Evidence-Based Medicine or Evidence-Biased?

Evidence-Based Medicine or Evidence-Biased?
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Evidence-based medicine may ironically bias medical professionals against the power of dietary intervention.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Dr. Esselstyn’s landmark study showing even advanced triple vessel coronary artery disease could be reversed with a plant-based diet has been criticized for being such a small study. But the reason we’re used to seeing such large studies is they typically show such small effects. Drug manufacturers may need to study 7,000 people in order to show a barely statistically significant 15% drop in ischemic events in a subsample of patients, whereas Esselstyn got a 100% drop in those who stuck to his diet—all the more compelling given that those 18 participants experienced “49 coronary events [such as heart attacks] in the 8 years before” they went on the diet. And these were the worst of the worst—most of whom having already failed surgical intervention. So, when the effects are that dramatic, how many people do you need?

Before 1885, symptomatic rabies was death sentence until July 6th, when little Joseph Meister became the first to receive Pasteur’s experimental rabies vaccine. “The results of this [and one other] case were so dramatic compared with previous experience” that the new treatment was accepted with a sample size of two. So dramatic, compared with previous experience, no randomized controlled trial was necessary. “Would you—having been infected by a rabid dog—be willing to participate in a randomized controlled trial…when being in the control group had a certainty of a ‘most awful death’?” Sadly, such a question is not entirely rhetorical.

In the 1970s, a revolutionary treatment for babies with immature lungs called ECMO, extracorporeal membranous oxygenation, “transformed mortality in these [babies] from 80 per cent [down] to 20 percent, nearly overnight”—from 80% dead to 80% alive. Despite this dramatic success, they felt forced to perform a randomized controlled trial. They didn’t want to. They knew they’d be condemning babies to death. “They felt compelled to perform [such] a trial, because their claim that ECMO [worked] would, they judged, carry little weight amongst their medical colleagues unless supported by a [randomized controlled] trial.”

And so, at Harvard’s Children’s Hospital, 39 infants were randomized to either get ECMO or not—just get conventional medical therapy. They decided to stop the trial after the fourth death, so as not to kill too many babies. And, that’s what they did. The study “was halted after the fourth [conventional medical therapy] death,” at which point nine out of the nine ECMO babies had survived. Imagine being the parent of one of those four dead children—just as one can imagine being the child of a parent who died from conventional medical or surgical therapy for heart disease.

“Medical students in the United States are taught [very] little about nutrition. Worse yet, their training [actually] biases them against the studies that show the power of dietary approaches to managing disease,” by encouraging them “to ignore any information that does not come from…double-blind, randomized controlled trial[s]. Yet human beings cannot [easily] be blinded to a dietary intervention.” They tend to notice what they’re eating. As a result, physicians [may be] biased [in favor of] drug treatments and against dietary interventions for the management of chronic disease.”

“Evidence[-based medicine] is a good thing. However, the medical profession [may be] focusing too much on one kind of evidence, to the exclusion of [all] others”—degenerating into a “ignoring-most-of-the-truly-important-evidence[-based] medicine.”

And heart disease is the perfect example. On a healthy-enough plant-based diet, our #1 cause of death may “simply cease…to exist.” The Cornell-Oxford-China Study showed that even “small amounts of animal-based foods [was] associated with small, but measurable increases in [the] risk of [some of these chronic] disease[s].”

“In other words, the causal relationship between dietary patterns and coronary artery disease was already well established before…Ornish…and…Esselstyn…undertook their clinical studies. The value of their studies was not so much in providing evidence that such a dietary change would be effective, but in showing that physicians can persuade their patients to make such changes,” and also providing interesting “data on the speed and magnitude of the change in severe atherosclerotic lesions as a result of dietary therapy.”

So, “[a]ny complaints that these studies were small or unblinded are simply irrelevant. Because the evidence of the role of diet in causing atherosclerosis is already so overwhelming, assigning a patient to a control group [eating the Standard American Diet could be considered a] violation of research ethics.”

“Evidence of the value of…plant-based diet[s] for managing [chronic disease] has been available in the medical literature for decades.” Kempner at Duke; John McDougall; The Physician’s Committee for Responsible Medicine. “Denis Burkitt warned us” that the Standard American Diet “is the standard cause of death and disability in the Western world,” for decades. “Yet physicians,…in the [U.S.], are still busily manning the ambulances at the bottom of the cliff instead of building fences at the top.

