More lessons in bad science (and reasoning) from Noakes

Tim Noakes’ essay-length comment on my previous blog post is unfortunately a simple amplification of the fact that eminent scientists can be guilty of some of the most elementary errors in reasoning.

In case you missed it, there’s a 1400 word comment from Prof. Tim Noakes on my previous blog post. Seeing as the bulk of his comment is entirely unrelated to the subject of that blog post, I thought it offered a handy opportunity to provide an additional example of reasoning gone wrong, this time both in basic logic, and again in science. (Also, I’d need another 800 or so words to match his word-count.) So, below you’ll find block-quotes of his full comment, and an explanation of the errors committed. If you want to see his quote in context, please visit the original piece, Lessons in bad science – Tim Noakes and the SAMJ.

Apologies, but this will be somewhat lengthy. I’ll try to keep each unit of quote and response comprehensible on its own, though. Those of you who get bored, please do scroll down and read the bit headed (in bold) “A very important bit” before you leave.

And a reminder – my post the other day wasn’t about the diet itself. This post isn’t about the diet either. It would be fantastic if Noakes/Taubes and the rest were correct in this instance, in that they would have re-discovered or popularised a highly cost-effective way to treat an a highly significant public health problem. Or, various problems, including obesity and diabetes. That would be something to be celebrated, and I’ll be one of those celebrating.

However, if we can arrive at that outcome while supporting (and reinforcing) the scientific method and basic logic, surely that’s an even better outcome?

Noakes begins by re-stating a powerful anecdote:

What is really so funny is that this is a report of how 127 people felt their lives had been dramatically improved by following a particular diet. Included were 14 who claimed they had been “cured” of Type 2 diabetes – confirmed in 3 cases I investigated further. To my knowledge the SAMJ has never before carried a report in which patients with an “incurable” condition (type 2 diabetes) were cured of that condition. One doctor who had told his wife he would be dead in 7 years because he had 5 “incurable” conditions, was completely healed of all conditions (no more medications required) when he restricted his carbohydrate intake.

Everything else he had ever tried (according to his conventional medical training) including treatment by the best medical specialists in Cape Town had done little for his health. Naturally this medical practitioner who had never in 57 years been exposed to this information (why not?), concluded that the dietary advice I gave him had produced a “miracle”. He now includes this method in his treatment options for his patients with obesity/diabetes/metabolic syndrome. He now informs me at least monthly of how much success he is having with this dietary treatment for these patients.

After the words “felt”, “claimed” and then the quotation marks around “cured” in the first two sentences, the thing you’ll note about this anecdote is that it uses language that is entirely inappropriate to the level of evidence available. Imagine yourself to be someone who has Type 2 diabetes, or who is overweight, and who then reads the two paragraphs above. If your level of scientific literacy was that of the average person, you’d come away thinking that there’s something akin to certainty that this diet is effective.

If you’re a marketer, this tactic is completely understandable, and appropriate. But science should be a domain of reason and evidence, not of hyperbole, and not of presenting contested evidence as if it obviously demonstrates something that it is not known to demonstrate. Second, as I’ve said in my original piece, if the evidence exists, you wouldn’t need the anecdotes. Unless, of course, Noakes has so little confidence in the acumen of his peers that he thinks that they would be equally persuaded by either.

Paragraph two contains the quite typical injection of conspiracy theory, with its suggestion that something must be afoot for this medical practitioner to not have heard this dietary advice before. And yes, it’s possible that something was and is afoot – that there is a systematic bias against this approach to diet. If so, that’s a problem that should be remedied. But it has no bearing on whether the advice is in fact good or bad advice. It can have a bearing on how much evidence we have, in that research might have been stymied or inappropriately directed. (Noakes, however, keeps insisting that the evidence is clear, so it seems that this problem is surmountable.)

I wrote the article to alert my colleagues to the fact that there is a simple dietary option that might be able to reverse the very conditions that our profession finds so difficult to treat – obesity, type 2 diabetes, metabolic syndrome. I also referred to the extensive scientific literature showing why and how this dietary intervention does and should work for people with these conditions. The explanations are simple, obvious and proven.

But then perhaps you need a training in the medical sciences to understand those mechanisms, Without some understanding of biochemistry, it is not possible to follow that argument. What one cannot understand, one naturally dismisses as irrelevant.

As I’ve asked before, if the “extensive scientific literature” makes the case, why do we need the anecdotes? As above, the use of the word “proven” massively overstates the case, and again indicates a failure to understand why he comes across as pseudoscientific in these regards. If it were “proven”, there would be far less disagreement in the medical profession than there seems to be about this sort of diet’s efficacy.

In general, though, to quote from a comment I made on the previous post, “the issue is that if non-anecdotal evidence for the same conclusion exists (as he asserts), that evidence would be sufficient by itself. So, either it doesn’t exist, and he needs to rely on the anecdotal evidence (which teaches a bad lesson regarding scientific reasoning), or it does exist, but he thinks that the anecdotal evidence adds weight to the conclusion (which it doesn’t, as he should know)”.

