The Arrow #175

Hello everyone.

Greetings from Dallas.

(Okay, here we are. I was able to salvage most of this week’s Arrow. I lost a bunch, but I’ve been recreating it for the last hour, so you’ve got an actual full newsletter this week. Sorry for all the hassle and the interim short pieces—I just didn’t know if I could recover any of what was missing, so I wanted to let folks know what was going on. Whew!)

Well, I screwed up last week with the poll. I don’t know how I did it, but I managed to make the five-star selection in bold instead of making it clickable. It’s amazing that that was the only major screw up given my jet lag and all the troubles that befell me in trying to get the whole thing written. The airports and the airplanes seemed to conspire against me, so I couldn’t get it finished until I got home.

I mentioned that I had written a rant about the whole experience, but had taken it down. I figured people were tired of reading about all my adverse experiences. A handful of people in the comments, in the poll responses, and even in emails wrote that they would like to have read it. Well, I saved it and stuck it in Dropbox, so those who do want to read it can read it here. Should you choose to read it, just remember I wrote it when I was white hot on the plane. My Mac was running out of juice, the internet was not functional, and the charging outlets on the plane were dead.

Okay, on to better things. It’s a new week, and I’m not jet lagged. My Stripe account seems to be working as it should, so all is right with the world.

Freak of Nature

Part one

I just read a long article in the Wall Street Journal about all the heavy rains that have been pouring down the world over. (And here I thought it was just in Montecito, where it almost never rains.) The absolutely freakish thing about this long article was that it did not use the term “climate change” once.

It did talk about the warming that had been taking place over the last 8-9 months, but did not refer to it as a function of climate change. The writers mentioned weather systems and discussed how the atmosphere can hold more water when it’s warm than when it’s cold.

Most freakish of all is the title of the article: The Science Behind Why the World Is Getting Wetter. It just begs to be about climate change. I figured it was, but kept reading and reading and reading. And no mention whatsoever.

I doubt you could find an article of this length on this topic in any mainstream media publication and not trip over the phrase climate change at least a dozen times. It truly is miraculous.

Here’s how it starts:

Deadly dam bursts in Kenya and Brazil, a highway sliding down a mountainside in southern China, desert airport runways underwater in Dubai, mining pits flooded in Australia: Large parts of the world are awash.

Extreme rainfall and killer floods that have struck around the globe in recent weeks have been unexpected both in their location and power.

Combined with infrastructure unprepared for such deluges, the intense rains have caused death, destruction and mass evacuations on several continents.

The powerful downpours are the result of natural weather patterns being supercharged by a record-breaking year for global temperatures.

As the globe gets hotter, it is getting wetter too. Simply put, the warmer the air, the more water it can hold.

But what’s really amazing is the next paragraph. Almost unbelievable.

Scientists still don’t know whether this yearlong record global heat—and the downpours that accompany it—amounts to a statistical blip, or requires a recalibration to a warmer, wetter future that will test national infrastructure, raise insurance premiums and complicate global food production. [My bold]

“Amounts to a statistical blip.” Would that explanation show up in this same article in the New York Times? If you think it would, you don’t spend much time reading that paper. “Climate change” would be in every other paragraph.

There are multiple authors of this article from all over the world, and I just want to give them credit for writing it in such a straightforward way without knuckling under to The Current Thing. I don’t know if it was the authors or the editor, but in either case I thank you.

I encourage you to read the whole thing just to see how journalistic articles should be written. It’s really pleasant to learn and not be inundated with ideology.

Part Two

Then we come to the article below in another section of the same paper. And it’s back to what we all would consider normal journalism today. The article is much, much shorter than the one above, but “climate change” appears three times along with a number of its kindred expressions, i.e., “the planet warming,” “climate capitalism,” “environmental disaster,” and a handful of others. All these expressions identify the author as being in the firm grip of The Current Thing.

The article isn’t about the weather. It’s about coffee, of all things. And not even real coffee, but artificial coffee. And about how we’re all going to love it because a) it tastes really good, and b) it’s good for the planet, i.e., it thwarts climate change.

Here’s how the article titled Why You May Soon Be Drinking Synthetic Coffee starts:

Your typical morning cup of coffee is a social and environmental disaster—but you’ll soon have the option to start sipping something less harmful: synthetic coffee.

Worldwide, people consume two billion cups of coffee a day. Given that the average Arabica tree produces only one to two pounds of coffee a year, that means every two-cup-a-day coffee drinker requires continuous production from around 20 coffee trees.

