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The American Board of Cardiology Is One Of Many Scams Providing Bogus Credentials To Physicians

Recently the skeptical cardiologist received a worrisome letter from the “American Board of Cardiology.”

The first page of the letter announced that I was in danger of losing my certification “in  strict compliance with homeland security cooperation”

ABC first page

For a few seconds I was concerned. I value my Board Certification in Cardiology and consider this a marker of a good cardiologist, one who has completed appropriate training and testing. However, I knew that my board certification is provided by the American Board of Internal Medicine (ABIM).

It quickly became apparent that the American Board of Cardiology was a scam.

The ABC website consists of a single page, all in caps, with the name and address followed by bizarre mumbo-jumbo including a suggestion that the organization is engaged in humanitarian efforts.

THE AMERICAN BOARD OF CARDIOLOGY IN CONCERT WITH THE CONGREGATION OF RELIGIOUS MEDICAL MINISTRIES, THE WORLD CHRISTIAN CHILDREN’S CRUSADE AGAINST THE MURDER OF STREET CHILDREN IN LATIN AMERICA,  THE WORLDWIDE MINISTRIES OF JESUS CHRIST, THE MOSQUE OF THE GOLDEN RULE, HAS RECENTLY ESTABLISHED A HOMELESS SHELTER FOR ABUSED WOMEN IN SOUTHERN NEVADA, A RECREATIONAL CENTER FOR TEENAGERS AND CHILDREN IN NORTH LAS VEGAS, AND WORK TO FOCUS THE CONSCIENCE OF THE WORLD ON THE MURDERING OF STREET CHILDREN IN HONDURAS AND OTHER LATIN COUNTRIES, AND WE BELIEVE THIS HUMANITARIAN, MEDICAL, RELIGIOUS APPROACH IS ALSO EXEMPLIFIED BY OUR DEVELOPING PLANS FOR HUMANITARIAN MEDICAL MISSIONS AND FREE CLINICS TO HELP THE POOR IN TABAC CITY IN THE BICOL REGION OF SOUTHEAST LUZON IN THE PHILIPPINES.

Keith Lasco,  Master of Multiple Bogus Medical Certificate Scams

The only mention of  this scam on the ABIM website is from 2009 and  references a warning issued  by  the then Connecticut Attorney General ( and current US Senator), Richard Blumenthal

Blumenthal’s office has learned that an out-of-state individual known as Keith Alan Lasko – who also uses the names K. Lasko, Keith Ferrari, K. Ferrari, and KA James Windsor – has sold phony certifications to doctors in a variety of medical specialties in exchange for submitting only basic information and a substantial fee.

At least 130 more complaints have been reported, including at least one in Connecticut.

Lasko’s alleged scheme particularly targets foreign-born or foreign-taught doctors who may be unaware of the proper certification process.

Lisa Salberg, the Founder and CEO of the Hypertrophic Cardiomyopathy Association, describes in detail in a  2014 post the various scams that Lasko has promulgated.

Salberg notes that  the credentials obtained from this bogus operation look confusingly similar to real credentials. For example, for 300$ anyone can purchase a Master of the American Academy of Cardiology certificate and put the initials M.A.A.C. after their name.

There is no legitimate American Academy of Cardiology but  non-physicians could easily confuse it with the American College of Cardiology which is the major professional organization for cardiologists.

Lasko has been named in multiple lawsuits such as this one from the American Board of Surgery.

The American Board of Surgery sued Lasko and his companies, the American Academy of Surgery and American Council of General Surgeons, and the American Council of Surgical Specialists, in Federal Court, for trademark violations and unfair and deceptive trade.
The Board claims Lasko set up both companies to trick physicians into believing they are affiliated with the American Board of Surgery, a legitimate group that “was founded in 1937 for the purpose of certifying surgeons who met a defined standard of education, training and knowledge.”
The ABS says Lasko has a long history of creating “medical organizations” to sell bogus certifications, and that he got into the business after losing his medical license.

Bill Roberts, the long time editor of the American Journal of Cardiology has described in detail another scam involving the bogus American Board of Cardiology:

In May 2014 I received the letter printed below with the caption American Board of Cardiology Committee on Honors and Awards, dated May 9, 2014, and signed by A.J. Alaa Windsor, MD. I was a bit surprised and transiently honored when I read the letter until I got to the second page which indicated that there were actually 3 engraved award plaques: one stated The American Board of Cardiology Award of Honor for 2014 ; another The Distinguished Master Laureate of the American Board of Cardiology , and the third one as Senior Consultant to the American Board of Cardiology . Under each of these was the option to order a number of plaques. Near the bottom of the second page was the following: “Please assist in the funding of this program of recommendation of excellence. Please enclose registration fee of $300 made to: American Board of Cardiology. Please enclose engraving and preparation fee of $70 for each 10″ × 8″ engraved plaque and $15 for shipping and handling of each plaque.”

Make Sure Your Cardiologist Has Real Credentials

It is very hard for patients to find good cardiologists. Such bogus certificates make it more difficult.

Make sure that the cardiologist you see is board certified in cardiology with the certification issued by the American Board of Internal Medicine. Seek out cardiologists who have the initials FACC after their name indicating they are fellows in the American College of Cardiology.

There may be additional initials following a good cardiologist’s name indicating membership or fellowship in other legitimate organizations.

If you see any of the above-referenced bogus organizations (American Board of Cardiology, American Academy of Cardiology, American Board of Surgery) after a doctor or cardiologist’s name be very suspicious. This physician is highly likely to be unethical.

Of course, Lasko changes the names of his bogus organizations and certificates as his scams are revealed so patients and physicians must perform due diligence on any other cardiology certification.

Skeptically Yours,

-ACP

Is September Really National Atrial Fibrillation Awareness Month (And Why Does It Matter?)

The skeptical cardiologist received an email from a woman telling him that September is atrial fibrillation awareness month and offering me the free use of an infographic given that I

“care deeply about helping people living with AF.”

Well, I do care about deeply about people living with atrial fibrillation and pretty much all cardiac diseases  (except perhaps Schuckenbuss syndrome.)

That’s the major reason I write this blog. I’ve written a lot about Afib and have a lot more i want to write (I really want to write about antiarrhythmic drugs, i.e. drugs that maintain you in normal sinus rhythm.)

But I don’t find it particularly helpful to assign a disease to a month or a day so my posts on atrial fibrillation come out randomly dependent on the mysterious machinations of my messy mind.

It turns out that September, 2009 was declared National Atrial Fibrillation Awareness Month (NAFAM) by Senate Resolution 262 although Stop Afib.org wants us to believe September is eternally NAFAM.

