hidden

Misinformation and being a scientist during the 21st Century

In a recently published paper, Dr. Lykke Sylow shares three challenges for scientists during a time where not only misinformation, but the quantity of misinformation questions what science stands for (1).

Dr. Lykke Sylow is an assistant professor for the department of Nutrition, Exercise and Sports at the University of Copenhagen. Her line of research involves muscle insulin sensitivity, GTPase, exercise cancer cachexia and metabolism. Dr. Sylow shares the following three challenges in a recent publication: 1) Balancing correct interpretation of results with the need for promotion, 2) Schism between the need for fast scientific communication and scientific trustworthiness, 3) Tackling the social media platforms as they take a leading role in how we seek information.

The figure below highlights the incentivization for scientists to promote their research findings, thus the idea of bias comes to mind. This supports challenging circumstances to rely on the public to determine if scientific results are correctly interpreted and translated into a meaningful and comprehensive message (2).

https://doi.org/10.1073/pnas.1317516111

It is important to notice the complexity of the third model and the larger circle of the socio-political context that may often be overlooked.

The next figure below similarly highlights the reliance on the public to balance political and societal concerns with what is shared to them (3). Think about the citizens never-ending exposure to streams of very often contradictory information and/or arguments. Science cannot tackle this age of misinformation alone.

10.1073/pnas.1704882114

I reached out and asked two other scientists for their thoughts about the current state of science and misinformation. Dr. Derek Kingsley is an associate professor at Kent State University in the School of Health Sciences in Kent, OH, US. Dr. Kingsley’s research involved cardiovascular dynamics and outcomes with resistance exercise interventions. His responses are below:

  1. “During times like these it is important to remind scientists to slow down. Good science takes time. It seems that nothing can come quick enough these days, but we all have to remember that is never how science works.”
  2. “When it comes to sifting through information it is important to look for repetitions and commonalities in the data. Science is about repetition. Any experiment should be repeatable, and produce similar findings. Three or four studies do something a little bit different, but the story should generally be the same.  If you find a study that stands out as different, then you have to ask the question, why is this one study different?” Dr. Kingsley reminds us that the difference could be strength or a weakness. He stated, “You should probably read more than just one piece of information from one source.”
  3. Finally he finished by stating “Look to understand both sides of the coin.” While commonalities are important, so are differences.  Scientists should embrace and understand them.  A great argument or point of discussion requires an open-mind, so at the minimum people should be exposed to both sides. This allows them to make a decision supported by the embraced evidence. Remember, this doesn’t make the other side wrong, sometimes it’s just a different perspective.”

Dr. Babajide Ojo is currently a research Fellow at Cincinnati Children’s, in Cincinnati, Ohio, US. His interests are involved with gastroenterology, hepatology, and nutrition. Dr. Ojo is earlier than Dr. Kingsley in his career and shared his thoughts shared below.

  1. He states the first challenge is related to fear. “Misinformation sells and already has a huge following. Breaking through huge following can be a bit scary especially for young scientists trying to establish themselves. Social media is now the number one channel for communicating scientific information to lay audiences. As a scientist with nutrition training, I see the supplement industry as a mess. People spewing a lot of advice on social media that are not backed by repeatable and valid research. My fear is not always about challenging the fake experts, but if I get into it with people on social media for this “good cause”, I worry about my image with my boss, my employer, future employers, and so on. What if some of the big supplement companies have some influence in government regulatory bodies, or with my employer?  Unfortunately, this is a real worry for some of my colleagues.”
  2. Dr. Ojo statement reminds us there is little to no reward in academia for science communication to lay audiences. “Why bother? So we decide to focus our time on what pays the bills– the science. This creates a vacuum that the fake experts have capitalized on.”
  3. Finally the third challenge Dr. Ojo states is related to the dearth of mentors. “When you look at senior scientists and achievers in your field, most individuals are where they are at because of science. Therefore, we naturally thread the path of our seniors to achieve that level of excellence in the field.”

Whether it’s remembering your fundamentals like repeatability, or strengths and limitations of a study design, or bringing a concern to help mentorship types of relationships change focus. Dr. Sylow puts misinformation concern best by stating in the article,

“The concern is less about perceptions of consensus, but about what it stands for. If the public are convinced that science is not settled, why would the public weigh scientific facts more heavily than conspiracy beliefs or “alternative facts.”

Misinformation is here to stay, scientists should continue to engage with transparency in the best ways available. You can find Dr. Sylow’s publication in the references below.