The intense demand for coffee has driven mass deforestation, poverty wages for farmers who see little of the rising prices for their commodity, and substantial carbon emissions due to both production and long supply chains. Research suggests that around half of the land best suited to growing coffee will become unsuitable for that purpose by 2050, thanks to climate change. In Brazil, that figure reaches 88%.

For all of these reasons, at least a half-dozen companies are using biotechnology and food science to replace the coffee in your cup with something that lacks all that baggage, and isn’t nearly as vulnerable to climate change. This pseudo-coffee can be made from a variety of ingredients, including chickpeas and “upcycled” agricultural waste like date pits. Other approaches use lab-grown cells from actual coffee plants. Companies like Voyage Foods, Minus Coffee, Atomo, Prefer, Stem and Northern Wonder have all either begun selling, or are working on, so-called beanless coffee alternatives. [My bold]

Looks like something you might read in Mother Jones instead of the Wall Street Journal, doesn’t it?

If this author is correct—and I have my doubts—given our coffee consumption, MD and I are alone swilling the output of about 70 Arabica trees each year. As I say, I have my doubts.

The author is apparently thrilled with the whole idea of synthetic foods as he discusses fake Nutella for sale now at Walmart.

…Voyage Foods sells a nut-free, cocoa-free Nutella alternative nationwide at Walmart. The company says its spread is comparable in price to “real” Nutella, and is also the lowest-cost allergen-free spread available at the big-box chain.

For people to convert from brands they know, it needs to cost nothing to make a switch, and the replacement needs to taste good, says Chief Executive Adam Maxwell.

He becomes so positively giddy with the notion that there might be a synthetic coffee substitute coming down the pike, he compares the coffee situation with another we’re all familiar with.

In the late 19th century, shortages of butter spurred chemists to find alternative sources of fats. Margarine, shortening and a variety of hydrogenated fats were born from this effort. The result is that today, most consumers don’t expect a box of Chips Ahoy cookies to be made with real butter.

Is it such a stretch … to imagine that in those same cookies, consumers might someday accept that the “chocolate” chips aren’t made from actual cocoa?

Our author is totally excited about these substitutions. These days people don’t expect food to be made with real food. I mean what a travesty. Why would anyone want to use real butter when soybean oil that has been put through the factory, deodorized, and colored can provide the same taste and mouthfeel? And who needs real cocoa in their chocolate chips when some chemical will do the job less expensively.

He is completely oblivious to the health problems incurred when we started using partially hydrogenated fats instead of butter. The same partially hydrogenated fats that are now banned in many places.

But if it’s all in the cause of defeating climate change, it’s worthwhile. I mean what is the health of individual humans when compared to the existential threat of climate change?

Not to be too petty about it, but our author tips his hand about halfway through the article. He describes how a purveyor of fake coffee “brewed [him] a flight of espressos and espresso-based drinks.”

The drinks that were mixed with oat milk—which is how I normally take my coffee—were indistinguishable from those made with traditional coffee beans. [My bold]

It takes a certain type of person to admit such a thing. The man is a virtue signaling soi boi. What else do you need to know?

Two articles, same day, same paper. What can I say?

The New York Times, the Vaccine Overton Window, and an Alternative Hypothesis.

A few days ago, the New York Times published a long, non-paywalled article titled Thousands Believe Covid Vaccines Harmed Them. Is Anyone Listening? about the vast number of vaccine injuries out there.

Before the Times article came out, I had read one of Midwestern Doctor’s missives about vaccine injuries in which he listed a handful of polls looking at the public’s perception of the subject. I’m always on the lookout for vaccine injuries myself, and I read about them all the time. But until I had read these polls, I had no idea what Joe Q Public thought about them.

(I know of a number of people who have died from what appear to be vaccine injuries, but I don’t know anyone personally who has. I had one reader write me about her son dying from what was pretty certain to be a vaccine injury, but that’s as close as I’ve gotten to knowing someone myself who has succumbed.)

In his Substack, Midwestern Doctor summarized the following poll findings:

•Half of Americans believe the COVID vaccines are not safe.

•Half believe the vaccines are causing a significant number of “unexplained” deaths.

•A quarter believe someone they knew personally died from the vaccine.

•34% do not believe the vaccines are effective.

•Around 7% experienced a severe side effect from the vaccine, and 34% experienced a minor side effect.

Note: one of the most important thing about this polling was while that both Democrat and Republicans had different perceptions of the safety and efficacy of the vaccines (since the the issue was politicized), they had almost identical rates of recognizing vaccine injuries in themselves and in those around them—which again illustrates that while powerful, there is still a limit as to what propaganda can make people believe. [My bold]

He provides a link to another Substack of his that links to each of these polls. I looked up and read every one.

