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Cranks, quacks, and peer review

Last week, I wrote one of my characteristically logorrheic meandering posts about what turns a scientist into a crank or a doctor into a quack. In a sort of continuation of this line of thinking, this week I’ll turn my attention to one of the other most common characteristics of a crank, be he scientific crank (i.e., a creationist), a quack, or historical crank (i.e., Holocaust deniers), specifically how he views the peer review system.

Not suprisingly, one of the favorite targets of pseudoscientists is, in fact, the peer review system. Indeed, it’s a very safe thing to say that, almost without exception, cranks really, really, really don’t like the peer review system for scientific journals and grant review. After all, it’s the system through which scientists submit their manuscripts describing their scientific findings or their grant proposals to their peers, and their peers make a judgment whether manuscripts are scientifically meritorious enough to be published and grant applications scientifically compelling enough to be funded. Creationists hate peer review. HIV/AIDS denialists hate it. Anti-vaccine cranks like those at Age of Autism hate it. Indeed, as a friend of mine, Mark Hoofnagle pointed out a couple of years ago, pseudoscientists and cranks of all stripes hate it. There’s a reason for that, of course, namely that vigorous peer review is a major part of science that keeps pseudoscientists from attaining the respectability that science possesses and that they crave so.

Far be it from me to get all Panglossian on you and claim that the peer review system is the “best of all possible worlds,” or anything like that. Having participated in the system at multiple levels, including at the receiving end, as a peer reviewer for journals, and as a reviewer on a study section, I know there’s no doubt that the system has problems and could do with considerable improvements. However, when I hear rabid bashers of peer review characterize it as “crony review,” I tend to echo Winston Churchill’s famous statement about democracy that peer review is “the worst way of determining what science should be published and funded except for all those others that have been tried.” Certainly, the bashers can’t seem to propose something better. Of course, that’s because the real purpose behind the numerous criticisms made by cranks about peer review is not to reform or improve the system in order to prevent bad science from being published and funded and good science from being rejected, but rather to weaken the system or alter it so that they can get their favorite pseudoscience published an/or funded, thus allowing them to attain the respectability of real science that they so crave. In other words, it is important in assessing attacks on the peer-review system to determine whether the criticism is designed to suggest real changes that might improve it or, as is the case with most cranks, to tear it down in order to make it more amenable to accepting their pseudoscience.

If there is one sterling example of this phenomenon that I’m aware of, it’s an article that I first encountered a couple of years ago by a surgeon at the University of Washington named Donald W. Miller, Jr. (website). I remember coming across it while delving into the blogs and websites of HIV/AIDS denialists. Not surprisingly, Dr. Miller is a regular columnist at LewRockwell.com, where he has referred to HIV/AIDS denialist hero Peter Duesberg as a “modern day Copernicus” and questioned the HIV/AIDS hypothesis as an “orthodoxy.” Not surprisingly, Dr. Miller is also an anti-vaccinationist, shamelessly promoting the myth that thimerosal in vaccines was a cause of the “autism epidemic” (it wasn’t; it’s a failed hypothesis) and that anthropogenic global warming is a “scam.” I first became aware of this article, The Government Grant System – Inhibitor of Truth and Innovation? on the HIV/AIDS denialist blog You Bet Your Life. It also appeared on LewRockwell.com under another title, The Trouble With Government Grants. In the article, Dr. Miller launched into a blistering attack on the current peer review system used by the NIH, an attack that revealed his profound ignorance of how government peer review systems (not system) work.

I knew there were going to be problems right away. First, Miller used the term “truth” in the title of one of the versions of his article. Science is not about “truth”; it is about understanding how the world around us works to as good an approximation as we can get. Worse, very early on in the article, Dr. Miller shows that he can’t seem to get his facts straight, mangling the concept of “triage” and making me seriously wonder if he has ever served on an NIH study section. Certainly, searching the CRISP database (the best way to find out if anyone has an NIH research grant, by the way), I could find no evidence that he has ever been the principal investigator or co-investigator on an NIH grant, which if true would more or less disqualify him from sitting on an NIH study section. I also can’t help but note briefly that Dr. Miller, like so many physicians and scientists who turn to the dark side of pseudoscience, seems to have had a respectable publication record in peer-reviewed journals as an academic cardiac surgeon until 1991, after which he has not published in peer-reviewed journals. (Note: Despite its claims otherwise, the Journal of American Physicians and Surgeons, as Dr. Miller has, does not count as a peer-reviewed journal, for reasons I have discussed extensively before.) In any case, here Dr. Miller describes the peer review system as he thinks it stands:

The Center for Scientific Review “triages” applications it receives. A cursory appraisal eliminates one-third of the applications from any further consideration, and it selects the remaining two-thirds for competitive peer review. CSR sends each application to a Study Section it deems best suited to evaluate it. Peers in Molecular Oncogenesis, Cognitive Neuroscience, Cell Structure and Function, Hematopoiesis, HIV/AIDS Vaccine, and 167 other Study Sections review grant applications. Each Study Section has 12-24 members who are recognized experts in that particular field. Members meet three times a year to review 25-100 grants at each meeting. Two members read an application and then discuss it with the other section members who collectively give it a priority score and percentile ranking (relative to the priority scores they assign to other applications). An advisory council then makes funding decisions on the basis of the Study Section’s findings, “taking into consideration the [specific NIH] institute or center’s scientific goals and public health needs” (Scarpa, 2006).

Not quite. This is what the NIH CSR says about peer review:

One or more CSR Referral Officers examine your application and determine the most appropriate Integrated Review Group (IRG) to assess its scientific and technical merit. Your application is then assigned to one of the IRG’s study sections. A study section typically includes 20 or more scientists from the community of productive researchers. Your application also will be assigned to the NIH Institute or Center (IC) best suited to fund your application should it have sufficient merit. (More than one IC may be assigned if appropriate.)

In reality, in the first pass through the CSR, Referral Officers do little more than (1) make sure the grant is formatted correctly (yes, they do check to see if you used a 10 point font instead of 11, shrank the margins beyond what the rules state, went over the page limit, or tried to get by without all the necessary institutional signatures, and if they find that you did any of those things or others the grant will not be forwarded to a study section); (2) verify that it fits the criteria for the grant mechanism being applied for; (3) check against an NIH database of grant applications to make sure that the applicant hasn’t submitted the same grant to two different funding mechanisms during the same grant cycle; and (4) figure out the most appropriate Integrated Review Group to send it to. I suppose it’s possible that 30% of scientists are too stupid or careless to follow the formatting requirements properly and to include all the needed information, but I doubt it. Even if that were the case, the scientists would have no one to blame but themselves; the instructions, although voluminous, are quite clear at least about the basic formatting requirements and page limits for an NIH grant application. In any case, pretty much every grant that’s formatted correctly and contains all the required elements is assigned to a study section for review.

During a study section, the appraisal of which grants are “triaged” is not “cursory.” Every grant application is assigned to approximately three reviewers (the number may vary, depending on the grant mechanism and study section). In the study section on which I last served, for example, every application was assigned to a two primary reviewers (Reviewer 1 and Reviewer 2) and a secondary reviewer (the Discussant). Both primary reviewers were expected to read the grant application in detail, write up a 2-4 page review of it, and assign it a proposed priority score. The discussant was also expected to read each grant assigned to him in detail but only to write up a briefer 1-2 page review and assign a proposed score. Everyone else on the study section tends to look over grants to which they are not assigned as Reviewer 1 or 2 or the Discussant, other than perhaps the abstracts of the grants, but that’s understandable, given that most reviewers are assigned around 10 grants to read in six weeks and that it can take several hours per grant to review it. (At least, that’s about how long it takes me.) At the study section meeting itself, to convene the meeting the chair listed the grants whose initial proposed priority scores were in the bottom half. Because these grants clearly had no chance at being funded during the cycle being discussed, they were then “streamlined” (or, colloquially, “triaged”), meaning that they would not be discussed in detail at the full study section. Potential streamlining candidates whose reviewers assigned them widely divergent scores, indicating a sharp disagreement over their scientific merit, were often specifically pulled aside for discussion before voting on streamlining. Indeed, if either reviewer was insistent about it such grants would usually be discussed before the whole study section despite their low average priority score, and if any study section member strongly objects to the streamlining of any grant application, it was discussed.