  1. Sylow L. Three challenges of being a scientist in an age of misinformation.
  2. Scheufele DA. Science communication as political communication. Proceedings of the National Academy of Sciences. 2014 Sep 16;111(Supplement 4):13585-92.
  3. Drummond C, Fischhoff B. Individuals with greater science literacy and education have more polarized beliefs on controversial science topics. Proceedings of the National Academy of Sciences. 2017 Sep 5;114(36):9587-92.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

 

hidden

An MD or PHD, what is the best path for you?

On the American Heart Association Research Committee, you can see 9 of 30 members marked having a Ph.D. Furthermore, you’ll see that all programs the committee members are affiliated with have some medical association.

This example of the committee brings the question “Can an MD do what Ph.D. does?” The short answer is yes. Ph.D.’s may not necessarily have all the training an MD has, so the profession cannot provide exactly the same opportunities. So does the difference lies with patient care? Many PhDs work with MDs, so maybe a Ph.D. can have a similar clinical care experience.

How do people with an MD (Doctor of Medicine) differ from those with Ph.D. (Doctor of Philosophy)? The most common answers are likely:

  • “MDs make more money.”
  • “MDs prescribe medications.”
  • “They’re the real doctors”

Some Differences and Similarities:

PhDs:

  • On average, about 4-6 years to complete the degree
  • Purpose – to develop original work
  • Considered an academic degree
  • Contribute new theory and knowledge to the field

MDs:

  • On average, about 4 years to complete the degree, not including residency
  • Purpose – trained to give patient care
  • Considered a professional degree
  • Apply the existing theories and knowledge practically.

Both:

  • Referred to as Doctors
  • Both can specialize in fields.
  • Both perform research and apply for funding

The foundational difference may be related to assuming that Ph.D.s advance knowledge and MDs apply existing knowledge. It is not required for MDs to produce original research, whereas PhDs write up a dissertation (includes original work).

Okay, so obviously the training for doctor degrees are different. But, who is more up-to-date on cutting edge knowledge? Maybe, this sways your opinion?

PhDs are required to do original work, so wouldn’t they be?  What about MDs that conduct clinical trials? Do they use cutting edge knowledge?

It begins to get cloudy when you look past the path of earning your MD or Ph.D. Both professions can conduct clinical trials. Both professions can conduct translational related work.  Which route is better for you? How do you choose?

The path to the degree prepares you for what is ahead in your career. Hence the obvious difference of original work vs patient-related work. This is how many view it. However, the cloudiness between which path to choose increases when ideas like a specialty in biomedical research come to mind. Acceptance into MD/PhD program absorbs expectations into a research-oriented career. The program is expecting you to make medical advances through your training as a researcher.

Ask yourself  “What is the next step after obtaining my terminal degree (MD and Ph.D.)? “

You can pursue research opportunities with just an MD degree. This can occur through a fellowship type of training. Sort of similar to post-doctoral training, an option after completion of a Ph.D.

Overall the training and mentorship past your terminal degree will maximize your opportunities. There is a lot to mull over for choosing a path. Make a Pros and Cons list? Or better yet, maybe just go observe both types of professions?  Find a lab to work in or do some volunteering over the summer, Maybe get involved in a big project. Do something that is even just solely preparing materials for a particular procedure. See if you like the environment. I suggest looking beyond obtaining the terminal degree. Look for people you admire and learn their stories. Keep your eyes up to see all the open doors.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

hidden

Virtual Meeting Preparation and Reflection of Scientific Sessions 2020

As I complete my first virtual meeting of 2020 as a graduate student in science, there was two things I decided to take away from Scientific Sessions 2020. First, there is a specific agenda you could create to help yourself at professional conference meetings. I have some tips on getting involved with the content at the meetings. Second, I want to provide a reminder about the few advantages of virtual meetings.  

An Agenda for Professional Conference Meetings: 

First you need determine your priorities for attendance. This could be looking at the science specific to your interest that compliments your current work, or engaging in a way where you will communicate with someone outside your current network. Professional meetings have loads of information and dynamics that could create an overwhelming feeling, especially if it is your first meeting as a student. This is the “adulting” component of being a graduate student. 

 To help with attendance cost, a student should apply for everything. That means any student travel grants, waivers for registration fees, of even finding other agencies that offer to fund “professional development” in students. As frustrating as it can be, plan to be a “penny-pinching patty.”  This is part of the goal in prioritizing what you hope to get out of a conference; you need to have the stamina to handle all the sessions you hope to see. This means making sure you eat throughout your entire experience, even if it is virtual.  

