As anyone who reads Synapses would know, I’m a proponent of scientific skepticism. What that means is something along the lines of “the practice or project of studying paranormal and pseudoscientific claims through the lens of science and critical scholarship, and then sharing the results with the public“ (from Daniel Loxton’s 2013 essay, “Why is there a skeptical movement?).
Last Tuesday, I gave a talk at the UCT medical school on the ethics of social media for medical professionals, which focused in part on the Health Professions Council hearings with regard to the ‘unprofessional conduct’ of Prof. Tim Noakes.
As those of you who are following the discussions and arguments regarding “Banting” or the LCHF diet would know, the hearings with regard to Professor Tim Noakes’ giving “unconventional advice” on Twitter resumed (after convening for one day, in June) on Monday.
I attended much of the first day, and the morning of the second, and hope to return for much of the rest. At the bottom of this post, you’ll find a couple of embedded interviews I gave on Monday.
So, in summary: Noakes is being characteristically savvy in leveraging these hearings into an opportunity to present the case for the LCHF diet (or “lifestyle”, if you’re a devotee). His legal team are ruthless and very well-prepared, in complete contrast to the floundering of the HPCSA team, who constantly need to be corrected on procedure and the like.
But that’s not what the hearings are meant to be about – they are meant to be about this tweet, and whether it constitutes unconventional or inappropriate advice:
@PippaLeenstra@SalCreed Baby doesn't eat the dairy and cauliflower. Just very healthy high fat breast milk. Key is to ween baby onto LCHF
As I said in my previous post on the hearings, while I think it’s unconventional, I don’t think it’s significantly problematic, in that it’s no different to the sort of advice we hear regularly on radio shows, or see suggested in other media.
I don’t think it’s reasonably interpreted as a “prescription” to a patient, and I think that it’s ambiguous enough to allow for a moderate interpretation, for example breast-feeding for 6 months before gradually converting your child to Banting (and perhaps introducing them to Jesus at the same time, while you’re at it).
So, the hearings are to my mind a huge waste of time and money, and will serve only as a PR opportunity for Noakes. The actual charge can be dispensed with in half an hour, and should be – the hearings are backfiring on the complainant in that Noakes is going to emerge stronger, in the sense that a win will validate his and his supporters feelings of martyrdom and being the victims of conspiracy.
All the worst aspects of the psychology of devout Banters have been on display – from the bullying and often condescending (arguably sexist) treatment of the initial complainant by one of Noakes’ legal team, to Marika Sboros following said complainant around to get photos of her in distress, others referring to her “falling apart”, and the ridiculously partisan nature of what’s being reported by those tweeting in support of Noakes.
As I was saying in a few of my occasional tweets from the hearings, if you want to play a game of fallacy-bingo, these hearings – and especially the input from van der Nest (acting for Noakes) were a goldmine. The conversations around medical ethics were absurdly superficial also – and if you add to that the manifestations of character I mention above, it’s really a frustrating thing to witness.
Arguments can be had here, and as objective readers (including some Banters) know, it’s those arguments I’ve been trying to air over the years. This isn’t a “trial” or a persecution, even though it might be a waste of time or even misguided, as I say in the interview with John Maytham below.
Just as Noakes is, in my view, utterly sincere about what he says (whether or not he’s right or wrong), the complainant in this case is sincere also, as the witnesses are in general, I imagine. For all talk of “science” the Banting crowd engage in, it’s a pity that their actions seldom manifest the careful, objective deliberations that science demands, preferring instead to perceive and/or provoke rather demeaning personal squabbles and character assassinations.
If 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!
@SarahLaats 1. What was exact composition of dietary fat? 2. Mice are not (wo)men. 3. In humans, carbs in pregnancy predispose to obesity
(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”?
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?
(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”.
@danteofdoom@greenorb No. It is a unique historical analysis of disease patterns written by a physician. Best to read it.
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.
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.
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.
As 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
Turns out the cranks and mavericks were right. Experts were wrong. Completely and utterly wrong. Damagingly wrong. http://t.co/hBWBNfMDqe
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.
In the conclusion of my previous post on Prof. Noakes’ Big Issue column, I mentioned that he had spoken of addressing the malignant influence of scientists via the power of crowdsourcing research findings on Twitter.
