Wrong Notions About the Heart

By Mark Noble

Grumpy old retired Prof of Medicine rails (with cartoons) against low salt and low fat diets, over-diagnosis of high blood pressure, inappropriate use of anti-coagulants, etc. For light relief, some unsolved puzzles of body function are discussed.

• Language: English
• Publisher: Lulu Publishing Services
• Release date: Oct 31, 2014
• ISBN: 9781483415628

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Noble

Copyright © 2014 Mark Noble.

All rights reserved. No part of this book may be reproduced, stored, or transmitted by any means—whether auditory, graphic, mechanical, or electronic—without written permission of both publisher and author, except in the case of brief excerpts used in critical articles and reviews. Unauthorized reproduction of any part of this work is illegal and is punishable by law.

The information, ideas, and suggestions in this book are not intended as a substitute for professional medical advice. Before following any suggestions contained in this book, you should consult your personal physician. Neither the author nor the publisher shall be liable or responsible for any loss or damage allegedly arising as a consequence of your use or application of any information or suggestions in this book.

ISBN: 978-1-4834-1563-5 (sc)

ISBN: 978-1-4834-1562-8 (e)

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

Any people depicted in stock imagery provided by Thinkstock are models, and such images are being used for illustrative purposes only.

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Lulu Publishing Services rev. date: 10/17/2014

CONTENTS

Preface: Why did I write this book?

Introduction: Facts, theorems, theories and absurdities

Chapter 1:   The cells of your body — control by membrane or gel?

Chapter 2:   False theory: don’t eat salt; it will put your blood pressure up; it will kill you. NOT SO

Chapter 3:   Command of contraction of the heart by calcium - but how?

Chapter 4:   False theory: the micromuscles in muscle

Chapter 5:   False notions of the heart: preload, afterload, Vmax, etc

Chapter 6:   Franck versus Starling, and Emax -true or false?

Chapter 7:   Heart attack: what is being attacked? Heart failure: what has failed?

Chapter 8:   The heart delivers a series of dollops of blood flow with each beat, interspersed with zero blood flow, but the body needs a steady blood flow!

Chapter 9:   Arteries are living things, and become diseased

Chapter 10:   The great cholesterol myth

Chapter 11:   What is so special about coronaries? And a silly debate!

Chapter 12:   Drugs for the heart - and a Bloody Mess

Chapter 13:   I’m so worried about my blood pressure. Why? My care team are so worried about my blood pressure. Why?

Chapter 14:   Stress, fight, flight and fright - and you can’t beat a beta block!

Chapter 15:   What diet should I eat if I am obese or diabetic? What diet should I eat if I’m normal?

Chapter 16:   You are not joking Mr Feynman: Where medicine went wrong

Bibliography

PREFACE

Why did I write this book?

1. The usual misrepresentation of science and medicine by the media.

2. The actions taken by Government on the basis of false theories leading to policies such as depriving normal people of essential elements of their food, such as salt and fat.

3. The hypocrisy of Government in proclaiming that their policies are helping the health of the people, when there is evidence that some of those policies harm the health of the people.

4. The failure of those with a public voice to point out that theories cannot be proved, only disproved.

5. A peer review system that is prejudiced in such a way that work supporting popular theories are favoured for funding and publication, even though theories can only be disproved, not proved. Dissent and discordant voices have difficulty to be heard.

6. That medical education and practice now follow labels and protocols which treat the average patient, not the individual.

7. The structure of the hospital training system for physicians and surgeons leading to the risk of creating incompetent consultants.

8. The incorrect interpretation of results of analytical statistics.

9. The double standards of people concerned about animal welfare.

In short, that policy, regulation, social political correctness (PC), ideology and hypocrisy govern much of science and medicine rather than common sense.

Fewer and fewer people vote. Fewer and fewer people have faith in religion, the police and the medical profession. More and more people say, The world has gone mad — Why? — because the controllers of the world lack common sense.

The same applies to a lot of modern medicine. As my field of research and medicine has been in the cardiovascular system, I have illustrated my theme by describing instances of conflicting theories about aspects of cardiology, and how the sway of false theories has caused problems. Some of these controversies are mainly of my own intellectual interest, but others have a serious impact on public health.

As Richard Feynman once stated— Reality is more important than public relations. You cannot cheat nature.