Unfortunately, given the largely increased number of grant applications and the down economy, which has led to NIH budgets that, until recently, have not even kept up with inflation, the percentage of NIH grants funded steadily fell from 2004 to 2008. At the low point, for some Institutes, less then 10% of grants were being funded. Consequently, often more than 50% of grants were triaged during that period, because any grant that didn’t reach at least the 30th percentile had no chance. It wasn’t even “in the zone,” so to speak. Fortunately, that trend is starting to reverse, thanks to additional funding to the NIH, although where the new equilibrium will fall is anyone’s guess.

After streamlining, once the discussion of the remaining grants started, Reviewer 1 would usually lead it it for his assigned grants, with Reviewer 2 and the Discussant chiming in. After a full discussion, each member of the study section would then assign a score. Contrary to Dr. Miller’s distorted description, the only differences in treatment between “triaged” grant applications and those discussed at the full study section is that triaged grants are not discussed in detail (although they are reviewed in detail), and a “summary statement,” which boils down the written reviews and group discussion into a summary, which is (usually) highly useful for applicants in guiding revisions of the application for resubmission. Also included are the individual reviewer comments appended to the summary statement. For triaged grant applications, on the other hand, the three written reviews are returned to the applicant, who is free to revise and resubmit based on the comments of the three reviewers. It’s not quite as useful, but still helpful. Indeed, my first application for an NIH R01 grant was triaged, and the comments were helpful in my revising and ultimately succeeding the second time around. Moreover, study sections do not assign percentile scores, only priority scores. Percentile scores are generated from the Gaussian curve of all the priority scores, and it is the percentile score that determines which grants are funded.

The bottom line is that, whatever major faults the NIH grant approval process has, doing only a “cursory” evaluation of the applications at any stage is not among them.

It’s at this point that you find out where Dr. Miller was really coming from, and it wasn’t from the perspective of someone who wants to reform the system. Indeed, the system could use some reform. Whether the “reform” of a new scoring system implemented this year or proposals to cut the page limits for grant applications from 25 to 15 in order to force applicants to deemphasize methodological detail and emphasize broad research rationale and strategy will improve peer review remains to be seen. However, that’s not where Dr. Miller is coming from in this article. Rather, he comes from the perspective of a friend of pseudoscience who feels that the system doesn’t give his HIV denialist buddies a fair shake, which is evident in how he starts out semi-reasonable and then goes right off the deep end. Here’s the semireasonable part:

The grant system fosters an Apollonian approach to research. The investigator does not question the foundation concepts of biomedical and physical scientific knowledge. He sticks to the widely held belief that the trunks and limbs of the trees of knowledge, in, for example, cell physiology and on AIDS, are solid. The Apollonian researcher focuses on the peripheral branches and twigs and develops established lines of knowledge to perfection. He sees clearly what course his research should take and writes grants that his peers are willing to fund.

There is some truth to this, again, depending on the specific grant mechanism. For example, the flagship grant of the NIH, the largest grant awarded to individual investigator (the R01), tends to emphasize research that is well-supported by preliminary data. One reason, of course, is that R01 grants can span up to five years and between $1 and $2 million. If such large investements are made in projects that are too speculative, the vast majority of them will fail and most of the money will have been wasted. Of course, the other tendency is to invest in science that is very well supported by preliminary data and therefore “safe,” meaning that the project proposed will almost certainly yield results. The problem with this latter approach is, of course, that it is so safe. Such projects are unlikely to challenge existing paradigms or create whole new areas of inquiry. Obviously, there needs to be a balance between risky, speculative projects (that are nonetheless well-supported scientifically) that could hit a home run if they succeed and “safe” projects that will produce incremental gains in knowledge and improvements in therapy (i.e., are evolutionary, rather than revolutionary, the equivalent of a base hit instead of a home run).

Where the pendulum swings between these two extremes depends upon funding levels. When funding gets tight, as it has been the last few years, reviewers tend to be more reluctant to fund riskier research, even if it is very compelling and interesting science, because they do not want to throw money at projects with a low chance of success. The “whiner” in me can’t resist pointing out that one way to get more “risky” science funded is to increase science funding overall, to make reviewers more willing to take risks, but that would just reveal me to be a tool of the system, just as Mark Crislip is a shill for big pharma and a tool of the medical-industrial complex. When the pay line (the percentile cutoff for funding) is the 20th percentile rather than the 10th percentile, reviewers are a bit more willing to score risky but brilliant projects higher and cut the applicants some slack for not having as much preliminary data as they normally might like to see. When the payline starts to plunge below the 10th percentile, scientific conservatism reigns.

In any case, there are other grant mechanisms, such as the R21, which provide smaller grants for shorter periods of time (usually one to two years) for riskier projects. Moreover, over the last few years, there has been a real push within the NIH to change the reviewing criteria for grants to emphasize novelty and impact more. Even so, if a tendency towards conservative science was Miller’s main critique of the system, I’d probably agree for the most part, but I’d also point out that the NIH is actually trying to remedy that situation. Unfortunately, Miller couldn’t resist tipping his hand that real reform of the system is not what his polemic was about. After listing what he characterized as “state-sanctioned unassailable paradigms” that will never be funded, Miller devolved completely into ranting crankery:

The human-caused global warming paradigm is most likely false (Soon et al., 2001; Editorial, 2006). Two climate astrophysicists, Willie Soon and Sallie Baliunas, present evidence that shows the climate of the 20th century fell within the range experienced during the past 1,000 years. Compared with other centuries, it was not unusual (Soon and Baliunas, 2003). Unable to obtain grants from NASA (National Aeronautics and Space Administration), Soon (personal communication, August 31, 2006) observes that NASA funds programs mainly on social-political reasoning rather than science.

Duesberg (1996), Hodgkinson (2003), Lang (1993-2005), Liversidge (2001/2002), Maggiore (2000), and Miller (2006), among others, have questioned the germ theory of AIDS. All 30 diseases (which include an asymptomatic low T-cell count) in the syndrome called AIDS existed before HIV was discovered and still occur without antibodies to this virus being present. At a press conference in 1984 government officials announced that a newly discovered retrovirus, HIV, is the probable cause of AIDS, which at that time numbered 12 diseases (Duesberg, 1995, p. 5). Soon thereafter “HIV causes AIDS” achieved paradigm status. But, beginning with Peter Duesberg, Professor of Molecular and Cell Biology at the University of California, Berkeley, a growing number of scientists, physicians, investigative journalists, and HIV positive people have concluded that HIV/AIDS is a false paradigm. The NIH awarded Duesberg a long-term Outstanding Investigator Grant and a Fogarty fellowship to spend a year on the NIH campus studying cancer genes, and he was nominated for a Nobel Prize. When Duesberg publicly rejected the HIV/AIDS paradigm the NIH and other funding agencies ceased awarding him grants. Government-appointed peer reviewers have rejected his last 24 grant applications. Peter Duesberg (personal communication, September 20, 2006) writes: “When I was the blue-eyed boy finding oncogenes and ‘deadly’ viruses, I was 100% fundable. Since I questioned the HIV-AIDS hypothesis of the NIH’s Dr. Gallo, and then the cancer-oncogene hypothesis of Bishop-Varmus- Weinberg-Vogelstein etc. I became 100% unfundable. I was transformed from a virus- and cancer-chasing Angel to ‘Lucifer.’”

Yes, anthropogenic global warming denialism and HIV/AIDS denialism (coupled with the oft-repeated cry of “martyrdom!” from Peter Duesberg, yet!) are what Dr. Miller is about. (Hint to Dr. Miller: Citing Christine Maggiore and Peter Duesberg is not a particularly good way to bolster the credibility of your arguments.) Other “unassailable paradigms” that Miller lists are not quite as ridiculous as his examples of AIDS and global warming, but they’re mostly strawmen; for example, the claim that “cholesterol and saturated fats cause coronary artery disease” is actually not quite what medical science states; rather it is that cholesterol and saturated fats are major factors, among others, that contribute to the pathogenesis of coronary artery disease. (Perhaps Dr. Miller is a member of The International Network of Cholesterol Skeptics, a.k.a. THINCS, which Harriet Hall so delightfully skewered last year.) Using these examples did not exactly bolster Miller’s credibility or case, either. Miller then went on a tear about how science is in service of the state, pulling out more HIV/AIDS denialism coupled with some rather blatant conspiracy-mongering:

AIDS research serves the interest of the state by focusing on HIV as an equal opportunity cause of AIDS. This infectious, egalitarian cause exempts the two primary AIDS risk groups, gay men and intravenous drug users, from any blame in acquiring the disease(s) owing to their behavioral choices. Duesberg, Koehnlein, and Rasnick (2003) hypothesize that AIDS is caused by three other things, singly or in combination, rather than HIV: 1) long-term, heavy-duty recreational drug use–cocaine, amphetamines, heroin, and nitrite inhalants; 2) antiretroviral drugs doctors prescribe to people who are HIV positive– DNA chain terminators, like AZT, and protease inhibitors; and 3) malnutrition and bad water, which is the cause of “AIDS” in Africa. HIV/AIDS has become a multibillion dollar enterprise on an international level. Government, industry, and medical vested interests protect the HIV/AIDS paradigm. The government-controlled peer review grant system is a key tool for protecting paradigms like this.