Please consider volunteering to help out on the site.

Images thanks to Wandering Eyre via flickr

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Dr. Esselstyn’s landmark study showing even advanced triple vessel coronary artery disease could be reversed with a plant-based diet has been criticized for being such a small study. But the reason we’re used to seeing such large studies is they typically show such small effects. Drug manufacturers may need to study 7,000 people in order to show a barely statistically significant 15% drop in ischemic events in a subsample of patients, whereas Esselstyn got a 100% drop in those who stuck to his diet—all the more compelling given that those 18 participants experienced “49 coronary events [such as heart attacks] in the 8 years before” they went on the diet. And these were the worst of the worst—most of whom having already failed surgical intervention. So, when the effects are that dramatic, how many people do you need?

Before 1885, symptomatic rabies was death sentence until July 6th, when little Joseph Meister became the first to receive Pasteur’s experimental rabies vaccine. “The results of this [and one other] case were so dramatic compared with previous experience” that the new treatment was accepted with a sample size of two. So dramatic, compared with previous experience, no randomized controlled trial was necessary. “Would you—having been infected by a rabid dog—be willing to participate in a randomized controlled trial…when being in the control group had a certainty of a ‘most awful death’?” Sadly, such a question is not entirely rhetorical.

In the 1970s, a revolutionary treatment for babies with immature lungs called ECMO, extracorporeal membranous oxygenation, “transformed mortality in these [babies] from 80 per cent [down] to 20 percent, nearly overnight”—from 80% dead to 80% alive. Despite this dramatic success, they felt forced to perform a randomized controlled trial. They didn’t want to. They knew they’d be condemning babies to death. “They felt compelled to perform [such] a trial, because their claim that ECMO [worked] would, they judged, carry little weight amongst their medical colleagues unless supported by a [randomized controlled] trial.”

And so, at Harvard’s Children’s Hospital, 39 infants were randomized to either get ECMO or not—just get conventional medical therapy. They decided to stop the trial after the fourth death, so as not to kill too many babies. And, that’s what they did. The study “was halted after the fourth [conventional medical therapy] death,” at which point nine out of the nine ECMO babies had survived. Imagine being the parent of one of those four dead children—just as one can imagine being the child of a parent who died from conventional medical or surgical therapy for heart disease.

“Medical students in the United States are taught [very] little about nutrition. Worse yet, their training [actually] biases them against the studies that show the power of dietary approaches to managing disease,” by encouraging them “to ignore any information that does not come from…double-blind, randomized controlled trial[s]. Yet human beings cannot [easily] be blinded to a dietary intervention.” They tend to notice what they’re eating. As a result, physicians [may be] biased [in favor of] drug treatments and against dietary interventions for the management of chronic disease.”

“Evidence[-based medicine] is a good thing. However, the medical profession [may be] focusing too much on one kind of evidence, to the exclusion of [all] others”—degenerating into a “ignoring-most-of-the-truly-important-evidence[-based] medicine.”

And heart disease is the perfect example. On a healthy-enough plant-based diet, our #1 cause of death may “simply cease…to exist.” The Cornell-Oxford-China Study showed that even “small amounts of animal-based foods [was] associated with small, but measurable increases in [the] risk of [some of these chronic] disease[s].”

“In other words, the causal relationship between dietary patterns and coronary artery disease was already well established before…Ornish…and…Esselstyn…undertook their clinical studies. The value of their studies was not so much in providing evidence that such a dietary change would be effective, but in showing that physicians can persuade their patients to make such changes,” and also providing interesting “data on the speed and magnitude of the change in severe atherosclerotic lesions as a result of dietary therapy.”

So, “[a]ny complaints that these studies were small or unblinded are simply irrelevant. Because the evidence of the role of diet in causing atherosclerosis is already so overwhelming, assigning a patient to a control group [eating the Standard American Diet could be considered a] violation of research ethics.”