However, the email prompted me to better organize my atrial fibrillation and stroke page (now containing all that I have written on the subjects) which I have copied below.

Posts on Diagnosing Atrial fibrillation

Take your pulse and prevent a stroke

TIAs and silent atrial fibrillation. Sometimes strokes present in unusual ways, like the inability to differentiated a spade from a diamond when playing bridge and afib is often the cause.

Estimating Stroke Risk in Patients With Atrial Fibrillation You can estimate your stroke risk using an app that utilizes the CHAD2DS2-VASc score. I prefer to call the Lip score.

Posts About Using Personal Devices To Diagnose Atrial Fibrillation

Two That Work Reasonably Well

AliveCor

Using a Smart Phone Device and App To Monitor Your Pulse for Atrial Fibrillation (AliveCor)

AliveCor Is Now Kardia and It Works Well At Identifying Atrial Fibrillation At Home And In Office

AliveCor Successes and Failures.

Sustained Atrial Fibrillation or Not: The Vagaries and Inaccuracies of AliveCor/Kardia and Computer Interpretation of ECG Rhythm

AfibAlert

How Well Does The AfibAlert Remote Hand-Held Automatic ECG Device Work For Detection of Atrial Fibrillation?

AfibAlert Versus AliveCor/Kardia: Which Mobile ECG Device Is Best At Accurately Identifying Atrial Fibrillation?

And One of Several Devices To Avoid: AF Detect

Do NOT Rely on AF Detect Smartphone App To Diagnose Atrial fibrillation

Posts About Treatment Of Atrial Fibrillation

        Lifestyle Changes

How Obesity Causes Atrial Fibrillation in FatSheep and How Losing Weight helps prevent afib from coming back.

Drug Therapy: Rate Control and Anticoagulation

Foxglove Equipoise. When William Withering began treating patients suffering from dropsy in 1775 with various preparations of the foxglove plant he wasn’t sure if he would help or hurt them. After 240 years of treatment, we are still unsure if the drug obtained from foxglove is useful.

Should Digoxin Still Be Used in Atrial Fibrillation? Recent studies suggest that we should not.

Why Does the TV Tell Me Xarelto Is A BAD Drug? Anticoagulant drugs that prevent the bad clots that cause stroke also increase bleeding risk. A bleeding complication is not a valid reason to sue the manufacturer.  The lawsuit are strictly a money-making tactic for sleazy lawyers.

Cardioversion and Ablation

Cardioversion: How Many Times Can You Shock The Heart?

Ablation: Cautionary Words From Dr. John Mandrola and The Wisdom of a Team Approach

Miscellaneous Topics

What Happens If You Go Into Atrial Fibrillation On A Cruise?

Infographics

Are infographics really helpful? Someone should do a study on that. Perhaps we could use the money we spend on infographics in atrial fibrillation to research whether the left atrial appendage should be excised at the drop of a hat.

Here’s the infographic (because everyone loves an infographic!)

The first part lays out the problem of AF with patriotic bunting.

The second part uses the annoying numerical infographic approach.

 

 

 

 

 

 

 

The third part explains why I got the email. A product is being promoted. The woman who sent me the email works for MyTherapyApp.

 

 

 

Eagerly Awaiting Schuckenbuss Syndrome Day,

-ACP

 

 

 

The Harvard T.H. Chan School of Public Health Now Recommends Full Fat Dairy For Your Kid’s Lunch Boxes

The skeptical cardiologist became overjoyed while reading an email from The Harvard T.H. Chan School of Public Health (THTHCSPH) which outlined  their recommendations for packing kids‘ lunch boxes.:

The Kid’s Healthy Eating Plate was created as a fun and easy guide to encourage children to eat well and keep moving. The plate guidelines emphasize variety and quality in food choices.

The majority of the recommendations were pretty straightforward and mainstream:

The formula is simple: Fill half your plate (or lunch box) with colorful fruits or vegetables(aim for two to three different types). Fill about one-quarter with whole grains like whole grain pasta, brown rice, or quinoa, and the remaining quarter with healthy proteinslike beans, nuts, fish or chicken. Healthy fatsand a small amount of dairy (if desired) round out a tasty meal that will fuel an active, healthy lifestyle.

What caught my attention was the comment about dairy.

The dreaded words skim or low-fat did not appear in the sentence!

It would appear that a highly respect and mainstream source of nutritional advice is not making the typical (and scientifically unsupported ) recommendation to consume low fat or skim dairy products!

Indeed, if we look at their expanded comments on dairy they read:

Incorporating dairy (if desired). For example: unflavored milk, plain Greek yogurt, small amounts of cheese like cottage cheese, and string cheese.

No mention of fat content. Zip. Zero. To me, if you don’t put non fat low fat or skim next to the word diary it implies full fat.

Following their yogurt link we find no reference to preferentially consuming low fat yogurt despite the fact that the vast majority of yogurt sold in the US has been processed to remove healthy dairy fat, something the THCHSPH must be painfully aware of. (My wonderful MA Jenny’s husband, Frank, until very recently was unable to find full fat yogurt at Schnuck’s.)

As I pointed out here, a huge scam was foisted on Americans when allegedly healthy non fat yogurt filled with added sugar began to be promoted as a healthy treat.

It is almost  as if the THTHCSPH  has become agnostic about dairy fat and therefore is trying not to make recommendations.

Elsewhere on the THTHCSPH site however the old unwarranted advice  to avoid dairy fat rears its ugly head. On a page devoted to calcium we read:

Many dairy products are high in saturated fats and a high saturated fat intake is a risk factor for heart disease”

Then this interesting (and ?ironic) observation:

And while it’s true that most dairy products are now available in fat-reduced or nonfat options, the saturated fat that’s removed from dairy products is inevitably consumed by someone, often in the form of premium ice cream, butter, or baked goods.

Strangely, it’s often the same people who purchase these higher fat products who also purchase the low-fat dairy products, so it’s not clear that they’re making great strides in cutting back on their saturated fat consumption.

The THTHCSPH seems conflicted, as well they should. They want to keep up the nutritional party line that they have been spouting for 30 years that all saturated fats are bad but they now realize that supporting non fat dairy products has likely worsened rather than improved the diet of millions of Americans.

Galactosely Yours,

-ACP

N.B. The overall Kid’s healthy eating plate is not likely to be a favorite of kids  and I disagree with some aspects of it.

Namely, I think it is fine to have red meat and processed meats in moderation and I wouldn’t push the pasta, rice, and bread.

 

 

 

 

Pistachios: Are Their Shells A Portal to Contamination, The Key To Weight Loss, or A Manicure Destruction Device?

