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Michel Accad

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My main current academic interests are in natural philosophy (hylomorphic), philosophical anthropology, and philosophy of medicine. I continue to investigate the tension between individual clinical care and so-called "population medicine,' particularly in the area of prevention of cardiovascular disease.
Address: San Francisco, California, United States

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Kathryn L MacKay

The University of Sydney

Cassandra Codes-Johnson

West Chester University of PA

Gregory Benjamin

Temple University

Simone Fullagar

Griffith University

West Virginia University

Lena C Palacios, MA, PhD

McGill University

University of Liverpool

The University of New South Wales

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Papers by Michel Accad

Population health: At odds with person-centered healthcare

European Journal of Person-Centered Healthcare, 2017

The Brain-Dead Body Is Alive, One, and Human: A Response to Maureen Condic and Other Proponents of Brain Death

This paper succinctly refutes the main arguments currently brought forth in defense of the concep... more This paper succinctly refutes the main arguments currently brought forth in defense of the concept of brain death. I begin with a reminder that a sound definition of life was articulated by Aristotle and accepted by St. Thomas Aquinas. Neglecting that definition and its underlying philosophy leads to confusion. Such confusion is apparent in the way scientists and philosophers who defend brain death have misinterpreted the significance of persistent cellular life in cadavers and in explanted organs. I conclude by also showing that, despite a permanent loss of capacity for rational thought, brain-dead bodies cannot be considered subhuman.

HYLOMORPHIC ELEMENTS AND THE CELL THEORY: A BASIS FOR BIOLOGICAL LAW

Modern cell theory articulates three basic biological principles: 1) all living organisms are com... more Modern cell theory articulates three basic biological principles: 1) all living organisms are composed of one or more cells; 2) the cell is the unit of life; and 3) all cells come from pre-existing cells. The article examines the cell theory within the framework of Aristotle’s hylomorphic elemental theory. I identify a strong parallel between the properties of elements postulated by hylomorphism and the properties of cells identified by modern biology. The hylomorphic doctrine of “virtual presence” is particularly apt at describing the behavior of cell species in multicellular organisms. This concordance between hylomorphism and biological phenomena opens the door for the discovery of additional compatibilities between hylomorphic metaphysics and modern science. Such compatibility offers the possibility of describing a so far elusive “biological law.”

Of wholes and parts: A Thomistic refutation of “Brain Death”

The Linacre Quarterly, 2015

972-102 Suppression of ICAM-1 and P-Selectin Adhesion Molecule Expression by Bolus IV Liposomal PGE1 (TLC-C53) Immediately Prior to Reperfusion in a Two Hour Canine Infarct/Reperfusion Model

by James Amirian, Margaret Uthman, and Michel Accad

Journal of the American College of Cardiology, 1995

imaging and digitization performed over a 2 sec period. Mean videointensity in the balloon cross-... more imaging and digitization performed over a 2 sec period. Mean videointensity in the balloon cross-sectional area was measured for every consecutive digitized image. Results: (1) Videointensity was found to be directly related to temperature induced changes in microbubble volume. (2) Under continuous ultrasonic irradiation, videointensity decreased over time. The slope of this decrease, defined as destruction index, correlated with both transmitted power and temperature, reflecting the destructive effects of irradiation, which were more pronounced at higher temperatures.

Heterologous embryo transfer: Magisterial answers and metaphysical questions

The Linacre Quarterly, Feb 2014

The debate regarding the morality of heterologous embryo transfer (HET) as a solution for the fat... more The debate regarding the morality of heterologous embryo transfer (HET) as a solution for the fate of cryopreserved embryos remains active. This paper endeavors to show that the magisterial instructions on bioethical issues can only lead to the conclusion that HET is always morally illicit. I begin by showing that the text of Dignitas personae recognizes HET as a procedure accomplishing a procreative function, and I indicate that it is through gestation that this procreative function occurs. I further show that the previous Instruction, Donum vitae, implicitly points to an ontological or spiritual consideration at play during gestation. This consideration is likely related to the procreative function identified in Dignitas personae. Finally, I place these two textual arguments in the context of the debate concerning HET and conclude that metaphysical questions must be clarified in order for the immorality of HET to be understood from a suitable anthropological perspective and gain more widespread acceptance.

On defining good health

Texas Heart Institute Journal , Feb 2013

Skills, knowledge, and prediction

The American Journal of Cardiology, Jul 2012

More reasons statin drugs are shunned

The American Journal of Cardiology, Mar 2011

16 to 30 ng/ml) versus normal (Ͼ30 ng/ ml) vitamin D status.