“Evidence of the value of…plant-based diet[s] for managing [chronic disease] has been available in the medical literature for decades.” Kempner at Duke; John McDougall; The Physician’s Committee for Responsible Medicine. “Denis Burkitt warned us” that the Standard American Diet “is the standard cause of death and disability in the Western world,” for decades. “Yet physicians,…in the [U.S.], are still busily manning the ambulances at the bottom of the cliff instead of building fences at the top.

Please consider volunteering to help out on the site.

Images thanks to Wandering Eyre via flickr

Doctor's Note

This is one of my favorite videos of the year so far. If you’re not familiar with Dr. Esselstyn’s  work I touch on it in:

And, in fact, he just released a much larger study. Read it here.

Sadly, medical students learn little about these powerful tools:

If you haven’t heard of Pritikin, I introduce him here: Engineering a Cure

An intro to Dr. Ornish: Convergence of Evidence

Dr. Burkitt: Dr. Burkitt’s F-Word Diet

The Cornell-Oxford-China Study: China Study on Sudden Cardiac Death

And more on Dr. Walter Kempner’s work at Duke coming soon!

If you haven’t yet, you can subscribe to my videos for free by clicking here.

62 responses to “Evidence-Based Medicine or Evidence-Biased?

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  1. There are none so blind as those who will not see. I think real change to real nutrition can happen only if/when we teach it in schools starting on day 1. The majority of “grown ups”, like the old me, see what they want to see and hear what they wish to hear. I was so much older then…I’m younger than that now.

    1. Nutrition won’t be taught in school until enough people agree on what proper nutrition is. And that won’t happen without proof. Carnivore advocates like paleos and the Weston Price Institute, would have a different idea than vegans of what’s nutritious. It’s the old problem of which came first, the sunflower or the seed?

      And forget schools, when will health specialist catch on in hospitals? They don’t seem to relate the affects of real food on patients. When I had surgery and an overnight stay at the largest chain-hospital in northern California last year (which is a company I respect and appreciate) I brought my own foods like oatmeal, lentils, brown rice and fruit. (I could have gotten some fruit from the hospital, but I wanted organic.) But as I recall, while they offered some fruits, they had only refined grains and animal products for breakfast, lunch and dinner. I’m sure I could have had a bologna and mayo on white bread sandwich if I asked for it. The staff was wonderful and very accommodating in helping with my meals, but it was food that I had to bring. How do people recovering get better on the stuff they serve?

      And for a friend who is currently in a county jail serving a 6 mo sentence, almost every lunch is bologna on white, and almost every dinner is low grade animal products and ramon noodles and a small serving of over-cooked canned veggies. Talk about your cruel and inhuman punishments.

      1. Yep, re. amazing hospital food. I worked for quite a while in a medical imaging research lab located at a prominent northern California VA hospital (i.e. in the heart of foodie USA). I was stunned the first time I checked out the cafeteria. Alongside the pepperoni pizza, greasy fires, fried chicken,and mammoth soda dispenser, the only “healthy” alternative was a plastic container full of iceberg lettuce and tasteless tomatoes.

        1. Same here. I’ve worked in hospital based imaging for over 40 years and the food was atrocious. The last place I worked,though, had an unusual but delicious salad bar, like someone knew what they were serving.
          Sad to say most MD’s are clueless to plant based reversal of heart dz. When I mentioned it to some of the MD’s I worked with their eyes glazed over and got very uncomfortable…If it was not in their “cookbook” of how to treat dz with the Burn Cut or Poison method they were like a fish out of water…

      2. If you are talking about Marin General Hospital: Yes, their food planning takes no notice of patient’s nutritional needs— They were incompetent to bring my husband’s blood pressure down from 180 (!!!) after a hemorrhagic stroke (likely pharmaceutical-induced) and it didn’t come down until I got him home, phased him off the cardiology-prescribed drugs— It didn’t even occur to them to try magnesium citrate: a real clown show. Additionally, my husband’s room was not properly sanitized— I swiped one of the bed rails with a paper towel dampened with water and hand sanitizer, turned the towel over and saw an impressive amount of grey matter… They hadn’t even cleaned the bed rails that the patient and others touch. Within 6 days of visiting the hospital, I came down with a respiratory infection that would have killed a less healthy person. You’d expect this kind of hospital in some backwater, like Tuskaloosa, Alabama, not in Marin County— within minutes of UCSF medical center and not that far from Stanford.

