The Eccentric Lipidologist Revealed

What’s a lipidologist? Well, immediately we can see that the term’s Latin roots indicate that a lipidologist is someone who studies lipids. Ah, lipids: the dreaded cholesterol, et al. That seemed simple enough. A friend told me that a lipidologist practiced in Santa Fe, the only one in the whole state of New Mexico.

Okay, it’s a small state, population around 2 million, about half that of the city of Los Angeles, California. Only about 400 lipidologists work in the entire U.S. Why are they so rare? After all, blood lipids are a big deal these days. Interestingly, there is very little information in Wikipedia’s entry on Lipidology.

Despite its simple bad reputation, cholesterol is far more complicated than a mere matter of suppressing “bad” cholesterol and supporting “good” cholesterol in the bloodstream. The drug companies have worked hard to popularize the idea that cholesterol is “bad.” We produce cholesterol in the liver and we ingest it in the food we eat.

So, why do they cast cholesterol in such a bad light? Think drug company profits. I won’t get into the complex disputes over the efficacy and dangers of statin drugs in attempting to control cholesterol in the bloodstream. Or the role statins play in minimizing the risk of plaque building up in the coronary arteries. Suffice it to say, it is not all science.

artery.crossectionPicture to the left is a  Micrograph of an artery that supplies the heart showing significant atherosclerosis and marked luminal narrowing. Tissue has been stained using Masson’s trichrome. As Dr. M. explained, old plaque is scar tissue, and may not necessarily cause such blockage. High performance on a stress test indicates no blockage of cornonary arteries. Unlike new plaque, old plaque does not flake off, risking heart attack or stroke, unlike new plaque. However, both contain calcium, so measures of plaque do not distinguish between the two. So, you can have a very high score for plaque, pass the stress test indicating no blockage, and have low risk. Yet most cardiologists don’t make such distinctions; they just prescribe statins. If my arteries looked like the one in the picture here, I could not have passed the stress test with ease, as I did.

Dr. M. occupies a modest office in the local cluster of medical practices near the only hospital in Santa Fe. When I went to see him, he seemed in no hurry and spent an hour and a half with me. We had a very informative (for me) conversation about heart disease, medical practice, and the flaws of scientific practice in medicine in the U.S., where so many decisions are controlled by the insurance companies and where medical practices are dominated by the drug companies – otherwise known as “Big Pharma.”

When Dr. M. described the complex of bio-chemical, genetic, environmental, and behavioral elements that are involved with the multiple variable factors in the way cholesterol acts, I was impressed. No cardiologist had ever mentioned any of this stuff to me. It had always been a simple, “if your LDL is too high, take [the latest statin drug].” End of story.

The practice of medicine is too often a high-volume assembly-line operation that executes the “standard of care” in conformity to the specifications of Big Pharma and the medical insurance industry. Dr. M. does not play that game. He and a few other practicing medical scientists carefully measure the complex of interacting factors that may be at play in each individual and adjust treatments based on re-testing of bio-chemical and genetic factors and patient characteristics. Such doctors epitomize the scientific practice of medicine.

Medicine, it seems to me, should involve the scientific study and practice of treatments, traditional as well as modern, of potential benefit to patients. It requires carefully testing the efficacy of each treatment for a particular problem and adjusting treatment to the conditions of the individual patient. It is far more labor intensive than simple prescribing pills in accordance with the “standard of care.” I know only one lipidologist, but if he is representative of others in the specialty, then lipidology represents the best practices in medicine.

Lipidology is to the “standard of care” in cardiology as prostate oncology is to the “standard of care” among urologists, who are surgeons.

Public Renaissance: What Ebola, Ferguson, and Finance Can Tell Us

Public concern over the possible spread of the Ebola virus epidemic from West Africa to the U.S. is growing. While the Centers for Disease Control (CDC) is taking various precautions, the situation is nevertheless of sufficient complexity to warrant concern. The outrage over the police killing of unarmed black teenager Michael Brown continues as a grand jury takes its time mulling over evidence. The Wall Street pundits on CNBC and the corporate economists claim the economy is turning around, yet most people are having trouble feeling it. What do these seemingly disparate events have in common?