Risk-Factor Medicine: An Industry out of Control

Cardiology, Oct 2010

On redefining hypertension

Texas Heart Institute Journal, 2010

A n elevated blood pressure can be a normal physiologic reaction, an abnormality of uncertain sig... more A n elevated blood pressure can be a normal physiologic reaction, an abnormality of uncertain significance, a marker of cardiovascular risk, or the cardinal sign of a disease with potentially serious immediate or long-term complications. Depending on the clinical circumstances, therefore, the physician can ignore the finding, extend the scope of observation, engage the patient in a conversation on statistical risk, or initiate antihypertensive therapy. From our observations in the private practice and academic settings, most physicians facing these possibilities initiate therapy reflexively, on the spot. The "decision to treat" almost certainly stems from the current dogma that defines and classifies systemic hypertension solely on the basis of arbitrary cutoff numbers. 1,2 Mindless adherence to these numbers prompts us to emphasize several points.

Is Jupiter also a god of primary prevention

Texas Heart Institute Journal , 2010

Statistics and the rise of medical fortunetellers

Texas Heart Institute Journal, 2009

Left ventricular systolic unloading and augmentation of intracoronary pressure and Doppler flow during enhanced external counterpulsation

Circulation , 2002

Management After Myocardial Infarction

Current treatment options in cardiovascular medicine, 2002

Increased atherosclerosis in LDL receptor–null mice lacking ACAT1 in macrophages

Journal of Clinical Investigation, Jan 2001

Mammalian acyl-CoA:cholesterol acyltransferases

Biochimica Et Biophysica Acta-molecular and Cell Biology of Lipids, 2000

Cholesterol, the chief sterol found in vertebrates, exists both as a free sterol and as a compone... more Cholesterol, the chief sterol found in vertebrates, exists both as a free sterol and as a component of cholesterol esters, which are synthesized by acyl-CoA:cholesterol acyltransferase (ACAT) enzymes. Considerable knowledge concerning cholesterol ester metabolism has accumulated during the past century. However, rapid advances have occurred in the past 7 years since the cloning of an ACAT gene, including the discovery that two ACATs function in mammalian biology. A clearer picture of the functions of ACAT enzymes in cellular cholesterol metabolism and physiologic processes is now emerging. These insights may have relevance for the development of ACAT inhibitors for treating hypercholesterolemia or atherosclerosis in humans. ß

Resistance to diet-induced hypercholesterolemia and gallstone formation in ACAT2-deficient mice

Nature Medicine, Dec 2000

The importance of cholesterol ester synthesis by acyl CoA:cholesterol acyltransferase (ACAT) enzy... more The importance of cholesterol ester synthesis by acyl CoA:cholesterol acyltransferase (ACAT) enzymes in intestinal and hepatic cholesterol metabolism has been unclear. We now demonstrate that ACAT2 is the major ACAT in mouse small intestine and liver, and suggest that ACAT2 deficiency has profound effects on cholesterol metabolism in mice fed a cholesterol-rich diet, including complete resistance to diet-induced hypercholesterolemia and cholesterol gallstone formation. The underlying mechanism involves the lack of cholesterol ester synthesis in the intestine and a resultant reduced capacity to absorb cholesterol. Our results indicate that ACAT2 has an important role in the response to dietary cholesterol, and suggest that ACAT2 inhibition may be a useful strategy for treating hypercholesterolemia or cholesterol gallstones.

Massive xanthomatosis and altered composition of atherosclerotic lesions in hyperlipidemic mice lacking acyl CoA:cholesterol acyltransferase 1

Journal of Clinical Investigation, Mar 2000

Lipemia Retinalis

New England Journal of Medicine, 1999

A 36-year-old woman with newly discovered diabetes mellitus had eruptive xanthomata on her elbows... more A 36-year-old woman with newly discovered diabetes mellitus had eruptive xanthomata on her elbows and knees together with striking retinal changes. Her vision was normal, but all retinal vessels appeared creamy white, and the veins were distinguishable from arteries only by their larger caliber (Panel A). This funduscopic finding occurs only with extreme hypertriglyceridemia -concentrations of triglycerides generally exceed 4000 mg per deciliter (45.2 mmol per liter). A blood specimen was lipemic (Panel B), with a triglyceride concentration of 21,040 mg per deciliter (237.5 mmol per liter; normal range, 10 to 190 [0.11 to 2.15 mmol per liter]). The patient was treated with insulin and a low-fat diet, and by the seventh day of treatment, her triglyceride concentration had fallen to 2192 mg per deciliter (24.7 mmol per liter) and the retinas appeared normal.