Personally, I always marvel at such amazing nonsense. For one thing, why would it “serve the interest of the state” for HIV/AIDS to be a “equal opportunity cause of AIDS.” Surely, it could equally serve the interest of the state to demonize one or two unpopular segments of the population, depending upon who is in charge at any one given time. Be that as it may, the evidence that HIV causes AIDS is exceedingly strong and has not been seriously challenged, not by Duesberg, and certainly not by any of Dr. Miller’s HIV “dissident” tracts published at the execrable LewRockwell.com. The views in his articles alone show that Dr. Miller’s critical thinking skills leave much to be desired, and this lack of critical thinking is very apparent in his article attacking peer review.

No wonder Dr. Miller was so unhappy about how peer review works! No wonder his article is such a gem of crankery that I remembered it two years later and have been meaning to discuss it for SBM almost since SBM began.

Personally, my view is that, whatever problems are inherent in the current peer review system (and, as I have said before, there are many), one thing the current system does do a reasonably good job of is of keeping pseudoscience (such as what Dr. Miller apparently subscribes to) from being funded by government bodies. I know, I know. There is one glaring–and I do mean glaring–exception to this rule. You probably know what it is. That’s right; I’m referring to the National Center for Complementary and Alternative Medicine (NCCAM), which exists primarily to fund pseudoscience. True, it does fund studies of herbal remedies, which could be considered a part of pharmacognosy, but such studies would be much better if done by one of the other relevant Institutes or Centers that aren’t dedicated to woo. As for the rest of the “alternative” medicines of which NCCAM funds studies, the vast majority are highly implausible, and NCCAM has utterly failed to produce a single truly positive study or to conclude that any woo doesn’t work. That’s why I have castigated NCCAM time and time again, and, with other SBM bloggers, called for President Obama to defund this agency. Indeed, I even suggested a how-to guide on defunding NCCAM.

Somehow, though, I doubt that NCCAM is what Dr. Miller had in mind when he castigated peer review by government granting agencies. To me, its past ability to keep pseudoscience from being funded and, for the most part, published was one of the great strengths of our peer review system. Unfortunately, the funding of NCCAM shows just how fragile that ability can be. Any reform that is undertaken must be done carefully in such a way as to minimize any weakening this firewall against ideas that are clearly without scientific merit and overwhelmingly believed to be so by scientists. After all, one of the risks of funding “riskier” science is that pseudoscience will sneak in, along with the legitimate science. Worse, one of the risks of funding based far more on ideology than science, which is what NCCAM does given that it was imposed upon the NIH by powerful quackery-friendly legislators like Tom Harkin (who was most unhappy earlier this year because NCCAM was too scientific for his taste in that it hadn’t “proven” more alternative medical modalities to be effective) rather than developed by scientists to fill a perceived need in response to a groundswell of support, is that more pseudoscience will be funded. Of course, that’s exactly what Dr. Miller wants: Legitimacy and funding for the pseudoscience behind HIV/AIDS denialism. Finally, one thing that I have to wonder about is this: If the “unassailable state-sanctioned paradigms” that Dr. Miller detests so much are, as he seems to believe, due primarily to the inherent bias of the NIH grant peer review system that is “designed to protect the existing paradigm,” why, then, is it that scientists around the world also consider Duesberg’s ideas about HIV to be profoundly incorrect and have come, after much wrangling, to believe that human-caused global warming is occurring?

Sadly, the ideas for reform seen in Miller’s article and elsewhere among the HIV/AIDS “dissidents” seem to boil down to either “let’s find a way to fund potential cranks like us” (a.k.a. “mandatory funding of contrarian research”) or “let’s get rid of peer review.” Dr. Miller opines:

One alternative to the competitive peer review grant system that the NIH and NSF might consider for funding specific research projects is DARPA, the Defense Advance Research Projects Agency. This agency manages and directs selected research for the Department of Defense. At least up until now it has been “an entrepreneurial technical organization unfettered by tradition or conventional thinking” within one of the world’s most entrenched bureaucracies (Van Atta et al., 2003). Eighty project managers, who each handle $10-50 million, are given free reign to foster advanced technologies and systems that create “revolutionary” advantages for the U.S. military. Managers, not subject to peer review or top-down management, provide grants to investigators whom they think can challenge existing approaches to fighting wars. As long as the state controls funding for research, managers like this might help break the logjam of innovation in the biomedical and physical sciences. Science under the government grant system has failed and new kinds of funding, with less government control, are sorely needed.

I fail to see how giving appointed managers this power would be “less” government control over research. After all, who hires these managers? The government! What’s to stop the government “orthodoxy” from simply hiring managers who believe the “government orthodoxy” and will therefore disburse research funds in order to support the “orthodoxy”? Nothing! After all, it would be even easier to enforce an orthodoxy if the managers, rather than largely volunteer peer reviewers drawn from diverse academic settings, controlled funding. Besides, military technology, although a broad area, is applied, not basic, science. It probably does not require as much of an understanding of the nitty-gritty of the basic science behind technology proposals as it does to understand whether a basic science or translational research proposal is reasonable, innovative, and feasible. Moreover, remember that the entire yearly budget of the NIH is only around $30 billion, and the entire budget of the NCI is less than $5 billion, both of which are utterly dwarfed by the size of the Defense budget. In other words, the military is much more lavishly appointed and can afford to throw money at risky scientific projects in a way that the NIH and NSF cannot. Moreover, contrary to this example of DARPA, the system that the U.S. Department of Defense uses to evaluate most submitted research proposals is actually peer review. Using peer review, in fact, the Army (believe it or not!) does quite a good job of emphasizing and fostering innovative proposals; indeed, for its biomedical research programs, the Army probably does better job in many respects of supporting scientific innovation than the NIH. If the NIH is going to emulate the military, it would do far better to examine how the Army conducts its scientific peer review sessions, rather than to listen to the posturings of people like Miller.

The rest of the peer review bashers tend not to do much better than Dr. Miller. For example, going back in time a couple of years, one of the most vociferous critics of peer review that I’ve ever encountered (not to mention a hardcore HIV/AIDS denialist) is blogger Dean Esmay. I refer to his ideas, even though he expressed them a couple of years ago, because he was quite impressed with Dr. Miller’s article and decided to add his ideas to Miller’s. Basically, Dean’s ideas (old version of post in the archive) seem to boil down to the sort of reasonable to the ignorant to the unworkable. For example, Dean proposed a seemingly not entirely unreasonable idea of completely eliminating the anonymity of peer reviewers that betrays his ignorance of the process. For one thing, he doesn’t seem to have noticed that Study Section rosters are already published on the web, allowing reasonable guesses as to who specific reviewers are for applications. (In fact, the NIH helpfully sends applicants the complete roster of the members of the study section that reviewed their grant, along with the summary statements and reviews.) He also seems not to understand that it is a not infrequent occurrence for more junior faculty to be reviewing applications by senior, well-entrenched faculty, the veritable “gods” of the field, if you will. How willing would these early mid-career scientists be to provide brutally honest feedback about a bad proposal if the applicant would know who gave him the bad score? In fact, I have felt that very pressure myself. After reading a truly execrable grant application by a very highly regarded scientist that looked as though it had been thrown together over a weekend, I’m not sure I would have had the courage to give it the review it deserved if I knew that the applicant would know who I was. Indeed, completely eliminating anonymity might actually have the tendency to worsen the very problem Dean and Miller decry by leading to grants by highly established and respected scientists getting even more of a pass from study sections than they do already.