  2. At the autopsy of young soldiers killed in Vietnam, doctors discovered a strong atherosclerosis. It turns cholesterol is not guilty?

    Michael what do you think?

    1. In my early career in imaging, I viewed an autopsy of a young gent. The pathologist said the same thing! This was 35 years ago. He said autopsy on WW2 soldiers had very little to no plaque in their hearts. Korean war, more plaque and with vietnam it was exploding, pardon the pun. The pathologist showed me the left coronary artery on this 20 something year old and it had little flecks of white in it. The beginning of Atherosclerotic Heart Disease…
      Kind of parallels the injestion of more meat products, high fructos corn syrup and highly processed food. Hummmmm…..

    1. I recall reading something a few years ago that said stress plays a factor because cortisol–produced by the body when it’s under stress–increases how fat and cholesterol collect as plaque around organs, especially the heart.

  3. Well presented! Thank you again and again and again! I’m glad you have not been blinded by the “science”!
    Reminds me of a song . . . “She Blinded me with science”

  4. Great video!
    Maybe a lot of doctors are in denial.
    As Dr Greger points out:
    It takes a big study to show minor results – and who cares?
    It takes a small study to show big results – and nobody cares !!
    Every M.D. know this, so I dont understand why the work of Dr Ornish, Dr Esselstyn and others doesn’t have a huge impact on modern medicine.
    Medicine have throughout its history recommended treatments based on probable evidence, but when we talk about food as a tool to prevent, control, reverse or cure disease the medical establishment demands absolute proof. Talk about bias….

  5. “This is one of my favorite videos of the year so far.” Justifiably so!

    But (of course! :) wouldn’t the intro be helped by mentioning Esselstyn’s recently-published study?

    1. Hi Brec! :)) The ECMO example is such a powerful analogy, isn’t it? To answer your question, Dr. Greger and his fab team scripted and recorded this video piece just a few weeks before Dr. Esselstyn’s most recent study was released. But if you look under “Doctor’s Notes” (above these comments, below the video), there’s a link to Dr. Esselstyn’s newest study. So stay tuned, I think Dr. Greger mentioned that he plans to highlight the new Dr. Esselstyn study in an upcoming piece. And if you’re not already, make sure you’re subsrcibed by going to: http://bit.ly/nutritionfactsupdates so you don’t miss it!

      NF community, if you like this piece, please share it with as many people as possible! Or at least with the people you care about living long, healthy lives! :)) Let’s get the word out!

      1. I’m frustrated because the people I LOVE in my life who need to take action on this message sadly have not. Despite my best efforts of sharing Dr Greger’s videos. You can lead a horse to water…sigh.

        1. You’re absolutely right. I am a physician working in a hospital and all around me I see colleagues , coworkers, and patients getting fat. I discuss diet and fitness on a daily basis yet, at the end of the day (a phrase I am rapidly tiring of) most people eat what they think tastes good. And it usually comes in a paper bag with a familiar logo on it. Poor eating habits are incredibly ingrained in our society. I always know when a class of nursing students is departing by the telltale pink doughnut boxes left behind as a token of their “appreciation.” You mention the word vegetarian to people and the most common response is, “So all you eat is salad?”

          1. When I went vegetarian (later vegan) I told friends having me over for dinner, at the time of invitation, to just serve me everything except the meat. At the dinner, my friend’s wife served me a chicken breast. When I reminded her that I was now veg she replied, “I know, that’s why your piece is smaller.” When I politely declined it she got upset and said, “but you can’t eat NO meat! You have to eat SOMETHING!” They never accepted it.

            1. mbglife: That may not have been funny at the time, but that’s just so funny now. I can just imagine someone so outraged/confused/bewildered and earnestly saying that.

              I guess it’s both funny and a sad testament to how lacking our education system is. Your friend’s wife no doubt hontestly believes that if you don’t eat meat, that’s tantamount to eating nothing or nothing of value. OK, now I’m sad again.

                  1. I’ve experienced the exact same response a number of times. When I repeat that I don’t eat any animal products I’ve even had an adult ask me “Is a fish an animal?”.

              1. Thea! So good to hear your “voice” again. I’ve missed you. I hope you’re enjoying the time you used to spend so diligently helping all of us out with your answers and references and links.

