Charlie Charlie, wherefore art thou?

Ferlon Christians, the Western Cape Leader of the African Christian Democratic Party, would have you believe that the problem with the occult – especially in schools – is that we don’t take it seriously enough. In fact, the problem is the opposite one – we take the occult far too seriously.

“We” take it seriously enough, in fact, that our Department of Basic Education, which sometimes can’t even provide textbooks or toilets to schools, are dispatching “officials to investigate‚ together with school authorities‚ the ‘Charlie Charlie Challenge’”.

For those of you who aren’t Error Naidoo or Harry Potter, you can catch up on what the ‘Charlie Charlie’ challenge is by watching eNCA’s “full investigation”. Alternatively, you can take my word for the fact that it’s a parlour game involving creating a yes/no grid, stacking two pencils on top of each other, and then freaking out when gravity causes the pencils to move.

The freaking out is as a result of the “successful” summoning of a Mexican spirit who is mysteriously called Charlie, in honour of the many thousands of Mexicans who are called Charlie. You ask Charlie a question, and then the pencils move to provide a yes or no answer.

And, the freaking out on the part of Mr Christians, the Department of Basic Education and Bored from Bonteheuwel, that frequent caller to talk-radio, is due to simple superstition and ignorance.

You’d think that schools and national Departments of Education would use this as an opportunity to teach basic physics, as well as truths about human psychology such as confirmation bias. Instead, we read of school principals saying that “any pupil caught playing it will be expelled”, and of school pupils reporting suicides and school walls collapsing as a result of this game.

Well, this is what happens when you take a perfectly explicable phenomenon and add wacko metaphysics involving demons and curses to your explanation of it, just as we used to do with something like the Ouija board.

Seriously, parents, Mr Christians and the Department of Basic Education – if kids kill themselves as a result of playing Charlie Charlie, it’s not a Mexican demon’s fault. It’s the fault of a worldview detached from reality, and an education system that tolerates and even encourages that worldview.

In other words, and to some extent, it’s your fault, and blaming imaginary Mexican demons makes as much sense as blaming Harry Potter would.

Here’s a Whatsapp message a friend forwarded to me, which is apparently being circulated in one school:

Parents, guardians and learners.
This is extremely important.
I have received a letter from a school today encouraging parents to speak to there children about the Demonic Game Charlie Charlie they are playing on the schools nowadays.

A grade 4 boy fainted while playing this game and his pencil started spinning. When he woke up the pencil was still spinning.

Then I received a Whatsapp message of an incident that took place in Tafelsig Mitchells Plain today regarding this Demonic Game Charlie Charlie. Some boys placed two pens across each other and called out Charlie Charlie. The pens started to spin by itself and stopped by pointing at one boy.

This boy just started to bleed from his head profusely. The condition of the boy is still unknown.

According to our Ulama and experts in Jinn, its a demon (very dangerous jinn) from Mexico moving around schools inciting youngsters to play this game in order to harm them. This could even result in their death. Plz inform as many as you can.

And, for more hyperbole, consider this official press statement from the aforementioned ACDP Provincial Leader, Mr Christians:

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You can science too – it’s easy!

mouse-801843_1280If you’ve always wanted a career in science, but never got around to studying biology, physics or whatever it is that you’re interested in, don’t fear – being (treated as) an authority is easier than you might think.

First, find a conclusion you like. Let’s say, for example, the claim that sugar is addictive. Then, find a study that supports that conclusion, and publicise it:

In this study, conducted on rats, we are told that sugar is addictive – a line that Prof. Tim Noakes repeats with some regularity. It’s of course more complicated than that, but let’s not be negative – this is a post about how easy science is, after all.

Next, what you need is a way to discredit studies that say things that don’t support your conclusions. Don’t worry about being consistent at this point – it’s fine if you apply one standard to research that supports your conclusion, and another standard to research that doesn’t.

A mouse model shows that eating high-fat diets during pregnancy might ‘program’ your baby to be fat? Rubbish – mice are not women!

There’s a mouse study that shows high-carb diets lead to as long and healthy a life as any other diet? Rubbish – mice are not men!

(Some of you might, upon reading confounding studies, be tempted to think that science is complicated, and rarely – if ever – suitable for justifying dogmatism. Eliminate that negativity – there’s no place for it in sciencing!)

Now, what do you do when someone praises you as a lifesaver, but in doing so, also endorses avoiding conventional doctors, seeking out naturopaths, regarding “almost all” drugs as “toxic” and vaccines as “highly dangerous”?

natureboyrr_2015-Jul-15

Well, you retweet them, of course (while perhaps reciting your mantra that science is not religion). And if someone calls you out for endorsing vaccine quackery, do not fear – dismiss their question with an insult and an appeal to authority:

Like Ms. Child, I’m also not an expert on immunology. And no, I haven’t read the book, which apparently “needs to be read by everyone with an opinion on vaccination debate”.

But why would one read this book when a cursory Google search results in extensive, well-referenced accounts of (at least) 11 flat-out misrepresentations of data in that book?

Or, when you discover that the only places the author is taken seriously is sites like quack-central Mercola? If you’re still not convinced that you’d be wasting your time reading it, what if you learned that the author is sympathetic to homeopathy?

You’d think of her as a quack herself, I’d wager, and you’d certainly not endorse her as an authority. Unless, of course, you have a conspiracy story to tell about big pharma and the medical establishment colluding to sell you drugs, while hiding “the truth” from you.

But let’s imagine you ignore all that instead. Now, you know that the public are rather upset to hear anti-vaccine messages – after all, didn’t around 170 people get measles just this year (so far) in the USA, mostly thanks to being unvaccinated?

Also, you’ve been in trouble for appearing to endorse anti-vaxx messages before, when tweeting a link to a video featuring Andrew Wakefield on how the CDC arranged a cover-up of evidence relating to vaccines and autism.

(Maybe, you also think of that pesky HPCSA hearing coming up later this year, and how it might complicate things for you to appear to be supporting a viewpoint that is widely believed to indirectly kill people, especially babies.)

So, let’s just deny that the book is anti-vaccination, instead calling it something more grand, like a “unique historical analysis”.

Except, how do you square that with the publisher’s own description of the book, which tells us that the book argues that vaccines are not “responsible for the increase in lifespan and the decline in mortality from infectious diseases”, or accounts of her work like this one, from Dr. David Gorski?

I suppose you just hope that people take your word for it. While, perhaps, reciting your mantra that science is not religion, and calling anyone who disagrees with you a “troll”.

If you are happier and healthier on LCHF, great, I’m happy for you. But you can, and should, expect more from those who you take as your authorities on diet and more importantly, the scientific method.

As I’ve said before, I think the jury is out on the diet questions. It’s not out on vaccinations, and hasn’t been for quite some time now.

It’s shamefully irresponsible to suggest otherwise, and disingenuous to pretend that this isn’t what you’re doing in recommending books like those of Humphries.

Postscript

Noakes is asking “have you read the book?” to anyone challenging him on this on Twitter. You don’t need to read the book – there are many interviews with this author available online, including an outline of the arguments in the book on sites like Mercola’s.

Asking if you’ve read the book is mostly serving Noakes as a way to refuse to contemplate the dereliction of common-sense that is anti-vaccination endorsement on this scale. But even if he refuses to contemplate that, you nevertheless can.

Here’s something else that might interest you, on the author in question, linking to various other strange views she holds.

#NoakesHearing, day 1: Reflections on futility

hpcsaAs anyone who clicked through to this piece probably knows, yesterday saw the start of a Health Professionals Council of South Africa (HPCSA) hearing to assess whether Prof. Tim Noakes is guilty of unprofessional conduct. The charge against Prof. Noakes states:

That you are guilty of unprofessional conduct or conduct which, when regard is had to your profession, in that during the period between January 2014 and February 2014 you acted in a manner that is not in accordance with the norms and standards of your profession in that you provided unconventional advice on breastfeeding babies on social networks (tweet/s).

I attended all of yesterday’s session, and offer some thoughts on what transpired, below. I have not attempted to catalogue everything that happened – if you want a more detailed account, the News24 live-blog offers an accurate summary.

On futility – once more with the distinctions

It continues to exasperate that I can think of only one person a handful of people who understand that there are (at least) two distinct issues at play in the general discussion around Noakes, LCHF and Banting. The first is the set of questions related to diet, and which is healthier for you.

In this set of questions, I’m bundling in long-term vs. short-term, treatment for obesity and diabetes, what proportion of population X are insulin-resistant and so forth. I do not, in general, comment on those issues. They are not a field of expertise for me. As I’ve repeatedly said, Noakes might well end up being a frontrunner in what eventually becomes scientific consensus.

The second set of questions relates to logic and philosophy of science, and to our responsibilities as educators, or journalists, or health professionals to discourage sloppy thinking on matters of significance (well, on all matters, but the stakes are sometimes higher than others).

So, I’ve consistently (with a few lapses, I’m sure) focused on the quality of argument that emerges from the Banting camp, rather than on the superiority of any particular conclusion. If you don’t care about those issues (you of course should), then you shouldn’t be reading my comments on them.

You certainly shouldn’t be asking me to present evidence that low-carb is bad, because that’s not what I’m claiming. You also shouldn’t be telling me that “there’s so much more bad science for the consensus” or somesuch, because maybe there is, and maybe there isn’t, but that’s not what I’m talking about. The fact that someone else (proponents of the consensus view) also does things wrong doesn’t give anyone else a free pass to be sloppy in their reasoning.

On futility II – the hearing that never happened

We spend the entire day hearing arguments about the constitution of the panel that was set to hear the case, and proceedings were eventually terminated at around 15:30 when it was agreed that the panel was improperly constituted. Proceedings will resume on November 23, assuming nothing else interferes with the process.

Should this hearing be happening at all?

I have mixed feelings about this. As with so many of our policies (and even heuristics related to social interaction), there’s a vast difference between what made sense in a pre-digital era and what makes sense now. Noakes is often to be found on Twitter – he’s written an ode to it, in fact, and his fans love him for how much he engages there.

