Hi Fatheads,

I told Tom I thought I felt another blog coming on, and he was happy to have the chance to spend the rest of the week putting the finishing touches on the final version of the Fat Head Kids DVD. So I get to stay in The Big Chair this week, too!

Think of it like this — your loss is his gain!

Feel better?

As always, I appreciated the comments people took time to write on my last couple of posts. Also, as always, I especially tend to appreciate the ones from people who don’t necessarily share my perspective. Everyone seems thoughtful and articulate. The international group we get showing up here still amazes me – this time while in The Big Chair, I got comments from Germany, Singapore, and New Zealand! The comment from our Kiwi friend, “S,” accidentally hit one of my triggers (hey, I’m a sensitive guy, ok?):

“…I’m not saying I support Obamacare… But perhaps the US should start thinking about *evidence based* health-care policies. There’s plenty of evidence out there if one is willing to look…”


Yeah, Obamacare doesn’t rattle me much, but I tend to have a visceral reaction whenever I hear the phrase “evidence-based.”

First of all, it gets some contempt just because it’s soooo overused. It’s one of those phrases that everyone seems to feel sounded cool when they first heard it, then started sneaking in anywhere they can.

Like right after Newt Gingrich lead the Republicans to take control of the House. You couldn’t have a conversation with a lobbyist without them saying “I would submit that….(blah, blah, blah).”

Another was as IT was sweeping the economy in the late 90’s as everyone decided they needed to computerize and network all of their systems at once, and the Project Management field got flooded with sharp, young, eager, confident consultants who probably still had to have their parents drop them off at work. If you were in a meeting and asked a question the consultant deemed not relevant to the whole group (meaning they had no idea what the answer was), they’d say “let’s take that off-line.” I heard a corporate type use it three times in a one hour presentation. To cob one of Tom’s lines — Head. Bang. On. Desk.

But those kinds of affectations are just irritating. Then there are the kind of things you hear all the time that are designed to mislead, usually repeated incessantly by people who have no idea what they’re saying.

One example Fat Head types have probably heard often (usually by some 10% body fat “expert” in Spandex) is “you need carbs because they’re your body’s main source of fuel!”

I always considered this a trifecta — it’s a misstatement of an intentionally misleading fact that’s also false. Tom and others have covered this one over the years, but it still comes up. The misstatement is that the correct term is “primary,” which denotes order (primary, secondary, tertiary, etc) – not “main,” as in quality. The correct statement is designed to mislead the uninformed to interpret it as the misstated version. And it’s false – your body will burn alcohol preferentially over carbs, because too much blood alcohol will kill you faster than too much blood sugar.

“Evidence-based” is all the way in this category, and then some.

It sounds appealing. It sounds like science, only with maybe a bit more rigor built in, doesn’t it? Like hey, this isn’t just theory – we’ve also got evidence! It also is cursed with an origin in good intentions. “Evidence-based medicine” is the root, which proposed that physicians incorporate clinical results in their decisions instead of just going by their particular beliefs and experience.

We all know how the “clinical studies” thing worked out, now that Big Pharma owns the medical schools, clinical study industry, and most of the professional journals, right? “Hey, statins reduce heart attacks by a third! Don’t take our word for it – here’s a clinical study — it’s ‘evidence-based!’ 

That kind of success was duly noted by the rest of the groups that regularly line up at the trough. You can’t read a letter to the editor these days without whoever is begging for more of other people’s money citing “evidence-based” research. There’s evidence-based school funding, evidence-based juvenile justice reform, evidence-based climate science, evidence-based management, etc., etc.

Makes one wonder, for example, what they’ve been going by in Illinois for the last decade or so, where we keep pouring $35-40 billion dollars a year into the public schools. “Spitballing it-based” funding, perhaps?

There’s more, of course. I kind of think the icing on the cake is — wait for it…

“Evidence-Based Dietetics Practice” (!)

…brought to you by the Academy of Nutrition and Dietetics. Yeah, the same turds who’ve been pushing the Soda-, Grain-, Candy-, and Pharma-sponsored “arterycloggingsaturatedfat, hearthealthywholegrains, calories-in/calories-out” program for decades. That’s “evidence-based” now, too.