        2. Blanster: I can so relate. And you are right, you can’t force people to do what they don’t want to do. What makes it painful is when the stubborn people (horses or another word for donkeys? ) refuse to change.

          If it is any comfort, I can say that I never thought my parents would change. But I kept being patient in terms of sending information and being a good role model without pushing. Eventually both parents went largely vegan (maybe 97% I think). And both have experienced significant health benefits. So, it may not happen fast enough to give you peace, but it *can* still happen.

          You may have done this already, but I highly recommend purchasing a copy of Forks Over Knives. (Or if you have Netflicks, I believe they have it.) And then bribe your loved ones to sit down and watch it with you. I think that movie is powerful. And while it didn’t have an immediate effect on my parents, I believe it was what started to change their thinking. Dr. Greger’s summary videos also helped greatly.

          Good luck!

          1. Thanks! My frustration is that so many friends have serious (even life threatening) health issues, yet prefer to take medications and suffer over trying dietary changes that would potentially cure their issues. And I have to worry and listen to them worry in the meantime. :(

            1. I just posted this link in a separate post on this page to a Dr Greger video about how vegans die at a higher rate than omnivores unless they are getting vitamins B6, B12, folate and balanced omega-3 to omega-6. The advice can also help omnivores, so you might want to try that info with your no-diet-change friends. https://www.youtube.com/watch?v=q7KeRwdIH04

          2. A friend of mine, who last year told me that he couldn’t live without meat, recently confided to me that he is changing his diet to more veg. Yay! I think recent health issues in his family along with all the delicious pics of my vegan dinners that I post on FB are changing his mind.

    1. That’s an excellent link, but it initially threw me for a loop. I recalled an earlier video which mentioned that heart disease was virtually unheard of in Uganda, yet according to this chart it is significantly higher than in the U.S. I went back and watched the Uganda video again and realized that the studies were done more than 50 years ago. My how they have progressed.

    2. Wow! I just went through every cause of death on that chart. It’s mindboggling. If you ignore infectious diseases, which obviously predominate in Africa, it’s difficult to see a pattern with the various cancers and other afflictions.

  6. This video is a perfect pairing with your “tomato effect” video, which remains one of my all time favorites: http://nutritionfacts.org/video/the-tomato-effect/ The main point you raise in each video, that scientists need to stop pretending that valid science regarding nutrition doesn’t exist, because it doesn’t fit the current generally accepted view, is perfect. Thank you so much for all of the useful information I get from your site every day.

  7. I read Esselstyn’s book, but it was a while ago. As I remember, his subjects took statins while on a strictly plant-based, low-fat diet.

    1. Some of them, perhaps a majority, took/take statins. I take one. But millions of people do. I need both (diet+statin) to get my TC and LDL to what I consider acceptable levels.

    2. Dr. Esselstyn added relatively low dose lovastatin and sometimes
      cholesyramine to push total cholesterol below 150 mg/dl, where the Framingham study indicated negligible cardiac risk.

      For most middle-aged, Western patients on low fat Pritikin/Ornish/Esselstyn diets, diet alone achieves cholesterol levels around 170 mg/dl. But achieving lower cholesterol through diet (or genetics) appears to have greater protective effects than through drugs. High-dose statins can reduce event rates by about 26%, whereas traditional low-fat plant based diets reduce events by upwards of 80-90%, and genetically lifetime low LDL reduces rates 3 times as much as pharmaceutical reductions with statins.

      I monitor my own progress with bimonthly blood donations, and indeed, my own levels hovered in the 170 mg/dl range for years after adopting a whole foods plant based diet. I finally had a 147 test result last week, and I suspect an almond binge (with its high levels of phytosterols) during the prior week contributed to the good number.

      1. I’m not quibbling with the effect of a WFPB diet on CAD (Joe Crowe’s angiogram in Esselstyn’s slide and first chapter of his book is all the more impressive because he refused statins), but doesn’t the footnote in Esselstyn’s book mention cholestyramine, 4 g twice daily, and lovastatin @ 40 mg to 60 mg/day? Don’t know about cholestrymine, but isn’t 60mg a pretty hefty dose of statins?