The results of the “Fourth Nut” poll are in and the winner is a nut first cultivated in Bronze Age Central Asia,

Almost 60% of readers who took the time to vote selected the pistachio nut.

Coming in a distant second was the macadamia nut. One reader prized it because it only contained saturated fat and monounsaturated fats. Another bemoaned their candy-like quality which makes over-consumption an issue.

A couple of readers were strong proponents of Brazil nuts. This prompted me to enter a selenium rabbit hole from which I have yet to emerge. If I can escape with my selenoproteins intact I’ll let you know.

Pistachios are a fine choice from a health standpoint and seem to be embraced by all nutritional cults, with the exception of  the very nutty Caldwell “NO OIL” Esselstyn’s acolytes.

The Pistachio Principle PR Institute

I’m in the process of sorting through the nutritional studies on pistachios, and the hardest part is determining which data are sponsored by the pistachio industry.

For example, poorly researched online articles about pistachios will typically state that “research suggests” that “pistachios could help to reduce hypertension and promote development of beneficial gut microbes. They’re even gaining credibility as a tool for weight loss”

The first reference is an open access review article which clearly just wants to extoll any and all positive pistachio data and was paid for by the American Pistachio Growers. The second article comes directly from “The Pistachio Health Institute,” a PR voice for the pistachio industry.

To Shell or Not to Shell

My major dilemma was deciding if the pistachios should be shelled or left in-shell. (This has led me down the pistachio production rabbit hole).

I was concerned that the outsides of the pistachio shells could be contaminated in some way and the idea of mixing them in with unshelled nuts seemed a little strange.

If you Google images of mixed nuts pistachio you only see mixtures with unshelled pistachios.

Why, then, are most pistachios sold and consumed in-shell?

According to How Stuff Works Louise Ferguson, author of the Pistachio Production Manual believes:

Between 70 and 90 percent of pistachios develop a natural split in their shells during the growing process, After those pistachios are shaken off the trees by harvesting machines, they can be salted and roasted while still inside the shells as that natural crack allows heat and salt access to the nut, eliminating a step in the industrial process and saving processors some money.

The pistachio PR machine would also have us believe that eating pistachios in-shell can lead to weight loss:

Why choose any other nut?

This pistachios principle is based on 2 studies in the journal Appetite (seems to be a legitimate journal) by JE Painter of the department of “Family and Consumer Sciences” Eastern Illinois University in Charleston, Illinois.

I’m awaiting a full copy of the paper, but the abstract notes that students offered in-shell pistachios consumed only 125 calories, whereas those offered shelled pistachios consumed 211 calories yet “fullness and satisfaction” were similar.

My skeptical sensors were exploding when I read about this study. I doubt that it will ever be reproduced.

If we look at cost, an unofficial analysis revealed:

The pre-shelled pistachios were priced at $5.99 for 6.3 oz of nuts.

The 8 oz bag of pistachios were priced at $4.49.  After shelling he was left with 4.3 oz of nuts.

Un-shelled pistachios = $1.04 per oz.

Shelled pistachios = $0.95 per oz.

If you go the lazy route, you save $.09 per oz!

Most likely, the fourth nut will be a shelled pistachio unless readers convince me otherwise or the blather from the pistachio PR machine  annoys me too much.

The eternal fiance’e has just weighed in and tells me that women who care about their well-groomed  nails will not consume  in-shell pistachio nuts for fear of damaging their manicures.

That, my friends, is the  nail in the coffin for shelled pistachios as the fourth nut.

Pistachoprincipaly Yours,

-ACP

Quackery Promotion By Mainstream Media: Part I, Reader’s Digest and Naturopathy

As the skeptical cardiologist surveys the heart health information available to his patients and the lay public, he sees two broad categories of misinformation.

First we have the quacks and snake oil salesman. These are primarily characterized by a goal of selling more of their useless stuff online.

I’ve described this as the #1 red flag of quackery. Usually I’m inspired to investigate these charlatans because a patient asks me about one of their useless supplements.

The second category is more insidious: the magazine or internet news site seems to have as its legitimate goal, promoting the health of its readers. There is no clear connection to a product.

Web MD, which I wrote about here, is an example of this second type.  Hard copy versions of these types of media frequently make it into doctor’s waiting rooms: not because doctor’s have read and approved what is in them. These companies send their useless and misleading magazines for free to doctor’s offices, and the staff believe it to be legitimate.

How does glaringly inaccurate and often dangerous information get into media that ostensibly has as its goal promoting its readers health? Most likely, it is a result of media’s need  to constantly produce new and interesting ways for readers to improve their health.

Clearly, readers will not continue subscribing, clicking and reading such sources of information if there isn’t something new and exciting that might prolong their lives: gimmicks, miracles cures, and “natural” remedies are more alluring than the well-known advice to exercise more, watch your weight, stop smoking and get a good night’s sleep.

Reader’s Digest and Stealth Quackery

A patient recently brought in a printout of Reader’s Digest’s “40 things cardiologists do to protect their heart” which is typical of the second category.

Reader’s Digest was a staple of my childhood. My parents subscribed to it consistently and I would read parts of it. It was small and enticing. Allegedly its articles were crafted so that they could be read in their entirety during a session in the bathroom.

To this day it has a wide circulation. Per Wikipedia”

The magazine was founded in 1920, by DeWitt Wallace and Lila Bell Wallace. For many years, Reader’s Digest was the best-selling consumer magazine in the United States; it lost the distinction in 2009 to Better Homes and Gardens. According to Mediamark Research (2006), Reader’s Digest reaches more readers with household incomes of $100,000+ than Fortune, The Wall Street Journal, Business Week, and Inc. combined.[2]

Global editions of Reader’s Digest reach an additional 40 million people in more than 70 countries, via 49 editions in 21 languages. The periodical has a global circulation of 10.5 million, making it the largest paid circulation magazine in the world.

Reader’s Digest used to run a recurring educational feature on the various body parts and organs of Joe and Jane which intrigued me.

Here’s the first paragraph of “I am Joe’s heart:”

I am certainly no beauty. I weigh 340 grams, am red-brown in color and have an unimpressive shape. I am the dedicated slave of Joe. I am Joe’s heart.

The health information in this series was generally accurate but the presentation lacks the kind of sizzle that apparently attracts today’s readers.

The article my patient brought to my attention is typical of the mix of good and bad information and fluff that mainstream media can produce to attract followers:

Not So Bad But Not Clearly True Medical Advice

#1. I keep a gratitude journal. An internist “at NYU” is quoted as saying: “Studies have recently shown that expressing gratitude may have a significant positive impact on heart health.”

Fact Check: following the links provided provides no evidence to support this claim.

