Friday, January 6, 2012

The Glorious Cause

Evolutionary medicine is important.  A common sense, evolutionary based approach to general preventative health care and diet advice  could possibly prevent your obese, demented and expensive nursing-home future, change the debt burden, create a healthy, productive, and prosperous individual subset amongst the oppressive planetary burden of 7 billion agricultural-dependent humans.

The stakes are high.  The adversaries (conventional wisdom and conventional commodities) well-funded and more or less articulate.  The doctors in the trenches are gun shy but pressured to adhere to "evidence-based medicine."  And by pressured, I mean, will be sued or not meet some evidenced-based "standard care marker" (such as a certain percentage of folks with high cholesterol taking statins) and will make less $$ if they don't adhere to "standard of care."  By gun-shy, I mean they were excited by vitamin E.   They were excited by B vitamins lowering homocysteine.  Then it turns out that vitamin E made everything worse.  Lowering homocysteine didn't prevent heart problems.  Chromium maybe hurts the liver.  The glorious Stumptuous put it best in her blog post - "F%^$ supplements."

If you think you will make your primary care physician happy by showing up with a list of non-standard labs to be checked and some half-baked theories as to why they are important, you are going to be disappointed.

Music:  Never Miss A Beat by the Kaiser Chiefs (right click in new tab, sorry about the ads!)

Doctors are conservative because we have to be conservative.  We are the last bastion of sense against shark cartilage injections and calcium as the cure for everything.  If you want to shoot across the bow of conventional wisdom, you need some hard core rigorous evidence and medicine.

Gary Taubes sent me (and many, many others) an email for a petition in support of insulin and hormonal fat regulation at the level of the adipocyte being the cause of obesity.  He wrote the petition in repsonse to Tara Pope's article about the difficulties maintaining fat loss after an initial bout of obesity.

Gary, I'm all for eating well as a long-term cure for obesity, but I'm not going to sign something blaming insulin alone. I can't do it.  There's too much evidence against it.   And I'm not sure I buy the "lean mass protection" gig Paul Jaminet endorses.  Why so many thin people with vitamin deficiencies, after all?  And I'm not going to sign up for the Harvard School of Public Health omega 6 fest of a food plate, either.  Epidemiology be dammed.  Show me the coronary arteries.  Hard evidence for such a departure from the ancestral norms of low omega 6.

And yes, I removed Perfect Health Diet from the "Of Like Minds" list at the right  (probably temporarily - depends on my mood) after one too many posts praising Dr. Mercola.

I can't do it.  I can't have my blog linking to direct endorsements of frauds.   Paul isn't an MD and is not in clinical practice.  He can give clinical advice on his blog whereas I, as an MD, cannot due to ethical and legal obligations.  He can feel free to consider the fringe of alternative medicine "on the same team" whereas I cannot.  I can't be on the same time as quackery because I am one phone call away from the front lines of the gun-shy primary care doctors.  I think Paul and Shou-Ching are amazing and thoughtful, but they never went through the humbling experience of clinical medicine training.  As many times as we are right, we are wrong.

So when Mat Lalonde gives a talk endorsing real science and hard evidence as a basis for Ancestral Health, I am in complete agreement (more or less).  I understand Andrew's reticence for the general population of folks and bloggers, but those who find "paleo" and have improvement will build it and spread the word on their own amongst their friends.  The real inertia to be lifted is with the primary care doctors and the incentives to keep pumping our processed food and vegetable oils.  No amount of enthusiasm and crappy anti-wheat polemics will change that.  Primary care doctors aren't stupid.  They need good evidence to turn the tide.

Here is the sordid truth - conventional wisdom is not wrong.  It is only skewed in favor of the vested interests. Cardiovascular disease has been dropping with the advent of the vegetable oil.  We have to get people caring about obesity, autoimmune disease, and mental health but the funding is problematic, to say the least.

Once doctors such as myself are linked with the lunatic fringe, we are done for.  Credibility, critical thinking, and scientific evidence are harsh mistresses.  I can have my little mistakes, but if I post anything showing major fallacies of critical thinking, I'm done for.  As it should be.  I'm a Harvard-trained physician, after all.  There are certain expectations, even in my hobby of a blog.

I'll try not to be blinded by science.  I'm not going to praise paleo for the sake of paleo (eat a g$$d%#@^ed banana already, and I don't have time to hunt and kill a boar).

Let's not throw the baby out with the bathwater.  Life is good and only getting better without the processed food, without the seed oils.  Let's protect it, nurture it, and not shove it out into the rocky shoals of the lunatic fringe too soon.

* The Glorious Cause is an excellent history of the American Revolution.  I highly recommend it.

103 comments:

  1. Thanks Emily for such a thoughtful post, and I want to thank you from the bottom of my heart for sticking your head above the parapet.

    I work in clinical research (changed my career after my diet changed my life for the better) and thank my lucky stars that I am not in the same career as the doctors I work with. I have the luxury of indulging in wacky theories (many of which turned out to be hilariously wrong, the docs are at least amused by my 'latest thing' and are really helpful at explaining more difficult concepts to me), but the doctors I work with don't have that luxury, hive mind thinking is encouraged, sometimes for really good reasons, sometimes not.

    Thanks for standing against the woo that sometimes pervades our little sphere!

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  2. Hi Emily,

    I'm sorry to have been removed from the "Of Like Minds" sidebar (though I think we are of like minds ...), but I hope to win you over to my view of obesity in time. This particular post was not an explanation of obesity, but of "The Fat Trap" -- of the conditions under which weight loss will be sustainable or unsustainable.

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  3. Paul - I think your "Fat Trap" post is excellent. It was the Mercola that drove me away. I'll be back. I just have to take a few showers.

