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December 2003

The Crumbling Walls of Medical Ignorance
William Faloon

A rebellion is taking place within the citadels of establishment medicine, as leading physicians and scientists come to the realization that doctors are failing to translate research discoveries into lifesaving therapies.

An article published in the New England Journal of Medicine1 exposes how doctors overlook proven methods of preventing and treating disease. The author, Claude Lenfant, M.D., is director of the National Heart, Lung and Blood Institute. This huge government agency funds numerous clinical studies aimed at finding better ways to treat cardiovascular and pulmonary diseases. While Dr. Lenfant acknowledges that gains have been made in disease prevention and treatment, he is highly critical of doctors who fail to incorporate the latest findings in their everyday practice.

Dr. Lenfant questions whether Americans have enjoyed the maximal return on the more than $250 billion of medical research the National Institutes of Health has funded since 1950. He points out that life expectancy in the U.S. lags behind that of 22 other countries and attributes this to doctors and their patients “not applying what we know.”

Indeed, Dr. Lenfant notes that growing numbers of experts are becoming aware that research findings are not being translated into medical practice or lifestyle changes.

The New England Journal of Medicine is one of the world’s most prestigious scientific publications. It is considered a bastion of the medical establishment. The fact that the New England Journal of Medicine published this meticulous article about the failings of conventional medicine provides further evidence that today’s health care is in urgent need of reform.

Failure to Treat Acute Heart Attack
Sudden-death heart attack most often occurs when a coronary artery is blocked by a blood clot, or when a piece of unstable atherosclerotic plaque ruptures to obstruct coronary artery blood flow. In the 1980s, drugs became available to dissolve a coronary artery clot, but emergency room doctors were slow to catch on, and many heart attack victims needlessly died.

As reported in Life Extension’s new Disease Prevention and Treatment book, current research reveals that emergency coronary angioplasty is more effective than clot-busting drugs in saving heart attack patients’ lives. One reason for this may be that the angioplasty procedure enables coronary arteries to be re-opened whether they are blocked by a blood clot or a ruptured piece of atherosclerotic plaque. Clot-busting drugs (fibrinolytics), on the other hand, are only effective in opening coronary arteries occluded by blood clots.

In his New England Journal of Medicine article, Dr. Lenfant cites shocking data that in the last quarter of 2002, nearly 33% of all patients nationwide who presented with an acute heart attack at a hospital emergency room received neither angioplasty nor clot-busting therapies.2 In other words, about one-third of emergency room doctors watched heart attack patients suffer and die while proven therapies available to save their lives went unused! This failure to translate research findings into clinical practice is therefore not an issue of a lack of fine-tuning medical abilities, but much more importantly a growing cause of patient morbidity and mortality. In today’s world

Landmark Advances IGNORED
These advances shown to save human lives
are grossly underutilized, resulting in needless deaths.

1. Use of beta-blockers to prevent second heart attacks.
2. Screening for hypercholesterolemia and properly treating with cholesterol-lowering drugs after heart attack.
3. Failure to use aspirin in patients at high risk for coronary artery disease before and after heart attack.

Ignoring Proven Scientific Findings
To document his assertion that doctors are not keeping up with proven research findings, Dr. Lenfant points out three startling gaps between the time when medical discoveries were made and their implementation into clinical practice.

Dr. Lenfant’s first example of this time lag is the delay in recognizing the value of beta-blocker drugs. This class of drug was conclusively established to save the lives of recovering heart attack patients in 1981.3 Yet by 1996, beta-blockers were being prescribed to only 62.5% of eligible patients, 15 years after their efficacy was proven.4

The Life Extension Foundation long ago cited the FDA’s failure to approve beta-blockers as causing millions of needless American deaths. While Europeans were benefiting from beta-blockers in 1965, the FDA did not approve beta-blockers for the treatment of hypertension and angina until 1978.5-6 In his article, Dr. Lenfant reveals that 37.5% of patients were not benefiting from beta-blocker drugs as late as 1996 (31 years after they were first approved in Europe).