It’s really quite simple. Each of these situations represents a larger problem that pervades our society. Ever since the Reagan presidency, well, ever since the economic reforms following the Great Depression, the power elites have tried to wrest economic and political control from the citizenry. The push to privatize public functions has succeeded in reducing the public interest in social and economic conditions to an afterthought. Importantly, these are only three examples among many. The corporate controlled political culture has carefully failed to recognize the public interest as a legitimate concern for citizens. Meanwhile, the cult of “free market” extractive economics has raised the specter of private greed to a nearly religious status.

Privatizing Public Health
The interest in public health as a concern for the entire society is almost universally recognized bymost nations, even those unable to provide adequate health resources. Universal healthcare is found in nearly every ‘advanced’ industrial nation, except in the U.S.A. With far lower costs, Europeans produce far better health outcomes for their citizens than we do and nobody is excluded. On many indicators of health and well being, we are down toward the bottom of the rankings. Further, in the interest of privatizing every public function imaginable, our politicians have been cutting budgets for the CDC and other public health institutions. But wait, there’s more.

Since the entire U.S. medical sector is organized around private profit for doctors, hospitals, insurance companies, and the pharmaceutical industry, only drugs deemed able to garner very high prices are developed. Flu vaccines are widely available in the U.S., since they are promoted by every medical institution and drugstore in the nation, subsidized by the federal government and profitable for Big Pharma. Ebola has been around for years. Some effort was made to develop a vaccine, but it was abandoned; little profit was projected. Public policy has not been driven by the public interest.

Jim Crow Law Enforcement
Ferguson is a symptom of a national failure to shape law enforcement policy in the public interest. Similar situations abound nationwide. Several trends converge to implement a destructive pattern resulting in what is best described as Incarceration Nation. The New Jim Crow, as aptly described by Michele Alexander, has created a caste of economically exiled men of color. The so-called war on drugs has been a war on young people of color prosecuted by increasingly militarized police targeting vulnerable neighborhoods.

Police no longer serve the public interest; they serve their interests in gaining funding and military equipment useful only for controlling an enemy population. The citizen is the new enemy and the police are the occupying force, as SWAT teams even serve minor warrants by heavily armed home invasion – innocents die. The bifurcation of police and public is palpable. Only a massive reorganization of police from top administration to recruitment, education, training and strict accountability of officers can come to serve the public good.

The Banksters and the Booty
The history of money is a mystery to most Americans. So is its current incarnation. But the essence of money is its function as a public medium of exchange. In societies where money is/was issued by the government to facilitate exchange of goods and services, economies have operated with stable prices and little taxation. Where money creation has been handed over to privately held central banks, governments have gone deeper into debt and taxes have grown to pay this arbitrary public debt.

The Federal Reserve Act of 1913 put the U.S. on the path of a debt-based money system. Instead of issuing money for public purposes, the government still borrows money from the central bank it authorized to issue money. There are many other absurdities in the U.S. debt-driven economy, but the basic problem is the same. A fundamental public function – issuing and managing the money supply for the nation – was given to a privately held central bank, which extracts booty in the form of interest and fees for the money it is allowed to create from nothing in its electronic accounts. Only public banks will manage money to serve the public interest.

Public Institutions for the Public Interest
Health, law enforcement, and the economic policies, among others, are three core elements of society that are inherently public functions. Their ‘privatization’ incurs extra costs and destabilizes the economy. In each of these areas, and others, we need public control over decisions in order to serve the public good. Until these important functions are returned to the people and their government, the plundering of the commons will continue.

Some Serious Social Illusions

It’s hard to accept the idea that most human activities are based on illusions.  But look at the nature and kinds of illusions out there.  Some illusions are necessary and good, while others are quite destructive.  We tend to see the illusions of tribal cultures as “myths,” illusory fictions about the world, whereas we see our beliefs as real.  But what’s the difference between the Native American’s image of the origins of “Turtle Island” and the biblical creation story?  Both are creation myths (stories around which a people organize their understanding of life) and they serve mostly the same purpose in their respective cultures.  Some myths conflict directly with scientific evidence, such as the idea that the earth was created four thousand years ago and that man walked with dinosaurs, or that recent and forecasted unprecedented climate disruption is unrelated to 200 years of accelerated emissions of CO2 into the atmosphere. Well, in these cases, the evidence just conflicts with the myth.

