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It’s all a Wonderland

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Curiouser and curiouser, as Alice might have said if she’d seen some of the research papers that have been passing across the WDDTY desks in recent weeks. They’re curious because they provide more evidence of the humbling fact that we have so much still to learn about how the body works and how (or why) disease develops.

And because we don’t really have a clue, it’s hardly surprising that conventional medicine and its tools of trade get it right less than half the time. On average, a drug benefits the patient in some way around 40 per cent of the time, while the British Medical Association has demonstrated that just one-third of drugs and therapies are effective. And by effectiveness, they mean it provides some benefit, such as a lessening of pain, but doesn’t necessarily cure anything.

The first paper we looked at is about the microbiome. The microbiome is all the rage these days; it describes the micro-universe of bacteria that exist in our gut. Medicine has been dragged kicking and screaming to the realization that the microbiome influences the course of a vast array of diseases, from cancers to diabetes and even depression. Get the balance wrong between ‘good’ and ‘bad’ bacteria, and you raise the possibility
of disease.

But as medicine is still slowly wrapping its corporate head around this revelation – not that it’s being taught in medical schools, or anything radical like that – this new paper has just revealed that breast cancer can also be caused by bacterial imbalances. So far, on message – except that the microbiome isn’t in the gut at all: it’s a mini-microbiome present in the breast tissue itself.1

The implications are dizzying, and make medicine want to sit down in a darkened room, gently sipping a comforting cup of hot chocolate. For one, it could mean that there are mini-microbiomes scattered all over the body. For another, it completely changes the way that breast cancer could be treated – not with chemotherapy or surgery, but with prebiotics and probiotics that restore the bacterial imbalance within the breast’s own mini-microbiome.

The second paper came from one of our favourite maverick doctors (we collect
them), Dr Malcolm Kendrick. Dr Kendrick is a family doctor who has become convinced that cholesterol, and especially ‘bad’ LDL cholesterol, has nothing to do with heart disease.

He has been derided by conventional medicine, which, at the same time, is slowly tip-toeing around to his point of view as it quietly drops the idea that fats have anything to with cardiovascular disease – instead, it’s always been sugars, stupid.

Having won that little skirmish, Dr Kendrick has raised the bar a little higher by questioning the long-held convention that a heart attack, or myocardial infarction (MI) in medical-speak, happens when a coronary artery becomes blocked.

There’s plenty of evidence to show that it doesn’t always happen like this; in fact, the blood clot can form after a heart attack, as researchers like Carlos Monteiro have shown, and sometimes a blood clot never does appear.

One paper discovered that “a substantial minority of MI patients” don’t have any obstruction in their arteries – and yet still had a heart attack.2 And to make it all curiouser and curiouser, other research has discovered that in some cases where an artery has become blocked, a heart attack happens days, or sometimes weeks, later.

There have even been cases where the artery has become completely blocked, and the patient never suffers a heart attack.3

Finally, there are heart attacks that aren’t heart attacks at all: they are instances of Takutsubo cardiomyopathy, more commonly described as ‘broken heart syndrome’. It has all the usual tell-tale signs of a heart attack, but it’s caused by extreme stress and not a blocked artery.

So that’s just how curious you are: you don’t just have a gut microbiome, you have mini-microbiomes; bacterial imbalances in the mini-microbiome can cause cancer; a blood clot that is supposed to cause a heart attack can appear after one happens, and some people have a heart attack when there’s never a blood clot at all. Still others never have a heart attack even when their arteries are completely blocked.

As Alice almost said, go figure.

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