Today, I’ll conclude with my description of how much that Big Issue column gets wrong, and also provide a fresh example of shoddy thinking from the LCHF crowd, in the form of a debate topic that is being proposed for the upcoming “First International Low Carb High Fat Summit“.
(I don’t think it’s relevant here, but in case you think it is, I’ve been invited – and have accepted – to attend the LCHF summit as a guest of the organiser, Karen Thomson. So if you see me becoming all soft on LCHF in late February, you’ll know that I’ve either been bought off, lost my senses, or “seen the light”.)
Let’s first return to “The Digital Doctor” (the title of the Noakes column). One of the things he’s right about in the column is that increased availability of information via the Internet has undoubtedly given consumers and patients more power.
You’re able to shop around, whether through using Dr. Google to find out what your fellow sufferers have tried, or for crowdsourcing information about who seems to do good work in a certain area, for what price and so forth.
Patients can enter the consulting room armed with some understanding of what ails them, and I’m sure that can help (and also sometimes hinder, no doubt) the process of diagnosis and treatment. We’re no longer victims of as large an information asymmetry as we once were.
But this doesn’t mean that truth becomes something that is resolved via democratic process. The majority can be wrong, and this is especially the case when we’re dealing with a majority drawn from a select population, and where the audience does further filtering of what they think worth listening to and what worth ignoring.
In short, this is again the problem of the filter bubble, writ large.
To quote Noakes:
But the growth of social media and the internet has changed that reality irrevocably.
Today as a result of these very modern developments, patients now have access to the experiences of hundreds of millions of others producing what has been termed The Wisdom of the Crowds.
Exposing millions of people with common issues to a multitude of different interventions soon determines the relative efficacy of treatments more effectively, cheaply and swiftly than any other testing method yet invented. (Indeed, these crowd-based, uncontrolled experiments will add a new model of “scientific” research that will overcome the weakness of traditional laboratory-based research, which by its very nature is “unnatural”.)
We have access to the millions of anecdotes shared by the population that self-selects to be on Twitter, yes. But we have no way of verifying the (literal) truth of those anecdotes, and we also know that because they are uncontrolled experiments, there is no way of verifying their truth in the sense of having confidence that the right cause for the observed effect has been identified at all.
This is precisely why we have and value the scientific method: to rigorously test hypotheses, in a way that minimises errors that might result from selection bias and so forth. We’d should take care to compensate for – and not celebrate – the fact that all of our case reports come from a demographic (because they are on Twitter) that was perhaps on average wealthier, and with more leisure time, than the typical person.
Why? Because that characteristic might be associated with different dietary choices, or different levels of physical activity, both of which would be relevant to how we interpret the data. So the anecdotes can be useful, in pointing to what we should research, but they are not themselves the research we should treat as conclusive.
(Sidebar before moving to the next quote: I’m leaving the “unnatural” towards the end of that quote alone, but just to briefly note that it’s another example of the paranoid and conspiratorial talk Noakes seems partial to. Sure, lab-based research has flaws, but its lack of being “natural” – whatever that might mean – isn’t one of them.
One can say we can’t replicate some real experiences and effects in a lab, and there it becomes a potential problem, but describing this in terms of “natural” sets up an advantage for the Romantic Paleo argument, and poisons the well against anything positioned as non-natural, which might include GMOs, vaccines, etc.)
Then, we’d want to compensate for our own biases also. Later on in the column, Noakes says:
I soon learnt that Twitter is unquestionably the best way to acquire the most up-to-date information on my particular areas of scientific interest. By following a group of scientists who use Twitter to disseminate information they find interesting, I now have access to new knowledge within minutes of its first appearance in the scientific literature. The result is that acquiring new information is absolutely effortless, and dependent only on my choice of whom I follow on Twitter.
So, if I listen to the people who tell me things I like to hear, I get to hear a lot of things I like to hear. And, just to make certain that things I don’t want to hear don’t intrude on this, I’ll block people who post contrary research from my Twitter feed (he doesn’t say the latter above, but it is something he does, with me being one example of someone whose links to relevant research don’t get through).