The last paragraph contains another fairly typical tactic for Noakes, namely an attempt to discredit an opponent through focusing on something irrelevant or personal, as we saw in the “fat-shaming” comment in the previous post. Because there are two possibilities here: first, that he’s right that we need medical training to understand this. If so, I’m mystified as to why Noakes does all this public speaking to laypeople, and also that he writes on these matters in (almost exclusively) lay publications and books as much as he does, seeing as he knows none of those audience-members can understand what he’s saying.

Alternatively, he’s subtly suggesting I’m too thick to “get it”. But again, seeing as my post was not about the diet, but about what evidence and arguments look like, I’d have to protest and tell him that I “get that” very well, and that of all the medical practitioners who have commented or Tweeted about the post in question, everyone except Noakes thinks I’m on to something. Not, I again remind you, about whether the diet is good or bad, seeing as I don’t express a view on that, but simply that this sort of “research” or “study” sets a very low standard in terms of what we should aspire to as scientists.

At no point in the article is the claim ever made that this is an attempt at a scientific proof of a particular diet. That is why the title includes the words – Occasional Survey. It is simply a group of case reports showing that some patients achieve remarkable cures for their intractable medical conditions simply by following advice, the key point of which is that it normalises hunger. For the truth is that these patients are not dying of obesity etc, so much as they are dying of hunger. Once their hunger is controlled by simple dietary advice, they can start to cure the conditions caused by the overconsumption of addictive, highly processed, carbohydrate-rich foods (made worse by their insulin-resistant state).

I have been in science long enough to understand how people try to divert attention from the message. I wrote about this extensively in Challenging Beliefs. First they always question the methods. The methods I used in this study are entirely appropriate for the extremely limited goals of this paper. That simple goal was to show that some people benefit dramatically and in some cases miraculously from this simple advice. Whether or not they would have benefitted equally from other advice is utterly irrelevant since I am not trying to prove (in this article) that one treatment is better than another. Of course I would guess that 100% of the 127 had all tried the conventional advice and it had failed for them. But I only made that claim if I it was supported by the information I had.

A group of “case reports”? I don’t know about you, but that seems an awfully strong description for a series of self-reported and completely uncontrolled and in most cases unverified narratives. But it’s nevertheless a legitimate description, with a track record in medical literature.

However, because a large group of case reports, as in this case, can create an impression of generalisability or significance where there might be none, we find Johns Hopkins, for example, requiring IRB (institutional review board) clearance for any case studies (or a case series, in this instance) involving more than three participants. No clearance is mentioned in this case.

Again, I remind you that I’m simply saying that the study offers little of scientific merit, and that the SAMJ erred in accepting it for publication – not that the anecdotes are false. (It’s that we can’t know whether they are false or not that is part of the problem.)

As for “I have been in science long enough to know” – I refer you to the point about deflection and conspiracy mentioned earlier. The fact that methods are questioned isn’t evidence that the scientist is a martyr for the truth, as Noakes seems to want to imagine himself here. As Occam’s Razor suggests, it might also be because the methods are questionable.

It’s entirely relevant to question whether the participants would have benefited equally from other advice, precisely because 127 cases offers an impression of significance or generalisability. The goal was “to show that some people benefit dramatically and in some cases miraculously from this simple advice” (my emphasis) – and how do you show that through 127 unverified self-reported anecdotes? If the science already shows this, then it can stand alone, with the anecdotes as illustrations if one so desires. Noakes says (in the paper) that this “data” is “of value” and “challenges current conventional wisdom” – and yes, it would, if we had reason to believe it was replicable. It might well be replicable, but the anecdotes are not evidence for that conclusion.

A key point about South African medical ethics is that if there is more than one treatment options it is ethically unacceptable for a South African practitioner to prescribe only one. My ethical responsibility as an educator and scientist is to bring the attention of my colleagues to the established fact that there is more than one option for the treatment of obesity, diabetes and metabolic syndrome and that the scientific evidence for this is well established in the literature (as recently accepted by the highest Swedish medical authorities).

Having been involved in high-level research ethics myself, of course I’d agree in the main. Except, Noakes is leaving something crucial out of the summary: it’s not only when there is simply “more than one treatment option”. Instead, it’s when there is “more than one effective/proven/viable/etc. treatment option”. This might well become known to be one of those options, perhaps even the best one. But it isn’t known to be that as yet, which is a reality Noakes again evades in the above quotation.

