In our last newsletter, we reported on the first two days of the HPCSA’s continuation hearing, the previous sessions having been held in November 2015 and February 2016. Readers may remember that the November 2015 hearing was a shambles, ineptly managed and conducted by the Pro-Forma Complainant, and showing scant respect for Prof Noakes and the humiliating position he found himself in – having to answer the charge that his use of Twitter was irresponsible, and that his LCHF advice was dangerous.
In February this year, a new advocate for the Pro-Forma Complainant was appointed, Adv Ajay Bhoopchand. He led the hapless bioethicist, Prof Willem Pienaar, in his evidence concerning whether Prof Noakes had behaved unprofessionally, only to have the witness exposed for not understanding Twitter and for being more concerned with the threat to the medical profession than whether being active on social media was an unprofessional or dangerous activity for a medical professional.
From Tuesday through to Thursday, Adv Bhoopchand cross-examined Prof Noakes on his testimony. There was much anticipation in the gallery as to the strategy Adv Bhoopchand would follow – either tackle Noakes on his controversial science, or interrogate him on his irresponsible use of Twitter.
Not surprisingly, Adv Bhoopchand chose the latter course, and the hearing panel, press, and gallery had to endure three days of argument over whether Noakes had been in a doctor-patient relationship, giving advice relating to a specific case, or, as he argued, had been merely participating in a forum where knowledge is exchanged.
The fact that Noakes held his temper during hours and hours of trivial argument bore its own testimony to his integrity and his dignity.
Democratisation of medical knowledge will replace old order
Towards the end of the cross-examination, Prof Noakes gave us some useful insight into the role social media can play to remove much of the danger inherent in the traditional model, where a patient puts all their faith in a single, apparently all-knowing expert doctor/specialist. Noakes pointed out that the democratisation of information and the transparency with which it can be exchanged has a number of advantages. Firstly, the fountain of knowledge “no longer lies in the hands of the anointed,” Instead, he foresees wisdom moving into the hands of the crowd.
He pointed out that Google, Wikipedia, Twitter, Facebook, online newsletters, websites, and blogposts have created an incredibly rich forum in which science can be discussed.
While good moderation and curation are arguably not present in every channel, nonetheless, the whole social media phenomenon is fundamentally self-correcting with regard to the balance of argument, for and against different hypotheses.
Noakes explained that if he had given an opinion which was contentious, or plain wrong, Twitter is exactly the place where his mistake would have been identified.
He would have been immediately called out, and arguments back and forth would enrich the general body of knowledge, allowing readers and followers to make up their own minds. This rarely, if ever happens in the traditional doctor/patient environment.
The lesson for the lay public, as well as for professionals wanting to keep up with the latest thinking and scientific developments, is not to avoid researching online. Learn who are the trusted authors, researchers, journalists and publishing forums, and make a point of adding to your body of knowledge continuously.
One excellent source of leads into the best wisdom in the crowd is RMR’s very own members’ forum. We are indebted to our members and contributors for the excellent quality of discussion on the forum. This may very well be the future of medicine in a world that is steadily losing faith in traditional authorities that avoid holding themselves accountable to the people they were meant to serve.
Zoe Harcombe shows US Dietary Guidelines to be baseless
From Friday through to Monday, Zoe Harcombe (Ph.D.), a researcher in the field of dietary health, gave expert testimony on two key aspects of the HCLF vs. LCHF science argument. Her first presentation was to examine and give her expert opinion on the quality of evidence supporting the US Dietary Guidelines of 1977, and the UK Dietary Guidelines introduced in 1983. Drawing on her Ph.D. thesis, she presented the evidence as it existed pre-1977, and then for the more recent period, to support the current dietary guidelines being used by western countries.
Using the statistical tools of her trade, a good dose of common sense, and razor-sharp logic, Harcombe presented her systematic review and meta-analysis of Randomised Control Trials (RCTs), where the relationship between dietary fat, serum cholesterol and the development of CHD was examined.
It turns out that less than 2,500 males participated in only six dietary trials. Harcombe was able to show that there were no differences between control and intervention groups for all-cause mortality, and insignificant differences for CHD mortality. Further, the recommendations that governments were seeking to put into the guidelines regarding reduced fat intake (especially regarding saturated fat intake) were untested in any trial prior to introduction of the guidelines.
Her conclusion, typically pithy and to the point: “Dietary recommendations were introduced for 220 million US and 56 million UK citizens by 1983, in the absence of supporting evidence from RCTs.”
Academic foundation of complainant’s case demolished
Harcombe then turned her attention to the original meta-analysis that was the basis of the evidence supporting and motivating the charge against him by the HPCSA. The study, by lead author Dr. Celeste Naude, leading the Cochrane Group of dietary academics at Stellenbosch University and UCT, is titled Low Carbohydrate versus Isoenergetic Balanced Diets for Reducing Weight and Cardiovascular Risk: a Systematic Review and Meta-Analysis.
Harcombe showed 14 material errors in the analysis, some of them a result of sloppiness, such as reversing columns of figures during the copying process, others more blatantly sinister, in that they were clear manipulation of the data designed to skew the result of the meta-analysis.
Remarkably, all 14 material errors discovered happened to be in the favour of the established dietary hypothesis that fat is less effective for reducing weight and cardiovascular risk. When Harcombe restored the data, the meta-analysis showed that a “more” LCHF diet was slightly more effective, though she also pointed out that none of the trials actually involved true LCHF diets. Further, the condition for the meta-analysis of only including trials where both control and intervention groups took in the same amount of energy, partially negates one of the main benefits of the LCHF diet, namely that hunger is naturally suppressed when eating fat in the diet, one of the main reasons why LCHF diets lead to reduced caloric intake and consequent weight loss.
Not surprisingly, Adv Bhoopchand made little headway in cross-examining Harcombe, for her answers were consistent, logical and clear for both the expert and the lay public. On Tuesday 25th October, Nina Teicholz took the witness stand and presented equivalent evidence to the panel to show that the US Dietary Guidelines were never based on any sound science or evidence. At the conclusion of her testimony, Adv Bhoopchand wisely chose not to ask any significant questions, other than to hope that she enjoy the attractive city of Cape Town.