Dr. Lenfant’s second example of doctor-ignored research is a study showing that only 50-75% of heart attack patients are screened for high cholesterol levels (hypercholesterolemia), let alone prescribed proper cholesterol-lowering medications.7 We at Life Extension hear this all the time from new members who survived their first heart attack. In other words, after emergency treatment in the hospital, little effort is made to identify and correct the underlying reasons that caused the heart attack to occur in the first place.

“Given the ever-growing sophistication of our scientific knowledge and the additional new discoveries that are likely in the future, many of us harbor an uneasy, but quite realistic suspicion that this gap between what we know about diseases and what we do to prevent and treat them will become ever wider. And it is not just recent research results that are not finding their way into clinical practice and public health behaviors; there is plenty of evidence that ‘old’ research outcomes have been lost in translation as well.”

—Claude Lenfant, M.D.
“Clinical Research To Clinical Practice–Lost In Translation?”
New England Journal of Medicine, August 28, 2003

Dr. Lenfant’s third example of doctor neglect is the failure to use aspirin as a cardiovascular drug. Overwhelming evidence demonstrates that aspirin is highly effective as a short-term therapy for acute heart attack and as a preventive therapy in those with cardiovascular disease.8 Despite these findings, Dr. Lenfant cites two large studies showing that as late as 2000, aspirin was prescribed to only 33% of patients with coronary artery disease.9

It was in 1983 that the Life Extension Foundation recommended low-dose aspirin to prevent heart attacks.10 Not only did the medical profession soundly reject this recommendation, but the FDA initiated draconian actions to make sure the public was not informed about aspirin’s cardiovascular benefits.

Dr. Lenfant states that these three simple examples “show that we have a problem in getting providers (doctors) to apply knowledge gained through research.”

Overlooking the Obvious
Obesity has become an epidemic that threatens to undo decades of progress in reducing coronary heart disease incidence. Despite widespread publicity, Dr. Lenfant describes a 1999 study in which only 42% of 12,835 obese adults were advised by their physicians to lose weight.11

While out-of-hospital coronary heart-disease deaths have declined in people aged 35 to 64,12-15 the elderly are suffering epidemic levels of stroke16-21 and heart disease.22-25 The aging process and obesity inflict many pathological changes that increase the odds of suffering a cardiovascular event. Now, those over age 70 are suffering the brunt of heart and vascular-related disorders. Conventional doctors, however, are overlooking proven methods to reduce cardiovascular disease incidence in this population. Some simple ways of cutting heart attack and stroke incidence in the elderly involve testing their blood for C-reactive protein, homocysteine, fibrinogen, etc., and taking steps to reduce these levels if they are elevated.

In another example of physician neglect, a 1999 study of 9,299 people reported that only 34% had been counseled about exercise during regular visits to their physician.26

Doctors Are Not Solely to Blame
While it is easy to point to physician shortcomings, patients who fail to assume responsibility for their health are also the cause of research findings not being optimally utilized to save lives.

Dr. Lenfant points to a study of coronary artery disease patients who were all prescribed aspirin by their doctors. A follow-up questionnaire showed that only 60% of these patients took their prescribed daily aspirin in 1995, though this number increased to 80% by 1999.27

Controlling hypertension is one of the best-proven disease- prevention strategies, yet Dr. Lenfant points to studies showing that rates of blood-pressure control in hypertensive patients are shockingly poor. One study found that 47% of patients failed to take their antihypertensive medications as prescribed.28 Compounding this problem are doctors who do not prescribe the best anti-hypertensive therapies. For example, Gerald Reaven, Professor Emeritus (Active) of Medicine at Stanford University, states that it is vital that every healthy-heart program address the hypertension/SyndromeX association or little success in shielding hypertensive patients from heart attack can be expected.29 The results of inappropriate prescribing and patient irresponsibility are enormous numbers of needless strokes and other hypertension-related illnesses.