Some illusions conflict with reality because they are more detached from our everyday lives; others are consistent with everyday observations.  Yet, the idea that society operates on illusions points to some other kinds of phenomena.  Social illusions are mental constructions that are used as a means of interacting with the lived world.  They appear to be real because they are consistent with our experience and help guide our actions.  But our experience may also be constrained by those illusions – that’s where we get into trouble.  For tribal peoples who have lived in a particular stable ecological context for many generations, the social illusions they use work for them, or else the group would have died out.  Today, in our far more complex societies – really, our complex world financial and industrial system – social illusions that are so abstracted from our experience and observations, and are controlled by powerful institutions, can get us into very serious trouble.

If our ideas conflict with the environmental conditions under which we live, then the result can be detrimental to our survival.  Think of the Mayans, the Easter Islanders, the Norse in Greenland, or the collapse of other societies that Jared Diamond so presciently described in Collapse: How Societies Choose to Fail or Succeed.   The Mayan “chronic emphasis on war and erecting monuments rather than on solving underlying problems,” is more prophetic than recent speculations about the meaning of their calendar.  While the ecology could sustain it, Mayan illusions worked well as the abstractions around which the society was organized.  The economic illusions of our waning industrial age worked rather well until growth got out of hand; now they confront contrary conditions of planetary ecology.

Certain groups in the deep jungles of the Amazon hold complex views of the nature and uses of certain plants.  These ideas have been worked out over many generations and result in an indigenous pharmacology that works because it is precisely integrated with the conditions of jungle life and the properties of those plants.  But for the university trained pharmacology researcher, the native conceptualization of such plants may be considered misguided (unscientific) illusions.  Through laboratory research the western professional can isolate certain molecular compounds key to the medicinal benefit of the plants.  Oh, boy!  It’s patentable-profitable!  The abstractions each believes best represent reality may or may not work depending on the environmental context – the jungle or the economics of Big Pharma.

So, who is right?  Both illusions work for their respective adherents within the right context.  What?  Yes, the pharmacologist’s ideas are illusions too.  In this sense, I am using the word to indicate that illusions can be defined as particular conceptual packages that represent our experiences in the world and that what’s an illusion within one framework is a fact within another.  So, let’s just call them all illusions for simplicity and examine their usefulness and veracity separately.  We can thus state that all human imaginations regarding reality are illusions, because none are reality, they merely represent reality in the abstract.  Seriously.  If we can make that leap and recognize that all images and concepts we have about reality are not reality but illusions that represent reality well or poorly, it will be easier to evaluate each one on, dare I say it, a realistic basis.

Now, that is where ideology comes in.  All illusions reflect in some way the interests people have in their reality, or more accurately, in those aspects of reality that interest them.  So, we are not so surprised to find that the executives of the giant multinational oil and gas companies are not so interested in the fact that peak oil production has already occurred (2005) and that world production has flat-lined ever since – except to the extent that they can temporarily use “fracking” to forestall the inevitable decline in supplies – which raises society’s obvious need to contemplate energy-source substitution.  Their financial interests lie in keeping the focus of energy policy on more exploration and production – not on the catastrophic effects of climate disruption on the rest of us – even as the fruits of exploration rapidly diminish.  The seriousness of their illusion is to be found in its effects on survival of our species on the planet.

Nor do we really expect the Big Banksters to give up their control of the real economy they so handily manipulate by using the money system, or to give up the continued promotion of their illusion that the vastly expanded abstract debt-driven system of financial expansion is somehow the core driver of the real economy.  The seriously damaging illusions promoted by financial, petro-chemical, and industrial-military elites all merge into the political-economic illusions of permanent prosperity through imperial expansion and endless economic growth in a finite world of rapidly diminishing environmental resources.  Sometimes it’s too easy to believe in magic, especially when the prestidigitators so totally control the illusions.