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9 June 2013
Commendably, the Mayor of London is moving toward a de-dieselisation of London with an ultra low-emission zone for the congestion charge area but the target date is inevitably too far out in the future at 2020 because technology may overtake it. By then the driverless car may be emergent, electric and emission-less.
16 October 2013
Lifespan shortening due to air pollution.
23 January 2014
2014 study on the health consequences of air pollution provides up-to-date evidence.
24 January 2014
Nissan has this month announced its new NV200 Taxi for London with a petrol engine and no diesel variant. It has much improved disabled persons access. An electric version will be launched next year.
A new Frazer-Nash Metrocab was also announced this month with a hybrid petrol-electric drivetrain and, like all new generation taxis, improved disabled access.
The Mayor of London is pledging that from 2018 all taxis presenting for licensing will have zero emissions capability.
5 May 2014
As well being a substance vital to health it does increasingly look like cholesterol is a bit like lubricating oil in an engine - it protects the cardiovascular system from inflammation and from damage from unhelpful molecules and particulates. If so, one might speculate that its reduction in the bloodstream might be a cause of mini-strokes.
Which other natural defences against particulates are there in the bloodstream?
[2015 The endothelium, about 1% of arterial mass, needs to be kept in good condition. How can it if particulates lodge in it or pass through it without something to carry them away or envelope them relatively safely?
Dutch research shows that lifetime exposure to particulates reduces life expectancy by 0.6 years. The volume of airborne nanoparticles is increasing. Cholesterol and the endothelium may be acting as the particulate filter traps of last resort.]
8 December 2014
The Paris Mayor, Anne Hildago, yesterday announced plans to ban diesel cars from the capital by 2020 and today the Environmental Audit Committee of MPs called for hospitals, schools and care homes not to be built close to busy roads because of the pollution risk.
In The Daily Telegraph Dr James Le Fanu writes:
Readers may recall the highly improbable claim from 'leading experts earlier this year that the cholesterol lowering statins have 'virtually no side effects and thus can safely be prescribed to everyone over the age of 60 or one in four of the adult population. It might thus appear rather puzzling that several speakers at last months annual conference of the American Heart Association asserted, on the contrary, that far from being 'safe' nearly half of patients are 'statin intolerant.
The Daily Telegraph also reports that a poll has found:
two thirds of GPs are refusing to comply with controversial NHS advice to prescribe statins to millions more adults.
Family doctors said guidelines from the National Institute for Health and Care Excellence advising 40 per cent of adults to take the pills were "simplistic".
They insisted they would not allow the "mass medicalisation" of the public.
27 September 2015
The Volkswagen nitrogen oxide scandal raises a worrying possibility: have particulate emissions from diesel vehicles also been under-reported by the same vehicle testing?
The European vehicle manufacturers need to own this one and move to petrol-electric hybrids across the board of their vehicle ranges, without delay, as the low emissions options and flagships. The hybrid Audi A9 concept car, ironically a VW product, shows the way.
Governments need to incentivise petrol-electric hybrids through tax regimes.
Newly published evidence in the American Journal of Physiology from Tulane University is showing that statins are speeding up the ageing process. The class of drugs is said to deleteriously affect stem cells which repair damage to the body, protect against muscle and joint pain and help guard against memory loss.
The hypothesis that cholesterol, of whichever kind, is harmful is not supported in nature either. There is no evidence that animals that have much higher cholesterol levels than humans are unhealthy. Cholesterol is essential to life and rises to maintain and extend life.
3 October 2015
The French senate has estimated that air pollution costs the country £75 billion a year. This would imply costs to Britain on a similarly frightening scale.
AN ALTERNATIVE HYPOTHESIS
Reviewed by ANDRE BEAUMONT
As the reputation of the post-millennium NHS went underwater with the publication of The Mid Staffordshire Foundation Trust Public Inquiries on 6 February 2013, the fracturing of another tired health orthodoxy could still be discerned in the newspapers covering Robert Francis QC's report - that cholesterol is to blame for heart disease.