      2. I’m glad to hear that the almonds lent a hand. I need nuts and seeds to maintain a healthy weight. So I eat variously raw (when possible) almonds, walnuts, pumpkin seeds, sunflower seeds, Brazil nuts, hemp seeds, and peanuts (I know, not a nut). I try not to over-do it, as I could easily be eating a “high-fat” diet.

        Darryl, do you have any comment on unsweetened, shredded coconut?

        Superb video, Dr. Greger.

  8. Thanks for another great video. It always astounds me how much misinformation gets spread through doctors, who most people believe have the best information on nutrition.

  9. Dr. Esselstyn has published a new, larger study of zero-added fat whole plant food diets in coronary artery disease:

    Esselstyn, Caldwell et al. (2014). A Way to reverse CAD? J Fam Practice, 63(7), 356-364.

    It will be criticised for not having a randomized control arm, but a 10% (and only 0.6% “recurrent”) adverse event rate in the 177 adherent patients vs 62% in the 21 patients who fell off the wagon deserves a more prominent outlet than J Fam Practice.

  10. I’m still waiting for a meat and dairy sponsored Esselstyn-like study to demonstrate that a high fat low carb diet can reverse heart disease.

    1. Cute. ;-) Don’t hold your breath, or you’ll turn purple.

      (Or maybe they will come up with something by creating yet another twisted/invalid study. Yikes. Be careful what you joke about…)

    2. You would be surprised how many doctors even cardiologists and lipidologists have been persuaded to accept LCHF diets as an alternative to plant-based nutrition. Part of this has to do with the efforts of Gary Taubes & Assoc/NuSI. It’s possible some have been able to lose weight themselves on such a diet, despite risk factors worrsening in many but not all who undertake the diet.

      (Though I have yet to see proof of regression, theoretically it is possible that weight loss alone can induce it. Problem is, no one can lose weight indefinitely, which leaves one eventually with the stark effects of the foods themselves.)

      1. Celebrated lipidologist Thomas Dayspring, for example, discounts Ornish’s study on the basis of the shortcomings of older angiographic evidence (vs newer IVUS imaging tech, I presume, AKA moving the goalposts).

        https://twitter.com/drlipid/status/484094667823546369

        https://twitter.com/drlipid/status/250310413852495872

        Here is my latest exchange with him beginning with this tweet by Charles Grashow (so follow the thread after this tweet on Twitter):

        https://twitter.com/cvictorg/status/494177945368674304

  11. The only way Dr’s will prescribe a good diet over of pills is if pharmaceutical companies can have their own grocery stores where patients HAVE to go and fill out their orders.

  12. I think the level of difference vs chance should help determine the extent of studies needed to demonstrate efficacy. If 18 out of 18 who complied with Esselstyn’s diet were functionally cured, as it appears they were, then what is the likelihood you’re going to see something different in patient 19? Not much. Certainly low enough to take the chance, especially with the meager results of other things, many of which failed his 18 patients already before they even started on his diet.

    The science demonstrating diet is unknown to the public. I have to say that before I found Esselstyn, Campbell, Ornish, Fuhrman, Greger, Burkitt, Klapper, Barnard, and some others, I had NO IDEA there was any real dietary science being done, that the results were in, and that the miracle cure had been found. It is so cool, yet the public is mostly unaware how powerful all this information actually is, or where exactly to find it amidst all the hype and confusion.

  13. This is an especially important video! Thank you dr. Greger! You and your team rock my world with the latest and greatest in nutrition and all around useful and practical information (almost) every day! Keep up the good work!

  14. Dr Greger has a 1hr 15min video on youtube of his presentation in the early 2000s about vegans dying of heart disease, cancer, stroke and Alzheimer’s at rates higher than meat eaters. https://www.youtube.com/watch?v=q7KeRwdIH04

    In it he explains the cause was discovered to be that people need to take folate, B6 and B12 to get homocystine levels down, and get their omega-3 and omega-6 levels within a 1 to 4 ratio or better. And the results showed that this was the case regardless of cholesterol being over 200. Good video but loooooooong. I wish he would make a mini version for this site. It was really good. I’ve enjoyed and supported this site for years, but never saw the video until recently. Now I tell my omnivore friends to at least pop a few more pills (the above listed supplements) to protect themselves better. Some are doing it. So it’s a start.

