Further Information

Death Rates from Coronary Disease - Progress and a Puzzling Paradox | Daniel Levy, M.D
Article Published: 1998

Type: Articles and Dissertations
Published By: NEJM 1998; 339: 915-917 -- September 24, 1998

Further Information

We report this 1998 editorial as general indication of the effect of ideological postulations on objective observation.

In this piece it is noted that “no decline in the incidence of myocardial infarction was observed in the ARIC sample during a period when the prevalence of causal risk factors was reduced.”

The risk factors in question are hypertension, hypercholesterolemia — and smoking, of course.

The most elementary observation, that requires no skills at all, points to a simple course of action: if the hypothesis on causality does not square with the objective observation, it should be at least considered that the hypothesis, or part of that hypothesis, is untrue, and that it must be changed. Unfortunately, if the hypothesis represents an ideology (i.e., smoking is a major cause of coronary disease), the hypothesis is not changed, and the whole thing is defined as a more or less puzzling  “paradox” — to explain which, in turn, numerous and creative new hypotheses of all kinds are dreamt up. The antitobacco hypothesis (sacred cow) simply cannot be changed because of fixed ideology.

Although this particular article and case should not be taken as representative of the general situation for coronary diseases (and aside from the greatly positive news on general decline in mortality largely due to regression in coronary chlamydia infection and to technology), nevertheless it represents well the unwillingness to change assumptions when faced with objective observation, which in turn drifts away from the scientific mentality to deliver conclusions to prejudice, ideology, and even emotions – none of them belonging to the realm of scientific investigation and pursuit of the truth.

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