Dr. Malcolm Kendrick is the Mark Twain of medical writers, wielding his own pen warmed up in hell. Hell, in this case, is a modern medical system designed to persuade doctors and the public that nearly everyone with a pulse is abnormal and in need of treatment.  In fact, I can summarize Kendrick’s latest book Doctoring Data by paraphrasing Twain himself:  “If your doctor doesn’t read the medical literature, he is uninformed.  If he does read the medical literature, he is misinformed.”

I first became aware of Kendrick when Dr. Mike Eades recommended his book The Great Cholesterol Con.
I ordered a copy and expected to be educated.  I didn’t expect to laugh my ass off while being educated, but that’s Kendrick’s style.  He attacks nonsense with facts and logic, yes, but also with a razor-sharp wit.  (If you don’t read his blog, you should.)

As Kendrick has made clear many times, he’s not anti-medicine.  He is a doctor, after all.  Take surgeries and the true wonder drugs out of the picture, and many of us would be far worse off, if not dead.  I’d be limping around on a ruined knee, deaf in one ear, and unable to raise my left arm above chest-level.  So much for doing farm work and playing disc golf on weekends.

But Kendrick is very much against the nonsense that pervades much of preventative medicine these days.  The nonsense is driven by what he calls doctored data.  In a nutshell, the system works something like this:

Even though you’re probably fine, you undergo a lab test at your doctor’s insistence, and lo and behold, you’re diagnosed with a previously unknown “disease” … which was discovered just in time to coincide with the approval of a new wonder drug … which was approved based on suspicious data … from a study designed and run by the drug-maker … which paid key opinion leaders to sit on a government committee that wrote the treatment guidelines … which instruct your doctor to prescribe the new wonder drug … which produces nasty side-effects … which must be treated with more wonder drugs. Oh, and you also need to stop eating anything that tastes good.

Here’s how Kendrick describes the situation in the book’s introduction:

It has become exceedingly difficult to enjoy life’s simple pleasures. Lying in the sun… “Do not do that, or you will die of skin cancer.” Eating a bacon sandwich… “You mad fool, the saturated fat in that will raise your cholesterol levels and you will die of heart disease.” Putting salt on food… “That raises blood pressure and you will die of a heart attack or a stroke.” Drinking an ice-cold gin and tonic after a hard day’s work… “If you drink more than 15 units a week you risk dying of cancer and liver failure.” Hey ho, what jolly fun.

At the same time we are being cajoled to undergo ever more screening tests to pick up the early stages of cancer and numerous other diseases. As if this were not enough, your GP will be haranguing you to have endless measurements of blood pressure, cholesterol, and blood sugar levels, to name but three. As if good health is only really possible through constant monitoring by the medical profession.

As for the elderly, it has become virtually impossible to find anyone taking fewer than four or five separate medications. One of my jobs is working in Intermediate Care where I help to look after elderly people, many of whom have suffered an injury or fracture of some sort. When patients enter this unit, the average number of medications taken is ten. That is ten different drugs, to be taken each and every day, some of them three or four times each day. I suppose it saves on buying food.

At the same time, the boundaries that define illness have narrowed inexorably. When I first graduated from medical school in 1981, a high cholesterol level was anything above 7.5 mmol/L. Over the years, this level has fallen and fallen to the point where a ‘healthy’ level is now 5.0 mmol/L. I suspect it will soon be 4.0 mmol/L. Anything above this figure, and you have an increased risk of heart disease – allegedly. Considering that over 85% of the adult population in the western world has a cholesterol level higher than 5.0 mmol/L this is a quite amazing concept. I will admit that I have never been that brilliant at statistics. However, it seems to me that attempting to claim that more than 80% of people are at high risk of heart disease stretches the concept of ‘average’ to breaking point – and well beyond.

The sad truth is that most of the advice we are now bombarded with varies from neutral to damaging. In some cases it can be potentially very damaging indeed. Advising people with diabetes to eat a low fat, high carbohydrate diet, for example. As a piece of harmful idiocy, this really could hardly be bettered.

How about frightening people to stay out of the sun, or slap on factor 50 cream at the first suspicion that a deadly photon may sneak through 10 layers of protective clothing? Not necessarily a good idea, because without vitamin D synthesis in the skin, from exposure to the sun, there is a significant danger that we can become vitamin D deficient, which can lead to all sorts of other problems.

