI

I am not attacking their work, but there are so many other reasons to be vary of transfusions - the significance of this one seems like it would be minimal, but I do applaud their work in trying to minimize complications of transfusion.

Despite the fact that you've been modded into oblivion, I'll respond because it's a fairly common belief that people with heart problems requiring a pacemaker are always restricted in terms of their cardiovascular activity. In fact, pacemakers are often prescribed to treat symptoms such as exercise intolerance, and the patients who have them can often exercise just as vigorously as anyone else (barring other physical problems). A quick googling turned up this American Heart Association paper which details many of the common misconceptions associated with pacemaker use.

First off, a public service announcement. The current guidelines (which are actually backed up by some pretty good science) are a ratio of 30:2 compressions to breaths. Another important thing to note is that the rate of compressions is 100/min. This is faster than you think and believe it or not is incredibly difficult to do. For the tempo, think "Another One Bites the Dust" (and pardon my irony).

Ok, now on to the reasoning behind the change. ("Well, I could explain it better, but I'd need charts, and graphs, and an easel.") Essentially, the flow of blood through the arteries and into the myocardium requires the creation and maintenance of a pressure head. Research has shown that it takes about 5-7 compressions to create that pressure head, and every time you stop pumping, you lose that pressure. Now only when this pressure head exists is oxygen being delivered to the myocardium, thus any time you stop pumping, you're creating a period of time in which oxygen is not being delivered. And apparently 30:2 was the best ratio for oxygenating blood in the lungs and delivering blood to the heart.

Here's the official guidelines and all the studies behind them in all their linky goodness. http://circ.ahajournals.org/content/vol112/24_supp l/

I'm not sure if the guidelines vary by country, but the U.S. guideline was 15 compressions for every 2 breaths (5 + 1 if two people are working). The guidelines were changed to 30 + 2 at the end of 2005. The reason for the change, as others have mentioned, is that the circulation of blood is most important. Rescue breathing takes time, is harder to do correctly than chest compressions, and takes time (consider it an operational overhead). Also, the compression of the chest causes some air movement on its own, though it is shallow.

The AHA's current guidelines page is here. A good quick summary for recent changes is the 'Summary of Changes' document which covers the changes from community to skilled provider CPR. http://www.heart.org/presenter.jhtml?identifier=30 35517

When big changes in the AHA guidelines happen, they are usually published in a special edition of Circulation. That has the details ad nauseum. http://circ.ahajournals.org/content/vol112/24_supp l/

Before I was an ER physician, I was an EMT. I didn't have as much clinical information as I do now, but I was able to think for myself. One particular event comes to mind... in the book Brady Emergency Care (the text for most EMT courses) it tells you that if possible, if the person has vomiting or diarrhea, you should try to transport the effluent to the hospital.

I was stuck working with another EMT who was (literally) a sorority girl who was a sophomore pre-med at UNC. We were up in the back woods of Orange County (20 miles and 50 years from Chapel Hill) and had a call at a house with no indoor plumbing. The teenage daughter had a bad stomach flu. Unfortunately without a toilet, the family facilities (in winter) was a 5 gallon plastic cement bucket on the back porch (filled about 2/3 full with excrement of various family members.) Ms Alpha Kappa Dumbass decides we must take the bucket of shit and piss to the ER. Arguing with her that A) their were multiple samples of people's shit in said bucket, B) the bucket would spill and smell on the 20 mile ride, and C) no ER nurse would ever let me live this down if I walked in with that bucket'o'turds.... were all quite meaningless in light of her photographic memory of Brady Emergency Care's dictum.

Ultimately I just gave up and told her I would drive, she could do what she wanted, but if that shit spilled SHE would clean it up.

The predictable thing happened, and by arrival at UNC Hospitals, we had a 1/3 full cement bucket which had been 2/3 full. Ms Alpha Kappa Dumbass (now smelling of shit to high heaven) marches in with the bucket and the stretcher. I was literally physically incapacitated and had to sit on the floor as the triage nurse had the most entertaining (yet incredibly short) conversation with this idiot.

The morals of this story are that 1) you are better off knowing why you are doing something than memorizing rote procedure and 2) someone who thinks things through rather than carrying 3 gallons of shit and piss to the ER is the one that gets to take an hour lunch break while the unit is 10-7 as the ignorant sorority chick gets to scrub shit out of the ambulance. Same thing with this argument. You are better off with a thinking EMT helping you who will be able to take basic concepts and expand them to fit the situation.

In addition teaching that a protocol that is at best evolving to be somewhat evidence based is infallible will make it a while lot harder to retrain people if they think they learned the absolute truth a decade ago.

