Articles

Science-based medicine, skepticism, and the scientific consensus

Editor’s note: This weekend was a big grant writing weekend for me. I’m resubmitting my R01, which means that between now and July 1 or so, my life is insanity, as I try to rewrite it into a form that has a fighting chance of being in the top 7%, which is about the level the NCI is funding at right now. This weekend, I buried myself in my Sanctum Sanctorum and tried like heck to try to pound the revision into a really good draft that I can distribute to my colleagues for feedback. Fortunately, I have some old posts that I can pull out, tart up (i.e., update a bit, as in correcting the parts that led me to groan as I reread them, thereby hopefully making them better). I think they’re quite good, if I do say so myself; so hopefully you will too.

There are some arguments made in blogs, articles, or books that strike me so hard that I remember them, even three and a half years later. Sometimes I even file them away for later use or response if the issue raised by them is interesting, relevant or compelling enough to me. Although this topic is a bit broader than many of the topics I write about for this blog, I think it also goes to the heart of science-based medicine and communicating scientific skepticism about medicine to the masses. A few years back, a Swedish blogger named Martin Rundkvist made a rather provocative observation about skepticism. Specifically, he argued that a “real skeptic always sides with scientific consensus.” Among his reasons was this one:

Science presupposes that all participants have a skeptical frame of mind and arrive at conclusions through rational deliberation. If a large group of knowledgeable people working in this way arrive at a consensus opinion, then there is really no good reason for anybody with less knowledge of the subject to question it. Informed consensus is how scientific truth is established. It’s always provisional and open to reevaluation, but as long as there’s informed consensus, then that’s our best knowledge. Humanity’s best knowledge.

Although at the time I saw where Martin was coming from, I found this viewpoint somewhat disturbing, leading me to echo Martin’s own words in response to his own rhetorical question asking whether accepting a scientific consensus is nothing more than “kowtowing to white-coated authority”: Well, yes and no.

For a skeptic and supporter of science-based medicine, in matters of science it is undoubtedly true that the scientific consensus is always the best place to start when evaluating unfamiliar issues. While it is certainly possible that a given scientific consensus regarding an issue can be wrong in almost any area, it nonetheless almost always represents the best current scientific understanding. It is also correct, as Martin argues, that legitimate authority matters. I emphasize the word “legitimate” because in pseudoscience arguments from authority are common, but rarely is the authority relevant to the point being argued. Often it’s not even legitimate, as in when anti-vaccine activists point to Andrew Wakefield’s work as justification for their claims that vaccines cause autism and other conditions. Like Martin, I’m more inclined to accept the pronouncements of someone who has actually dedicated his or her life to studying the issue systematically; i.e., an expert. If the topic is evolution, then that expert would be an evolutionary biologist. If the topic is the Holocaust, then a historian specializing in World War II and/or the Holocaust would represent an appropriate expert. For cancer, an appropriate expert would be an oncologist (or an surgical oncologist, such as myself). The list goes on.

Where I start to have a bit of a problem with Martin’s viewpoint is when I start to contemplate the nature of scientific consensus itself in many areas of science. Not all scientific consensuses are created equal because, in different fields the strength of scientific consensus can vary quite markedly depending upon the topic or even the subtopic within the topic. For example, the scientific consensus supporting the theory of evolution, particularly common descent, is exceedingly strong. It’s one of the strongest of all scientific consensuses, arguably the strongest. Similarly, the consensus that natural selection is a major driving force behind evolution is very nearly as strong. However, as the discussion devolves into more detailed areas, inevitably the consensus weakens. Eventually, subsidiary areas of a discipline are reached where the consensus is weak or where there is no consensus, such as what the function of “junk DNA” is, whether it is subject to natural selection, and if so how much. (Real evolutionary biologists could probably come up with a better example.) These sorts of questions are often at the cutting edge of scientific knowledge, and it is not always easy to recognize what they are. It is also these issues at the edge of our knowledge that are attacked as proxies for the much more strongly supported core theory. Creationists are notorious for this sort of tactic, often using new findings of molecular biology that appear peculiar or out of sync with specifics of evolution as wrecking balls to try to demolish the edifice of “Darwinism.” I can’t count the number of times I’ve seen supporters of “intelligent design” creationism point to either “junk DNA” or the findings of new genomic techniques as “evidence” that “Darwinism” is doomed. Never mind that some of the very strongest support for the theory of evolution, in particular common descent, comes from genetics and that new genomic techniques only keep confirming that.

The same is true of scientific consensuses in many other disciplines, including my own disciplines of medicine and surgery. However, scientific consensuses in medicine are almost never as strong as the theory of evolution. Germ theory of infectious disease probably comes close, but otherwise I’m hard-pressed to think of one. Usually, the strength of a consensus in medicine is proportional to the ratio of data supporting it that comes from randomized clinical trials to data from epidemiological studies, the latter of which are more prone to confounding factors. That does not, however, mean that there doesn’t exist strong consensus about many medical issues. For example, there is, for all intents and purposes, no doubt that HIV is the causative agent for AIDS, the claims of HIV/AIDS denialists notwithstanding. Similarly, there is in essence no doubt that smoking cigarettes vastly increases a person’s risk of lung cancer and heart disease, along with a host of other medical problems. Not even the tobacco companies try to argue against that anymore. When we come to subsidiary questions, however, the consensus is generally not as strong. For example, it has become increasingly appreciated that secondhand tobacco smoke increases the risk of heart disease and lung cancer in people chronically exposed to it. However, because the effect is considerably smaller than it is for people who actually smoke cigarettes, there is a lot more “noise” in the studies, giving more wiggle room for people who dislike the idea of the government banning smoking to claim that such bans are not scientifically supported, and it’s taken a long time for scientific and clinical studies to firm up the conclusion enough to the point that it is now a strong consensus.

Not surprisingly, given the difficulty doing controlled experiments and the nature of the material, which makes it more easily politicized or influenced by biases, a truly strong consensus is harder to come by in the humanities and social sciences. However, even so, it is not impossible. For example, one of my areas of interest is the Holocaust. There is overwhelming and incontrovertible evidence that the Nazi regime embarked on a systematic program to round up and exterminate the Jews in territories they controlled. Methods used included shooting, hanging, gas chambers, and a system of camps designed to literally work their inmates to death through a combination of grueling labor, insufficient food, and unsanitary and crowded conditions. However, this consensus becomes less clear when various issues surrounding the Holocaust are discussed. For example, there is the whole “intentionalism” versus “functionalism” debate. In a nutshell, this debate is over the question of whether the intent was there from the very beginning of the Nazi regime or even before the Nazis rose to power to exterminate the Jews or whether the Holocaust evolved “organically” or “functionally” from the persecution of Jews that began early in the Nazi regime and became increasingly radical and violent in the pre-war era, the radicalization of Nazis carrying out the program, and the question of what to do with the millions of Jews that suddenly fell under Nazi control after Hitler had invaded the Soviet Union. Holocaust deniers love to misrepresent and misuse this debate to claim that Hitler didn’t know about and didn’t order the Holocaust or to claim that there was never a plan to systematically exterminate European Jewry.

One thing that I’ve come to realize is that it’s not always obvious when skepticism devolves into denialism. In some cases it’s pretty easy, for example creationism, Holocaust denial, HIV/AIDS denialism, anti-vaccine activism and the germ theory denialism that often fuels it, and many sectarian belief systems that lead to the use of unscientific “alternative” medicine, such as homeopathy. Sometimes, appropriate skepticism about most scientific issues can exist side-by-side in a single person with credulity and pseudoskepticism about other scientific issues. For example, among skeptics who count themselves science-based, there is a disturbingly large contingent who do not accept the science behind anthropogenic global climate change, as Penn Jillette, for example, does not. Only recently does he appear to be grudgingly dragged towards accepting the scientific consensus in this area. His resistance to the idea appears to be due to his Libertarian beliefs.

One example that I used to use routinely before she shut down her blog was Sandy Szwarc at Junkfood Science. Most of her non-obesity-related posts were often actually not too bad. However, whenever she blogged about diet and obesity, there was usually a problem, sometimes a big problem like the one Steve Novella blogged about a couple of years ago. And it’s not the sort of thing that necessarily jumps right at you off of her blog, as it does from an obvious crank blog like Age of Autism. Certainly it didn’t for me. Rather, it’s the sort of thing you have to read her blog closely for a while (which I did) to start to realize. As I read her blog, more and more it bothered me that all of her “skepticism” was inevitably in the direction that being obese is not only not unhealthy but is actually at least as healthy as not being obese, that eating fatty foods is perfectly fine, and that virtually any study she looks at that says that eating fatty foods or too many calories predisposes to health problems is a pile of crap while any pile of crap study claiming otherwise is the latest and greatest. All of this led her to conclude that virtually every warning made by scientists and physicians about diet is fearmongering. Worse, she had a distressing tendency to use unscientific tactics, such as cherry picking data, attacking consensus, and alleging conspiracies. I also found it telling that, unlike most bloggers, myself included, Szwarc does not permit comments. If there’s one thing that skeptics usually encourage (as we do here on SBM), it’s spirited debate. That’s impossible in a blog that doesn’t permit comments.

In the end, I remain a bit uncomfortable with Martin’s blanket statement that “a real skeptic always sides with scientific consensus.” The reason is that what the scientific consensus actually says is not always that clear for many issues, even among those who work in the field. Indeed, there are comparatively few issues in science (evolution, for example) for which a strong consensus exists, and even fewer in the social sciences and history (the Holocaust, for example) for which an equally strong consensus exists. These are very strong consensuses, and to overturn them would require extraordinary evidence, evidence at least equal to the evidence supporting them. Consequently, when someone says that evolution is false or that the Holocaust didn’t happen (or the lessor form of Holocaust denial, that nowhere near 6 million Jews died), it’s fairly easy to recognize such person as a crank and denialist, and I usually do not hesitate to label them as such when appropriate.

But what about consensuses that are strong but not as bullet-proof, usually because, although there is a consensus, there are fairly wide error bars around the predictions or uncertainty regarding the importance of various factors? The prototypical example of this is anthropogenic global warming, for which there is a strong consensus among climate scientists but still a fair amount of uncertainty about the outcome. Another example, of course, is the scientific consensus about the link between obesity and adverse health outcomes. How do we differentiate legitimate skepticism about the consensus from denialism?

This is where I tend to agree with Mark Hoofnagle. It’s more about tactics and how evidence is used to support an argument. Scientific skepticism looks at the totality of evidence and evaluates each piece of it for its quality. Cranks are very selective about the data they choose to present, often vastly overselling its quality and vastly exaggerating flaws in current theory, in turn vastly overestimating their own knowledge of a subject and underestimating that of experts. In medicine in particular, denialists frequently emphasize anecdotes over epidemiology, clinical trials, and science. They also tend to leap to confuse correlation with causation. A great example that I just saw a week or two ago comes from our “friends” at the anti-vaccine group the International Council on Vaccination, a group that Mark Crislip and I had such fun deconstructing. There, Sherri Tenpenny posted an article entitled Vaccines and Blue Foot Syndrome (crossposted on her own blog). In the post, after citing anecdotes about “vaccine injury,” Tenpenny then segues into a story of a child who dropped a large frozen turkey on his foot, which became painful and blue within hours. The parents are then confronted with doctors who tell her that this is “Blue Foot Syndrome” and that they have shown by epidemiology that it is not linked to being struck by a frozen turkey. It’s an analogy obviously designed to mock scientists who quite correctly refer to the studies that have failed to find a link between vaccines and autism that ignores the fact that correlation does not necessarily equal causation and that the correlations reported by parents are not nearly as obvious as a blue foot after having a frozen turkey land on it. Anti-vaccine activists think they are, though.

In addition, because the mainstream rejects their ideas, there is often a strong sense of being underappreciated—persecuted, even—among cranks, leading them to view their failure to persuade the mainstream of the correctness of their views as being due to conspiracies or money. Global warming denialists, for example, tend to see the currently existing scientific consensus as being politically motivated by the desire of “liberals” to tell them how to live. Evolution deniers view evolution as the result of atheistic scientists wanting to deny God. People like Sandy Szwarc view the consensus that obesity leads to health problems as being due more to moralizing and bigotry against the obese, which, whether it is true or not, is an easy claim to make because there has been and is a lot of bigotry against the obese. Antivaccinationists view the rejection of their belief that mercury in vaccines or even vaccines themselves cause autism by mainstream medicine as evidence that we’re all in the pocket of big pharma. Practitioners of “complementary and alternative medicine” view the rejection of their beliefs in homeopathy, “energy healing,” and vitalism similarly: Science-based doctors must be in the pocket of big pharma! Or they’re close-minded! Or they’re threatened by the “success” of alternative medicine!

What a lot of this distinction boils down to is that crankery, denialism, pseudoskepticism, or whatever you want to call it tends, either intentionally through ideology or unintentionally through an ignorance of the scientific method, to conflate and/or confuse emotiona, nonscientific, and/or ideological arguments with scientific arguments. This is not to say that scientists and skeptics and supporters of SBM are free from their own biases, whether ideological or simply a desired result that they hope to find. Far from it. However, skepticism means applying the scientific method to claims, whatever its faults, scientific method is the best method thus far devised to minimize these biases. As scientists, the reason we use the scientific method is not because we consider ourselves superior to the cranks, but rather because we recognize that we are human too and thus just as prone to falling into the same traps as they. As Richard Feynman once famously said, “The first principle is that you must not fool yourself—and you are the easiest person to fool. So you have to be very careful about that. After you’ve not fooled yourself, it’s easy not to fool other scientists. You just have to be honest in a conventional way after that.” The scientific method is, above all, a methodology by which scientists try to avoid fooling themselves. Skeptics cross the line dividing skepticism and denialism and quacks the line between science and quackery when they forget that.

Moreover, skeptics and supporters of SBM know that science is a work in progress. What is considered correct today may well be modified tomorrow. This change, however, is not brought about by cranks cherry-picking data but by rather skeptical scientists probing for weak spots in our current understanding, making hypotheses, and then testing whether current theory or the new hypotheses make the better prediction. Thus, being skeptical of the consensus is not the mark of the crank. It’s how and why that skepticism exists that distinguishes crankery from genuine scientific skepticism.

Posted in: History, Medical Academia, Science and Medicine

Leave a Comment (107) ↓

107 thoughts on “Science-based medicine, skepticism, and the scientific consensus

  1. nybgrus says:

    An excellent post Dr. Gorski. Good luck with your grant – R01 is some tough stuff.

    I think this article sums up a lot of what I have commented about over the past year and reflects a lot of what I have been learning. I think I would add though, that while Rundkvist’s notion that “a real skeptic always sides with the scientific consensus” is certainly too far, I think it actually should always apply as a default stance when addressing a consensus in a field you are not intimately acquainted with.

    In other words, when I learn of a consensus in economics or particle physics I always assume the consensus to be correct. If it doesn’t make sense to me then I try and actually learn the consensus and what the experts are trying to say and then form a skeptical opinion based on that. I suppose I’m trying to say that while a real skeptic needed always side with the scientific consensus, (s)he must always start with the assumption it is correct and then try to conscientiously disprove if necessary instead of immediately attacking.

    As Dr. Gorski said (and I recently did in a thread over at NeuroLogica) it is easy to pick apart the edges of scientific understanding, but to assume that tear goes all the way back to the basics of a consensus/theory is denialism for sure.

  2. daedalus2u says:

    Nice article, and I think you have laid out the consensus viewpoint of skeptics pretty well. However I must pretty much completely disagree with it. When there is an actual consensus, usually it is a reasonable heuristic to go along with it, but that heuristic does not rise to the level of an argument or data. It is an argument from authority, but with the “authority” being distributed across those who are in consensus.

    A skeptic can never argue from authority, even when that authority is the consensus of the field, a skeptic can only argue from facts and logic. If a skeptic doesn’t have the facts and logic to back up and idea, the skeptic has to default to “I don’t know”. A skeptic may take the position that “I don’t know, but I will provisionally accept the consensus viewpoint until I know enough to make up my own mind about it”, but that is not a valid argument.

    Some fields do get hijacked by cranks who then enforce their “consensus” viewpoint by censoring other viewpoints. A good example of such a field is the genetics of intelligence.

    Peter H. Schonemann (late) was a researcher who did try to stand up to the “consensus” and documented his struggles.

    http://en.wikipedia.org/wiki/Peter_Sch%C3%B6nemann

    For example in this paper:

    http://www.schonemann.de//pdf/86.pdf

    I appreciate that skeptics want to be able to make arguments outside of their fields of expertise, and that usually the consensus of a field is a good place to start, but the consensus can be hijacked and be demonstrably wrong. That is the goal of cranks, to hijack a scientific field and impose their own bogus “consensus”. That cranks have succeeded in doing so, does not make their bogus “consensus” correct.

    The genetics of intelligence field is a good example of a field taken over by cranks because there are a lot of issues that have been raised, by Schonemann and by others and the field has not addressed them. These are not peripheral issues, they go to the core of the field, the definition of “g”, and how IQ tests supposedly measure it (they do not). The recent genetics data also does not support the idea that intelligence is largely genetic. The “genes for intelligence” can’t seem to be found.

    The faux consensus in the genetics of intelligence field is not like the true consensus in the AGW field. The theoretical basis of AGW goes back over 100 years and is based on extremely well tested and consistent theories of radiative heat transfer. The only uncertainty in the AGW models is the degree to which there will be warming, how much there will be, how fast it will happen and what the effects will be. That there is ongoing global warming due to CO2 buildup in the atmosphere is not at all in doubt.

    AGW denial is being funded by fossil fuel interests. If they had the ability, they would exclude the real scientists and only allow their crank views to be published.

    That the genetics of intelligence field has been hijacked by cranks is an unfortunate adverse side effect that can happen with peer review. Once the cranks can reach a critical mass and can exclude the non-cranks, then a field is doomed. It is like the acupuncture field. Acupuncture researchers are unable to accept that acupuncture is a placebo. When toothpicks have the same effects as needles, they proclaim “toothpicks work too”, rather than conclude acupuncture itself is a placebo.

    This is also an adverse effect of such low pay lines. When 93% of proposals are rejected, it is trivially easy to apply non-scientific criteria to those proposals and not fund ideas that are “controversial”, go against the mainstream, or that are well decided, or that are “high risk”.

  3. kulkarniravi says:

    David,

    Very erudite and well argued piece. But I notice you don’t bring in the “hard sciences” such as physics or chemistry in your arguments. The consensus is also very strong in those fields, if not stronger than, say, in epidemiology. In my opinion, it is wrong to give the status of “hard science” to medicine as it is practiced today. To illustrate I will use another field: cosmology.

    Until Copernicus, the western civilization thought the earth was the center of the universe. There was a very strong consensus among the lay people, scientists and even clergy. People were even burnt at the stake if they thought otherwise. And we all know what happened after Copernicus. The reason is quite simple: cosmology deals with a subject that is very vast and there are, even now, a large number of unknowns. So I would take the “strong consensus” that exists among cosmologists with a grain of salt, because, to be fair even they are assuming a lot of things which may or may not be true.