And later in the introduction:

So you trust the experts… right?

No, I do not think that would be the best way to go. In fact, long sections of this book are dedicated to an exploration of the role of the ‘expert’ (chapter six). The bottom line is that experts are just as prone to grasping the wrong end of the stick as anyone else, then hanging on for blue bloody murder. Far more so, in many cases.

If truth be told, my view of medical experts has become extremely jaundiced. At times I feel they are like those highly decorated generals in North Korea with the funny hats. They look splendid and important, but the only point of their existence is to suppress dissent and keep an idiotic regime in place. In reality, you are not likely to get much nuance from an expert. You are more likely to be ‘educated’ on the party line. Room 101 lurks.

I don’t have to convince a bunch of Fat Heads to be skeptical of experts, but the question remains: when we’re bombarded with medical advice, or with headlines proclaiming New Study Says Blah-Blah-Blah, how do we separate the gems from the garbage?  To a large degree, that’s what Doctoring Data is about:

Should you believe everything, or believe nothing? Trying to establish any type of system for establishing the truth is clearly not simple, and it is fraught with its own biases.

Having said this, I do think that there are certain ‘tools’ that you can use to analyse health stories and clinical papers. Using them will allow you to spot many of the manipulations and biases. These tools are not complete, and they are not some sort of mathematical formula, whereby a score of five means the paper is true, and a score of ten means it is untrue.

However, I believe that they can guide you, and give you a much clearer picture of what is really happening out there in the murky world of medical research, a way of looking at the world to try and establish the truth. Or something as close to the truth as can be achieved.

The truth toolkit: Ten things to remember, to help you make sense of a medical story; they are also the chapters of this book.

• Association does not mean causation
• Lives cannot be saved; we’re all going to die
• Relative mountains are made out of absolute molehills
• Things that are not true are often held to be true
• Reducing numbers does not equal reducing risk
• Challenges to the status quo are crushed – and how!
• Games are played and the players are…
• Doctors can seriously damage your health
• Never believe that something is impossible
• ‘Facts’ can be, and often are, plucked from thin air

The rest of the book is like an in-depth version of Science For Smart People.  Kendrick guides the reader through the process of how studies are conducted and how the numbers are crunched.  Then he shows how everything gets turned upside-down and sideways so researchers can declare that a new wonder drug or procedure will “save” hundreds of thousands of lives … even if “saving” a life means extending it by an average of three months.

Statins, blood-pressure medications, various cancer screenings … as Kendrick repeatedly demonstrates with actual study results (minus the medical-industry spin), many of the sacred cows of “preventative” medicine don’t seem to prevent much of anything:

Those involved in cancer screening have even created their own, virtually-impossible‐to-understand language, in order to make their figures look stunning. Stunning they may look, but luckily there are other people out there who are less than stunned, and who choose to look a bit more closely.

The United States Preventative Task force reviewed all the data on Prostate Cancer screening (using the prostate specific antigen (P.S.A.) blood test) and came to the conclusion that it does more harm than good.

Lo, it turns out that the prostate screening test, which improves survival from 68% to 99% does not actually save lives – at all. Fantastic sounding cure rates, which completely bedazzle doctors, are simply meaningless.

In the chapter titled Challenges to the status quo are crushed – and how!, Kendrick cites examples of how results that challenge prevailing medical opinion are squashed … or fudged, or simply ignored.  For example, one study was published with the title Excess deaths associated with underweight, overweight, and obesity.

Well, there you go: you clearly don’t want to be overweight or underweight.  If your doctor glanced at the journal article, that’s the conclusion he or she would draw.  Just one little problem: the actual study data showed that people in the overweight category (BMI of 25 to 30) had the longest lifespans.  But wait, it gets even better:

You may note that, in this study, even those in the obese category (BMI 30-35) had a lower mortality than those of ‘normal’ weight.

The overwhelming belief in the medical community is that being overweight is bad for you. It causes a host of diseases, which will inevitably result in premature death. To state that being overweight means that you live longer is the scientific equivalent of standing up and shouting that the Emperor is not actually wearing any clothes at all.