A very important bit

Above, Noakes says “as recently accepted by the highest Swedish medical authorities”. This, in a nutshell, demonstrates his rather casual relationship with reality when it comes to promoting the conclusion he wishes to. You’ll note, as a starting point, that the language is unambiguous – a trusting reader will be left utterly convinced that the Swedes have accepted LCHF as obviously the recommended diet. So, let’s look at the evidence. The quote from his paper reads as follows:

The Swedish National Board of Health and Welfare has concluded that ‘low carb diets can today be seen as compatible with scientific evidence and best practice for weight reduction for patients with overweight or diabetes type 2, as a number of studies have shown effect in the short term and no evidence of harm has emerged … ’

It’s a direct quote, so you’d expect a reference (and quotation marks, which might look a little alien to some potential readers). We have both in this case, and the reference given is to the Swedish Board in question…. oops. No, sorry, my mistake – the reference is to a blog post titled Low-carb for You. The Swedes are eating more butter! In another interesting development, the full quote reads (my emphasis):

Professor Christian Berne, one of Sweden’s leading diabetes experts, had carefully investigated the case against Dr. Dahlqvist and presented his findings to the Swedish National Board of Health and Welfare. He said, “…a low-carbohydrate diet can today be said to be in accordance with science and well-tried experience for reducing [obesity] and type 2 diabetes…a number of trials has shown no effects in the shorter run and that no evidence for it being harmful has emerged in systematic literature researches performed so far. [There is] no scientific support yet for treatments in excess of 1 year. A thorough evaluation of long time treatment results is therefore an important demand on the practitioner.”

So what we learn here is:

  • In the source Noakes refers to in order to support a very strong claim, we find Berne reporting findings to the Board
  • But that quote is presented by Noakes as a resolution of the Board, rather than an opinion expressed to the Board
  • An important bit of the quote is left out, because it’s inconvenient (namely, that there is no scientific support for treatments “in excess of one year“)
  • Notice that this question – around long-term efficacy – was a central theme of my previous blog post that inspired this Noakes essay in response – and his own source makes the same point
  • Lastly, we learn that quotation marks don’t mean the same thing for Noakes as they might to you, in that a sentence like “a low-carbohydrate diet can today be said to be in accordance with science and well-tried experience for reducing [obesity] and type 2 diabetes” morphs, in Noakes’ version, into “low carb diets can today be seen as compatible with scientific evidence and best practice for weight reduction for patients with overweight or diabetes type 2” (I’m not asserting here that he changed the meaning – it’s just odd to quote-and-not-quote at the same time).

The SBU (Swedish Council on Health Technology Assessment) have however published guidelines on diet and obesity – but unfortunately, they’re not yet available in English, so Noakes couldn’t easily have quoted from them in an English-language journal. But let’s see what Google translate can do for us, seeing as we’re able to take such liberties on a blog post.

“SBU has previously addressed food for people with diabetes [link to English pdf]. The results for people with obesity and diabetes, pointing at large in the same direction.”

That direction, according to the English diabetes report, includes bits like this (my emphasis):

  • Scientific evidence is not available to evaluate the long-term safety of moderate and extreme low-carbohydrate diets. This includes cardiovascular morbidity and other complications of diabetes.
  • There is strong scientific evidence that lifestyle intervention, combining a low-fat diet with high fiber intake and increased physical activity, prevents diabetes in people that would otherwise be at high risk for the disease

Back to the Google translate version of the obesity report, which also says (my emphasis):

  • In the short term (six months) is advice on strict or moderate carbohydrate diet more effective for weight loss than low-fat diets advice. In the long run there are no differences in efficacy between weight loss tips on strict and moderate carbohydrate diet, low-fat diets, högproteinkost, Mediterranean diet, diet focuses on low-glycemic load diet or a high proportion of monounsaturated fats.
  • After that obese people have lost weight they can maintain their weight better with advice on low-fat diets with low glycemic index and / or high protein content than with low-fat diets with high glycemic index and / or low protein content. There is no basis for assessing whether even advice, eg, low-carbohydrate diet and the Mediterranean diet is effective in preventing weight gain after weight loss

Once again, it might one day be common knowlege that Noakes et. al. are right. But that day doesn’t seem to have arrived yet, and in the meanwhile, it certainly looks as if support is being appropriated where it doesn’t quite (as yet) exist. This, again, is bad science, if not simply dishonest.

Back to the Noakes comment

The reasons why this information is not taught more widely across the world is not material to this article and whether or not there is a conspiracy is not relevant. The point is that students in South Africa (as in most other countries) are currently taught only one side of a two-sided story. As far as patient care is concerned, that is unethical.

Sentence one, and then two and three seem somewhat contradictory. If students are being misled into providing unethical patient care, surely that must be relevant? But in any case, my point was that if something was obvious, and as evidence-based as Noakes keeps asserting, it would be taught all over the world. He constantly refers to conspiratorial reasons why that isn’t the case, rather than considering the possibility that others don’t think the evidence is as clear as he thinks it is.