#2  I get 8 hours of sleep a night, every night.  This cardiologist seems to have been misquoted, because her comment is actually “getting a good night sleep is essential. I make a point of getting seven to eight hours of sleep every night…Poor sleep is linked to higher blood pressure.”

Fact Check. One review noted that:

Too little or too much sleep are associated with adverse health outcomes, including total mortality, type 2 diabetes, hypertensionand respiratory disorders, obesity in both children and adults, and poor self-rated health.

Another broke down mortality according to number of hours of sleep.

A J-shaped association between sleep duration and all-cause mortality was present: compared with 7 h of sleep (reference for 24-h sleep duration), both shortened and prolonged sleep durations were associated with increased risk of all-cause mortality (4 h: relative risk [RR] = 1.05; 95% confidence interval [CI] = 1.02–1.07; 5 h: RR = 1.06; 95% CI = 1.03–1.09; 6 h: RR = 1.04; 95% CI = 1.03–1.06; 8 h: RR = 1.03; 95% CI = 1.02–1.05; 9 h: RR = 1.13; 95% CI = 1.10–1.16; 10 h: RR = 1.25; 95% CI = 1.22–1.28; 11 h: RR = 1.38; 95% CI = 1.33–1.44; n = 29; P < 0.01 for non-linear test)

Thus, in comparison to those who sleep 7 hours, those who sleep 5 hours have a 5% increase in mortality and those who sleep 11 hours have a 38% increase in mortality.

These data are based entirely on observational studies so it is impossible to know if the shortened sleep is responsible for the increased mortality or if some other (confounding) factor is causing both.

My advice: Some people do fine with 6 hours and 45 minutes of sleep. Some require 8 hours 15 minutes for optimal function. Rather than obsessing about getting a specific amount of sleep time, it makes more sense to find our through your own careful observations what sleep time works best for you and adjust your schedule and night time patterns accordingly.

#3. I do CrossFit.

Fact Check. There is nothing to support CrossFit as more heart healthy than regular aerobic exercise (which the vast majority of cardiologists recommend and perform).

#4. I meditate. “Negative thoughts and feelings of sadness can be detrimental to the heart. Stress can cause catecholamine release that can lead to heart failure and heart attacks.”

Fact Check. There is a general consensus that stress has adverse consequences for the cardiovascular system. Evidence of meditation improving cardiovascular outcomes is very weak.

A recent review

Participation in meditation practices has been shown to reduce depression, anxiety, and negative mood and thus may have an indirect positive effect on CV health and well-being. This possibility has led the American Heart Association to classify TM as a class IIb, level of evidence B alternative approach to lowering BP.32

Non randomized, non blinded studies with small numbers of participants have suggested a reduction in CV death in those performing regular TM.

However, we need better and larger studies before concluding there is a definite benefit compared to optimal medical therapy.

Thus far, the recommendations have been pretty mundane: exercise, stress reduction and a good night’s sleep is good advice for all, thus boring.

Seriously Bad Advice From Quacks Mixed In With Reasonable Advice

In order to keep reader’s interest (and reach 45 things) Reader’s Digest is going to need to add seriously bad advice.

My patient had circled #34. “I mix magnesium powder into my water. If sufficient magnesium is present in the body, cholesterol will not be produced in excess.”

This bizarre and totally unsubstantiated practice was recommended by Carolyn Dean MD, ND.

What do we know about Dr. Dean?

-She was declared unfit to practice medicine and her registration revoked by the College of Physicians and Surgeons of Ontario in 1995. From quackwatch.org :

  • After being notified in 1993 that a disciplinary hearing would be held, Dean relocated to New York and did not contest the charges against her.
  • Dean had used unscientific methods of testing such as hair analysis, Vega and Interro testing, iridology and reflexology as well as treatment not medically indicated and of unproven value, such as homeopathy, colonic irrigations, coffee enemas, and rotation diets.

-The initials after her name (ND, doctor of naturopathy) should be considered the second red flag of quackery. See quackwatch.org (here) and rational wiki (here) and the confessions of a former naturopath  (here ) for discussions of naturopathy. As noted at science-based medicine:

Naturopathy is a cornucopia of almost every quackery you can think of. Be it homeopathy, traditional Chinese medicine, Ayurvedic medicine, applied kinesiology, anthroposophical medicine, reflexology, craniosacral therapy, Bowen Technique, and pretty much any other form of unscientific or prescientific medicine that you can imagine, it’s hard to think of a single form of pseudoscientific medicine and quackery that naturopathy doesn’t embrace or at least tolerate.

-She has a website (Dr. Carolyn Dean, MD,ND, The Doctor of The Future) where she incessantly promotes magnesium as the cure for all ills.

-She has written a book called “The Magnesium Miracle” (hmm. wonder what that’s about).

-She sells her own (really special!) type of magnesium (see red flag #1 of quackery).

-She writes for the Huffington Post (I’m considering making this a red flag of quackery).

-She is on the medical advisory board of the Nutritional Magnesium Association (an organization devoted to hyping magnesium as the cure for all ills and featuring all manner of magnesium quacks).

Prevention Magazine 

Reader’s Digest is not alone in allowing the advice of pseudoscience practitioners to stand side by side with legitimate sources.

For example, Prevention Magazine in its August 2017 issue highlights “35 All-Time Favorite Natural Remedies” with the subheading

“Go ahead, try them at home: Experts swear by these nondrug cures for back pain, nausea, hot flashes, and other common ailments.”

Who are these “experts”? Let the reader beware because the first quote comes from “Amy Rothenberg, past president of the Massachusetts Society of Naturopathic Doctors.”

Finding The Truth

It’s getting harder and harder for the lay public to sort out real from fake health stories and advice.

When seemingly legitimate news media and widely followed sources like Reader’s Digest and Prevention Magazine  either consciously or inadvertently promote quackery, the truth becomes even more illusive.

Readers should avoid any source of information which

  1. Profits from selling vitamins and supplements.
  2. Utilizes or promotes  naturopaths or other obvious quacks as experts in health advice.

IamJoesfootingly Yours,

-ACP

Dupixen Has Miraculously Cured My Eczema

Although this post is most unskeptical and decidedly noncardiac, the skeptical cardiologist feels compelled to share this information with readers who have or know friends or family with eczema or atopic determatitis, a chronic skin condition that results in itchy, scaly, dry and red skin.

For most of my life I have dealt with periodic flare-ups of eczema along with continuously itchy skin . Control of flare-ups was by meticulous attention to keeping my skin clean and moisturized along with frequent applications of topical corticosteroids.

Things worsened a few years ago and I began to think I might have Red Skin Syndrome, which some dermatologist believe is due to withdrawal from topical corticosteroids.