    Human body is like the universe. There are still a large number of unknowns. Practitioners of medicine would like (or at least would like us lay people) to believe they know everything. There is no doubt there is a “strong consensus” even among them about a large variety of topics related to medicine. The reasons for the wide spread delusion are the same as those that existed prior to Copernicus – fear of authority among academics and inability to think outside the box. When there is an establishment that benefits a large number of people that flock together, it is difficult for the practitioners to question their core beliefs. It is indeed hard to overcome the human nature.

  4. daedalus2u says:

    K, nice straw man and ad hominem attack on medical professionals. No medical professional I have ever known or have ever worked with has ever tried to make me believe that they knew everything. Virtually all have been professionals, and the mark of a professional is knowing your limits.

    The author of this post, a medical professionals with one of the largest egos that I know doesn’t do that. His large ego is well deserved because he does know a lot. It is even more well deserved because he doesn’t BS about what he doesn’t know. He does what all good professionals do, works within the limits of his knowledge, and expands that knowledge when it is insufficient.

    In my experience is it non-professionals, usually cranks who think they know a lot more than they actually do. Much of what they think they know is actually wrong. It wasn’t professional astronomers who persecuted Galileo, it was religious authorities.

    Delusion has a specific meaning: “adherence to a false belief when there is overwhelming evidence that the belief is false”. By that definition there is essentially no “delusion” among medical professionals. It is only cranks and quacks that adhere to false beliefs even when there is overwhelming evidence that the belief is false. From all that I have read, it is cranks and quacks who are claiming to know more than they do know, not mainstream medical professionals.

    Your belief that there is a lot of delusion in the medical profession is itself a delusion.

  5. tyro says:

    Dr Gorski,

    Great article, not dusty at all. I’m sure we’ve all had experiences where we’ve either come across these people or perhaps we’ve even been these people.

    Can people think of any examples where the consensus is possibly or probably wrong? If you suspect that it is wrong, what are some things to look for to confirm or reject your hypothesis?

    As background, I’ve gotten into discussions with people who represent themselves as biblical scholars and who say that the consensus of the field is X and I’m acting like a crank for disputing it. However, I question whether the consensus is reached through the unbiased evaluation of evidence as in the best physical sciences or whether it has been strongly biased by the (faith-based) prior belief of the members. Since it is bible studies, there’s a lot more at play than merely the best practices of science

    I am a rank amateur so my opinion counts for little but when I read the arguments on both sides, the anti-X side seems to deal with all the evidence in a fairer, more respectful sense while the pro-X side (representing the consensus) seems more dismissive of evidence and ad hoc in their explanations. How should I, as an outsider and would-be sceptic, make this call?

  6. Scott says:

    @ Daedalus:

    A skeptic may take the position that “I don’t know, but I will provisionally accept the consensus viewpoint until I know enough to make up my own mind about it”, but that is not a valid argument.

    It’s not meant to be an argument. It’s a way to reach conclusions, not a way to convince others of that conclusion. This is an important distinction, to be sure, but it is what it is.

    @ K:

    Until Copernicus, the western civilization thought the earth was the center of the universe. There was a very strong consensus among the lay people, scientists and even clergy.

    Largely unrelated to the topic of the post, since that consensus wasn’t vaguely scientific. (Meaning that it was not reached via the scientific method.)

    So I would take the “strong consensus” that exists among cosmologists with a grain of salt, because, to be fair even they are assuming a lot of things which may or may not be true.

    It’s not a good approach to describe an entire field as a single consensus, because that glosses over all those differences Dr. Gorski was talking about. Going on with this example, the consensus that the Big Bang + inflation model is a very good description of our actual universe is very strong and needs minimal seasoning. The exact effects of dark energy on large-scale structure, on the other hand, is open to far more question.

    So unfortunately your post rather falls apart on close inspection.

  7. tyro says:

    @Scott

    Largely unrelated to the topic of the post, since that consensus wasn’t vaguely scientific. (Meaning that it was not reached via the scientific method.)

    I take your point but to what extent could we, as outsiders, know that a conclusion is scientific or not? I think that’s the point they were getting at and it’s one I’m interested in myself. Clearly religion and faith are biasing the decisions but how do we know that at the time. Is faith a sufficient reason to reject the consensus or just a reason to look more closely?

  8. Scott says:

    You know by looking at the sort of arguments being made, as a starting point. Are they referring to scientific literature? Or the Bible?

  9. daedalus2u says:

    tyro, not knowing the facts and the logic yourself is always reason enough to not believe the consensus. That is what you have to do if you are a skeptic. You may provisionally accept the consensus as a consensus, but that is a faith-based belief (a belief based on faith in the consensus), and not a belief based on facts and logic (the only beliefs that are valid to a skeptic).

    If you don’t have the facts and logic to backup one belief, you are right to reject it, but then you can’t substitute another belief for which you also don’t have facts and logic to back it up either. You have to reject all beliefs for which you don’t have facts and logic.

    When a consensus is arrived at from other than facts and logic, that consensus has even less weight than a consensus that is arrived at through facts and logic. The “consensus” of the Catholic Church was not arrived at via facts and logic, such a consensus is never sufficient for a skeptic. One can accept a faith-based consensus as a matter of religious faith, but that is about religion, not about reality. The Catholic Church has as one of its articles of faith that the existence of God can be rigorously proven. Unfortunately they are unable to provide such a proof, but that one exists is one of their articles of faith. They didn’t arrive at that belief via facts and logic, or they would have such a proof before believing it existed.

    When you are a skeptic, you don’t get to pick and choose what to believe. You have to go with the most reliable facts tied together with valid logic, and then your conclusions are never more certain than the facts and logic that you use to arrive at them.

    The default of a skeptic has to always be “I don’t know” when the skeptic doesn’t have sufficient facts and logic to back something up. The default of a skeptic is never “this idea is wrong” when the skeptic has insufficient facts and logic to demonstrate that.

    This is something I come across a lot with pseudoskeptics and my nitric oxide ideas. Pseudoskeptics try to argue but don’t have the facts to argue with, so they make arguments from ignorance. That isn’t skepticism, that is rhetoric.

  10. David Gorski says:

    Very erudite and well argued piece. But I notice you don’t bring in the “hard sciences” such as physics or chemistry in your arguments.

    That’s because I’m a physician, not a physicist, and I tend to try to stick to what I know. Less chance of embarrassing myself that way. :-)

    As for Daedalus, I don’t really have time to go into why I think he’s a bit off-base about scientific consensuses and arguments from authority. Certainly, he’s bashing a bit of a straw man. For instance, my jaw dropped when I read, “tyro, not knowing the facts and the logic yourself is always reason enough to not believe the consensus,” but explaining why will probably have to wait until I get home from work.

  11. daedalus2u says:

    David, we are much more in agreement than not. My point about not “believing” the scientific consensus is that a skeptic can’t “believe” anything. A skeptic certainly can’t adopt a belief just because someone else has it, or even if zillions of other someones have it, even if those someones are scientists.

    I am going to be tied up until this evening too.

  12. kulkarniravi says:

    David,

    “That’s because I’m a physician, not a physicist, and I tend to try to stick to what I know. Less chance of embarrassing myself that way. :-)”

    I guess I was not clear enough. You are comparing medicine with other disciplines such as global warming or evolution. As a scientific discipline is medicine at the same level as physics or chemistry? My contention is that it is not.

  13. Manduca says:

    Geocentrism may have been consistent with biblical descriptions of the universe, but belief in it wasn’t strictly a matter of faith.

    There was good scientific evidence to conclude that the earth was the center of the solar system. Aristotle correctly reasoned that if the sun was at the center, we should see parallax of the stars. We do not see parallax (with the naked eye). Tycho Brahe calculated how far away the stars must be for parallax to be too small to observe, and rejected the idea that there could be that much empty space in the universe.

    Copernicus did not settle the matter – almanacs made with the Copernican system were not much better than those made with the Ptolemaic system. Galileo’s observations of the moons of Jupiter and the phases of Venus were more consistent with a heliocentric solar system, but only with Keppler’s equations can you accurately predict the positions of the planets.

    It took until the 1830′s for stellar parallax to be observed and clinch the matter.

  14. Harriet Hall says:

    @kulkarniravi, “As a scientific discipline is medicine at the same level as physics or chemistry?”

    Dr. Gorski wrote “scientific consensuses in medicine are almost as strong as the theory of evolution.” From the context, it appears that he meant to write “almost never as strong.”

    We are all aware that medicine is applied science. Nevertheless, some scientific medical concepts like the germ theory are as well established as anything in physics or chemistry.

  15. Scott says:

    @ daedalus:

    I’d be interested to know what you suggest as an alternative approach. Let’s take a hypothetical situation to illustrate. Suppose Skeptical Joe is considering whether to visit an acupuncturist for his back pain. Should he:

    1. Read over the scientific literature on acupuncture himself before deciding.

    2. Pick randomly whether or not to go.

    3. Assume that it works and go.

    4. Observe that the scientific consensus is that it does not work, and therefore not go.

    5. Something else entirely (please specify).

    If you’re going to claim #1, please address how Joe can possibly have the time to do this for all decisions (even all scientifically-related decisions) which must be made day-to-day.

  16. Dea says:

    Awesome post – I’ve been thinking about doing a post on this for a long time, but unfortunately couldn’t find all the right words – so I guess I’ll just send folks to you!

  17. Kushana says:

    The problem with the statement, “[a] real skeptic always sides with scientific consensus,” is that it misses the true point of agreement between skeptics and the scientific community. That point is the scientific *process*, not the results. That’s what distinguishes skeptics from all the non-skeptics. Even if the current “consensus” turns out to be wrong, there’s only one good way to replace it. Not with God’s word (Intelligent Design), not with anecdote (anti-vaxxers), and not with ideology, but with more science.

    A better quote would be, “A true skeptic accepts that the scientific method is better than any other at narrowing in on the truth.” A corollary is that scientific method practitioners are likely closer to the truth than other sources, and are thus better-quality experts.

  18. kulkarniravi says:

    Harriet,

    “We are all aware that medicine is applied science. Nevertheless, some scientific medical concepts like the germ theory are as well established as anything in physics or chemistry.”

    I would question that too. How much does the medical community know about the gut culture and its impact on overall health? Only recently they have discovered that every body can be categorized into one of the three categories based on the gut culture. When you drop an apple, it falls down 100% of the time. Can you say with same certainty that everyone exposed to a germ reacts the same way?

  19. tyro says:

    @daedalus,

    I am a little concerned that saying “I don’t know” is still a form of rejecting the consensus. For instance, I think most of us here would says that anyone who said “I don’t know” when asked if evolution happened, germs cause disease, or humans are a primary cause of global warming are not taking a sceptical, neutral position.

    On the other hand, if there’s reason to think that the consensus opinion is not based on the evidence but on dogmatism or faith then we should reject it.

    On the third hand, all cranks think that the consensus opinion is based on dogmatism and faith. IDists and Creationists say that evolution is a means of rejecting God, for instance. While that may seem looney to us, they seem to believe it.

    In the end, I think your conclusion is right. Saying “I don’t know” is the best I can manage. With so much dogma clouding the field, consensus is a poor judge.

  20. Scott says:

    Can you say with same certainty that everyone exposed to a germ reacts the same way?

    This question has nothing to do with germ theory.

  21. Harriet Hall says:

    @kulkarniravi,

    You say you question that germ theory is well established. Before you question something, you would do well to try to understand what you are questioning. Your comment betrays a deplorable misunderstanding of the germ theory of disease. Germ theory only says that some diseases are caused by microorganisms, as opposed to former ideas like spontaneous generation and miasmas. Germ theory doesn’t say everyone exposed to a germ reacts the same way. It doesn’t address the impact of gut culture on health. Categorization based on gut culture does not in any way discredit the germ theory of disease.

  22. tyro says:

    I think I found another example. Apart from bible studies and religion, there’s one obvious secular dogmatism which is almost as bad: economics.

    I can think of a half-dozen instances off the top of my head where a consensus opinion was formed for reasons other than evidence and sometimes in the face of counter-evidence. The Efficient Market Hypothesis for example still has adherents even though it has never been supported by the evidence (there were a half-dozen bubble markets before EMH was ever formalized).

    Not that there aren’t some good bits, just saying that consensus opinion may be a poor tool.

  23. David Gorski says:

    I’d agree in things that aren’t really science—like economics. :-)

  24. Geoff says:

    I agree that a skeptic must always take the scientific consensus as the null hypothesis when he begins any investigation of a field of study. It sounds to me like this is what Martin is saying. However, to say that a skeptic must always side with the scientific consensus is flat out wrong.

    Scientific consensus is typically 10 or more years behind the people on the cutting edge of a given field, and medicine is typically 10 or more years behind scientific consensus. Nutrition is my favorite example of this, because it is just the most glaring example of consensus being totally wrong, and it happens to be a field that I am more knowledgeable than say 99.9% of the population on.

    So let’s talk cancer nutrition. Dr. Seyfried at Boston College has a substantial body of evidence in both animal trials and human trials of reversing the growth of various cancerous tumors, particularly in the brain, using ketogenic diets. Now by no means am I shouting Eureka! and claiming that the cancer issue is solved, but the fact that almost no one even discusses this type of lifestyle intervention as a possible adjunct treatment for cancer; particularly brain tumors and epithelial cancers; boggles my mind.

    The fact is that a skeptic will and should always value his mind above anyone else’s, scientist or otherwise. He should especially value his mind over that of the masses. A skeptic can come into a field of study assuming the scientific consensus as his null hypothesis, and come out deciding that the scientific consensus is probably or definitely wrong. Scientific consensus changes, and skeptics will always be ahead of the curve of the masses by definition, because they were the ones who chose to question the conventional wisdom rather than dogmatically accept it.

  25. David Gorski says:

    Scientific consensus is typically 10 or more years behind the people on the cutting edge of a given field, and medicine is typically 10 or more years behind scientific consensus.

    Uh, no. One problem: The cutting edge of a given field is where you’re most likely to find ideas that fail to pass muster when investigated further and turn out to be wrong. That’s why so many articles in high impact journals like Cell turn out later not to hold up. Medicine can’t afford to be trying things in humans based on cutting edge basic science without a bit more evidence to suggest they’re worth translating to the clinical realm.

    More importantly, in medicine the consensus changes pretty fast. In my own field, the way we practice breast cancer care has changed markedly over the last decade, and the medical consensus guidelines for treating breast cancer are ever-evolving. The same is true of many other diseases.

    As for Dr. Seyfried, all I see is some somewhat interesting animal model data and a couple of case reports described in his 2011 review. I also note that he doesn’t seem to have any problem publishing his work. In any case, where’s the clinical trial data? Of course, one wonders what you think the consensus on nutrition and cancer actually even is that you can so confidently declare it “totally wrong.”

  26. nybgrus says:

    @tyro:

    I take your point but to what extent could we, as outsiders, know that a conclusion is scientific or not?

    That is actually a very good question – one I do not think is answered quite as easily as scott seems to think. Many apologists for blatantly non-scientific realms (i.e. religion) claim to have science and reasoning behind their arguments. Many sCAMsters also make such claims. And the “good” ones even sound convincing on the surface – they use language that is quite hifalutin and toss out numbers and statistics.

    That is why in my previous comment I said the skeptic should first try and understand the consensus the way the “experts” of the consensus are framing it, after provisionally accepting it. Then look at the evidence put forth by the consensus makers. If you are well acquainted with science in general and the scientific method specifically, you can often make a pretty good judgement at this point. But if the subject is far outside your expertise then I think you must move on to the next step – looking at the opposition’s arguments.

    For example, since the notion of religion was brought up, I was actually baptised and raised with some religion but not much. In college I have a very religious roommate and we had discussions – turned out I was pretty agnostic but for a while felt my disbelief in god was faith based and due to ignorance and left it at that. In essence that stage is where I think most people should be at on most topics (since people are definitively not experts in most topics) – try and give a brief look at the consensus, discuss it a bit, and then form an opinion the strength of which is directly related to how much time you invested in learning the matter. I hadn’t vested much time at this point. The consensus to me was that there was a god (i.e. most people on earth and religions agreed on that one point). I thought the argument sounded weak, but acknowledged I did not know enough so I left it at that and if anyone said there was a god, I did not argue and said I simply wasn’t convinced but that they could likely be right in some way.

    Then I became more interested and I started out by reading religious apologists. I became fundamentally familiar with their arguments. I examined their evidence. Then I looked at the opposition to consensus – Hitchens, Dawkins, Harris, etc. Then I watched debates between the two camps. Listened to probably 100+ hours of these. Then determined what were considered to be the best apologists and read and listened to them. And finally came to the conclusion that the consensus was wrong. And now I can clearly and confidently say so – because I took the time to learn the arguments of the consensus as well as the counter-arguments. I examined the evidence myself.

    Of course this took an immense amount of time. And that is the point. No matter what the field, the theory, or the consensus, you simply cannot claim a strong stance on the topic (while retaining a shred of intellectual honesty) unless you have actually put in the time. Until that point, a skeptic must provisionally accept the consensus opinion (unless it is obviously reached without use of the scientifc method in any way) and then in good faith do at least some groundword to understand the consensus before trying to dismantle it.

    If something is important enough to you, then there is no substitute for that. You simply cannot claim, for example, that evolution is nonsense and that it is a notion of vital importance without having done all that legwork – that is what the intellectually dishonest creationists (yeah, I know, a bit redundant) do.

    If you do not have the time, and it is not that important to you, then finding a source you have vetted on other topics to help inform you is a good surrogate. SBM is such a surrogate for me – on many topics I trust the consensus of the authors because over time I have seen them consistently apply the scientific method and intellectual honesty. That’s not to say I think they are incapable of making a mistake – we all are. But I trust that if the mistake is made and discovered it will be admitted and rectified.

  27. nybgrus says:

    @kulkarniravi:

    I would question that too. How much does the medical community know about the gut culture and its impact on overall health?

    Please refer to my wall of text above where I describe how you must first become aware of the consensus view before attempting to attack it. As Dr. Hall rightly stated, the germ theory of medicine has nothing to do with your question. You may not intentionally be building straw men to set ablaze but you are certainly doing just that.

    You continue to do so when you time and time again make the assertion that we in the medical community feel so certain of ourselves that we liken the practice of medicine to a hard science like physics or chemistry. Once again, this is a straw man. You use Dr. Gorski’s claim that there are certain things in medicine that are nearly as robust as say, evolution, as “evidence” of this claim. But you don’t take the time to learn what things in medicine are considered to be so robust and simply paint across the whole of the profession that way.

    As in my original comment in this thread, it is easy to pick at the edges of a field – and medicine has many edges indeed – but to then assume those tears go all the way back to the core is a fallacy you continually fall into.

    It most certainly is difficult to even know where to start, for someone in your position. You (and the vast majority of people) do not have the time, desire, or wherewithal to learn medicine from the ground up. (BTW, that fact alone should demonstrate to you how vast the topic is – otherwise you would think it a reasonable endeavor). But you can still take on the skeptic mantle and accept the expert opinion and consensus and try and learn it in detail before attacking it and making claims. It is indeed a somewhat arduous process – but if you start doing so you will learn more about other facets of medicine and perhaps begin to realize you have less and less to attack.

    Your misunderstanding and mischaracterization of germ theory is a prime example of this. I hope you take it to heart and learn from it :-)

  28. ccbowers says:

    There are a couple of factors that are resulting in disagreement. One is whether or not there is a strong consensus. When data are lacking to make a strong statement one way or another, there should be no consensus (ideally). So I am thinking that when Martin says “informed consensus” he is talking about fairly ‘big’ topics for which there are good data. I don’t think that many people here would disagree.

    The other factor is regarding the person judging the consensus view. If we are talking about ‘amateurs’ like skeptics or experts in another field, I’m afraid that he is correct most of the time. It is a good rule of thumb (imagine if our politicians always followed consensus views) to follow the consensus unless there is an substantive reason why not. Although consensuses are found to be wrong, they are usually the best bet.

    I think that people with some expertise in a relevant field can disagree with a consensus view, as long as there is sound logic and relevant substance to their disagreement. For example a physician may disagree with a particular consensus that appears to be ahead of the evidence (e.g. consensus based upon expert opinion, lacking clinical data, or the use of a weak surrogate marker) . Actually I’m sure surgery historically has some very good examples.

  29. daedalus2u says:

    Scott, I am not sure that there always is a skeptical process for a skeptic to make a decision in the time available. If you don’t have the time to do the scientific method, then you can’t use the scientific method to make a decision. That is not a flaw of the scientific method, and it doesn’t give you the freedom to take a shortcut and call it the scientific method.

    To me, someone who simply follows someone else’s beliefs, even if those beliefs are from a consensus is indistinguishable from a dittohead.

    http://www.urbandictionary.com/define.php?term=dittohead

    I know that people who think of themselves as skeptics don’t believe that they are simply following someone else’s beliefs like a dittohead. There are degrees of this, but in the limit if you blindly follow a leader, any leader, you are a dittohead.

    If you want to not be a dittohead, you have to either have as your default “I don’t know”, or put in the time to understand the issues from reliable sources. If you don’t want to put in the time, and don’t want to say “I don’t know”, then you are a dittohead. I am not saying this to be harsh. If you haven’t put in the time to understand the field, it is very difficult to not exhibit the Dunning-Kruger effect unless you default to “I don’t know”.

    As I see it, this is pretty much what nybgrus is saying and which I am in agreement with.

    Medicine is just as much a science as is physics. Physics is trivially easy compared to medicine. In physics, there are only couple handfuls of particles, and they mostly interact as a linear superposition of the wave functions. In physiology nothing is linear and the number of coupled and interacting variables is astronomical. There are a few tens of thousands of genes, vast quantities of DNA with unknown function(s), that DNA can be transcribed, epigenetically programmed, transposed, duplicated, deleted, mutated or scrambled as in most cancer cells. Then there is the bacterial component which is several orders of magnitude larger and much less well characterized. Every individual is unique and changes over time. Physiology also couples to the environment at the level of noise (via stochastic resonance).

    I have nothing against physicists, I have some good friends that are physicists, and there is plenty of good science for physicists to do. But physics as a field is trivial compared to physiology.

    In terms of fields where the scientific consensus is wrong, I only know of a few cases. The genetics of intelligence is one as I mention above.

    The consensus that the problem in diabetes type 2 is due to elevated blood sugar is wrong.

    The consensus that there is such a thing as homeostasis is wrong.

    That is all that I can think of right now.

  30. David Gorski says:

    If you want to not be a dittohead, you have to either have as your default “I don’t know”, or put in the time to understand the issues from reliable sources.

    Reliable sources. That’s the key. How do you define “reliable” sources? And, if you don’t know enough to look at the primary literature on your own, how can you possibly educate yourself about an issue enough to be able to apply the scientific method to it? Accepting the scientific consensus in a field as a starting point is not being a “dittohead,” as you so wrongly and disparagingly call it. Rather, it’s recognizing that science is the best method to determine how nature works and, until one has enough of a grasp to understand the details and weaknesses of a scientific consensus,” not an unreasonable or “unskeptical” position to take initially.

    Medicine is just as much a science as is physics. Physics is trivially easy compared to medicine.

    Uh, no. Medicine ideally should be based on science, but it is not itself a science. I and my cobloggers have said as much time and time again right here on this very blog. There are too many other nonscientific issues that come into play in medicine when we decide which treatments to give a patient, such as bioethics, patient desires and values, etc. We thus try to make sure that our medical recommendations are grounded in science and based on science, but medicine can never be as much of a science as physics.

    I say this as a physician who practices medicine and surgery, and there is nothing for us to be ashamed of in admitting this.

  31. nybgrus says:

    @ccbowers:

    That is where I believe the strength of your opinion on the matter must be modulated and your word choice should reflect that. It is the same as any theory – always ready to be thrown out the window should the evidence dictate, but the longer it has hung around, the more lines of evidence converge, and the larger and more robust the consensus, the harder to chuck it out and the more willing you should be to follow the consensus. The further removed from your area of expertise is from the consensus in question, the more willing you should be to say, “I don’t know for certain, but the consensus is X and until I know more I will go with that.”

    That, I think is what daedalus is getting at and why I think he agrees with me there. BTW, that is my current stance on anthropogenic global warming. I really don’t know – the relevant sciences are so far removed from my expertise that I simply can’t even describe what the climatologist consensus is beyond “They say people are making the world hotter.” Over the past year I have been very interested in it and kept wanting to start diving into it like I have with evolutionary biology, physics, and theology. But until I actually do, I cannot honestly say more than, “The little I have looked at shows the denialists to be using dirty tactics, the few studies I have looked at seem legit, and the consensus is that AGW is happening. Therefore, I defer to the climatologists since I don’t know any better.” This past 2 weeks have been incredibly cold for Brisbane – so much so people are complaining left and right that it never gets that cold here. But I would never be so arrogant as to say that was evidence against global warming like some politicians have been apt to say (and my sister’s FIL as well).

    Unlike kulkinaravi I would like to actually know the details of what the consensus actually is and at least some of the science behind it before I start spouting off about how AGW is a conspiracy or bad science.

    People think they can learn the necessary definitions from sound bytes after a 2 minute Google search. Skeptics know better.

    And lastly, I will echo Dr. Gorksi’s sentiment, daedalus. Medicine is (and should be) very much rooted in science, but the actual practice of it is anything but. During a surgical elective I did last year I sat on a “tumor board” that consisted of general surgeons, plastics, thoracic surgeons, heme-oncs, rad-oncs, pathologists, radiologists, and a genetic counselor. We discussed difficult cases of cancer and what the best evidence showed in terms of staging, grading, treatment options, and prognosis. The beginning was always very scientific – looking at PET/CT fusions, histology slides, immunohistochemistry, and then using guidelines to define and characterize the cancer. The patient’s attending physician presented her to the group, including any relevant history as well as values, wishes, and mental state. From there, the relevant specialties offered opinion as to what sorts of interventions were possible and which ones fit within the evidence. Once a decision (or small range of options was reached) we all went to physically examine and chat with the patient. Afterwards the patients wishes were incorporated into the final recommendation from the board. Most times it fit in with the evidence based guidelines. Sometimes, the board was forced to make an official statement defining what was thought to be the best scientific decision but that the patients wishes did not fit in with that – and that is what was honored. Sometimes discussions lasted a while as to how to best accommodate the wishes whilst retaining as much of the evidence base as possible. But ultimately non-scientific concerns always took precedence – as they should.

    In defense of daedalus, I would say I think your argument was not that medicine is a science, but that the scientific aspects of something like physiology are very complex. I think that is a fair statement – I sometimes discuss these sorts of things with my girlfriend. She is currently doing hypersonics engineering and models airflow at Mach 8-15 and diffusion of fuel through porous solids. When I explain some of the intracacies of physiology she is amazed at how complex it would be do model such dynamic and stochastic processes, since her own modeling is difficult and is indeed less complex. There are many shortcuts we as physicians have to take to understand these processes because of such complexity – and many more shortcuts a student like me must take to start wrapping my head around them in the first place. So in that regard when discussing only and specifically the science of medicine, I would agree with your statement. But when discussing medicine as a whole, I do agree with Dr. Gorski.

  32. kulkarniravi says:

    Nybgrus (and Harriet),

    Yes, I admit that I was hasty in my response to Harriet above. I could have looked up germ theory before rushing to hit enter. I will also admit that I am not the most well informed layman as far as medicine is concerned. I am learning some amount here and I am grateful for that.

    Having said that (there is always that), you still can’t take away my core argument. If there are some areas of medicine that are considered robust I would like to know what those are. And after that the rest of the field is on a sliding grade of robustness. The consumers need to know this distinction. The whole point of my participation here on this forum is to have a public debate about which part of medical practice is robust and which is on a lesser foundation.

    Common man needs to know that he is responsible for his own health. A good example of this lack of robustness occurs when children get a routine dose of antibiotics when they get an ear infection. The fault doesn’t entirely lie with the pediatrician here – there is also an expectation of immediate relief from the consumer. If the consumer were better educated about the less than perfect (non-existent?) impact of antibiotics on viral infections, less than perfect robustness in the practice of medicine and perhaps most important, potential side effects of antibiotics, he or she would be more circumspect. What’s more, in the long term, the child would be healthier.

  33. nybgrus says:

    kulkarniravi:

    This really is not the forum, per se, to suss out exactly what we think is “robust” and what is less robust. That sort of spoon feeding would take incredible amounts of time and be so disjointed as to be almost meaningless. At that point, you may as well just go to medical school.

    We are all glad that you are learning and I for one certainly encourage it. Part of what I hope for you to learn is that it is dangerous and difficult to work backwards from a very particular notion you have about (in your case) nutrition in medicine and then extrapolate that towards some core fault in the medical proffesion. Things are just much more complicated than that.

    You say that we “can’t take away your core argument.” I honestly haven’t been able to figure out what that even is to try and take it away in the first place. You claim that doctors don’t learn enough nutrition and that it is underemphasized. We have all agreed with you on that, but disagree with the extent and emphasis you place on it.

    You say that “Common man needs to know that he is responsible for his own health” and everyone here would agree wholeheartedly. So what now? What is it that you think we are doing to intentionally prevent that? Every single author on this site has openly admitted to shortcomings and faults in the system – and openly lambasted practitioners who perpetuate such faults. If you argument is that the system needs to be improved, you are preaching to the choir.

    The problem you continue to have seems to be that your core argument is in agreement with the general ethos of this blog – but that your examples are poor and your suggestions for fixing them based in something other than evidence and reality.

    You tout gut flora and microbiomes – I don’t think anyone here would argue they aren’t important. How would you go about incorporating that into practice? The answer is we don’t know. The science isn’t there yet. Researchers are working on it in some fascinating new ways (the lungs were once thought to be sterile but I saw a paper last year showing DNA analysis that would lead one to think otherwise, for example). But the solution is not to simply say, “They are important so do…. something about it!” We can’t – these are people we are dealing with so we need evidence and science to back up what we do. You claim things like probiotics and some sort of specific diet are key. Where is your evidence? Then you tout a paper or two, or something with a small effect size. We dismiss it and say it doesn’t say much or say what you think it says. What then?

    It seems you would like to push the clinical ahead of the science, and as has been discussed, that simply cannot be done. That means sub-optimal decisions are made simply because optimal is not known – but we make the most optimal decisions we can at the time. Anything else would be pure guesswork. And believe me – you wouldn’t like to be my patient 1 year out of medical school and have me try out some guesswork on you.

    For things like antiobiotic prescription in viral illness – ask any physician on this blog, we would all have a solid stance on that. Patient education – absolutely. But you think that it is as simple as that? You think all patients want to be educated? You think every parent would be content with an explanation as to why their child gets no antibiotics? Of course, I would say that the duty of a physician is to use the evidence and hold strong. But Dr. Hall might offer another perspective, having actually had to treat countless such patients. And that is why Dr. Gorski has said that medicine is based in science but cannot itself be science. And don’t forget, that we physicians are people as well – prone to the same biases, the same shortcuts, the same desires and beliefs as any other human. We can just strive to do our best and believe me – we push ourselves harder in that goal than the vast majority of people out there.

    To close, before I drone on too much I want to address a simple point:

    A good example of this lack of robustness occurs when children get a routine dose of antibiotics when they get an ear infection.

    That is not an example of lack of robustness, as you say. That is an example of not adhering to the robustness. It is indeed a robust thing in medicine that viral illness should never be given antibiotics. Your example is a clinical scenario where that is neglected. The solution is not to claim medicine is not robust – it is to determine what causes that lapse in adherence to the guidelines and to rectify that.

    I assure you that just about every point you raise is a systems issue, not a critique of the robustness of medical science. And I can also assure you that each point is (more or less) well known already and there are concerted efforts to change that. This blog is one such effort in and of itself.

    But you do yourself a disservice when you claim fault in medicine and say it lacks a robust framework and then proffer your own ideas, which in and of themselves are the antithesis of robust. And I do not mean to insult you, but a claim like you’ve echoed about CoQ10 solving your problem and that is generalizable is exactly what is not robust.

  34. Scott says:

    @ daedalus:

    I strongly disagree. A skeptic considers all available information. That available information includes the judgements of the experts in the field, and the emergence of a scientific consensus. If that is the best information available to the skeptic, then the only possible skeptical course of action is to provisionally draw a conclusion based on that best available information.

    This is utterly and fundamentally different from a dittohead, because the skeptic’s conclusion is provisional, reached with the full understanding that the evidence for it is weak, and completely subject to revision if additional information becomes available. It’s the difference between “authority is always right” and “in the absence of evidence to the contrary, legitimate authority is more likely to be right than wrong.”

  35. Geoff says:

    Well,

    I have known, either directly or indirectly, about 20 or so people who have been diagnosed with cancer over the last 5 years. Every one of them has been instructed to lower their meat and fat intake. So while I’m not in the field, I can say with let’s say a 90% confidence interval that the medical consensus is that being fat increases your risk of cancer and eating fat makes you fatter.

    I agree that we need clinical trials, they are few and far between. But that is arguably because the medical consensus on heart disease is totally wrong. People still believe in the lipid hypothesis and its buddy the diet-heart hypothesis, and so they refuse to fund studies on ketogenic diets. There’s also no one to really make money off of such an intervention, which is going to make it that much harder to get funding for.

    Take this study for example: http://www.time.com/time/health/article/0,8599,1662484,00.html. It’s promising, but has some severe limitations as well. For example, in order to qualify for the study, patients had to be deemed untreatable or non-responsive to treatment, so that will obviously severely handicap the study. It also doesn’t seem like their controlling for cancer type. Then of course, there’s the issue of the fact that they are using a disgusting and unhealthy version of a ketogenic diet comprised of PUFA and soy protein, which is totally unpalatable (and they had major compliance issues), and long term will cause other cancers, heart disease, etc.

    We have a very good proposed mechanism: tumor cells have damaged mitochondria and are thus incapable of generating energy from fat, so starving these cells of glucose will cause them to die. While some types of cancer are capable of making energy from glutamine, brain tumors cannot because glutamine cannot cross the blood-brain barrier. I agree that this is still a theory and is as yet untested, but to the extent which it has been tested, it’s very promising. If I had cancer, I would be on a ketogenic diet, albeit a much more intelligently designed one (50g safe starch a day, high levels of medium chain triglycerides from coconut oil, fatty meat). That said, I’m a self experimenter. But I find it hard to imagine that someone who is out of options would feel the need to wait for scientific consensus before testing something so innocuous. To not offer a patient that option is arguably unethical.

  36. daedalus2u says:

    Scott, the dittohead can and does change his/her position. Just as soon as the “expert” the dittohead has put their faith in changes their position the dittohead will change theirs to match.

    Reliance on the opinion of someone else is never a skeptical position. It can be something that a skeptic does, but skeptics are humans too and they have to do a lot of human things that have nothing to do with skepticism.

    If you don’t have the expertise to evaluate the evidence directly, you also don’t have the expertise to evaluate the expertise of a self-proclaimed expert. Trusting someone else’s expertise is not a skeptical position unless you evaluate it directly. Evaluating someone’s expertise in one field tells you nothing about their expertise in a different field.

    The dittohead has used what the dittohead considers to be a reliable method to figure out the expertise of the expert the dittohead has put their faith in. The religious person has what they consider to be a reliable method too; rely on what a self-proclaimed religious person says.

    The skeptic knows that personal opinions and statements don’t rise to the level of evidence. They are simply testimony. A skeptic may choose to make a decision based on testimony, but that skeptic really needs to appreciate that they are not making a decision based on skepticism, but a decision based on testimony.

  37. Scott says:

    Scott, the dittohead can and does change his/her position. Just as soon as the “expert” the dittohead has put their faith in changes their position the dittohead will change theirs to match.

    Which doesn’t address the fundamental difference between the two positions at all.

    Reliance on the opinion of someone else is never a skeptical position.

    That is, quite simply, false. More below.

    If you don’t have the expertise to evaluate the evidence directly, you also don’t have the expertise to evaluate the expertise of a self-proclaimed expert.

    Completely wrong. It is many, many, orders of magnitude easier to evaluate a person’s credentials. I really hope you meant something completely different than what you said, because the strict text of this claim is quite frankly ludicrous.

    Evaluating someone’s expertise in one field tells you nothing about their expertise in a different field.

    No relevance whatsoever.

    The skeptic knows that personal opinions and statements don’t rise to the level of evidence. They are simply testimony. A skeptic may choose to make a decision based on testimony, but that skeptic really needs to appreciate that they are not making a decision based on skepticism, but a decision based on testimony.

    And here is the crux of what makes you so horribly wrong. Let’s examine a simpler example to illustrate.

    Let’s suppose I am in a room with no windows. I have no evidence of whether it is raining outside, or sunny. You come into the room. I ask you whether you’ve been outside, and you state that you have and that it is sunny.

    According to you, I still have no evidence and cannot draw any conclusion. According to me, the fact that you have made such a statement constitutes evidence and therefore I can draw a conclusion.

    The question you must ask is whether considering a particular piece of data (in this case, your statement of sunny weather) makes a conclusion more likely to be true, less likely to be true, or neither. Clearly, if I conclude what the weather is like in the absence of your statement, I am less likely to be correct than if I consider your statement. Ergo, it constitutes evidence.

    Similarly, if an MD states that the most appropriate treatment for [fill in the blank] is [fill in the blank], then a conclusion reached by considering that statement is more likely to be correct than one reached without considering it. And in the absence of any other evidence, that makes the most-likely-correct conclusion the same as the MD has stated.

    It’s really quite simple. If it increases the probability of being able to draw a correct conclusion, then it is evidence. The statement of an individual with relevant credentials increases the probability of being able to draw a correct conclusion. It is therefore evidence, and a skeptic MUST not only take it into account, but also draw a conclusion based upon it if there is no other evidence available.

  38. Scott says:

    Actually, let’s be more explicit. What constitutes evidence? This seems to be the crux of the disagreement. I would (as you can see above) define it as “any observation that, if it is considered in drawing a conclusion, makes that conclusion more likely to be correct.” Such as, the observation that a particular person has made a particular statement.

    What definition are you using?

  39. nybgrus says:

    @Geoff:

    I wont have much time to attend to your post since I have a final exam a little later today, but I wanted to address a few key points.

    First off, you cite not a scholarly article, but a Time piece. And it is very poorly written:

    unlike healthy cells, which generate energy by metabolizing sugar in their mitochondria, cancer cells appeared to fuel themselves exclusively through glycolysis, a less-efficient means of creating energy through the fermentation of sugar in the cytoplasm.

    Sugar is not metabolized in the mitochondria. Acetyl-CoA is. Neither is glycolysis a fermentation process, it is a subrate level phosphorylation. The main thrust of the sentence is still discernible and reasonably correct, but my ears always perk up when such sloppy usage is employed. You can’t even argue that they were simply trying to dumb it down – they used big words like glycolysis throughout the peice.

    Next, the “study” only manged to use 5 people for 3 months. That hardly constitutes anything at all. In fact, I would argue that it adds nothing to the discourse – the basic sciences you speak of do make some sense. Having 5 terminally ill people live for 3 months does absolutely nothing to bolster or refute the science.

    You use this to claim that such a diet should be at least recommended to patients and “to not offer a patient that option is arguably unethical.” It is only arguably unethical if you’ve only read a poorly written piece by Time and come to the conclusion that “this is still a theory and is as yet untested, but to the extent which it has been tested, it’s very promising.” There has been essentially zero testing and while bench science can be described as “very promising” in clinical medicine that is like calling a 2nd grader who can do division “very bright.” Both statements are true, but the impact factor must be modulated with the context.

    You latch on to this notion of a ketogenic diet but you fail to think of what sorts of negatives can be associated with it. There is a reason why diabetic ketoacidosis is so dangerous – in fact it currently has a 10% mortality rate even with our best modern medicine. You neglect to think about all the co-morbitities that patients with cancer are likely to have. Remember that cancer is a disease of old age – the older you are the more other problems you will have. Inducing a ketotic state in someone with decreased pulmonary function, for example, could tax them enough that over the course of a few months that alone could kill them. You also neglect to realize that while the body can, in general, switch to increasing use of ketone bodies for energy, there is an upper limit to that. You absolutely cannot switch every cell in the body to use nothing but ketones. The upper limit is roughly 40%. And by pushing things that far you go into a starved state and you increase counter-regulatory hormones like epinephrine and glucagon. You will start to catabolize your own proteins to form glucose through gluconeogenesis. You will become acidotic. Your red blood cells will undergo significantly more oxidative stress – they have no mitochondria and use the HMP shunt for energy and to replenish NADPH to replenish glutathione so they do not spontaneously burst. The HMP shunt requires…. yup you guessed it, glucose.

    I can go on and on. The point is that you make such a sweeping comment without any consideration for these salient points to consider and then say it is unethical for physicians to not recommend a ketogenic diet as if it were equivalent to recommending taking a nice bath. There is a very good reason why bench science is not translated directly into clinical practice and why we don’t mention it willy nilly like that. Because for every person that would benefit from the ketogenic diet in cancer I can guarantee you there will be at least one person that is directly harmed by it (I’d bet way more than that). And that, Geoff is unethical.

    So the best you can say about this diet is that it shows some potential as an adjunct to existing chemotherapy but only in certain patient populations, not all of them. The science and research must be done to determine exactly who that would benefit and how.

    I wont get into the problems with the first two paragraphs you wrote since I don’t have time.

  40. daedalus2u says:

    Scott, “credentials” are not the same as “expertise”. Credentials are easy to evaluate. You go and look and see if someone has a degree. Expertise is much more difficult to evaluate. It is essentially impossible to evaluate someone who has expertise much greater than your own. To recognize expertise you need the pattern of expertise inside you to use as an example to do pattern recognition on. If you don’t have authentic expertise to use as a pattern, you can’t compare it to anything else that someone else has.

    All degrees are not equal. Dr Oz has an MD. Dr Oz says that Reiki is an effective treatment. According to what you just said, because he has an MD, then Reiki is likely to be an effective treatment. The credentials that Dr Oz has do not confer any expertise on him and do not make him anything other than a quack for recommending Reiki. I know enough about Reiki to know that anyone who does recommend it is a quack no matter how many degrees they have.

    The original question was (paraphrasing) how does one evaluate the scientific consensus when one does not understand the science behind it. My response is that the skeptic should say “I don’t know”. The usual context is where skeptics and non-skeptics are trying to argue a point. A skeptic repeating something (the scientific consensus) that the skeptic does not understand is simply being a dittohead.

    There is only one type of evidence, that is data. Actual measurements about actual reality.

    If you have an idea about how data fits together and represents reality and that idea is consistent with all known data, then you have a hypothesis. A hypothesis is not data, but if the hypothesis is consistent with a lot of data, then the hypothesis can be considered to be more reliable than individual pieces of data. The hypothesis of evolution is such a hypothesis.

    When a hypothesis has been confirmed to such a degree that it would be perverse to withhold provisional assent, then the hypothesis is considered to be scientific fact. That is as high as anything ever gets. That is where evolution and common descent are. They are confirmed to at least thousands of nines.

    There are ideas that are considered to be the scientific consensus that happen to be wrong. This is a problem because these wrong ideas make actual progress more difficult and in the case of medicine, harmful treatments can be given based on these wrong ideas and more helpful treatments are not considered. Part of this problem comes from the egos that scientists have, and how they want their ideas to be correct, how they want to win arguments about their ideas and how they are sometimes sloppy or more zealous at advancing their idea than the data supports.

    Overturning a wrong scientific consensus requires extraordinary data. It shouldn’t, it should require only ordinary data because the scientific consensus doesn’t fit the data, the scientific consensus should be what ever hypothesis best fits the most data. However that is not how a scientific consensus is arrived at. It is arrived at with egos and politics and fights over funding.

  41. Scott says:

    It seems we have a fundamental philosophical disagreement then. I’m willing to accept any information, so long as I always use the best available, and consider that part of skepticism. You decline to apply the term to any use of information which doesn’t reach a certain threshold of quality.

    I do see the merit in your position, though I continue to strongly disagree. But I don’t think either of us is going to convince the other, and the positions seem to be well-fleshed-out at this point, so I propose that we agree to disagree.

  42. Geoff says:

    @nybgrus I am aware that that was a Time article, but it was about a study that is in progress. I was unable to locate the actual study, but it’s not relevant, because I wasn’t citing the study as evidence, I was citing the article’s description of the study as an illustration of the problem with the “where’s the clinical trials” question. I was specifically pointing to the fact that they refuse to even conduct these types of studies on people unless they are terminally ill and beyond treatment, and that they are using a bizarre, unpalatable version of a ketogenic diet that is in no way even remotely similar to anything that our metabolism has ever encountered in nature.

    Dr. Seyfried’s research is far more compelling, especially in the context of the mechanism. This is something that should be studied immediately, and it’s not even in the conversation.

    There are no dangers of a ketogenic diet. Ketoacidosis is somewhere on the order of 10-20x the level of ketones in the blood as compared to even a long tail ketosis measurement. Metabolic ketosis is a natural state that healthy individuals experience at least to some degree every night while they sleep. We have anthropological data on a numiber of cultures who ate either all meat diets or meat + dairy + blood, and experience perfect health. Atkins diet trials have never shown any merit to the “dangers” of low carbohydrate dieting, at least as compared to a standard american diet, a south beach diet, a Mediterranean diet, and a low fat diet.

  43. daedalus2u says:

    Scott, there is room for all sorts of information with varying degrees of reliability, but when you are using information of low reliability, and you try to infer reliable conclusions, you can’t. If you don’t know how reliable the information is, you have to default to the information having low reliability.

    That is why anecdotes are not very useful, they are data, but of low reliability and of unknown statistical significance. Even so, most skeptics use the information that anecdotes do supply in a wrong way. A positive anecdote can never reduce the plausibility of what ever the anecdote is positive about. A positive anecdote adds a little plausibility, not zero, and certainly not negative.

    I run into this a lot. I present a bunch of theory about how nitric oxide is involved in something and people get interested, then I tell them I have n=1 data and they become “oh, that is an anecdote, it can’t be right, the idea must be wrong”.

    This is an example of people being pseudoskeptics. They understand that anecdotes are not data, so if they hear an anecdote about something they don’t understand they default to the idea must be wrong. If you don’t understand something, you have to default to “I don’t know”. You can’t default to the idea being right, or to the idea being wrong without having a train of facts and logic to make that conclusion.

  44. Harriet Hall says:

    @Geoff,
    “There are no dangers of a ketogenic diet.”

    I question that. It has been linked to kidney stones, to elevated blood cholesterol levels, and to cardiomyopathy in children:
    http://www.ncbi.nlm.nih.gov/pubmed?term=neurology%202000%20ketogenic%20diet%20children%20cardiomyopathy

    There are other concerns such as micronutrient deficiencies and menstrual irregularities. The long-term safety of the diet has not been established.

  45. Scott says:

    and you try to infer reliable conclusions, you can’t.

    Who said “reliable” conclusions? I certainly didn’t. Better than random is not at all the same thing.

    I present a bunch of theory about how nitric oxide is involved in something and people get interested, then I tell them I have n=1 data and they become “oh, that is an anecdote, it can’t be right, the idea must be wrong”.

    No, you claim that you know for an absolute fact that NO controls virtually everything, admit you have no more than an anecdote, and get told that you are drawing a conclusion far more firmly than said data permits. Ironically, exactly what you’re claiming is “pseudoskepticism.”

  46. Geoff says:

    @Harriet

    I could not get access to the full literature of that study, so if you’d be so kind as to send it over, I’d appreciate it. That said, I am going to venture a guess and hypothesize that the ketogenic diet used in the study is a bizarre, unpalatable ketogenic diet made from chemically unstable PUFA and protein from soy. A ketogenic diet designed properly, using whole food sources, animal fats and proteins, ~50g a day on average of starch from safe sources like white rice and potatoes, and keeping dietary PUFA <5% of total calories will not have these same effects.

  47. Harriet Hall says:

    Geoff,
    I don’t have access to the full study either. But take a look at this:
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1198735/

    It is obvious that ketogenic diets as used for children with epilepsy have not been shown to have “no dangers.” If your particular version of the diet has been shown to have no dangers, please provide citations.

  48. nybgrus says:

    @Geoff:

    As Dr. Hall pointed out – there are dangers to a ketotic diet. We have not yet established a firm safety profile of it.

    I was specifically pointing to the fact that they refuse to even conduct these types of studies on people unless they are terminally ill and beyond treatment

    They are not unwilling to do the trials – there are protocols for it and ethics that need to be followed. The whims of some bench science are not justification for jumping into a large cohort study. That was done in the past and we had things like Tuskeegee and Guatemala and other atrocities of human research. No matter how much you wish it to be the case or what you intentions are there are rules and barriers to such things for very good reason. The primary being that is has been abused in the past and a very close second is that the vast majority of such basic science data does not pan out in clinical trials and often leads to people getting hurt. Ethics dictate that the benefits of the trial must outweigh the risks (potential as either side may be). When you have such little data about the interventions and states in question, you must always err on the side of caution. People who are terminally ill and in such dire straights are the only group for whom any benefit might possibly outweigh risk (though I would be wary that this is also preying on desperation and a form of indirect coercion). The fact that there are no people enrolled who are not “beyond treatment” means that there are science based treatments available to them with known benefits and risks – having them subjected to something completely experimental with no idea of what it may actually do is irresponsible and unethical. Hence, the dearth of studies you are looking for. Human studies research is a tricky and necessarily ethically a quagmire that does not lend itself to sound byte analysis and shoddy commentary of a Time piece.

    Next point:

    , and that they are using a bizarre, unpalatable version of a ketogenic diet that is in no way even remotely similar to anything that our metabolism has ever encountered in nature.

    Followed by:

    Metabolic ketosis is a natural state that healthy individuals experience at least to some degree every night while they sleep.

    So why doesn’t sleep cure cancer? You are implying that the diet is safe based upon the fact that we are naturally slightly ketotic during our sleep, but then if that isn’t enough what is? Apparently not the “bizzare, unpalatble version” of the diet. Perhaps you would be so kind as to define precisely what diet is more palatable and something more like “our metabolism has ever encountered in nature.” Or perhaps you would like to describe exactly (or even roughly) what level of ketosis would have “no dangers (of a ketogenic diet)” and be therapeutic?

    All these questions (and more) need to be answered before we can begin enrolling people with treatment options in a study to examine the effects of a ketogenic diet.

    But of course, you haven’t even addressed the core of the research or the concept of the mechanism. It is not the ketosis that is helpful in cancer. It is the lack of glucose because of the aberrant mitochondria in most (not all!) cancers. So you could have all the bloody ketones you want, it will do nothing if the cancer cells can still get their grubby cellular machinery on glucose.

    So care to explain to me how we can remove access to glucose from cancer cells without a “bizarre, unpalatable version of the ketogenic diet?” Because I can tell you that cancer biology is an interesting thing and if you start depriving the cells of glucose to a significant enough degree I can assure you that in some (and probably many) of the cases they will adapt and evolve to compensate somehow. That is how cancers can become resistant to chemotherapeutics (you did know that right? That is why we give multiple drugs at the same time because cancer cells can develop resistance to single therapy similarly to how bacteria can develop antiobiotic resistance). If they can adapt to secret angiogenic growth factors they can certainly adapt to constitutively express GLUT receptors in high amounts. And that is just one method I thought up off the top of my head. I’m sure there could be many more.

    So once again, ketogenic diet might be useful as an adjunct to standard chemotherapy and help push the cancer cells out of existence. But it can never be a therapy on its own, and the science is not there yet to ethically justify the kind of studies you are pushing for.

    This is something that should be studied immediately, and it’s not even in the conversation.

    The basic sciences are being done. But there is much more to consider than you are aware of. And your conspiritorial tone that it is arguably unethical not to do these studies and that it should be studied immediately are completely unwarranted.

  49. Geoff says:

    @nybrus

    Are you being serious with a question like “why doesn’t sleep cure cancer?” I said that the fast caused by sleeping induces a low level of metabolic ketosis. Not the sleep, although I do think that sleep plays a major role in inducing apoptosis in cancerous mutations. For example, egyptians ate really terrible diets, and had a ton of the gout and heart disease that comes along with that, but they still had no cancer. I suspect that a lack of artificial light and ample, consistent sun exposure were major factors in this.

    As for this “it’s not the ketosis that’s helpful to cancer” comment, I specifically said that “We have a very good proposed mechanism: tumor cells have damaged mitochondria and are thus incapable of generating energy from fat, so starving these cells of glucose will cause them to die.” I also specified that I was talking about certain types of cancers, in particular brain tumors and epithelial cancers. I’m not sure how you’re why you are totally misinterpreting my comments, but it’s pretty irritating, and kind of makes me want to choke you. I have no patience for straw men attacks.

    @Harriet

    First, let’s start with prior plausibility, because this is the place where all SBM evaluations must start. Humans evolved to be adapted to a wide variety of macronutrient ratios, included in this is a zero carb, high fat one. We have isotope research done at the Max Planck institute that suggests that humans were at least as carnivorous as or more carnivorous than the arctic fox. Now, before the objection comes up, I want to stress that I am not saying that high carb diets cannot be healthy, just that it’s probably a bad idea for someone with cancer.

    Next, we have ample anthropological evidence of modern hunter gatherer societies eating traditional diets in near perfect health, i.e. no cancer, no heart disease, no autoimmune disease, very few cavities, straight teeth and no impacted molars, no obesity, no type II diabetes. We also have studies of these people transitioning from a traditional diet to a western one, and the health deterioration that results from that. Included in this are traditional Masai, who ate almost no carbohydrate, and the carbohydrate that they did eat came primarily from milk. Also included in this are traditional Inuit, the Ache in Peru, and many others.

    So from a prior plausibility perspective, the idea that a ketogenic diet is going to be healthful is the null hypothesis, not the alternative. There needs to be a very compelling set of data to overturn this hypothesis, and diets made of industrial seed oils do not qualify. If you’re interested, I’m happy to go into the mechanisms as to how industrial seed oils can cause problems that animal fats would not, but for now let’s just accept that they are totally outside of our evolutionary experience, even moreso than wheat, and so it is very plausible that our body is not very good at utilizing them long term.

    Experimentally, there have been a number of medium to long term low carb diet trials, particularly “Atkins style diets” that always come in at least as effective or more effective than the other diets in these trials, including the standard american diet, the mediterranean diet, vegetarian and vegan diets, the south beach diet, the Ornish diet and others. I would say in general that the results of these studies are rather unimpressive, because even though low carbohydrate diets do consistently outperform the other diets in every metric, it’s never by much. However, as to the question of their safety, these studies are very relevant to this discussion, because in none of these trials is mortality increased in the low carb group. If I have time tomorrow I’ll pull some of those studies up and get more specific.

  50. Harriet Hall says:

    @Geoff,
    You say “First, let’s start with prior plausibility.” No, first let’s start with answering my question: do you have evidence that your version of the ketogenic diet has “no dangers?” It appears that you don’t have any such evidence. All you offer is speculation based on evolutionary reasoning and anthropological claims that may or may not be true. And the fact that mortality rates have not been higher in studies of low carb diets.

    Unless your ketogenic diet has been adequately tested, you cannot claim that it has no dangers.

  51. daedalus2u says:

    Scott, if you don’t know if the result is reliable or not, it is no better than a random decision. That is my whole point. If you can’t know the result is reliable because you don’t understand the underlying science, you can’t achieve a reliable result via any technique that does not involve understanding the science.

    This really is quite ironic. You are arguing for very loose standards of evidence, I am arguing for very strict standards, and then you reject the conclusions I have reached using my very strict standards and then tell me that I am wrong using your very loose standards, in a field which I understand and which you do not.

    There is lots and lots of data that bears on the role of NO in physiology. It isn’t my data, it is data that has been published in the literature. It is well known that there are at least hundreds of pathways that directly involve NO in a direct one-to-one feedback mechanism. I appreciate that you don’t know about that data, but that is only because you don’t consider it important enough to learn about.

    I don’t claim to know anything for an absolute fact. What I say about NO I consider to be very reliable, probably about 95 to 99% likelihood (or higher). For what I am saying about NO physiology to be wrong, there would have to be serious errors in the data in hundreds of independent papers. A few tens of papers could be wrong, I have found papers that are wrong. Usually the data is ok, it is just the conclusions that are wrong. The likelihood that the data in hundreds of papers are wrong, and are all wrong in the same direction so that the inferences I have made from that data are incorrect is very small. If I ever do find that any of that data is wrong, I will revise my hypothesis.

    For you to infer from my confident tone that I have the non-scientific standard of absolute certainty (which I have never said) and so therefore what ever I am saying must be completely wrong is not any type of skeptical reasoning. I know all the data that I have used to arrive at my conclusions. Knowing that data, I am confident that anyone else would come to the same conclusions if they looked at all the same data in the same degree of detail.

    That is a mighty big straw man you have about me. I am not saying this to be pejorative. If there is something that is wrong about my NO hypotheses, I would be glad to know it. But just telling me that I am wrong without giving an explanation that is rooted in data is not a skeptical position to take.

    Actually the n=1 data that I have is not an anecdote. It is instrumental data on multiple occasions but on a single individual. There is nothing extraordinary about the claims I am making, there is nothing in those claims that is the least bit incompatible with any data that there is in the literature. It may be incompatible with some of the consensuses that there are in various fields, but lack of consilience with consensus is not a bar for an idea to be correct. Lack of consilience with data is a bar for an idea to be correct.

  52. nybgrus says:

    @Geoff:

    No straw men here, mate. You claimed that a ketotic state exists in sleep. I agreed. It happens because of a slight fasting state. My question as to why sleep doesn’t cure cancer was a tongue-in-cheek way of illustrating (which I then actually explained) that a slight ketotic state is not enough to cause an effect – ergo you must have a significantly higher ketotic state. I then juxtaposed that with your other extreme of the “bizarre” ketogenic diet. And I then asked you where is your cutoff betwixt the two? The point was to illustrate that there is no science to dictate that ergo you have no answer and thus a clinical trial of a ketogenic diet inducing a ketotic state is putting the cart before the horse.

    I then went on to further explain how ketosis in and of itself is not the mechanism proposed. Thus your continued insistence that a ketogenic diet is harmless (still unproven and with evidence to the contrary) is actually moot. Because the issue is not inducing ketosis, but restricting glucose for cancer cell metabolism. Thus, the “bizarre” diet was actually trying to follow up on that mechanism. Your claims as to some intermediate diet, focusing only on the ketogenic properties (I haven’t even touched on the fact that you keep talking about differences in what induces the ketosis – a ketone body is a ketone body and we’ve established those don’t even matter anyways for the mechanism proposes. Glucose is glucose. Focus on that before you start trying to justify some soy based gobbly gook diet) would somehow do the trick.

    My counterpoint to that was that since it is not the presence of ketones that affect the cancer cells, but the lack of glucose, is that the concept of a ketogenic diet is pointless. The ketosis is a side effect of taking advantage of the mechanism of glucose starvation. So please, try and actually understand your own argument before you claim I am building straw men.

    I’ve explained how you cannot completely starve the body of glucose – you will die without it, period. Therefore glucose must exist in the body and that your body will destory itself to make sure that is the case. Thus, since you cannot possibly completely starve the cancer cells of glucose, you can at most reduce the amount they have available (i.e. restrict carbohydrate intake and by side effect induce ketosis). First off, we have no idea if the physiologically attainable levels of glucose starvation would even matter to the cancer cells. But secondly, I offered a mechanism by which the cancer cells could likely (and easily) counter the effects of decreased glucose availability, completely nullifying the mechanism you are so endeared to.

    My point is to illustrate a) that there are considerations you haven’t thought of that make more basic research necessary before jumping into human research studies and/or recommending a ketogenic diet to cancer patients and b) to illustrate precisely how and why basic sciences with very good mechanisms often do not translate into good clinical outcomes (see a).

    And don’t feel bad about wanting to choke me – that often happens when one gets thwarted in their understanding of matters outside their expertise. But try and actually understand the points instead of simply repeating the same tripe and missing the point.

    And your claim about mummies and cancer is also off the mark. Cancer is a disease of old age. Ancient Egyptians had half the life span of modern humans. That alone is likely to explain the difference. And the notion that more sun causes less cancer is, um, wrong. Here in Queensland, because of the excess exposure to UV light and lots of sun the melanoma rates are sky high – 1 in 17 vs 1 in 80ish in America.

    Oh yeah:

    near perfect health, i.e. no cancer, no heart disease, no autoimmune disease, very few cavities, straight teeth and no impacted molars, no obesity, no type II diabetes.

    Pass some of whatever you are smoking over here.

  53. daedalus2u says:

    I think the reason ancient Egyptians had such good health was their use of crocodile dung to treat just about everything. ;)

  54. Ohhh, I love mummies. Here’s an interest magazine article, you’ll have to search out the paper they are referencing if you are interested.

    http://www.msnbc.msn.com/id/34258529/ns/technology_and_science-science/t/bad-teeth-tormented-ancient-egyptians/

    Yes, that’s right, Bad teeth tormented ancient Egyptians.

    “After examining research of more than 3,000 mummies, anatomists and paleopathologists at the University of Zurich concluded that 18 percent of all mummies in case reports showed a nightmare array of dental diseases. ”

    also

    degenerative disorders, osteoarthritis, atherosclerosis, chronic infectious middle ear disease; other infectious diseases included tuberculosis and gangrenous stomatitis, an often fatal gangrene of the cheek and gums, Plasmodium falciparum, the most malignant form of malaria. Ten cases showed symptoms of tumorous lesions, with four of them possibly malignant.

    pulmonary diseases, which included pneumonia, emphysema and lung oedema. “Interestingly, most pulmonary affections were related to the presence of anthracotic pigment [carbon] in the lungs. This suggests air pollution by smoke from fires or oil lamps

    They also explain that mummies are great, but the cause of death can not be found in many, since the disease processes would have affected the organs that were not preserved.

  55. David Gorski says:

    There was also a study that showed that there was a high incidence of cardiovascular disease found in Egyptian mummies. I don’t remember where I saw stories about it, but it was sometime this year if I recall correctly.

  56. Scott says:

    Scott, if you don’t know if the result is reliable or not, it is no better than a random decision. That is my whole point.

    It’s also completely, utterly, and indisputably false. I don’t have to know that it reaches any standard of reliability other than “more likely than random chance to produce a correct result.” Which is an exceedingly low bar. And once it is reached, your statement is mathematically false.

    I also suggest that you go back and reread your own NO claims. You DO present it as just as well established as germ theory, you DO repeatedly go from “NO is involved in this pathway” to “the functioning of this pathway is completely determined by NO”, you do NOT have any sort of robust evidence, and you ARE a complete crank for claiming such level of certainty without robust direct tests of the claim. But that’s off-topic for this thread so I’ll say no more on the direct NO point.

  57. nybgrus says:

    Was it this one Dr. Gorski?

  58. Geoff says:

    @Harriet

    It’s true, I don’t have any direct experimental evidence to prove that my version of a ketogenic diet is safe, I’m pretty sure I acknowledged that above. In logic, there is no way to prove a negative, i.e. prove an absence of disease with a diet. The best you can do is point to examples of people not getting sick on a given diet, which I have done. The onus is on you to demonstrate that people get sick on any given diet. You have done this with the vegetable oil and soy diet, you have not done this with a high animal fats and protein diet.

    I on the other hand, have pointed to studies and populations who don’t get sick on a ketogenic diet made of animal fats and proteins. For example, the inuit: http://wholehealthsource.blogspot.com/2008/07/inuit-lessons-from-arctic.html and the masai: http://wholehealthsource.blogspot.com/2009/11/malocclusion-disease-of-civilization_28.html. (There are countless examples like these).
    Also, there are many low carbohydrate trials, for example these three lined in this post here: http://lowcarb4u.blogspot.com/2010/08/low-carb-versus-low-fat.html

    @nybgrus

    The presence of ketones in the blood matters indirectly. When you eat a very low carbohydrate diet, well below the glucose requirement for the brain in the absence of ketones, the body switches over to ketosis, making the muscles insulin resistant in order to spare glucose for the brain. In ketosis, the brain needs about 400 calories a day of glucose, and the rest of it can run on ketone bodies. So restricting your carbohydrate intake to 50g a day will undershoot the glucose requirement, but there will be sufficient excess protein in the diet to make up the short fall through gluconeogenesis.

    There are potential dangers of zero carbohydrate diets, particularly around vitamin c deficiency and mucosal membrane insufficiency in the colon, but eating ~50g of carbohydrate a day is sufficient to alleviate these dangers and ensure that even on a moderate protein intake the glucose requirement for the body is met and the rest of the body runs on ketones.

    What diet induces the ketosis does matter, because if there are other elements in a diet that are harmful, for example the highly unstable PUFA getting oxidized in the blood or the anti-predation proteins in soy that inhibit micronutrient absorption, inflame the gut, and influence thyroid function through excess estrogen.

  59. nybgrus says:

    I am about to head off for a short vacation having just finished my final exams so this will be brief:

    Geoff – you have not addressed the mechanism in question for cancer cells. You even state that the ketosis is important indirectly. It is a surrogate marker for glucose starvation. The ketone bodies present have nothing to do with the mechanism proposed. You do not need to school me on the concept of eating a low carb diet inducing ketones – I am (it seems) much more familiar with it than you are. You need to address the mechanism which you are touting as so promising – namely that cancer cells must utilize glucose for energy and cannot make use of the ketones/fats like other cells can. So, in a ketotic state what level of glucose is actually still available to the cancer cells and would it actually be low enough to hinder their growth? That is a question not yet answered – and try as you may you cannot escape that fact.

    Furthermore, you have to consider the adaptive capability of cancer cells – in a glucose deprived environment will they be able to compensate? I think it is very likely yes, and I have described a simple mechanism as to how. You have not addressed that either.

    You may (I stress may) be correct about the additional negative factors (or better risk profile) of one ketogenic diet vs another. But that in no way affects the central issue which you still have yet to address – the levels of glucose in the blood still available to cancer cells. You cannot start saying one ketogenic diet is better than another (even if you are correct!) before addressing whether any ketogenic diet will actually have any effect on cancer cells in vivo.

    Until you address those two key issues you cannot proceed on with anything else. All of your dodging and blustering about type of diet, carb intakes, types of carbs, and ketones is completely moot. If you are getting frustrated it is because I am not letting you slide on with a gish gallop about diets until you have addressed the core principle of the mechanism in question.

  60. Harriet Hall says:

    @Geoff,
    “The onus is on you to demonstrate that people get sick on any given diet.”

    Whaat? No, the onus is on you to provide evidence to support your claim that the ketogenic diet you recommend is a safe and effective treatment for cancer.

  61. daedalus2u says:

    An extremely common symptom of cancer is cachexia, where the muscles waste away. The reason this happens is because the body is turning those muscles into amino acids so that the liver can turn those amino acids into glucose so that cells that need glucose can get it.

    Another common disease state that triggers cachexia is sepsis. In sepsis, the same thing happens. People can lose many pounds a day of muscle, which gets turned into amino acids, which get turned into glucose, which gets turned into lactate, which gets turned into fat. People lose muscle and gain fat during sepsis.

    There is an actual case report on using a ketogenic diet to treat glioblastoma multiforme

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874558/?tool=pubmed

    I don’t think that what is happening is as simple as low glucose starving the tumor.

  62. Geoff says:

    @Harriet

    As compared to what diet? One that has wheat and vegetable oils in it? It is impossible to prove something safe. It defies the laws of logic. You can demonstrate that one diet is less harmful than another through a well designed comparison, but there’s no such thing as proving something safe, it’s attempting to prove a negative.

    I think that your problem is that you’re starting from an incorrect starting premise, and as a result you’re being skeptical of the wrong things. When it comes to health, there is one defacto starting premise, and any other starting premise is nonsensical. The starting premise is that humans living under the environmental conditions in which they evolved do not experience chronic disease. Any diseases that occur in individuals living in said environmental conditions is a result of genetic mutation (very rare, on the order of 1/100,000) or parasites.

    The reason why this is the defacto starting premise is that there exist groups of people who experience this type of freedom from disease. I’ve mentioned some of them above. Then the next question you must ask yourself is what changes do we nee to make to the lives of these perfect health individuals in order to give them modern western disease? There are a number of possible factors, but the data supports grains (especially wheat), vegetable oil, unfermented soy, a lack of natural sunlight and a lack of sleep as the most compelling factors. As such, it is unlikely that any diet that excludes these toxic foods will be less healthy than one that includes them, period. There is a potential for long term micronutrient deficiencies, but if we see a traditional culture in perfect health long term on a particular diet, then there is no reason to believe that their diet is deficient.

    It seems to me that your starting premise is that in general, disease is random, and while you can reduce your disease risk by living a healthy lifestyle, that risk never approaches zero.

    @nybgrus

    I appreciate that you’re bringing the discussion back to the level it should be on, I assure you that my frustration was not with the fact that you were questioning me, I’m happy to have an intellectual debate, but with what I perceived as a willful misinterpretation of what I was saying.

    So let’s address your question. Obviously this is still speculation, and it NEEDS TO BE TESTED in vivo, but my mental model predicts the following:

    In a ketogenic state, virtually no glucose is available to the cancer cells because all organs in the body become insulin resistant except the brain. Glucose is still circulating in the blood, but is not being passed into the cells because the central nervous system is sending some kind of signal to the cells to retract their insulin receptors (not sure if “retract” is the right word). Even in cancers that are capable of growth in the absence of glucose, the rate of growth should be substantially reduced since they will have to generate their energy from the glutamine –> glutamate –> TCA cycle pathway. I am a skeptic not a zealot though, so if any experimental evidence contradicts either of these two hypotheses, then it will be time to revise my mental model.

    One other point about this mechanism: there may be a way to induce the same metabolic changes on a very high carbohydrate diet from safe starch sources.

    The Kitavans, a traditional culture from an island in the south pacific, are a very interesting bunch indeed. They eat a hypercaloric diet of 60-70% carbohydrate, almost completely from tubers. They have terrible lipid profiles, low HDL, very high LDL and triglycerides, yet have no arthersclerosis. The Kitavans are the negative example that shatters the worldview of lipid hypothesizers and low carbers alike.

    One thing that is really interesting about the Kitavans is that they seem to be primarily fat burning despite their high carbohydrate diet. They often accidentally fast for a day or three without feeling any effects typically associated with a drop in blood sugar. They also have extremely good glucose tolerance. It appears that what is going on in their bodies is that their high carb diet, from a metabolic perspective, is actually a ketogenic diet. Nearly all of the carbohydrate that they eat is almost immediately converted to fat and stored.

    In my mental model of cancer, this Kitava style high carb diet is probably not the best prescription for cancer though, because cancer requires metabolic damage to manifest itself in the first place (in healthy individuals cancerous mutations die off quickly through apoptosis). The prerequisite metabolic damage will in many individuals be related to a fatty liver and/or issues with glucose metabolsm.

    Have a great vacation.

    1. Harriet Hall says:

      @Geoff
      “The starting premise is that humans living under the environmental conditions in which they evolved do not experience chronic disease. Any diseases that occur in individuals living in said environmental conditions is a result of genetic mutation (very rare, on the order of 1/100,000) or parasites.”

      Your starting premise is a false premise. Your mental models and speculations are not convincing.

  63. Geoff says:

    @Harriet

    Okay, so how do you explain the absence of heart disease, cancer, autoimmunity, obesity, cavities, etc in many traditional cultures and the subsequent proliferation of these diseases upon the inclusion of western foods in their diet?

  64. SloFox says:

    @ Geoff,

    I’m no epidemiologist but I am unaware of any society that does not have the diseases mentioned above. Incidences of disease certainly will vary with diet (and many other factors).

    I have yet to see convincing data regarding the absence of cancer and autoimmune diseases in so-called ‘traditional’ cultures. Most of the data I have seen is either too old (predates any knowledge of autoimmunity or modern conceptions of cancer), completely uncontrolled and/or non-random, too small, or has other methodological problems.

    I have absolutely no issue in looking at (even prima facie bizarre or counter-intuitive) diets to tease out their effects on health (positive AND negative).

    Before advocating one diet over another for therapeutic reasons, however, it’s probably best to actually study it prospectively (and in vivo). Most claims for therapeutic diets scream of a combination of the naturalistic fallacy and propter hoc ergo post hoc among others.

    I look forward to seeing your published results. We could use a straight forward game changer in fighting any of the diseases you mentioned (although I think the solution to obesity and cavities is obvious though difficult to implement/enforce).

    Regards.

  65. Geoff says:

    @SloFox

    Teeth seem to be the “canary in the coal mine” so to speak when it come to health, so even in very old studies, it’s actually quite easy to tease out cultures with perfect health based on just looking at how straight their teeth are.

    In any case, there are a number of such cultures. Weston Price wrote specifically about seven of them (I believe) in Nutrition and Physical Degeneration in great detail. One of the seven were the Inuit, who Vilhjalmur Stefansson wrote about. The Masai in Kenya have been extensively studied multiple times. There’s also the Tokelau, the Ache, the !Kung, and many, many others. While some of these studies go back as far as the 1920s, many have been more recent including Staffan Lindeberg’s study of the Kitavans in 1989.

    Stephan Guyenet, who’s an obesity neurobiology researcher, talks a lot about traditional cultures on his blog, and has a number of examples of cultures with very little or no disease.

    Label here: http://wholehealthsource.blogspot.com/search/label/native%20diet.

  66. SloFox says:

    Thanks for the references. I’ll take a look.

  67. daedalus2u says:

    Geoff, my explanation of the differential disease rates between the developed world and the rural undeveloped world has nothing to do with diet.

    http://books.google.com/books?id=a3mwmXzpsjkC&lpg=PP1&pg=PA103#v=onepage&q&f=false

    I think that most of the association of diet with disease is association, not causation. That there is a significant amount of programming of diet selection by health status and “healthy” people simply choose to eat a diet that has come to be associated with health.

    Large, long term, prospective and blinded dietary studies are essentially impossible to do and none are reported in the literature (that I have been able to find). It might be possible to do them in a captive population, a prison, but then there are other complications and ethical considerations.

    Getting people to change their diet is very difficult to do. Presumably food choice is predicated on nutrient needs of organisms. If organisms couldn’t self-select a diet that provided all the nutrients they need, they would be unable to survive in the wild, where diet is only self-selected.

    Essentially all of the diseases of the developed world that are rare in the undeveloped world are exacerbated by “stress”. Presumably those same stress pathways couple to the physiology that is perturbed between the rural undeveloped world and the developed world.

  68. Harriet Hall says:

    @Geoff,
    “how do you explain the absence of heart disease, cancer, autoimmunity, obesity, cavities, etc in many traditional cultures”

    I don’t accept that those diseases were absent. Weston Price is not a credible source. The Kitava study is not convincing.

    “it’s actually quite easy to tease out cultures with perfect health based on just looking at how straight their teeth are.”

    Whaaat?! References, please.

  69. Geoff says:

    @daedalus2u

    I do think that chronic stress is something that we are not adapted to, and it plays a role in disease. However, I think it plays more of a role in the ability or lack thereof to prevent disease in the face of food toxins than it does in the actual progression of the disease itself. Particularly in the case of autoimmune disease, people see dramatic disease process reversal in less than 30 days when they remove toxic foods from their diet.

    It is highly unlikely that it’s just a placebo effect of altering one’s diet, especially considering that many of the people who start eating in a paleo/primal-ish way get there after failing on vegetarian and vegan diets. From the totally unscientific 10,000 foot “it just makes sense” perspective, the fact that the majority of our calories on the standard american diet come from either grains; which are seeds that don’t want to be eaten and have anti-predation proteins to protect them; and vegetable oils; which were only invented in the last 100 or so years; is very meaningful. Not proof, but certainly sensible.

    Getting people to change their diet long term can be very difficult to do, but if someone is sick and they feel dramatically improved in only a few weeks of beginning a new diet, it becomes much easier.

    @Harriet

    There are way too many of these studies by too many independent researchers to just dismiss off-handedly like that. If Weston Price was the only one, the credibility of his research could be brought into question, but because of the shear quantity and variety of the research that substantiates what he found, I don’t really think that your position holds much weight. How do you fake a photograph of someones teeth with 1930s technology? I think our debate is over.

  70. Harriet Hall says:

    @Geoff,
    I am not dismissing the claims off-handedly. I’m asking for better evidence. A picture of someone’s teeth? Yes, our debate is over, since you persist in making ridiculous statements like “it’s actually quite easy to tease out cultures with perfect health based on just looking at how straight their teeth are.” without providing any supporting evidence.

  71. Geoff says:

    @Harriet

    I almost feel like you’re never going to accept anthropological data as compelling evidence anyway, so I don’t really see the point of bothering.

    There have been a number of transition studies in the cultures that you don’t believe were disease free, and the common thread seems to be that when a traditional culture transitions to a western diet, their dental health deteriorates first. In these specific traditional cultures that have perfect health, usually <5% of the population has any cavities, and this number jumps dramatically when they switch to a western diet. Chronic disease typically takes a little longer, somewhere on the order of 7 or so years.

    While dental hygiene definitely plays a role in dental health, I suspect that it is secondary to the role that tooth repair plays. Weston Price, who again you consider to be an unreliable source, successfully repaired early stage cavities using supplementation of vitamins A, D, K2 and calcium, which suggests that the teeth are living tissue that can repair themselves. If this is true, which I believe it is, then dental health is more about the body's ability to repair its teeth than it is about bacteria, plaque or anything else that we commonly implicate. These days I don't really go to the dentist anymore, but do supplement with Green Pastures fermented cod liver oil/high vitamin butter oil product since I don't really eat liver.

    Dental hygiene probably plays no role in teeth straightness, which is about the structural development of the arch and jaw. I suspect that the development of teeth leading to either straight teeth or crooked teeth serves as such a good predictor of health because asymmetries matter so much to the function of the jaw, so any malnutrition or reabsorption issues will be magnified in the teeth.

  72. SloFox says:

    I’ve spent the past few hours looking at the references above. The conclusions they draw are tenuous at best. I would not be able to make ANY recommendations (in good conscience) based on the very limited and circumstantial ‘evidence’ I’ve been able to find thus far. The only conclusion that think can be reasonably arrived at is that diet and lifestyle are likely to be important factors in the development of chronic disease. I think this conclusion could also be drawn by looking at Western societies alone. I definitely think more research into the specific effects of diet on disease is warranted. Who knows, maybe, a paleo diet can eliminate all chronic disease from society? I wouldn’t put any money on it. The data I’ve seen, although certainly comprehensive, represents all the above stated evidence and seems to be the most cited I’ve found on the web. It’s very weak and far from conclusive. Sorry, Geoff.

  73. Geoff says:

    @SloFox

    Conclusive is a strong label, and I don’t really think that much of what I’ve argued here would fall under that category. I can conclusively say the following:
    1) Epithelial cancers, heart disease, diabetes, obesity, autoimmune diseases and dental diseases are all modern diseases that are caused by one or multiple factors in the western lifestyle.
    2) Ketogenic diets, when designed using whole food sources, are no less healthy than mediterranean diets, south beach diets, vegan diets, vegetarian diets, Ornish diets, AHA diets and the standard american diet.

    Everything else is tenuous at best, and ever evolving, but that’s not to say that it doesn’t sit on a wide body of evidence. These are hypotheses that are ripe for the testing. They’ll get tested eventually, and I suspect that the studies will validate much of what I’m saying, but not for a while, because there just isn’t enough money in elimination diets to motivate the parties that be.

  74. Harriet Hall says:

    @Geoff,
    “I can conclusively say”

    You can say anything you want. That doesn’t make it true.

  75. SloFox says:

    @Geoff

    I agree that conclusive is indeed a strong label. I think both your claims fall far short of conclusive. From what I’ve found I’d put them in the dubious category. To be clear that doesn’t mean that there’s overwhelming evidence AGAINST the claim, just that there is very limited evidence to support it. I think we have different standards for what constitutes good evidence. I’ve seen a lot of better evidence end up leading to nothing.

  76. Geoff says:

    @SloFox

    I think that the discrepancy is that I have a lot more applied experience with some of these ideas since they have been floating around in my head for over two years now. I myself have/had systemic scleroderma, and in my personal experience I can see a difference in my disease process based on what I eat. If I eat wheat more than a couple days in a row, I will start to develop ulcers on my elbows and knuckles. I also know/know of many of other people who have had similar experience with these types of diets.

    Experience can remove objectivity from an individual, but it can also give people specialized knowledge that the layman doesn’t have. This is more the latter situation. On that accutane post I linked to a whole bunch of n=1 case studies of people who reversed autoimmune diseases including type I diabetes, two examples of RA, and ulcerative colitis. I’ve heard similar success stories with MS and lupus, though I couldn’t find any testimonials to link. As someone who has experienced an autoimmune disease first hand, I know that even when it gets better on its own, it does not get better anywhere near that fast, so unless you literally think that all of those people and me are straight up lying, it’s pretty hard to come up with an alternative explanation.

    Even still, I really don’t see how you can so dramatically discount anthropological evidence. I suppose that you could also think that these different anthropologists/doctors lying about their findings in traditional cultures, but I find highly implausible given the shear quantity of independent findings. There’s no other conclusion to draw other than that something in the western lifestyle is making people sick.

  77. Harriet Hall says:

    @Geoff,
    “I have a lot more applied experience with some of these ideas”

    Your experience has led to beliefs; beliefs can be wrong and must be tested.

    I find it difficult to believe someone could reverse type 1 diabetes with diet. Do you think the diet somehow resurrected pancreatic cells after they had been destroyed by the disease? I couldn’t find any documented case reports in PubMed. Unless you can come up with evidence, we are justified in dismissing such claims as hearsay.

    “I really don’t see how you can so dramatically discount anthropological evidence”
    We are not discounting it; we are questioning the quality of the evidence and the conclusions drawn from it.

    “There’s no other conclusion to draw other than that something in the western lifestyle is making people sick.” OK, there’s no other conclusion to draw: certainly not the conclusion that you have already identified exactly what that “something” is.

  78. Geoff says:

    @Harriet

    I understand this about beliefs, I’m actually in the middle of reading Michael Shermer’s “The Believing Brain” right now, but I wouldn’t be saying the things I am saying if I wasn’t confident that these beliefs will hold up to empirical scrutiny.

    I have identified something that I feel is the most compelling something, yes. I think that wheat and to a lesser extent other grains, and excess linoleic acid are the two primary agents of disease. We’ve talked a little about the problem with wheat, and I think that type 1 diabetes is actually a very good illustration because WGA in particular has a very similar amino acid structure to the pancreatic beta cells, which makes the molecular mimicry thing seem highly plausible. And obviously in celiac we already know that the disease action occurs as a result of antibodies to transglutaminase, which is an enzyme integral in pretty much all protein synthesis in the body.

    I suspect that the pancreatic beta cells cannot heal themselves at all once they are all dead, but they may be able to heal themselves so some degree if the offending antibodies are removed before all function has been lost. Even if they cannot heal themselves though, if you intervene before they are permanently damaged, you can maintain some beta cell function as long as you stop the disease process. In this scenario, it would be advisable to choose a diet that will not rely heavily on glucose metabolism because of the diminished insulin secretion capacity. This seems to be born out anecdotally, as there are people who have been able to get off of insulin after switching to a grain/legume/dairy free diet.

    As far as the vegetable oil thing, the problems seem to be two fold. First, PUFA with all of the extra double bonds are extremely chemically unstable and easily oxidized as a result. There is good evidence that it is oxidized LDL that causes heart disease, hear Chris Masterjohn lay that case out here: http://thehealthyskeptic.org/the-healthy-skeptic-podcast-episode-11. The second issue is that when you cause an imbalance in your omega-6:omega-3 PUFA ratio by consuming excess linoleic acid, you have the inflexible n-6 fatty acids out competing the n-3 for receptors and potentially all of the membrane structures in your body will be effected. This is why short term high dose supplementation of fish oil seems to be very effective and anti-inflammatory, but long term supplementation may do more harm than good.

    So hopefully you’re seeing that this is more than just a cute story, it is actually more of a hypothesis that has the potential to become a unifying theory of medicine. People seem to forget that medicine is a subset of biology, and as the famous quote says, “nothing in biology makes sense except in light of evolution.” In this very post, which the discussion has obviously gotten away from, David says that evolution is one of the most experimentally validated theories that we have in science, so why doesn’t it get discussed as part of a prior plausibility analysis? I have been and will continue to petition you guys to include this type of discussion.

  79. Harriet Hall says:

    @ Geoff,
    “I wouldn’t be saying the things I am saying if I wasn’t confident that these beliefs will hold up to empirical scrutiny.”

    Do you realize how foolish this sounds? Do you have any idea how many people with false beliefs have said the same thing? You have much to learn from Shermer’s book.

  80. Harriet Hall says:

    @Geoff,
    “evolution is one of the most experimentally validated theories that we have in science, so why doesn’t it get discussed as part of a prior plausibility analysis?”

    Because anyone can make up “just so stories” and there is no way to tell whether they are true.

  81. Geoff says:

    @Harriet

    I don’t really expect to learn much from Shermer’s book to be honest, it’s all pretty much in line with what I already know thus far. I really liked his section on Ayn Rand, his discussion is very much in line with the things I talk about on my blog.

    My beliefs are based on a wide body of a variety of evidence. You’re problem is misplaced skepticism, stifled by false beliefs born out of your trust in bad science starting with Ancel Keys and the lipid hypothesis.

    Not sure how much you’ve followed the work of Ioannidis, but it is becoming increasingly clear that somewhere on the order of 90% of medical research is false, yet for the last 30+ years this is all we’ve had to go on. Since I am younger and haven’t been as influenced by the bad science, and my primary training is in math and statistics rather than biology/medicine, I am able to make a more objective assessment of the evidence and come to rational hypotheses, unstifled by false beliefs born out of bad science. As I said earlier, the medical consensus is typically 10 years behind, but it will catch up.

  82. Harriet Hall says:

    @Geoff,

    Wow! You have provided the most impressive demonstration of hubris I have seen in a long while. Dunning-Kruger strikes again!

    You trumpet your youth and lack of medical/biological training as an advantage. I can play that game too. Since I am older and have much more experience and do have training in biology and medicine and science rather than just in math and statistics, I can argue that I am able to make a more objective assessment of the evidence. Rather than having “false beliefs born out of bad science,” I try not to “believe” anything but to provisionally accept the most reasonable conclusion based on the best quality evidence available, and I think I have developed considerable expertise in evaluating the quality of evidence. I have also seen many a “rational hypothesis” like yours proven wrong in the 41 years since I graduated from medical school.

    As for the lipid hypothesis, it has been established beyond any reasonable doubt that elevated blood lipid levels are a risk factor for atherosclerotic cardiovascular disease and that lowering those levels decreases risk. Lipids are only part of the problem: inflammation and other risk factors are involved. It has NOT been established that eliminating grain from the diet reduces cardiovascular risk.

  83. SloFox says:

    @Geoff,

    You accuse Harriet of misplaced skepticism yet you continue to use personal and anecdotal experience as evidence. I’m not sure if by “90& of medical research is false” you’re implying overt fraud, poorly conducted science, or good science leading to false conclusions. Even I agreed (and I don’t) that we can discount 90% of all medical studies your evidence is still not compelling. It may be true. I certainly don’t have direct evidence to falsify your claim since I haven’t seen any robust test of your hypothesis. But it’s precisely for this reason that I have my doubts.

    Is it implausible to think that some diseases may be exacerbated by a diet including wheat but that the ingestion of wheat is not the CAUSE of the disease? This hypothesis (that I’m not advocating) would be consistent with the anecdotal evidence you provide AND a modest degree of skepticism. You argue as if there is no room for doubt.

    The evidence you provide is at best sufficient to form a hypothesis, not draw a conclusion. In my relatively short 12-year career as a physician and researcher I’ve seen a lot of plausible hypothesis with far stronger evidence than you provide fail. Some of these failed hypotheses were my own.

    I think the thing that troubles me most is the veracity with which you cling to your belief in the absence of GOOD evidence. Perhaps, as you mention, age and experience underlie your unfounded exuberance.

    Honestly, I hope you’re right. I’d love to see your panacea for chronic disease stand the tests of rigorous investigation. I’m glad it is working for you in the management of your disease. I hope in 10 years you’ll have the opportunity to lay it on thick with a well-deserved “I told you so.”

    Until then, I remain skeptical.

  84. Geoff says:

    @SloFox

    I must say, I appreciate your response. The way that you are interacting with me is respectful, while still skeptical. That is the level that this discussion should stay at.

    The only thing that I would add though, is that you and I and the rest of us still have to live in a world of uncertainty. In order to bridge that gap of uncertainty, next step is n=1 experimentation.

    Obviously I’ve done a lot of this myself, and have drawn certain conclusions from it. For example, last Thanksgiving my dad had high blood pressure and high cholesterol, and was on medications for both of them. Between Thanksgiving and Christmas, he lost 15 lbs and then afterward another 5. When he had is annual in January, his doctor took him off of the lipitor and reduced his blood pressure medication substantially because his numbers had improved sufficiently. All he did was eliminate grains/legumes/dairy and substitute potatoes and fruit for snacks in their place.

    @Harriet

    It increases the risk, but the lipid hypothesis is causal. Many people with normal range levels have heart attacks, and many people with high levels do not. When you then throw in the Diet-Heart hypothesis, which is that eating dietary saturated fat and cholesterol raise these levels in the blood, and is also bogus despite being the medical consensus, you get a view of the the medical literature that is dramatically skewed from truth.

    Yes, inflammation is definitely involved. And it is caused by grains/legumes with their anti-predation properties, and excess linoleic acid with its oxidative properties and its displacement of n-3 fatty acids in cell structures.

  85. Harriet Hall says:

    @Geoff,

    “he lost 15 lbs and then afterward another 5… his doctor took him off of the lipitor and reduced his blood pressure medication substantially because his numbers had improved sufficiently. All he did was eliminate grains/legumes/dairy and substitute potatoes and fruit for snacks in their place.”

    The simplest interpretation is that his numbers improved because of his weight loss. Weight reduction is part of conventional medical treatment for his conditions because we know it reduces high blood pressure and blood lipid levels. We know that calorie restriction achieves those results, and we have no evidence that the source of the calories makes a difference. It is entirely plausible that his numbers might have improved just as much if he had achieved the same calorie reduction by eliminating potatoes and fruit. You are drawing conclusions not warranted by your observations.

    The idea that lipids “cause” cardiovascular disease is simplistic. I don’t accept it, and it does not represent the current medical consensus. So your argument is a straw man.

    Your statement about grains, etc. is just another unsupported belief based on an untested hypothesis, like your claim that straight teeth are a sign of perfect health. You can’t get away with that kind of thing here.

  86. Geoff says:

    @Harriet

    He didn’t restrict calories, and was specifically instructed not to. In fact he actually at over 2k kcal a day. I know, it’s impossible to lose 4lbs a week, especially if you’re already pretty close to your natural weight (he was around 20% body fat before the weight loss at 6′ tall 180 lbs), and certainly if it’s possible you need to create a 2000 kcal deficit, which lifting in the gym once a week will not achieve.

    You keep saying that you don’t see things as strictly cause and effect, labeling my argument as a strawman, and yet you continue to discuss these items as if they are cause and effect. In our email thread, you said that there’s no such thing as the gluttony-sloth hypothesis, and yet you are recommending deliberate calorie restriction as a means for inducing weight loss. Now you’re saying that the lipid hypothesis is not strictly cause and effect, but do you prescribe Lipitor to your patients? Do you recommend that they increase or decrease their saturated fat and dietary cholesterol intake if they have markers for metabolic syndrome?

    The reason that weight loss and lipid improvement are correlated is because they are both caused by the same dietary factors, and so reducing the offending dietary factors reduces them both simultaneously (again, confusing association with cause and effect). In the case of weight gain, the inflammation response interferes with the leptin signalling in the hypothalamus, disrupting the negative feed back loop between fat mass and the brain. The hypothalamus interprets the fat mass in the body as being below the setpoint, and does everything it can to increase it. This includes, but is not limited to, increasing appetite. When you remove the offending dietary agents, inflammation is reduced, and the hypothalamus sees the elevated blood leptin levels, which triggers the body to do everything it can to reduce weight. Appetite is a small part of this, but futile cycling and NEAT are much larger parts.

    Yes, it’s all theory, but it is a theory that explains all of the experimental observations, in particular the disappointing results of overfeeding and underfeeding studies in both normal weight and overweight individuals.

  87. Harriet Hall says:

    @Geoff,
    “He didn’t restrict calories, and was specifically instructed not to.”

    He may not have deliberately restricted calories, but if he lost weight, the laws of physics tell us that he must have eaten fewer calories than required to maintain his original weight. Every weight loss diet that limits food selection in any way has been shown to result in lower total calorie intake. And people’s own estimates of calorie intake tend to be very unreliable. I’m not accusing you of deliberately misrepresenting the facts, but I’m suggesting your observations and interpretation of the facts may be not be accurate.

    “Now you’re saying that the lipid hypothesis is not strictly cause and effect, but do you prescribe Lipitor to your patients?”

    You are failing to understand the nuances of my position. It is overly simplistic to say lipids “cause” heart disease. They are one factor in a complex web. It has been established that lowering blood lipid levels lowers cardiovascular risk, but that has to be seen in the context of the whole picture. I don’t recommend statins indiscriminately for everyone, but I do recommend them when indicated by consideration of the individual’s overall risk status.

    I don’t believe that sloth and gluttony are “the cause” of overweight. The evidence shows that people who eat too much and exercise too little for their particular individual metabolism will gain weight: the real question is what “causes” differences in metabolism and what “causes” them to eat more calories than they burn; and that is attributable to genetic differences and psychosocial factors. And it is well established that any individual will lose weight if his calorie intake decreases enough.

    I don’t think you know enough about “all the experimental observations” to be so sure your hypothesis explains them all; and even if it did, it still might not be correct. Like everything in science, it must be properly tested.

    You go on and on with your hypotheses and speculations, and you keep making unsupportable statements like the one about straight teeth as a sign of perfect health. And you’re not even consistent: you claim the Masai are healthy because of their diet, which includes milk, and then you say your father eliminated dairy along with grains. The only thing that will persuade us is evidence, and you simply don’t have any credible evidence. The most you can hope to accomplish is to get us to keep an open mind while we wait for evidence. You insult us by implying that our minds are not open enough. They are. Our minds are open to evidence, just not open enough for our brains to fall out. Being convinced by the kind of “evidence” you offer would mean our minds were open to all kinds of pseudoscience and quackery.

  88. Geoff says:

    @Harriet

    I am stating my opinions, my hypotheses based on the data, I am not claiming that much of what I am saying is fact. This is a blog, not a medical journal. I don’t need to say “in my opinion” every freaking time I state something as an opinion. You’re the one insulting me by holding everything I say up to the scrutiny of a statement of fact. I am calling you close minded, not “everyone,” in fact I have consistently complimented everyone else on their tone specifically because of how it contrasted with yours. An appropriate tone is an interested skeptic, playing devils advocate using the Socratic Method, not throwing out ad hominem attacks like “pseudoscience and quackery.”

    When I say that grains cause UC and Crohn’s, for example, the “in my opinion” is implied. The evidence that I have is not nearly sufficient to prove it to be the case, but it is enough to give it a hard freaking look. There are hundreds if not thousands of people around the country who are reversing autoimmunity through grain/legume/dairy free diets. Just because it isn’t sufficient to prove it, doesn’t mean it isn’t enough to prove that there is value in testing it.

    Speaking of grain/legume/dairy free diets, just because something is safe for a healthy person to eat does not mean that it cannot be problematic once someone is already sick. Dairy is healthful for a healthy person, but can be problematic for people with an inflamed gut. Casein has a number of structural properties that are similar to plant lectins, and has similar opiate receptor hitting elements that can trigger reward factors, an important element in the fat mass setpoint.

    When you ask me for evidence, I am doing the best that I can to provide you with data that supports it in an effort to illustrate why I have formed that opinion. The goal was never to convince you one way or another. The level of evidence required to “prove” something in science is inordinate. The level of evidence required to demonstrate that studies need to be done, on the other hand, is much lower. I can’t prove anything because no one is doing the studies. That is why I am bringing my opinion up, because it needs to be a part of the discourse. It is informed, fully thought out, completely consistent, and basically explains the vast majority of the phenomena we see empirically.

    Imagine for a second that I am right, that grains/legumes and plant oils along with a lack of sleep, fear of the sun, and hyperrewarding industrial foods have caused basically all diseases that we experience today. Imagine we literally solve that problem, and in one generation start to experience the kind of health that the Kitavans experienced. Think of all of the cool things science could do with the research budget. Think of how much easier it would be to drill down even further into these diseases now that we have that laser focus. All of the overcrowding problems we would create, and how we’d need to solve them.

    So that’s why I am going to keep demanding prior plausibility analysis that involves our most up to date understanding of human evolution and anthropology. Because no one else is doing it, and it needs to be a part of the conversation. That and to make us more skeptical of the “Medical Consensus” (which is why I commented on this post to begin with), because they got something glaringly wrong, totally ass backwards. Not only did they screw the pooch, they screwed all 101 dalmatians.

    So we need to have more skepticism of the medical consensus, because a lot of it is not science based. The diet-heart hypothesis as defined in the literature is backwards, not just wrong. The lipid hypothesis is wrong. The gluttony-sloth hypothesis is wrong. We need to go back to basics and include an evolution and anthropology based prior plausibility analysis.

  89. nybgrus says:

    Back from a well deserved weekend vacation on the coast and ready to tackle a few things I noted in the discussion. I think Dr. Hall and Slofox covered most of it and extremely well at that. Geoff, you would be wise to actually listen to what they are trying to tell you. Anyways, here are a few points I teased out of the thread since I have been gone (in chronological order):

    In a ketogenic state, virtually no glucose is available to the cancer cells because all organs in the body become insulin resistant except the brain. Glucose is still circulating in the blood, but is not being passed into the cells because the central nervous system is sending some kind of signal to the cells to retract their insulin receptors (not sure if “retract” is the right word). Even in cancers that are capable of growth in the absence of glucose, the rate of growth should be substantially reduced since they will have to generate their energy from the glutamine –> glutamate –> TCA cycle pathway. I am a skeptic not a zealot though, so if any experimental evidence contradicts either of these two hypotheses, then it will be time to revise my mental model.

    Geoff, I have agreed with you about the basics of a ketogenic diet. But you continue to miss the important conceptual point of the biology here. It is incorrect that the peripheral tissues become a bit insulin resistant and downregulate the expression of GLUT channels (BTW, if you are forced to say “some kind of signal” and “retract” even with caveats that means you do not know the material very well at all and you should learn those basics before trying to apply clinical medicine to them. Additionally, such a “signal” does not come from the CNS per se, but it a complex interaction of hormones from many sources) – it is simply that low blood glucose decreasing insulin secretion which decreased GLUT channel expression on cells surfaces which would then act to shunt available glucose to the brain. But, and here is the part you really need to pay attention to – how does that glucose get to the brain? By the blood. How do cancer cells grow? By shunting blood to themselves via increased angiogenic factors they secrete. So blood laden with glucose (as much as can be mustered) is flowing to the cancer cells – there is no way to prevent that. Do you think the cancer cells are listening to “some kind of signal” to downregulate their GLUT channels? Of course not, they are cancerous! In fact, as I have said before – they are quite likely to upregulate the GLUT channels to pull even more glucose from the blood.

    So right there, plain and simple, you need to revise your mental model. Drastically. This simple fact has been the crux of my critcism of ketogenic diets in cancer.

    The Kitavans, a traditional culture from an island in the south pacific, are a very interesting bunch indeed.

    I did a search on Kitavans. In google, I get a bunch of new-agey sites and blogs that look pretty woo-ish to me. When doing a PubMed search I find a number of scholaraly articles. I browsed through a dozen or so of the top hits. Every single one of them was pretty weak at best. They used small samples of self reported data. The closest I saw to actual hard data points were blood labs. Nothing else except remembered recounting of symptoms and causes of deaths was used. So your claim that they have no heart disease, etc is technically in line with the studies, but the studies are garbage and don’t say anything useful. I can’t say for certain that there is heart disease or stroke in the Kitavan population, but no on can say there isn’t either. And here is the kicker – even if there actually wasn’t any HD or stroke – you couldn’t say that it was a result of their diet.

    in healthy individuals cancerous mutations die off quickly through apoptosis

    This statement belies your lack of understanding in cancer biology. The health of a person has nothing to do with apoptosis. That happens on a cellular level. When a cell mutates (as happens quite frequently actually) that mutation is either completely silent or can have some sort of noticeable effect. P53 is a regulatory protein that verifies the integrity of newly synthesized DNA and if there is such an error, anywhere, it will halt the cell cycle and evetually lead to apoptosis. This is why individuals don’t get cancer every day. This is also why a defunct p53 is found in over 50% of all cancers. There are other regulatory pathways that can be affected as well – ret, myc, abl just to name a few. That forms some of the heritability of cancers – if you have one bad copy of p53 or ret you only need to muck up the other copy. But your health, and your diet, have nothing to do with this cellular level apoptosis and once a cell has mutated to avoid apoptosis or to defeat the regulatory steps, then it is cancer and it continues to grow, divide, adapt, and mutate. These are things you seem not to know very well and are necessary for commenting about the plausibility of anti-cancer mechanisms.

    teeth seem to be the “canary in the coal mine” so to speak when it come to health, so even in very old studies, it’s actually quite easy to tease out cultures with perfect health based on just looking at how straight their teeth are.

    As Dr. Hall said – citation please. That doesn’t even seem to make sense on the surface (and yes, I read the bit about how teeth can heal themselves. Any dentsist will tell you that teeth can grow and heal and are living tissues themselves). So by that token since my lower teeth are crowded by my wisdom teeth and are therefore not straight, I must be unhealthy? Or is it that I am healthy but since my girlfriend’s teeth are perfectly straight she is healthier than I am?

    This is another basic assumption without warrant that is clearly influencing your beliefs and interpretation of data – aka a bias.

    in the face of food toxins than it does in the actual progression of the disease

    Ah yes, the old toxins gambit. This has been written so much about here and over at RI that the only appropriate response is to tell you to read up on it and say, “Oh noes! Teh toxins!1!!”

    In these specific traditional cultures that have perfect health, usually <5% of the population has any cavities, and this number jumps dramatically when they switch to a western diet

    Perfect health? Once again, pass over whatver you are smoking. If I had piles of money (instead of piles of debt) I would love to fund a study where I send you and all your buddies over to one of these traditional cultures and have you live exactly as they do and see how long you last. And see how good and perfect your health is after you get back. I promise, it won’t be very good.

    1) Epithelial cancers, heart disease, diabetes, obesity, autoimmune diseases and dental diseases are all modern diseases that are caused by one or multiple factors in the western lifestyle.


    2) Ketogenic diets, when designed using whole food sources, are no less healthy than mediterranean diets, south beach diets, vegan diets, vegetarian diets, Ornish diets, AHA diets and the standard american diet.

    Those are the only two things you can say with a conclusory note. Yet you say so much else with completely unwarranted conviction. The second one no one here is even arguing – we’ve all said that there isn’t much data either way. My earlier statements were “what-ifs” about how a ketogenic diet could be harmful, especially in certain patient populations which make recommending it irresponsible. But there is no good data either way, so you can’t tell me it is healthier either.

    However number 1 is a big reach. Those are extremely broad and diverse categories and, as an actual skeptic, any statement so broad and sweeping is almost immediately disregarded. That is the hallmark of a belief system not reasoned scientific discourse.

    I think that the discrepancy is that I have a lot more applied experience with some of these ideas since they have been floating around in my head for over two years now.

    You and Dr. Jay Gordon should have a chat and commiserate about how none of us nasty skeptics takes your “applied experience” seriously.

    Actually I think the discepancy is more likely that you are in the company of physicians (and a medical student) with vastly more experience and knowledge in the relevant sciences. That allows us to more accurately evaluate studies, data, and mechanisms which is why you would look at something (say the Kitavans) and think that is compelling data and to us it is not. Dr. Google is no substitute for actually studying the relevant sciences for years and going to medical school (and through it, and residency, and practice).

    As Dr. Hall pointed out, your hubris is astounding. You get upset if we make a snark or two at your claims and demand to keep things civil and then go and make such pompous and arrogant claims yourself. That is a common tactic of pseudo-scientists, sCAMsters, and religious apologists. “Keep the discussion civil so it can sound like I have valid and equal points, but let me go on and tell you how my two years of ideas rattling around in my head trumps your actual experience and expertise.”

    Tone doesn’t matter to science. If you have it, then you will be vindicated. If you don’t, it will get shot down and thats it. The difference is that if we get shot down, we will find more data or, if warranted, change our viewpoints. Every time you have been getting shot down you stick to the same few points and elaborate on others without addressing the first rebut. You still haven’t even addressed the issue of physiological levels of glucose in a ketogenic diet and how cancer cells would be deprived of glucose. You simply hand waive and say “ketosis = no glucose since it all goes to the brain, therefore cancer cells don’t get any.” That is wrong and you have not addressed it yet.

    If I eat wheat more than a couple days in a row, I will start to develop ulcers on my elbows and knuckles.

    Once again with the anecdote – it seems very compelling to you, but it really is pretty worthless.

    If a person with celiac disease eats a slice of bread they get extremely upset GIT. If my girlfriend drinks milk she gets stabbing pains and diarrhea. If my friend in Germany eats a raw apple his throat swells up and he may die. My friend back in California can keel over dead from 1 piece of fish. If a heart failure patient eats a salty Chinese dinner he will suddenly have trouble breathing and experience profound paroxysmal nocturnal dyspnea.

    Perhaps bread, milk, apples, fish, and chinese food should also be eliminated from the diet?

    As someone who has experienced an autoimmune disease first hand, I know that even when it gets better on its own, it does not get better anywhere near that fast, so unless you literally think that all of those people and me are straight up lying, it’s pretty hard to come up with an alternative explanation.

    No one says you are lying. We are saying that anecdote is a very poor data point because it is inherently prone to bias. There are plenty of explanations besides what you offer with just as much data to support them (i.e. none).

    Even still, I really don’t see how you can so dramatically discount anthropological evidence.

    Dr. Hall was quite judicious in her response. Mine is less so – because most anthroplogical data is garbage. It is so blinkered from cultural relatavism and “just-so” stories that you cannot reliably use the vast majority of it.

    Did I mention I have a degree in anthropology? (Graduated with honors in it too).

    WGA in particular has a very similar amino acid structure to the pancreatic beta cells, which makes the molecular mimicry thing seem highly plausible

    So eating foods that may be able to create a similar antigenic profile to pancreatic beta cells will allow for the auto-antibodies to target said food instead of the cells, thus stopping and reversing to small extent type 1 diabetes? And you consider that even remotely plausible, let alone highly plausible?

    First off, the food gets digested into mono- and oligo-peptides. There wouldn’t be anything left to mimic the beta cell antigenecity in the blood stream. But lets say that were even possible – do you know what the outcome of your “highly plausible” theory would be? Besides the fact that there would never be enough of your molecular mimicry molecules to have an effect, when the Ab-Ag complex forms in the bloodstream it becomes bigger and much less soluble. It then will settle into tissues where blood flow is less (i.e. kidney, capillary beds). This is called a Type III hypersensitivy reaction – immune complex deposition. Look it up, if you need. The point being that if your hypothesis bore weight you would have much bigger issues than Type 1 DM.

    Never mind the fact that Type 1 DM is silent until less than 5% of your beta cells remain – you wouldn’t exactly have much to work with even if none of those above considerations were the case.

    I suspect that the pancreatic beta cells cannot heal themselves at all once they are all dead, but they may be able to heal themselves so some degree if the offending antibodies are removed before all function has been lost.

    Once again, your lack of basic sciences shows. The antibodies are produced in LARGE quantities by B cells in your marrow. You cannot eliminate the antibodies unless you eliminate those cells. Eating food that is antigenically similar will only serve to form those immune complexes. Any Ab removed from serum will simply be replaced by the B cells producing it in the first place.

    Now if you are actually a skeptic as you say, you would revise your “mental model” to incoporate these facts and discard your highly plausible hypothesis.

    First, PUFA with all of the extra double bonds are extremely chemically unstable and easily oxidized as a result

    Double bonds make compounds MORE stable. Not less. There is a reason why we have to take organic chemistry for a year before getting into medical school. The reason why double-bonded fatty acids are implicated is because they are more stable, and tend to hang around longer in fatty streaks, and have more opportunity to get oxidized.

    So hopefully you’re seeing that this is more than just a cute story, it is actually more of a hypothesis that has the potential to become a unifying theory of medicine.

    Actually, it just went from being a cute story to a seriously and appallingly arrogant statement of ignorance. You can’t really expect us to take you seriously after a statement like that can you? I have pointed out a smattering of the very simple and basic assumptions and mechanisms you have wrong. Hopefully you will realize that you cannot build a “unifying theory of medicine” when you can’t even get basic science right.

    Not sure how much you’ve followed the work of Ioannidis, but it is becoming increasingly clear that somewhere on the order of 90% of medical research is false, yet for the last 30+ years this is all we’ve had to go on

    I suggest you read the extensive articles on this site about Ionnidis. Once again your hubris is astounding. You really think you could come to a blog like this and think you are dropping some sort of bombshell of knowledge on us like that? You really thought the response would be, “Oh my! I’ve never heard of Ionnidis! This changes everything! You must be right Geoff!” Please, if you demand a civil discourse, you yourself need to be much less insulting. This reminds me of when my 7 year old nephew confidently asserts he knows more about a particular topic than I do. But at least he is 7 (and btw, managed to learn in very short time that I do know a fair bit more than him and instead of claiming he is right, he constantly asks me to do experiments with him and teach him. If a 7 year old can learn it so can you Geoff).

    In order to bridge that gap of uncertainty, next step is n=1 experimentation.

    “In order to bridge the gap and make it seem like my hypothesis bear weight, we need to look at anecdotes and add them up to seem convincing”

    There, fixed that for you.

    Yes, it’s all theory, but it is a theory that explains all of the experimental observations

    I think that everyone at some point in their high school careers should have the definitions of “theory,” “hypothesis, and “guess” burned into their brains. Perhaps tattooed on their arms if necessary. No Geoff, you have a guess based on a few “just-so” stories strung together with a hypothesis here and there and tacked up with a tiny bit of data. A theory is a very powerful thing – evolution is a theory, gravity is a theory, germs causing infections is a theory.

    And just because you can explain a set of experimental observations doesn’t make that accurate. There is a reason they are called “just-so” stories.

    At first I though you may have actually been interested in genuinely learning why your diet ideas might be wrong. Now it seems pretty clear you think you know better than actual experts in the field and are out to try and convince us regardless of what the evidence or science says. If you want to actually be a skeptic and not a pseudo-skeptic I suggest you change that attitude and actually learn the basics and listen to people like the authors of this site – they are actually experts and extremely knowledgeable.

  90. nybgrus says:

    When you ask me for evidence, I am doing the best that I can to provide you with data that supports it in an effort to illustrate why I have formed that opinion. The goal was never to convince you one way or another. The level of evidence required to “prove” something in science is inordinate.

    Exactly. You have a pre-concieved idea and find whatever it takes to fit that. That is not just wrong, that is exactly backwards.

    The level of evidence required to “prove” something in science is not inordinate. It is exactly where it needs to be – there is a reason why the bar is so high and that is lost on you, it would seem.

    When I say that grains cause UC and Crohn’s, for example, the “in my opinion” is implied

    Not on this blog. If you say something that has bearing on the discussion it is your onus to prove it. If you don’t cite references you can and will be called out for it. Otherwise, people can say whatever they want and expect it to be held in good standing. No, this is not a journal, but why does that mean the authors and commenters here can’t hold it to the standards of one? When I write things to you I am not giving you my opinion unless I say so. If you notice, I don’t cite a reference for everything. I am also not called out on it because the authors and commenters here know it to be correct. So a reference is not needed for everything, but if you are asked for one you better be able to provide it. Otherwise you can (and have) fall back on “it was just my opinion” and continue to weave your “just-so” stories.

    Imagine for a second that I am right,

    That’s not the way science works. You don’t imagine your just-so story is right and then justify research based on that.

    and in one generation start to experience the kind of health that the Kitavans experienced.

    Once again, a premise rejected and yet you still base your arguments on it.

    That and to make us more skeptical of the “Medical Consensus” (which is why I commented on this post to begin with), because they got something glaringly wrong, totally ass backwards.

    It doesn’t fit your just so story. When that happens, it is vastly more likely you are wrong than a large group of experts. Skepticism requires being a bit humble. There’s a reason why I don’t tell my girlfriend she is wrong on things – I don’t understand hypersonics engineering.

  91. Geoff says:

    @nybgrus

    You are dramatically overstating the scientific consensus with regard to glut4 receptors and insulin resistance. I used the general terms because I think that it is likely that glut4 is not the only receptor site, number one, and I don’t think that you can dismiss the central nervous system as quickly as you’d like to. The hypothalamus seems to regulate weight just as tightly as it regulates temperature in the body, at least until something breaks. Insulin resistance that we see often in obesity always occurs downstream of leptin resistance, so there is good reason to believe that the central nervous system has a primary role in this action.

    Your conjecture about cancer cells upregulating glut4 receptors is valid conjecture, but it doesn’t hold up to the scrutiny of the animal models on ketogenic diets. Mine does. Not much else to say there.

    The other thing that they did in Kitava is use ultrasound to examine the athersclerosis, of which there was none. Taken by itself, the Kitava study may not be convincing, but taken in the totality of the anthropological evidence, we have good reason to believe that it is probably pretty accurate.

    Apoptosis is heavily influenced by all of what we’re discussing here. Hyperinsulinemia definitely seems to interfere with retinoic acid production, for example. I have every reason to believe that someone with a healthy metabolism should be largely protected from cancer. That is why the Kitavans and the Masai, who both smoke like chimneys; I know that 75% of Kitava smokes; have no lung cancer. That’s why three in four people who smoke never get lung cancer. Because any cancerous mutations that did occur get killed off instantly via apoptosis.

    Since your lower teeth are crowded, you did not get adequate nutrition in childhood. If your girlfriends teeth are perfectly straight and she never had braces, it is very likely that she will be more resistant to disease than you. It’s a marker, it’s evidence. Just like lipid profiles. Not causal, just a marker.

    The rest I will have to get to later. I do appreciate the long response though, and will try to get to the rest of it when I can.

  92. nybgrus says:

    @geoff:

    You are dramatically overstating the scientific consensus with regard to glut4 receptors and insulin resistance. I used the general terms because I think that it is likely that glut4 is not the only receptor site

    GLUT4 is a channel, not a receptor. The insulin receptor is a tyrosine kinase g-coupled receptor that activates pathways that lead to mobilzation of GLUT4 to the cell membrane so that glucose can diffuse into the cell. If you think there is another way for glucose to enter a cell besides GLUT (the number varies with the cell type, 4 being present in muscle and adipose, primarily) then you are sorely mistaken. If you think that there is a mechanism other than insulin to up-regulate GLUT4 expression you are also mistaken.

    The hypothalamus seems to regulate weight just as tightly as it regulates temperature in the body, at least until something breaks. Insulin resistance that we see often in obesity always occurs downstream of leptin resistance, so there is good reason to believe that the central nervous system has a primary role in this action.

    Leptin, ghrelin, NP-Y, etc act on the hypothalamus to regulate appetite. The brain does not have a direct effect on insulin secretion, which is what you statement implied and what I was responding to. I dismissed your assertion that the CNS can directly influence insulin secretion or sensitivity.

    Your conjecture about cancer cells upregulating glut4 receptors is valid conjecture, but it doesn’t hold up to the scrutiny of the animal models on ketogenic diets

    This is when you will need to provide a relevant reference. However, you needn’t really since my conjecture was downstream of the basic mechanism and premise upon which you have built your argument for ketogenic diets in cancer. Furthermore I have freely admitted it is simply one conjecture amongst many, any of which could handily dismiss your assertion that ketogenic diets should be recommended to cancer patients if the basic premise of your argument holds true… which it hasn’t yet.

    The other thing that they did in Kitava is use ultrasound to examine the athersclerosis, of which there was none

    Can you link a study please? In my review before I found no such study and in a pubmed search for kitava and ultrasound I came up empty as well.

    That is why the Kitavans and the Masai, who both smoke like chimneys; I know that 75% of Kitava smokes; have no lung cancer.

    Actually, that is because smoking imparts a significantly greater risk of lung cancer. It doesn’t guarantee it and absolute risk is still actually quite low. But when we are talking about something like lung cancer, even a couple of percentage points is a pretty big health problem. There is absolutely no reason to attribute that finding (even if) it is true to something about their diet.

    Because any cancerous mutations that did occur get killed off instantly via apoptosis.

    You still don’t understand basic cancer biology. I tried to explain it briefly, but it is a complex topic – one I am still admittedly a novice at. Dr. Gorski would school me in a nanosecond. However, your understanding of the role of apoptosis in cancer genesis is fundamentally flawed. I spent weeks learning the relevant genetics and basics and that was facilitated by my years of undergraduate education in the relevant sciences. I don’t have the time or ability to properly educate you on the topic. Suffice it to say, that overall health (especially vis-a-vis nutrition) have no role in apoptosis. You could be extremely malnourished, overweight, fit and athletic, what have you and that would not influence apoptosis in a setting of a pre-cancerous lesion.

    It’s honestly frustrating because you seem to mean well and you aren’t a stupid person – you are just out of your field and out of your depth. I wish I could beam the knowledge into your brain instantly so you could frame the discussion properly and realize where you are making fundamental errors and poor assumptions.

    Since your lower teeth are crowded, you did not get adequate nutrition in childhood.

    Actually, I led a very healthy and nutritionally adequate childhood. My teeth are crowded because I never got my wisdom teeth removed. It hurt like hell when the came in and shoved my teeth over but I was stubborn and didn’t want them out (I don’t like dentists much). After many years, they settled down and dentists told me they were in their fixed and permanent position so getting them out was purely cosmetic. I decided I’d leave my crowded teeth and spare the surgery. Oh, and my teeth where perfectly straight and immaculate prior to the wisdom teeth.

    If your girlfriends teeth are perfectly straight and she never had braces, it is very likely that she will be more resistant to disease than you.

    Actually she has atopy, allergies to some common foods, and extremely sensitive skin and GIT. She is not unhealthy at all but by any metric I am more, for lack of a better word, robust than she is – something she freely admits.

    t’s a marker, it’s evidence. Just like lipid profiles. Not causal, just a marker.

    It is a marker – I agree there. But it is one that you have been using incorrectly. You have applied it to cases where it makes no sense and over reached what it is a marker for. My little anecdotes demonstrate that you should be much less certain of your claims.

    The rest I will have to get to later. I do appreciate the long response though, and will try to get to the rest of it when I can.

    You are welcome. I enjoy debates like this since I always learn more in the process. However, there is only one point I would like you to address, so please refrain from responding to anything else until you have dedicated one post to this (and I’ll even ask it again):

    The mechanism proposed for your ketogenic diet is that cancer cells require substrate level phosphorylation due to inactived mitochondria. That is not in question. However, this hinges not on ketones being present, but glucose being absent with the presence of ketones being a side effect of the decreased glucose.

    Thus the question is twofold: do you have any data describing how low blood glucose levels can get in a physiologically feasible ketogenic diet (of any kind) and would those levels be sufficiently low to clinically alter the course of a cancerous lesion?

    Until you address those specific points any discussion of recommending a ketogenic diet to cancer patients is out of the question and any suggestion of clinical trials is also premature.

  93. Geoff says:

    @nybgrus

    So I think what I was actually talking about with the Kitavans was a coronary artery calcium score, but I can’t find the reference anywhere. It’s possible that I am confusing them with another population, the fact that I can’t find the data is really making me second guess myself, but I really don’t think so. Will keep looking.

    It sounds like I do need to learn quite a bit more about the GLUT4 channel, and when I get a chance, maybe I will. Still, I am not willing to concede that the central nervous system doesn’t play a more critical role than you’re allowing for. I’ll have to go digging for the references, but I have seen at least a couple of studies in which injecting leptin in the brain of rats causes spontaneous weight reduction under the most improbable of conditions, suggesting that the hormone cascade you described above is potentially still regulated by the central nervous system.

    There’s no question that the body has redundancies in many areas, so there’s probably a degree to which this stuff can self regulate, while at the same time there is probably also a pathway by which the CNS can regulate it. A more obvious example of this is my heart. I had a heart transplant in 2007, and the nervous connection between my heart and brain is severed. My heart still beats on its own though. It’s not ridiculous to think that there could be other pathways by which the body becomes insulin resistant that are driven by the brain as a means to ensure that glucose is spared for that purpose, and in animal models, it seems to be the case that these cancer cells are dying, suggesting that they are likely not getting the glucose, if that mechanism is correct, or that maybe there’s some other mechanism by which inducing ketosis kills off cancer, since this is definitely what we see in certain types of cancers in animal models.

    When I talked about recommending ketogenic diets to cancerous patients, I specifically discussed it in the context of it being a last resort for patients who are otherwise out of options. That is when it is *arguably*; which I also used very specifically; unethical to not suggest it as something to investigate and maybe self experiment with on an n=1 basis. Scroll up and read what I said, a search for “arguably unethical” will help. I do think that doctors should be making the suggestion to their patients, because in my opinion a properly designed ketogenic diet is not harmful and it can potentially be a powerful adjunct treatment. But I understand that not everyone will agree with my opinion on the matter, and may not feel comfortable making this recommendation. That does not mean, however, that even these doctors who don’t feel comfortable with the long term safety of a ketogenic diet shouldn’t be recommending it as a last resort.

    One thing that I probably should have made more clear with regard to the teeth being the canary in a coal mine is that I was talking about it in a population basis. In these superior health populations, everyone has straight teeth, and very few people have cavities. Their wisdom teeth come in properly as well. That’s not to say that some people on inferior diets can’t also have straight teeth, but on an inferior diet, straight teeth are more the exception than the rule. I had braces in middle school, and just about everyone I know did as well. The only two people who come to mind right now who didn’t have braces are particularly healthy, but my point was about populations, not individuals.

    What you said about your wisdom teeth makes no sense biological sense. No evolutionary sense. It is ridiculous to think that your wisdom teeth could naturally come in impacted. That they are some vestigial body part that need to be removed for anyone to have straight teeth. This is exactly what I am talking about with regard to prior plausibility analysis. The fact that your wisdom teeth didn’t come in properly is evidence that you did not get adequate nutrition as your jaw was forming. That’s not an insult, I didn’t either. It could potentially be more about nutrient absorption or re-absorption than about the total nutrition of the diet.

    Your girlfriend sounds like she needs to be checked out for celiac. My sister had very similar symptoms, very itchy skin, a ton of allergies, etc. If she has celiac and is eating wheat, that could cause basically all of the symptoms you just mentioned. Even if she doesn’t have celiac, I can all but guarantee that if she goes grain/legume/dairy/nightshade free for 30 days that the majority of her allergies and skin irritation will go away. Let’s use less strong language, the model that I am putting forward; which I don’t want to call “my model” because it really isn’t mine at all; predicts that that stuff should go away in less than 30 days on a paleoish type diet. Again, this is where self experimentation fills in the gaps in the literature. I’ve done a lot of this self experimentation already, which is why my degree of certainty is so much higher than yours. That’s not to say I’m not skeptical, but I’ve just seen it work too many times to ignore.

    Fasting glucose in very low carb populations tends to be in the 70-100 mg/dl range. Still, in the animal models, it seems that this glucose is not getting into the cancerous cells, so it seems that it is less about fasting glucose and more about something downstream of this, which is why I was suggesting that the central nervous system may have a role. Listen to Dr. Seyfried’s discussion of his research here: http://www.thelivinlowcarbshow.com/shownotes/1172/dr-thomas-seyfried-on-killer-carbs-ketosis-as-a-cancer-cure-episode-302/.

    To your other points:
    I am already very strict about what I eat, so I have no reason to believe that my health would improve eating a Kitavan diet or a Masai diet, but that’s not to say that yours wouldn’t. Or your girlfriends. I’m willing to bet a lot of money that both of you would experience health improvements. You don’t even have to go live there to experience the changes, just eat what they eat, sleep more, and get sensible sun exposure.

    To your point about self experimentation, I say let’s gamble. I’ll throw down up to $5000 that if I create a 30 day meal plan for your girlfriend, she will see a DRAMATIC reduction in her symptoms, and in 90 days virtually all of them will be gone. I know you’re a med student in debt, so we can bet less if you’d like. I’ll even cover the up front cost of food, as long as it is recovered when I win the bet. Nothing more to say there other than I’m right, and I’m willing to put my money where my mouth is. How’s that for hubris?

    To the point about WGA, first of all, when you’re dealing with intestinal hyperpermeability, the point is that proteins are getting into the bloodstream undigested. Second, WGA can cross receptors in the intestinal barrier undigested even in a healthy gut. Cordain talks about this in his MS talk linked above. WGA is an adjuvant in a number of allergies, including an egg allergies, reference here: http://www.ncbi.nlm.nih.gov/pubmed/11168640?dopt=AbstractPlus. A lot of the allergies you described in your friends above can likely be cleared up by going grain free for a while to heal the gut and staying wheat free permanently.

    The point about the antibodies to the pancreatic beta cells is that they are released in response to the WGA in the bloodstream NOT the beta cells themselves. Removing the WGA does restore some insulin function in some people, at least anecdotally. On another post I linked to the testimonial of one type 1 diabetic who got off of insulin by going low carb paleo, I have heard of examples of others. I can see how it seems improbable from your perspective, but experience suggests otherwise.

    Hydrogen double bonds are not more stable than completely saturated carbon molecules, not sure if you just don’t know what you’re talking about, or if you just have it backwards in your head, but that is just straight up wrong and not really debatable. That is a fact. If you want to test this, put out a glass of coconut oil and a glass of vegetable oil on your counter, see which one goes rancid first.

    Definitely will check out the articles on Ioannidis, thanks for the tip. I have bought into his message in large part based on my own observations about the issues with medical research, but I am certainly interested to learn more.

    My point in commenting on this blog post is that the medical consensus is wrong. They screwed up. They had flawed basic premises, then they designed the studies based on these flawed premises, and came to wrong conclusions. What you learned about nutrition in medical school is wrong. What doctors around the world have been recommending to their patients for 40 years now is wrong. That is why my opinion has value as someone who came up outside of that world.

    Still, I’m not asking you to take my model hook, line, and sinker. I am asking for two specific things:
    1) I am asking for a prior plausibility analysis that includes evolutionary biology and anthropology, since evolution is the unifying theory of biology, and medicine is a subset of biology. That is it. When Harriet writes an article about whether red meat is bad for you, and she doesn’t examine the likelihood that something that has been one of our primary sources of calories for literally millions of years could be problematic for us, that is a problem. That needs to be fixed.
    2) When we accept the medical consensus at face value, since so much of it is based on bad science, you get bad conclusions, so we need to be more skeptical of the consensus before we choose to accept it as our null hypothesis.

  94. Harriet Hall says:

    Geoff’s incredible hubris is demonstrated once more in the two specific things he asks of us.

    In (2) he implies that he is better able to judge which conclusions are good and bad than the consensus of medical/scientific experts.

    In (1) he tries to impose his philosophy of evolutionary explanations on us. He doesn’t want to engage in a discussion of whether his approach is reasonable or useful; he “knows” it is. I disagree. I explained why in http://www.sciencebasedmedicine.org/index.php/evolutionary-medicine/
    “Seeing everything in medicine through evolutionary glasses impresses me as more of a gimmick than as a clinically useful approach.” There is no way to distinguish a false “just so story” from a true one.

    Just to highlight the problems with looking at prior plausibility through evolutionary glasses: Geoff thinks evolution shows that a meat diet is good for us, and fruitarians think evolution shows that a meat diet is bad for us. Evolution is a bit like the Bible: you can find something to support any prior opinions there. One could argue that since our ancestors lived outdoors and went naked, it would be healthier for us to eschew houses and clothes. And since our ancestors ate raw meat, we should follow suit. One could also argue that our evolution has continued well beyond the paleolithic stage: we have “evolved” a civilization that has vastly improved our fitness for survival.

  95. Geoff says:

    @Harriet

    I’m not talking about evolutionary medicine, I’m talking about prior plausibility analysis. There is quite a lot we know about our ancestors, and to the extent which we know things, they need to be a part of our prior plausibility analysis. For example, we know definitively that our ancestry ate a lot of meat. We have isotope studies, we have all kinds of bones with carving marks, we have tools, we have cooking sites. We have an overwhelming amount of evidence. Comparing this to the Fruititarian story is not a fair comparison.

    A discussion of evolution has value in the formulation of hypotheses, not in treating people. But to the extent which it has value in the formulation of hypotheses, when we have an adequate level of information, like in the case of the meat question, it is unscientific to ignore this information because evolution is the fundamental theory in biology. It’s like trying to do experiments on the settings of a GPS chip without using relativity to calculate our expectation.

  96. Harriet Hall says:

    @Geoff,
    Your logic is faulty. Our ancestors ate meat. They also ate plants. We don’t know that they enjoyed some ideal state of perfect health; and if they did, we don’t know whether it was due to meat, plants, or some other factor or combination of factors.

    I can’t think of any case where your recommended kind of evolutionary thinking about plausibility was instrumental in leading to any useful scientific discovery. I think it amounts to mental masturbation rather than a reliable method of guiding scientific inquiry. If you can provide concrete examples, I’ll reconsider.

  97. Geoff says:

    @Harriet

    You’ll be able to think of a case when clinical trials prove that in fact grains and legumes are making us sick and eliminating them from our diet can prevent or cure most of the medical problems we see today.

    Speaking of curing problems, if you’re so sure I’m wrong, why not stake nybgrus in my proposed wager? Free money.

  98. Harriet Hall says:

    @Geoff, “You’ll be able to think of a case when clinical trials prove that in fact grains and legumes are making us sick and eliminating them from our diet can prevent or cure most of the medical problems we see today.”

    I am rolling on the floor laughing! In other words, there’s never been a case but you are confident there will be. So I should believe you? A true believer is confident that science can only validate his hypothesis; a true scientist asks whether his hypothesis is true. Every comment you make just lowers my opinion of your understanding of science and of your critical thinking abilities.

    “if you’re so sure I’m wrong”
    I’m not so sure your hypotheses are wrong; I’m only asking for the same kind of evidence I require before accepting any hypothesis as true.
    Your astounding hubris is ridiculous. I will not be responding to any more of your comments for the reasons nybgrus has explained above. Your lack of substantive response to the many rebuttals in the comments above shows that you are clearly not interested in a productive dialog but only in venting your opinions. I have been patient and polite, but my patience is exhausted.

  99. Geoff says:

    @Harriet

    Here’s a question:
    Imagine that the studies are done and it turns out that I am right. In that case, was it still pseudoscientific of me to trust my experience and interpretation of the data as opposed to having your position? Or does it validate everything that I have been saying and vindicate me as having exactly the appropriate level of skepticism necessary to tease out fact from fiction under such uncertainty?

    I imagine that how you answer that question versus how I answer that question is the root of our fundamental difference of opinion.

  100. nybgrus says:

    @Geoff:

    Dr. Hall is spot on. Your hubris knows no bounds and you are consistently putting the cart before the horse. I had harvested a bunch of points to address further and discuss the topic with you, but after your exchange with her I simply don’t feel motivated to do so anymore.

    Suffice it to say, your basic level of knowledge and understanding if the interactions in physiology and biochemistry is flawed. You think we have the basics wrong, but really it is the other way around. You’ve even partially admitted that when I called you out on insulin receptor vs GLUT channel. But you still hung on to “some other” mechanism for glucose intake and cling to some notion that the CNS must have “some” other direct influence. You cite your heart transplant as evidence – but it is a completely and utterly flawed reference. You could cut out a chunk of your heart wall, sit it on a plate, and it would beat.

    I do feel the need to briefly address some points – which if you listen to will hopefully educate you a bit and humble you enough to actually try and do science instead of spouting ideology.

    Hydrogen double bonds are not more stable than completely saturated carbon molecules, not sure if you just don’t know what you’re talking about, or if you just have it backwards in your head, but that is just straight up wrong and not really debatable.

    You are correct. I was writing tired and meant to say that they were stronger, which they are. However, the extra electrons make it more reactive so I was incorrect in my discussion of that.

    Imagine that the studies are done and it turns out that I am right. In that case, was it still pseudoscientific of me to trust my experience and interpretation of the data as opposed to having your position?

    Yes. Because the way you are approaching it is pseudoscientific. Post hoc ergo propter hoc does not validate your methodology. It just means you got lucky. And that has nothing to do with science. You may possibly get lucky, but the chances are low. We may possibly be wrong, but the chances of that are also low. The way we do things have a much greater chance of yielding useful data than your ideological rants.

    I imagine that how you answer that question versus how I answer that question is the root of our fundamental difference of opinion.

    exactly. you don’t know how science works or why and do not have a grasp on what it means to be a skeptic. Do bear in mind there is a difference between a skeptic and someone who decides the consensus is wrong after being educated at Google U.

    As for my girlfriend, she really doesn’t have much symptoms of anything so taking your bet would be stupid on both sides – there really wouldn’t be an accurate data set since her baseline is so low. Besides, offering such a bet further belies your core is a belief system not a science based claim.

    That is all I plan on writing – you still haven’t addressed relevant points, when shown you are wrong you come back with “but maybe there is still something else,” you keep using evolutionary and anthropological data incorrectly (did you read the part about how I have a degree in anthropology, graduated with honors, and even got A+’s in my classes?? I also studied evolutionary biology – you think I don’t know a thing or two about this stuff?), and you continually are finding ways to fit data into your preconceived idea and to explain away data that doesn’t fit. That, Geoff, is the hallmark of pseudoscience. For all those reasons, plus the fact that you don’t have a clue how medical ethics works, I am pretty much done with this conversation.

Comments are closed.