One of the first books I read while researching Fat Head was The Cholesterol Myths, by Dr. Uffe Ravnskov. I was, to put it mildly, stunned. I highlighted so many sections, the ink began to bleed through. Too bad … that book is no longer in print, and pristine copies sell for hundreds of dollars. To fill the void, Dr. Ravnskov next published an updated and expanded version of The Cholesterol Myths titled Fat and Cholesterol Are Good For You, which I reviewed in a previous post.
Both books employ two of my favorite weapons — logic and math — to poke huge holes in the Lipid Hypothesis. Perhaps more effectively than anyone on the planet, Dr. Ravnskov declares that the Cholesterol Emperor has no clothes, then sets out to prove his case.
His latest book is titled Ignore the Awkward! How the Cholesterol Myths Are Kept Alive. This time, Dr. Ravnskov focuses more on how the anti-cholesterol hysterics manage to keep applying body-paint to the emperor and insisting he’s all dressed up and ready to rule. As the introduction explains:
My aim with this book is to show how white has been turned into black by ignoring any conflicting observations; by twisting and exaggerating trivial findings; by citing studies with opposing results in a way to make them look supportive; and by ignoring or scoring the work of critical scientists.
If you haven’t read Dr. Ravnskov’s previous books, don’t worry: the first 45 pages are a shorter, simpler version of the evidence he originally presented in The Cholesterol Myths. (By simpler, I mean you don’t need to understand the difference between a one-tailed test and a two-tailed test for calculating statistical significance. You just need to follow along with a bit of math and logic, which is presented clearly.)
Most of the other 100 or so pages demonstrate how and why bad scientists keep the Lipid Hypothesis alive, despite the contrary evidence. I’m sure you can guess the why: money, money, and money. Scaring people into believing their cholesterol is too high is a multi-billion dollar business. As I explained in Fat Head and Dr. Ravnskov recounts in this book, the current cholesterol guidelines were created by a quasi-government organization called The National Cholesterol Education Program. Read the financial disclosures for the NCEP committee, and you soon realize the committee is essentially Big Pharma’s All-Star Team.
But it’s not just the all-stars who suckle at the bosoms of Merck and Pfizer … university research departments, medical journals, and countless individual doctors depend on regular injections of Big Pharma dollars. Papers published in medical journals are often written by pharmaceutical hacks, yet list prestigious researchers as the official authors. Those researchers merely review the articles and pocket a hefty fee — essentially renting out their names and reputations. (Perhaps we need a new label for those researchers. Statin Sluts comes to mind. Pill Pimps. PharmaHos.)
But it wasn’t the why that I found so interesting in Ignore the Awkward! — it was the how. In case you haven’t noticed from my posts and recent speech, I’ve become a bit obsessed with the topic of bad science. In chapters with titles such as How to Exaggerate Insignificant Results and How to Lie Convincingly, Dr. Ravnskov provides plenty of examples of how bad science is done.
One common technique is simple selection bias, otherwise known as cherry-picking. If you dig through the scientific literature, you can find studies that refute the Lipid Hypothesis. But you’ll have to dig deep because, as Dr. Ravnskov demonstrates with citation figures, if one study supports the Lipid Hypothesis and another published in the same year disputes it, the supporting study is far more likely to be cited in other papers — at least six times more likely.
Another technique is to cite supporting evidence that is not, in fact, supporting evidence. In one of its influential papers, the National Cholesterol Education Program wrote:
A large body of epidemiological evidence supports a direct relationship between the level of serum total and LDL-cholesterol and the rate of CHD.
Dr. Ravnskov examined the studies that were cited and found that most didn’t mention LDL at all, one concluded that LDL is not a heart-disease risk factor, and one — only one — concluded that LDL is a risk factor … but only in men ages 35 to 49 and women ages 40 to 44. So the “large body of epidemiological evidence” turned out to be a single study in which LDL was identified as a risk factor — but only for people in certain age groups.
The most egregious technique (in my opinion, anyway) is what might politely be termed misinterpreting the results. (You may choose a more descriptive verb.) For example, in one clinical trial of a low-fat diet, men experienced a very slight reduction in heart disease, while women experienced no reduction at all. Yet the study authors wrote:
Although the results of this trial do not permit firm conclusions, they support the idea that also among female populations the serum-cholesterol-lowering diet exerts a preventative effect on CHD.
So the low-fat diet fails, but the results “support the idea” of prescribing low-fat diets. Ladies and gentlemen, welcome to scientific never-never land.
In another study, the data showed that people who had suffered heart attacks ate no more saturated fat than people who hadn’t suffered heart attacks. But in their conclusions, the authors wrote:
Within the context of the total literature, however, the present observations support the conclusion that the lipid composition of the diet affects the level of serum cholesterol and the long-term risk of death from coronary heart disease.
Look at the emperor’s new clothes, ladies and gentlemen! In the context of his total entourage, he is wearing clothes, and they’re lovely!
Perhaps the most clever techniques for ignoring the awkward are those employed by pharmaceutical researchers. Did a statin produce an unacceptably high incidence of cognitive disorders in your clinical study? No problem … just subdivide those disorders into as many categories as possible: depression, mood swings, confusion, memory loss, etc. Now each subdivided disorder has an acceptably low incidence. Was the rate of new cancers too high in your previous statin study? Here’s your solution: in the next study, exclude everyone who’s ever had cancer from the patient pool. Then, if the statin takers end up with a higher rate of skin cancer, just refuse to report it as “cancer.”
As you might suspect, Dr. Ravnskov is not exactly a popular figure among the scientists who are paid by Cholesterol Panic Incorporated. He’s had scientists jab him in the chest and demand to know who funds his research. (The answer: Uffe Ravnskov.) Many of his papers have been rejected by numerous medical journals, often with laughable explanations:
It is highly unlikely that the experienced researchers who have written the dietary recommendations should have made such flawed conclusions as Ravnskov claims.
To answer Ravnskov, it is necessary to examine all of his arguments in detail. This is not possible.
The author may not be aware of a vast body of literature that convincingly supports the association between saturated fat and heart disease.
In other words, We can’t dispute the data presented here, so we’ll just declare that Dr. Ravnskov is wrong because so many of our peers say he’s wrong.
Not all anti-cholesterol hysterics are satisfied with merely saying Dr. Ravnskov is wrong. After all, he has managed to get some of his papers published, he’s written books, and he’s more or less elbowed his way into scientific conferences to present his case. He’s a threat.
So a handful of scientists have apparently waged a campaign to portray him as a crank or a conspiracy nut. Someone even managed to hijack his email account and send out kooky emails … including one that was full of foul language and informed the recipient You really need to get a clue, you stinky buttholed woman.
I’ve read Dr. Ravnskov’s books and some of his papers, I’ve interviewed him, and I’ve exchanged emails with him. Trust me, his rhetorical skills are a little more polished than that.
(By the way, one of my email accounts was hijacked recently. I have no interest in selling Viagra to anyone, so if you received a pitch from me, ignore it. Dr. Malcolm Kendrick replied by asking for a price list, but I’m reasonably sure he was joking.)
Unfortunately for the bad scientists and the lipophobes, the supposed crank actually wants you to check his references. Ignore the Awkward! is full of citations, and in the introduction, Dr. Ravnskov explains to his readers how to use those citations to look up the studies online, then urges them to do so:
If you find that what I have written is hard to believe, please consult the sources given at the end of each chapter … by doing this systematically, as I have done, you will not only discover the truth for yourselves, you will also learn more about cholesterol and the heart than most doctors.
Sadly, he’s right about that.