Medical Mish-Mash

Three for the price of one

Although on vacation we never sleep in our ongoing quest for knowledge. Here are the results of our selective insomnia.

Item One: Molecular and cellular biology are fields chosen by many of our best and brightest students who want to be in the thick of things, have a good career, and derive plenty of job satisfaction. Learning about cell processes and then manipulating them to their bidding beats accounting for general excitement. From these specialties has come information about changing the way cells make HDL cholesterol.

The latest issue of Journal Watch Cardiology reported the development of a compound which specifically raises levels of "good" HDL cholesterol. At least it does so in lab rats, and human trials are soon to be underway. Most of us have for the last ten years felt that increasing HDL was just as important as decreasing LDL in anyone with real or potential coronary artery disease.

When there is an effective weapon, we use it. The statin drugs are certified as excellent in the realm of lowering LDL, and the more used the lower it goes. There has been no comparable success story for a pharmacologic agent which raises HDL, so the finding noted above is exciting. Here's a note of caution: Don't look for a new effective (and expensive) pill on your pharmacy's shelves in the near future. These things take several years to get from the lab to your drug store.

Item Two: Another thing we've learned recently is the concept of "selective satiety", which suggests that we don't eat so much if our diet is boringly simple. (This may have something to do with the brief success of Atkins and other programs which severely limit food choices.

Most of you won't remember the Duke University Rice House and its rice diet of the 1960s. There, captive consumers got nothing to eat but rice and vitamins. Great recipe for success, but what happened to the patients when they graduated from the Rice House? As you would guess, they generally rediscovered variety and regained the weight they paid dearly to lose.)

Conversely at "all-you-can eat" buffets a wide variety of foods encourages us to eat well beyond satiety and into the realm of gluttony. Tired of meat and potatoes? Shift gears, hit the Mexican food table, or go right to desserts. You can put away an amazing quantity of food. And the charge is the same for good sense or excess. These eating facilities should be used only by professional wrestlers, offensive tackles, and stevedores, but are unfortunately also popular with sedentary chow hounds.

Item Three: A friend told us reently that his wife was "always cold since she started taking blood thinners." This sincere comment missed the mark on two counts. The first is in the idea that thicker blood makes us warm. "Thicker" in this case might mean more red blood cells or more of certain dense proteins, and in both of these scenarios circulation would be impaired, thus distributing heat to the body less efficiently.

The second misperception is that medications used to prevent clotting (coumadin is the prime example, but aspirin is included) actually thin the blood. They do no such thing, and doctors are to blame for spreading this falsehood. The reason for this is the patronizing attitude we have of deciding patients wouldn't understand if we more properly said "anticoagulant".