Two months ago, however, my spirits brightened when I heard that the FDA had approved a new biologic injectable called Dupixent (dupilumab), to treat adults with moderate-to-severe eczema (atopic dermatitis), whose eczema is not controlled adequately by topical steroids.

My fantastic dermatologist, Dr. Amy Ney, agreed this was appropriate therapy for me, and within a week I received a refrigerated package containing the initial dosage: two syringes filled with the drug.

The pre-loaded syringe filled with Dupixent. The syringes come with very detailed instructions to guide you through the process of injecting the liquid into either the abdominal region or the thighs.

 

Within a week of injecting the contents of the syringes into my abdomen, my itching ceased and I had no more eczematous rashes. For me this was a minor miracle.

Since then I’ve injected one 300 mg syringe every two weeks and I continue to be free of my life-long signs and symptoms of eczema.

Atopic Dermatitis and Dupixent

The cause of atopic dermatitis is a combination of genetic, immune and environmental factors. In atopic dermatitis, the skin develops red, scaly and crusted bumps, which are extremely itchy. Scratching leads to swelling, cracking, “weeping” clear fluid, and finally, coarsening and thickening of the skin.

Dupixent’s active ingredient is an antibody (dupilumab) that binds to a protein [interleukin-4 (IL-4) receptor alpha subunit (IL-4Ra)], that causes inflammation. By binding to this protein, Dupixent is able to inhibit the inflammatory response that plays a role in the development of atopic dermatitis.

Dupixent acts by inhibiting two cytokines that are responsible for the hyperimmune response in skin. They are called IL-4 and IL-13. IL is an abbreviation for interleukins, proteins that are produced by leukocytes (3) and play a part in regulation of the immune system. Steroids, such as prednisone, also suppress the immune system, but taking them for an extended period of time will get you into trouble. (See: Prednisone: Satan’s Little Helper) Unlike prednisone, Dupixent inhibits specific targets. It works more like a scalpel than a bomb.

More Stories of Miraculous Relief

I am not alone in experiencing miraculous relief from this new drug. I first heard of it from a  New York Times article in 2016 which details the dramatic responses of several patients who were involved in the clinical trials that proved the drug’s efficacy:

One participant in the trial, Lisa Tannebaum, a 53-year-old harpist in Stamford, Conn., was so thrilled that she wrote a letter to Regeneron suggesting they use her before and after photographs in advertisements. She developed a severe form of the disease 14 years ago and tried everything imaginable in conventional and alternative medicine without relief — specialized diets, immunosuppressive drugs, special clothing, bleach baths. She even had the gold fillings removed from her teeth on the theory that they may be causing an allergic response, but to no avail.

“It was like every day I had poison ivy and fire ants on myself,” she said. “You don’t sleep at all. You can’t go out, you have staph infections all the time,” because the skin’s protective barrier is broken by the rash. “I couldn’t drive my kids to school because the itching was so bad I couldn’t put my hands on the steering wheel.”

Now, she is performing again and will be playing her harp at Carnegie Hall on Oct. 30.

Randomized Controlled Trials Proving Efficacy

Of course we can’t rely on anecdotes to prove the safety and efficacy of drugs: we need randomized, controlled, double-blind studies.

Dupixent has three such clinical trials with a total of 2,119 adult participants, and the results were remarkable. (for details see here). Overall, participants who received Dupixent achieved greater response, defined as clear or almost clear skin, and experienced a reduction in itch after 16 weeks of treatment.

Panel A shows the proportions of patients with the primary end point (both a score of 0 or 1 [clear or almost clear] on the Investigator’s Global Assessment [IGA; scores range from 0 to 4, with higher scores indicating more severe disease] and a reduction from baseline of 2 points or more on the IGA at week 16) among patients who received dupilumab every week, dupilumab every other week, or placebo in SOLO 1 and SOLO 2. Panel B shows the proportions of patients with the key secondary end point (which was considered to be a coprimary end point by regulators in the European Union and Japan) of an improvement from baseline of at least 75% on the Eczema Area and Severity Index (EASI-75) at week 16 in the two trials. P<0.001 for all comparisons between dupilumab and placebo. For binary end points, patients who received rescue medications or withdrew from the study were categorized as having had no response, as were those with all other missing values.
The only side effect which was more common with Dupixent than placebo was conjunctivitis, an inflammation of the eye.

Cost of Dupixent

When I first read of this drug I assumed it would be horribly expensive. In cardiology we have two injectable biologics (Repatha and Praluent, PCSK9 inhibitors) for lowering cholesterol, which typically have been costing my patients with insurance coverage over 1000$ per month.

Fortunately Sanofi/Regeneron have learned from prior experience and priced the drug at $37,000, a number that insurance companies have apparently warmly welcomed. This article suggests that the drug is priced significantly lower than newer biologics now available for psoriasis and rheumatoid arthritis.

With my  insurance (United Health Care) coverage I was asked to pay 150$ for 2 injections per month.

I then discovered that Sanofi has a co-pay card that covers that 150$ so that for now I am paying zero dollars out of the 37,000$.

I’m paying nothing for a brand new biologic injectable that has cured my eczema. Now that is miraculous!

Unskeptically Yours,

-ACP

N.B. Featured Image before and after hand is from National Eczema organization and is not of my hand.

Why Are The Dutch So Heart Healthy and Happy (And Tall)? Part I: Is It Their Diet?

The Skeptical Cardiologist and his  eternal fiancee’ recently spent 5 days in the Netherlands trying to understand why the Dutch are so happy and heart healthy.

We were driven by Geo (former statin fence-sitter) from Bruges to Haarlem, a city of 150,000, which lies about 15 km west of Amsterdam and about 5 km east of the North Sea.

 

Haarlem is one of the most delightful towns I’ve ever stayed in.

 

 

I was struck by  the beauty of its architecture, its canals and the happiness, height and friendliness of its inhabitants.

I was lucky enough to have a bike at my disposal. One day I set off randomly, and after 20 minutes of riding on delightfully demarcated bike lanes, I scrambled up a sand dune and looked out at the North Sea.

Just down the road was the  beach resort of Zandvoort, where one can enjoy sunbathing, surfing or a fine meal while gazing at a glorious sunset.

 

 

 

 

Like Amsterdam, which is a 15 minute train ride away, bikes and biking abound in Haarlem, but unlike Amsterdamers, the Haarlemers were universally engaging, polite and friendly. Everything and everyone seemed clean, well-organized, relaxed and pretty…and, well, …happy.

The Dutch High Happiness Rating

The World Happiness Report 2017, which ranks 155 countries by their happiness levels, was released in March of this year at the United Nations at an event celebrating The International Day of Happiness.