-Nick

First, while this one study was not an RCT, there are RCTs that give similar results in the same direction. This one was just the study that got press (likely because it was the first big one published after the AHA changed the CPR guidelines.) The data from the King County Washington group come to mind immediately, but there are other studies that show the same thing.

Second, while airway is important in cardiac arrest, it is less emphasized according to the new AHA ACLS guidelines. For example, with the VF/pulselessVT/asystole/PEA algorithm, intubation of the trachea takes a lower priority. In the words of the mothership about treatment of pulseless arrest: "Insertion of an advanced airway may not be a high priority," from the AHA's 2005-6 update: http://www.americanheart.org/downloadable/heart/11 32621842912Winter2005.pdf

Or if you want the original article from Circulation: "Thus, during the first minutes of VF SCA the lone rescuer should attempt to limit interruptions in chest compressions for ventilation. The advanced provider must be careful to limit interruptions in chest compressions for attempts to insert an advanced airway or check the rhythm." http://circ.ahajournals.org/cgi/reprint/112/24_sup pl/IV-51

So even with in-hospital arrests, during the first few minutes which determine in large part whether a patient survives neurologically intact, being aggressive about securing the airway may be misguided. I think I am pretty facile with a laryngoscope, but it is still a good 20 seconds of interruption of compressions to intubate, more if its at all difficult. Those 20 seconds may make the difference, so intubating *after* ROSC may be a better option. If they don't have ROSC in 10 minutes, it is unlikely that intubation will help anyway.

Lastly, even if the absolute risk reduction was small, why not do the kind of CPR that gives you the slightly better outcome and exposes people to less risk of communicable disease? The couple of times I've done CPR au natural, it was just about the grossest thing I've ever had to do.

Nick

sorry to say but this was in the 2005 guidelines , also if you took an Emergency first response course in the last 6 months you'd also be trained that 30 compressions followed with 2 breaths less than 1 second each, and if you took the AED portion you'd see that early defibrillation with an AED will help more more so.

• DCA and a related chemical TCE were both found to play a prominent role in creating liver cancers with DCA accelerating the growth rate of liver cancer

• Later research found that DCA and its metabolites may have different roles in the cancer process and that dose-response is very non-linear because DCA inhibits its own metabolism.

• DCA has such serious side effects on the human nervous system that in a recent study 15 out of 15 test patients had to be taken off experimental DCA treatment because of toxic neuropathy and the study was terminated early.

• DCA has been found to prevent and reverses pulmonary high blood pressure

http://www.circ.ahajournals.org/cgi/content/full/1 09/25/3106

While men and women are roughly equal in heart disease totals, men are still twice as likely to have a heart attack. A fact unaccountably omitted by the site you cited. Statistics -- check out tables 15A and 15B.

>the "secondhand-smoke" hysteria genuinely was shoddy pseudoscience

Reading carefully, it looks like this might have been speaking hypothetically. If not:

Are you referring to the peer-reviewed EPA report EPA/600/6-90/006F, or to the Surgeon General's report on second-hand smoke, or to the National Cancer Institute, or to the articles in this bibliography, or to the Journal of the American Medical Association, or to the American Heart Association, or to another article in the Journal of the American Medical Association, or to the British Medical Journal?

Have you ever tried it? Just google for "dog blood pressure". Other studies also showed that the mere presence of a dog during a meeting led to fewer "pissing contests" between meeting participants, and more productive meetings, even if all the dog did was sit curled up in a corner ignoring everyone. Not having a pet in the office is costing businesses billions a year in sick days, lost productivity, extra medical costs, etc.

http://hyper.ahajournals.org/cgi/content/full/38/4 /815 American Heart Association: Pet Ownership, but Not ACE Inhibitor

Therapy, Blunts Home Blood Pressure Responses to Mental Stress

Abstract---- In the present study, we evaluated the effect of a nonevaluative social support intervention (pet ownership) on blood pressure response to mental stress before and during ACE inhibitor therapy. Forty-eight hypertensive individuals participated in an experiment at home and in the physician's office. Participants were randomized to an experimental group with assignment of pet ownership in addition to lisinopril (20 mg/d) or to a control group with only lisinopril (20 mg/d). On each study day, blood pressure, heart rate, and plasma renin activity were recorded at baseline and after each mental stressor (serial subtraction and speech). Before drug therapy, mean responses to mental stress did not differ significantly between experimental and control groups in heart rate (94 [SD 6.8] versus 93 [6.8] bpm), systolic blood pressure (182 [8.0] versus 181 [8.3] mm Hg), diastolic blood pressure (120 [6.6] versus 119 [7.9] mm Hg), or plasma renin activity (9.4 [0.59] versus 9.3 [0.57] ng mL-1 h-1). Lisinopril therapy lowered resting blood pressure by {approx}35/20 mm Hg in both groups, but responses to mental stress were significantly lower among pet owners relative to those who only received lisinopril (P<0.0001; heart rate 81 [6.3] versus 91 [6.5] bpm, systolic blood pressure 131 [6.8] versus 141 [7.8] mm Hg, diastolic blood pressure 92 [6.3] versus 100 [6.8] mm Hg, and plasma renin activity 13.9 [0.92] versus 16.1 [0.58] ng mL-1 h-1). We conclude that ACE inhibitor therapy alone lowers resting blood pressure, whereas increased social support through pet ownership lowers blood pressure response to mental stress.