Population health: At odds with person-centered healthcare

European Journal of Person-Centered Healthcare, 2017

The Brain-Dead Body Is Alive, One, and Human: A Response to Maureen Condic and Other Proponents of Brain Death

This paper succinctly refutes the main arguments currently brought forth in defense of the concep... more This paper succinctly refutes the main arguments currently brought forth in defense of the concept of brain death. I begin with a reminder that a sound definition of life was articulated by Aristotle and accepted by St. Thomas Aquinas. Neglecting that definition and its underlying philosophy leads to confusion. Such confusion is apparent in the way scientists and philosophers who defend brain death have misinterpreted the significance of persistent cellular life in cadavers and in explanted organs. I conclude by also showing that, despite a permanent loss of capacity for rational thought, brain-dead bodies cannot be considered subhuman.

HYLOMORPHIC ELEMENTS AND THE CELL THEORY: A BASIS FOR BIOLOGICAL LAW

Modern cell theory articulates three basic biological principles: 1) all living organisms are com... more Modern cell theory articulates three basic biological principles: 1) all living organisms are composed of one or more cells; 2) the cell is the unit of life; and 3) all cells come from pre-existing cells. The article examines the cell theory within the framework of Aristotle’s hylomorphic elemental theory. I identify a strong parallel between the properties of elements postulated by hylomorphism and the properties of cells identified by modern biology. The hylomorphic doctrine of “virtual presence” is particularly apt at describing the behavior of cell species in multicellular organisms. This concordance between hylomorphism and biological phenomena opens the door for the discovery of additional compatibilities between hylomorphic metaphysics and modern science. Such compatibility offers the possibility of describing a so far elusive “biological law.”

Of wholes and parts: A Thomistic refutation of “Brain Death”

The Linacre Quarterly, 2015

972-102 Suppression of ICAM-1 and P-Selectin Adhesion Molecule Expression by Bolus IV Liposomal PGE1 (TLC-C53) Immediately Prior to Reperfusion in a Two Hour Canine Infarct/Reperfusion Model

by James Amirian, Margaret Uthman, and Michel Accad

Journal of the American College of Cardiology, 1995

imaging and digitization performed over a 2 sec period. Mean videointensity in the balloon cross-... more imaging and digitization performed over a 2 sec period. Mean videointensity in the balloon cross-sectional area was measured for every consecutive digitized image. Results: (1) Videointensity was found to be directly related to temperature induced changes in microbubble volume. (2) Under continuous ultrasonic irradiation, videointensity decreased over time. The slope of this decrease, defined as destruction index, correlated with both transmitted power and temperature, reflecting the destructive effects of irradiation, which were more pronounced at higher temperatures.

Heterologous embryo transfer: Magisterial answers and metaphysical questions

The Linacre Quarterly, Feb 2014

The debate regarding the morality of heterologous embryo transfer (HET) as a solution for the fat... more The debate regarding the morality of heterologous embryo transfer (HET) as a solution for the fate of cryopreserved embryos remains active. This paper endeavors to show that the magisterial instructions on bioethical issues can only lead to the conclusion that HET is always morally illicit. I begin by showing that the text of Dignitas personae recognizes HET as a procedure accomplishing a procreative function, and I indicate that it is through gestation that this procreative function occurs. I further show that the previous Instruction, Donum vitae, implicitly points to an ontological or spiritual consideration at play during gestation. This consideration is likely related to the procreative function identified in Dignitas personae. Finally, I place these two textual arguments in the context of the debate concerning HET and conclude that metaphysical questions must be clarified in order for the immorality of HET to be understood from a suitable anthropological perspective and gain more widespread acceptance.

On defining good health

Texas Heart Institute Journal , Feb 2013

Skills, knowledge, and prediction

The American Journal of Cardiology, Jul 2012

More reasons statin drugs are shunned

The American Journal of Cardiology, Mar 2011

16 to 30 ng/ml) versus normal (Ͼ30 ng/ ml) vitamin D status.