The front page headline of the Daily Express of 6 February 2013 was Heart Attack Risk in 'Healthy Spreads' based on newly published research by the National Institutes of Health in Maryland. On 7 February 2013 the Daily Mail's Joanna Blythman was writing:
Long held beliefs on cholesterol are beginning to look as shaky as those about saturated fats.
There is emerging scientific evidence that overall health prospects may be better for individuals with above-average levels of cholesterol.
Once again, beliefs that have shaped official health diktats for decades are being turned on their head. More research urgently needs to be done, but that apology should precede it. 'We got it wrong - sorry,' would be a good start.
This is the basis of an alternative hypothesis:
1) Cholesterol is brain food. It rises in middle age to protect brain function. It has some protective effect against neurological diseases like dementia and contributes to extension of lifespan.
2) Animal fats are the common currency of the animal world. In winter particularly, survival is often ensured by eating another creature with fat reserves. Nature has neither designed animal fats to be a danger to animals nor for homo sapiens to mysteriously be the only species threatened by the natural blood component cholesterol.
3) Of the few fats that threaten circulatory health trans fats or hydrogenated fats are the worst.
4) The rise in circulatory disease post-war and its now progressive but continuing decline has nothing to do with pharmaceutical intervention and little to do with medical intervention but mirrors, with a time delay, the rise then subsequent decline of air pollution, specifically particulates, sulphur dioxide and nitrogen oxides.
The circulatory disease caused by this pollution was erroneously blamed on animal fats and the artificial fats industry unintentionally made the incidence of circulatory disease worse by promoting widespread consumption of their alternative.
Beyond this hypothesis, which surely can be tested by those with the scientific tools to do so, there is the ethical problem of medicalising the normal and medicalising the beneficial variation found within the species.
Dr James Le Fanu has tackled this issue (Daily Telegraph, 29 March 2010):
This takes several forms, the most successful of which is the enthusiasm for prescribing cholesterol and blood-pressure-lowering drugs to millions in anticipation of preventing heart attack or stroke in the future. Here, the likelihood of benefit to the individual is very small it is estimated that 850 people need to take drugs to lower their blood pressure to prevent a single stroke. Thus, 849 people may be taking several tablets a day to no purpose. This lack of benefit is compounded by the fact that variables, such as blood pressure or cholesterol, rise with age and may be irrelevant in senior citizens. Too often, this factor is ignored, so many end up taking medication with almost zero probability it will do them good.
It is worth noting that many doctors are well meaning in prescribing these drugs without seeing a full enough picture. Even when they do not get a bonus for prescribing these drugs others may benefit financially. Blood pressure limits are probably set too low so an excessive number of people may be being classified as having high blood pressure. Once the diagnosis has been arrived at, usually unchallenged, some financial consequence may flow. Should the patient have private medical insurance he or she may find the premium raised substantially on moving to a new insurer, an increase unlikely to be justified if the tablets supposedly work so well.
If the variables are irrelevant in senior citizens this becomes particularly hard on them, with their already elevated premium levels, simply because of NHS zeal to classify people unnecessarily.
With statins, the £2 monthly cost of the generics prescribed by the NHS is more than covered by the prescription fee for those that pay it.
As for medicalising beneficial variation, I do know of one visibly healthy Nobel laureate with exceptionally high cholesterol but unfortunately cannot draw statistical significance from such a small sample. A study exploring whether high intelligence had a link to cholesterol would be interesting since 60% of the dry mass of the brain is fat.
Sir Cyril Clarke demonstrated half a century ago an exact correlation between the increase in centenarians receiving telegrams from the Queen and the decline in the dark coloured peppered moth in previously polluted industrial areas after the introduction of the Clean Air Act 1956. Previously the light coloured variant of the moth had been predated more. Now it was the turn of the dark coloured one as unsooty bark replaced sooty and natural selection quickly played its part.
There is no evidence that a health administrator of Sir Cyril Clarke's stature was being employed when New Labour ministers began appearing on television pushing statins and millions were apparently browbeaten into taking them using marketing techniques in the surgery. Most likely New Labour had already swallowed the marketing wholesale instead of the pellets.
Where centenarians are now found in greatest concentration in the EU (on a Greek island we are told) it is pretty probable that the air is largely unpolluted and that their Mediterranean diet has an absence of trans fats.