So why did the paper’s title declare that the risky categories are underweight, overweight and obesity?  As Kendrick writes:

If they dared to write a paper with this title… Excess deaths associated with underweight, normal weight, and obesity. …one of two things would have happened. Either the peer reviewers would have rejected it, or, had it been published, their names would be mud in the world of obesity research.

If the medical world crushes people who say being overweight won’t kill you any sooner, imagine how it treats people who say statins won’t save your life.  Time to call in the North Korean generals with the funny hats.

In the chapter titled Doctors can seriously damage your health, I finally learned the origin of a colorful phrase that means giving someone a load of nonsense:

If someone was close to death, or even apparently dead through drowning or suchlike, conventional wisdom was that you could save their life by blowing tobacco smoke up their rectum with a pair of bellows. So strong was this belief that hundreds of set of bellows were hung up around the Thames to revive those who had fallen in and drowned.

The hell with CPR, just blow smoke up someone’s backside, that’ll do the trick. How idiotic does this now sound? Pretty idiotic I would think. However, very intelligent people believed it was true. Doctors thought it to be true… Not, of course, that I would necessarily confuse doctors with intelligent people.

Sadly, each generation easily convinces itself that such arrant nonsense has become thing of that past.

But such arrant nonsense isn’t a thing of the past.  Doctors used to blow smoke up our arses; now they prescribe statins to beat down our cholesterol.  I’d rather take the smoke.

That’s the point of Doctoring Data:  there’s still a lot of nonsense in medicine – perhaps more than ever.  I can barely turn on my TV these days without seeing a commercial for some new drug, always ending with the line Ask your doctor about SuperlaBlex or whatever it’s called.

No, don’t ask your doctor if you need the new wonder drug!  The entire system of studies, reviews, approvals, guidelines, etc. is designed to convince your doctor that you’re ill and need that new drug.  You simply can’t count on your doctor (unless you’re lucky) to be skeptical of modern medicine.  You have to be the skeptic.  Doctoring Data teaches you how to be an informed skeptic.  As Kendrick writes in his closing:

How can Dr Kendrick be right, and all the highly decorated experts be wrong? Well, obviously, they are right about many things. However, when it comes to the area of preventative medicine it seems that every stick that can be grabbed at the wrong end, has been grabbed at the wrong end. Alongside this, experts seem obsessed with simplistic ideas where cause and association are hopelessly muddled. It has become a mess, in part driven by money. Things that are high should be lowered, things that are low should be raised. Yes, we have a drug for that… Kerrching. ‘Look for underlying causes? What idiot said that?’

So I decided to try and expose, if that is the right word, how data are produced. How statistics are used to terrify people, or falsely reassure them. Also, what are the drivers for this behaviour? I know I will be attacked for some of the things I have said. That is inevitable. However, that does not matter. What matters is that you, once you have read this book, can understand more clearly how and why data are ‘doctored’. You can then understand the headlines more clearly. Two sausages a day increase your risk of bowel cancer by 50%. Shock, and horror, and bollocks. You can make the decisions for yourself about what you can and should do to live a longer, healthier and happier life.

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61 Responses to “Review: Doctoring Data”
  1. Tom Welsh says:

    Couldn’t agree more. Dr Kendrick is one of those highly unusual people who question everything and insist on correct logic. In other words, one of the people who have taken science forward throughout history. Long may he thrive, and I personally am raising a brimming lass of Ardbeg (single malt) to his health.

  2. Barbara says:

    Sounds like an interesting book. I’ll definitely check it out.

  3. James H. says:

    “I can barely turn on my TV these days without seeing a commercial for some new drug, always ending with the line Ask your doctor about SuperlaBlex or whatever it’s called.”

    Ain’t that the bloody truth? I swear the “possible” side-effects scare the hell out of me; I suppose you’ve noticed “death” is a frequent possibility? It’s gotten to the point that I’d rather take a beating with a dead cat than go to the doctor. Holy moly.

    • Tom Naughton says:

      My daughter Sara came running into my office awhile back to say she’d just seen a drug commercial where one of the side effects was death. “Why would anyone take a drug that can kill you?” she demanded to know. Try answering that one.

      • Arturo says:

        Oh, I’m sure there might be a market for those wishing to “treat” grain-induced depression, especially after they’ve been thoroughly convinced that everything and anything will kill them anyway.