Here he elaborates on one of the polls comparing Democrats to Republicans.

In September 2023, 47% of those surveyed stated they did not believe the vaccines were safe and 34% did not believe they were effective. These results also politically stratified as Democrats were less likely to believe the vaccines were unsafe (14% vs. 51%) or ineffective (17% vs. 57%). [Link in the original]

Which is what makes the statistic from the first Substack so stark. Despite their belief that the vaccines were safe, Democrats had rates identical to Republicans in terms of recognizing vaccine injuries in themselves and others.

In his first Substack linked above, Midwestern Doctor writes

These polling results in turn are mirrored by real life data which continues to show a lot of people started dying after the vaccines hit the market and that many more became disabled. Yet, despite this being the biggest story in America, most of the networks won’t touch it. In turn, this has created an unprecedented window for the independent media to flourish and messages which previously went nowhere to suddenly reach millions of people. [Link in the original][My bold]

Not but two days after Midwestern Doctor’s post appeared, the New York Times, arguably the most influential mainstream media outlet in the world comes out with an article about vaccine injuries.

How’s that for timing?

Right after the article came out, Jeff Childers, of Coffee & Covid, came out with his own idea of why the Times, after years of promoting the vaccines and avoiding any mention of the downside of these vaccines would come out with such a lengthy article on vaccine injuries.

You can read Jeff’s whole piece at the link above. I’m just going to hit a few high points.

It’s finally happened: the dam of jab omertà has broken wide open. While you read this morning’s update, remember that one of the New York Times’ primary functions is to referee the liberal Overton Window — what is acceptable for progressives to think about and to talk about.

His piece is vintage Childers, funny but devastating. He writes

The Times’ first expert, a Yale immunologist, admitted what we all know to be true but which corporate media has so far steadfastly ignored, if not outright denied: that vaccine injuries are “just completely ignored and dismissed and gaslighted.” But ignored by whom? And, who is doing the gaslighting? The Times avoided naming anyone in particular.

Rather, the Times went to great effort to highlight the good intentions of public health officials. It quoted former FDA Commissioner Janet Woodcock, safely retired as of February, who mused she wished she’d done more for vaccine injured people:

He then quotes from the Times article:

“I feel bad for those people,” said Dr. Woodcock, who became the F.D.A.’s acting commissioner in January 2021 as the vaccines were rolling out. “I believe their suffering should be acknowledged, that they have real problems, and they should be taken seriously.”

“I’m disappointed in myself,” she added. “I did a lot of things I feel very good about, but this is one of the few things I feel I just didn’t bring it home.”

Childers continues

This is a promising start, but what about the dead? Never mind! Here we find the first serious gap in the article’s coverage. The Times avoided this difficult issue, only briefly referring to possible deaths. But maybe it was too much to expect in this cautious, tentative first step toward officially acknowledging that Houston, we may have a problem.

My goodness! How could all this anti-progressive gaslighting and illiberal lack of sympathy have possibly happened? How can the Times reconcile this long period of denial and deception? Because it’s just so darn difficult to track vaccine injuries, and because we need even bigger government, that’s how:

This from the Times:

The nation’s fragmented health care system complicates detection of very rare side effects, a process that depends on an analysis of huge amounts of data. That’s a difficult task when a patient may be tested for Covid at Walgreens, get vaccinated at CVS, go to a local clinic for minor ailments and seek care at a hospital for serious conditions. Each place may rely on different health record systems.

There is no central repository of vaccine recipients, nor of medical records, and no easy to way to pool these data. Reports to the largest federal database of so-called adverse events can be made by anyone, about anything. It’s not even clear what officials should be looking for.

Back to Childers:

I could give them some ideas of what to look for. It’s not really that hard. But I digress.

You see, covid vaccine injuries are brand new types of injuries, so what can you expect from busy, hardworking scientists? Dr. Woodcock explained, “I mean, you’re not going to find ‘brain fog’ in the medical record or claims data, because it doesn’t have a good research definition.” The former FDA Commissioner insisted, “It isn’t, like, malevolence on their part.”

It’s not like malevolence. It is malevolence. It’s like deliberate institutional neglect. But they meant well. “Federal officials,” the Times explained, “worry that even a whisper of possible side effects feeds into misinformation spread by a vitriolic anti-vaccine movement.” But health agencies’ duty is to pursue the truth, even when it's complex or inconvenient, not to curate a simplified narrative for their perverse perception of an infantilized general public.

Well said.

Jeff’s article goes on in this vein, then hits the point at the end that was the point I hit when I first read the article.