The report notes that:

Increasingly, happiness is considered to be the proper measure of social progress and the goal of public policy

Norway was at the top of the happiness list but

All of the other countries in the top ten also have high values in all six of the key variables used to explain happiness differences among countries and through time – income, healthy life expectancy, having someone to count on in times of trouble, generosity, freedom and trust, with the latter measured by the absence of corruption in business and government.

The top 4 were closely bunched with Finland in 5th place, followed by the Netherlands, Canada, New Zealand, and Australia and Sweden all tied for the 9th position.

Despite the immense wealth of Americans, the report notes:

The USA is a story of reduced happiness. In 2007 the USA ranked 3rd among the OECD countries; in 2016 it came 19th. The reasons are declining social support and increased corruption  and it is these same factors that explain why the Nordic countries do so much better.

Dutch children seem to be especially happy.

A UNICEF report from 2013 found that Dutch children were the happiest of the world’s 29 richest industrialized countries.  America ranked 26th, barely beating out Lithuania and Latvia.

Cardiovascular Disease in The Netherlands

Ischemic heart disease (IHD) deaths are due to blockages in the coronary arteries. Typically, this comes from the build up of atherosclerotic plaques in the arterial system and in most countries heart attacks from this process are the major cause of death.

The Netherlands has the third lowest rate of IHD deaths in developed countries, only slightly higher than France and less than half the rate of the USA.Screen Shot 2017-07-26 at 10.53.26 AM

In all developed countries over the last thirty years we have seen a marked drop in deaths due to IHD. In The Netherlands it has dropped 70% and the rate in 2013 was nearly as low as France’s rate.

In addition, the Netherlands has a very low rate of deaths from  hypertensive heart disease. This table from 2008 shows that they are second only to Japan and their mortality rate is a third of that in the US.

A recent update noted

The current Dutch age-standardised mortality from circulatory disease is 147 per 100,000, and only Spain and France have lower cardiovascular mortality rates (143 and 126 per 100,000, respectively). In all other European countries, including for instance Switzerland and Greece, cardiovascular mortality is higher [26].

What factors could be causing all this happiness and heart healthiness?

The Seemingly Horrid Dutch Diet

We have been programmed to believe that heart attack rates are related to saturated fat in our diets.

The fact that the French consume lots of saturated fat and rank so low in IHD deaths has been called the French Paradox as it seems to contradict the expected association.

One thing is clear-the Dutch are not following a whole foods, plant-based diet. They are among the world leaders in consumption of both fat and sugar as the graph below indicates.

While in The Netherlands I sought out raw herring,  a dish which Rick Steves and others indicate is a Dutch obsession.

Since there is evidence that fish consumption, especially fatty ones like herring and mackerel, is associated with a lower risk of coronary heart disease, perhaps this was protecting the Dutch.

I didn’t see much herring consumption in Haarlem (a native Haarlemer informs me that the Dutch raw herring consumption might be confined to older generations or tourists).

It turns out that the Dutch aren’t meeting their own nutritional guidelines for healthy food .

The recommendation to eat fish at least twice a week, of which at least once fatty fish such as salmon, herring or mackerel, is followed by a mere 14 percent of the population. Less than 25% of them meet the recommended daily amount of fish, fruit, and vegetable consumption.

Screen Shot 2017-07-26 at 11.58.57 AM
purple bar=women yellow bar=men orange bar= total

They do catch and export a lot of fish and shellfish and are in the top 10 of seafood exporting countries (99% of all those mussels consumed in Belgium come from The Netherlands).

And, to my great surprise, they eat lots of French, or as I have started calling them, Flanders fries.

 

I personally witnessed  massive amounts of cheese and butter consumption.

In fact, the Dutch average 15% of calories from saturated fat, which is far above the 10% recommended by the Dietary Guidelines for Americans.

A recent analysis of Dutch fat consumption found:

The mean baseline intake of total saturated fatty acids (SFAs)  in the population was 15.0% of energy. More than 97% of the population exceeded the upper intake limit of 10% of energy/d as recommended by the Health Council of the Netherlands.

The Dutch weren’t eating so-called healthy fats as “The main food sources of SFAs were cheese (17.4%), milk and milk products (16.6%), meat (17.5%), hard and solid fats (8.6%), and butter (7.3%).”

Surprisingly, the more saturated fat the Dutch consumed, the LOWER their risk of death from IHD:

After multivariable adjustment for lifestyle and dietary factors (model 4), a higher intake of energy from SFAs was significantly associated with a 17% lower IHD risk (HR per 5% of energy: 0.83; 95% CI: 0.74, 0.93)

The Dutch Paradox

Data shows that  the Dutch are eating lots of saturated fat from dairy and meat, but it appears to be lowering their risk for heart attacks

Yes, despite 40 years of high saturated fat consumption, the Dutch have seen a 70% drop in mortality from heart attacks. Their rate of dying from ischemic heart disease is lower than the US and only slightly higher than the French.

Thus, rather than talk about a French paradox, we should be talking about the Dutch paradox.

For the French paradox many theories, both fanciful and serious,  have been proposed

The one most laypeople remember (due to a 60 Minutes episode in 1991) is that the French are protected by their high red wine consumption. Although this theory proved a great boon to the red wine industry (sales rose 40% the year after Morley Safer made his presentation on 60 Minutes), it has never had any serious scientific credibility.  Current thinking is that all forms of alcohol in moderation are equally protective.

Others have proposed garlic or onion or faux gras consumption. My own theory for the French is that it is fine cheese and chocolate consumption that protects them.

In subsequent posts I’ll lay out the evidence for my startling new theory to explain the Dutch paradox.

 

 

What Pain Medications Are Safe For My Heart?

The skeptical cardiologist is frequently asked by patients if it is OK to take certain pain medications.

Yesterday, I got a variation on this  when a patient called and indicated that he had been prescribed meloxicam and tramadol by his orthopedic surgeon for arthritic leg joint pain. The orthopedic surgeon said to check with me to see if it was OK to take either of these medications. (Patients, if you want to skip to my answer skip down to the last two sections of the post and avoid the background information.)

What Is The Risk Of Pain Medications?

Cardiologists have been concerned about the increased risk of heart attack and heart failure with non steroidal anti-inflammatory drugs (NSAIDs) since Vioxx was withdrawn from the market in 2004.

NSAIDS have long been known to increase risk of gastrointestinal (GI) bleeding  by up to 4-5 fold, Scientists developed Vioxx, a COX-2 inhibitor, hoping to reduce that risk but Vioxx  turned out to  increase the risk of heart attack.