What all these advocates seem to have in common is that people are catching on to them. As I replied when another commenter (Brandon), while finding the plethora of “evidence-based education” initiatives laughable, thought perhaps it was a hopeful improvement:

“Evidence-based” is strictly a rhetorical (or perhaps more accurately — “marketing”) device. It’s used by people who’ve already been wrong so many times that even they realize people are onto them. It’s a term invented to give the impression there is something like science involved … when it’s the exact opposite of science. 

Collecting evidence (even done objectively, with no intention of isolating results that support a preferred outcome) and then developing recommendations based on interpretations of that data is not science. Its old (discredited) name was Observational Study.

Science is when you take that collected data, form a question, design a disprovable hypothesis, test the bejeesus out of it, then if you can’t disprove it, send it out to see if other people can replicate the results. No one using the term “evidence-based” has any interest in that kind of activity, although they desperately want whoever they’re lobbying to think of it as scientific.

Teachers’ unions use “evidence-based.”  Bureaucrats use “evidence-based.” Lobbyists use “evidence-based.”  Politicians use “evidence-based.”

Galileo didn’t use “evidence-based.” Newton didn’t use “evidence-based.” Einstein didn’t use “evidence-based.” They used “science.”

My suggestion is to adopt a mental habit of whenever you hear or see the phrase “evidence-based,” you automatically substitute “circumstantial evidence-based,” “cherry-picked evidence-based,” or “evidence- instead of science-based” before processing the rest of whatever statement a person has issued.

I believe you’ll find that the reconfigured statement will be much more understandable, both in integrity and intent.

Tell all your friends.


The Older Brother

29 Responses to “The Older Brother Has an Evidence-based Hissy Fit”
  1. Beatrix Willius says:

    Oh no. Nonono. Doctors don’t understand science. At all. One of the basic principles of science is once it’s disproven it’s disproven FOR ALL TIME. Doctors don’t get that. Unfortunately, most people don’t get that either.

    If I want to amuse myself I look at the delicious blog called “science based medicine”. As far as I can see they are using evidence-based medicine to advocate for the same old. The only time they get a real controversy if they do side-effects on statins. Then there are a few brave souls who go against the majority because they actually have side effects. Which we learned are just in the minds of people according to the doctors.

  2. JillOz says:

    Feeling you, Older Bro!

    All the phrase means to me now is that the stuff they’re saying probably ISN’T evidence-based, especially when it’s used oh-so-smugly by “accredited practising dietitians” who recommend grains for all!

    • The Older Brother says:

      Well, technically it is evidence-based. It’s just that, in the words of the great philosopher, Inigo Montoya: “You keep using that word. I do not think it means what you think it means.”

      Or what they want us to think it means.


  3. James H says:

    Well articulated.

    When I first noticed this “evidence-based” thing I looked for the evidence but all I saw was (biased) opinion based upon some something or other. I now equate Evidence-Based with Government Knows Best or, worse, “I’m from the Government and…”


    James H

  4. Judy B says:

    I also hate “at the end of the day.” We were listening to the radio in the car last week. The person being interviewed used that phrase three times within a ten minute period. Ugh, just ugh…

    • The Older Brother says:

      Shoot. I meant to include that one. Definitely the most current and irritating in the “harmless affectation” category. Thanks for the catch!

      The Older Brother

    • Firebird7478 says:

      The one that gets me is when someone agrees with me they say, “I would agree.”

      Here I am waiting for the “but”…that never arrives.

  5. David says:

    As a physicist who changed careers after 25 years to be a mental health/substance abuse counselor, it drives me crazy whenever I hear counselors talk about particular modalities of therapy being “evidence-based”. There is little to no real science in psychotherapy related “research”. Most studies have incredibly small sample sizes and negative results are seldom published (unless they fit the authors preferences – prove the other guy wrong). The few therapies that are considered “evidence-based” and hence pushed by insurance and the government are those that are simplistic to the point of being useless, so that a clinical study could actually get accomplished. Reproducibility is notoriously bad in this field. I love what I do, but it is not science, it is art.