Why are we seeing this now? I’m speculating, a lot, but cynically I sense politics at play. We’re six months out from the election. Who does admitting even partial failure of the vaccine program help, politically, and who does it hurt? The acknowledgement of the reality of widespread, unaddressed vaccine injuries would seem to hurt President Trump the most.

This was my first take when I read the Times article. (Actually, my first take was that I was pissed. The Times article came out the day after I sent the last issue of The Arrow, and I knew I was going to get scooped by everyone.)

As we all know, the Covid vaccines were/are highly politicized. I have somewhere in the bowels of my computer a montage of a half dozen Democrats, including Joe Biden, Kamala Harris, Mario Cuomo, and others saying they would not take a vaccine developed under Trump. (I’ve posted it previously, so if anyone has it at hand, please send it to me.)

The vaccine was totally funded and its development driven by Trump and his administration, so it’s easy to see why Dems wouldn’t like it. But as soon at Trump is out the door, the Dems turn on a dime. The vaccine instantly becomes the best thing since sliced bread and the Dems don’t all just want to take it, they want to mandate it.

If Trump had been re-elected, the Dems wouldn’t have taken the jabs. But once he’s gone, they claim it as their own and mandate it for the military, federal contractors, and anyone else they can coerce into taking it. This turnabout took just a few weeks.

Same vaccine, same development team, different party in control.

Now, just imagine the alternate universe we would all have been living in for the past three and a half years had Trump been re-elected.

Instead of the mainstream media acting as cheerleaders for the Covid vaccines, they would have been publicizing every post-jab illness imaginable as a vaccine injury. All the big social media companies, instead of blocking stories of vaccine injuries, would have been amplifying them. All the doctors and other scientists who were warning against the vaccines would have been guests on all the mainstream media talk shows instead of being canceled.

The Dems and their media friends would have scared everyone off of the vaccines. Trump called SARS-CoV-2 the China virus, because it came from China. And he was called a racist for it. I can guarantee you that what with all the jab illnesses and deaths that we’ve seen, the Dems and the media would be calling it the Trump vaccine. There would have been death clickers on CNN, clicking away every time someone supposedly died from a Covid vaccine.

And just like the Dems vastly increased the number of so-called Covid deaths by including anyone who died with a positive PCR as a Covid death even though they died in a car wreck or from a heart attack, they would have done the same with Covid vaccine deaths.

And Trump, given his nature, would have called it all fake news and would be disputing all the statistics.

If you don’t believe this would have happened had Trump been re-elected, then you were asleep at the wheel while Trump was actually in office.

Which brings me to why I think this Times article came out when it did.

Trump is fending off all these lawsuits right and left. And I think the public believes they are an attempt not to “seek the rule of law,” but to keep Trump from winning the election. He’s surged ahead among many groups who traditionally vote Democrat: Blacks, Hispanics, Asians, and young people.

Here’s my prognosis. And soon enough we’ll be able to see if I am right or not.

It think the Times article is a gentle opening that doesn’t blame any of the agencies involved for anything, as you can see if you read it. But I believe the attacks are going to turn on Trump the closer we get to the election. The media and the Dems will slowly edge away from the idea that any of these excess deaths, vaccine injuries, and vaccine deaths could possibly be the fault of the Democrats or any of the hardworking scientists and public health officials in the various government agencies.

It will be The Donald’s fault instead. Tales will arise about how he browbeat people to cut corners to get the vaccine developed before the election. People will say they tried to tell him it couldn’t be done safely that quickly, but he shut them down.

And Trump will play his role. He’ll persevere to the bitter end that he alone was responsible for the vaccine miracle.

So, here I am, out on a limb. Nice thing is, we’ll know soon enough.

CODA: Maybe I’m already wrong. While waiting to hear back from the platform on my disappeared newsletter, I was going through emails and came upon this one by Matt Taibbi. Most of it is behind a paywall, but you can read enough to learn that the New York Times has a new executive editor who plans to change things. There are plenty of quotes from the new editor before you hit the paywall to see things may be way different than I thought. Here is one in particular. Says Joe Kahn, the new executive editor:

There are people out there in the world who may decide, based on their democratic rights, to elect Donald Trump as president. It’s not the job of the news media to prevent that from happening. It’s the job of Biden and the people around Biden to prevent that from happening.

I guess only time will tell if he hews to that notion.

Terrific New Book

Just about every week I get requests via email, poll feedback, and comments for book reviews. I go through a slew of books every month, but not all of them—in fact, not most of them—are review worthy. I read these books so you don’t have to.

So far this year, End Times by Peter Turchin is still my favorite read, but I’m a quarter of the way through one that may top it. I’m hoping the final 75 percent will be as good as what I’ve read so far.