The point of highlighting the pre/post-digital era is of course it would be irresponsible for a physician to encounter you in the street and tell you what your baby should eat, unless your advice is something rather generic and consensus-based. Even if the consensus is wrong, as Noakes thinks it is, it does sit with an advantage here – his job is to create a new consensus, after which he’ll get the same advantages.

But perhaps Twitter is different, in that it’s a broad discussion or sounding board for ideas, in which we shouldn’t expect people to view what Noakes tweets as prescriptions in the medical sense. That’s presumably what he thinks. I think he’s wrong in practice, because people do view them as prescriptions, and he should know that and act accordingly.

However, it’s possible that holding him to account for all possible consequences of his tweets does overstate the importance and role of Twitter, and also paternalise his Twitter following. For example, a non-prejudicial look at the tweet that started all the trouble is consistent with slowly weaning a child onto LCHF, perhaps in a manner that doesn’t run the risk of causing the complications the complainants in this case claim it would.

So, this case is raising very important background issues related to the appropriateness (or not) of how people with positions of influence engage on social media.It’s not going to be a waste of time, but is rather going to force everyone to resolve what I think are important issues.

It’s a great shame that many of Noakes’ supporters are struggling to see anything beyond a vendetta or bad faith here, and also that Noakes himself misses the point that it’s not about freedom of speech, but rather about the responsibilities of healthcare professionals to avoid causing harm.

He’d retort that it’s the Association for Dietetics in South Africa’s (ADSA) advice that causes the harm, but even if true (and even if he’s even representing what their advice is accurately), that’s something you demonstrate in journals, not with other people’s babies.

Is Noakes speaking “outside his field of expertise”?

One of the things that caused a fuss during the hearing was a statement made by the HPCSA’s lawyer that Noakes was operating or speaking as if he were a dietician, and that this is not his field of expertise. To briefly return to my futility theme, this was immediately leapt on by the Noakes-supporters as an attempt to suppress Noakes’ freedom to research and write on nutrition, while it was in fact nothing of the sort.

The argument was simply that because he’s operating outside of the “normal” General Practitioner (GP) set of ideas but rather as a dietician, it makes sense to include a dietician on the panel. Nevertheless, the motivated reasoning in response to this was quite something to behold, as it was immediately taken up as further evidence of the conspiracy against Noakes, who was now “not allowed” to talk about diet.

The clue as to what GPs do is in the name – they consult on a general set of health-related concerns, one of which is diet. But the claim made by the HPCSA lawyer was that Noakes was presenting himself as more than a generalist, but rather as a specialist in this area, and he should thus be assessed by a specialist also.

What was the problem with the panel composition?

The technical problem that (rightly) led to the cessation of the hearing was that the panel was lacking one particular member as per the regulations, where that member needed to be in Noakes’ profession, i.e. a GP. There was one GP on the panel, who was also a pediatrician, as well as a dietician (who I’ll return to in a moment), but there needed to be another Medical and Dental Board-registered GP present for a properly constituted panel.

What was interesting about the debate on the panel composition?

Both sides seemed intent on creating as favourable a panel as they could, which should of course be no surprise. The complainants argued strongly for the presence of a dietician, and Noakes’ lawyers argued strongly against. Noakes, of course, thinks that the dieticians exemplify bad science in this area, and he’d probably argue that they aren’t competent to assess the evidence he’ll present.

However, the problem with ruling them out is two-fold: one, it presents a circular argument, in that it assumes they are incompetent (or rather, cedes the argument regarding their competence) as reason to rule them out as assessors of the evidence; and two, if they are as incompetent as he thinks, surely it would be a simply matter to demonstrate this in the course of the hearing?

There’s the risk of a strategic blunder from the Noakes team here – the more intent they appear on trying to rule a dietician out as a panelist, the more people might wonder what they are so concerned about. If they are as scientifically backward as Noakes would have us believe, why not publicly expose that via the hearings?

And then….

The strange case of Prof. Blaauw

The dietician panelist, Prof. Blaauw, was initially considered a perfectly acceptable member of the panel, until we discovered two things about her (and the second, only rather late in the day). Over lunch, she informed the (superb) Chair of proceedings, Joan Adams, that she had once co-supervised an ethics thesis on the “media implications of Tim Noakes”. This was claimed to not impair her objectivity, and the Noakes legal team seemed happy with her, despite this knowledge.

Later on, though, we discovered that she was also a member of ADSA, whose President in fact laid the complaint against Prof. Noakes. This caused significant dissent around her suitability, as you’d expect it to given the conflict of interest.

Debate then ensued as to whether she was in fact legally part of the panel at all, as given that it had already been ruled that the panel was improperly constituted, she could not officially or automatically be considered part of a future, properly constituted panel either. Noakes’ lawyers went as far as to say that they might consider taking this issue to the High Court, if Prof. Blaauw ended up remaining on that future panel.

Bad faith and Tex bars

In an amusing turn of events, we reconvened after lunch to find that some prankster had placed Tex bars (a chocolate) on the desks in front of each panelist. Some of the Noakes supporters on Twitter immediately assumed that this was ADSA’s doing, which seemed to fit the generally uncharitable attitude on the #NoakesHearing hashtag, which also included some fat-shaming of various members of the complainant’s party.

Yes, these are emotive issues, and I can understand why people feel that someone they respect and admire for standing up to orthodoxy is being unfairly singled-out, but you don’t make an effective case for his virtue by demonstrating a lack of virtue yourselves. Even if “the other side” sometimes do the same, that does not make your doing so more appropriate either.

One of the Noakes supporters seems to have cottoned on to the reality that people like me don’t have a vendetta, but is rather simply interested in the arguments and ethics of how we debate them. But there’s still far too much ad hominem, and accusations of trolling put in terms that are themselves distinctly trollish. This is the problem of the filter bubble, as I’ve argued before, and I’ll again simply suggest that there is a conversation to be had here, and some of us are having it in good faith – whatever you might believe.

In conclusion

The Noakes legal team seem better prepared, and certainly appeared more effective in their rhetoric and argumentation. Now that the hearings have been extended to run for 7 days, I suspect that the complainants are going to have a difficult time competing. And, at the end of the day, Noakes will “win” on any permutation.

If he is (in the extreme scenario) struck off the roll and disallowed from practicing medicine, that’s of little consequence to his main interest, which is research and (mostly public) dissemination of findings related to diet. And, he and his supporters will have further “evidence” of his persecution.

And if he wins, that will of course serve as his – and the Banting diet’s – most significant tipping point towards public acceptance yet…

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P.S.: The screenshot above is from Noakes’ Real Meal Revolution website, and you might find the last bullet-point of interest.

Sugar given Carte Blanche to cause panic

When you (by which I mean, the average person) thinks about something as being “addictive”, I think we mean that the substance or activity in question is particularly likely to cause you to develop some combination of dependence, tolerance, cravings and withdrawal symptoms.

You’d also, if addicted, go to significant lengths to obtain the thing that you are addicted to. On a trivial end of this spectrum, people who smoke cigarettes might walk out into a cold and rainy evening to go and purchase cigarettes, instead of staying under the duvet like any sensible (i.e., non-addicted) person would.

When you think of addiction, in other words, I’d guess that you typically don’t mean that you know this fellow, George, who has become so obsessed with playing Minecraft that you describe Minecraft as addictive, as opposed to acknowledging that people can become “addicted” to Minecraft.

sugarThe distinction is important, and points to one of the significant problems in discourse around sugar “addiction”, as recently portrayed on the South African current affairs show, Carte Blanche. It’s important because the things we like are rewarding at the level of the brain, in that they result in dopamine release – but this does not necessarily mean that they are addictive in the stronger sense that we tend to reserve for things that you can’t help but find rewarding.

In other words, there’s almost zero chance of my becoming addicted to running, because I don’t like doing it, and tend not to do it. But there’s a significant chance – and a similar chance to your chance – of my becoming addicted to heroin, if either of us were to try it.

We’re using the word “addictive” in a very broad sense when we describe the Internet, exercise, and sugar as addictive. In fact, the sense in which it’s being used is broad enough as to mostly lose its meaning, by contrast to the strong sense in which certain substances are very likely to result in the sorts of reactions mentioned above, for many people.

Most of us exercise, use sugar or the Internet, and have sex quite unproblematically (in terms of addiction, Beavis). More of us use things like heroin or cocaine unproblematically than the standard sorts of addiction panics claim also, but that’s a story for another day. The point I’m making here is quite simply that any claim that sugar is “addictive” is using the word “addictive” in a misleading and hyperbolic way.

Long-term addiction is the exception, not the rule – we suffer from a confirmation bias here in the sense that we don’t get to hear about the people who live with addictions that are largely under control and remitting (in other words, most of them). We hear about the horror-stories, of people struggling with a demon, and (sometimes) heroically fighting it off.

And, as the cases and science detailed in Johann Hari’s Chasing the Scream persuasively suggest, the primary vehicle we have for escaping addiction is to give ourselves a sense of purpose and above all, agency – and agency is last thing that panics around things like sugar addiction have time for. Instead, the narrative is all about you being a victim of conspiracy.

You can watch the Carte Blanche insert yourself, in which you’ll be told that “sugar may be as addictive as nicotine and hard drugs”, that sugar can “hijack the brain” and so forth. But what you’ll mostly see is three self-described (and apparently self-diagnosed) sugar addicts telling you how addictive it is.

Their primary scientific resource, Prof. Nicole Avena, doesn’t even herself support the strong addiction claim, saying “a little bit of sugar won’t hurt you. It’s not a bad thing in general, it’s just the way we are consuming it is a bad thing”. The “we” is perhaps too broad there, in the sense that many of us who aren’t on LCHF-type diets have been restricting added sugars for our entire lives already, given that warnings about refined sugars have been a staple of dietary advice for quite some time now.

Nevertheless, I’d agree that people are eating too much sugar. And, people who are prone to compulsive behaviour might well find themselves becoming “addicted” to sugar – and you wouldn’t be surprised to find (as you do in one of the three cases presented in the show) that these people can become “addicted” or even addicted to a range of things over the course of their lives.

The problem, in short, might be with their lives and their circumstances – at least in large part – rather than in the substances or activities. We should not be surprised that our brains find food rewarding, and that we seek it out. We’d be surprised if it was any other way. But if we can (typically, as with most consumers of sugar) control the impulse to eat too much of it, then addicts need to shoulder a large portion of the responsibility themselves, and not hand it over to sugar.

