The Bale/Doneen Method is proud to announce a new blog by Lisa Collier Cool, co-author of the forthcoming Bale/Doneen Method book (Beat the Heart Attack Gene with Bradley Bale, MD and Amy Doneen, ARNP).
This is from the Bale Donnen web site. My apologies for stating incorrectly that your blog was established to promote the book but that was where I got that - my intent was to understand the vitriol directed by you against me and when I discovered the association I must admit I lost interest in further specifics. You are co-authoring a book that I was indirectly criticizing and in response to fairly innocuous comments suggesting that formal randomized trials would be appropriate you then proceeded to make the following assertions:
In your first post three misfires in rapid succession. When I first started placing stents in 1994 (that's when they became available) they were FDA approved based on definitive trial evidence showing superiority to balloon angioplasty. A scientific truth established through large trials and never refuted. The comment about the irony involved in the naming of the COURAGE trial is that there were at least five published trials prior to that which arrived at the same conclusion - for a thoughtful cardiologist with a proclivity to read the literature (although I guess others have questioned that) this trial added little to what was already known - it assists with angina control at the expense of a small increase in early complications. That you would accuse me of placing stents inappropriately without data would then also be incorrect but perhaps my subtlety hid that so I point it out know. You then make the snide comment "presumably not for free" and we all understand your insinuation however insulting but I know you write books and articles for free so the real accusation is that I was placing stents that were not indicated for financial gain - thank you for that.
Your second post ruminates about "common sense" and again misstating that I was placing stents prior to a randomized trial. The common sense was the training afforded by a cardiology fellowship and the general knowledge attained with the certification, practicing in accord with best clinical data/recommendations and again your snide comment about deriving less than ten percent of my income is noted. The latter issue is addressed above. Your insinuation that an interventional cardiologist would not institute preventative therapy is also noted and is incorrect.
Your third comment adds little. I have no idea what the last sentence means. Do you mean that if I don't have self reported prevention outcome data than I can't comment on the scientific method or suggest that a treatment trial be conducted - kind of like dueling banjos in Deliverance?
Your fourth comment I largely agree with - no kidding. Aside from the "turf war" comment which is ridiculous for those of us already overwhelmed. I understand that it would be difficult to compare a "method" with standard of care but think of the conceptual model here and the questions raised by Bale and Donnen - is treatment of insulin resistance the key to preventing vascular endpoints or is it simply a marker, are Berkeley panels and following CIMT worth the expense and how much additional benefit is conferred, how much better is this versus statins plus niacin alone - many more questions come to mind well worthy of study but remember there has never been a change in the standard of care absent investigation and frankly single center studies have a long history of disappointment so self reporting outcomes absent randomization and multi-center involvement will always be open to critique. Hardly a closed mind in my opinion.
Your fifth comment underscores the entire point of my posts and I agree with the notion that much of what we do is tenuous scientifically and often based on "expert" opinion and as you point out those "experts" are invariably subject to commercial interests that may impede objectivity whether it be industry involvement, "institutes" or profiting from a book. The solution is a randomized trial and where have we heard that before?
Your final comment I have addressed. There are two comments that I have made that I regret. The first was the "snake oil" reference because it can have a double meaning which I had not thought of when I posted it. I did not intend the interpretation of an intent to defraud. I was referring to the times before the Exner Report and the FDA when medicine was not regulated and anyone could claim anything and hence "snake oil" sold for profit. We learned that our entire profession is diminished if we do not adhere to a method to best ensure truth and that lesson is no less relevant today. The second comment "she has started a blog to promote it" as you pointed out is incorrect not because I cannot conduct proper research but because the undisclosed conflict of interest is established by the fact that you are writing the book and my interest had pretty much been satisfied at that point.
I hope that you look at all my posts and understand that despite the various insults directed at me I have tried to objectively maintain the simple stance that however good a story this makes it will not gain traction to supplant standard care without a randomized clinical trial - and if this is a cure for atherosclerosis not verified and not disseminated that would be a loss for all. Finally I promise I will read the book - a good physician is a skeptic who knows by virtue of the profession that he is often wrong but still strives to get it right.