 Second you need to develop general outline for the time frames of the sessions you plan to attend. This is almost like brainstorming what you hope to experience in the scientific sessions you attend at a conference. For me, this year I used the app associated with the American Heart Association meetings. The “AHA” conferences app helped provide reminders and take notes, it’s a virtual planner for your brainstorm session. I found myself on three different occasions changing the sessions I planned to attend virtually. These changes were more related to sessions I was asking others to attend for me, where then I  attended a session they could not see in return.  

 So that brings me to my third point for creating an agenda. Third, a buddy system, which seem obnoxious for scientific conferences. However, if there is an overload of content you want to see and engage with, like I did for this year’s Scientific Sessions, then creating a system to get coverage for all sessions is ideal. Furthermore, this buddy system can lead to an expansion of networks due to attendance of sessions you may not always find yourself becoming involved with. 

 A Research Tool Box and Advantages of Virtual Meetings: 

 The main point of research conferences is the presentation of new research in a format that catches attendee interest. Presentations at conferences are typically followed by questions and discussion between presenters and their audience. All of which is was still the framework for virtual scientific conference. 

 One advantage is no travel and lodging expenses. Most students have to pay out of pocket for travel and lodging at conferences (1). Although, there is nothing that can replace human interaction, there is some light from reduce burden of costs for students in virtual meetings. The stress of affording the expected costs of scientific meetings becomes slightly more manageable. I highlight this because depression and anxiety continue to grow with graduate students. Almost 40% students showed anxiety and depression scores in the moderate to severe range (2). Virtual conferences still allow you connect with others in a different manner. This point is especially important considering the how the pandemic is eroding graduate student mental health. From a  current survey of about 4000 U.S. STEM doctoral students , 40% reported symptoms aligning with generalized anxiety disorder and 37% with depression (3). 

 In addition to the reduced conference expenses, two are three helpful tools for your research conference tool box. 

  1. Take breaks and or watch conferences sessions in different environments. Do not be afraid to go outside with the laptop and listen to a session while being in the sun. This can help create a comfortable environment for you to fully immerse yourself in the session.
  2. Get involved on social media for these virtual conferences, it allows for continuing conversation and to expand networks. You can take notes from posts on social media reported by others that you may have missed. 

 2020 carefully reminds us about the value of human interaction for our lives. We will continue to learn and grow as students, adding to our toolbox.  Have a safe, socially distanced, and peaceful holiday. 

  1. Malloy J. Stop making graduate students pay up front for conferences. Nature. 2020;13:2020.
  2. Evans TM, Bira L, Gastelum JB, Weiss LT, Vanderford NL. Evidence for a mental health crisis in graduate education. Nature biotechnology. 2018 Mar 6;36(3):282.
  3. Chirikov I, Soria KM, Horgos B, Jones-White D. Undergraduate and Graduate Students’ Mental Health During the COVID-19 Pandemic.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

hidden

The Final Day (5/5) of AHA Scientific Sessions “Step on the Gas, so you can Hit the Breaks”

In the scientific session titled “Beyond Biomarkers: Inflammation and CVD across the Translational Spectrum”, inflammation was the topic of interest. It is important to note that inflammation has been established as a focus for the development of complications for cardiovascular diseases for some time now. The changes in inflammatory markers have been shown to be predictive of future cardiovascular events. But, do we know what exactly inflammation is? Are the markers we use precise enough to provide meaningful guidance for specific targeted therapies?

Dr. Russell Tracy from the University of Vermont was given the challenging opportunity to open the session in explaining how inflammation in cardiovascular disease works. He starts off by highlighting not just the amount of cells to consider, but all the different types and subtypes. There’s a multitude of pathways linked to inflammation and atherosclerosis. He proposed to focus on the pathophysiology that plays a role over the lifespan. Interestingly, the concept of trained immunity was highlighted as an influencer to the chronic inflammation that is signaled through adipose tissue. Dr. Tracy goes on to share that the inflammatory process could be related to input from multiple small pathways and that adaptative immunity impacts the inflammation research is attempting to characterize (Figure 1).

Figure 1.

Dr. Peter Libby from the Brigham and Women’s Hospital took a shot at addressing why some anti-inflammatory therapies work and then why some do not. He highlighted three studies to keep in mind for attendees: 1)  the Canakinumab Anti-inflammatory Thrombosis Outcomes Study or “CANTOS”, 2) the Cardiovascular Inflammation Reduction Trial “CIRT”, and 3) the Colchicine Cardiovascular Outcomes Trial or “COLCOT.  CANTOS focused on interleukin-1ß (IL-1ß) and its role in the reduction of rates of recurrent myocardial infarction, stroke, and cardiovascular death among stable patients with coronary artery disease who remain at high vascular risk (1). Canakinumab at a dose of 150 mg every 3 months led to a lower rate of recurrent cardiovascular events (1).