  4. Onlooker says:

    Thanks so much for this review, Tom. Clearly this is a book that everybody should read; and I don’t think that’s being hyperbolic. Though clearly that won’t happen.

    We need to be armed to be able to advocate for ourselves (and/or those close to us) as the health care system becomes ever more bureaucratic – and corrupt. And a good dose of critical thinking instruction is never a bad thing (though it’s a rare thing these days).

    I’m certainly going to put it on my reading list.

  5. Nads says:

    Three cheers for Malcolm Kendrick!

  6. Bob Fenton says:

    Thank you for writing this. Having been a follower of Dr. Kendrick’s blog for a few years, I am happy to read the review. Now I will have to save for the book.

  7. Armando says:

    Hello Tom,

    Have you heard the controversy in regards to Peter Evans paleo cook book for babies?

    http://www.theaustralian.com.au/life/food-wine/pete-evans-paleo-cookbook-for-kids-bubba-yum-yum-shelved/story-e6frg8jo-1227259740471?nk=74d3a35269aa38c79ffc7973516adb39

    http://www.dailymail.co.uk/news/article-2989393/There-s-real-possibility-baby-die-book-goes-ahead-Paleo-baby-cookbook-includes-formula-form-bone-liver-broth-delayed-amid-fears-recipes-stunt-children-s-growth.html

    I find kind of sad that they are dismissing something that they do not understand. I do not think they understand much of what humans ate thousands and thousands years ago. What are your thoughts on this matter?

    • Tom Naughton says:

      Bone broth and liver will kill babies, but grains are necessary for health? This is exactly the kind of nonsense Kendrick describes in his book. The North Korean generals with their funny hats are protecting the idiotic regime.

      • CNC says:

        This one is getting lots of press, driving me nuts when I saw it on the BBC. Breast milk is best I would assume but bone broth and liver would not be a bad substitute as it would have many of the same nutrients. The “vision of the anointed” again telling us what is good and what is bad for us. I read comments like “He is only a chef.”

        Great review, I have order the book. No Kindle version yet so I will have to wait a few weeks for the book to come.

        • Tom Naughton says:

          The Korean Generals with the funny hats are making ridiculous arguments such as “that’s TEN TIMES the RDA for vitamin A.” The RDA amounts are the minimum necessary to keep you from developing a disease, not the ideal amounts. The RDA for vitamin D is 400 I.U. — just enough to prevent rickets. If you spend a half hour in the sun, you can get more than TEN TIMES that amount … and you should.

          • Armando says:

            Also Tom, thank you for recommending Dr.Malcom Kendrick blog. I have read the current articles on his blog and it blows my mind! I just came accross Statin Nation, great doco with great data. I am also ordering his book from your recommendation. Once again thank you.

  8. Phyllis Mueller says:

    Thanks for reminding me to order this book.

  9. Jeanne says:

    Over exposure to the medical institution can be hazardous to your health.
    I reccommend The Patient’s Checklist by Elizabeth Bailey to anyone who has a family member going to the hospital.

  10. Janknitz says:

    Is THAT the origin of the phrase “to blow smoke up one’s *$$”????

    I hope doctors read Dr. Kendrick’s book!

  11. Chris says:

    Great article….By the way I watched “Cereal Killers 2 … Run on Fat” yesterday it was pretty good.

  12. Jim says:

    There was a great example of “relative mountains are made out of absolute molehills” in the news this week. A study found that vegetarians had 22% less risk of developing colon cancer than non-vegetarians. Relative risk, that is. Nobody was writing about the difference in absolute risk. So I examined the study, found the relevant data buried in a table, and ran a quick calculation. The difference in absolute risk was a whopping 0.014%. I wrote about it on my blog: http://www.lifeaftercarbs.com/2015/03/red-meat-and-colon-cancer-whats-the-real-risk/

    • Tom Naughton says:

      Good analysis. Most people hear that figure and one out of five meat-eaters will develop colon cancer. There have also been observational studies in which vegetarians had higher rates of colon cancer, so it’s not even a consistent correlation.

      • Firebird says:

        I posted a link to the movie “Cereal Killers 2” on my Facebook page. I have been having a discussion with a former colleague of mine who turned vegan a couple of years ago. He suggests that I need to lower my fat and raise my carbs (lived like that for 30+ years) and that…INCOMPLETE PROTEINS ARE BETTER FOR US THAN COMPLETE PROTEINS.