In addition, Dean proposed another idea that revealed his ignorance of the NIH, namely to make peer review funding boards “truly multidisciplinary” (whatever that means) and forcing every application to be looked at by a mathematician or someone with a “background in mathematics.” I’m not sure if he was referring to the study sections, which do initial peer review, or advisory councils of each institute, which do the second tier of peer review taking into account specific scientific and/or programmatic priorities of their Institutes, but Dean apparently has never actually looked at the roster of a few typical NIH Study Sections. If he meant study sections, I point out that they already are multidisciplinary, and virtually all of them include biostatisticians! (I hope that’s “mathematical” enough for Dean.) For example, the study section on which I sat until last year included internists, physiologists, surgeons, computer experts, radiologists, medical imaging experts, molecular biologists, a medical physicist, and biostatisticians. I suppose that we could make things even more “multidisciplinary” with “no direct interest” in the field (we could bring in an archaeologist, I suppose, to look at cancer biology proposals), but we would do so at the risk of decreasing the familiarity of reviewers and study section members with the detailed science behind grant applications assigned to them. (On second thought, maybe that’s just what Dean would like. On third thought, there’s no “maybe” about it.) On the other hand, if Dean meant Institute advisory councils, it is hard to see what added benefit that making the these second tier reviewers even more “multidisciplinary” would provide, given that the primary driver of what gets funded is the review provided by the study section, not the post-review committees, which largely rely on the study section’s priority score and the priorities of their respective Institutes to dole out funds. They tend not to make a big difference except for close calls or in cases of proposals that are highly congruent with the Institute priorities but missed the funding payline by a relatively small margin. Making these advisory councils more “multidisciplinary” would be unlikely to affect these priorities because it is not the advisory councils who determine NIH funding priorities; they only implement them. It is the NIH Director and the Directors of the various Institutes, who are appointed by the President, who determine NIH funding priorities, heavily influenced, of course, by Congress and the President.

No one denies that there are problems with the NIH peer review system for grant evaluation; like all human endeavors, there’s room for improvement. Indeed, the complaints bubbling up against it over the last few years are nothing new; I heard the same complaints when I was in graduate school in the early 1990s. Ironically enough, that, too, was a time of very tight paylines, even tighter than they are now, which makes me wonder if the recent budget travails of the NIH are a blessing in disguise, in that they are catalyzing a discussion of how we as a nation can do better with peer review and thus better at deciding what grants to fund. I’ll grant you that the recent ARRA Challenge Grant fiasco, in which we have 20,000 applications chasing between 200-400 Challenge Grants actually isn’t the best argument for this. However, that’s not because of peer reviewers; rather it’s because of a policy decision to put so little of the ARRA stimulus funds into new grants of this sort, which has led to a shortage of reviewers and likely the need to review grants so fast that peer review may suffer. Fortunately, this is a one-time program.

Despite those problems, the system has largely served us well for the last several decades, as long as politicians are kept as much as possible out of the mix, as what failed to happen with NCCAM. Despite their flaws, the NIH and NSF peer review systems, once in place, have remained remarkably immune to political influence and corruption, at least as much as any government entity can be. Certainly they have much to recommend them. For example, junior scientists compete for funds with more senior scientists on a more equal footing than perhaps any other nation in the world. In fact, new investigators who have never received a major NIH award are even given a significant (although, some would argue, not significant enough) break on funding lines to give them a better chance of being funded. Also, applicants can propose virtually any sort of health science-related research project, and it will be seriously considered for grant funding by a study section composed of experts qualified to evaluate it. Moreover, scientists are actively working to address the system’s shortcomings. Meanwhile, contrary to the impression given by Dr. Miller’s article of a system that scientists accept and never challenge, articles about the problems in the peer review system, and there has been much discussion of this at meetings that I have attended, and the NIH even maintains a web page called Enhancing Peer Review.

Of course, substantive and real reform of the peer review system in order to make it function better and allow the funding of meritorious but risky projects is not the true goal of “critics” like Miller, Esmay, and others. Neutering it is, the better to allow pseudoscience like HIV/AIDS denialism an opening. Mark Hoofnagle was right two years ago to warn us to beware the bashers of peer review.

Posted in: Medical Academia, Politics and Regulation, Science and Medicine

Leave a Comment (73) ↓

73 thoughts on “Cranks, quacks, and peer review

  1. Jivlain says:

    Good points, but I feel that the third and fourth paragraphs are missing conclusions.

  2. Great article. I now have more ammo when creationists, woo-meisters, Dana Ullman and other pseudoscientists make strawman arguments that the peer-review system keeps out new ideas and real science. I’ll have to add this to my extensive list of bookmarks from this site.

  3. mckenzievmd says:

    Excellent article! I certainly agree with the points you’ve made about the desire of pseudoscientists to give their nonsense the appearance of legitimacy by taking on the mantle of brilliant innovator oppressed by the uninspired, conformist orthodoxy. And no doubt the psychology of cranks you described in the previous essay explains much Dr. Miller’s attitude towards the peer review system.

    The only quibble I have is that I think you downplayed the importance of the factor of political ideology. Certainly CAM quacks come from all political persuasions, but consider the venue for Dr. Miller’s rant. Lewrockwell.com is the far fringe of libertarian and Randian thinking, and Mr. Rockwell has an extensive history supporting alternative medicine, including sponsoring a conference at which Duesberg and Miller both spoke (http://www.lewrockwell.com/blumert/blumert118.html). The organizing principle of the conference was the belief that government is inherently evil and incompetant and that the free market does everything better, including science and medicine. Talks were given such as “The Nazi Medical Welfare System,” “Concentration Camps? Fascist Medicine? What Lies Ahead?” (by congressman and MD Ron Paul), and “Alternative Medicine is Libertarian Medicine.”

    I understand Science-Based Medicine is non-partisan, but in opposing quackery we can’t ignore the influence of political ideologies. Much of the legislative success of CAM proponents has come from the appeal of the “health care freedom” concept, in which any attempt to regulate CAM or require scientific evidence for safety and efficacy is cast as an unholy infringement of the sacred individual freedom to buy and sell, even medical therapies that are useless or even harmful. While the lewrockwell.com end of the spectrum is a tiny fringe, the idea that government involvement in promoting science and regulating quackery is an infringement on the market and individual rights resonates with a much larger segment of the public, and we can’t afford to ignore the impact of those arguments on the conflict betwee science and pseudoscience.

    Brennen McKenzie, MA, VMD
    http://www.skeptvet.com
    http://skeptvet.com/Blog

  4. Pliny-the-in-Between says:

    As usual, an excellent article and I believe that the majority of readers agree with importance of the peer review system. It isn’t perfect but anything involving humans isn’t going to be. I do think that it is important to separate peer review of completed research from grant review however as most of the complaints I hear about cronyism come from the grant side rather than the publication side of the equation. There is a tendency to lump them together.

  5. Zetetic says:

    Hmmm….. “Defense Advance Research Projects Agency” – Are these the idiots who funded research for “remote viewing” as a potential methodology to be used by the military intelligence community?

  6. apgaylard says:

    Of course, the cranks can (and do) get around the publication problem by setting up their own journals and selecting peers who are equally undiscriminating or unqualified (Elsevier’s ‘Homeopathy’ is one among many). Then you can get ‘peer reviewed’ quantum-flapdoodle homeopathy papers published.

    Rustum Roy (a very respectable materials scientist turned crank) has his own “super peer review” concept based on reviewing the authors (as I understand it) for his ‘Materials Research Innovations’. It seems to favour people with a good prior publication record – just ideal for a respectable scientist who turns cranky in late career.

    All it needs is a little imagination and the collusion of print-for-profit publishers.

  7. DevoutCatalyst says:

    “…Of course, the cranks can (and do) get around the publication problem by setting up their own journals…”

    Anyone here ever seen a copy of the Townsend Letter for Doctors? Did these guys graduate from high school, possibly?

  8. James Fox says:

    A quick review of Dr. Miller’s web site shows a man completely lacking in critical thinking skills. I’d go so far as to say that there appears to be some near delusional thought processes going on with Dr Miller that could have a deleterious effect on his job performance. Seriously didn’t UW read his bat-shit crazy stuff before they hired him???

  9. James Fox says:

    A quick review of Dr. Miller’s web site shows a man completely lacking in critical thinking skills. I’d go so far as to say that there appears to be some near delusional thinking going on with Dr Miller that seems to me could have a deleterious effect on his job performance. Seriously didn’t UW read his bat-s**t crazy stuff before they hired him???