But, say some (and as presented at 2m21s in the video, with an unfortunate reference to quack-central Natural News), studies prove that sugar is more addictive than cocaine. Unfortunately, studies prove what you want them to, depending on which studies you read, and which you ignore.

Plus, of course, how attentively you read them can be an issue – as I’ve noted before, Avena and others are far more circumspect and tentative than they are presented to be by the media and vested interests. Her own oft-cited paper is full of scare-quotes for the word “addiction”, and stresses that “whether or not it is a good idea to call this a “food addiction” in people is both a scientific and societal question that has yet to be answered.”

The hyperbole in blogs and online news sources, never mind repositories of the worst sorts of pseudoscience like Natural News, don’t help resolve these issues. Neither do personal anecdotes, regardless of our compassion for people who struggle with compulsive behaviour of various sorts. Movies like Fed Up are of little use also, in that they simply populate the scaremongering filter-bubble with cherry-picked and misrepresented data.

If you want to read about why the Lenoir et. al. study quoted in Natural News doesn’t resolve my doubts about sugar addiction, not to mention comparing rat data to human experience – especially given the fact that psychological rather than physiological factors seem most relevant to addiction – I’d recommend reading this Scicurious post closely.

That post points out that there’s perhaps a vast difference between the self-administration of drugs in humans compared with rats, who can’t reason about their choices like we can. It also notes that the study doesn’t measure a progressive ratio – in other words, it doesn’t tell us what the rat prefers when it really has to work to get its reward. When things get tough, will it prefer sugar, or will it quit trying?

We don’t yet have good human data for sugar addiction. What we do seem to have is limited evidence for “eating addiction“, but as I’ve stressed above, an addictive behaviour is not the same thing as an addictive substance. People who are addicted to eating might well find foods – including sugar – deeply rewarding, but it’s premature to blame the sugar itself.

To conclude: there’s no problem with saying we find sugar rewarding. Of course we do, as we would exercise and so forth. To say it’s addictive makes a far stronger claim, and that claim is the suggestion that it’s a sinister substance that’s out to get you, rather than something you’re free to enjoy in moderation, just as you can alcohol or any other drug, depending on the legislation where you live, and your own personal risk-tolerance.

One thing I’m quite concerned about, though, and have noted before, is that it seems quite likely to me that your risk-tolerance can only be compromised through being treated like a perpetual victim – and that believing your food is out to kill you seems a wholehearted embracing of that victimhood.

Saturated fat not exonerated in 2015 US dietary guidelines

I’m traveling back from giving a talk to a room full of dieticians about their social responsibilities, in which I emphasised that one of their important tasks is to try to beat back the surge of hyperbole and exaggeration coming out of the Banting and LCHF camps.

There are plenty of posts here on Synapses on the topic, many dealing with Professor Tim Noakes and how his confirmation bias has led him to re-tweeting false and potentially dangerous claims. You’d recall him “just asking questions” on vaccines and autism, or spreading the (false) idea that Sweden had become the first nation to “officially” adopt LCHF as their diet.

imagesAs I’ve said many a time, and repeated at the talk last night, some of the ways in which we can aid the spread of scientific literacy is through simply reminding people of the virtues of not overstating the evidence we have for our claims, and also through encouraging people to be consistent in their judgements – if something is wrong in one case, it’s usually wrong in similar cases also.

A recent example of salesmanship trumping science arrived in time to include in my remarks, and I also want to note it here for folks who have been following the topic. Yesterday morning, Prof. Noakes tweeted

The text of the tweet is a quote from the linked post, so not Noakes’ words, but I am fairly confident that he endorses the sentiment seeing as he’s frequently said similar things. Many times, they have in fact been described as “tipping points”, which makes one wonder how many tipping points are necessary before whatever it is actually gets around to tipping.

Anyway – if you go read the post that is linked to in the Tweet, you’ll find that it’s a smug “I told you so” by Dr Malcolm Kendrick, author of “The Cholesterol Con”. What he wants to gloat about is that he was right all along, and that in short, “cholesterol is healthy, saturated fat is healthy, salt is healthy and sugar is unhealthy”. Speaking of the 2015 Dietary Guidelines Advisory Committee’s (DAG) report, he says:

The entire report, I believe, stretches to about a bazillion pages. However, here are four of the highlights.

Cholesterol is to be dropped from the ‘nutrients of concern’ list. [I love that phrase ‘nutrient of concern’].

Saturated fat will be… ‘de-emphasized’ from nutrients of concern, given the lack of evidence connecting it with cardiovascular disease.’ [Whatever de-emphasizing may be. Pretending you never said it in the first place, I suppose].

There is concern over blanket sodium restriction given the… ‘growing body of research suggesting that the low sodium intake levels recommended by the DGAC (Dietary Guidelines Advisory Committee) are actually associated with increased mortality for healthy individuals.’

And… ‘The identification and recognition of the specific health risks posed by added sugars represents an important step forward for public health.’

The entire report does indeed stretch to a bazillion pages, or close enough at 571 pages. I presume that’s why Kendrick hasn’t read it, and therefore goes on to substantially misrepresent what it says.

To say that “cholesterol is healthy” is misleading because while dietary cholesterol has been de-emphasised, the DAG has not concluded that cholesterol in the blood is unproblematic – contrary to what Noakes’ journalist has reported.

To say that saturated fat will be “de-emphasised” is literally false, as that line comes from the Academy of Nutrition and Dietetics, who (this press release is even pasted in Kendrick’s post) say that they support “the DGAC in its decision to drop dietary cholesterol from the nutrients of concern list and recommends it deemphasize saturated fat from nutrients of concern” (my emphasis).

So, the Academy of Nutrition and Dietetics say to DGAC “good work, but you could do better” (on their model, of course). But the report does not say what Kendrick says it does, and the US Guidelines will continue to warn against overconsumption of saturated fat. If you read it, or even do a simply word-search for “saturated”, you’d know that, because you’d read that they recommend “less than 10 percent of total calories from saturated fat per day”.

I didn’t read up on the sodium commentary, and agree that added sugars are problematic (while not being addictive), so will say nothing about those last two bullet points, except to quote the report in saying “the DGAC also found that two nutrients—sodium and saturated fat—are overconsumed by the U.S. population relative to the Tolerable Upper Intake Level set by the IOM or other maximal standard and that the overconsumption poses health risks.” Go figure.

But before wrapping up by giving you a few quotes from the DGAC report’s conclusions, I’d like to note the double-standards at play in endorsing the Academy of Nutrition and Dietetics’ comment to the report, as Kendrick does and Noakes would likely do also, seeing as he’s explicitly told us that saturated fat is not a concern.

When the Association for Dietetics in South Africa (ADSA) decided to report Noakes to the Health Professions Council for “unprofessional conduct”, he and his supporters had a field day on Twitter looking at ADSA’s list of sponsors, and then dismissing ADSA’s case on the grounds that they had had financial dealings with Kelloggs and other (allegedly) evil corporations.

Why is the same standard not applied to the Academy of Nutrition and Dietetics, who have been the subject of a Senate enquiry thanks to their pharmaceutical connections, and who have a list of sponsors and funders a mile long, including Sarah Lee (makers of evil carb products!), Coca Cola (so very evil!) and evil Monsanto (the Great Satan!).

It can’t simply be because they say the right things, can it? Because that’s not how science works, as the Doctor and Professor surely know.

Lastly, seeing as the Noakes’ echo chamber on Twitter is in full swing with “see, he’s vindicated!” types of comments following the release of the DAG report, I’ll leave you with this quote from it. Make up your own minds as to whether it supports Banting, or whether it’s largely the same advice as ever.

The dietary patterns associated with beneficial outcomes for cardiovascular disease:

Dietary patterns characterized by higher consumption of vegetables, fruits, whole grains, low-fat dairy, and seafood, and lower consumption of red and processed meat, and lower intakes of refined grains, and sugar-sweetened foods and beverages relative to less healthy patterns; regular consumption of nuts and legumes; moderate consumption of alcohol; lower in saturated fat, cholesterol, and sodium and richer in fiber, potassium, and unsaturated fats.

The dietary patterns associated with beneficial outcomes for obesity:

Dietary patterns that are higher in vegetables, fruits, and whole grains; include seafood and legumes; are moderate in dairy products (particularly low and non-fat dairy) and alcohol; lower in meats (including red and processed meats), and low in sugar-sweetened foods and beverages, and refined grains; higher intakes of unsaturated fats and lower intakes of saturated fats, cholesterol, and sodium.

Dietary patterns in childhood or adolescence that are higher in energy-dense and low-fiber foods, such as sweets, refined grains, and processed meats, as well as sugar-sweetened beverages, whole milk, fried potatoes, certain fats and oils, and fast foods are associated with an increased risk.

(But the diet’s not for everyone, only for the insulin resistant!) The dietary patterns associated with beneficial outcomes for Type 2 diabetes:

Dietary patterns higher in vegetables, fruits, and whole grains and lower in red and processed meats, high-fat dairy products, refined grains, and sweets/sugar-sweetened beverages.

 

Flu vaccines might be ineffective, so try… water (otherwise known as Oscillococcinum)?

A friend forwarded a press release issued by “LeBron Health” to me, and the quackery it contains is too delightful to keep to myself. But because the press release also trades on fear-mongering of a rather pathetic sort, it’s also an reminder of how uninformed or unethical some medical “professionals” are, and of how quackery can harm in scaring people away from effective treatment.

The press release discusses the upcoming flu season in South Africa, and in particular, how to cope with the H3N2 strain of influenza. The H3N2 strain of influenza is indeed deadly, having reportedly killed dozens of children during the most recent US winter. That’s not good, of course – we’d like the number of deaths to either be 0, or much closer to 0 than that.

However, the number of deaths and hospitalisations this winter have not been significantly out of the normal range – the flu is not killing more people than it typically does. Furthermore, it’s also quite routine for the CDC to “issue a health warning to doctors”, as they are reported by the press release to have done. A “health warning” is not an advisory broadcast regarding an impending apocalypse, but (typically) simply information that the CDC thinks practitioners might find useful.