How Life Works by Philip Ball is a stunner of a book, but it’s probably not everyone’s cup of tea. It is a complex book on the complexity of life. In a way, it is a book on epigenetics, but not totally. The author delves deeply into how various systems operate within our cells.

One of the central tenets of biology was laid down by Francis Crick, co-discoverer along with James Watson of DNA. In 1956 Crick described what he called the “Central Dogma” of biology that describes the direction in which information travels molecularly in protein synthesis. According to Crick—and everyone else at the time—information goes from DNA to RNA to the ribosome where the protein is constructed. Here is a figure from the book showing how it all works:

In short, the gene for a protein sends a signal to mRNA (messenger RNA). mRNA finds a particular piece of DNA, which encodes for the protein, and transcribes that code. Then the mRNA carries that template to the ribosome, an organelle within the cell, and translates it. The ribosome then cranks out the protein.

That’s how I learned it in medical school. That’s how I thought it worked when I was reading and writing about the mRNA vaccines. That’s how probably 99.9 percent of physicians believe it works.

But it doesn’t work that way at all. It is vastly more complex. It is so complex that it requires many pages just to get an overview. The first thing I thought when I read it was how much we are playing with fire by injecting mRNA into people as a vaccine. Once you understand the complexity of the system, it makes you realize how much could go wrong by inserting outside mRNA. (The author hasn’t mentioned the mRNA vaccines in as much of the book as I’ve read so far, so he didn’t tee up the Covid vaccines. I came to my own conclusions based on my new learning of the complexity involved.)

One of the profound statements the author makes is

The popular view that science is the process of studying what the world is like needs to be given an important qualification: science tends to be the study of what we can study. [My bold]

This is an ongoing theme throughout the book. He writes it this time after a long section on the identification of various proteins. He discusses how some lab people are truly gifted in determining the structures of various protein using x-ray crystallography, much like Rosalind Franklin who provided the images of DNA to Watson and Crick. But not all proteins have a crystalline structure, so we don’t know the structure of way more than half the proteins in the human body simply because we have no tools to study them.

I learned of this book from a review in Nature. Since I haven’t read the entire book, I’ll quote liberally from the review.

For too long, scientists have been content in espousing the lazy metaphor of living systems operating simply like machines, says science writer Philip Ball in How Life Works. Yet, it’s important to be open about the complexity of biology — including what we don’t know — because public understanding affects policy, health care and trust in science. “So long as we insist that cells are computers and genes are their code,” writes Ball, life might as well be “sprinkled with invisible magic”. But, reality “is far more interesting and wonderful”, as he explains in this must-read user’s guide for biologists and non-biologists alike.

It’s therefore a huge oversimplification, notes Ball, to say that genes cause this trait or that disease. The reality is that organisms are extremely robust, and a particular function can often be performed even when key genes are removed. For instance, although the HCN4 gene encodes a protein that acts as the heart’s primary pacemaker, the heart retains its rhythm even if the gene is mutated1.

Another metaphor that Ball criticizes is that of a protein with a fixed shape binding to its target being similar to how a key fits into a lock. Many proteins, he points out, have disordered domains — sections whose shape is not fixed, but changes constantly.

This “fuzziness and imprecision” is not sloppy design, but an essential feature of protein interactions. Being disordered makes proteins “versatile communicators”, able to respond rapidly to changes in the cell, binding to different partners and transmitting different signals depending on the circumstance. For example, the protein aconitase can switch from metabolizing sugar to promoting iron intake to red blood cells when iron is scarce. Almost 70% of protein domains might be disordered.

One of the really exciting issues that motivated me to read this book in the first place was the author’s take on evolution as described in the Nature review:

Classic views of evolution should also be questioned. Evolution is often regarded as “a slow affair of letting random mutations change one amino acid for another and seeing what effect it produces”. But in fact, proteins are typically made up of several sections called modules — reshuffling, duplicating and tinkering with these modules is a common way to produce a useful new protein.

And as a believer in agency, the ability to change our own lives for the better, I was really sold when I read of the author’s belief in agency at a cellular level:

Agency — the ability of an organism to bring about change to itself or its environment to achieve a goal — is the author’s central focus. Such agency, he argues, is attributable to whole organisms, not just to their genomes. Genes, proteins and processes such as evolution don’t have goals, but a person certainly does. So, too, do plants and bacteria, on more-simple levels — a bacterium might avoid some stimuli and be drawn to others, for instance. Dethroning the genome in this way contests the current standard thinking about biology, and I think that such a challenge is sorely needed.