CIRT addressed low-dose methotrexate use among patients with stable coronary artery disease (CAD). The investigation showed low-dose methotrexate does not reduce inflammatory markers or cardiovascular events (2). Dr. Libby quickly pointed out the difference in baseline inflammation between the two populations. Where the CANTOS study already showed some residual inflammation as compared to CIRT.

He went on stating,

You have to step on the gas to press the breaks.”

The baseline level of inflammation is a characteristic to be more aware of when designing and evaluating drug studies like CIRT.

COLCOT involved the use of Colchicine to decrease the migrations of neutrophils, a white blood cell type that is essential for the resolution of inflammation. Neutrophils are a marker used for cardiovascular risk (4). Colchicine at a dose of 0.5 mg daily showed a significantly lower risk of ischemic cardiovascular events. Dr. Libby summed the presented work up with the slide below addressing residual inflammatory risk (Figure 2).

Figure 2.

He left the attendees with Winston Churchill’s famous quote from London’s Mansion House, just after the British routed Rommel’s forces at Alamein, driving German troops out of Egypt,

This is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.”

Referring to the development of targeted anti-cytokine therapies for the treatment of atherothrombosis.

Overall it seems there is an oversimplification of inflammation at times, thus inaccurately conveying the heterogeneity of the processes involved. It is a challenge to accurately assess the mechanisms underlying CVD risk in each patient. More work around specific anti-inflammatory pathway is vital to characterize inflammation and develop targeted therapies that provide a cardiovascular benefit.

 

References:

  1. Ridker PM, Thuren T, Zalewski A, Libby P. Interleukin-1β inhibition and the prevention of recurrent cardiovascular events: rationale and design of the Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS). Am Heart J. 2011 Oct;162(4):597-605. doi: 10.1016/j.ahj.2011.06.012. Epub 2011 Sep 14. PMID: 21982649.
  2. Ridker PM, Everett BM, Pradhan A, MacFadyen JG, Solomon DH, Zaharris E, Mam V, Hasan A, Rosenberg Y, Iturriaga E, Gupta M, Tsigoulis M, Verma S, Clearfield M, Libby P, Goldhaber SZ, Seagle R, Ofori C, Saklayen M, Butman S, Singh N, Le May M, Bertrand O, Johnston J, Paynter NP, Glynn RJ; CIRT Investigators. Low-Dose Methotrexate for the Prevention of Atherosclerotic Events. N Engl J Med. 2019 Feb 21;380(8):752-762. doi: 10.1056/NEJMoa1809798. Epub 2018 Nov 10. PMID: 30415610; PMCID: PMC6587584.
  3. Tardif JC, Kouz S, Waters DD, Bertrand OF, Diaz R, Maggioni AP, Pinto FJ, Ibrahim R, Gamra H, Kiwan GS, Berry C, López-Sendón J, Ostadal P, Koenig W, Angoulvant D, Grégoire JC, Lavoie MA, Dubé MP, Rhainds D, Provencher M, Blondeau L, Orfanos A, L’Allier PL, Guertin MC, Roubille F. Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction. N Engl J Med. 2019 Dec 26;381(26):2497-2505. doi: 10.1056/NEJMoa1912388. Epub 2019 Nov 16. PMID: 31733140.
  4. Kain V, Halade GV. Role of neutrophils in ischemic heart failure. Pharmacol Ther. 2020 Jan;205:107424. doi: 10.1016/j.pharmthera.2019.107424. Epub 2019 Oct 16. PMID: 31629005; PMCID: PMC6981275.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

hidden

Modifiable Factors Influence Non-modifiable Factors for Cardiovascular Health?

The scientific community continues its full force swing at reducing cardiovascular disease risk. In the Scientific Session titled “Microbiome in Cardiovascular Disease,” the complexity of accounting for human variation was the theme. The important difference and interactions between non-modifiable (genetics) and modifiable (diet, exercise, smoking, etc..) factors were presented. Dr. Katherine Tucker opened up the session by highlighting work from Thanassoulis et. al., 2012, which identified 13 single nucleotide polymorphisms (SNPs) to generate a genetic risk score (GRS) to predict cardiovascular events and coronary artery calcium (CAC). Single nucleotide polymorphisms are the most common type of genetic variation among people and are used to help quantify the variation in individuals (1). The CAC score comes from a test that quantifies the amount of calcium accumulation in the walls of the coronary arteries. A lower score represents a greater risk and a lower score relates to a lower risk of heart disease. Dr. Tucker went on to explain the genetic risk is influenced by individual environmental factors (i.e. smoking, exercise, and diet) (2). Recent data from the CARDIA study supports this in reporting that, “low-carbohydrate diets at a younger age is associated with an increased risk of subsequent CAC progression, particularly when animal protein or fat are chosen to replace carbohydrates. (3).”