The health warning itself also reports something quite mundane on an aggregate level (though of course not mundane at all if you’re someone who has had flu-related illness or death in the family). It simply says that the current vaccine can’t compete effectively against H3N2, and that everyone should be prepared for a bad flu season.

This is also routine – vaccine developers select flu strains in January to May (for the US), based on which strains they predict will be most prevalent, and vaccination then begins in October. Things can change between those two phases – they are 5 months or more apart, after all – and one of the things that can change is the seriousness with which you could have (with perfect hindsight) regarded the threat of a particular influenza strain.

But you can’t know, 6 months in advance, and so you make the most informed predictions you can. Some years, the vaccine works very well, because you picked the right strains, and other years it works far less well.

And here’s the frustrating thing: in December last year (when the flu season hit the USA), the same scaremongering was prevalent. We read that the CDC had “admitted” that the vaccine doesn’t work, just as in this local press release’s headline, which claims that “flu vaccines may not work”.

Well, the CDC admitted nothing of the sort, and the flu vaccine “works” just fine, within the parameters of how it normally works, where the reasonable standard is never “perfectly”.

Even though this might be a particularly bad year for the vaccine’s efficacy, it’s still going to be better at helping you to avoid influenza than certain other “remedies” would be. It will help more than prayer, it will help more than avoiding cellphone towers, and it will certainly help more than homeopathy (with the caveat that hydration is good, so homeopathy in extreme quantities might help a little bit, because water).

Homeopaths disagree, as you might expect them to. One of those homeopaths is Dr Erika Coertzen, who suggests that we take a “reputable medicine such as Oscillococcinum, the most popular homeopathic product for flu symptoms in France”.

homeopath
This box contains as much medicine as a microscopic box of Oscillococcinum does.

That quote tells us that Dr Coertzen and my understanding of what the word “reputable” means is as orthogonal as our understanding of the word “medicine”. We can also note that a “medicine’s” popularity is only relevant to sales, profit, and analysis of marketing and gullibility – it tells us nothing about efficacy.

As with all homeopathic “remedies”, there is no good clinical data to support the claims made in favour of Oscillococcinum as treatment for influenza. It’s not going to help you to “rebalance and heal”, and even if it is true (no citation is given for this claim) that a “majority of patients who take Oscillococcinum at the onset of flu-like symptoms show improvement or resolution of symptoms after reduced time”, if this is in comparison to patients who take nothing, then the placebo effect is a perfectly good explanation for this observation.

But I suspect that the data is more… what’s the technical term?… made up than that, or that it at the least involves some fairly extravagant inferences being made from a poor data set. Dr Coertzen says that patients “symptoms show improvement or resolution of symptoms after reduced time” – if this is true, the data should support this claim. Unfortunately, they don’t.

As assessed by the Cochrane Collaboration, where trials do show favourable results for Oscillococcinum, “the overall standard of research reporting was poor, and thus many aspects of the trials’ methods and results were at unclear risk of bias. We therefore judged the evidence overall as low quality, preventing clear conclusions from being made about Oscillococcinum® in the prevention or treatment of flu and flu‐like illness.”

Amusingly, the Oscillo.com website – of course not a neutral scientific arbiter – claims that “unlike other flu medicines, Oscillococcinum does not cause drowsiness or interact with other medications”. Given that Oscillococcinum is a homeopathic “remedy”, therefore containing nothing that might cause drowsiness or negative interactions, this claim only gains traction if you’re able to persuade people that homeopathy is at all respectable or efficacious – surely nothing that any “reputable” healthcare practitioner would do?

In her defence, Dr Coertzen isn’t ever quoted as directly suggesting that you not take real medicine also, which might be the only thing that prevents the Health Professions Council (HPCSA) Medicines Control Council (MCC) from chastising her for this batshittery.

However, if she is the “medical expert” quoted in the headline, telling the public that vaccines might not work and that they should consider alternatives does seem to be a direct encouragement to forsake medicine in favour of homeopathy, and I do hope that a complaint is laid so that the MCC HPCSA can then rule against this idiocy.

Briefly, on Oscillococcinum itself, you’d be amused to read up on it, as the story of its origins and composition is quite the catalogue of pseudoscience in action. While there might be nothing that trumps Scientology for batshittery, Oscillococcinum gives it a damn good try…

 

PRESS RELEASE (source)

Flu vaccines may not work, consider alternatives — medical expert

Global health authorities have cautioned that current flu vaccines may not prevent a severe new strain of influenza, highlighting the need to seek alternative ways to protect against falling ill this winter.

The US Centers for Disease Control and Prevention (CDC) issued a health warning to doctors during the northern hemisphere winter about the severity of the 2015 flu season. It said the current flu vaccination protects against three or four strains but is not a match for the dangerous H3N2 strain which has mutated and has contributed to more deaths and hospitalisations of children and the elderly. (See: http://www.health24.com/Medical/Flu/Preventing-flu/Flu-vaccine-missing-its-mark-20150112)

Nearly 30 children died in one of the worst flu outbreaks in the US over their winter. In SA, a new modified vaccine is now available to match two of three new strains, including H3N2. However flu can still be contracted if other strains are not covered by the vaccine (See: http://www.health24.com/Lifestyle/Winter-Wellness/South-Africans-warned-of-severe-flu-strains-20150420).

SA doctor and homeopath, Dr Erika Coertzen, suggests boosting the immune system naturally by following a healthy, nutritious and balanced diet, getting enough sleep, regular exercise and taking preventative natural or homeopathic medicines to counter the onset of flu symptoms.

“A reputable medicine such as Oscillococcinum, the most popular homeopathic product for flu symptoms in France, has shown to help alleviate flu symptoms such as body aches, pains, chills and fever without drowsiness or the worry of negative interaction with other medication. Oscillococcinum works with the body to help rebalance and heal, and is suitable for all ages. Oscillococcinum’s efficacy in reducing the severity and duration of flu-like symptoms is well-known. A majority of patients who take Oscillococcinum at the onset of flu-like symptoms show improvement or resolution of symptoms after reduced time” she said.

For product info visit http://www.lebron.co.za/, www.oscillo.com or call 021-403-6390.

Roundup – 2015 LCHF Summit #OMHealth #LCHF2015

In news that came as a surprise to some us who are here, myself included (thanks to the generosity of the organiser, Karen Thomson), critics of Noakes and the low carbohydrate, high fat diet are apparently “boycotting” the Old Mutual Health Convention, that wraps up today.

The convention took place over 4 days – the first 3 operating as a professional event, with healthcare practitioners earning continuing professional development (CPD) points for attending, and the last day defined as a public event.

There are also a number of skeptical dieticians here, as well as a few GP’s that I know to be critical, after having discussed this issue with them at various talks over the past few years. But what I suspect Noakes and Thomson thinks proves the boycott point is that none of the 15 critics who were invited to participate in a debate accepted the invitation to do so.

I’ve explained why I would not have done so in a previous post – and can also tell you that I was part of email correspondence with 5 of those who were invited, who (thanks to the choice of debate topic) thought the invitation in bad faith, given how much it stacked the deck against them.

Anyway – enough back-story. I mention these things mostly to make the point that there’s lots of room for “eye of the beholder” interpretations of reality here, and crucially, also for subjective interpretations of evidence.

This is not because the evidence itself is subjective, but more because what you are exposed to (and crucially, what you are not exposed to), cannot help but frame your interpretation of things. If you construct a case that only represents one point of view, it’s little surprise to find that point of view emerging with credit.

To highlight some positives from the conference right off the bat – the catering has been very good, and the organisation (excepting the schedule not consistently allowing for questions, discussed below) exemplary. So, well done to all – there have been 400+ people here every day, and having organised this sort of thing myself in the past, congratulations are well-deserved.

(One peculiar thing about the catering that some of you will find amusing, though, is that no sugar was provided with coffee/tea – in fact, waitstaff had to – nervously, I’d imagine – tell delegates that sugar was verboten. This strikes me as bizarrely paternalistic, and also arguably evidence of some serious groupthink, in that even if sugar is addictive (it’s not) rather than “addictive”, we can surely trust adults to give themselves a small maintenance dose every now and then.)

Which brings me to my first general critique – if you want a conference to be viewed as an objective overview of current science, giving equal (or at least substantial) airtime to critics seems a good idea (whether via a fair debate topic, or via giving them opportunity to make presentations).

A related point – opportunity even for questions from the audience has been irregular and often non-existent. At the very least, a programme on a controversial topic like this (if academic/scientific objectivity is a goal) should include dedicated time for questions.

So, the event is framed in such a way that sympathetic folks will get to hear more about something they are already (at least somewhat) committed to, and – unfortunately – that folks who view authority uncritically (as in, here’s yet another “expert” defending LCHF) will get the impression that LCHF is the dominant view.

You might think it should be the dominant view, sure. But I mention this to note that when people ask me (as quite a few have, including one rather abrasive journalist) whether I’ve been persuaded by being here, I have to keep reminding them that persuasion occurs – or should occur – after you’ve heard the best articulation of competing points of view, and then conclude that one is stronger.

Having said that, I’ve independently exposed myself to various points of view and arguments on the mainstream or consensus side, so do have some ability to weigh these up against what I’ve heard here. Others might not have had the same opportunity, which is why – if I was one of the speakers here – I’d have made sure to emphasise that what’s being presented here is not obvious, inescapably true and so forth.

So, if you want to know about the current state of research into LCHF, this is certainly the place to be. If you want to know about the current state of research into diet and health, not so much.

But it has been useful to me, both in terms of understanding their arguments better, but also in terms of noticing (a) they don’t agree with each other about everything; and that (b) Prof. Noakes is arguably on the extreme end of commitment to various propositions, with other voices emerging as more convincing in consequence (because dogma is antithetical to good science).

These points are both important – (a) because it suggests that some of the LCHF proponents are avoiding dogma, and wanting to nudge us towards a different diet direction, rather than call for revolution; and (b) because this is what I’ve been saying all along – I don’t necessarily disagree with everything Prof. Noakes says, but I do think he says it in very unhelpful ways. (Unhelpful in terms of persuading those who are skeptical, I mean – his approach is spot-on in terms of motivating the flock, via catchphrases, conspiracies and the like.)

