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.

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37 Responses to “A Scientist Calls Out The Bad Scientists”
  1. shutchings says:

    So I’m going to bounce the question off you that runs around in my head. If this is true, and I think it is, shouldn’t I avoid doctors entirely? I mean, I know sometimes you have to end up at the mercy of a doctor–like when my appendix burst (I’ll spare you all my opinions on that experience)–but why would I ever go to the doctor–even for checkups? 90% of the information they rely on is flawed. And I don’t think you’re just talking about nutrition. My elderly mother worries about my avoidance of doctors. I’m not sure this article would make her feel any better.

    I wouldn’t take nutrition advice from most doctors, but if I’m sick and can’t figure it out what it is, I’ll go see one.

  2. RobR says:

    Tom, will your speech be filmed ? I’d love to watch it if you are able to get it recorded.

    I plan to record it.

  3. Elenor says:

    Please please PLEASE record your speech and post it!! Maybe Jimmie Moore will give you some server space!! Or put it on iTunes ({shudder} but for you, I’d actually join iTunes). (At least long enough to get your speech!)

    If you don’t have one, pick up a Sansa Clip (MP3 player), hit ‘Record’ and clip it to your lapel or shirt pocket: super little device, excellent mike, takes no fussing to get a really good recording.

    I’d SO love to hear your speech!

    We’re going to record it because I’d like to do more of them, and this will (if it goes well) serve as a demo.

  4. Discover Magazine also has an article titled Reckless Medicine. It is not online anywhere but I have some quotes on my blog. Also worth a read and dovetails nicely with the Atlantic piece without being repetitive.

    M

  5. R Dunn says:

    Very nice post Tom. I would’ve looked forward to the 90 minute version of the speech as well.

    I’ve been following the climate debate over man-made global warming for about 4 years now.

    As someone who has become immersed in studying nutrition as well (primarily the paleo/primal type – I’m into the food, but haven’t got around to the exercise part yet) I’ve had similar thoughts about the way people doing nutritional science and climate science seem to use the same questionable methodologies and have the same questionable character.

    I recall that Gary Taubes, in one of his speeches, said that someone remarked to him that “if you think the science in physics is bad, you should look at the science about nutrition.” Or something like that. Look at what he uncoverd there.

    I thought that if I ever got to talk to him, I would say “if you think the science about nutrition is bad, you should look at the science being done about climate.”

    A Taubes book on climate would shake things up in that science as much as “Good Calories, Bad Calories” has in nutrition.

    It seems that bad science drives bad policy no matter what the discipline – and vice versa.

    Oh yeah, I bought the Fathead movie about a month ago and thought the song at the end alone was worth the price of admission.

    I appreciate the compliment on the song. Tom Monahan (composer for the film) and I plan to release some songs later this year.

  6. Anon. says:

    I just found this webpage. – “Five Explanations For the French Paradox”

    http://blogs.ocweekly.com/stickaforkinit/five-great/five-explanations-for-the-fren/

    Well at least the fourth explanation has some plausibility.

    The rest of them are quite laughable when you know the real reason behind the ‘paradox.’

    That one makes a bit of sense. Desserts or not, the French consume something like 1/5 of the sugar that Americans do on average. I think that explains both the leaner bodies and the low rate of heart disease.

  7. k_the_c says:

    Science is the biggest religion…

  8. The trouble is finding a way to share these revelations without coming off as a conspiracy theorist and having people look for your tin-foil hat.

    I’m currently trying to decide whether to change my science major to nutrition – on the basis that if I can escape the brainwashing during the years of study I could actually HELP people at the end of it – but I’m not sure whether I could make it through the study. I suspect I would either get depressed or violent…maybe both…but it wouldn’t be pretty lol

    I was relieved to see the article in the Atlantic because I can screen-cap it for the speech. The logic of what I’m saying ought to be enough, but let’s be honest; some people need to hear it from an MD or PhD.

  9. Dusty says:

    I hope you can record your speech and post it online! I would look forward to that.

    In other news, have you checked out the Wikipedia entry on The China Study recently? An (admitted vegan) editor has removed all criticism and controversy information from the article, citing a rule that requires ‘peer reviewed sources with established credentials’ rather than ‘pretty girls studying English’. Its interesting to see the lengths the vegan community is willing to go to protect their idol.

    Yup, I read about that. If the pretty girl studying English is wrong in her analysis, all they have to do is point out the errors in her math. Perhaps someone like Richard Feinman should do a critique of Campbell; it would be fun to see how the vegan censors try to claim he doesn’t have credentials.