http://whyfiles.org/shorties/cat_stress.html

As the experiment began, the subjects started controlling their blood pressure with lisinopril, an inhibitor of angiotensin converting enzyme (ACE). Although lisinopril reduced systolic pressure to an average of 123 mm, it was far less effective in controlling the rise in pressure that occurs during stress.

Better than drugs!

At the outset, half the broker-guinea pigs were directed to choose a cat or a dog as a pet. The fun part came when these guinea pigs were asked to do mental arithmetic -- or (we love it!) -- to respond to an experimenter who, posing as a client, demanded: "Upon your advice, I lost $86,000. What are you going to do about it?"

The demand stressed the non-pet owners enough to essentially cancel the benefit of the ACE inhibitor, Allen says, yet the systolic pressure among pet owners rose only 9 mm. Furthermore, their pulse rose by 10 beats per minute, less than half the 21-beat rise seen in the control group.

In other words, pets were much better at reducing the stress-induced rise in blood pressure than the drug.

http://www.wcanews.com/archives/2000/Feb/feb00j.ht m

Pets prove better than drug for high blood pressure

High blood pressure has become one of the most common health problems in the country today, a byproduct of high-stress and poor diet. To correct the problem, many medical doctors have turned to drugs, such as ACE inhibitors.

If you're alone with the victim, do what you can for him immediately, then haul ass to the closest point to call 911.

optimus2861 is correct, but to clarify this, if you're alone with an unresponsive adult, haul ass to call 911, then come back to do what you can for him (rescue breathing, CPR, defib with AED).

Ref: 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - Part 4: Adult Basic Life Support - Section: Adult BLS Sequence

Interesting question. What they call "Blood, Injury (and Injection)" phobia is actually rather different from other phobias. Most specific phobias produce anxiety and the desire to fight, flee or freeze. BII phobia causes a brief anziety-type reaction followed by light-headedness and sometimes loss of conciousness (syncope). A paper published in Circulation (a journal of the American Heart Association) suggests that it is not a "phobia" at all, but a different type of condition related to neural circulatory control. Text and abstract are here: http://circ.ahajournals.org/cgi/content/full/104/8 /903

While you're quite right that there is a particular risk of VF at frequencies similar to some of the neurosystem's natural heart control signal frequencies, there's a more important consideration:
      AC at 50-60 Hz and 110 to 240 V still allows nerve impulses to transmit during the flat parts of the cycle so a person grabbing a line doesn't have their muscles lock, and can swiftly let go. DC in typical transmission ranges can override muscle control. Typically, the person is either somewhat protected, by being thrown forcibly away from the voltage source by their own muscle contractions, or becomes locked to the current source by their own grip and is electrocuted by sustained exposure. Chances are relatively close to 50/50 for either. Even being thrown by the current is not necessarily non-lethal, as muscle contraction in such cases has been known to break bones or damage internal organs, but being locked on for such time as it takes for someone else to cut power or breakers to engage is very frequently lethal.
        Incidentally 50-60 Hz isn't the right frequency to cause ventricular fibrilation, it's just one of them. Low number multiples of the patient's pulse rate (typically the stress accelerated rate, since grabbing a live wire tends to count as an adrenaline booster) will produce much the same effect if they happen to be close to exact whole number multiples. (That's a range from about 8 to 40 Hz., with several peak risk points in it that vary by person)
        If this paper is correct in its suggestion about overlapping pressure waves being the underlieing mechanism, and if what applies to pigs applies equally to humans, higher frequencies should also be just as dangerous at roughly similar total power imputs, probably (just my guess) for at least to 200 Hz. or so before the extrapolated relationship is likely to break down.
http://circ.ahajournals.org/cgi/content/full/102/1 3/1569

A portuguese link don't help too much =)
Not only Brazil doed that before India, Texas Heart Institute use this type os treatment on experimental scale.
Here the links.. googled in few seconds:
http://www.tmc.edu/thi/stemart1.html

http://circ.ahajournals.org/cgi/content/abstract/1 07/18/2294

http://sfgate.com/cgi-bin/article/article?f=/n/a/2 005/02/02/international/i180707S22.DTL&type=health

Man.. don't take this too serious.. Times of India editors do not like to lost time doing resarch berfore publish someting.