So, hearing the arguments expressed in a less hyperbolic way than South Africans have typically been exposed to has been very useful. It’s like hearing about Jesus from a religious studies professor versus from Errol Naidoo or Pat Robertson, if you get my meaning.

For example, at least one speaker (and others in conversation) used the phrase “low carb, healthy fat” (healthy, instead of high, for the H in LCHF). My primary concerns – and the concern of consensus guidelines at present, has been about the extreme stance that a person like Prof. Noakes takes on these matters – not only limiting carbs, but limiting them severely; not just being unafraid of certain fats, but embracing those fats as well as saturated fat.

If we limit refined carbs, and eat more healthy fats, then we’re in the territory of the Mediterranean diet, which is pretty much how I’ve eaten for the last 8 years in any case, and also what my reading suggests is the diet recommended by most experts.

But the problem remains that even those who spoke of “healthy fat” peppered their speech with talk of addiction, or the evil 1977 McGovern report which led to the dietary guidelines that have “made us sick”, and various other tropes from the LCHF playbook.

No amount of repetition seems to make this point stick, but the dietary guidelines in question never told us to eat lots of refined carbs, and in fact cautioned against sugar – but we never followed them. They did tell us to limit fat and be careful of cholesterol, yes, but they have since caught up with science (policy inescapably lags behind science, given committees, consultation and the like).

CarbSane_2015-Feb-21

And sure, I’m sympathetic to the point that “big food” added sugar to compensate for less fat – but that’s a a separate point in that it explains (in part) why we ended up eating too much sugar, but also tells you that we didn’t follow the guidelines, albeit not entirely because of informed choice.

It’s possible, in short, that we wouldn’t be in the state we’re in in terms of obesity and/or non-communicable diseases if we had followed the guidelines then, or start following the guidelines now. The burden of proof, in other words, is still on people who want to propose an alternative to guidelines based on the totality of evidence.

Anne Childers repeated this misleading claim about the guidelines, showing us a graph of NHANES data, according to her showing that Americans complied with those guidelines (in that carbs were up, fat was down, yet obesity increased).

livinlowcarbman_2015-Feb-20

But that shows us nothing of the sort, in the guidelines were not “increase carbs in general”, and folk ended up (whether via the evil Big Sugar or not) eating far too many of the wrong sorts of carbs. They didn’t eat the fruits and whole grains they were supposed to, and they ate far too many of the refined grains and desserts, while guzzling plenty of soda.

This sort of misrepresentation (misleading, even if not mendacious) was not uncommon. Consider Gary Taubes, who in his talk repeated the claim made in Why We Get Fat: And What to Do About It, that “Weight loss achieved in clinical trials of calorie restricted diets are so small as to be clinically insignificant.”

As evidence for this claim, he cites a Cochrane Collaboration report (since withdrawn, simply because the evidence and analysis is now out of date) where the abstract concludes as follows:

The review suggests that fat-restricted diets are no better than calorie restricted diets in achieving long term weight loss in overweight or obese people. Overall, participants lost slightly more weight on the control diets but this was not significantly different from the weight loss achieved through dietary fat restriction and was so small as to be clinically insignificant.

Read the abstract for yourself, or the full report if you have access, but it tells us that the weight loss in the “low fat group was -5.08 kg (95% CI -5.9 to -4.3 kg) and in the control group was -6.5 kg, (95% CI -7.3 to -5.7 kg)”. So, people did lose weight in the calorie-restricted diet, and the “clinically insignificant” from the Cochrane report refers to the difference between the two diets, not weight-loss in a calorie-restricted diet.

As you might expect, many speakers retreaded the line about this all being the fault of Ancel Keys and his allegedly manipulated data (cherry-picking 6 data points instead of the full 22 he had access to, when arguing that heart disease correlated positively with fat intake). But as others have argued in detail, the correlation remains if you include the full 22 countries, and the fact that everybody plagiarises Gary Taubes in saying otherwise doesn’t make it more true.

We also heard some odd contradictions between speakers – Christine Cronau wanted us to believe that fibre “tears holes in our bowel walls” and was to be avoided, Dr. Jason Fung thought fibre was cardio-protective and in general good. During a rare question session, Dr. Eric Westman explained the contradiction as being attributable to “different philosophies”, which hardly seems a compelling answer in matters of physiology.

Dr. Aseem Malhotra gave a talk of two distinct halves – the first half great, on innumeracy, false positives, over-prescription of drugs and the like. But he also engaged in some conspiracy theorising around funding sources for research, and repeated the question-begging narrative about the dietary guidelines. More weird, perhaps, is that his arguments all seem to support the Mediterranean diet, and then his conclusion veered off into the LCHF direction (maybe he’s being paid off by Big Cauliflower? (I joke, of course.)).

The prize for most bizarre statement must go to Dr. Robert Cywes, who told us that “Two hours after a high carb meal, you have effectively swollen your brain and caused concussion”. As The Doctor remarked, those poor Italians must be in a state of perpetual concussion!

On the final (public) day, Dr. Aseem Malhotra was the highlight, in focusing (in quite sober tones) on the consequences of overconsumption of sugar, and how easily you can consume too much without noticing it. My respect for him was undiminished, and possibly enhanced, over the two presentations he gave here.

The main disappointment on the final day was to hear “The Diet Doctor”, Andreas Eenfeldt, repeat the falsehood that Sweden’s SBU has shown that LCHF is the “best” diet. As I’ve written before, and as Slipp Digby has extensively catalogued, they said nothing of the sort. Their report discussed diets for obesity – not everyone – and even so, found LCHF superior only on a time horizon of 6 months or less.

Even the SBU authors have made this clear, after LCHF advocates started trumpeting the (false) claim, so it’s rather disturbing to see Dr. Eenfeldt take advantage of a primed-to-be-receptive audience in this way. I’d have hoped that misrepresentation was incompatible with the LCHF understanding of primum non nocere – first, do no harm. But perhaps Eenfeldt is simply misinformed.

[Edit: The above portions have been struck out because Dr. Eenfeldt contests that he said this. Given that I make a rather impolite accusation towards him here, it’s only correct that I be sure of whether it’s justified. I can only do that when the recording comes out. So at present, this was a regrettable failure of decorum, for which I apologise.]

Prof. Noakes wrapped proceedings up, first discussing causation. I’ve written enough about him, so will just say: no, calling your success story anecdotes Black Swans neither makes them good examples of Black Swans, nor makes them more than anecdotes. They were uncontrolled experiments, so we have no way of knowing cause-effect worked the way you claim it did. Saying that it proves your case begs the question. But he was charming, as usual.

Two final points before concluding: for a medical conference (on the first 3 days – the final day was for the public), with continuing professional development (CPD) points on offer, it was a tad disappointing to hear two purely autobiographical talks on the first day. But this again speaks to the purpose of the conference, as indicated above – it was constructed filter-bubble, rather than a general investigation of the issues.

Second, Old Mutual were careful to distance themselves from the LCHF diet and movement itself, despite apparently throwing buckets of money at it. I’m not sure if this is a winnable game to play (in terms of public impression of them being supportive), but there were three mentions of this not being a show of scientific support by Old Mutual in the first half-hour of the conference.

They argued that they merely wanted to facilitate the debate, help create the space for discussion, and bring information to South Africans. Credit to them for that, as these are worthy goals, but I can’t help thinking that they should then have insisted on the programme being more balanced. In the absence of that, they can’t blame people for thinking they’ve offered an endorsement.

Others can pick over the details once the talks are on the web, as I’m told they will eventually be. But to summarise, I heard plenty that further convinced me that refined sugars are (in general) bad, and that (certain) fats are not a problem. I better understand the arguments for why this is the case. So, I’m pleased to have been here, and feel like I’ve learned plenty.

A last point: I’ve enjoyed having more personal contact with some folks who I’ve previously debated or encountered on social media, notably Karen Thomson and Dr. Gail Ashford, both of whom are pro-LCHF. Thanks to you both for the civil and often fruitful engagements we had over the past four days.

[Edit: I spoke with John Maytham on CapeTalk567 for a few minutes towards the end of day 2. The podcast of that conversation is embedded below.]

Professor Noakes and the Echo Chamber Made of Lard

The 2014 “Collector’s Edition” of The Big Issue contains a number of interesting pieces, but there’s one specific piece that I’ve been looking forward to being able to share with you.

The day for doing so has finally arrived, so here is the first instalment of some thoughts on “The Digital Doctor”, contributed by Prof. Tim Noakes, and freshly uploaded to the Interwebs (thanks to @BigIssueSA on Twitter).

As a framing concept for this post, consider the “echo chamber“, which you can understand as roughly analogous to, or intersecting with, confirmation bias and the “filter bubble“.

Participants in online communities may find their own opinions constantly echoed back to them, which reinforces their individual belief systems. This can create significant barriers to critical discourse within an online medium.

Another emerging term for this echoing and homogenizing effect on the Internet within social communities is cultural tribalism.

What the extract highlights is the problem of “groupthink”: if you surround yourself with people who say the sorts of things that agree with the sorts of things you’d like to believe are true, you all end up reinforcing each others’ beliefs, and opposing views have a difficult time getting heard.

So, it seems fairly obvious – given we know that we’re prone to weighting confirmatory evidence more favourably than disconfirmatory evidence – that someone who cares about keeping their mental furniture nearly arranged would actively seek out ways in which they might be wrong.

Supporters of Prof. Tim Noakes believes that he does exactly that, and that this is why he could famously change his mind on something so fundamental as the value of an entire category of organic compounds (carbohydrates, in case you aren’t aware).

But – and yes, I have said this before – one change of mind, no matter how fundamental or (in)famous, does not indicate anything about a general disposition, and it’s perfectly possible that Noakes (again, regardless of whether his conclusions are correct or not) has adopted (and is encouraging) sloppy thinking in this regard.

Which brings me back to The Big Issue, where it wouldn’t be unfair to describe Noakes’ contribution as a love-letter to confirmation bias, or an attempt to attract companions to occupy an echo chamber made entirely out of lard.