    • The Older Brother says:

      You seem to be in the same position as Dr. Michael Eades, who was an engineer before becoming an M.D. Funny when someone with a background in a scientifically rigorous field moves into one of the “more art than science” fields. They don’t seem to let their credentials and having their egos stroked by industry reps affect their analytical capabilities.

      The thing is, these things are by definition not “rocket science.” I don’t mean that in a derogatory way. If you want to launch a rocket from point “A” to point “B,” you’re dealing with a relatively small set of variables. Thrust, mass, gravity, wind speed, angle will get you within a few hundred yards. Gather drag, air temp, humidity, barometric pressure, and maybe a dozen more, put them in the computer and you can put that baby on a dime from a thousand miles away.

      Now consider all of the variables with just the gut biome (routinely ignored in medicine). You’ve got literally thousands of different organisms, with multiple inter-dependencies that are state-dependent (“required at this quantity”, “harmful if more than this or less than that”, “if this also, deadly”, “if not this also, beneficial”,”but if this too, antagonistic”) that impact the state of physical and mental health. The possibilities are exponential beyond the imagination, which means “science” as is implied by these apologists isn’t even possible.

      Not that we don’t want to keep looking for answers. But I’d be more trusting if I saw a bit more humility replacing some of the cocksure arrogance routinely conveyed with the “evidence-based” trope.

      Meanwhile, in today’s paper, the syndicated doctor’s advice column that they carry authoritatively informed an inquiring reader that “all physicians are scientists, but not all scientists are physicians.” [retch]


    • Brandon says:


      You make a great point in reference to social science research – it’s inherently subjective. Many of the therapies considered to be most effective are simply more amenable to measurement, like cognitive behavioral therapy. You have clients take a 20 question depression scale (which they can easily skew in either direction) give them 8 weeks of structured therapy and have them take the scale again. We can expect they will have lower depression scores simply from receiving treatment and based out of social desirability. That’s a very simplistic example and there are better RCTs conducted, but I’ve read psychologists (many of my mentors and my background is in counseling & school psychology) who claim CBT is a “cure” for depression, anxiety, addiction, etc. I’m came out of grad school largely with this naive belief and found it doesn’t quite work like this in the real world. I still use and like some of these techniques, but they aren’t sufficient in and of themselves and there is a great deal of art to the practice of psychotherapy. As you astutely pointed out, we also have to consider the file drawer problem, as well as the fact that a large portion of psychology research is done with freshman undergraduate students or the new convenience sample of choice, Amazon Mechanical Turk “workers.” I wouldn’t go as far to say that psychotherapy or social science research is useless, or as The Older Brother said, “Not that we don’t keep looking for answers” but I think many practitioners and scholars fail to admit how much subjectivity there is in these fields or display the humility that should be displayed when discussing work in the social sciences.

  6. Walter Bushell says:

    Ah, yes — alcohol the fourth macro nutrient. Even more toxic than glucose. Mr. Al Cohol gets no respect.

    • The Older Brother says:

      Well, I respect it.

      For medicinal purposes only, of course. As a matter of fact, I believe I feel a Friday night cough coming on as I write this.

      The Older Brother

  7. Andrew Huang says:

    Hey now, don’t knock all of us 10% body fat folks. I got this way by noshing on ribeyes and lamb chops. Plus some carbs from sweet potatoes, yogurt, and occasional fruit, but still a mere fraction of what’s conventionally recommended by the USDA or trainers.

    • The Older Brother says:

      No offense intended. I was thinking more of the Jillian Michaels-types who ar born on on third base metabolically, and thinking they’re experts. I’m guessing you don’t push crappy carbs and grains on people, then lecture them for cheating or not trying hard enough!