        Two things:

        1) If incomplete proteins are so much better than why did I spend three years of my life as a vegetarian mixing lentils w/rice to complete proteins?

        2) He’s having this discussion without even watching the documentary…and won’t. Claims more athletes are turning to veganism than LCHF. I think CK2 disproves that to an extent, as does LeBron James and Flyers forward Jake Voracek, who went LCHF this past summer to lose weight and is having a career season.

        • Tom Naughton says:

          I wouldn’t bother making logical arguments to a vegan. Veganism is based on emotion, and as the saying goes, you can’t reason a man out of a belief he didn’t reason himself into.

  13. tony says:

    Have you noticed that when they recite the drug side effects in the TV drug commercials they do it so fast that it sounds like an auction at the country fair.

    • Tom Naughton says:

      Well, when you have to recite 50 side effects in 20 seconds, that’s bound to happen.

    • Gwen says:

      When they speed up the disclaimer so fast it’s nearly incomprehensible, I refer to those as “babble disclaimers”. They don’t expect you to hear and understand them, they’re just doing it in case they’re sued. Then they can whip out the recording as evidence that they DID “tell” you the side effects. It’s like fine print in a contract. You can only barely “read” it with a magnifying glass, but the real effect is that you don’t bother to try because it’s just a hair above unintelligible. The babble disclaimer is the audio version of the same thing — after a while, you stop hearing them because they’re basically semantically null.

      • Walter Bushell says:

        What is the difference between unethical and ethical advertising? Unethical advertising uses falsehoods to deceive the public; ethical advertising uses truth to deceive the public.
        Vilhjalmur Stefansson (1879 – 1962), “Discovery”, 1964

  14. Sky King says:

    So…is is true, then? Two sausages a day increase your risk of bowel cancer by 50%..?? :-O

    ;-D ;-D ;-D

  15. Linda says:

    I just finished reading “Selling Sickness,” which is a mind blower and passed it on to my rather pious scientist brother who knows everything and will tell you that while scarfing down a load of toast and a bowl of cereal in the morning! He has always poo-pooed everything I’ve told him about diet, but now, he’s sort of back-tracking- amazed that the docs he’s always worshipped as “gods” might be just a wee bit skewed! I just ordered Dr. Kendrick’s latest- thanks so much for the review! My brother refused to read “The Great Cholesterol Con,” dismissing it as just one more hack writing a bunch of garbage. I think he might be coming around a bit, since yesterday he came by to see our 95 year old father I take care of and asked me the name of that weird blog I liked so much! That was your blog!!! Thanks for all you do!

    PS- I feed our 95 year old father three scrambled eggs with butter and cream in them along with four slices of bacon every morning of his life! He lives for that breakfast!! Takes him an hour to get it down, but as he says, “I don’t have a train to catch.”

    • Tom Naughton says:

      If your brother is a scientist with true scientific curiosity, he should read “The Great Cholesterol Con.” Kendrick can be laugh-out-loud funny, but he makes his arguments using rigorous logic and data from the studies.

    • Catherine says:

      I like the sound of your dad, Linda! My own father, a type 2 diabetic, has bacon, eggs, mushrooms, tomatoes and sometimes black pudding for his breakfast every day – he’s 84. They’re clearly doing something right! Tom – wonderful overview of Dr K’s new book.

  16. RonBoyd says:

    I am not sure what this means:

    “For example, one study was published with the title Excess deaths associated with underweight, overweight, and obesity.”

    “If they dared to write a paper with this title… Excess deaths associated with underweight, normal weight, and obesity. …one of two things would have happened. Either the peer reviewers would have rejected it, or, had it been published, their names would be mud in the world of obesity research.”

  17. Bo says:

    Hello,

    Saw the lecture Science For Smart People, brilliant info, loved it.

    A question: If I wanted to start programming what is your advice on how to start? I follow your blog and I know you have a couple of black belts in programming so I seek Sensei Tom’s advice 🙂

    So I wish for some cool programming katas/advice from the masterful sensei Tom 🙂

    Regards
    Botomas from Sweden.