Three years ago I decided that it my ethical responsibility to acknowledge publicly that my advice on high carbohydrate diets for runners, widely read in Lore or Running, was wrong for those with insulin resistance/type 2 diabetes/metabolic syndrome since it would contribute to their ill-health in the long term as it has to mine. This article is one outcome of that admission.

I could have kept quiet and hidden my error but I chose not to. Now that this article has been published in the SAMJ (and I have spoken about it at the most recent SAMA conference), South African medical practitioners, perhaps for the first time, have been exposed to the evidence that there is an alternative option that they might like to consider in future for the treatment of these conditions.

The result is that if the 127 patients reported here are any indication, many patients in South Africa with these conditions will be offered another treatment option that before they would not have been offered. I suspect that many will do much better on that therapy than if they continue to follow advice that does not work (for them).

Nothing to add here, except to repeat that the point is precisely that we have no reason to believe that the 127 patients reported here in fact are any indication.

So this focus of this discussion should not be about whether or not I am a good scientist who understands what is and what is not good science.

Erm, no. I choose what the focus of the discussion is on my own website, thanks.

Fortunately in science, there are simple markers of our standing as scientists that are based on hard measureables and not on the opinions of others. These are the h-Index and the number of citations. Anyone who wishes to determine my status as a scientist is welcome to find those numbers and what they mean. Those are measures of scientific influence over a life-time, not as the result of one single good or bad article.

Yes, they are indeed “simple” markers. “Crude” might be another appropriate word, as Prof. Noakes knows full well. They offer a valuable heuristic in making snap judgments, but they aren’t any sort of guarantee of sense or quality in perpetuity. I don’t dispute, and have no reason to dispute, that Noakes has done tremendous work in the past. But that tells us nothing about the present topic, except to make it statistically more probable that he’s worth paying attention to here than many others might be, because of that track record. This doesn’t mean that – once you look at a particular case – you need to grant extra authority to that person if they present weak arguments.

To do so would be to commit the informal fallacy of making (or rather, falling for) an appeal to authority. It’s particularly disappointing when the authority him or herself makes the appeal on their own behalves.

It is sad that this article which should be a celebration of how simple dietary advice may be able to reverse intractable medical conditions in some people (it would have been valuable even if it had reported just a single “cure”) has been used by some to argue what a dreadful scientist I am, who is trying to push some sort of devious agenda that has no scientific basis.

It’s arguably more sad when eminent scientists start practicing bad science, and then doubly so when they defend it as weakly as this. “This article”, meaning my blog post, is about that topic, not about the diet. Readers, or subjects of a post, don’t get to say what a post “should be” about. Furthermore, nobody is being described as being “devious”, or having an “agenda”. Someone is being described as making poor arguments for a conclusion.

My agenda is clear. I want my profession to teach more than one option for the management of obesity/diabetes/metabolic syndrome and to understand that our current dietary advice is in my opinion the cause of so much of our ill-health.

My agenda is also clear. I teach critical thinking, and the Noakes paper, and his responses to criticisms of it (and, general criticisms on social media) provide great classroom examples of how reputations are no guarantee of good sense.

I have spent 3 years researching this topic and am happy that the scientific evidence supporting this position is as powerful as any evidence I have touted in the past (see Challenging Beliefs). However the topic is much more important that anything I have ever tackled since it is the single most important medical problem in the world and is currently out of control and getting worse by the day.

Agreed entirely, which is why I want the science supporting it to be beyond reproach, especially on such obvious grounds.

What this paper shows it that there may be simple answers for what seem to be intractable conditions. That is why the final sentence of the article calls for a properly funded and designed study to test the hypothesis (not proof) advanced by the finding of this Occasional Survey.

As argued above, the occasional survey doesn’t present a case for doing so, because of the quality of the data. Furthermore, we are told by Noakes that non-anecdotal evidence exists – and if this is the case, the anecdotes are superfluous. This was the topic of my last post, so I won’t repeat the argument here.

I would be only too happy if that trial disproves me. But if it shows that a carbohydrate-restricted diet can reverse intractable obesity and some cases of Type 2 diabetes, then we will have shown that the causes of the obesity and diabetes epidemics are much simpler than we believe and that we might be able to do something to protect our future generations from these diseases. Of course, it there is a conspiracy, then it will do all it can to insure that we do not ever make that finding.

Agreed entirely. And of course a scientist should be happy to be corrected (even if it’s sometimes difficult to swallow).

Perhaps we can move the debate forward by focusing on what this paper actually found and how that might be of value in trying to understand what is causing the obesity and diabetes epidemics globally. Then we will be making a positive contribution to the future health of the world.

No, there are different debates. Noakes, and his peers, can move that debate forward. My focus is critical thinking, logical fallacies, the standard of education and so forth. That’s the debate I’m going to “move forward”, and these sorts of examples are great resources for doing so. In fact, they allow for us to make a positive contribution to the current – and future – health of the world too, by helping to inculcate and reinforce clear and cogent reasoning, without which medical science is doomed.