  8. Bill says:

    ‘Fit for purpose’- used extensively here in the UK by politicians and the like, it was a phrase used way back in the early ’80s in manufacuring to define what level of quality fitted a particular component. Now they apply it to everything they want to ‘change’ the assumption being that in all instances ‘change’ is always for the better

    My late uncle was a mathematician; if he, and his colleagues, were not sure that what they were proposing was solid they called it a conjecture, a guess. The object was to disprove your theory, I think it’s called the null hypothesis. Carl Popper talked about this. We live in an age where science, of the kind practised in the medical and climate change ‘science’ world are more often than not terribly skewed conjectures which are then sold to hapless politicians who in turn sell them to the largely ignorant public, then of course a whole slew of new ‘professionals’ emerge, these people are trained, they are not thinkers; f*****ts seems like an apt description- the attempted discrediting of Tim Noakes seems like a good example of of Fts hiding behind ‘qualifications’ and their ‘professional’ bodies . The origins of this lie in money, nothing more or less. We live in an age where we are turned into consumers at a very early age, and as such science is part of a machine that is there to make sure we spend, aka comply. I could go on…..

    PS, I’m not an Einstein fan either- too many holes in the theory for me.

    • The Older Brother says:

      I’m sure I agree with you even though I can only guess that what all the **’s stand for.

      Funny thing about Einstein’s theory. In the last year I’ve seen a couple of stories where someone has proposed a new theory that would invalidate Einstein’s. What didn’t happen was a bunch of physicists angrily denouncing the proposal, pointing out that “97% of physicists agree that Einstein’s theory is real,” or asserting anyone who inspected the new theory was a “physics-denier.” Instead, what you heard was something like, “that’s a intriguing, we’ll have to take a look.”

      So what happened was actual science, as practiced by actual scientists.


  9. Mike says:

    Evidence-based is frequently a marker that what you are about to hear isn’t evidence-based, or is being presented by someone who doesn’t really understand science, or someone who advocates scientism over science. It’s sort of like calling your news channel “fair and balanced” every 5 minutes.

    To be fair though, we haven’t done a randomized controlled trial where we randomize many people into smokers and non-smokers and turn them lose for 70 years to see what happens. We will never do that study. So our finding that smoking causes lung cancer is mostly based on observational science, but it’s a pretty strong signal.

    There are legitimate scientific disciplines where certain experiments are impossible. We can’t reform the Earth and repeat evolution on one Earth, and not on the control Earth. We do the best we can to tease out the results.

    I did just see the article about a group of researchers who are recruiting healthy 70-year-olds with the intent of randomly putting half of them on stains. Apparently that one passed the ethics committee.

    • The Older Brother says:

      Right. The smoking thing is another root of bad science. They took observational evidence — i.e., correlation, i.e., “evidence-based” — and used that to form a conclusion. The correlations were very strong, and the “sample” of smokers was huge. Unfortunately, the conclusion coincidentally turns out to be correct.

      This set a precedent where if you could show a correlation, no matter how tenuous, you could just proceed directly to the conclusion without doing the rest of the actual science. The marketing people and advocates rejoiced. That’s how we got statins, hormone replacement, second-hand and now “third-hand” smoke nazis, and evidence-based everything.


      • Healthy Skeptic says:

        “Unfortunately, the conclusion coincidentally turns out to be correct. ”

        Really? What’s the proof? I’m genuinely interested.

        • The Older Brother says:

          Actually, that’s a good question. I assumed a metabolic/biochem pathway had been described at some point.

          Googled around a bit and found a reference to this 1996 study (which I have not read):

          “In the paper published today in Science, researchers from the University of Texas M.D. Anderson Cancer Center in Houston and the Beckman Research Institute of the City of Hope in Duarte, Calif., studied the effects of a cigarette-smoke ingredient on a gene known as p53.

          The gene is vital to the body’s well-being because it acts to suppress the runaway growth of cells that lead to tumors. When p53 genes are damaged, the body becomes much more susceptible to cancer. Dr. Vogelstein said that problems with the p53 gene are related to half of all human cancers and are found in up to 70 percent of lung cancers.”

          Without doing a Tom-style dive into the paper, I’m ok with figuring it makes sense combined with the millions of n=1’s who ended up lung cancer/emphysema/etc.