Since this revelation it has become clear that NSAIDS in general increase the risk of heart problems as well as GI problems

This includes the two over the counter (OTC) NSAIDS:

-ibuprofen (in the US marked most commonly as Motrin or Advil, internationally known as Nurofen). For extensive list of brand names see here.

-naproxen (most commonly sold as Aleve. Per wikipedia “marketed under various brand names, including: Aleve, Accord, Anaprox, Antalgin, Apranax, Feminax Ultra, Flanax, Inza, Maxidol, Midol Extended Relief, Nalgesin, Naposin, Naprelan, Naprogesic, Naprosyn, Narocin, Pronaxen, Proxen, Soproxen, Synflex, MotriMax, and Xenobid. It is also available bundled with esomeprazole magnesium in delayed release tablets under the brand name Vimovo.)

In 2015  the FDA mandated  warning labels on all prescription NSAIDs including

1) a “black box” warning highlighting the potential for increased risk for cardiovascular  (CV) events and serious life-threatening gastrointestinal  bleeding, ulceration, and perforation;

(2) statements indicating patients with, or at risk for, CV disease and the elderly may be at greater risk, and that these reactions may increase with duration of use;

(3) a contraindication for use after coronary artery bypass graft surgery on the basis of reports with valdecoxib/parecoxib;

(4) language that the lowest dose should be used for the shortest duration possible

5) wording in the warning section that there is no evidence that the concomitant use of aspirin with NSAIDs mitigates the CV risk, but that it does increase the GI risk

Since then, hardly a day goes by without me having a discussion with a patient about what drugs they can safely take for their arthritis.

A reasonable approach to using NSAIDS, balancing GI and CV risks, that I have used in the past comes from a 2014 review
This table and many authorities recommend naproxen as the NSAID of choice for patients with high CV risk.

Indeed prior to the publication of the PRECISION study in 2016 I believed that naproxen was the safest NSAID for my cardiac patients. I told them it was OK to use from a CV standpoint but to use the least amount possible for the shortest time in order to minimize side effects.

The PRECISION study compared a COX-2 NSAID (celecoxicib or Celebrex) to ibuprofen and naproxen in patients who required NSAIDS for relief of their joint pain.

The findings:

cardiovascular death (including hemorrhagic death), nonfatal MI, or nonfatal stroke, occurred in 2.3% of celecoxib-treated patients, 2.5% of the naproxen-treated patients, and 2.7% of the ibuprofen group.

There was no placebo in this trial so we can only look at relative CV risk  of the three NSAIDS and it did not significantly differ.

GI bleeding was less with celecoxib than the other two NSAIDS.

Although this study has flaws it throws into question the greater CV safety of naproxen and suggests that all NSAIDS raise CV risk.

My Current Patient Advice on Cardiac Safety of Pain Meds

Here is an infographic I came across from the Arthritis Foundation (complete PDF….here)

It’s a reasonable approach for these OTC drugs and I will start handing this out to my patients.

We should consider that all NSAIDS have the potential for increasing the risk of heart attack and heart failure, raising blood pressure, worsening renal function and causing GI bleeding.

Therefore, if at all possible avoid NSAIDS.

Acetaminophen (Tylenol) is totally safe from a heart standpoint and overall if you don’t have liver disease it is your safest drug for arthritis. However, it provides no anti-inflammatory effects and often is inadequate at pain relief.

Treating The Whole Patient

Meloxicam is an NSAID so my patient should , if at all possible, avoid it.

The other drug he was prescribed, tramadol, is an opiod. Opiods have their own set of problems including, most importantly,  addiction and abuse.

A recent review concluded

 reliable conclusions about the effectiveness of long-term opioid therapy for chronic pain are not possible due to the paucity of research to date. Accumulating evidence supports the increased risk for serious harms associated with long-term opioid therapy, including overdose, opioid abuse, fractures, myocardial infarction, and markers of sexual dysfunction; for some harms, the risk seems to be dose-dependent.

As his cardiologist I am concerned about his heart, of course, but a good cardiologist doesn’t just focus on one organ, he looks at what his recommendations are doing to the whole person.

I certainly don’t want to have him become addicted to narcotics in order to avoid a slightly increased risk of a heart attack. On the other hand, the risks of the NSAIDS involve multiple organs, most of which don’t fall in the domain of the cardiologist.

My patient’s risk of taking either the meloxicam or the tramadol is best assessed by his primary care physician, who has the best understanding of his overall medical condition and the overall risk of dangerous side effects from these drugs.

Ultimately, I think the decision of which pain pill to take for chronic arthritis has to be made by an informed patient in discussion with his  informed (and informative) primary care physician. Only the patient can decide how much pain he is having and how much risk he/she wants to assume in relieving that pain.

Analgesically Yours,

-ACP

Removing Signs of The Confederacy in Forest Park

A few weeks ago I was interviewed by Fox2 News . Not for anything having to do with cardiology but because I randomly stumbled upon the City of St. Louis taking down a street sign.

This was no ordinary street sign.

It was associated with the small strip of road that runs adjacent to the Confederate Memorial that sits in Forest Park (America’s #1 Urban Park!)

Workman removing the Confederate Drive sign. He left the Cricket Road sign. Confederate Drive sign replaced by nothing.

The Forest Park Confederate Memorial became part of a national discussion after long-time St. Louis Mayor, Francis Slay, writing in his blog in 2015, proposed a a committee for reappraisal of the statue:

 

Their charge would be to recommend whether, with the benefit of a longer view of history, the monument is appropriately situated in Forest Park – the place where the World was asked to meet and experience St. Louis at its best and most sublime — or whether it should be relocated to a more appropriate setting.

They also should address whether the monument represents a peculiar memorial to what euphemistically was referred to in the American South as a “peculiar institution” – slavery-and wherever ultimately situated, whether the monument should be accompanied by a description of the reality and brutality of slavery, over which the war was waged, including in this city, and the bitter badges of slavery, Jim Crow and de facto discrimination and segregation, that are its continuing legacy.

I would ask the commission, also, to reappraise the name “Confederate Drive,” the Forest Park thoroughfare on which the monument is situated. They might consider whether “Freedom” or “Justice” would be more fitting.

