Breakthrough

There's a "major breakthrough" in the newspapers this morning. Of course, there are only "major breakthroughs" in the media world. In reality, we learn incrementally. I've been in the medicine game for over twenty years. In that time, there hasn't been a single "breakthrough". Everything that we've learned (an incredibly enormous amount) has been a painstaking development of accumulated tid bits of information and hundreds of publications. Anyway, CRP is a protein that is not as famous as some biomarkers. It reflects a state of chronic inflammation which we know is probably an important part of what we now call "metabolic syndrome" which is possibly a pre-cursor state of diabetes versus a chronic "not healthy state" (that's my term). In essence, it's a sign of being an American: non-exercising and unhealthy eating. There was a study of 18,000 people with elevated CRP and normal cholesterol levels who were given statin drugs. There was a 50% reduction in the risk of heart attack and stroke. This isn't a huge surprise. There's been data on this published before. There is also data on reducing these cardiovascular risks by treating people with "normal" blood pressure with blood pressure lowering medications. The mediterranean diet and the effects of exercise, if they're additive probably have an equal effect. We seem to be getting relatively close to figuring out that it's good to be healthy. We are developing all sorts of medications to combat the poisoning that we're doing. Soon, we're going to be just as good at giving ourselves chemicals to stay healthy while we poison ourselves and neglect our well being as if we were just healthy. And we're also going to figure out that it's all a spectrum. The healthier the better. We "just found out" recently (in another "major medical breakthrough") that we can improve outcomes by treating kids with cholesterol lowering medicines. So we can start earlier and earlier. Treating CRP is just one step down the chain from cholesterol. It's a way of starting earlier, because 50% of people who have a first heart attack have "normal" lipid profiles. I think before I retire we'll start giving infants medication in their formula to fight off the effects of poor health habits. (Oh, wait. We do that already - it turns out that breast milk is better for babies, but we can avoid that healthy behavior, cause harm and then add chemicals!)
I try to get patients to exercise and eat right. But this is definitely not the American way. It's very hard in this culture to do that. We're not structured for it.