The piece begins with a rejection of expertise, where it turns out (according to Noakes) that an “exclusive clan who have climbed the academic ladder of success” “carefully programmed” Noakes and his fellow students to believe that what the clan professed is the “absolute truth, for now and forever”.

Alien_probeTo help this conspiracy narrative along, these evil people with their degrees and academic credentials are given the sneery nickname of “The Anointed”, which helps to set up the us vs. them dichotomy, where the everyday folk are victims of an intellectual aristocracy, preserving their privilege at our expense.

At this point, some of us are perhaps thinking about how odd it seems that one of the people who has climbed the academic ladder about as high as one can in South Africa thinks he should be trusted, despite his own membership of this shadowy clan.

But by definition, Noakes cannot be part of The Anointed, for he has seen the light, and rejects their gospel. Perhaps he might be part of the New Reformed Anointed or somesuch, because he makes it quite explicit that the outdated dogma he was taught is false, and should be replaced by something else.

The something else, though, is never expressed with qualifications, or room for being wrong – it’s presented as absolute truth. And this is the problem – replacing one dogma with more (albeit different) dogma doesn’t help the argument for being critical of received wisdom. It simply asks you to replace received wisdom with an alternative version of the same.

There’s a problem in this simplistic account of dogma also, in that it’s only unthinking consensus that’s a problem (what we normally call dogma) – consensus isn’t a problem of necessity. So, if “The Anointed” happen to be wrong in this instance, we shouldn’t use that as an excuse for discarding the idea of expertise in general.

Experts do exist, and “common wisdom” is frequently very far from wise. Yes, “experts” can also be wrong – but as ever, we can assess arguments on their merits, rather than throw the epistemic baby of expertise out with the bathwater of a few bad arguments.

Then – crucially – we’re dealing with a complete misrepresentation of what “The Anointed” say. On the Noakes narrative, dieticians and these sneaky academic folk are pushing the line that fats are bad, and carbs at least not as bad as Noakes would have you believe (some might even say that some carbs can be good).

However, the truth doesn’t support these caricatures. It’s (now) common cause that we used to over-emphasise the dangers of fats in general. It’s (now) common cause that refined carbs are bad.

The point is that “The Anointed” have modified their position over the years, in light of the evidence. Noakes might say that they haven’t modified their position enough, or that they are ignoring some evidence or over-valuing other evidence.

But either way, they are not dogmatically pushing one line. Their arguments have evolved (whether rightly or wrong, time will tell), and it’s untrue and uncharitable to present them as inflexible purveyors of eternal “truths”.

There’s only one dogmatic voice in this conversation, and as far as I can tell, it’s not that of The Anointed.

P.S. Noakes’ solution to the problem of The Anointed is to rely on The Wisdom of the Crowds, and especially Twitter, which is “unquestionably the best way to acquire the most up-to-date information on my particular areas of scientific interest” (this is no joke. Well, I mean it’s an accurate quote.) But more on that another day.

Consensus guidelines are anti-science, says Noakes

Here’s an elegant lesson in salesmanship at the expense of principled communication about science. It’s from Professor Noakes™, as so many of my recent examples have been – the popularity of his lifestyle/diet message means that here in South Africa, source material is unlikely to run dry anytime soon.

Earlier this year, Noakes™ addressed a conference in Australia on the “Medical aspects of the low carbohydrate lifestyle”. Those interested in his arguments around health should watch the video below – it’s one of the better ones of his that I’ve watched, in that it’s clear, succinct, and mostly free of conspiracy and ad hominem argument.

The bit I want to focus on starts at 10:17, where he says:

And you must never trust consensus guidelines, because they are anti-science. Science is not about consensus, it’s about disproof, disbelief and skepticism. It’s not about consensus. When you’ve got consensus, you’ve got trouble.

This conflates two very different stories into one, to serve the rhetorical purpose of granting credence to the underdog-story. The two stories are first, that yes, dogma is antithetical to science. The second is that if a preponderance of evidence points in a consistent direction, consensus guidelines could be well-justified, and it would only be irrational or inattentive people who would not believe in that consensus.

In the second story, you’d have been rational to believe in the consensus account even if it later turns out to be false. I spend a lot of time talking about this at TAM2014 as well as in the paper I gave at a recent nutrition conference, so won’t repeat all that here, but the point is that denying a well-justified consensus doesn’t make you a better scientist – it makes you a conspiracy theorist (or simply wrong).

In other words, consensus guidelines that emerge out of honest engagement with the evidence, and that are open to correction, are not anti-science at all. They are the product of good science, and their later overturning (if that happens) in favour of a new consensus is also the product of good science.

You don’t measure or identify good science from its conclusions – because we don’t know that those will survive future data – but by method, and by openness to correction in light of evidence. The first kind of story mentioned above, involving dogma, is of course an example of bad science. That doesn’t mean that consensus is by definition bad.

Science is indeed about “disproof, disbelief and skepticism” – but all of these serve to challenge any existing view and replace it with a better one. They are tools, or methods, for reaching a better consensus, not for rejecting consensus in general.

The simplest way of putting the point is this: Noakes™ would like it to be the case that medical practitioners and educational programmes see the light, and teach the same message he professes. In other words, he’d like his own views to be the basis of a new consensus, because he believes that the existing consensus is wrong.

When you’ve got dogma, you’ve got trouble. And when you’ve got consensus, you might have dogma. But you might also have a bunch of responsible people agreeing that yes, that’s what the data imply, and until we learn something to overturn our view, the evidence leads us – as rational, responsible scientists – to a certain consensus.

In short, while the quote above can play as a sexy soundbite for undercutting received wisdom, it’s another instance of Noakes™ playing scorched earth with understanding of the scientific method.

Big Food, Big Babies: moral panics and the business of eating

Earlier this year, Owen Frisby (the chairperson of SAAFoST) invited me to give a presentation at the 25th Congress of the Nutrition Society of South Africa. While the majority of speakers at the congress were dieticians and others working in medical science, my focus – as in previous posts and columns – was on poor critical reasoning and hyperbole in science writing, and the negative consequences this might have for public understanding of science. If you care to, you can read the text of my presentation below.


 

I’m speaking to you today not as a scientist, but as a philosopher – mostly focused on philosophy of science and critical thinking – and as a columnist for various publications, most regularly the Daily Maverick.

It’s been said that the philosophy of science is as useful to scientists as ornithology is to birds, so instead of speaking on that topic, I’ll focus on how issues related to health and nutrition are presented to the public, and whether those who do scientific work and try to communicate it to the public are getting their message across. Also, I want to look at whether it’s the right message at all.

There’s no question that, for most of us, health is important. This doesn’t however mean it needs to be treated as a good that always trumps all other goods. It’s entirely possible, and possibly even rational, for an individual to sometimes prioritize goods other than health.

If pursuing such goods comes at a cost to the health of others (for example, second-hand smoke), or at a cost to public welfare in terms of increasing the costs of healthcare for all the rest of us, we can also be excused for wanting to regulate such choices, or to at least disincentivise them in some way.

But one thing that I think is often missed when health is treated as our only or our primary interest is the effect that debates on nutrition, or science more generally, might have on the public’s ability to think critically about evidence and the scientific process.

Our health is a topic that lends itself to over-reaction, panics, and sometimes, the rise of what might appear to be cults, complete with prophets that can lead us from the wilderness of confusion, so long as you trust and obey.

The fact that we mostly do tend to regard our health as a good in itself, and a very important one at that, can lead to our being susceptible to discarding nuanced – and more accurate – understandings of the scientific process and its conclusions in favour of misleading headlines and hyperbole.

So as a starting point, one of the things I hope to persuade you of – seeing as many of you are communicating science in one way or another – is that one of the important lessons healthcare professionals, scientists, and science writers can teach others, including the public and government policy makers, is that things are often uncertain.

We might have very good reason to believe something, yet not feel entitled to claim that we are sure of it. This attitude of epistemic prudence is a reminder and demonstration to laypersons that (in the words of Dara o’ Briain) “science knows it doesn’t know everything – else it would stop”.

The point is, claiming certainty, or adopting a dogmatic stance, not only forecloses debate, but more importantly puts science in the same realm as pseudoscience. Homeopaths confuse the public with unfalsifiable claims, astrologers likewise, and these things waste people’s time, money – and occasionally – lives. It’s the fact that we embrace questions, and doubt, that makes the scientific method superior.

To put it another way, being right often starts with embracing the possibility that you might be wrong.

By contrast, the tone of much popular discourse, including coverage of important scientific fields in newspapers and on social media, proceeds as if things can be known, for certain.

This leads to absurd contestations where things are “proved” and then “disproved” with each new bestseller, and where apparent “authorities” rise and are then quickly forgotten as our attention shifts to the next sensation.

This infantilises the public – not only in treating them as if they are unable to make choices for themselves, but also more literally, in helping to ensure that they can’t make choices for themselves, through misleading them and teaching them to believe in simplified versions of the truth.

Let’s start with a very clear message, as captured in this quotation from the “Bellagio Declaration” of 2013, subtitled “Countering Big Food’s Undermining of Healthy Food Policies”.

The influence of Big Food in preventing public policy initiatives was clearly outlined by Dr Margaret Chan, Director-General of WHO (June 2013):

‘Research has documented these tactics well. They include front groups, lobbies, promises of self-regulation, lawsuits, and industry-funded research that confuses the evidence and keeps the public in doubt. Tactics also include gifts, grants, and contributions to worthy causes that cast these industries as respectable corporate citizens in the eyes of politicians and the public. They include arguments that place the responsibility for harm to health on individuals, and portray government actions as interference in personal liberties and free choice.’

This statement might have come out of a North Korean government press office. It’s infused with hysteria, paranoid thinking, conspiracies, and the evasion of personal responsibility in favour of placing blame elsewhere. And this is why I chose the title I did – big food has turned us into big babies, no longer capable of looking after ourselves.

To very briefly focus on some complex issues that the statement above ignores in favour of promoting paranoia: first, “these tactics” assumes there is a consensus around what the tactics are, and that they are already known to be evil.