Thanks for the opportunity to express myself more fully and I look forward to your contribution to that agenda should you think it sufficiently important.

It’s vital. But also, that agenda is not my field. This one is.

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  • margie

    I incline towards the low-carb, high protein diet from experience but I really appreciate what I have learnt about critical thinking from your two posts. Prof Noakes and those people who have come to his defence on Twitter keep missing the point that you make repeatedly – that it’s about the method of reporting, not the value of the diet. This underlines how emotional investment in an idea can reduce our rationality, which is exactly why reporting must be rigorously scientific.

    • Tim Noakes

      What is also needed to insure balance in this debate is a critical analysis of the science supporting the high carbohydrate diet and which produced the 1977 Dietary Guidelines which led directly to the obesity/diabetes epidemic that began in 1980. All very well to ask those supporting carbohydrate restriction to produce studies that are scientifically flawless and thinking that is free of emotional investment. But what is required of the one, must be required of the other.

      So what about the science behind the work that we attack? Was that flawless? Was it free of commercial bias and emotional investment? Was there good hard evidence to change our diets in 1977? And if so, why did obesity and diabetes become so prevalent thereafter if these dietary changes were going to make disease go away (as the proponents of the dietary change predicted)?

      I thought that Gary Taubes did a good job pointing out the weaknesses of that information.

      Look forward to future analysis of the scientific rigor of people like Ancel Keys and Jeremiah Stamler et al.

      • Zig Gibson

        Again Tim – how did you 28 years of promoting Carbohydrates happen? How were you misled about your own research for so long?

        Zig

  • Tim Noakes

    Great post.

    Now perhaps you can focus on the individual papers and meta-analyses that I cited in my paper and which support the low carbohydrate diet. Would be good to understand why they are incorrect in their conclusions.

    Also the biology.

    It is clear that a high carbohydrate diet produces detrimental metabolic effects in those with insulin resistance and which will cause obesity, type 2 diabetes, metabolic syndrome and set up conditions making heart disease, dementia and cancer more likely. These effects are not produced by a carbohydrate-restricted diet.

    Those are key factors in the debate.

    So now to take your case forward, you need to go and point out why those studies are flawed and why we cannot use them to support the theory that a carbohydrate-restricted diet will be beneficial for those with insulin resistance – which you will recall was the point I made in Challenging Beliefs and which started this debate going.

    • If you were aiming at an elegant demonstration of Poe’s Law ( http://rationalwiki.org/wiki/Poe's_Law ), well done.

      • Zig Gibson

        Jacques, if TIm’s argument in this field now has been ‘boiled down’ to a simple argument that too much carbs / sugar is bad for type 2 diabetes and is associated with the obesity epidemic, and that doctors aren’t being taught this, then he must have been living on another planet to the rest of us medical doctors the last few decades – that is like saying medical doctors aren’t taught that that high blood pressure causes heart disease/problems – again, absolutely astonishing statements….

        Zig

        • Peter

          Then why am I as a diabetic advised to eat more carbs by doctors and dieticians when my blood sugar is completely under control thru LCHF

        • George

          If you all know it, why is the publicity being left to Prof Noakes?

          • Zig Gibson

            That’s a very good question to ask Tim himself, George – why he would want to ‘shout so loud’ about something so well known to doctors, nutritionists and even most lay people (that too much carbohydrates is bad for type 2 diabetics) is beyond me – if Tim feels that doctors don’t know about this then he should do a study on this specific aspect of the issue before pontificating about it (ie what percentage of doctors don’t know this from an epidemiological perspective – rather than just accepting the word of one or two people who email or post such thoughts) – again, if you ‘shout’ before having data on this point too its acting like a politician rather than a scientist (and perhaps a desire to be in the limelight for its own sake?), which is perhaps what Jacques’s article is about…..

            • George

              Doctors might know, even some diagnosed patients might know, but the at-risk public here is definitely being told something else.

    • Zig Gibson

      I had to read what you say above that Jacques perhaps doesn’t understand what you are saying because of his lack of training in ‘medical sciences’ several times as at first i did not believe you could say something like this Tim. Absolutely horrific stuff, similar to when you appeared to be saying that the dietician lady’s opinion doesn’t count because you perceive her to be overweight – ‘fat shaming’ as Jacques calls it. Is this what you perceive to be sound methods of academic debate?

