Hi Everyone,

Happy New Year! Thank you sincerely for being a subscriber to my newsletter. My goal this year is to continue bringing you detailed and reliable information primarily on diagnostic and preventive medicine. I’ll be focusing heavily on cardiovascular disease and cancer this year, but I’ll also cover nutrition, exercise, sleep, and current events from time to time.

My goal is to bring you a newsletter every two weeks. In 2021, I didn’t make this happen, but I’ll be doubling down on this goal for 2022.

In this issue, I’d like to share with you two new articles that I’ve posted to my website, and a few notes from two podcasts that I listened to this week.

As always, I enjoy feedback, so please reply to this email if you have any comments, critiques or questions.

Best,

Steve

Contents

• Write Your Own Last Act
• Why Lower LDL-Cholesterol?
• Podcast: Lex Fridman interviewed Pfizer CEO Albert Bourla
• Podcast: COVID-19: Current state of affairs, Omicron, and a search for the end game - Peter Attia

Write Your Own Last Act

By Steven Kornweiss

Facing Death

One of the great privileges, and most difficult parts of working as an emergency physician, is that I’m with people as they face their own mortality. To my perpetual amazement, many people remain undaunted when faced with critical illness and death.

At times, people face the decision between dying versus prolonging a life hardly worth living. Those who have thought ahead, who have defined what type of life is worth living, are able to choose death with confidence and serenity when the time comes.

That’s how I’d like to be. I’d like to approach my end with tranquility and dignity, to exert my will up until my last breath, to leave a legacy of strength and pride rather than fear and self-pity.

I am doubtful that if I were faced with my own mortality at this moment that I would live up to such grand expectations, which is why I wanted to highlight two inspiring stories that were in the news this week.

• Read the Full Article to learn about Jeff Dickerson, Jaime Marquez, Ian Fleming, oldsters, gomers, and a few thoughts on aging and the end of life.

Why Lower LDL-Cholesterol?

by Steven Kornweiss

A Remarkable Discovery

In 1978, a pathologist performing a routine autopsy made a remarkable discovery — A 76 year old woman without any sign of atherosclerosis.

What’s so remarkable about this?

Autopsy studies have revealed that by age 70, most people have raised atherosclerotic lesions covering 20-60% of the intimal surface of the coronary arteries and aorta (source).

The authors of this study hypothesized that this woman had a rare condition that made her resistant to atherosclerosis.

Atherosclerosis is a gradual degenerative process whereby lipoproteins (and their cholesterol) deposit within the arterial wall and an inflammatory response ensues. The wall of the artery thickens over time and plaques form. These plaques can enlarge and encroach upon the vessel lumen, limiting blood flow to vital organs like the heart muscle itself. Eventually, plaques can rupture and cause thrombosis and occlusion of an artery, which results in total lack of blood flow and oxygen to whatever it supplies. If this happens in a sufficiently large coronary artery, a deadly heart attack can result.

Atherosclerotic heart disease kills one in eight Americans each year. Contrary to the current medical paradigm, this is not a disease of the elderly. Even though most heart attacks occur in people who are past their fifth decade of life, the disease process starts in the second or third decade of life.

• Read the Full Article to learn about people with unusual genetics who have low LDL levels and how scientists developed a drug that can do the same.

Podcast: Lex Fridman interviewed Pfizer CEO Albert Bourla

I think this interview is particularly important to listen to. It seems like big companies, especially pharmaceutical companies, are often demonized. Their CEOs are made out to be evil profiteers with a singular goal to make money without regard for the people they serve. In this interview, I think it’s clear that Albert Bourla is a humble and caring person like the rest of us, and that Pfizer’s effort and success in manufacturing a safe and effective vaccine is a great testament to human ingenuity and potential.

Here is my favorite quote from the podcast:

If you focus too much on making money, you will never make it. You should focus on what is the real value driver. And the real value driver is to make breakthroughs that change patients’ lives. If you don’t do that, you will never make money. If you do that. Don’t worry. Things will fall into place and also money will follow.

— Albert Bourla, CEO Pfizer

Podcast: COVID-19: Current state of affairs, Omicron, and a search for the end game - Peter Attia

The second podcast I’d like to share is Peter Attia’s podcast with Zubin Damania and Marty Makary in which they discuss the current state of COVID-19.

I know what you’re thinking - I don’t want to hear about COVID anymore. I couldn’t agree more. But, this is a really great discussion and it could just be the last one you need to listen to on this topic.

There are many highlights, but I think the most important point they discuss is the “end game.”

We’re all tired of COVID. The big question is, “when can we stop worrying about it?” There’s this tension between wanting to ignore it but also wanting not to regret a decision that makes us sick, or makes a loved one sick.

For me, the end game is here.

As Attia, Damania, and Makary discuss on the podcast — COVID is now a quantifiable risk, and for most of us, it’s quite manageable. We now have testing, tracking, vaccines, therapeutics, and useful in-hospital care. For those who wish to understand their personal risk and mitigate it to a high degree, that is now possible.

I think it’s reasonable at this point to integrate the risk of COVID with all other background risks that we face on a daily basis—it’s now a routine “cost-of-living” risk. Cost-of-living risks are risks that are built into daily life and are implicit in everything we do.

We drive, fly, go out in public, eat, and drink at restaurants without constantly worrying about car accidents, plane crashes, and contaminated food and drinks. Okay, we worry from time to time, but we generally accept these risks and mitigate them with behaviors like wearing a seatbelt, driving defensively, flying on reputable airlines, sticking to safe places, and checking reviews before we go to a restaurant. COVID now falls into this category of cost-of-living risks.

For a more extensive discussion of this topic, I highly recommend listening to the podcast.

They also discuss:

• mRNA vaccine safety in young men
  • One dose is safer than two, and Pfizer is safer than Moderna in mitigating the risk of vaccine related myocarditis
• J&J Vaccine risk of thromboembolic disease
  • It was overblown
• The push to vaccinate children
  • It’s not clear that the benefits outweigh the risks in children
• The idea that vaccines should prevent spread of disease
  • Vaccines drastically reduce the risk of severe disease and death, but do not eliminate spread of disease
• The idea that we need ubiquitous testing at this point
  • Testing is only useful if the results will change our actions
• Ignoring natural immunity (especially with regard to vaccine mandates)
  • Immunity from infection as opposed to vaccination is likely long-lasting and equal to or more potent than vaccine mediated immunity
• The value of boosters
  • They’re over-valued for immunocompetent people
• The potency of Omicron
  • It doesn’t infect the lungs efficiently and thus produces mild disease in most cases

Other articles that might interest you:

• No Time to Die From an MI
• What is LDL-Cholesterol?
• Case Report: The Metabolic Effects of Losing 30 Pounds
• Get the Blood Work You Want Without a Doctor’s Order
• Create a Helpful Food Environment