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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“I believe their intentions were good.”
And what is the road to hell paved with?
Too true.
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.
Tom,
You might like this article.
http://wattsupwiththat.com/2010/10/20/vegans-are-not-from-vegas/
Very well done.
When you have free time search out Iaonnidis’ research at Plos. He has quite a few good paper’s on-line there.
Count me among those who would like to see (and read) your speech.
Thanks for all that you do.
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.
Tom,
You might like this article.
http://wattsupwiththat.com/2010/10/20/vegans-are-not-from-vegas/
Very well done.
When you have free time search out Iaonnidis’ research at Plos. He has quite a few good paper’s on-line there.
Count me among those who would like to see (and read) your speech.
Thanks for all that you do.
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.
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
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
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.
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.
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.
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.
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/.
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/.
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.
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.
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.
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.
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.
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.