      Zig

    • Gamabunta

      Your consistency in missing the point of this discussion is fascinating. Anyway,
      the current evidence does not consistently support the supremacy of low-carb dieting for treating type 2 diabetes. In fact, in a recent systematic review & meta-analysis, the diet that performed best for weight loss and glycemic control (although not to a statistically significant degree) was the Mediterranean model (up to 55% of total kcal from carbohydrate), not the low-carb (20-60 g/day) model. And keep in mind the vast majority of subjects in the studies were overweight & obese. To quote the authors:

      “Dietary behaviors and choices are often personal, and it is usually more realistic for a dietary modification to be individualized rather than to use a one-size-fits-all approach for each person. The diets reviewed in this study show that there may be a range of beneficial dietary options for people with T2D.”
      http://www.ncbi.nlm.nih.gov/pubmed/23364002

  • Tim Noakes

    You state: “If so, I’m mystified as to why Noakes does all this public speaking to laypeople, and also that he writes on these matters in (almost exclusively) lay publications and books as much as he does, seeing as he knows none of those audience-members can understand what he’s saying”.

    Actually most of my lecturing is done to highly sophisticated audiences who have absolutely no trouble understanding what I am saying and appreciating how they have been misled by a false “science” for the past 40 years.

    They say the first error you make in public speaking is to under-estimate the intelligence of your audience. Always a good lesson to remember.

    • I state that as part of a disjunction, then expressed in the form of a conditional (in the bit you selectively quote). You’re ignoring both one of the disjuncts, as well as the antecedent of the conditional. Under-estimating the intelligence of my audience is not a problem here.

    • Zig Gibson

      If this is the case, why are so many researchers round the world thinking you have lost the plot with what you are saying, and do have great trouble in agreeing with what you are saying, and don’t feel that they have been misled by ‘false science’ for the past 40 years…..

  • Lorne Morrow

    Perspective is key. A critical thinker sees poor argument skills. An emotional academic with evident personal interests sees criticism.
    I see a brilliant future of greater overlap amongst all fields of study, but I wonder what soul will bring that vision to a workable reality.
    Scientists need to learn thinking, debating, writing and presentation skills. But that sounds like arts!
    Scientists are expected to study minutae microscopically. How then can they engage with the populace? When can they find the time or energy to see what is happening in other fields? In what setting does the biochemist get to review the endeavour of a geneticist, or the findings of a anthropologist or debate methods employed by a neurolgy researcher.
    TED talks is not the answer. They are merely entertainment that hint at a future possibility. MOOCs and Khan Academy are signs as well that humans are ready to pursue some means of consolidating our wonder while maintaining the enthusiasm for specialization.
    I feel blessed to have stumbled upon this exchange between the two of you. I hope to see more!

    • Tim Noakes

      Thanks so much. Glad you are enjoying the debate.

      A key problem is the nature of debate in science which is very different from law.

      In law we discover what is; in medicine (especially) only what might be.

      The claims on both sides should be put before a court of law and properly interrogated by trained legal teams. Only then will the real truth emerge.

      Until then we will stumble along with each group becoming increasingly more certain of its correctness.

      What amazes me is how little people read of the vast amount of material available on this topic. The evidence is all around us but for some reason only part of it is considered acceptable to be taught.

      • Zig Gibson

        Now you are an expert in the law Tim – astonishing stuff. Legal practice is based on a set of laws that differs in every country, and in every country laws are different, let alone how each law is interpreted in law courts as part of normal legal discourse – it is probably even more ‘muddy’ in many ways than science. Basically the ‘law courts’ of scientists who are your peers are horrified at you publishing peoples letters to you in a scientific journal as the evidence for your hypothesis – and not even your hypothesis, as this has been debated for decades. And once again your own arguments are changing by the month – in all the discussion above you are no longer talking about pushing high fat diets and saying cholesterol et al is good for you – so actually, yes, it would be good to actually find out what exactly you are arguing for and about in a legal argument manner – as Jacque says above, is it the obesity epidemic, people eating too much carbs, athlets shouldn’t be eating carbs, the efficacy of a high fat diet, that fat dieticians shouldn’t have an opinion? in true Tim style the arguments are a ‘weaving target’ that changes by the minute….

      • Kevin Charleston

        Bingo! Are you really suggesting law to resolve questions of science?
        “The evidence is all around us but for some reason only part of it is considered acceptable to be taught.”
        You appear to have hit just about every tick mark on the Pseudo-science checklist Professor Noakes.
        About the only thing left is ‘conspiracy theory’ – and this runs pretty close.
        Is this ‘vast amount of material’ all on the internets?
        Are you also a creationist Tim?

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  • Sceptical

    Am I the only one who noticed the quotes don’t match, not
    only in actual wording as Jacques says, but also in the overall meaning:

    From the Noakes article: as a number of studies have shown effect in the short term

    From the Swedish blog post: a number of trials has shown no effects in the
    shorter run

    The Swedish blog says that no effects were i whereas Noakes says have shown effect

    how can anything else in the SAMJ article be trusted if simple quotes aren’t reported correctly??

  • esja

    Good article and I agree with pretty much everything stated in it. Nice to see someone being able to separate between different subjects.

    I have nothing to add except for the translation of högproteinkost = high-protein diet.