Here is the best recommendation I can give this book. It is the only book I’ve ever paid more than $15 for in Kindle. This baby cost me over twenty bucks, which is an all-time Kindle purchase record for me.

As I wrote above, this isn’t a book for everyone. It is quite well written, so I doubt anyone will have trouble understanding it. The question you have to ask yourself before taking the plunge is: Do I really want to know all this stuff in such detail?

I do, and I’m having a ball reading it. And, as a consequence, I’m vastly more knowledgeable than I was just a few days ago. It’s a terrific book and a fabulous read.

Statins and the Adherer Effect

I’ve been meaning to write something about a Medscape article fed to me via email for a few weeks now, but I can’t find the actual article. Those of you who have been reading this newsletter for a while have heard me piteously whine about my appalling habit of keeping countless tabs open. And my inability to find whatever it is I’m looking for among them. On the plane last Thursday after I couldn’t get internet and couldn’t charge my laptop thanks to a dead outlet, I spent the remainder of my laptop battery’s life taking down tabs. I was in no mood to be indecisive, so I cratered a bunch of them.

I just lined up all my open windows in Chrome and stacked them. This is just one browser. I also have Safari, Brave, and Arc open, but you can’t see them in this screenshot.

I’ve tried a bunch of tab-management apps, but none of them does what I want it to do. I’m even paying for a couple of them I haven’t been able to get to work for me like I want them to. I’ve stumbled on to a new one I’m giving a try now. If it works, I’ll let you know.

This long intro is to let you know that despite my having a zillion tabs open, I don’t seem to have the Medscape one I really want. But I do remember the study it mentioned, which was a few years old. Medscape is underwritten by pharmaceutical ads, and despite new studies coming out in the literature every day, Medscape isn’t beyond recycling older studies to help with pharma sales.

I was glad to see the study in question appear because it gives me yet another opportunity to discuss another little-known way to evaluate studies that Big Pharma will never tell you.

The study titled Cardiovascular effect of discontinuing statins for primary prevention at the age of 75 years: a nationwide population-based cohort study in France looked at a cohort of aging patients in France who were free from cardiovascular disease but had been prescribed statins as a preventative. Some of these subjects—all 75 years old or older—took their statins like clockwork while others took them irregularly or not at all. The researchers followed these subjects for an average of 2.4 years to see if there was a difference in cardiovascular outcomes in the regular statin takers vs non- or irregular takers.

What happened? Here is the conclusion from the abstract.

Statin discontinuation was associated with a 33% increased risk of admission for cardiovascular event in 75-year-old primary prevention patients.

So, those who didn’t take their statins were at greater risk for developing cardiovascular disease, right? That’s what the study seems to show.

Let’s back up and take a deeper look. Not at this study but at an older study that is quite enlightening.

Before we go to this older study, let me assure you that all of the randomized trials of statins done years ago showed no benefit in terms of decreased all-cause mortality in elderly people of either sex. In other words, taking statins didn’t make them live any longer.

This very study admits this in the Introductory paragraph:

…the role for statin therapy in primary prevention in the elderly remains a subject of debate, with little evidence for or against its benefit.

Actually, there is a lot of evidence against its benefit determined by multiple RCTs back in the day, but everyone wants to forget about that. If they just keep studying, they’ll finally come up with a benefit. So they think.

Now let’s go back to the results of another cholesterol-lowering trial described in the New England Journal of Medicine almost 45 years ago. In this study the authors re-evaluated the outcome of an earlier randomized controlled trial of clofibrate.

Clofibrate was an early cholesterol-lowering drug, and since everyone believed cholesterol was a risk factor for heart disease, it was thought that lowering cholesterol might prevent heart disease. When the results of the RTC came in, there was no difference in outcome between those patients on clofibrate and those on placebo. After five years, there was a 20 percent mortality rate in those subjects taking clofibrate and a 20.1 percent mortality rate in those on placebo. So, essentially no difference despite the cholesterol levels being lower in the clofibrate group.

The authors of the NEJM article decided to do a deeper dive on the data to see if they could pull out anything the researchers in the original clofibrate study overlooked. What they found was pretty stunning.

I’m sure they were of the opinion that cholesterol was the driving force behind the development of heart disease, so they couldn’t understand how there could be no difference in mortality despite the lowered cholesterol levels in the study group.

When they probed further, one of the things they looked for was to see how many of the subjects on clofibrate actually took their drugs. So they went into the data and discovered that a lot of the subjects didn’t take their drug, or took it sporadically. They compared the outcomes of those subjects who slacked off and didn’t take their clofibrate to the outcomes of those who took it regularly.