Missouri was a deeply divided border state during the Civil War, pitting neighbors and kin against one another. As St. Louis was a Union stronghold, it is not surprising that even 50 years after the war ended, the erection of the Confederate Memorial was controversial. It was dedicated in December 1914 after the Ladies’ Confederate Monument Association spent 15 years raising $23,000 for its construction. To avoid provoking further antagonism to the project, the Association declared that the design they would choose could not depict any figure of a Confederate soldier or object of modern warfare. The resulting monument features a 32-foot-high granite shaft with a low relief figure of “The Angel of the Spirit of the Confederacy.” Below is a bronze group, sculpted by George Julian Zolnay, depicting the response of the South to this spirit as a family sends a youth off to war. Of Hungarian birth, Zolnay had come to St. Louis as director of the art department for the 1904 Louisiana Purchase Exposition and remained here for some years afterward, teaching at Washington University and the Art Academy in University City. Choosing Zolnay’s model over two other submissions caused another battle when one of the losers, Frederick Ruckstull, wrote to the committee demanding that Zolnay’s design be eliminated, as the male figure too closely depicted a soldier. Calling the letter “contemptible,” Zolnay shot back that Ruckstull’s allegorical group, featuring figures of Glory, History, Poetry and Sorrow, was “suitable for a wedding cake.” On the back of the shaft, designed by William Trueblood, is a tribute “To the Memory of the Soldiers and Sailors of the Southern Confederacy,” written by St. Louis minister Robert Catlett Cave, who had served as a Confederate soldier from Virginia. Beneath that is a quotation by Robert E. Lee: “We had sacred principles to maintain and rights to defend for which we were duty bound to do our best, even if we perished in the endeavor.”
I rode to Forest Park and asked in the visitor center where the confederate memorial was. When I arrived it was surrounded by this temporary fence, erected in the morning, presumably to protect workmen from pro-statue protestors.

 

 

It looks like the committee delivered their report in December , 2015 and it can be found here. They indicate their charge was to assess how best to get rid of the statue, not really to “reappraise” it.

They asked for proposals from various museums/historic organizations for moving the statue and received no satisfactory proposals. . The cost of moving the statue to another site was estimated at 268,000$ and moving it to storage at 122,000$.

A new mayor of St. Louis,  Lydia Krewson, was elected last November and she has vowed to move the statue.

Apparently, it’s a lot easier and cheaper to remove the street sign than the statue.

Don’t expect any brilliant insights into this controversy from my interview with Fox2 News.  Before I’m ready to make any public pronouncement on an issue I require hours and hours of research and clearly I have no expertise or background that would qualify me to pontificate on the fate of this statue.

Since then, I’ve thought about it and read more and hope to share some observations down the line.

-ACP

Since the interview aired it seems to have gone viral around St. Luke’s hospital with many marveling at my odd “beekeeper’s” hat and others impressed by my handling of a random cyclist’s yelled comments.

This is the link to the Fox 2 News Interview

 

Nonskeptical Musical Thoughts On Dick Dale and the Dead While Running For Longevity

Since determining that running would lower my cardiovascular risk and that it was actually good for my wonky knees (running is associated with a lower risk of ostearthritis or hip replacement, see here), I’ve been trying to do it regularly.

It has become therapeutic in many ways, aiding sleep and reducing stress levels. And, unlike my bike riding adventures, I have yet to fall and injure myself running and I don’t get dirty looks for not wearing a helmet.

I’ve even contemplated running 5 kilometers,  although not as part of any formal exhibition: just a personal , private goal. To this end I have for the first time recently run 4 kilometers.

Listening to music during these longer runs greatly helps the time pass and sometimes I am able to find songs which fit my running cadence, albeit not through any systematic analysis but through mere serendipity. I let my entire musical collection (nicely streamed by Apple music) be my running playlist and this ranges from the Talking Heads to Thelonius Monk to Bach.

This morning’s run (the second time I reached 4K) I was aided by two songs: one by the king of surf guitar, the other by the kings of psychedelic jam rock.

Dick Dale and Miserlou

Although, Dick Dale was huge in the early sixties, he did not register on my musical radar until  I watched Pulp Fiction and in its dazzling opening scene and  was jolted by Dale’s staccato machine gun guitar riffs alternating with his plaintive trumpet solo on  “Miserlou“.

I immediately strapped on my Strat and began trying to emulate his unique playing style.

Here’s Dick and the Del-Tones performing their version for the movie “A Swinging’ Affair”

This version contains none of the rhythmic power and electrifying guitar attack of the single and the band appears to be on tranquilizers. To make matters worse, Dick  doesn’t play that magical melodic moaning trumpet solo which contrasts so brilliantly with the pile-driving reverb-drenched guitar riffs on the original version.

You can see some of the power of the left-handed Dale in this live performance of Miserlou from 1995 but alas, no trumpet solo.

Dick Dale, remarkably, is still touring and playing well at age 80.

As fortune would have it the beats per
minute of this song is 173 which fits my preferred running speed stride cadence perfectly.

The Other One (Not Cryptical Envelopment)

The next song to aid me on my run was a live performance from the Grateful Dead’s 1972 European Tour  which is 36 minutes long.

I was slow to revere the Dead but when I first listened to their live album Europe ’72 I was hooked. Instead of studying in college, I spent way too many hours playing Sugar Magnolia (and Blue Sky, et al..)  thereafter.

The Other One highlights their free and wild improvisational style. While running I could focus on what Keith Godchaux was doing on the piano and that takes me to a psychic place in which I feel no pain.

Please excuse my hubris but I am convinced that I could have done a good job as the Dead keyboardist.  It’s probably a good thing I never got that gig, however, as it carries a very high mortality rate (not to mention that I’m a much better cardiologist than keyboardist.)

As Billboard pointed out in its obituary on the last keyboardist, Vince Welnick (who committed suicide by slitting his throat at age 55 in 2006):

Welnick was the last in a long line of Grateful Dead keyboardists, several of whom died prematurely, leading some of the group’s fans to conclude that the position came with a curse.

Welnick had replaced Brent Mydland, who died of a drug overdose in 1990. Mydland succeeded Keith Godchaux, who died in a car crash shortly after leaving the band. And Godchaux had replaced the band’s original keyboard player, Ron “Pigpen” McKernan, who died at 27 in 1973.

Last week a very good Grateful Dead documentary (Long Strange Trip) was released on Netflix. I’ve been somewhat mesmerized by what I’ve watched so far.  For example, at one point, Phil Lesh reveals that Jerry Garcia asked him to join the band as their bassist even though he had never played the instrument. (If only he had asked me!)

Strangetrippingly Yours

-ACP

N.B. Miserlou is a very old folk song with a scale that sounds exotic to Western ears: the double harmonic scale

per Wikipedia

The song’s oriental melody has been so popular for so long that many people, from Morocco to Iraq, claim it to be a folk song from their own country. In fact, in the realm of Middle Eastern music, the song is a very simplistic one, since it is little more than going up and down the Hijaz Kar or double harmonic scale (E-F-G#-A-B-C-D#). It still remains a well known Greek, Klezmer, and Arab folk song.