  10. Jennifer says:

    Anyone who thinks saturated fats contribute to heart disease are not familiar with nor have read the 18 clinical dietary intervention studies and 26 prospective studies on this issue.

    The whole anti- saturated fat agenda is a farce started by Ancel Keys manipulation and ommision of data.

  11. Jennifer says:

    The system has let them get away with lying to people about that for 50 years. So it’s not like mainstream views have that much credibility at all.

  12. weing says:

    And you are qualified to verify this crap?

  13. HCN says:

    James Fox said “Seriously didn’t UW read his bat-s**t crazy stuff before they hired him???”

    He probably starting that crazy stuff after he got tenure. Have you heard of Peter Duesberg and Boyd Haley? — they also have some crazy ideas, yet they are protected with tenure.

  14. marilynmann says:

    For your possible amusement, on this page of the THINCS website, complaints about peer review and how one of Uffe Ravnskov’s articles was rejected by three journals before being accepted by Quarterly Journal of Medicine.

    http://www.thincs.org/links.htm

  15. wales says:

    Here’s an interesting piece on Open Access peer reviewed journals.

    http://www.newscientist.com/article/dn17288-crap-paper-accepted-by-journal.html

  16. David Gorski says:

    The only quibble I have is that I think you downplayed the importance of the factor of political ideology. Certainly CAM quacks come from all political persuasions, but consider the venue for Dr. Miller’s rant. Lewrockwell.com is the far fringe of libertarian and Randian thinking, and Mr. Rockwell has an extensive history supporting alternative medicine, including sponsoring a conference at which Duesberg and Miller both spoke (http://www.lewrockwell.com/blumert/blumert118.html). The organizing principle of the conference was the belief that government is inherently evil and incompetant and that the free market does everything better, including science and medicine. Talks were given such as “The Nazi Medical Welfare System,” “Concentration Camps? Fascist Medicine? What Lies Ahead?” (by congressman and MD Ron Paul), and “Alternative Medicine is Libertarian Medicine.”

    If there’s one thing I emphasize time and time again, it’s that attraction to pseudoscience is a bipartisan affair that spans political ideologies. The differences tend to be in the type of pseudoscience and the reasons. For example, right wingers tend to distrust the government and couch their arguments in terms of freedom, while left wingers tend to be highly distrusting of big pharma and the medical establishment.

    This discussion has broken out on this blog before. Wally Sampson, for instance, tends to blame liberal politics and the rise of postmodernism as the primary drivers of the current infiltration of woo into academia and conventional medicine:

    http://www.sciencebasedmedicine.org/?p=414
    http://www.sciencebasedmedicine.org/?p=234

    In a lively exchange, I’ve pointed out to him that the far right is also quite prone to pseudoscience (in my experience, antivaccinationism, to name one example, spans left and right), even mentioning that the Nazis were big proponents of naturopathy. Kim later pointed out that naturopathy is based on profoundly reactionary ideas and, until recently, was associated not with liberal politics, as it is now, but with hard core John Birch-type politics:

    http://www.sciencebasedmedicine.org/?p=415

    In any case, I think it’s highly simplistic to attribute the quackery that is much of CAM to one political ideology or another. Both sides of the political spectrum are prone to this sort of nonsense.

  17. Gary P says:

    Peer review can be a good filter to keep out junk but can be misused. Peer review is not validation of a paper. It merely means it was worth publishing. I have seen too many claims lately about peer reviewed papers as though it was validation. My main interest lately is in Climate and the claims about AGW. There is a large number of papers about climate modeling and also about what the effects might be if the models are correct. There is a shortage of papers on validating climate models.

    More critically, a number of journals and agencies that control grant money require that the authors make the data and methods available to other researchers. Steve McIntyre has been greatly hampered in his work of auditing many papers by the refusal of the authors to release the data and methods even when required to by journal policies and granting agencies and where the work was funded by the taxpayers. See http://www.ClimateAudit.org for details. The work of Michael Mann who produced the infamous ‘hockey stick’ graph that hid the Medieval Warming Period was completely discredited by Steve McIntyre. Yet this became a very important part of the IPCC reports.

    A drug company that hid data from the FDA on negative or null results would likely face huge fines and lawsuits. Peer review has not been working in the climate journals because the reviewers have been failing to ensure that the data and methods used for the paper are available to other researchers.
    This is inexcusable where many of the climate researchers are claiming that CO2 is damaging the world and immediate action must be taken to reduce emissions.

    If the people sounding an alarm are correct they should do everything possible to see that the work is replicated and validated. How can they rationalize hiding the data?

  18. Chris Noble says:

    If there’s one thing I emphasize time and time again, it’s that attraction to pseudoscience is a bipartisan affair that spans political ideologies.

    Perhaps the same personality type makes them prone to both pseudoscience and extreme political ideologies.

    Cranks overvalue their own capabilities and undervalue those of people with differing views. The same is true of both far right and far left extremists (and other extreme ideologies).

    Personally, I’m fascinated by the differences in the demographics behind the HIV=bioweapon conspiracy theory and the HIV-doesn’t-cause-AIDS conspiracy theory.

  19. Jennifer says:

    Scientists are people and are just as petty and behave just as inapproproately as anyone else.

    Dr. Uffe Ravnskov is showing the Lipid Hypothesis has very little evidence supporting it. If you had read the studies carefully you would know this Marilyn……

    All 18 clinical intervention studies to date , 24 out of 26 prospective studies show no support at all to the anti- saturated fat maina started by he ego maniac Ancel Keys who deliberatey omitted data to “prove” his point.

    Also if you had read The Lipid Research Clinics Coronary Primary Prevention Trial you would know the death rate from CAD in the control group vs the treatment group was 38 vs 30 out of 3,086 patients. The total mortality rate was 71 vs 68 . Completely NON supportibe of cholesterol lowering.

    NON statin drug trials and dietary cholesterol lowering are failures. ONLY STATINS (which have 11 strong other effects besides mere cholesterol lowering) have been shown to reduce CAD mortality ( and only a bit) The results are exaggerated and cholesterol reduction has NOTHING to do with this reduction in CAD mortality.

    Cholesterol Theory proponents knew it was a failure and all you will see in SUMMARIES is the relative risk figure. Typical behvaiour of those who have not gotten the result they wanted and make the numbers SOUND impressive……

    ANYONE who has read “The Great Cholesterol Con” by Anthony Colpo , a fabulous book (with over 1,400 references to look up ) can NOT look you in the eye and say saturated fat and cholesterol contribute to heart disease- THEY DON’T.

  20. Jennifer says:

    The burden of proof is on THOSE saying saturated fat is harmful All Colo and Ravnskov are doing is SHOWING that so far that proof HAS NOT BEEN DELIVERED.

    Saturated fat is NOT a problem in humans. Why don;t you check out Stephan’s detailed article on The Lyon Diet Heart Study on the whole health source blog. It was REJECTED . You know why?

    A HUGE CAD and total mnortality reduction WITH NO CHANGE IN LDL OR TOTA CHOLESTERL. This SHOWS hwo scientists have their beliefs and are PETTY. The Lancet finally picked it up.

    The Cholesterol Theroy is a bunch of bull of the first order, was allowed to gather steam becase of political and money reasosns.

    Colpo and Ravnskov are NOT cranks.

  21. Jennifer says:

    So PLEASE marylnmann become familiar before spouting your mouth off again against Dr. Ravnskov , Colpo and THINCS and displaying your complete ignorance on the research behind the false and farcical anti- saturated fat movement……

    Stephan from whole health source has said EVERYTHING Colpo cites is TRUE and matched what he said. The man is accurate and detailed and ALOT smarter than most of the doctors on this forum..

  22. David Gorski says:

    Jennifer,

    Please do not flood this post with so many repetitive comments. You do not help your case in doing so, especially since these comments are very similar to what you posted elsewhere.

    Perhaps you should read these posts, where some of your concerns have been discussed before:

    http://www.sciencebasedmedicine.org/?p=251
    http://www.sciencebasedmedicine.org/?p=22
    http://www.sciencebasedmedicine.org/?p=219
    http://www.sciencebasedmedicine.org/?p=282
    http://www.sciencebasedmedicine.org/?p=400
    http://www.sciencebasedmedicine.org/?p=385
    http://www.sciencebasedmedicine.org/?p=437

  23. David Gorski says:

    Peer review can be a good filter to keep out junk but can be misused. Peer review is not validation of a paper. It merely means it was worth publishing. I have seen too many claims lately about peer reviewed papers as though it was validation. My main interest lately is in Climate and the claims about AGW. There is a large number of papers about climate modeling and also about what the effects might be if the models are correct. There is a shortage of papers on validating climate models.