And, Bingo!, they found the answer.

Those who took their clofibrate as directed (80 percent of the doses prescribed) had a mortality rate of 15 percent vs 24.6 percent in those who took their clofibrate irregularly or not at all.

Wow! So clofibrate really does work…if you take it. And, it should go without saying, clofibrate does not work if you don’t take it.

Proof that clofibrate works, right?

Well, not exactly.

The researchers went on to look at the control group on placebo and discovered that they—like the study group on clofibrate—were made up of subjects who took the placebo like clockwork and others who didn’t.

When they evaluated the control group, they discovered that those 80 percent who took their sugar pill faithfully had a mortality rate of 15.1 percent just like those who regularly took the clofibrate. And those who were slackers ended up with a mortality rate of 28.3 percent, not that much greater than the clofibrate slackers.

What this study demonstrated—and many after it have confirmed—is that those who adhere to a regimen fair better than those who don’t.

It’s called the adherer effect.

It’s part of the healthy user bias in a way. Those people who follow their doctor’s orders have been shown to do better than those who don’t. Adherers are less prone to deaths by misadventure and accidents. They are more careful, more healthy people.

Now, knowing this fact, let’s take a look at the French study in question.

Elderly people were given statin prescriptions (God only knows why since all the RCTs showed them to be of no value in the elderly) and some took the pills faithfully while others didn’t. It’s a classic case of adherers vs non-adherers, and based on the results of the clofibrate study above and many others that have followed, one would expect the group who took their statins faithfully to do better than those who didn’t. Even if, as is known, statins are of no value to the elderly.

Adherers are going to adhere. And they are going to come out better than non-adherers whether they are taking a statin or a placebo.

In searching for the French study that I didn’t have at hand because I somehow lost my Medscape tab, I came across a Harvard Medical School report written by a cardiologist describing the study headlined Study supports benefit of statin use for older adults.

Let me ask you, now that you understand what the adherer effect is, do you think the study supports the benefits of statin use for older adults?

Of course not. It’s a prime example of the adherer effect hard at work.

Does it trouble you that a cardiologist writing for the Harvard Medical School newsletter would put her name to such a conclusion?

I love how some of the writing in this newsletter is biasing.

The EHJ study carefully analyzed a large healthcare database, following over 120,000 French men and women ages 75 to 79 who had been taking statins for at least two years, but who had no previous history of CVD. They were observed for up to four years to see if those who discontinued their statins were more likely to be admitted to the hospital for a CVD event (heart attack, stroke, or other arterial problem). [My bold]

One assumes the researchers would not analyze haphazardly. The term “carefully” is put in there to give the study more credence than it deserves. You’ve always got to watch out for such meaningless embellishments.

Our cardiologist writing for Harvard concludes

As with everything we do in medicine, we must weigh the risks of statins against the benefits. In older patients, the risk of side effects may be somewhat higher, but so is the benefit. This new study tips the balance in favor of continuing statins in our older patients, to lower the risk of strokes and heart attacks. However, we must stay on the lookout for side effects and interactions, to ensure that we do not overtreat this often-vulnerable population. [My bold]

This study in no way “tips the balance in favor of continuing statins in our older patients” All it does yet again is show that those who adhere have better outcomes than those who don’t. These subjects could have been taking jelly beans and the outcome would have been the same.

Always remember the adherer effect when you’re reading a study.

If you want to support my work, take out a premium subscription (just $6 per month)—it’s cheaper than a Starbucks Vente gingerbread latte whatever. And a lot better for you.

Great New Study on Dietary Protein

Don Layman has been studying dietary protein forever. A friend of mine and the OG of protein research, he’s just come out with a new comprehensive study discussing basically all there is to know to date about dietary protein.

The study, titled Impacts of protein quantity and distribution on body composition, discusses, among other things, the minimal amount of dietary protein required for muscle protein synthesis (MPS) and the optimal time to eat it.

As we’ve discussed many times in these pages, it is more difficult to maintain muscle mass as you age age than it is when you’re young. And it’s even more difficult to build or increase muscle mass when you’re older. If you let things ride, you’ll lose a bit of muscle mass each year and ultimately develop sarcopenia. You can see the difference in the graphic below:

Prior to age 30 one can more easily maintain the look on the left in the graphic above without a lot of effort. It requires some resistance training and protein intake to maintain, but it can be done much, much more easily at that stage than at age, say, 65. With no intervention it’s all too easy to drift into the look on the right.

Even worse is sarcobesity. That’s the look on the upper right (in the image above) with a bunch of fat laid over it. Sarcobesity is really no bueno and leads to a shortened life. It requires a lot of work and a lot of good quality protein intake to reverse it.

