Information distribution [was Re: Protein intake and kidney disease]

Robert Bradbury bradbury at sftwks.UUCP
Mon Oct 26 04:49:43 EST 1992

In article <1992Oct13.053710.21608 at pegasus.com> richard at pegasus.com
  (Richard Foulk) writes:
>In article <1992Oct9.173554.9327 at u.washington.edu> I wrote:
>>...my comments are rarely based on currently accepted
>>medical treatments.  They are based on a careful review of the literature
>>and some hard thought about what goes on in our bodies as we age.
>`Currently accepted medical treatments' used to be based on `careful review
>of the literature' and other vehicles of scientific knowledge.
>Did that change while I looked away for a minute?

You bet!  The problem is that our knowledge base was doubling every 5 years
in the early '80's and it doubles faster now.  The "bureaucracy" and "inertia"
associated with the people who must approve new treatments and lack of time
available to the people who must learn and implement them result in a huge
delay between our understanding something and it being used to help people.
I spend 30-40 hrs/week in class, perusing MEDLINE and reading current journal
articles.  This is much more time than most doctors or federal bureaucrats
have to devote to updating their knowledge base.  [There are certainly
exceptions to this so please hold the flames.]  I have no 'bias' in my
research (i.e. no grant to justify, no job to protect, no fear of lawsuits
for prescribing "experimental" treatments, etc.).  I simply want to understand
what we "really" know.

Case in point is the lack of awareness among the physicians and the general
population about the relationship between cholesterol and coenzyme Q.  It
has been known since the early '80's that both compounds are derived from
the same precursor (HMG-CoA/Mevalonate).  There are a large number of
people in our society who are on HMG-CoA reductase blockers (provostatin,
lovostatin, etc.).  The problem with this is that while this lowers cholesterol
synthesis it also reduces coenzyme Q synthesis (Ref 1).  Given that coenzyme
Q occupies a critical path in mitochondrial energy generation and also plays
a role protecting lipids from oxidation (Ref 2) one should attempt to maintain
or increase coenzyme Q levels.  Refs 3&4 show the benifits from doing this.
Are medical professionals aware of this?  Neither my physician (a young,
bright MD from Stanford) nor my pharmacist had any understanding of
this.  My father's doctor who is prescribing lovostatin for him has not
mentioned coenzyme Q.  I asked Joseph Goldstein, who won the Nobel prize
for the discovery of the cholesterol receptor, about this at the Science
Innovation '92 conference in July and he was aware of the relationship
but did not offer any explanation as to why other physicians were not.
The only conclusion I can draw is that there is a *large* gap between the
understanding that the research scientists have and the general distribution
of that understanding to most doctors and the general population.

<The above is all personal experience, the following is speculation>

Now, I personally find it quite interesting that since I've supplemented
my diet with coenzyme Q that my cholesterol level has dropped 10-15 pts.
Given the feedback regulation of end-products on precursor synthesis
which one commonly finds in biochemical pathways this makes sense.
I have yet to find a study which indicates that coenzyme Q supplements
can lower cholesterol levels, but in the back of my mind I wonder if the
FDA and drug companies are disinclined to publicize/explore this since
if it were true it would take a big chunk out of the provostatin/lovostatin
market.  There is also the interesting 'fact' that in studies where drugs
are used to reduce cholesterol there is not a corresponding reduction
in the overall mortality rate.  Now, if one uses drugs to reduce cholesterol
which at the same time reduce coenzyme Q (an antioxidant), then one
may increase oxidant levels and the DNA damage associated with them.
The result could be a reduction in heart disease with an increase
in cancer rates.  Thus we trade off diseases whose symptoms we
can measure now for those whose consequences are now unknown but
which in the end may be identical.

I would say that in general "currently accepted medical treatments"
are based on literature that is 5-10 years old.

Robert Bradbury			uunet!sftwks!bradbury

Death is an imposition on the human race, and no longer acceptable
				Alan Harrington, The Immortalist (1969)
(1) PNAS, 1990, 87:8931-34, K Folkers et al
    "Lovastatin decreases coenzyme Q levels in humans"
(2) PNAS, 1990, 87:4879-83, B Frei, MC Kim, BN Ames
    "Ubiquinol-10 is an effective lipid-soluble antioxidant..."
(3) J. Clin. Pharmacol, 1990, 30:596-608, S Greenberg MD, WH Frishman MD
    "CoEnzyme Q10: A New Drug for Cardiovascular Disease"
(4) Int. J. Tiss. Reac XII(3):163-168, H Per Langsjoen, K Folkers et al
    "Pronounced Increase of Survival of Patients with Cardiomyopathy
     When Treated with Coenzyme Q10 and Conventional Therapy"

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