Wikipedia told us in 2011(with some citations missing) that
"Epidemiological studies suggest that more than 500,000 Americans die each year from cardiopulmonary disease linked to breathing fine particle air pollution..." A study by the University of Birmingham has shown a strong correlation between pneumonia related deaths and air pollution from motor vehicles. Worldwide more deaths per year are linked to air pollution than to automobile accidents. [A study] published in 2005 suggests that 310,000 Europeans die from air pollution annually. Causes of deaths include aggravated asthma, emphysema, lung and heart diseases, and respiratory allergies. The US EPA estimates that a proposed set of changes in diesel engine technology (Tier 2) could result in 12,000 fewer premature mortalities, 15,000 fewer heart attacks, 6,000 fewer emergency room visits by children with asthma, and 8,900 fewer respiratory-related hospital admissions each year in the United States.
Diesel exhaust (DE) is a major contributor to combustion derived particulate matter air pollution. In several human experimental studies, using a well validated exposure chamber setup, DE has been linked to acute vascular dysfunction and increased thrombus formation. This serves as a plausible mechanistic link between the previously described association between particulate matter air pollution and increased cardiovascular morbidity and mortality.
Estimates found in UK published sources for contemporary annual excess deaths from air pollution (2008) and trans fats (2011) are 29,000 (UK) and 7,000+ (England only) respectively. A large percentage of these will relate to coronary heart disease (CHD). On top of this must be added deaths from CHD hastened because of earlier exposure, often over many decades, to air pollution, the ingestion of trans fats and to other little disputed causes like smoking, diabetes and genetic inheritance. The statistics can be cut and mixed by those best able to do so but they leave little statistical space to scapegoat cholesterol.
With the last of the major statins soon coming off patent it is not hard to find pharmaceutical researchers who will say that the same money is better spent on newer drugs.
In 2010 the environmental audit committee of MPs found that life expectancy was being cut by 7-8 months by poor air quality.
70% of soot in Europe, North and Latin America is in the form of diesel particulates which due to their size are particularly dangerous when inhaled. Soot is washed out of the atmosphere within a few weeks but whilst it is there it has a greenhouse effect greater than methane has over a much longer span. It accumulates close to the ground and is harmful to animals and humans that breathe it in.
When a time is reached when newborns can live a life unexposed to the principal toxic air pollutants - particulates, sulphur dioxide, nitrogen oxides, lead - and to the ingestion of trans fats, it is not unreasonable to expect life expectancy to rise to over 90 and for some illnesses of old age like CHD and dementia to be deferred or reduced. (Hence it is also sensible to get on with introducing technologies that make old age easier to handle, like driverless cars, as sitting around taking statins for 30 years as an alternative is in the world of unreality. Not even vitamins are taken for 30 years non-stop by their adherents).
It would be ironic if cholesterol were also found to be an elixir of life after all the blame it has received.
30 March 2016
Sometimes in life it is simply worth insisting because time will substantially disprove the opposite view.
The hypothesis is that diesel particulates in air pollution, especially nanoparticles, enter the bloodstream primarily through the lungs.
Once in the bloodstream they cause inflammation to the endothelium of the blood vessels. Cholesterol arrives to attend to the inflammation. If the inflammation has caused lesions the cholesterol accummulates at their sites to attempt to seal them. Without its presence the particulates would pass more readily into organs, lesions or not.
Once in the brain particulates may be the cause of silent strokes, mini-strokes, strokes, dementia and, as yet insufficiently researched, mental illnesses and brain cancers. Heart attacks and strokes are also known to have greater incidence in periods of high air pollution.
Cholesterol is a pre-cursor for essential hormones like testosterone and the synthesis of vitamin D. It assists the functioning of the brain and if its level is too low life may be shortened. Its function is not dissimilar to that of the immune system and numerically based limits on its level in the blood, when imposed on a population, may be a danger to humanity. Immune system activity and cholesterol level vary from individual to individual. Cholesterol levels rise naturally with age because there is a greater need of the protection it affords.
There does not appear to be much convincing evidence that statins benefit anyone other than those who have had heart attacks and in those cases the benefit does not derive from reducing cholesterol but because the drugs act in other ways.