  10. Deborah M says:

    Thanks for pointing us to that article, Tom – fascinating reading – and like someone else said, it does tempt you to stay away from doctors entirely!

    I thought this was particularly telling:

    “We could solve much of the wrongness problem, Ioannidis says, if the world simply stopped expecting scientists to be right. That’s because being wrong in science is fine, and even necessary—as long as scientists recognize that they blew it, report their mistake openly instead of disguising it as a success, and then move on to the next thing, until they come up with the very occasional genuine breakthrough. But as long as careers remain contingent on producing a stream of research that’s dressed up to seem more right than it is, scientists will keep delivering exactly that.”

    As you showed in Fathead, it was the governmental expectations of “give us an answer we can tell people to live by” that started much of the problem with nutritional advice today. Doctors had to say “do this” or “don’t do that” and start ‘proving’ things that they couldn’t really prove.

    Gary Taubes describes in his book how after the government officiallly adopted the Lipid Hypothesis, the goal of most research became to support the government position. Governments should not take sides on scientific issues that are still being worked out.

  11. Sue says:

    When I was doing an assignment for Evidence Based Practice I came across the following paper – . Martinson, B.C., Anderson, M.S., and De Vries, R. (2005). Scientists behaving badly. Nature, 435: 737-738.

    Research can be undermined by ”questionable research practices” that go “beyond falsification, fabrication and plagiarism” (Martinson, Anderson & De Vries, 2005). A survey that collected empirical evidence on questionable research practices found the top questionable behaviours by research scientists were ‘overlooking others’ use of flawed data or questionable interpretation of data, changing the design, methodology or results of a study in response to pressure from a funding source, dropping observations or data points from analyses based on a gut feeling that they were inaccurate and inadequate record keeping related to research projects”. These behaviours do not fall within the “narrow definition of misconduct” (Martinson et al., 2005) but should be addressed.

  12. Becky says:

    Re: Le French
    Interesting statistic: France has almost half again as many [male] smokers as we have, but those smokers die at only 3/5 the rate ours do. Why is the cancer stick “less deadly” to the frogs? (Or the Japanese, whose rate is smidgen over a quarter of ours?)
    http://www.kidon.com/smoke/percentages3.htm

    I wonder if option #4 has any bearing on this…?

    I think it’s because sugar feeds cancer and we consume far more sugar. Carcinogen + fuel = disaster.

  13. Ellen says:

    I know you’ve been preoccupied with the speech … but have you seen this news? http://www.nytimes.com/2010/10/19/science/19bread.html

    Interesting, but I don’t know why fans of paleo diets would be upset, as the article says. They’re talking about making dough from roots and tubers, which are paleo foods. It’s the cereal grains that were a disaster.

  14. Seth W. says:

    Just posted this morning http://healthland.time.com/2010/10/19/balancing-skin-cancer-risk-and-low-vitamin-d/ . Yet another great example of misguided warnings. Avoid the sun, it causes skin cancer, resulting in a lower production of Vitamin D which can cause…skin cancer. Laugh.

    I always wondered why native people who lived outdoors weren’t covered with cancerous skin.

  15. Patrick says:

    Great post Tom. I read the article and found a bit towards the end that jumped out at me:

    “Some fear that there may be less funding because we stop claiming we can prove we have miraculous treatments. But if we can’t really provide those miracles, how long will we be able to fool the public anyway?”

    In the case of low-fat, high-carb diets for everyone, I’d say by and large it is at least 30 years or long enough to help create (or aggravate) the problems of obesity, diabetes and etc.

    Regards.

  16. gollum says:

    Here’s something for you. The prolefeed, I mean, quality media reported: Diet rich in fat may make sepsis worse. And by may, we mean, will.

    (Now, sepsis isn’t your common cold. It’s a life-threatening issue and usually the result of a quack screwing up again. Note how they shift the blame to the victim.)

    But really, you cannot blame the media much, since the paper itself

    BMC Physiology 2010, 10:20doi:10.1186/1472-6793-10-20

    speaks of “high-fat” and saturated fats.

    What these poor mice really were fed is in Table 1, which is bur.. I mean, on one of the later pages.
    “Western”, “high-fat” diet is … tadaaa.. 500g/kg sucrose. 50 % pure sugar!! The poor WD mice also got less other nutritients and less protein, it seems.