    More critically, a number of journals and agencies that control grant money require that the authors make the data and methods available to other researchers. Steve McIntyre has been greatly hampered in his work of auditing many papers by the refusal of the authors to release the data and methods even when required to by journal policies and granting agencies and where the work was funded by the taxpayers. See http://www.ClimateAudit.org for details. The work of Michael Mann who produced the infamous ‘hockey stick’ graph that hid the Medieval Warming Period was completely discredited by Steve McIntyre. Yet this became a very important part of the IPCC reports.

    I’m afraid that citing Climate Audit does not exactly back up your case very well. The reason is that Climate Audit is to climate science what Uncommon Descent is to evolution, Age of Autism is to vaccines and autism, and Science Guardian is to HIV/AIDS. Examples:

    http://scienceblogs.com/deltoid/2005/08/climate-audiot2.php
    http://scienceblogs.com/deltoid/2005/07/climate-audiot.php
    http://scienceblogs.com/deltoid/2008/01/climate_audit_comedy_of_errors.php

    I suggest you march through the points listed in How to Talk to a Climate Skeptic. Pretty darned near all of your complaints are discussed in one of the links from the copious list aggregated there, and it is shown why they are not valid scientific criticisms of AGW.

    As is the case with most climate change “skeptics” I encounter, I think you are conflating what the science says about climate change with policies advocated by various groups to mitigate climate change.

    Now, as to your other point. That is more or less true. Peer review can’t “validate” a paper. Other scientists validate a paper by trying to replicate its results and build upon them. That’s how scientific consensuses are slowly built and ultimately how hypotheses come to be accepted. All peer review can do is to make sure there aren’t any gross methodological flaws and that the background science is not misrepresented, and it often fails a that. However, my point stands, I believe. Cranks aren’t interested in better peer review; they tend to castigate the very concept of peer review, as the examples I cite above show. Indeed, AGW “skeptics” are noted for this, for instance David Bellamy:

    http://scienceblogs.com/deltoid/2009/03/david_bellamy_rejects_peer-rev.php

  24. Jennifer says:

    Davis

    I hope you are able to understand that it is statins pleotropic effects that are responsible for their slight reduction in CAD especially in light of

    *ENHANCE,

    *JUPITER

    *the fact that dietary cholesterol lowering and NON statin cholesterol lowering drug trials were complete failres for reducing CAD mortality

    the fact that with statin drugs there is no dose reponse. ( They have wroked whether cholesterol was lowered a little or a lot) CRP levels predicted mortality best regardless fo resultant LDL levels

    Statins have increased total mortality in many trials and the CAD mortality reduction is not that great- certainly not a miracle drug.

    Statin drugs if anything STRONGLY, STRONGLY REFUTE the Cholesterol Theory.

    CAD is an inflammatory disease.NOT a cholesterol disease.

    If you don’t know this David I feel sorry for you, being that you are a doctor and should know this.

  25. Jennifer says:

    Perhaps you Davis should watch this video from Dr. Malcolm Kendrick on statin drugs to become educated.

    http://www.youtube.com/watch?v=jE_RIQY53ys

    Statin drugs can cause much, much harm and so many have cognitive p[roblems including my dad who now IS OFF them because he has no evidence of heart disease and was being CONNED by his doctor.

    More and mor epatients are wising up , David, and confronting their doctor, hopefully due to Colpo’s and my efforts.

  26. Jennifer says:

    Statin drugs show how The Cholesterol Theory is nonsense. I can’t believe this anti- saturated fat scam has been allowed to go on for so many years……

  27. weing says:

    Jennifer,

    You appear to be spouting nonsense like a lot of religious zealots. Nothing we can say could convince you. The cholesterol hypothesis is well established. Is it the only factor in CAD? Of course not. Why don’t you google PCSK9 deficiency and try to explain the lack of CAD in these people with extremely low cholesterol levels.

  28. Jennifer says:

    I’m YOU KNOW WHO by the way and I have been FROTHING at the mouth to say:

    F U C K YOU DAVID, YOU CHOLESTEROL THEORY PUSHING LOSER SCAMMING AND CONNING YOUR PATINETS

    THEY WILL CONFRONT YOU SOON, WHEN THEY FIND OUT THE DEAL

    WATCH DAVID SQUIRRRRRRM

    UP YOUR BUTTHOLE !!!!!!

    CONFRONT YOUR DOCTORS ON THE CHOLESTEROL SATURATED FAT ISSUE PEOPLE!

  29. Jennifer says:

    YOU ARE UNFAMILIAR WITH THE LIETARURE WEING YOU A S SHOLE WIPE

    READ COLPO’S BOOK LOSER

    YOU WILL SEE IT IS NOT SUPPORTED.

  30. Jennifer says:

    NOTHING SUPPORTS DIETARY CHOLESTEROL LOWERING

    NOTHING SUPPORTS REDUCING SATURATE DFAT

    NOTHING SUPPORTS THE CHOLESTEROL THEORY

    ANCEL KEYS STARTED ALL OF THIS WITH HI SFRAUD

    READ THE PRIMARY STUDIES

    THEY DO NTO SUPPRT THE CHOLESTEROL THEORY

  31. Jennifer says:

    YOU ARE A MISINFORMED LOSER WEING

    YOU HAVE NOT ADDRESSED MY POINTS

    IN FACT THEY ARE SO GOOD, YOU CAN’T.

    THEY CLEARLY SHOW HOW THE CHOLESTEROL THEORY HAS NO EVIDENCE SUPPORTING IT

    LRC-CPPT – NO SUPPORT

    SEVEN COUNTRIES- NO SUPPORT

    ALL 18 CLINCIAL INTERVENTION TRIALSL – NO SUPPORT

    GET FAMILIAR OR BOW OUT

  32. Jennifer says:

    YOU LOSWER WEING

    CHAS AFFECTS PERSONS WITH CHOLESTEROL AS LOW AS 111

    COLPO CITES THE STUDY

  33. Jennifer says:

    CAD CAN AND HAS AFFLICTED A PERSON WITH A CHOLESTEROL LEVELS AS LOW AS 111 MG/DL

    SEVERE ATHEROSCLEROSIS IN FACT

    CHOLESTEROL IS ASSOCIATED

    FIREFIGHTER DO NTO START FIRES BUT ARE USUALLY AT FIRES

    BLAMING CHOLESTEROL FOR HEATR DISEASE IS THE SAME THING

  34. Jennifer says:

    THE ONLY QUAXCKERY HERE IS THE GREED MANIPULATION AND SHODDY SCIENCE BEHIND THE CHOLESTEROL; TJEORY

    DECEIT, GREED MONEY

    THAT IS WHAT THE CHOLESTEROL THEOIRY IS AND HAS BEEN ALL ABOUT

    IT IS COMING OUT SLOOOWLY BUT SURELY

  35. weing says:

    You’re proving my point.

  36. Jennifer says:

    ALSO WATCH DR MALCOLM KENDRICK’S VIDEO ON FAMILIAL HYPERCHOLESTEROLEMIA

    WATCH THRE VIDEO , LOSER

    SORRY TO HAVE DESTYROYED AND S A H T ON YOUR LIFE LONG BELIEFS THAT ARE FALSE

  37. Jennifer says:

    NO WEING I MADE MY POINT CLEARLY

    ALL YOU CAN DO IS AD hominems

    YOU CAN’T DISPUTE WHAT RESERACH HAS FOUND

    NONE OF THE 18 CLINCIAL INTERVENTION STUDIES SHOW ANY SUPPORT TO DIETARY CHOLESTEROL LOWERING OR SDATURATE DFAT RESTRICTION

    NOPNE

    ZERO

    LOOK THEM UPO

    READ COLPO’S BOOK

    READ RAVSKOV BOOK

  38. Jennifer says:

    MINNESOTA CORONMARY SURVEY 1989 NO SUPPRT

    LYON DIET HERTA STUDY NO SUPPORT

    WHI 2006 NO SUPPORT

    ANTI CORONARY CLUB NO SUPPORT

  39. Jennifer says:

    DART 1989 NO SUPPRT

    NMATIONA DIET HERAT STUDY 1968

    NO SUPPORT

  40. Jennifer says:

    READ STEPHAN FROM WHOLE HEALTH SOURCE YOU LOSER WEING

    HE DETAILS LYON DIET HERAT STUDY

    STEPHAN FROM WHOLE HEALTH SOURCE KNOWS THE CHOLESTEROL THEORY IS BULL F U CKING SHIT AND OWNS YOU BUTTHOLE

  41. Jennifer says:

    STEPHAN WHOLE HEALTH SOURCE OWNS YOU

  42. Jennifer says:

    STEPHAN FROM WHOLE HEALTH SDOURCE DETAILED THE LYON DIET HERAT STUDY AND KNOWS THE CHOLESTEROL THEORY OF HEART DISEASE

    IS B U L L F U C K I N G S H I T

  43. Jennifer says:

    Cholesterol Theory worshipping

    L O S E R S

  44. Jennifer says:

    MANY STUDIES HAVE TESTED THE IDEA THAT REDUCING SATURATED FAT REDUCES CAD MORTALITY

    GUESS WHAT YOU LOSER?

