I finally finished writing the text of the speech I’m giving next week. The problem wasn’t coming up with material; it was paring the material down. My first draft ran well over 90 minutes when I timed it, and the speech is supposed to be 60 minutes with time for Q&A afterwards. During my days on the road, I saw what happened when otherwise good comedians didn’t know when get to off the stage. When people in the audience start leaving, you should take the hint.
So I dropped sections on grains and lectins, the effects of various diets on HDL and triglycerides, and how stress raises cholesterol. In short, I pared it down to the subject matter that fits the title: Big Fat Fiasco — how the misguided fear of saturated fat caused the epidemics of obesity and diabetes.
I figured the biggest challenge would be convincing people that the nutrition field is full of bad science. Before I started doing research on Fat Head, I frankly had no idea. I always liked to think of scientists of neutral seekers of the truth, and I suspect most other people do as well. I’m never sure how they’ll react when a filmmaker and comedian tells them a lot of scientists are hacks.
To stack the deck in my favor, I’m dedicating part of the speech to explaining the differences between good science and bad science, as well as the differences between observational studies and clinical studies. If they follow along with those sections, I’m halfway home.
In a perfect example of fortunate timing, the Atlantic just published an article titled Lies, Damned Lies, and Medical Science. Turns out I don’t have to call the nutrition scientists hacks, at least not by myself. A doctor who has dedicated his life to exposing bad science is already doing it for me. You can bet I’ll be lifting some quotes from one:
He and his team have shown, again and again, and in many different ways, that much of what biomedical researchers conclude in published studies-conclusions that doctors keep in mind when they prescribe antibiotics or blood-pressure medication, or when they advise us to consume more fiber or less meat, or when they recommend surgery for heart disease or back pain-is misleading, exaggerated, and often flat-out wrong. He charges that as much as 90 percent of the published medical information that doctors rely on is flawed.
Only 90 percent? Perhaps he’s more optimistic than I am.
He first stumbled on the sorts of problems plaguing the field, he explains, as a young physician-researcher in the early 1990s at Harvard. At the time, he was interested in diagnosing rare diseases, for which a lack of case data can leave doctors with little to go on other than intuition and rules of thumb. But he noticed that doctors seemed to proceed in much the same manner even when it came to cancer, heart disease, and other common ailments. Where were the hard data that would back up their treatment decisions? There was plenty of published research, but much of it was remarkably unscientific, based largely on observations of a small number of cases.
When it comes to what most doctors know about nutrition and health, I believe a quote from original Mayor Daley in Chicago is appropriate: “Nobody knows nothing.”
Baffled, he started looking for the specific ways in which studies were going wrong. And before long he discovered that the range of errors being committed was astonishing: from what questions researchers posed, to how they set up the studies, to which patients they recruited for the studies, to which measurements they took, to how they analyzed the data, to how they presented their results, to how particular studies came to be published in medical journals.
This array suggested a bigger, underlying dysfunction, and Ioannidis thought he knew what it was. “The studies were biased,” he says. “Sometimes they were overtly biased. Sometimes it was difficult to see the bias, but it was there.” Researchers headed into their studies wanting certain results-and, lo and behold, they were getting them.
And just think: there are vegan evangelists in the world who still believe T. Colin Campbell went into the China Study as an open-minded scientist.
The article spelled out his belief that researchers were frequently manipulating data analyses, chasing career-advancing findings rather than good science, and even using the peer-review process — in which journals ask researchers to help decide which studies to publish — to suppress opposing views.
I guess the Climategate gang can always work in the medical-research field if their current funding runs out.
It’s an enlightening article, and I hope you’ll read the whole thing. Dr. Ioannidis is a man on a mission, and we should all hope he succeeds.
In the meantime, I’ll be working on creating slides.