          Of course, this was naturally used to then press for banning smoking in “public” venues, etc. where it would have no relevance, illustrating how The Anointed, upon tripping over the truth like a blind pig with a truffle, immediately push beyond the science for more control of our lives.


    • Thomas E. says:


      This is where my engineering mindset meets health care.

      Right now the standard as you describe says, let’s take some inputs, put them into a black box for 70 years, and see what the output is. Obviously the black box in my thinking is the human body, and the inputs are food, chemicals in the environment and so on. This is all interesting, and is good for creating theories, but does little to prove those theories as T.O.B. points out!

      So my biggest pet peeve right now, is there is far too much money being spend on these black box tests, these epidemiological studies that they keep on embarking on to attempt to validate their preconceived theories. Argggg!

      This is where Dr. Robert Lustig, Dr. Peter Attia, Dr. William Davis, and so on strike a huge accord with me. As an engineer I have to dig into that black box to figure out what is broken. And that is what those I list and many more do.

      Dr. Lustig’s video “Sugar the Bitter Truth” https://www.youtube.com/watch?v=dBnniua6-oM&t=540s appealed to me.

      He opened up the black box of Fructose consumption and showed clear biochemical pathways from consumption to disease state.

      That is where research money needs to be spent.

      The other type of engineering problem resolution strategy is to look at the system when it worked, and then when it is broken. What are the differences??? And in those differences you will often find the root cause. Dr. Cate (http://drcate.com/), Gary Taubes and others either directly, or indirectly follow this approach.

      Dr. Cate looked at what humans ate over the centuries, and then what we eat right now, and said, hey, what is this vegetable oil doing in our diet?

  10. Firebird7478 says:

    I linked a video of his in your last post and I am linking another one here. It fits right in with the “Evidenced-based” nonsense. Where I disagree with him is the plant-based diet and juicing.

  11. S says:

    Wow, I’m famous. Thanks, I guess.

    To be clear, my use of “evidence-based” was because you *can’t* apply science to health-care policy (which is, I think, the correct usage of the term). But you can have a good look at other countries, look at the overall costs and outcomes of their systems, and draw some conclusions about what might work well, and what doesn’t work well.

    • Bill says:

      It seems to me that regardless of the style of healthcare system a given country operates the cost is growing exponentially. Why is this? Lets think about the cost of drugs, the complexity of procedures, the complete lack of the established ‘medical science’ community to accept any alternative suggestions as to how you might treat these all to common diseases (I think it was always thus- think of leeches). As we all know on this website the interests of those espousing and setting current ‘policy’ are foremost , they get paid on the basis of what they stand for.

      Evidence (and I use that term ironically) based medicine is at the core of the spiralling black hole in health care. Poor dietary advice, lack of interest in attempting a cure (no money in cure is there) are producing positive feedback (think of a howling loudspeaker in a PA system). That is to say, unless something is done we seem to be on a path of self destruction. In the current system it seems that everything£$€ is designed to flow upwards to those who already have cash. Think of Robin Hood and the Sheriff of Nottingham. In many ways we have slipped back to the middle ages. Tithes anyone?

  12. Nick S says:

    IDK, man, I agree with your concerns about the regular use of bad/misleading/biased/incomplete evidence to push for poorly thought-out policies, but there’s no better means by which to evaluate a policy than evidence. For example, I think a retrospective look at the evidence on a huge number of regulations to evaluate their costs and effectiveness would be a great way to prune down the worst of the regulatory state, in an “evidence-based” way.

    It seems like the real need is not to reject “evidence-based policy”, but to demand a more rigorous approach to evaluating evidence.

    • The Older Brother says:

      I think the fatal flaw in the whole “evidence-based” concept is that it’s ALWAYS going to be the legacy players who get to pick the evidence.

      Does anyone with a reasonable grasp of reality need any more evidence that the Leviathan State is reducing our wealth, well-being, and liberty? What more would we need?

      If the rabble gets worked up enough, the current owners will form a commission to perform an “evidence-based” study and report back. The answer will be “everything is working pretty well, except we have a few more regulations that will help the other ones work even better.”


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