“Industry-funded research” is spoken of as if it’s axiomatic that funding has to corrupt, which isn’t necessarily the case. And even if it tends to be, more often than not, the research can still stand or fall on its own merits, and we can’t dismiss it without looking at the evidence.

The “tactic” whereby “they” “cast these industries as respectable corporate citizens” again implies that they cannot possibly be respectable corporate citizens, and also assumes that we are already in agreement as to what a corporation’s responsibilities are in this regard.

Most importantly, consider the way in which personal responsibility is framed: it simply doesn’t exist, in that it’s someone else’s fault that you’re sick and overweight, never yours.

Arguments that “place the responsibility on individuals” are presented as suspect, so instead of reflecting on your own contribution to your problems, you’re encouraged to find a scapegoat – or better yet, let government do it for you, ignoring those idiots who think the state is interfering with “liberties and free choice”.

In summary, conspiratorial thinking is presented matter-of-factly, and thus normalized, in the course of this hyperbolic statement. And given the statement is from an “authority”, we’re primed to grant it our attention and (perhaps) trust.

But for me, this sort of fearmongering indicates that the World Health Organisation is perhaps less concerned with our cognitive health than with other forms of wellbeing. This statement is effectively bullying, rather than persuading the public – and if you teach people that they can’t think for themselves, you shouldn’t be surprised to find that they stop being able to.

And if you’re primed to spot a pattern involving malice and conspiracy, malice and conspiracy there will be. Eli Pariser’s concept of the “filter bubble” articulates this point well – if you go looking for evidence of Bigfoot on a cryptozoology website, you’ll find it. Chances are you’ll end up believing in the Loch Ness monster too, simply because the community creates a self-supporting web of “evidence”.

When these tendencies are expressed in the form of conspiracies, the situation becomes even more absurd, in that being unable to prove your theory to the doubters is taken as confirmatory evidence that the theory is true – the mainstream folk are simply hiding “the truth” so as not to be embarrassed or exposed.

You are all familiar with the language that becomes common in these sorts of situations, but perhaps that familiarity has made us somewhat less vigilant than we should be. Perhaps we should still take note, and be suspicious, when someone replaces argument with summary terms and slogans like big pharma, big ag, GMOs, organic and FairTrade.

These terms serve as triggers for fear or hope – in general, for reinforcing our biases. They describe folk who are doing these things to us, while we helplessly eat what we are told.

I don’t mean to suggest that these labels don’t refer to some real problems – it’s more that the labels take the place of argument, assume both the presence and magnitude of problems, and encourage us to stop thinking.

Thinking is a good in itself – healthcare choices are just one area where we need to make decisions, and rational decisions are only possible if we are thinking things through.

A sound relationship to evidence, reasoning, and the role of authorities in guiding us towards conclusions is a general virtue. Our failure to cultivate such a relationship won’t only impact choices related to health. Becoming lazy in making any category of choices means tolerating sloppy thinking, which is bad for our health in a different sort of way.

From a macro sort of perspective, here’s something that should give us pause for thought. Even though conversations around diet often involve fear, judgement, hyperbole, panic and so forth, consider:

Food isn’t moral. It’s not immoral, either. It’s morally neutral.

What should we then say about so-called “addictive” foodstuffs? The first thing to remember is the point Paracelsus made in the 15th century – “the dose makes the poison”.

sugar

While there might be no safe number of cigarettes to smoke, there will be a dosage of carbohydrates, or sugar, that’s unproblematic in all but the most rare cases.

Let’s look more closely at “sugar addiction”, and addiction in general. Two papers are typically cited as evidence for sugar being addictive, at least in the popular media. But what they mostly reveal is that science journalists no longer read or understand the journals, and that the public – and some professionals – are far too trusting when it comes to the sensational headlines that convey elements of those studies to us.

First, the Avena study, published in Neuroscience & Biobehavioral Reviews in 2007:

Food is not ordinarily like a substance of abuse, but intermittent bingeing and deprivation changes that. Based on the observed behavioral and neurochemical similarities between the effects of intermittent sugar access and drugs of abuse, we suggest that sugar, as common as it is, nonetheless meets the criteria for a substance of abuse and may be “addictive” for some individuals when consumed in a “binge-like” manner. This conclusion is reinforced by the changes in limbic system neurochemistry that are similar for the drugs and for sugar.

Pause there – who might be inclined to consume in a “binge-like” fashion? Perhaps someone with a pre-existing impulse control disorder, who happens to latch on to sugar? In other words, the reverse inference from the bingeing to the sugar might get the causal direction entirely back-to-front. We’ll get back to the neurochemistry later, but also, notice the scare-quotes – the author is hedging her bets, with the text only weakly supportive of any claim to sugar addiction, at least if “addiction” is taken to mean what it normally does.

It is not clear from this animal model if intermittent sugar access can result in neglect of social activities as required by the definition of dependency in the DSM-IV-TR (American Psychiatric Association, 2000). Nor is it known whether rats will continue to self-administer sugar despite physical obstacles, such as enduring pain to obtain sugar, as some rats do for cocaine (Deroche-Gamonet et al., 2004).

Nonetheless, the extensive series of experiments revealing similarities between sugar-induced and drug-induced behavior and neurochemistry lends credence to the concept of “sugar addiction”.

In other words (to get to the gist of the first two sentences above), there are some fairly typical features of what we normally understand as addiction that are missing here – but we’ll call it addiction in any case.

As I’ll argue in a moment, our common understanding of addiction is itself flawed, but I pause here just to note that the rats are supposedly “addicted”, but don’t fit the DSM definition of dependency – in other words, we’re using words rather liberally.

One is perhaps reminded of a line from Lewis Carrol’s “Through the looking glass”, where Humpty Dumpty said: “When I use a word, it means just what I choose it to mean—neither more nor less.”

Then, there’s Johnson & Kenny’s paper in Nature Neuroscience (2010), on junk food and addiction (also conducted on rats):

Notably, it is unclear whether deficits in rewards processing are constitutive and precede obesity, or whether excessive consumption of palatable food can drive reward dysfunction and thereby contribute to diet-induced obesity.

As in the Avena study, we don’t know whether an impulse control disorder is simply being expressed – rather than discovered as an effect resulting from the junk food – in this experiment.

Common hedonic mechanisms may underlie obesity and drug addiction.

Yes, if you grow to like something (or find it rewarding), you’ll seek it out. This does not mean the thing is innately addictive. In fact, Hebebrand’s recently published paper in Neuroscience & Biobehavioral Reviews concludes that if anything, “eating addiction” rather than “food addiction” best captures what’s going on when people compulsively over-eat. The food is an expression, not a cause of the impulse control disorder.

Both of these studies use brain imaging to support their conclusions. I worked for five years as part of a multi-disciplinary team investigating disordered gambling, also with the help of fMRI data, and in that time I got to read enough of the literature on fMRI to know just how misleading it can be, especially as presented outside of the lab.

As Sally Satel (who works as a psychiatrist in a methadone clinic) puts it, brain scanning is “a perfect storm of seduction”, promising “great revelations and great objectivity”. More to the point of my presentation today, it offers the possibility of eliminating your responsibility for what’s wrong with you – we can say, “it wasn’t me, it was my brain!”

Many of you will know this image, but before I go on to talk more generally about addiction, here’s an indication of just how misleading fMRI can be:

fmri-salmonThe short explanation of why this image is interesting is that it neatly summarises why you can’t reach firm conclusions from fMRI data. This fish is in fact dead, yet the scanner showed signs of brain activity.

fMRI data are suggestive, and weakly so at that, in that they reflect neural correlates of various stimuli, but nothing of the perceived and subjective mental responses to those stimuli.

In slightly more detail: Increased blood flow and a boost in oxygen are treated as proxies for increased activation of neurons, and from there we induce to what those neurons are doing. We compare that data to a baseline, and subtract the one from the other, averaging out over the many data points of all participants in a study, with software filtering out background noise and creating these seductive images.

But our experimental conditions are imperfect – think of the difficulties of creating appropriate baseline tests, for one – and large sample sizes cost a lot of money. Add to that the fact that our brains can process the same stimuli in different regions – no one specific area can reliably be said to perform the same task for all of us – and it should be clear that it’s far too soon to reach definitive conclusions from fMRI data.

The philosophical problem is one of reverse inference – we reason backward from neural activation to subjective experience. But if identified brain structures rarely perform single tasks, one-to-one mapping between activation in a region and a mental state is very speculative.

The images that get the attention in the media ignore these complexities. As we know, headlines don’t have space for subtleties, and furthermore, novel and exciting claims get our attention. If your fMRI scans can be said to show that sugar is “more addictive than cocaine”, you’re guaranteed some prime media attention, and who can blame you for trying to capitalize on that?

To quote Satel, we can’t tell – yet – “whether fMRI scans indicate an impulse that is irresistible, or one that simply hasn’t been resisted”. But it’s easier to make choices when you believe that there’s a choice to make, rather than a forced one, such that an “addiction” narrative might support.

To put it another way, diminished expectations of agency can lead to diminished agency – if you’re not aware of your choices, it’s more difficult to make choices.

Furthermore, addiction – and here I mean what we more commonly think of as addiction, like with heroin – retains elements of being a voluntary behaviour. It might be more difficult to make certain choices, in certain circumstances, but it’s still possible, and you’re more in control than you might think.

Yes, we see increased dopaminergic action (limbic/reward system) – where expectation is mediated by something known to be an addictive substance, or a correlate of an addiction. But we can’t conclude from this that all volition is lost, or that the addictive substance has “hijacked the brain”.

When we speak of things “changing the brain” in what Satel refers to as the “brain disease” model, we not only frame our choices as being all-or-nothing (sugar is toxic!), we also overstate the significance of changes to the brain in general.

This is because we’re changing our brains all the time, and we like the fact that we can do so. When you learn to play chess, or learn a language, you’re “changing the brain” too.

And what’s forgotten in this “brain-disease model” is how much we can tweak our behaviour – even our most compulsive behaviour – through using our past experience as a guide to influencing our futures through sanctions, incentives, and adjusting the contingent facts of our day-to-day lives.

Addiction – even of the most acute kind – is a behaviour whose course can be altered by the application of sanctions or incentives. Satel describes the brain level of analysis as subject to neurocentrism – the notion that the brain is inevitably the best level at which to explain behaviour.