Risk-Factor Medicine: An Industry out of Control

Cardiology, Oct 2010

On redefining hypertension

Texas Heart Institute Journal, 2010

A n elevated blood pressure can be a normal physiologic reaction, an abnormality of uncertain sig... more A n elevated blood pressure can be a normal physiologic reaction, an abnormality of uncertain significance, a marker of cardiovascular risk, or the cardinal sign of a disease with potentially serious immediate or long-term complications. Depending on the clinical circumstances, therefore, the physician can ignore the finding, extend the scope of observation, engage the patient in a conversation on statistical risk, or initiate antihypertensive therapy. From our observations in the private practice and academic settings, most physicians facing these possibilities initiate therapy reflexively, on the spot. The "decision to treat" almost certainly stems from the current dogma that defines and classifies systemic hypertension solely on the basis of arbitrary cutoff numbers. 1,2 Mindless adherence to these numbers prompts us to emphasize several points.

Is Jupiter also a god of primary prevention

Texas Heart Institute Journal , 2010

Statistics and the rise of medical fortunetellers

Texas Heart Institute Journal, 2009

Left ventricular systolic unloading and augmentation of intracoronary pressure and Doppler flow during enhanced external counterpulsation

Circulation , 2002

Management After Myocardial Infarction

Current treatment options in cardiovascular medicine, 2002

Increased atherosclerosis in LDL receptor–null mice lacking ACAT1 in macrophages

Journal of Clinical Investigation, Jan 2001

Mammalian acyl-CoA:cholesterol acyltransferases

Biochimica Et Biophysica Acta-molecular and Cell Biology of Lipids, 2000

Cholesterol, the chief sterol found in vertebrates, exists both as a free sterol and as a compone... more Cholesterol, the chief sterol found in vertebrates, exists both as a free sterol and as a component of cholesterol esters, which are synthesized by acyl-CoA:cholesterol acyltransferase (ACAT) enzymes. Considerable knowledge concerning cholesterol ester metabolism has accumulated during the past century. However, rapid advances have occurred in the past 7 years since the cloning of an ACAT gene, including the discovery that two ACATs function in mammalian biology. A clearer picture of the functions of ACAT enzymes in cellular cholesterol metabolism and physiologic processes is now emerging. These insights may have relevance for the development of ACAT inhibitors for treating hypercholesterolemia or atherosclerosis in humans. ß

Resistance to diet-induced hypercholesterolemia and gallstone formation in ACAT2-deficient mice

Nature Medicine, Dec 2000

The importance of cholesterol ester synthesis by acyl CoA:cholesterol acyltransferase (ACAT) enzy... more The importance of cholesterol ester synthesis by acyl CoA:cholesterol acyltransferase (ACAT) enzymes in intestinal and hepatic cholesterol metabolism has been unclear. We now demonstrate that ACAT2 is the major ACAT in mouse small intestine and liver, and suggest that ACAT2 deficiency has profound effects on cholesterol metabolism in mice fed a cholesterol-rich diet, including complete resistance to diet-induced hypercholesterolemia and cholesterol gallstone formation. The underlying mechanism involves the lack of cholesterol ester synthesis in the intestine and a resultant reduced capacity to absorb cholesterol. Our results indicate that ACAT2 has an important role in the response to dietary cholesterol, and suggest that ACAT2 inhibition may be a useful strategy for treating hypercholesterolemia or cholesterol gallstones.

Massive xanthomatosis and altered composition of atherosclerotic lesions in hyperlipidemic mice lacking acyl CoA:cholesterol acyltransferase 1

Journal of Clinical Investigation, Mar 2000

Lipemia Retinalis

New England Journal of Medicine, 1999

A 36-year-old woman with newly discovered diabetes mellitus had eruptive xanthomata on her elbows... more A 36-year-old woman with newly discovered diabetes mellitus had eruptive xanthomata on her elbows and knees together with striking retinal changes. Her vision was normal, but all retinal vessels appeared creamy white, and the veins were distinguishable from arteries only by their larger caliber (Panel A). This funduscopic finding occurs only with extreme hypertriglyceridemia -concentrations of triglycerides generally exceed 4000 mg per deciliter (45.2 mmol per liter). A blood specimen was lipemic (Panel B), with a triglyceride concentration of 21,040 mg per deciliter (237.5 mmol per liter; normal range, 10 to 190 [0.11 to 2.15 mmol per liter]). The patient was treated with insulin and a low-fat diet, and by the seventh day of treatment, her triglyceride concentration had fallen to 2192 mg per deciliter (24.7 mmol per liter) and the retinas appeared normal.

Aristotelian in Spite of Himself? Christopher Boorse and The Philosophy of Nature