INTRODUCTION

Facts, Theorems, Theories and Absurdities

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This book is intended to explain to intelligent non-medical people the various disagreements about how the heart and circulation works that I have encountered in my career. In this introduction, I point out that all the the things that we think we know about in bioscience, are in the form of theories, which are, by definition, capable of disproof and are therefore potentially falsehoods. Maybe, after my explanations, the reader may think that some of these ideas might well be more false than others!

The idea that I write about controversies in cardiovascular science and medicine arose from frustration at the popularisation of certain theories that have become so fashionable as a result of inappropriate preaching of them in the media — newspapers, TV etc. People are changing their lives under the influence of these popular theories.

Sometimes the theory concerned is compatible with some real scientific data, and their adoption into ordinary peoples lifestyle appear just now to be beneficial, e.g., that smoking is detrimental to health and should be avoided. Other theories are associated with very little compatible evidence, and other evidence which strongly challenges the validity of the theories, for example that the normal population should starve itself of salt and fat, an action very likely to be detrimental to health.

The worst crime of the TV reporter is when he or she says Scientists believe that so and so…. If the scientists did indeed say that to the reporter then they are not scientists but charlatans. The verb to believe is totally banned from the scientific thought process. If the non scientist tries to check for himself about such things in the scientific literature, he is more likely to come to false rather than true conclusions. Acceptance by scientific journals of submitted pieces of research are strongly biased toward some theories by two factors:

Positive interpretations (compatible with popular theory) are preferred over negative skeptical ones.

Papers are judged by peer reviewers who often turn out to be so-called experts, who are really very strong supporters of the popular theory. To support a theory is a fundamentally non–scientific attitude.

Facts, Theorems, Laws, Theories

and Statistics.

Fact: These are the basis of all advancements that can be made in knowledge and are what they are. For instance, the fact that there are 60 seconds in one minute.

Theorem: A theorem is the result of a deduction, worked out in pure mathematics and logic.

Theory: A hypothesis, or prediction about a process, in applied mathematics, physics, chemistry and biomedicine. A theory cannot be proved but may become a law, for instance Newton’s Laws.

Law: A theory that has resisted all attempts to disprove it. All data is consistent with the theory being true, but only under certain conditions.

Statistics: Statistics has two meanings: raw data and the analysis of data. Analysing data can show a possible trend, relationship or problem. All analysis of data is probabilistic, it never shows a link between sets of data.

Nothing can be proved with statistics.

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I like to discuss these matters with colleagues in both medical and non medical scientific fields in order to try and clarify my mind amongst the vast number of supposed discoveries being thrown at us daily.

Philosopher: There have been many proofs of mathematical relationships; these are called theorems, for example, the law of Pythagorus.

Prof: "I regard the science of physics and chemistry as a single subject. (‘All science is either physics or stamp collecting’ – Ernest Rutherford, Nobel Prize winner for Chemistry (1908)). We have a mixture of relationships that can be proved and some that have not been proved, and are therefore theories, not theorems (e.g., the big bang theory). In biology, we only have theories, and we have been taught by Carl Popper that all theories can be disproved. The correct scientific method to increase knowledge is to endeavour always to try and disprove theories."

Philosopher: Someone has to think up the theories in the first place.

Prof: Yes, Feynman said that you start with a guess, then work out the consequences of your guess, then test that, and if experimental results are not as predicted, you have to scrap the theory however clever you think it is.

Philosopher: We could avoid a lot of unnecessary work by using a maxim of mathematics, ‘Is this answer reasonable?’. If not, that pathway in the exercise can be set aside as absurd, a number of theorems have been proved using this process, the process of logic. An absurdity in the practice of logic is a process that enables a particular possibility to be excluded by the use of common sense.

Prof: What we think we know in bioscience are facts and measurements — data, also confusingly called ‘statistics’, established and confirmed by observation or experiment. The joy in the BBC programme, ‘The Joy of Statistics’ is the joy that so much data is available. However, that programme confirmed the maxim that theories based on statistical manipulation of data (analytical statistics) cannot prove theories, only disprove them.

Surgeon: Most important for us are the facts of anatomy that can now be determined for each individual by modern imaging techniques, particularly to help us surgeons assess diseased organs and know what to expect when we operate.

Philosopher: Facts differ from theorems; the latter are derived from a sequence of logical steps.

Prof: "Facts in biology are obtained from correct observations, raising the problem of whether a supposed fact really is a fact or comes from a flawed observation. Our theories need to take into account reliable facts." Even the more precise science such as mechanics involve measurements which all have an uncertainty, expressed by the ± sign. In biomedical science we also have further uncertainty as no result is identical on repetition, so that this variation also has to be accounted for as a ± (‘A result without uncertainty is meaningless’ — Walter Lewin).