    Isn’t amazing how any diet that produces negative results somehow becomes a “high-fat” diet?

  17. Paul451 says:

    My education and background is in engineering and it’s been something of a standing joke for some time now that way too much of medical research doesn’t meet the standard of good science. If engineers designed cars the way doctors conduct medical research, you’d be riding your bicycle to work.

    And the people building the cars would be explaining how they actually work, but people don’t know how to drive them.

  18. gollum says:

    Yes, it’s astonishing.

    There may have been sort of an overreaction on my part. At least they did list the exact diets, including an exotic preservative I never heard of. Certainly laudable, and better than other papers where you have to dig into other papers for the details you won’t get anyway. Also, sadly, 50% carbs and protein deficiency is sort of an approximation to the “Western diet”. So if you feed mice 50% sugar, not enough protein, and 2000 ppm poison No. 5, their health will be fragile. Sounds like these fathead conspiracy theories.

    BTW, I do translations, should you need one.

  19. Mallory says:

    hahai just love how people find common sense in nutritional studies… no way. bais?!?!?! lol…..

  20. Verimius says:

    The author of the Atlantic Monthly article, David H. Freedman, wrote a book called “Wrong”. In addition to medicine (and Ioannidis), the book covers finance, self-help, and other areas prone to error. Well worth a read.

    I’ll check it out.

  21. Crusader says:

    Honestly I think the low-fat crusaders from the 1970s had good intentions, but little science. Gary Taubes covered all of this in detail in his book GCBC. However that 10% might have to do with “eat less, exercise more”. A full-carb burger and fries never hurt anyone, once a month.

    I believe their intentions were good. But when the science didn’t support their beliefs, they should’ve changed their minds.

  22. Hey, Tom, I’d like to know your take on this study TIME magazine covered considering the BMI standard is, well, crap.

    These study subjects may feel healthy because they in fact are. Study: Many Obese People Think They Look Great the Way They Are By MEREDITH MELNICK Tuesday, October 19, 2010

    Excerpt: People who misperceived their body size were happier with their health, and felt healthier, than those who did recognize their obesity; they were also more likely to think they were at low risk of developing high blood pressure or diabetes or having a heart attack during their lifetimes.

    http://healthland.time.com/2010/10/19/study-many-obese-people-think-they-look-great-the-way-they-are/?hpt=C2

    I’d be one of those people with a “distorted” body image, since I believe I’m healthy at 200 pounds. I’m still a little thick around the middle and probably always will be, but there’s nothing wrong with my health.

    The racial breakdown was interesting. It underscores what Eric Oliver told me: equating being thin with being beautiful is sort of an upper-class white attitude.

  23. Willa Jean says:

    “Researchers headed into their studies wanting certain results-and, lo and behold, they were getting them.”

    Ouija-Board science.

  24. Brian says:

    Good luck with your talk. Hope they are open to your ideas and the feedback is good and positive. I gave a talk last year at an international conference. A guy from Russia was in the back. He asked a question that I could not understand. Turns out, he was asking about carbohydrates but saying harbokydrates. Too funny. We all got a kick out of that.

    Thanks too for the nice words on my Suck post. Don’t know if you read any of the comments, but a guy named Jesus Christ came by. He wasn’t the Jesus I expected.

    Brian

    I saw that Jesus made an appearance.

  25. verimius says:

    “I believe their intentions were good.”

    And what is the road to hell paved with?

    Too true.

  26. Liz Downunder says:

    Childbirth is another area of medicine that is ‘prone to error’. Doctors (including obstetricians), by the very nature of their work, do not know what a natural birth looks like, let alone how to ‘enable’ one. Most believe it is at best unnecessary, and at worst risky and dangerous, to let an uncomplicated birth proceed without some sort of medical intervention (‘we’ve got all this great technology, let’s use it, even when it’s not warranted’). Sure, there are many who will say ‘without the doctors/hospital our baby/mother would not have survived’ but in many cases the doctors cause the problems in the first place by messing with a natural process. Here in Australia, midwives complete their midwifery training never having witnessed a natural birth (by natural I mean without medical interference from start to finish) and OBs are trying their damndest to show, through skewed studies and data, that homebirth is always dangerous (and they’re winning – it’s soon to be illegal here). Birth is one of the most misunderstood areas of ‘medicine’ (yes, I know that’s ironic – medicine only actually NEEDS to be involved in a small percentage of births).

