Replies to post #175559 on Amarin Corp Plc (AMRN)

[Whalatane]

zz1. Wow ...great post

My own brief comment re JL
In 2012 my MD was insisting I keep trying to take Niacin ...which I hated ( flush effects etc )
JL suggested I take EPA instead ...Garden of Life ( from memory ) ....and the rest is history .
Niacin ...harm outweighed benefit in follow up trials .
EPA ...outstanding risk reduction ...benefit far outweighed any harm .

So whether JL is egotistical , rough on those who oppose his ideas etc etc or not ....credit given where credit is due .

He was way out front ..by either thorough research or plain luck ...on the benefits of EPA .
Those who followed his advice, are now wealthier and healthier .
JMO .
Cardio ...if you by chance read this. As a CAD patient I also value your views so please keep posting . We all benefit from the debate .
However , I've come to the conclusion that there's little value gained , by engaging in " cat " fights .

Kiwi

[Babr]

Zz1

So Eloquently said and Amen!
This Is the pulmonary guy on the board

[Biobillionair]

ZZ-Your post really pissed me off until

our own unyielding Hulk BB

As I've said before...this board could literal run a BP...some have been biotech CEO's...CFO...Ph.D's.......

Great post...

BB

[Chemist2]

Hi zz1 Excellent summary of where we've been and where we are going! Thank you very much for your post!

[jfmcrr]

On the threshold!
We are on the threshold of a major paradigm shift in the treatment and prevention of CVD and EPA is taking center stage.
This is something many of us will probably never see again in our lifetime and those who have boarded the train years ago on this Board will hopefully be able to share this amazing ride with loved ones and friends for years to come.

With the exception of a single word, this gets the JF seal of approval (

). Obviates whatever post I'd have done to fan/extinguish the flames. Bummer.

[Cardiologymd]

ILT, Zz1, kiwi and others. I have a 3 post limit per day so i will write my impression to everyone ‘s input from yesterday.


Intervention Study (JELIS) found no benefit in CVD risk reduction in relation to baseline TG. ..."



ILT

Bingo.

Thank you ILT. This trial finding proves that Dr Bhatt and Dr Fuster are indeed correct and JL and BB unproven hypothesis is just that: Unproven hypothesis. That’s how science works.


Let me state that I am not an expert in EPA physiology and its mechanisms of action. I can say my expertise is cardiology.
But i am quite sure the closest mechanism of EPA action matches to that of Preston Mason’s work rather than JL and BB’’s hypotheses. Preston has actually proven his hypothesis by performing various experiments in the basic research lab in the last 7 years. We can all agree that Preston Mason is an expert in the EPA field, perhaps bigger than JL :). I know JL will disagree with this :). He may think he is better expert than Preston.

Now based on my conviction I will start writing Vascepa scripts for any triglyceride levels. I already have written a few scripts on patients with severe atherosclerosis and triglycerides below 135.

I believe based on current experimental data (Mason’s work) and Jellis and RIT trials the mechanism of EPA effects are pleothropic:

Reduction of inflammation
Plaque stabilization
Antiplatelet effects
Membrane stabilization
There may be a small triglycerides effect but nothing major.

EPA has been proven not to make any statistical difference in diabetes control based on Amarin’s own data.

ZZ1. What a wonderful post. I enjoyed reading it. You hit my points so well when going through various unproven hypothesis in medicine that eventually failed the final test known as randomized control trial.
I would like to apologize to you ZZ1 for my ignorance in regard to endocrinology and lipids.

In fact I didn’t even know that endocrinology has its own lipid guidelines thus I learned something new. I thought we only have aHA/ACC guidelines.
I think having more than one set of guidelines can be very confusing. I would like to ask ZZ1 if there is a study on type of physicians following each set of guidelines?

I did know that endocrinologists deal with lipids but I felt this work was not the focus of your specialty as endocrinologists deal mostly with hormonal issues (thyroid, adrenal etc).



Kiwi

I don’t want cat fight either.
I expressed my opinion and did not expect any responses from JL.
Next i know he calls us the cardiologists dummies who don’t understand basic science and are only good to dose statins. How do I not respond to this? (Ralph called him “useful a$$hole” yesterday). What kind of medical professional talks like this? I bet only the ones with superiority complex and narcissistic personality disorder.

BB. You resume does not match your behavior based on my impression reading your posts.
I see a lot of anger and temper tantrums that my initial impression was that you were a big fat club bouncer by trade. You also talk to other medical professionals that may disagree with you with inappropriate tone. There are many scientists that disagree with each other. However this is done in civil manners and without offensive name calling.
Please try to suppress your frustrations regardless of how you feel about something. This current approach paints a very different picture of you which does not match your CV.

Best

Cardiomd
Graduated from medical school other than Harvard.

[sts66]

zz1 - can I make an editorial suggestion? Could you try using the <return> key on your device to separate different trains of thought into individual paragraphs? I really wanted to read everything you wrote, but gave up because everything looked like a run-on sentence that made my eyes and brain hurt.

I did read the bit on homocysteine with interest, since it is one of the CVD risk markers V has not helped with, nor have attempts to lower levels with certain forms of B vitamins worked. I just saw my internist last Friday, and we're going to tackle this from a different path (I have a major methylation problem due to MTHFR defect). Since my young and extremely knowledgeable doc is quite concerned with my high homocysteine level, I was very surprised that you wrote that the homocysteine theory is dead - it goes against everything I've learned over the years. The HOPE2 trial only had one endpoint that was stat sig, stroke, and RRR was -25% with p value of 0.03:

https://www.medscape.com/viewarticle/528469#vp_2

There were also a host of criticism about the NORVIT trial design and how it was reported - this is an excellent explanation, and it also mentions how the MTHFR defect could have changed the results (they also used way too low a dose of B vits to show efficacy IMO). Author of below article also says (and I agree) that despite a 28% reduction in homocysteine levels, the patients were still at risk because levels were still way too high - I only cut and pasted my favorite part of the article because it's related to a current topic here, the error of appeals to authority, but it's worth reading the whole thing:

https://holisticprimarycare.net/topics/topics-o-z/vitamins-a-supplements/378-is-homocysteine-dead.html

Dr. Bonaa commented, "the results of the NORVIT trial are important because they tell doctors that prescribing high doses of B vitamins will not prevent heart disease or stroke. B vitamins should be prescribed only to patients who have B vitamin deficiency diseases." He went on to state "The homocysteine hypothesis is dead." God must be jealous!

Extrapolating the results of NORVIT, a secondary prevention trial, to stable patient populations who've not had MIs is beyond arrogant. It is irresponsible and reprehensible. Clinical and epidemiological studies in the past two decades show that elevated Hcy is at least a modest independent predictor for atherosclerosis, cardiovascular disease and stroke in the general population, supporting the "homocysteine hypothesis," though causality and precise pathophysiological mechanism(s) remain unproven.

Note: this was written way back in 2000, so the end of the last sentence is not exactly accurate.