The problem with the Big Issue article is that it takes a couple of sound points, and explodes them into such a grand narrative that they lose any sense they had.
Noakes tells us that “now it is only the advice that works that has long-term credibility”, and that is true, up to a point. You’ll get caught out on social media if you spread misinformation. But that doesn’t mean information gains credibility through being widely disseminated (on channels you’ve hand-picked) on social media. Those are separate issues.
It’s also true that professionals – in various spheres – were able to exploit the ignorance of the consumer to peddle quackery or defective goods, and that they are now less able to do so than in the past. But our easier access to information doesn’t mean that (proper) experts don’t often know better than we do. Those are also separate issues.
There’s a tendency in the LCHF narrative, at least how it’s playing out in South Africa, to continually hyperbolise the consequences of choice, and the lack of middle-ground options between one or another extreme.
To conclude, here’s a recent example of that elimination of the middle-ground (in logical terms, a false dichotomy), that comes from the Facebook page of the LCHF summit I spoke of at the top of this post. On that page, Karen Thomson says:
I am desperately trying to find medical professionals willing to debate: ‘Is the low carbohydrate diet the cause of, or the cure for the global epidemic of chronic ill-health?’ with our LCHF team.
Any thoughts? None of my invitations have been met with any success.
Here’s a thought: if a debate topic is framed so that only the pro-LCHF side have any chance of winning it, you’re unlikely to garner any interest from potential opposing speakers. The topic is itself a pithy example of the shoddy reasoning that I’ve written about so often here, in that:
The topic sets up a false dichotomy, because the truth might lie somewhere in the middle with LCHF being neither the cure nor the cause.
Second, the topic sets the non-LCHF people up for failure, in that it would be impossible to prove that LCHF is the cause of “the global epidemic of ill health”. This is true even on the simple grounds of chronology, where (leaving aside the contentious issue of what pre-social humans ate) modern humans haven’t been eating LCHF for long enough – or in large enough numbers – for LCHF to be identified as the cause of much at all except book sales, never mind a “global epidemic”. You might therefore think the topic indicates bad faith, but even if you don’t want to be uncharitable, the pro-LCHF folks have rigged the game here, by ensuring that they can amass at least some evidence for their position, while the opposition cannot.
Third, one can challenge the presumption of the topic that there is a “global epidemic” at all, in that despite diabetes, heart disease and the like, we somehow keep living for longer. So, simply accepting the premise of an epidemic accedes to one of the key claims made by the LCHF folk, namely that humans in the 21st Century are (in general) sick and dying, despite any appearances to the contrary.
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).
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”.
To 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.
On November 25, I gave a talk with the above title at an event hosted by SAAFoST* and ADSA**. Unfortunately, the proceedings weren’t recorded, so you won’t be able to hear the superb presentation that preceded mine, by Dr. Celeste Naude, who focused on an evidence-based approach for differentiating between varying macronutrient-focused diets.
Those of you who are interested in the topic of diets, and specifically the role Prof. Noakes has played in popularising the LCHF approach to diet, might already know of the recent study by Naude and others, which found that low carb diets showed a similar reduction in weight to other diets. Noakes’ response to that study was to say that the “researchers have no clue”. I leave it to you to determine who you find more persuasive.
You won’t be able to watch my talk as presented either, but in case it’s of interest, I decided to record a version of it in any case, accompanied by the slides I showed on the day. By contrast to Dr. Naude, who focused on science, I focused on rhetoric, hyperbole, and sound scientific reasoning – or, the lack of it.
You can find that recording immediately below, followed by the approximate text of the presentation. It hasn’t been edited into essay form, so is telegraphic in places. Lastly, I’ve embedded the presentation slides at the end, for no particular reason.
*SAAFost: the South African Association of Food Science and Technology
**ADSA: the Association for Dietetics in South Africa
Is Noakes the North Korea of epistemology?
Betteridge’s Law – any headline that ends with a question mark can be answered with “no”.
Of course, “no” is part of the answer here – if we are asking the question of whether Prof Noakes is a propagandist who leads a repressive state, and is implicated in various human rights abuses, the answer is clearly no.