    Love your blog Tom, thanks for sharing so much.

    For one, I’ll stick up a bit for the doctors. In the U.S., doctors jump in immediately on births because if they don’t and anything goes wrong, they know they’ll be sued. Malpractice for obstetricians runs well over $100,000 per year because of the lawsuits.

  27. Walter says:

    Tom,

    You might like this article.

    http://wattsupwiththat.com/2010/10/20/vegans-are-not-from-vegas/

    Very well done.

  28. labrat says:

    When you have free time search out Iaonnidis’ research at Plos. He has quite a few good paper’s on-line there.

  29. Paul Eilers says:

    Count me among those who would like to see (and read) your speech.

    Thanks for all that you do.

  30. Rocky says:

    This is entirely off topic, but does anyone know what’s going on with Amazon and the availability of Fat Head? I’ve had a couple of copies on order for weeks and today I received an email from Amazon stating that my further approval is required because they’re still “trying to obtain the items ordered on Oct 5.”

    Has anyone else ordered and received a copy recently?

    We just let the distributors know after someone else alerted us. Thanks for your patience, and I’m sure they’ll restock soon.

  31. Walter says:

    You need to get the author of this article a copy of Fathead and Lies, Damned Lies, and Medical Science. Not sure it would help, I see at the bottom of the article that he has 4 books published and once a large public position is established….

    In some cases any public position. Have the book mentioned above – Wrong – checked out of the library. Think I’ll make it the next in the quee.

    http://www.huffingtonpost.com/dr-mark-hyman/food-addiction-could-it-e_b_764863.html

  32. darMA says:

    I also read that article and this sentence is the one that jumped out at me:

    “When you look the papers up, you often find the drugs didn’t even work better than a placebo. And no one tested how they worked in combination with the other drugs”.

    This was driven home for me and my sister recently. The doctors want her on Coumadin because a scan showed 2 previous silent strokes. When she looked up info on the medicines she was already taking, not 1 but 3 of them listed a possible side effect of increasing risk for a stroke on their own and the one for diabetes is contraindicated for someone with existing cardiovascular problems. It boggles the mind that doctors don’t look into this stuff before handing out meds like candy.

    It’s said, isn’t it? So many people are getting ill from the drugs that are supposed to help.

  33. Liz Downunder says:

    I guess that’s my point, Tom (albeit not particularly well made!). They do tend to pre-empt or react to avoid litigation but they’re doing it based on bad science and (often deliberately) biased studies and (often deliberate) incorrect interpretation of data. As with the fat/carb debate, a paradigm shift will only occur when the data is honestly studied and debated. Unfortunately that could lead to a realisation that OBs (like statins) are not as indispensable as they need us to think they are.

  34. Anna says:

    I’m with Liz Downunder on the medical birth issue; there’s a subject I like to see some light shed on. The OBs and the public can’t see the forest for the trees when it comes to the medical birth industry.

    My mother is a retired L & D nurse, with a 25+ year career in a women’s hospital. She has seen it all and shared a lot with me. I’ve had many conversations with my SIL in Norway about the differences between births in the US and Norway (where most births are attended by midwives, regardless where the birth takes place). Epidurals, medical interventions, and OBs are not as commonly used, and Norway’s infant mortality and well-being stats are the envy of the world (well, perhaps not the envy of Sweden.

    Check out Ricki Lake’s documentary, The Business of Being Born http://www.thebusinessofbeingborn.com/.

  35. Marilyn says:

    Tom wrote: “I wouldn’t take nutrition advice from most doctors, but if I’m sick and can’t figure it out what it is, I’ll go see one.”

    I would, too, but I’d have to be really sure I couldn’t figure it out first. I’ve lost so many dear friends and relatives who, it appears to me, would have been better off to skip their doctor appointments. I do avoid screenings and “annual physicals.” I think it’s too easy to end up with a problem where none existed before.

    Even when I do see a doctor, I know the diagnosis may be wrong.

  36. Marilyn says:

    Isn’t that the truth!!! My experience with an ear doctor is one of the reasons I don’t go to doctors any more. I sure wish the Eades were still practicing and lived closer.

  37. Brian says:

    Dr. John Ioannidis has succeeded, but as the Atlantic’s article says, scientists are aware of misinformation in their fields, and this “new” insight, that 10-80% of studies are misleading, isn’t apt to change anything, at least not within the medical field.

    No, it may not change their lousy science. But I think it’s important for the public to know.

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