Heart disease was once the number one killer in rich countries. Maybe it still is. Huge amounts of time and money have gone into trying to reduce it — statins, risk factor measurement (e.g., cholesterol measurement), telling people to “eat healthy” and exercise more, and so on. Unfortunately for the poor souls who follow the advice (e.g., take statins), the advice givers, such as doctors, never make clear how little they know about what causes heart disease. Maybe they don’t realize how little they know.
I encountered an ignorant-without-knowing-it expert after a talk I gave about the effect of butter on brain function. I found that butter improved my brain function (measured by arithmetic speed). I had been eating lots of butter for more than a year. A cardiologist in the audience said I was killing myself. He thought butter caused heart disease. I said that I had experimental data that butter was good for me. Easy to interpret. The notion that butter is bad has come from epidemiological (non-experimental) data, which is hard to interpret. The cardiologist said that the epidemiology has not been misleading. One sign of our correct understanding, he said, is that heart disease has declined. I said there were many possible reasons for the decline.
A 2012 paper called “An epidemic of coronary heart disease” by David Grimes, a British doctor, could hardly make clearer how little we know about the cause of heart disease. Grimes points out that before 1920 heart disease was almost non-existent, that it rose sharply from 1930 to 1970 and since 1970 has declined sharply, at roughly the same rate that it rose. Both the rise and the fall are mysteries, says Grimes, in agreement with what I told the cardiologist. The rise and fall contradict all popular explanations. Heart disease cannot be due to obesity or wealth — both increased substantially at the same time heart disease fell sharply. Nor was the decline due to government intervention:
The decline of CHD deaths in the UK was further described in a UK Government report of 2004, Winning the War on Heart Disease. In this report, the government predictably but undeservedly assumed responsibility for the decline. Clearly, the NHS [National Health Service] in the UK could not have had an international effect [the decline is international].
“There [has been] no obvious effect of statin therapy or other medical intervention,” Grimes continues. Yet statins continue to be prescribed in very high amounts and very great expense. The NNT (number of people you need to treat to save one life) is often in the thousands, he noted.
Those who complain about the high cost of health care fatally fail to grasp this enormous ignorance — about many things, not just heart disease — and its consequences. Reducing the cost of health care (reducing the cost of statins, for example) would improve health if cost were the only thing deeply wrong with our health care system. It isn’t.