I’m also make no claims with regard to their relative levels of sincerity. In the case of Prof. Noakes, I’m of the view that he is utterly sincere, and desires nothing but to enhance the health and wellbeing of those he engages with. He’s received far too much abuse related to claims regarding a profit motive, for example, and I think that sort of abuse unjustified, and deplorable.
But that’s not what my title is alluding to. Instead, I’m highlighting the fact that the North Korean press machine has a habit of making hyperbolic claims, and Kim Jong Un for appearing in various baroque, grandiose, and sometimes merely perplexing situations, all to buttress his mystique and support a particular narrative.
This narrative is of him being misunderstood, a maverick, and a person who has privileged access to knowledge and opportunity that he is able to share with the enlightened or anointed. He serves as an inspiration, and in doing so, the impression created is more important than the evidence – marketing is the point, rather than content.
This is the sense in which Noakes is the North Korea of epistemology. As I will show, he displays a pattern of what philosophers and psychologists call “motivated reasoning”, which can be defined as confirmation bias turned up to 11.
You all know what confirmation bias is, I’d imagine: our predisposition to take evidence that confirms what we believe seriously, while discounting contrary evidence. What motivated reasoning adds is a substructure or foundation to this, in which the agent develops background rationalisations to justify holding the beliefs that others argue are false, or at least not settled conclusively at this point.
The motivated reasoner might see conspiracy instead of disagreement, and tends to react defensively to contrary evidence, seeing conspiracy, or dismissing it out of hand for other reasons instead of responding to it on its merits.
The goal of my talk today is quite simple. I want to suggest to you that regardless of any debate on the virtues of the Banting diet – which I’m not interested in discussing, and haven’t expressed any public view on – there’s a language, method, and character that we should all value in scientists and scientific enquiry.
I believe that any of us who work in fields including science, education, or journalism have a responsibility to encourage a responsible epistemic approach, rather than to aim for persuasion above all else.
By this I mean an approach that is objective as regards the evidence, where we are willing to be wrong, and where we resist attacking the character or motives of opponents when arguments are the relevant issue.
Prof. Noakes has frequently set a bad example in these regards, and my concern as an educator – particularly one active in the field of critical reasoning – is that with 50 000 Twitter followers, and as an engaging and hard-working media personality who has garnered as many accolades as just about anyone you can think of in South African science, he has a powerful influence on how people perceive scientific activity.
One of the virtuous traits I mentioned a moment ago was a willingness to be wrong. Defenders of Noakes might immediately retort that of course he’s willing to be wrong – after all, he famously changed his mind on carbohydrates! And while this is a notable change of mind, it doesn’t (and shouldn’t) reassure anyone that it’s representative of a general disposition. As you’d know, it’s a single data point, and we don’t find a pattern in a single data point.
More to the point, perhaps, is that his own language regarding that change of mind comes with significant warning flags regarding his commitment to sound reasoning. Take this example:
At a public discussion with his erstwhile supervisor, Lionel Opie, in May 2014, Noakes told the audience “I’ve said one thing, and now I’m saying the exact opposite. And they can’t both be wrong. And that’s key.”
While a statement like that plays well to a crowd – and in this case, did result in some appreciative chuckles – it’s nonsense as far as logic is concerned.
He’s presenting his change of mind as evidence that he’s right now. And there are two immediate problems here – one is that the argument only gains traction if you agree with him that he was wrong before. If you think he was right then, then you’d think that he’s just strayed into error now.
The second way in which the logic is fundamentally flawed is that he’s suggesting that the audience embrace the logical fallacy of the false dilemma. What I mean is that the truth might actually be undiscovered, and exist somewhere in the middle – it’s not the case that one of the two extremes he’s suggested at various points have to be correct. We have other options, and he’s misrepresenting the choices available to us in leaving them out.
We should all – maybe A-rated scientists, teachers, and public figures in particular – have a concern for good scientific thinking and clear reasoning in expressing the conclusions we’d like to see adopted. Science does not work in absolute truths – it’s an inductive process, whereby we chisel away at falsehoods to arrive at a clearer understanding of what’s most likely to be true. The example above recommends absolutism, despite that being manifestly incompatible with the messy world of empirical data.
At various points in today’s talk, I’ll be showing you examples of statements like these, made by Prof Noakes on public media. There are many more such examples, but it would be tedious to belabor the point through repetition.