    IT DOES NOT

    http://wholehealthsource.blogspot.com/2008/10/saturated-fat-and-health-brief.html

    STILL THINK THE CHOLESTEROL THEORY IS WELL ESTABLISHED YOU A S S HOLE? WEING?

  45. Jennifer says:

    F U CK YOU WEING

    I WIN!

    YOU LOSE

  46. Scott says:

    I’m curious. Do you actually think this sort of thing will make people take you seriously?

  47. Mojo says:

    Full moon is a couple of weeks away, isn’t it?

  48. David Gorski says:

    Jennifer will be banned just as soon as I finish typing this and can get to the control panel. I may have to add a few more variants of the word “fuck” to the spam filters as well.

    Hmmm. I wonder if I can figure out a way to hold any comment in all caps for moderation.

  49. RickK says:

    David,

    Jennifer has provided a brilliant illustration of what it is you and the other SBM folks are fighting against. I don’t think you could ask for better. Joan of Arc would have seemed wishy washy compared to Jennifer’s religious fervor.

    And I applaud this website for offering access to those of dissenting (or, in this case, “disturbed”) viewpoints and commentary. A hallmark of quack/crank websites is their prevention of any dissenting commentary.

    Sadly, you may have to delete her comments as simply inappropriate and “not suitable for work”. But I’m personally glad I saw them.

    Thank you for your (and the other contributors and professionals on this site) efforts.

  50. marilynmann says:

    So far as I know, the dietary intervention for prevention of cardiovascular disease that has the best evidence behind it in the form of randomized controlled trials is fish oil.

    Interesting, it was just announced that the National Cancer Institute is funding a large study (n = 20,000), to be conducted at Brigham and Women’s, on the effect of fish oil and vitamin D on chronic diseases, including cardiovascular disease and cancer.

    Jennifer, I’m already familiar with the views of Malcolm Kendrick, Uffe Ravnskov, Eddie Vos, Mark Goldstein, Luca Mascitelli, and so on. Ravnskov told me that people with familial hypercholesterolemia have a higher rate of heart disease not because of high LDL but because of a higher tendency to blood clotting. There just is no evidence for that.

    Moreover, since my daughter, husband and mother-in-law have FH, and my husband’s relatives have suffered fatal heart attacks as early as their 30s and 40s, this is all very real to me. For years I have been watching my mother-in-law suffer with multiple severe morbidities because of having FH.

    It is true that statins have pleiotropic effects, but the idea that act only through pleiotropic effects, and not at all through cholesterol-lowering, is highly unlikely.

  51. David Gorski says:

    Sadly, you may have to delete her comments as simply inappropriate and “not suitable for work”. But I’m personally glad I saw them.

    Oh, I have no plans to delete Jennifer’s comments. I believe they should stand, so that it is crystal clear to everyone why she was banned. She was so far over the line that she had gone around the world and was rapidly approaching the line again.

    She should also search this blog for “JPANDS” if she wants to see just why the Journal of American Physicians and Surgeons is a crank journal.

  52. “Oh, I have no plans to delete Jennifer’s comments. I believe they should stand, so that it is crystal clear to everyone why she was banned.”

    +1 for this. I absolutely agree with the banning and with leaving her ranting in place as testimony as to why she was banned.

    The risk of SBM getting blocked by some heuristic web filter systems based on language content is worth it.

  53. David Gorski says:

    Jennifer’s still trying to make comments, BTW, under a different login. She’s just as charming as ever.

  54. Calli Arcale says:

    I find it particularly amusing to watch her progressively become more unhinged — first, she starts adding exclamation points, then she starts CAPITALIZING some words (channeling Robert E McElwaine, perhaps?) and then, as she becomes angrier and angrier that simply repeating her unsupported statements is persuading no one, she breaks out into full all caps. From there on, the rate of profanity increases, as does the rate of typographic errors.

    Banishment is actually a blessing; I’d be worried about her developing dangerously high blood pressure otherwise. *snark*

  55. mckenzievmd says:

    David,

    Thanks for your reply to my comment. I absolutely agree on all points, and I certainly didn’t mean to imply that pseudoscience was the province of one ideology or another exclusively. In fact, I believe I even said “Certainly CAM quacks come from all political persuasions…”

    My only point was that pro-market and anti-government ideology has been growing and has played a dominant role in American politics since 1980, and as such has come to influence where the middle ground sits on such issues. This gives CAM proponents a powerful tool. They use suspicion of government and sympathy to free market policies as a way to hamstring government attempts to require reasonable scientific standards of safety and efficacy for CAM and to carve out crticism free niches for herbs and dietary supplements, chiropractic, and so on. Several posts here have pointed this out, specifically in regards to the NCCAM and the DSHEA.

    My hope is that as the political pendulum inevitably shifts, this tool can be weakened and government policy can be made more science-based than it currently is. Obama suggested this as a goal, at least, in his inaugural comments about the “rightful place” of science. And I recently commented on a class-action suit in Alberta, Canada that names the government as a defendant for effectively promoting chiropractic by licencing chiropractors and failing to regulate them adequately, despite the evidence against the method. (http://skeptvet.com/Blog/2009/06/government-fails-to-protect-people-from-harmful-cam/)

    I don’t wish to introduce divisive political issues into the pro-science community, but I do think most of us can agree that the current shifting of the political winds, whatever we may think about them oevrall, may be somewhat helpful to our cause and less friendly to CAM proponents if we can convince people that government has a role in protecting people from CAM and that the market often fails to do so.

    Anyway, as I stated my comment was a mere quibble, and on balance I think your comments were right on target. Thanks again.

    Brennen McKenzie, MA, VMD
    http://www.skeptvet.com
    http://skeptvet.com/Blog

  56. Dave Ruddell says:

    I can understand how people get all unhinged about vaccines and the supposed link to autism (the children!), or various quack cancer therapies (the dying!), or AIDS denialism, but…cholesterol? Seriously? That can turn someone completely nuts?

    I guess I shouldn’t be surprised by what can cause people to go off the deep end in a blog comment section, but I still am.

  57. Zetetic says:

    The only fiercely anti-cholesterol person I’ve ever met was essentially in denial. This person had very poor eating habits and was grossly obese. Subsequently, she had multiple health problems related to this condition. Any discussion of diet or exercise to improve her condition was met with rationalizations about how fats in the diet did not matter or contribute to any of her health problems.

  58. The Blind Watchmaker says:

    Holy crap, who let the trols in?

    Clearly Jennifer’s comments need some peer review.

  59. MisterMarcus says:

    I too have always wondered why the trolls think personal abuse and *LOTS OF CAPITALS AND !!!! MARKS* will convince us.

    BTW David, I would take issue with one of your points. Criticising peer review doesn’t mean you have to suggest a ‘better’ alternative. One can accept the peer review process while still pointing out its flaws.

    I’m sure many scientists have had an experience where they couldn’t (or wouldn’t) publish in Journal X because Reviewer Y or Editor Z is a professional or personal rival. It happens. Openly acknowledging that reviewers are just as capable of bias, pettiness and favouritism as anyone else doesn’t mean peer review should be dumped.

  60. David Gorski says:

    BTW David, I would take issue with one of your points. Criticising peer review doesn’t mean you have to suggest a ‘better’ alternative. One can accept the peer review process while still pointing out its flaws.