    • Tom Naughton says:

      Hi, Botomas. If you’d like to do mostly web programming, you’ll need to learn web languages. HTML and JavaScript are good ones to pick up first. If you want to do desktop-application programming (which is what I do), the best option is to learn a .NET language such as C# or Visual Basic. Most desktop applications that anyone would pay you to build require a database, so you’ll also want to learn about databases.

      If I were coaching someone to learn my job (as opposed to web programming), my advice would be:

      1. Download C# Express or VB.NET Express (free from Microsoft).
      2. Download SQL Server Express (also free from Microsoft).
      3. Order some books in the Head First collection — they’re very well written and assume you’re learning from scratch.
      4. Join Virtual Training Company ($30 per month) at VTC.com. They have excellent video courses on everything from heavy-duty programming to PhotoShop. For C#, VB or SQL Server, look for the courses by Mark Long. He’s the best online teacher for this stuff I’ve ever seen.
      5. While reading books and watching tutorials, start trying to build something. There’s no teacher like experience.

      http://www.amazon.com/Head-First-C-Jennifer-Greene/dp/1449343503/ref=sr_1_8?ie=UTF8&qid=1426435465&sr=8-8&keywords=learning+c%23

  18. j says:

    Two sausages a day increase your risk of bowel cancer by 50%…??

    Thats almost like saying sugar and white rice can cure type 2..

    https://www.youtube.com/watch?v=1cl2IX94GCI

    ..it’s criminal

    • Tom Naughton says:

      “Fat is the cause of type 2 diabetes.” Yeah, and those low-fat, high-carb diets work so well for diabetics. McDougall is an intelligent imbecile.

  19. Nads says:

    A really good ABC radio link from Australia on this very subject.

    http://www.abc.net.au/radio/programitem/pg1a6bdWp7?play=true

    • Tom Naughton says:

      Glad they had the cajones to tackle that one. It’s not just that many modern drugs are ineffective; many are LESS effective than older drugs … but those older drugs are now off-patent and cheap, so they’re not prescribed.

  20. Adam Trainor says:

    Thanks for this post. It made my morning. Funny, and informative, which all things worth reading should be. I’ll add kendrick’s book to my list of need-to-reads. It sounds a little like the book Mike Howard wrote “Talking Back to Diet Guru’s,” but more technical. I will never be able to hear someone say “blowing smoke…” again without smiling a little. So fun to learn about the origins of common phrases.

  21. Eric from Belgium says:

    This brings back memories from my adolescence…. There is a famous french theater play from the 1930’s, called ‘Dr Knock, or the triumph of modern medecine’. It used to be a favourite in school amateur plays (and perhaps still is). The plot revolved around this Doctor, who manages to convince everybody that they’re sick and need treatment….

    Nothing seems to have change since. My favorite quote from that play is ‘Healthy persons are undiagnosed patients’

    I also recommend books by Ben Goldacre, Bad Science and Bad Pharma

  22. Thorn In Your Side says:

    I see you removed my comments from the moderation queue. Looks like you are unwilling to engage in a debate about contradictory evidence to your narrow point of view.

    • Tom Naughton says:

      That’s because you don’t present contradictory evidence, unless you’re cutting and pasting Ornish’s weak arguments, which I dealt with in the post.

      You really should stop flattering yourself with the moniker “Thorn In Your Side.” To be a thorn in my side, you’d have to present a challenge, which you don’t. Debating you is the intellectual equivalent of stepping into a boxing ring with a toddler. You’re a very minor annoyance at best. So choose an accurate moniker. “Zit On Your Butt” would be more appropriate.

      • Zit On Your Butt says:

        The immaturity level of your response is off the charts. Much like your probability of suffering a massive coronary in 5 years.

        • Tom Naughton says:

          Like I said … the intellectual equivalent of boxing a toddler. Come back when you have something more enlightening or challenging to offer than a prediction that I’ll have a heart attack. And don’t bother cutting and pasting more weak-ass arguments based on mouse studies from your vegan heroes. Not worth my time.

  23. Mike says:

    I like malcolm kendricks blogs and books. Only problem is he doesn’t tell you how to fix the problem. High blood pressure meds are bad but what else can you do to lower it. Tried low carbs, l-argine magnesium , excercise and many other thins. Nothing seems to work

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