Prof: That there are 60 seconds in a minute is a fact, but measurement of time always has some uncertainty. Hence the need for ever more accurate clocks such as Harrison’s chronometer. Even timing formula one cars qualifying times to one hundredth of a second does not exclude the possibility of different times measured in milliseconds (ms — one thousandth of a second). Current atomic clocks loose one second every billion years or so.

Philosopher, Isaac Asimov, in his ‘The Relativity of Wrong’ (see Asimov in Bibliography) quotes a correspondent of his who argued that with passing centuries, thought about the universe were changed, for instance (a flat earth displaced by a spherical earth) then replaced by an oblate spheroid; an earth centred universe replaced by a sun centred one, etc. From this he argued that each century’s different view showed that our ideas about the universe must always be wrong. Asimov countered with the argument that each idea was less wrong than that in the previous century and therefore we are less wrong than we have ever been.

Surgeon: An example of a reliable fact is that blood circulates around the body. Philosophers prior to the 17th century thought that blood ebbed and flowed in the arteries and veins. They could easily have disproved this by doing a simple observation. They only needed to be at a battle (there were plenty of those at the time) to see that a wound severing an artery caused blood to continuously flow out in high pressure squirts.

Prof: Don’t you surgeons just love to see the gore!

Surgeon: I have to confess that it was a physician, the great royal physician William Harvey in the 17th century, that pointed out these and many other aspects, such as the function of valves in heart and blood vessels, leading to the establishment of the circulation of blood as a fact.

Prof: "Yes, this must be adhered to in any theory we may form (or postulate) in the science of the cardiovascular system."

Philosopher: Although all theories in biology are capable of disproof, some are weird enough for us to say that they are very improbable and therefore very likely to be disproved. Others have so much evidence with which they are compatible that we can say that they are very probable. Or, to put it more correctly, the probability that they can be disproved is very low.

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Prof: In the case of Darwin’s theory of evolution by natural selection, the probability of disproof is so minute that I shall use it for the time being as if it were a fact. This is because evolution by human selection is a fact — we breed plants and animals to provide the best food, we even genetically modify organisms and produce clones. Also natural selection has been observed in wildlife, by Darwin and by many others since. We are presently observing in Scotland the displacement of red squirrels by grey squirrels by natural selection, only hindered by human intervention.

You cannot prove anything with analytical statistics

Prof: In biological research we use the word ‘probability’ very much in the branch of mathematics that we use most, namely statistics.

Philosopher: The most important fact about statistics is that it is impossible to prove anything with statistics, contrary to popular belief, because when we say that a result is statistically significant, we should be saying that the probability of the result being wrong is less than 5%.

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Statistician: A correlation between two factors depends on the choice of factors thought to be correlated. One (the dependent variable) has to be thought to depend on the other (the independent variable). Visually, this is presented as a graph with a vertical axis representing the dependent variable (y axis or ordinate) and a horizontal axis representing the independent variable (x axis or abscissa). Perfect correlation is obtained if you plot the same variables on both axes, when all the points lie exactly on a straight line.

Prof: If you plot different biological variables on the axes, e.g., height of a population versus shoe size, the points are scattered. Statistical correlation analysis will show a significant correlation, but that does not mean that a person’s height is caused by his or her shoe size. It probably means that both are caused by the extent of bone growth. But time and again, the progenitors of false theories argue from such correlations, for example, when cholesterol lowering drugs (statins) are given to people, there is a correlation between survival and cholesterol. This is not because the improved survival is caused by the lower cholesterol. It is a false hypothesis to say that the improved survival is caused by the lower cholesterol, in that it does not apply to all patients. The correlation arises because statins reduce arterial disease regardless of cholesterol level, but they also independently lower cholesterol, so a positive correlation will be obtained that does not mean any dependency of one variable upon the other.

Statistician: Even if one thinks one has found a meaningful statistical correlation between, say, a clinical problem in a population and a potential cause, say, smoking, this only applies to an average person in the population. The difference between a datum from an individual observation and the average varies with such individual observation and is analysed in statistics as a variance. Often the variance, the amount of the problem not related to the independent variable or average, is larger than that which is, for instance, tall individuals with small shoe size, short people with large shoe size (or foot size in the case of Hobbits). Nevertheless there is a considerable amount of bad medicine that is due to applying to individual patients that which applies only to the average patient.

Philosopher: