Medical Ghostwriting, Selective Publications,
and the death of the Evidence Base

The video below is an interesting lecture by Dr. Fung, who is a medical expert that I respect.
It provides some clear and convincing explanations; answering questions I've had due to personal experiences with specific medications previously prescribed for me, for my ageing mother (now deceased), and for other members of my family.

Body of Truth: How Science, History, and Culture Drive Our Obsession with Weight — and What We Can Do about it, by Harriet Brown (2015)

Body of Truth is an inspired and inspiring well-researched book about our cultural obsession with weight, our fetishization of thinness, and our demonization of fat. It is a compelling read which will make us think more deeply about the attitudes we have about our bodies and our health.

Over the past twenty-five years, our quest for thinness has morphed into a relentless obsession with weight and body image. In our culture, "fat" has become a four-letter word. Or, as Lance Armstrong said to the wife of a former teammate, "I called you crazy. I called you a bitch. But I never called you fat."

How did we get to this place where the worst insult you can hurl at someone is "fat"? Where women and girls (and increasingly men and boys) will diet, purge, overeat, undereat, and berate themselves and others, all in the name of being thin?

As a science journalist, Harriet Brown has explored this collective longing and fixation from an objective perspective; as a mother, wife, and woman with "weight issues," she has struggled to understand it on a personal level. Now, in Body of Truth, Brown systematically unpacks what's been offered as "truth" about weight and health.

Starting with the four biggest lies, Brown shows how research has been manipulated; how the medical profession is complicit in keeping us in the dark; how big pharma and big, empty promises equal big, big dollars; how much of what we know (or think we know) about health and weight is wrong. And how all of those affect all of us every day, whether we know it or not.

The quest for health and wellness has never been more urgent, yet most of us continue to buy into fad diets and unattainable body ideals, unaware of the damage we're doing to ourselves. Through interviews, research, and her own experience, Brown not only gives us the real story on weight, health, and beauty, but also offers concrete suggestions for how each of us can sort through the lies and misconceptions and make peace with and for ourselves.

The video below is an example of determination in dealing with a desire for food.

See Article Below:

 

Why being 'overweight' means you live longer: The way scientists twist the facts.
             by Dr. Malcolm Kendrick, M.D.

I have been studying medical research for many years, and the single most outstanding thing I have learned is that many medical "facts" are simply not true. Let's take as an example the health risks of drinking alcohol. If you are a man, it has virtually become gospel that drinking more than 21 units of alcohol a week is damaging to your health. But where did the evidence to support this well-known "fact" come from?

The answer may surprise you. According to Richard Smith, a former editor of the British Medical Journal, the level for safe drinking was "plucked out of the air". He was on a Royal College of Physicians team that helped produce the guidelines in 1987. He told The Times newspaper that the committee's epidemiologist had conceded that there was no data about safe limits available and that "it's impossible to say what's safe and what isn't". Smith said the drinking limits were "not based on any firm evidence at all", but were an "intelligent guess".

In time, the intelligent guess becomes an undisputed fact. On much the same lines, we have the inarguable "fact" that being overweight is bad for your health. I should say that, by definition, being "overweight" must be bad for your health – or we wouldn't call it overweight. But we do not define overweight as being the weight above which you are damaging your health; it has an exact definition.

To be overweight means having a BMI of between 25 and 30. Not as bad for you as obesity, but still damaging. Why else would all hospitals and doctors surgeries have BMI charts plastered on the wall with little green squares, orange squares and red squares? Green is normal weight, orange is overweight and red is obese. Even Wikipedia confirms this: "The generally accepted view is that being overweight causes similar health problems to obesity, but to a lesser degree. Adams et al estimated that the risk of death increases by 20 to 40 per cent among overweight people, and the Framingham heart study found that being overweight at age 40 reduced life expectancy by three years."

You can also find papers in prestigious medical journals such as the Journal of the American Medical Association (Jama) with the following headline: "Excess deaths associated with underweight, overweight and obesity." That certainly suggests that overweight is bad for you. However, if you look more closely at the paper in Jama, we can find these words: "Overweight was not associated with excess mortality." (My italics). Perhaps more extraordinarily, what the researchers actually found was that those who were overweight lived the longest; they lived longer than those of "normal" weight.
 
You may be surprised to find that you can have a paper in one of the world's leading medical journals entitled "Excess deaths associated with underweight, overweight and obesity", which found that overweight people lived the longest. After studying medical research for as long as I have, I am far from surprised. I regularly find that the title of a paper, the abstract, and even the conclusions often bear very little relationship to what the study actually found.

Perhaps you think I am being selective and only choosing one misleading paper. Well, here are the conclusions of another study done in Canada in 2010: "Our results are similar to those from other recent studies, confirming that underweight and obesity class II+ (BMI > 35) are clear risk factors for mortality, and showing that when compared to the acceptable BMI category, overweight appears to be protective against mortality." I love the way they couldn't bring themselves to say "normal" BMI. They had to call it "the acceptable BMI category". This, I suppose, helps to fend off the inevitable question. If people of normal weight have shorter lifespans than those who are overweight, why do we call them normal? Surely we should call them "mildly underweight", at which point we would have to call people who are now considered overweight "normal".

You can see a further example of the weird strangulation of the language occurring a year earlier. In 2009, a German group did a painstaking meta-analysis of all studies on overweight and obesity that they could find. As with most other researchers, they found that being overweight was good for you. Of course, they didn't phrase it in this way. They said: "The prevailing notion that overweight increases morbidity and mortality, as compared to so-called normal weight, is in need of further specification."

In need of further specification? An interesting phrase, but one that hints at the terrible problems researchers have when their findings fail to match prevailing dogma; if the prevailing consensus is "if your BMI is between 25 and 29, it is damaging your health and you should lose weight", then you challenge this at your peril. The end result of this is that the titles of scientific papers can end up twisted through 180 degrees, while in others, the prose becomes ever more tortured.

Despite the fact that study after study has demonstrated quite clearly that "overweight" people live the longest, no one can bring themselves to say: "Sorry, we were wrong. A BMI between 25 and 29 is the healthiest weight of all. For those of you between 20 and 25, I say, eat more, become healthier." Who would dare say such a thing? Not anyone with tenure at a leading university, that's for sure.

In truth, this discussion should not quite stop here. For even when we get into those with a BMI greater than 30, those who truly are defined as "obese", the health dangers are greatly overestimated, mainly because of the widespread use of what I call the statistical "clumping game". Obesity researchers are world-leading experts at the clumping game. In most studies, the entire population is divided ("clumped") into four groups: underweight, normal weight, overweight and obese – obese being defined as a BMI of 30 and above. That means those with a BMI of 31 are clumped together as part of a group which includes those with a BMI of 50 – and above. What does this tell us about the health problems of having a BMI of 31? Well, absolutely nothing.

There is no doubt that becoming heavier and heavier must, at some point, damage your health and reduce your life expectancy. Where is this point? Well, it is certainly not anywhere between 25 and 30, and it could be even higher. Indeed, I have seen research on Italian women showing that a BMI of 33 was associated with the longest life expectancy. In other studies, where obesity was actually further sub-divided, those with a BMI between 30 and 35 lived longer than those of so-called "normal" weight.

So, while I cannot tell you when "obesity" becomes a major health problem, I can definitely tell you that being "overweight" is the healthiest and most "normal" weight of all.



Malcolm Kendrick is a Scottish medical doctor, author of Doctoring Data (2015), and The Great Cholesterol Con (2008).

See

Video

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At this moment I feel like I’ve arrived at the end of the line. 

As a 5’0” tall, “reduced obese” sedentary 70 year old female, my weight continues to creep upward, no matter what macronutrients I eat or don’t eat; no matter how small I keep my portions; or how hard I work to keep my calories low.

This last calendar year I continued with my best efforts at recording every bite taken in a computer food journal, every single day.  Sometimes I ate large amounts of food, and sometimes I ate tiny amounts of food.  Sometimes I ate a “balanced diet” and sometimes I ate “low-carb; sometimes I ate “high-fat, moderate protein, low-carb”;  sometimes I worked to keep my calories around 1000 calories per day; sometimes I worked to have only two 5-bite meals of whatever.  My computer eating records show that my overall 365 day calorie average was about 780 calories per day.  That number was the total of all my big eating days combined with my small eating days, divided by 365 days. 

At this point in my life, I am elderly, and although I am in excellent health overall, I have developed a problem with my right hip which restricts my activities, and I lack the ability to do physical “exercise” except for brief periods of slow walking.  However, over the past ten years I’ve run many extensive personal experiments on how various exercise affects my own bodyweight, and the results have proven to me that however much or however little I exercise has almost no effect.  Apparently my metabolism adjusts down to keep me from dropping weight during periods when I engage in heavy exercise… however it does NOT adjust up to keep me from gaining weight when my food intake goes up whether with or without exercise.

During most of this past year, I’ve weighed in my mid-130s - which gives me a BMI in the “overweight” range.  During the past 9 years I’ve worked and worked on maintaining my large weight-loss, and tried to drop as low as possible inside the “normal” BMI range.  The middle of a “normal” BMI range is, for me, 115 pounds.  I struggled to drop and stay below that number for the first couple of my maintenance years, without success, then … while continuing consistently with my ongoing struggle at a food intake averaging around 1050 calories daily … my weight began climbing.  Instead of bouncing within a 5 pound range between 110 and 115, it bounced between 115 and 120.   Then despite a few more years of working hard to drop back to those lower numbers, my weight climbed to bounce between 120 and 125; then over more time, while eating even fewer calories, and additional exercise, my weight climbed to bounce between 125 and 130; then between 130 and 135.  This past several months, my weight has been bouncing between 135 and 140. 

There appears to be no end in sight.  This has been happening over a 9 year period. Since my activity cannot go up, and it is unlikely that I can tolerate consistently eating under a daily average of 780 calories,  it looks like an ongoing lifetime struggle will result in - at best - a gain of a few pounds each year for the rest of my life.  The good news is if I live another ten years to age 80, maybe this creeping gain will only bring me another gradual 20 pound gain, bringing me just slightly over my BMI border of obesity, allowing me to retain a total net loss of approximately 110 pounds … which would still be better than the alternatives - which are: Morbid Obesity or Death (whichever first appears).

At this point, I’ve tried just about every type of dieting, way-of-eating, lifestyle, or “non-dieting” including all types of intermittent fasting.  In fact, this past month, I did a couple of weeks of 24 hour alternate day water fasts, one 36 hour water fast, and one 72 hour water fast combined with a High-Fat/Low-Carb/Moderate-Protein eating plan.  Same results as with most extreme plans, about a 7 pound loss initially, with a slow regain back up to baseline.   Discouraging, since I’ve consistently experienced that same result dozens of times while experimenting with many different food plans.

Some food plans actually eliminate my motivation to live.  Long-term water fasting tends to make me feel ill, AND eliminating my food rewards makes me long for death. The one plan I have refused to experiment with at all is a vegan diet.  Frankly, I find my death preferable to eating Vegan, which appears to start by eliminating all animal products, continue on to extremes like minus grains, salt, oil, sugar, and no cooked foods, all interspersed with long and short periods of intermittent total water fasting.

My body is now near the end point of a lifetime of dieting, and I must admit that I’ve lost hope that it will ever normalize to "intuitively" sustain a weight under morbid obesity.

Because of my own experience, and my close observation of the experiences of many others,  I’ve come to believe that the longer a person’s body has spent well over the borderline of obesity, the less ability that body has to ever recover itself back to the natural weight tendencies it may have had at birth.  My own body appears to be an example of this truth.

I don’t think the following article applies to me personally at this stage in my life - where, if unchecked, my body will naturally lead me only back to morbid obesity, but I believe it contains good advice for young women, or for older women who have recently become overweight or borderline obese.

Be Careful, because
your Mind is Affecting your Health and Metabolism.
         By Caroline Dooner  - Over the Moon Magazine

You actually can’t control your body with external factors like diets. You just can’t.  It backfires. Your body is smarter than you. Which is why dieting, ultimately, after the occasional brief time of “working”, always fails. Your body is wired to slow down when you try to control how you eat. When you restrict – even in the tiniest way- your amazing, smart body freaks the fuck out, and slows down.

Even when we think about restricting and eating less, it slows down our metabolism, keeps the hormone ghrelin high and makes us stay hungry. This is called “mental restriction”. And it is just as bad for us as physical restriction. Physical restriction is actually eating less. Mental restriction is just thinking about eating less.

Mental restriction manifests as guilt, shame, “I shouldn’t eat this”, “I hope I don’t eat this whole thing”, “I’ll let myself eat this, but I really shouldn’t”, “I’m gonna have to make up for this later at the gym”, and on and on. You know the voice. All of those thoughts are so normal in our diet culture. We are taught that thinking that way is responsible. We think, “If I don’t feel shame over food, how will I ever be healthy? How will I ever like my body if I’m not controlling what I put in my body?”

So I am here to lovingly tell you that we were taught was wrong. Food shame is not responsible or healthy, and not only does it rob us of joy now, it actually messes with our bodies. My anti-diet journey came about because of a genuine, no-joke epiphany after ten years of obsessive diets and seeing my entire life through the lens of weight.

“What I am doing is NUTS.”

I had the strongest sense that my body and appetite would normalize if I just freaking ATE. I knew it. And thankfully, I did a good amount of reading then that totally backed up my internal guidance. I adopted what I like to call “the nourishing mentality”. In my mind I had this image of actually repairing and “reviving” my metabolism by eating.

So every time I ate, instead of thinking “Oh man, this is so bad for me. This is going to make me gain weight. Ugh this isn’t quite on my diet”… I thought: “Yessss. Nourishment. This’ll repair everything. This’ll help. This is exactly what I need. My body can handle lots of food, and is happy to have all of this.”

That shift makes a big, big, big difference. And you might think it shouldn’t. But if you read about leptin, ghrelin, and how our bodies actually react differently to eating based on what we THINK about what we are eating, it makes total sense. And what that means is… you can control your metabolism with your mind. But not the old way. Not the punitive, perfectionistic, fear-based control. Not the way that will only let you be happy if you lose weight. No, that way doesn’t work.

Instead, we are supporting our metabolism in the way the celebrates our bodies and trusts them to take the lead on this whole “food thing”. Our bodies actually work better when they are nourished and amply fed. Let’s finally get your mind on the same side as your body.