The neurocentric position is held to be more authentic, more true, and holding more predictive value. And while some brain disorders – Alzheimer’s, for example – can be interpreted in light of this sort of model, addiction is far more complex.

For addiction, the neurocentric view implies that the solution is always a medical one. And yes, methadone does work (for withdrawal), but can obscure other remedies. Here’s a detail that might surprise you – in the majority of cases, people quit on their own, usually by their early 30’s. But we suffer from a confirmation bias here, in hearing about the cases that don’t quit, because these cases are often dramatic, and tragic.

Addiction is also a remitting condition – and in chronic cases, addicts also tend to have depression, anxiety and other confounders. What this means is that there are various options for intervention, and the psychological and environmental tweaks that might help addicts are frequently overlooked in favour of the brain-level explanation.

nixon

Here’s a great example from history. In 1971, there was an epidemic of heroin use in SE Asia among US soldiers. Nixon panicked, and launched Operation Golden Flow. You couldn’t board a plane back to the US unless you tested clear (after having a few weeks to clean up). In July, an estimated 15% of soldiers were using heroin regularly, but two months later, all but 4.5% tested clear. In follow-up studies, 3 years later, only 12% of those who had dependence had re-experienced addiction.

The addicts who are in control of their dependencies also adopt self-binding strategies. One of the books I recommend most strongly for understanding how volition works is George Ainslie’s “Breakdown of Will”, in which he speaks of “Bright Lines” as ways to hack the brain, given that we know in advance which weaknesses we’re susceptible to.

Motivation, in short, can make a huge impact. And the brain level is not YET the level at which our interventions are the most useful. Addiction and impulse control issues are a human drama, occurring in a context.

But the problem is that we like stories, and the media feed that liking. Sensationalist stories gain traction via our confirmation bias, and our cognitive dissonance – not being able to reconcile the complicated version of events with the sensationalist one – results in the backfire effect, where we double-down on our existing beliefs and shut out dissenting views.

What this adds up to is hysteria and moral panics, with little tolerance for nuance.

Worse of all, sometimes people who work in science contribute to our illiteracy by cherry-picking data, by presenting science as settled when it’s actually contested. This might sell books and gain a following, but at the expense of our critical thinking skills.

One clear lesson here is that we have a responsibility to be prudent with advice, and to reinforce the character of scientific enquiry in how we operate.

Set this more complex snapshot of addiction against the version currently gaining traction in South African and international media, and it should be clear that a word like “addiction” is being exploited for political and marketing purposes. The intent might be sound, even noble, but is it necessary to mislead, or can the message get through without the hyperbole?

We need to factor in the cost to our critical thinking abilities, as an at least part offset against the purported health benefits. Physical health does not necessarily trump these other considerations.

bantingWe should also be concerned with the costs all of us bear. An establishment in Hout Bay called Harmony Clinic now offers an 8 week online program for R 2 500, as well as a more expensive 28 day inpatient programme, to cure you of your “sugar addiction”.

They also run a “Sugar & Carb Addicts Anonymous” group – and the thing that makes this more troubling than simply being a middle-class moral panic is first the amount of breathless media coverage it gets – usually uncritically – but also the fact that the programme has now been recognized by Discovery Health – which means we are all paying for quackery.

To briefly touch on some other examples of how popular culture can be nudged into believing some very controversial claims about health, consider the rise of the idea of “real food”, or the “real meal revolution”, which inserts panic regarding GMOs and soy products into dietary advice that can (and should) itself be the subject of critical interrogation, some of which I’m pleased to see happening at this congress.

Leaving details of any particular diet to one side, I’d want to simply pause and ask “What is real food?” Does golden rice, genetically engineered and holding the promise of saving the 670 000 children who die of Vitamin A deficiency every year count? Or what of the founder of the Green Revolution, Norman Borlaug, a biologist who invented high-yielding wheat that is credited with saving a billion lives?

One sometimes gets the sense that some of these concerns are what folk on social media ironically refer to as “middle-class problems” – for people who are struggling to simply stay alive, you won’t get much sympathy for your GMO-skepticism, or for scaring them with nonsense fears around vaccines and autism.

Here’s another middle-class problem: FairTrade – which is by and large an exploitative cartel. Growers are paid very little for Fair Trade coffee, and consumers pay more for it. But growers sign up for fear of being frozen out, thanks to the marketing clout FairTrade has. So it’s either sell something at a lower profit, or sell nothing – which sounds quite a lot like a protection racket, but good luck convincing a hippie of that.

As London’s SOAS reported in their study of FairTrade:

What did surprise us is how wages are typically lower, and on the whole conditions worse, for workers in areas with Fairtrade organisations than for those in other areas.

Likewise with “organic” food – organic farms are currently 80% as productive as conventional ones, so immediately, we need more space to farm in, and more people willing to be farmers.

Science is also unable to support claims that organic food is safer or healthier. In the meanwhile, who pays the price for our affectations? The less well-resourced farmers, who can’t get by without the pesticides and so forth, because they have to concern themselves with yield above all else.

They also can’t afford the extra staff, and organic farming is more time and labour intensive, results in more spoilage, and at the end of the day, less profit.

The lesson might be: when you’re struck with a noble sentiment, try to ensure it’s not being funded by poor people, who don’t have the luxury of choice.

quinoaAlso, organically reared cows burp twice as much methane as conventionally reared cattle – and methane is 20 times more powerful a greenhouse gas than CO2 is. So future generations might be a little less than pleased at your organic food fixation.

Again, as with FairTrade, there are various cartels controlling organic certification, in a process that results not only in various confusing standards, but also creates a market for regulatory bodies to interfere with choice.

We end up with something like a religion, as in the potential need for separate bread slicers!

bread_signIt’s rarely true that people can’t think for themselves – if we allow them to. As I hope I successfully conveyed earlier, even addicts have all sorts of lucid periods, figuring out coping strategies for themselves.

Furthermore, the things we’re attracted to – even drugs – serve a purpose in our lives, and we need to understand that in our responses too. We’re inclined towards thinking that one model of health is compulsory for all of us – but self-harm on your definitions does not always need to be pathologised.

The problem with these panics, and with “science” and science reporting being infused with scaremongering, is that the state will turn to paternalism. Some things – that are always unhealthy – deserve serious nudging. But as I mentioned earlier, there is a safe level of sugar, wheat and so forth, and diets shouldn’t be medicalised all the time – it’s food first, rather than medicine. And food should be fun.

When nudges are appropriate, for example through taxes, or increased healthcare premiums for smokers, the most important question is simply whether they work or not – food should not become a moral battleground.

As you know, South Africa is now talking about a sugar tax. There are reasons for pessimism, and for thinking this a moralistic move rather than a pragmatic one. Alchohol taxes here are not very effective, and cigarette taxes haven’t increased the fiscus greatly, thanks to cross-border smuggling.

But even in more coherent economies, results are poor. Bloomberg’s soda tax didn’t work, and created perverse incentives such as people simply buying two sodas. Denmark’s “fat tax” lasted only a year- but in the meanwhile, authorities said the tax had inflated food prices and put Danish jobs at risk. The Danish tax ministry has also said it was cancelling its plans to introduce a tax on sugar.

I’m arguing that we are able to take responsibility for our choices, but have been trained into doubting that, and now need someone to blame for our poor choices. Even if there is more unhealthy food available than ever before, we’re eating more of it than ever before too – and that’s our fault.

On top of that, we’re moving less too, spending all our time in cars, in front of televisions or computer screens, perhaps reading about how the evil food producers are making tasty food.

There’s no reason to think it’s a conspiracy – they are making the food that we ask for. We’ve taken 3 decades to reach our current levels of obesity – and now that we cotton on to the fact that many of us need to learn new habits, and in general simply eat less, why not give that message a little time to sink in, instead of rushing to legislate/medicalise?

A short-term reaction involves panicking, and governments telling us what to do, perhaps gaining some revenue through taxing the things we’re told have made us sick. A longer-term – but more sustainable – solution involves education, teaching people to think critically about evidence, and encouraging them to take responsibility for their choices.

Yes, of course non-communicable diseases are a problem – but we’re still living longer than ever before, which means the story is on the whole positive, rather than catastrophic. This is something that’s easy to forget when only focusing on the panics.

Advertising might well be a contributing factor to buying unhealthy food – but it’s parents who buy the food, not the kids, and parents can understand the risks if they choose to. Meanwhile, we can’t blame companies for making their products attractive – that is, after all, their job. Of course food is engineered for our pleasure. Would we want it any other way?

We have no compelling reason to doubt that the food market – and “unreal” food, whatever that might mean – can’t develop into being healthier. And to some extent, our interests and those of the food producers are aligned – after all, the longer we live, the more product we buy!

Nuance in these debates is sacrificed for hyperbole, and slacktivism replaces activism in the field of education in critical reasoning about science. In the world of social media and short attention spans, we overstate the value of our own experiences, and generalise from them to universal truths.

But a collection of anecdotes does not equal data, but that’s difficult to remember when temperatures run as hot as they do.

The democratization of knowledge via the Internet has brought real boons to society. But it can also make us forget that real scientific breakthroughs happen in journals, not in bestselling cookbooks. And you hear about them on the news, not on the Dr Oz show.

It’s our job to fight for nuance, and to demonstrate, partly through showing that we’re willing to embrace uncertainty, what the value of the scientific method is, and why our best-evidenced conclusions should be preferred to conspiracies and folk wisdom.

And we devalue our scientific currency, or credibility, when we assert certainty – and we do the political cause of science harm, in teaching people that there are easy answers.

Our worth as scientists or science communicators is not vested in conclusions, but in the manner in which we reach conclusions. It’s not about merely being right. Being right – if we are right – is the end product of a process and a method, not an excuse for some sanctimonious hectoring, or dietary evangelism.

Sometimes we need to remind ourselves of what that method looks like, and the steps in that process, to maximize our chances of reaching the correct conclusion. Focusing simply on the conclusions rather than the method can make us forget how often – and how easily – we can get things wrong.

As Oscar Wilde had it, “the truth is rarely pure and never simple”.