  15. I notice there were only a handful of women in Dr Esselstyn’s study of nearly 200 (see link to July, 2014 “A Way to Reverse CAD?” article, under Doctor’s Note, above).

    Thanks, Dr G.

  16. So glad you are on the case of current medical practices. Clearly (after all the life-endangering compliance with cardiologists’ “aggressive risk management” in uncritically prescribing the usual trilogy of drugs to anyone over 50—— “evidence-based medicine” is a grotesque misnomer in a profession that operates in the pre-scientific age— relying on a drug-effect reporting system with vast holes and massive evidence suppressed, ignored, unreported, unobserved and beyond the ken and outside the radar in medical settings. “Prescribe and forget” —- e.g., No baseline testing in the first place to see if a patient needs any anti-platelet aggregant, or not! No drug response monitoring— Even when patients go to emergency rooms with life-threatening drug reactions, doctors have no system to notice or even care —-this is obviously off their’ radars— except perhaps for the E.R. doctors whose job it is to administer antidotes. Examples: patient comes in with edema, compromised kidney and pancreatic function, joint pain, gout— in response to cardiology-prescribed drugs. “Oh, you have venous insufficiency!” or, “Did you know you have a heart arrhythmia?” — More drugs to treat drug-induced disorders. A hemorrhagic stroke, sudden hearing loss, anaphylaxis, abducens nerve palsy? Couldn’t be the aspirin or the other aggressive risk management drugs I prescribed which is so good for you! Gotta be Old Age or Patient Non-Compliance!

  17. I am looking for guidance on the Gardasil vaccine for me daughter. If she, and our whole family, are vegan and generally practice a healthy lifestyle, will that decrease her chances of getting cervical cancer enough to skip the vaccine? I am quite dubious of the pharmaceutical industry…

    1. I can understand being a little dubious of the pharmaceutical industry since they haven’t exactly covered themselves in glory with respect to the safety and efficacy of many different drugs. But vaccines are not an area where we should not let that skepticism make us avoid being vaccinated. With regard to not needing the vaccine due to a vegan diet, HPV, the virus that is the target of Gardasil, is a sexually transmitted virus rather than food born. In fact HPV is THE most sexually transmitted virus in the US with nearly all sexually active people being infected at some point in their lives. So being vegan won’t make any difference.

      Vaccines are extraordinarily safe. The only significant negative effect of the HPV vaccine reported in the clinical trial with over 15,000 participants was due to allergic reaction to components of the vaccine. So unless your daughter has specific allergies, the HPV vaccine is about as safe a thing as you can get in medicine. The benefits far, far outweigh the tiny risks. I strongly encourage you to get your daughter vaccinated now because once exposed to the virus it is too late and will dramatically increase the chances that she will develop cervical cancer, as well as a couple other types of cancer, later in her life.

      Oh, and all boys should be vaccinated as well. Men seldom display any symptoms (such as genital warts) of HPV infection, yet can still serve as a disease vector passing the virus along to all sexual partners. Getting rid of HPV will require that all young girls and boys be vaccinated. If even a small fraction go unvaccinated, HPV is so easily transmitted that it will continue to circulate in the population. But the vaccine is extremely effective and so within a matter of years or decades at most, we could completely rid ourselves of this virus (much like we did with small pocks and are on the verge of doing with polio. And while HPV infections is mostly closely associated with cervical cancer in women, men can also develop penile cancer and other cancers as a result of HPV infection. Thus boys being vaccinated isn’t just a bit of altruism on their part so that girls don’t develop cancer.

      Bottom line, everybody needs to be vaccinated before their first sexual encounter.

  18. Jim, thank you for your thoughtful comments. You certainly give me more to think about. However, I keep reading that the risk of getting cervical cancer from HPV is small. While most of us have the HPV in us, only a few strains of it are linked to cervical cancer and even then, it doesn’t always turn into cervical cancer. Even the American Cancer Society’s website lists eating fruits and vegetables as one way to reduce risk of cervical cancer. I also read that there are risks, as with any vaccine. (For point of reference, our family has taken all our vaccines to date). Gardasil contains aluminum in the vaccine and it does not contain the actual virus. So, I still question the necessity of this vaccine given our family’s healthy vegan lifestyle (and commitment to it). I post, because I am still interested in learning more to convince me one way or another!

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