But I mention this to offset concerns you might have that I’m indulging in cherry-picking here – the pattern is unmistakeable in itself, and more to the point, many of the examples I’ll show you are examples of Noakes responding to critics accusing him of over-simplifying. In other words, even after applying the principle of charity and seeking clarification from him, his responses validate the concerns I’ll be highlighting.
A taxonomy of trouble
For ease of reference, I’ve loosely categorized the issues into 5 groups:
This is the site that argues that Microsoft are developing eugenics vaccines. And that HIV doesn’t cause Aids. And Icke? The world is controlled by reptiles from outer space, who live in underground tunnels and take on human form (Thatcher, Bush)
This from a series of tweets explaining how his conclusions will be vindicated in the end. But if you’re going to suggest that there are better and worse ways of proceeding in science, perhaps better examples than Agassiz could be chosen. He is, after all, an evolution-denier, and a proponent of scientific racism – does one want to cite him as an authority on the scientific method?
Weston Price – “holistic dentist” whose treatments included homeopathy. The site carries numerous articles arguing that vaccines cause autism. Current board member Joseph Mercola has received at least three FDA warnings for making misleading and/or unsubstantiated claims regarding the products he sells.
Franschhoek: “If you’re insulin resistant, you do not have to get any disease whatsoever. If you eat a high-fat diet all your life, you will not develop diabetes, you will not get cancer, you will not get dementia. That I can guarantee you” – that’s where, and when (audio).
“Sweden becomes first nation to reject high fat dogma!” Noakes was making this claim in 2013, when the SBU report wasn’t even available in English, RT’ing AuthorityNutrition & Diet Doctor.
Two mis-interpretations have, in our opinion occurred in the wake of the publication of the SBU report. One is that low carb high fat is by far better. Yes, during the first 6 months you lose weight faster on low carbohydrate diets. But after one and two years that diet has no advantage than other diets for obesity.
After having this pointed out to her, Teicholz blocks me and others. I couldn’t point it out to Noakes, because contrary voices also get blocked from being heard on his timeline. Contrary to what I think the ideal approach – of seeking out ways in which you could improve your arguments – motivated reasoning can involve simply shutting out dissent.
Then, addiction, where I fear that the LCHF movement is doing great harm to public understanding of the difference between compulsive and destructive behavior, and lifestyle choices which can be better or worse but are not intrinsically problematic.
From Real Meal Revolution:
The final blow to the gut: because carbohydrates are nutrient-deficient and often packaged with salt and sugar, you feel the need to eat more of them, thereby putting yourself into a near-perpetual cycle of weight gain.
Unless, of course, you break the addiction…
There’s plenty of “addiction” talk on his Twitter feed, as well as a partnership with Harmony Clinic in Hout Bay, that offers in and outpatient treatment for sugar addiction. Well, Harmony Clinic now liquidated, so perhaps not anymore.
The problem is – there’s no compelling evidence for sugar addiction, yet, and the case is being overstated in the service of promoting Banting.
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”.
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 of cases.
Let’s look more closely at sugar addiction, and addiction in general. Two papers are typically cited as evidence for sugar being addictive. 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:
“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.”
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 – 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.
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.
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.
We can easily engage in a battle of link-sharing – but the point is that the truth is complex, and not settled by individual studies. In this case, there’s one clear issue with using these studies as definitive, and this is that both of these studies use brain imaging to support their conclusions.
As Sally Satel (who works as a psychiatrist in a methadone clinic) puts it, brain scanning is “a perfect storm of seduction”. The technology promises 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!”
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, and 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 the 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.
To avoid the false positive of the fish brain activity above, we need to use multiple comparison fMRI, which comes at far greater expense in terms of cost and time. But headlines don’t have space for subtleties, and furthermore, novel and exciting claims get the public’s 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? Well, perhaps nobody can blame you if you’re trying to sell newspapers. And perhaps we can blame you, or be rather concerned, if you’re presenting yourself as a responsible scientist.
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. Diminished expectations of agency lead to diminished agency – if you’re not aware of your choices, it’s more difficult to make choices. So, it’s politically useful to say that carbs are addictive – but that isn’t equivalent to it being true.