  • GingerNinja

    Jacques – it’s starting to sound very much like you have a vendetta? Zig – your comments too: now the comments sound very much along the lines of what started these posts: personal attacks. Let’s get past that – unless your intention is to write reams of Noakes-bashing material and that does not impress.

    • Zig Gibson

      Nah GingerNinja – I worked with Tim for 16 years and have published somewhere between 50-100 co-authored papers with him – probably one of his most prolific co-authors. I figure if I someone like me, who has always been close to him, and who he knows always ‘says it like it is’, is critical abput each example of what does not appear to be resonant with what he himself used to tell people how science should be done in the ‘old days’, then perhaps he will absorb the critical analysis, more so than if it came from ‘Joe Blogs’. I don’t want to see so many years of good science Tim did and potential brilliant legacy be destroyed, and hope that by disagreeing with what I think needs to be disagreed with, it may benefit both him and general scientific debate. But thanks for your honest concerns…..

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  • Harris Steinman

    I am a somewhat late to this discussion. There are a number of issues that have not been addressed.

    Firstly, I have attended a number of Prof Noakes’ talks. In an earlier comment, Prof Noakes wrote: “. . . that there is more than one option for the treatment of obesity, diabetes and metabolic syndrome”. However in the talks I attended, Prof Noakes did not acknowledge the benefit of other approaches – they were all “wrong”.

    Secondly, for some reason there appears to be a lack of postings of anecdotal evidence where the LCHF has been detrimental to users. Let me mention them here: two dietitians (one a researcher at the MRC), shared with me reports of their husbands (type II diabetics) who required urgent hospital admission following loss of diabetic control resulting from implementation of the LCHF diet. ((I am a medical doctor – their spouses implemented the LCHF contrary to their wishes). Can I conclude that the LCHF diet does not work for diabetes? Of course not, I am simply making the point that anecdotal evidence contrary to positive results have not been alluded to or posted and surely this influences the debate. For all we know, there may be an article in press of the 127 anecdotal reports of individuals who were deleteriously affected by the LCHF! This simply argues for proper scientific research.

    Thirdly, Prof Noakes makes the point: “That new GMO wheat is a real issue of concern for generalized inflammation, weight gain and ultimately brain damage and dementia.” Could I request a reference for this particular claim?

    And as much as I admire Prof Noakes for his past work, I believe that all scientists have the ability to make major mistakes. Has Prof Noakes done so? I am simply making the point, as Jacques Rousseau has made, that ALL researchers are at risk of error: Prof Linus Carl Pauling, one of only two people to be awarded Nobel Prizes in different fields, believed that megavitamin therapy of Vit C would prevent colds. To date, following dozens of trials, this has not been demonstrated. Prof Peter H. Duesberg received acclaim early in his career for research on oncogenes and cancer, but has played a central role in AIDS denialism. I am not equating Prof Noakes with these two – simply making the point that only a proper scientific process will confirm Prof Noakes’ contention (belief).

    • Very good points. I’ve also attended a number of his talks, and there does seem to be some flexibility to the claims, depending on the audience/context. I saw the GMO thing on Twitter, and was similarly astonished at it.

      • Zig Gibson

        You have hit the nail on the head here again Jacques – several of us have noticed this for many years now – the argument seems to change by the day, or is different for different audiences, or the argument eventually both comes back to what is pretty much standard information and / or is associated with a huge global issue – and thus become difficult to argue against from a logical perspective, and at the same time becomes absurd from a reasoning perspective, Most of us science folk call it a ‘moving target’ argument which sounds great and has lots of soundbites, but is evasive. Again, these are ‘nursery book’ scientific principles of debate which seem to have been avoided in order to make what sounds like a great arguments to the public in a soundbite way, but when substantive academic challenges are made, are avoided by changing the argument or saying more global issues at stake and therefore it is heresy to challenge what is being said. Astonishing stuff from a now ‘long on the tooth’ academic….

    • Zig Gibson

      That’s a very good reply Harris and is what is worrying about this – as you say for 127 good commments, there could be 127 bad, and we need as scientists to test the issues with robust trials before passing judgments. In this case it has been a bit like the ‘cart before the horse’, with ‘wild’ statements from an academic and now a published ‘research’ article based on anecdotes, before that academic has done the carefully studies which may or may not validate the issue. The basis of good science is make a public statement after you have very good evidence for what you propose, otherwise you are being a politician rather than a scientist, which in the end erodes confidence and respect for us scientists as a general body. If Tim Noakes wants to shout out his ideas to the publish, thats’ fine, but then he must say he is being a politician / social crusader, rather than cover it with a veneer of science or him say as a leading scientist (in his opinion) he is ‘entitled’ him to make the pronouncements……

      • Harris Steinman

        Hi Zig,
        What I would particularly like to know is this: the mere fact that individuals share with me that the LCHF has been deleterious to them suggests that either no-one is giving similar feedback to Prof Noakes, or they are and he has not acknowledged these cases. I am not making this point in order to attack Prof Noakes, but I am merely fascinated whether people are reluctant to give negative feedback to someone so well respected, or whether there are other aspects at play. In other words, a point I did not make in my previous posting is this: what percentage of individuals embarking on the LCHF actually benefit – either physiologically, or able to sustain the LCHF. 90%? 50%? 5%?

