Review of Bad Science and Thoughts on Diabetes
Health Guide November 11, 2009
Whenever I become conscious of a word or concept new to me, I began to notice it everywhere. All of you probably have had this experience.
It is so common that we even have a nice big word for it thanks to the great Swiss psychiatrist Carl Jung: Synchronicity.
A couple of weeks ago a member of the diabetes support group that meets in my apartment loaned me a book called Bad Science. A practicing physician in the U.K.'s National Health Service and newspaper medical columnist named Ben Goldacre wrote it and Fourth Estate published it last year in the U.K.
The book is a detailed indictment of the British press for its woeful ignorance of some basic scientific concepts. Like one of my favorites, "regression to the mean." This sounds complicated. But it is simply the fact that everything, including our health, has a natural cycle. Since we tend to see a doctor when we feel the worst, we think that his or her treatment helped us, while we would soon feel better no matter what the treatment was.
"The art of medicine consists in amusing the patient while nature cures the disease," as Voltaire wisely wrote almost 300 years ago. That's still true today.
Another favorite concept of mine that Dr. Goldacre discusses is the "Hawthorne effect." This concept came out of a study of workers at a Western Electric manufacturing facility outside Chicago. Not surprisingly, output improved when researchers turned up the lights. But for some serendipitous reason, near the end of the study they turned down the lights and found that productivity went up even more. Eventually the researchers realized that they weren't studying lighting. What happened was that the workers were doing better just because somebody was paying attention to them. People in all sorts of studies -- including clinical trials -- get better just because researchers study them.
One of the biggest problems in bad science is the placebo effect. Even when our doctors give us fake medicine -- so-called sugar pills -- we quite often feel better because of the power of suggestion.
Another statistical fraud -- and this is one that is all too common in the published literature -- is to ignore dropouts. Of course, they don't call it that. Technically, it's intention-to-treat analysis, and supposedly this is good science. While Dr. Goldacre mentions it only in passing, Michael Eades, M.D., demolishes it in his article on "The fraud of intention-to-treat analysis."
Cherry-picking the data is even more statistical stupidity that Dr. Goldacre discusses. The most terrible example in all recorded history -- and one that we are still living with -- is the famous Seven Countries study by Ancel Keys that Harvard published in 1980. By cherry picking seven of the 22 countries for which he studied the data, Dr. Keys proved to his satisfaction and to that of the American medical establishment that consuming saturated fat in meat and milk leads to high cholesterol, which in turn leads to heart disease. Read The Cholesterol Myths by Uffe Ravnskov, M.D., Ph.D., for the full sad story.
Reading Dr. Goldacre's Bad Science increased my awareness of all the bad science that I read every day. Almost always I try to write about good science. If I broadened my beat to include even a little of the bad science that comes my way, I would be writing several articles every day. And I can do without the hate mail that I get any time I find something to be worthless.
Mangosteen is a case in point. Nothing that I ever wrote got me so many attacks as my article on "The Mangosteen Myth." So since the multi-level marketers of this juice already hate me, here I go again with an awful example of "research" finding one brand of mangosteen juice "reduced CRP [C-reactive protein] levels (increase change from baseline) compared to placebo..." Nutrition Journal published this article on October 20.
Sounds good, right? The worst problems with this "research" is so basic that Dr. Goldacre doesn't even deal with it. The company that sells the brand of mangosteen juice that supposedly improved CRP levels "sponsored the study." At least the authors acknowledged that fact. Another thing that leaves a bad taste in my mouth about this study is that the authors work for Medicus Research LLC. The company's website describes Medicus as "a full-service CRO." They don't describe what a CRO is, but my acronym finder says that it is a contract research organization.
Who does the study matters. It matters a lot when a doctor trumpets a diet as the best one for people with type 2 diabetes. I won't mention the title of the book or the author's name, because any publicity is good publicity (except I hope with mangosteen). The diet in question is a low-glycemic diet, which is good as far as it goes.
But I know from my own experience that I wasn't able to fully control my diabetes or my weight during the many years I followed this diet myself. I wondered how well the author of this brand new book was able to control his own type 2 diabetes on his diet. Scouring the book in vain for any such facts, I wrote him.
"Within 3 months of discovering my diabetes, I put myself on 2 grams of metformin and 10 units of insulin," he replied. "That combination hit the sweet spot. Now, ten years later, I am taking the very same: 2 grams of metformin and 10 units of insulin."
Well, then is his A1C in the normal range? "My last A1C was 6.4. It's always in that range." Unfortunately, only a level between 4.5 and 6.0 is considered normal.
And his weight? "My BMI is 25." Unfortunately a BMI of 25 is where being overweight starts.
No wonder that the good doctor didn't disclose those statistics in his book. Who would buy a book recommending a treatment that doesn't work for the author himself?
So many traps for the unwary! As Mark Twain wrote, "Be careful about reading health books. You may die of a misprint." Or from bad science.