Figure 1 source: https://doi.org/10.1093/nutrit/nux001

The changes in macronutrient content in a diet is related to what happens in the gut. Within the gut, there are trillions of bacteria that make up a microbiome. An individual microbiome modulates the immune system and metabolic processes. The microbiome influence on human health is so pronounced in that it actively reprograms the genome in response to the environment, changing the bacteria phyla ratios that lead to down-stream effects that could influence cardiovascular health (Figure 1) (2). Dietary fiber and prebiotic consumption are two components that modulate the composition of the gut microbiome (Figure 2) (4). Also, there is some great news for you Kombucha fans out there! Fermented foods have some benefits for the gut.

Figure 2. Source: https://doi.org/10.1093/nutrit/nux062

Bhat and Kapila 2017 further highlight diet in a review stating “The composition of the gut microbiota has a tremendous influence on host metabolism.” Perhaps specific dietary interventions can reduce the risk of cardiovascular disease with the focus on obtaining an optimal microbiota composition. Zhang et. al., 2020, showed how detrimental diets with contain highly processed foods can be the bacteria in our gut (Figure 3) (5).

Figure 3. Source: https://doi.org/10.1093/ajcn/nqaa276

To further highlight how much people differ from one another, Dr. Tang from the Cleveland Clinic explained only 37% of the gut is actually shared between twins. In addition, there are significant diurnal variations in response to meals consumed among people. The work presented the relationship between microbiota and trimethylamine (TMA)/trimethylamine–N-oxide(TMAO) generation. Elevated TMAO levels predict major adverse cardiac events like death, myocardial infarction (MI), and stroke (Figure 4) (6). Dr. Tang explained that risk is highest with people who displayed the highest baseline levels of two TMAO precursors choline or L-carnitine, while some may show no risk with higher levels. Dr. Tang emphasized the variation again among individuals.

Figure 4. Source: Tang, W. W., & Hazen, S. L. (2014)

We are only scratching the surface with the modifiable risk factors for heart disease. Specifically, the gut shows an area rich for investigation. The gut microbiota contributes to human physiology and diseases and it is something to be excited about for biomedical researchers.

 

References:

  1. Thanassoulis G, Peloso GM, Pencina MJ, Hoffmann U, Fox CS, Cupples LA, Levy D, D’Agostino RB, Hwang SJ, O’Donnell CJ. A genetic risk score is associated with incident cardiovascular disease and coronary artery calcium: the Framingham Heart Study. Circ Cardiovasc Genet. 2012 Feb 1;5(1):113-21. doi: 10.1161/CIRCGENETICS.111.961342. Epub 2012 Jan 10.
  2. Mohd Iqbal Bhat, Rajeev Kapila, Dietary metabolites derived from gut microbiota: critical modulators of epigenetic changes in mammals, Nutrition Reviews, Volume 75, Issue 5, May 2017, Pages 374–389, https://doi.org/10.1093/nutrit/nux001
  3. Gao, J. W., Hao, Q. Y., Zhang, H. F., Li, X. Z., Yuan, Z. M., Guo, Y., … & Liu, P. M. (2020). Low-Carbohydrate Diet Score and Coronary Artery Calcium Progression: Results From the CARDIA Study. Arteriosclerosis, Thrombosis, and Vascular Biology, ATVBAHA-120.
  4. Genelle R Healey, Rinki Murphy, Louise Brough, Christine A Butts, Jane Coad, Interindividual variability in gut microbiota and host response to dietary interventions, Nutrition Reviews, Volume 75, Issue 12, December 2017, Pages 1059–1080, https://doi.org/10.1093/nutrit/nux062
  5. Zefeng Zhang, Sandra L Jackson, Euridice Martinez, Cathleen Gillespie, Quanhe Yang, Association between ultraprocessed food intake and cardiovascular health in US adults: a cross-sectional analysis of the NHANES 2011–2016, The American Journal of Clinical Nutrition, https://doi.org/10.1093/ajcn/nqaa276
  6. Tang, W. W., & Hazen, S. L. (2014). The contributory role of gut microbiota in cardiovascular disease. The Journal of clinical investigation, 124(10), 4204-4211.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”