Why are “experts” being trivialized here? Experts do exist, and the public are often misinformed. If experts disagree with you, then you defeat them in the battleground of expertise – peer reviewed journals. An army of laypeople doesn’t make the scientific case.
Why is journo Gary Taubes pushing for scientific studies into #LCHF diets (http://blogs.scientificamerican.com/cross-check/2014/10/07/gary-why-we-get-fat-taubes-speaks-out-on-diet-studies-including-his-own/ …) while @ProfTimNoakes focuses on populism?
.@sarahemilywild Because change will only come when public understands truth expressed in @garytaubes book. New science will not change that
So, I watched it. Here’s one rather interesting bit (the text below is copied from a previous post):
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. 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 about the facts.
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.
He might say that the public health concerns are too significant to care about niceties like the ones I’ve been talking about today. To that, there are two immediate responses. First, sloppy thinking should arguably never be encouraged. For someone who is regarded as an inspiration by many budding scientists, and who is one of South Africa’s most decorated scientists, one might even argue that he has a moral obligation to encourage sound scientific thinking.
The second response is that even if this were true – that we should misrepresent the strength and consensus behind a certain dietary position, in order to save lives – we should be able to debate how far we’re allowed to take the misrepresentation.
But this would require agreeing that misrepresentation occurs, and Noakes insists that it’s others who are being obtuse rather than himself. More disturbing, perhaps, is that those who do disagree are ignored or blocked, or characterized as shills, or victims of “groupthink”.
In conclusion, two tweets that show the best and worst of Prof Noakes:
This is the worst, obviously, in that the consequences of him being wrong could be far more acute. The logic here is entirely circular, in that his conception of being “wrong” simply ignores all the harms that competing views say could result from a high-fat diet.
He’s assuming he’s right, even while speculating about the consequences if he were wrong.
Even Noakes’ supporters should expect more of him, for two reasons:
The scientific method deserves better.
If he’s right, he’s impairing the credibility his viewpoint garners. The same dietary advice could be given without the “aid” of examples like these, and that might well get the revolution taken seriously in a far more widespread fashion.
It’s been an amusing few days for those of us who follow the social media commentary related to Prof. Tim Noakes and the Banting diet. Earlier this week, an investment strategist named Magnus Heystek posted an opinion piece titled “Is Noakes running a Ponzi scheme?“, in which Heystek uses the example of Ponzi schemes (where people get suckered into poor investments via a combination of wishful thinking and deception) to riff on the “collective delusions” that can accompany diets.
The analogy is clear, even if imperfect – in the Banting analogue, someone uncharitably disposed towards what they think of as a fad diet could argue that the flock isn’t seeing the evidence and argument objectively, but are instead being seduced by the charisma of a person or an offer into a poor investment (in their health) – just as is the case in the investment analogue.
The analogy is imperfect in the sense that – as I’ve argued in the past – Noakes seems entirely sincere, and second that he is using the proceeds of the “real” meal revolution to fund research into health, rather than for personal enrichment. But even if imperfect, it’s fair comment, and has certainly provoked debate (if not much thought).
Heystek is making a similar point to the one that I’ve repeatedly made here, which is that the evangelical fervour in support of the diet, and the casual dismissals of any opposition to it as simply uninformed, both offer little reassurance that people are thinking things through carefully, rather than being in the grip of a collective delusion (of sorts).
By contrast, what Heystek is pointing to (and again, my main point in all these words about Noakes and Banting) is that we already know things are not simple, and that we therefore have reason to believe that evangelism is taking the place of reason when people claim they are simple.
It’s when reason is sacrificed that we encounter Noakes saying, on the one hand, that when you get personal, you’ve lost the argument; and on the other hand dismissing the arguments of critics on the grounds of their being overweight (as he’s done at least twice, with Catherine Collins and with Anthony Dalby).
His followers have learnt the lesson well, rushing to dismiss Heystek on the grounds that he, too, could lose a few kilograms (which is something Heystek himself points out in the column, but since when does the playground pay attention to details like that?).
This doesn’t mean that criticism of Noakes and Banting can’t itself sometimes be overly simplistic – nobody is immune to error. Heystek was pricking a bubble of pomposity, though, not making a scientific argument, and his column needs to be read in that context.
