Notes on "The Clot Thickens" by Dr. Malcolm Kendrick

We’ve all been told for years that (1) eating saturated fat is bad-bad-bad because it gooses LDL, the so-called “bad cholesterol”, and that (2) LDL is what leads to cardiovascular disease (CVD), specifically atherosclerosis - the formation of artery-blocking plaques.

Dr. Kendrick disputes both. He argues it is impossible for LDL to raise blood cholesterol levels and, besides, LDL isn’t what causes arterial plaques in the first place. Kendrick outlines the alternative thrombogeneic hypothesis which involves blood clots resisting breakdown and accumulating into artery-restricting plaques. If he’s right, millions of people have spent trillions of dollars on statins to control cholesterol for apparently no good reason whatsoever.

Apparently the science isn’t settled.

Anyway, like the late Randy Pausch, I am a doctor, but not the kind who helps people. So, Dr. Kendrick’s arguments might be flawed or incomplete and I don’t have the expertise to detect that. However, I find his thesis is interesting and persuasive. If you’re on the statin wagon, or have reason for concern about atherosclerosis, you might want to read this actually quite entertaining book.

Instead of rehashing his argument, I offer a series of quotes from the text. I quite like the good Doctor’s irreverent sense of humor and occasional bursts of outrage. YMMV.

For example, Kendrick discusses results of a study conducted long, long ago by the principal architect of the cholesterol/saturated fat/heart disease hypothesis, Ancel Keys. However, it has only recently emerged. The Scientific American headline was “Records found in dusty basement undermine decades of dietary advice.” He notes:

Is hiding data that you don’t want people to see, the same as simply lying about it? Discuss. I know what I think.

Kendrick also discusses a study on plaques commissioned some years back by a big pharma company (guess who!). That study backed the blood clot route to CVD and not LDL and also got buried. Why?

Perhaps you can guess which pharmaceutical company paid for this document to be produced?.. A company that went on to complete a hostile takeover of Warner Lambert, thus acquiring the rights to Lipitor (atorvastatin). The statin which went on to become the world’s largest selling drug, ever. From then on it was cholesterol, cholesterol, all the way.

Yes, once upon a time, before they had a cholesterol lowering drug, Pfizer had decided to progress down the thrombogenic route. Why did they change their mind? I think money might be a possible answer…

Yes, oh yes, they knew… They are not daft. They employ some of the finest scientific minds in the world. Unfortunately, the finest scientific minds in the world are very clearly directed to make money - not to explore the true causes of disease… Imagine how much money they would lose if we could actually prevent, or even cure, CVD.

Kendrick triples down:

The reality is that the reason why you have not heard of the thrombogeneic hypothesis is almost entirely because of money. A substance that can move research in any direction it wishes. A substance that can effectively purchase silence. A substance that has had the power to turn cholesterol into gold.

Big Pharma is heavily invested in the cholesterol hypothesis and viciously attacks any attempts to criticize it. “Facts that create painful cognitive dissonance are usually attacked with great venom, followed by dismissal,” Kendrick says.

Kendrick spent years studying CVD and notes that “I know it may not seem like it, but I have spent considerably more time looking for evidence that contradicts the thrombogenic hypothesis, than I have spent searching for evidence supporting it.” He also remarks:

Science and politics are not comfortable bedfellows. In fact, they mix very badly. Politicians demand immediate, simplistic answers. Scientists, at least true scientists, want to get at the truth. There is very rarely much overlap.

We do have the best politicians that money can buy but, to be candid, scientists are cheaper and easier to control (via grant money).

Some wisecracks:

On the use of passive voice in the scientific literature:

All emotion, all excitement and interest sucked away, leaving a bloodless corpse. Who decided that scientific writing must be so flat and dry? For example, the dreaded phrase ‘The experiment was carried out’. Who carried it out? Where did they carry it? Did they need a lorry? Was it heavy?

Also:

‘Seems not’ in a scientific paper can be translated as ‘do not’. It is a way of not upsetting the other experts too much.

“In my defence, many people, including me, have almost forgotten that there was such a thing as the Soviet Union.” Well, in America, the Democrats are still officially in mourning.

“As a general rule, figures as seemingly accurate [precise] as this should be taken with a large pinch of salt. Seven point two five grams of salt is best.”

“The anti-platelet of choice used to be aspirin. Nowadays it is usually clopidogrel. In the trade we call this, very expensive aspirin.”

“Take an aspirin. Or buy a snowblower - much more fun. As an added benefit, you can cover the next-door neighbor’s drive with snow.”

Kendrick discusses factors that elevate the risk of thrombogeneic CVD, which includes Hughes’ syndrome. The National Health Service warning signs regarding Hughes’ syndrome involve adverse pregnancy events such as miscarriages and premature births. “As you can see, this advice is more for women than men. But, yes, men suffer from Hughes’ syndrome too, in about the same numbers. However, if you don’t get pregnant, it is less likely to show up – before something else drastic happens.”

Lucklily, the Democrat Party has reliably informed us that now men can get pregnant, too, so this sexist inequity will soon disappear!

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Brilliant! Sometimes things are funny because they are true.

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Thank you, Cyrano. Inspired by your review, I obtained a copy of “The Clot Thickens”. It is highly readable, thanks to Dr. Kendrick’s generally lighthearted style. Only when writing about the evil money-grubbing pharmaceutical companies does his passion shine through.

Who would have guessed that a book which cites 280 medical papers, both old and recent, could be so readable! It is fascinating how he ties together apparently unrelated observations, such as the prevalence of heart disease in people with sickle-cell anemia, the sudden spike in chronic heart disease in Lithuania when the Soviet Union broke up, and the prevalence of coronary disease in Russian deep coal miners. Plus news we can use, such as breathing through the nose stimulates the body to produce nitric oxide, as does Viagra.

The surprising part is that most of this information has been available for years or decades, but the medical profession (under the influence of the evil money-grubbing pharmaceutical companies) settled on the diet/heart/cholesterol hypothesis and has studiously ignored the deficiencies in that theory. Dr. Kendrick’s book thus brings to mind the recent “Science Fictions” by his fellow Scot Stuart Ritchie; but while Ritchie focused on mainly academic matters where the prizes from distorting science were grants & tenure, Dr. Kendrick is focusing on something where human lives are at stake.

While the book is clearly of most immediate interest to those wondering about heart disease, the really important issue it reveals is the perversion of the scientific method in today’s society. Tenuous hypotheses are treated as Revealed Truth; inconvenient facts are ignored; voices are stifled; and progress consequently suffers.

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You’re welcome. And well said!

Sometimes we laugh because it releases pain.

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I have for a long time been skeptical of “Best Practices” as the scientific basis of practicing medicine. So cholesterol, from being a heart patient’s risk factor, has now become THE leading treatable “disease” - as if statins had no side effects, and cholersterol wasn’t an essential ingredient in the production of numerous hormones in the body. Just drive that sucker into the dirt - side effects don’t count.

Just one example

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