        • Zig Gibson

          Good points Harris and I think pretty much the point of Jacques’s two posts on this – the way the science has been done is up for debate – just reporting on people who say something worked for them is terrible science – as you say, what about the people that the diet did not work for or have negative effects – until I knew all these facts as I scientist absolutely I wouldn’t be ‘shouting’ about the efficacy of anything about it….

    • “Thirdly, Prof Noakes makes the point: “That new GMO wheat is a real issue of concern for generalized inflammation, weight gain and ultimately brain damage and dementia.” ”
      WHAT new GMO wheat?? There is, as far as I know, NO GMO wheat on the market – and I work in that area of plant biotechnology, So I think I might have heard about it!
      There is a LOT of GM maize and soybean and cotton – but he seems not to be making claims about that, except to quote the Seralini paper in Nature – that had to be retracted.

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  • Martinique Stilwell

    Tim has made some valid points. Anecdotes can spark research, and if Tim’s intention was to say: “Hey guys, I think there’s something going on here and we should take a look,” well, there shouldn’t be too much wrong with that. Journals publish case reports, and in the article, Tim has been upfront about his methods. He writes that he got
    127 emails from people who told him they lost weight and although the weight
    loss is self-reported and he doesn’t know exactly what they ate, he thinks
    there is some value in that.

    So is there? The limitations of anecdotes are well known, they may appear to represent a trend when in truth they do not. As several commentators have pointed out, in this
    instance we do not know the size of the group who went on the diet, and it is
    more likely that people who had spectacular results would contact Tim. People
    are probably also more likely to write during the honeymoon phase of the diet,
    before attrition and backsliding sets in. Those who have less success or perhaps
    even die on the diet are probably not going to write fan mail.

    Confirmation bias is a fundamental human trait that doesn’t just affect researchers. It’s human nature to seek meaningful narratives, preferably positive stories of clear
    cause and effect. And, as medical students soon learn when they begin to take
    histories, human memory is highly fallible, and personal accounts of events can
    be unreliable.

    We know anecdotes should be avoided where possible, and if they are used, the facts must be documented as meticulously, with all the measurements, tests and results, exam findings, the exact timeline of events, interventions etc carefully recorded. Tim gives us no hard data because he was never examined the dieters who wrote to him. So rather than well-documented scientific sort of anecdotes, we are presented with anecdotal sort of anecdotes. And that’s when things get dodgy.

    For example, in Case 2, Tim presents a man who is refused weight loss surgery because of his anaesthetic risk, chooses a low carb diet as “ a last resort” and dramatically
    loses 75kgs and is “cured “of diabetes (although I couldn’t find any test
    results.). The man claims his addiction to carbs is what nearly killed him. It’s
    a satisfying and compelling story.

    This week, Dr Luc Evenepoel wrote in TimesLive , that he was involved in the care of the man Tim described in Case 2. The dieter was not refused surgery and his weight loss plan included an inspection of his past eating habits, exercise, counselling, and support
    groups. Luc makes no claims of a dramatic diabetes cure. This account is more
    nuanced, accurate and less compelling.

    I can understand the dieter and the general public preferring the first version of events, but a scientist should not embrace the story with a similar fervour. In response to
    Luc’s article, Tim rather unprofessionally calls on the dieter via Twitter to come
    forward and state what really helped him. “Overcoming my sugar, starch and carb
    addiction,” the named man replies.

    Faced with criticism of the lack of hard information in his anecdotes, Tim has responded by referring to the studies he cites, and here Jacques is completely right, if those studies are any good, they can stand on their own, and their value is not increased by the preceding anecdotal anecdotes.

    Tim, would it not have been more appropriate to write a letter to the SAMJ, saying, “I’m getting lots of emails from people who have lost weight on this diet, perhaps we should look into it?” And then some clinicians involved in the care of patients could
    provide the case studies? That way we might get a better idea about what is going on?

  • George

    You might appreciate the tone of Prof Grant Schofield’s New Zealand version of a similar program to Tim Noake’s.

    http://profgrant.com/2013/10/31/nzs-health-leaders-respond-to-our-research-publicity-saturated-fat-its-bad-low-carb-radical-and-unsafe/

    • Indeed I do, thanks. Schofield sounds reasonable rather than evangelical, which helps to bolster credibility and respect.

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  • I might even have been inclined to believe the good Professor Noakes about diet, despite it not being his medical speciality – if I had not heard about his views on GMOs. Now I wonder if I can believe ANYTHING he says.

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