By contrast, this Sunday Times piece arguing that Noakes has made a u-turn on dairy is shamefully misleading (rather than simply mischievous), and really just an example of someone exploiting a popular trend to generate some traffic, with complete disregard for the evidence.
The ninth of the “10 Commandments for beginner Banting” – right there in the first edition of “Real Meal Revolution”, you are told “Control your dairy. Although dairy is good for you, it does contain carbs and can be a stumbling block for some. In your Banting beginning, perhaps avoid eating too much dairy.” (I’m leaving complexities regarding particular forms of dairy aside here – they aren’t relevant to this argument.)
Later on in the book, readers are told: “If you are not intolerant to dairy products and find they do not affect your weight loss or blood sugar levels, aim for high-fat dairy products, not skim or reduced fat, light or fat-free alternatives – they must be full-fat.”
In other words, the advice regarding dairy was always qualified advice. The authors made a mistake in compiling their green, red and orange lists of foods, though, in that greenlisted foods were described as follows: “GREEN is an all-you-can-eat list – you can choose anything you like without worrying about the carbohydrate content as all the foods will be between 0 to 5g/100g. It will be almost impossible to overdo your carbohydrate intake by sticking to this group of foods.”
That needed a “terms and conditions apply” in the case of dairy, especially because we can predict in advance that many people would go for the simple heuristic of the list (you don’t even need to read the book for the list – it’s freely available on the Real Meal Revolution website), but despite this error, there’s no evidence of any flip-flopping or change of mind for dairy, as purported by the Sunday Times.
The team simply realised that dairy being in the green list was causing people to consume more of it than was compatible with the weight-loss they were expecting, so they moved it to the orange list – in line with the qualifications above. To put it even more simply, the heuristic of the colour-coded lists wasn’t sending the right signal, so it was adapted.
And then, because people don’t pay sufficient attention to detail or relevant qualifications as they sometimes should, there was a freak-out regarding dairy suddenly being unsafe, and Noakes having “changed his mind” – so they moved it back to the green list, and re-iterated the relevant qualifications.
So, no drama there. Of course, that didn’t stop the chief lobbyist for the Banting cause (or, “science” “journalist”) Marika Sboros, from using this as an excuse to write a new piece of hyperbolic prose in defence of her hero (in which she of course links to all her old pieces, which continue being edited and added to yet carry the same permalinks as before, which seems a rather odd way to practice journalism. But I digress.).
In this new piece, much effort is directed at undermining the criticisms made by Patrick Holford in relation to Noakes. Now, contrary to how some Noakesians like to read me, I’ve never called Noakes a quack (I have said he can sound like one, though) – but I have no reservations in calling Holford a quack, and I also think he’s a mendacious one, in that he knows he’s a fraud.
There’s no need to waste time debunking Holford’s criticisms, if you are Noakes or a mouthpiece of Noakes, like Sboros. Doing so is like writing a column refuting the metaphysical views of George down at the pub, as Holford is irrelevant to science and scientific reasoning – except as an example of doing so badly.
It’s perhaps instructive, though, that even Noakes seems to think he needs to play in that market, or believes that he should – I suppose that once you become a populist, it comes with certain obligations, or at least expectations. The thing that should concern you, though, if you are a Noakes-supporter, is how defending oneself against populist criticisms can lead you to oversimplification – itself a characteristic of populism.
Sboros reports that Noakes said (it’s not an attributed quote, unfortunately) that “the clear evidence is that carbohydrate in the diet is linked to colon cancer”, in response to Dr Roger Leicester (via Holford) claiming that Banting is a risk-factor for colon cancer. Noakes also says – and I’m sure that you’ll all find this as persuasive as I do – that “that’s all unscientific twaddle”.
Except, that’s utter bullshit. It might turn out to be false – as might any hypothesis – but right now, we’ve got good evidence that high red-meat consumption is associated with increased risk of colorectal cancer. And yes, association/correlation isn’t causation, but it’s the best clue as to causation available to us in many cases – and a staple of much pro-Banting literature also (and as much as you might like to, you don’t get to cherry-pick).
Oh wait, you do get to cherry pick. Sorry, I forgot.