I get emails, poll inquiries, and occasional comments from people telling me they are on low-carb diets and have stalled. They ask me what to do to give things a boost. Problem is, for medico-legal reasons, I can’t respond. They are not my patients. If I were some self-styled nutritional guru, I could answer all these questions without a problem. But I’m a licensed physician, which puts me in a different category. Simply answering a question from someone who is in a state in which I’m not licensed could get me hauled up for practicing without a license in that state. And don’t for a minute think that hasn’t happened, because it has. Not to me, but to others.

But just to touch on it in a general nutritional sense, not specific to any one individual, in our practice, MD and I ran into this situation all the time. Our recommendation was always to increase the protein intake. Usually that did the trick.

In his paper, Dr. Layman describes a 12-month diet study he and colleagues did on a group of 130 overweight men and women. These subjects (avg BMI ~33 and avg age ~ 45) were randomized into two groups. Both groups went on a calorically-restricted diet, but one group followed a high-protein diet while the other went on a low-protein diet.

After 12 months the average weight loss of those subjects on the high-protein diet was 24 percent greater than that of those on the low-protein diet. The high-protein dieters lost more body fat and about the same lean body mass as those on the low-protein diet. (Remember, obese people tend to lose some lean body mass with large overall weight loss simply because they don’t need the same muscle mass since they’re not carrying as much weight.) In this study, the loss of lean body mass represented 34 percent of the total weight lost in those on the low-protein arm. Of the weight lost by the high-protein dieters, only 26 percent was lean body mass.

Compare that to those on Wegovy. In that study, 42 percent of the weight lost by the Wegovy subjects was lean body mass.

So in losing more fat and less lean mass, the dieters following the high-protein diet ended up with a much better overall body composition than those on the low-protein diet.

MD and I did not do a similar study, but we managed many, many more patients than were in this trial. And in doing so, we discovered that protein is really the key to good weight loss. And by good weight loss, we mean losing mainly body fat while retaining (or even building, in some cases) lean body mass.

This paper goes over what we’ve gone over in these pages a number of times: How mTOR is the signaling complex that turns on muscle protein synthesis (MPS). It even has a nice diagram of mTOR and what drives it.

There is also a nice graphic showing the leucine threshold required in people as they age to fire off the mTOR complex.

This graphic shows the amount of protein required to provide the 2.5-3 g of leucine needed to get muscle protein synthesis going. Just to give you an idea of what this means in terms of real food, a chicken thigh contains about 30 grams of quality protein, so it has enough leucine to trip the trigger. A bit more would be better. Meat in general contains about 7 grams of protein per ounce. So a six ounce hamburger patty would give you 42 grams of protein and a little over 3 grams of leucine.

Another point Dr. Layman makes in this paper is that it is better for MPS to front load protein intake earlier in the day rather than later. If you skip breakfast, eat a salad for lunch, and go face down in a 16-ounce ribeye steak for dinner, you would not stimulate as much MPS as you would if you had more protein earlier in the day.

I would encourage everyone to read Dr. Layman’s paper. It’s pretty easy to understand and is filled with hugely valuable information on how to maintain and increase muscle mass as you age.

But if you would rather hear it from the horse’s mouth, here is an excellent video of Dr. Layman on a recent podcast going over much of the same information. Hat tip to my friend Richard Feinman for alerting me to it.

Odds and Ends

Newsletter Recommendations

I didn’t have the time this week to scour around looking for new newsletters, so I’ll have to settle for a couple of repeats.

First, there is OutlanderMD, the Substack written by my lovely wife. If you’re a fan of the Outlander series, you’ll love her descriptions of medicine in the late 18th century. She tells you when they got it right on the show…and when they didn’t.

Then there is one of my favorite free daily newsletters, Morning Brew. I read it every morning.

Video of the Week

After all the talk you heard about protein above and what it can do for you in terms of muscle protein synthesis, I figured this would be a good place to stick this video. This guy is amazing, and I’m sure he worked on this a long time before being able to do it. Gives us all hope.

Time for the poll, so you can grade my performance.

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That’s about it for this week. Keep in good cheer, and I’ll be back next Thursday.

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Thanks for reading all the way to the end. Really, thanks. If you got something out of it, please consider becoming a paid subscriber if you aren’t yet. I would really appreciate it.

Finally, don’t forget to take a look at what our kind sponsors have to offer. Dry Farm WinesHLTH CodePrecision Health Reports, and The Morning Brew (free)

And don’t forget my newest affiliate sponsor Jaquish Biomedical. Highly recommended to increase your lean body mass.


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