    Quite true. But, once again, that’s not what cranks do. They point out flaws, real, exaggerated, and imaginary, in order to delegitimize peer review and argue that the reason it rejects their woo is because it is hopelessly biased.

  61. Mojo says:

    The point is that cranks criticize peer review in order to reject it.

  62. Gripe says:

    To be fair to the deranged poster, there is a growing body of evidence that low carbohydrate (high fat) diets not only compare favourably to low fat diets in terms of fat loss and treating metabolic disorders, but also improve blood lipids.

    Of course, then there is the age old problem – What did they actually measure? ie What is a better predictor of CVD – TC and LDL-C, or HDL-C, TG and small dense LDL percentage? A high fat diet often increases TC and LDL-C, but it does the former by increasing HDL-C and the latter by shifting from predominantly atherogenic Pattern B LDL to non-atherogenic Pattern A LDL; meanwhile, a low fat diet usually decreases both HDL-C and LDL-C, but achieves the latter by shifting LDL from Pattern A to Pattern B. According to the conclusions of studies that measure only TC and LDL-C, such patients on a high fat diet are increasing the risk of CVD, while those on a low fat diet are reducing it. This is then used by various diet experts as evidence to support a low fat diet. However, such a conclusion appears not to take into consideration the fact that Pattern A LDL cannot physically penetrate the endothelium to begin the ‘plaquing out’ process, whereas Pattern B is not only up for the job but is also more prone to the dreaded oxidation that gets the ball rolling. Obviously this is simplified, and there are other risk factors involved, but in those who manage/eliminate them, this is the conundrum with which they are faced – Different measurements lead to two completely different pieces of dietary advice. If there supposedly IS an ‘optimum’ diet for human beings, which is it – Low fat or low carb?

    My two cents: The problem with denialists is that they get personally involved in the ’cause’ and start projecting their indignation onto the science – it becomes a crusade for spreading their ‘truth’ rather than a simple quest for personal knowledge. I find the best way to avoid bias is to simply disdain people in general, and therefore not be swayed by either literary charisma or general nutty-ness, thus allowing me to exercise judgment based upon the merit of the argument, not the source. The peer-review process is, in my opinion, as good as it will probably ever be while it is conducted by human beings. As I often say, no species perverts science like we do!

    However, in the case of the role of fat and cholesterol (in their various forms and vehicles) in CVD, there is certainly a cause for concern about how the media, government, the various ‘heart foundation’ enterprises’ and ‘nutritionists’ have (perhaps inadvertantly) helped build a seemingly solid foundation for a predominantly glucose-(hence triglyceride)based diet (through the demonisation of fat) based on what is slowly revealing itself to be quite simplistic and certainly incomplete science.

    Now wasn’t that better than Jennifer’s arguments?

  63. storkdok says:

    New troll?

    Very nice discussion!

  64. Gripe says:

    Oddly enough, I am a tad kyphotic. Since I wasn’t born with the condition, I postulate that it is due to the enormous weight of the club I carry…

  65. marilynmann says:

    I am not a nutritionist, but I agree that simply focusing on cutting saturated fat can lead you astray. You could end up eating lots of fat-free cookies and the like. There is a fair amount of evidence for the benefits of the Mediterranean diet. See this heartwire article for details: http://www.theheart.org/article/982093.do

  66. Gripe says:

    The latest CVD research tends to point to endothelial dysfunction as the mastermind behind plaque (Cholesterol – surely not the fall guy, you say?); which makes sense (if you are looking at low carbohydrate diets) when you consider that it is high GI carbohydrates that are the most inflammatory foods. The Mediteranean diet contains a great deal of whole foods, thus minimising high GI carbs sources (which even ‘nutritionists’ agree are often part of processed foods). I notice that the scientists include a MUFA to SFA ratio, yet where was the ratio of low GI to high GI carbs? Blatant macronutrientism, if you ask me!

  67. marilynmann says:

    Gripe,

    I’m not sure I totally understand the points you are making, but you are right that endothelial dysfunction is a hallmark of cardiovascular disease. Moreover, it tends to be associated with cardiovascular risk factors, including hypercholesterolemia.

    Statins improve endothelial function — that is a feature of their “pleiotropic” effects.

    Liu, et al., Evidence for Statin Pleiotropy in Humans: Differential Effects of Statins and Ezetimibe on Rho-Associated Coiled-Coil Containing Protein Kinase Activity, Endothelial Function, and Inflammation. Circulation. 2009;119:131-138.

    http://circ.ahajournals.org/cgi/content/abstract/119/1/131

  68. EddieVos says:

    Dr. Gorski, first, let me suggest you DO remove postings like by Jennifer and not leave them to show what person he/she might be, and replace the posting with the mention “removed by moderator for containing rudeness or insult”. That saves space and inspire all to be polite and not at hominem. Any gutter or toilet word would qualify. A blog referenced above, WholeHealthSource, is an example of massive and polite exchanges.

    Secondly, I am a long term member of thincs.org, so ‘delightfully skewered’ in an earlier blog. While I think the main cause of cardiovascular disease is homocysteine [ http://www.health-heart.org/why.htm ] and that cholesterol per se is not the cause of arterial decline, we do have to deal with statins. Let me refer to this letter regarding Crestor / the JUPITER study: http://circoutcomes.ahajournals.org/cgi/eletters/2/3/279#83
    After spending $m29 on Crestor at the July 2009 Vermont price, NO statistically significant difference in cardiovascular deaths [P=0.37] or in all-cause deaths [P=0.17 if you accept the steering committee's theory that a cancer mortality benefit was one of chance].

    What statins DO do is simple: they ‘imitate’ safe and cheap nitroglycerin**) and thus fewer people are recorded with non fatal chest pain but that sends some people to the interventional cardiologists. Indeed, JUPITER’s MAIN finding was a reduction in interventions from statin. Here’s the simple way to see the effects of Crestor / rosuvastatin: http://www.health-heart.org/JUPITER_Table_3_Outcomes.gif

    So, maybe there is some evidence base to the scepticism of thincs members regarding the use of statins, even in most high-risk groups. Can the U.S. afford to spend $m29 on 8900 high-risk people for a drug [class] that fails to save people in a fatal disease?

    I am with Marilyn regarding omega-3′s and, in my case, a good multivitamin to lower homocysteine, agreed artery toxin.

    **) The Liu group Marilyn mentioned in the posting above has done truly superb work in that department!
    vos{at}health-heart.org

  69. EddieVos says:

    Dr. Gorski, first, let me suggest you DO remove postings like by
    Jennifer and not leave them to show what person he/she might be, and
    replace the posting with the mention “removed by moderator for
    containing rudeness or insult”. That saves space and inspire all to be
    polite and not at hominem. Any gutter or toilet word would qualify. A
    blog referenced above, WholeHealthSource, is an example of massive and
    polite exchanges.

    Secondly, I am a long term member of thincs.org, so ‘delightfully
    skewered’ by HH in an earlier blog [actually a very intelligent exchange
    of ideas and data]. While I personally concluded that the main cause of
    cardiovascular disease is homocysteine [
    http://www.health-heart.org/why.htm ] and that cholesterol per se is not
    the cause of arterial decline, we do have to deal with statins. Let me
    refer to this letter regarding Crestor / the JUPITER study:
    http://circoutcomes.ahajournals.org/cgi/eletters/2/3/279#83
    After spending $m29 on Crestor [at July 2009 Vermont price] NO
    statistically significant difference in cardiovascular deaths [P=0.37]
    or in all-cause deaths [P=0.17 if you accept the steering committee's
    opinion that the cancer mortality benefit was likely by chance].

    What statins DO do is simple: they ‘imitate’ safe and cheap
    nitroglycerin and thus fewer people are recorded with non fatal chest
    pain that sends people to the interventional cardiologists. Indeed,
    JUPITER’s MAIN finding was a reduction in interventions from statin.
    Here’s the simple way to see the effects of Crestor / rosuvastatin:
    http://www.health-heart.org/JUPITER_Table_3_Outcomes.gif

    So, maybe there is some evidence base to the scepticism of thincs
    members regarding the use of statins, even in most high-risk groups. Can
    the U.S. afford to spend $m29 on 8900 high-risk people for a drug
    [class] that fails to save people in a fatal disease?

    I am with Marilyn regarding omega-3′s, and in my case a good
    multivitamin to lower homocysteine, agreed artery toxin.
    vos{at}health-heart.org

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