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  4. I think Gary Taubes has it kind of right. It is alot to do with insulin for about 1/2 the overweight population. One group can lose weight by calories in /calories out. The other group (those with metabolic issues, like me and many, many others) need to watch carbs and be aware of Insulin levels. Diane Kress RD, CDE really has it right with the plan to eat carbs in a specific amount and within specific timing. Her new book, The Diabetes Miracle.. just out now, can save lives. As far as "proof" goes, my labs say it all. I've been following Kress' The Metabolism Miracle diet for 2 years now have kept off the weight and my labs say I'm not in diabetic range. FBG 100 HA1c 5.4 for the past 1 1/2. Prior to following this diet, FBG 180 Ha1c 6.4.

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  5. just curious.. what exatly is bothering you about mercola? i'd say about 80% of his articles and tips are well-founded and helpful to potentially hundreds of thousands of readers. ok, the rest is sometimes a bit woo-woo or not yet clinically proven or widely accepted ("earthing" etc). which isn't prove that it's wrong or untrure either. so where exactly is the problem in your view? people reading mercola (or your blog) can still think, reserach and decide for themselves, right?

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  6. Quaila I don't know if you are joking. Is it is pseudoscience? The damaging alarmism? The whoredom for the almighty dollar? The color scheme? The whole site is intolerable.

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  7. Hi Emily,

    What can I say, I like the guy. I've spent about 3 hours talking to him. He was a Rosedale VLC guy when we started talking and now he eats starches, has found it improved his health including his kidney function which may have been damaged on VLC, and he forthrightly said so on the air. I like that honesty. He's been very friendly, very reasonable, in our conversations. He understands everything I say, and often restates it better than I did.

    I'm persuaded that he honestly believes in the products he endorses. I don't think he always finds the truth, but that is a common flaw. I don't consider him a doctor, but a businessman, and I think honest belief in the products he pushes is a more appropriate test of integrity than conformity to evidence-based medicine.

    Finally, I firmly adhere to the principle that when I link to something, I am only endorsing (if anything) the thing I link to, not everything else the party linked may have said or done. If we can't link to sinners, whom can we link? Solzhenitsyn said "the dividing line between good and evil runs through every human heart," and I think usually the right thing is to reward the good with attention and ignore the bad, thus starving it.

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  8. Very smart, Emily. You can do more to change the way people eat by being careful about who you endorse and which approaches you recommend. You're being held to the highest standard because of your M.D. -- and yes, because of your M.D. from Harvard. Fair or not, those are the facts, and you're wise to not to anything that would compromise your credibility.

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  9. emily, i think you're judging of mercola is manily based on some emotional and personal factors and a ton of misinformation ("the color scheme"..??? WTF has that to to with anything? ;). you obviously only know him rather briefly and rather superficially. i stumbled upon his site about 2y ago, when i had my serious health issues (you may remember - we chatted a few times here in the comments). first i had a similar initial response to his site ("who is this guy? can he be trusted?"). but during the last 2y or so, reading probably 100s of blog posts and and watching a ton of his videos on youtube, i'm sure he's 100% personally convinced about the stuff and theories he promotes, and only wants the best (really) for his readers. of course he is also a gifted businessman - but who wouldn't want to be successful with what one does and loves? that's no argument against him. sorry to say, but your judgement seems to be mainly bases on hearsay, prejudice, misinformation and a personal/emotional aversion. that's not very objective and scientific either - is it :)

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  10. What? Where does that petition say that obesity is caused by insulin alone?

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  11. Qualia - you don't think color matters in a business site? And how do you know how much I've read? I've seen many articles, most of which are offensive (along with the color). Your taste is apparently different.

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  12. Eloquent...

    You just summed up how I have been feeling lately. I have my foot in two worlds and there is tugging on each side. I think my practice will eventually fall into a rhythm that I am happy with but for now *sigh* I am discouraged by the lack of research while excited that many have given CW the boot. The problem is how do you translate that into a successful and safe practice.

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  13. Dropped in via Melissa McEwen's RT of yours. I'll add my appreciation for publicly standing your ground in following the evidence and rejecting the "KOL's" of the Paleo crowd where they deviate from it.

    I am very disappointed in Dr. Jaminet's engagement with and defense of Jimmy Moore and Joe Mercola. They both are selling product - it's how they are primarily generating income, and they have obvious conflicts of interest.

    Another commenter complained that she read widely from blogs. But that is not the same as reading and educating oneself in a scientific discipline, adhering to the ethics and standards of practice in that discipline and publicly advocating what can reasonably be expected to do no harm - as Kurt Harris, so often leads with in his blogging.

    I am greatly enamored of Mat LaLonde, having attended his generous day long essentials of nutrition seminar. I used to teach undergraduate nutrition concepts along with adult health and critical care nursing, physical assessment and healthcare administration curriculum. I knew I didn't know enough, but I hadn't put together just how incorrect much of the clinical concepts and practices were as presented around nutrition and food.

    Where I think the ancestral health nutrition and health interests might go, if enough people are interested, is to crowd sourced databases where varying diets and health strategies may be elaborated, compared and evaluated by users.

    The CureTogether.org website is an exemplar of that.

    I'll re-subscribe to your blog, but I have no plans to do more than offer a passing glance at the musings of the likes of the heavy sellers - Taubes, Moore, Mercola, William Davis, Mary Dan and Michael Eades - anyone who is using the "paleo" community to generate a primary source of income. That's exploitative, even if the purveyors of it are smiling, friendly and appear benign.

    Best-

    aek

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  14. Thank you. This was very well said. I'm a researcher, and like you was trained to think critically. It's come to the point where the acronym CW is for me a red flag that someone is tilting at windmills. Conventional wisdom is not in itself the heart of the problem, the heart of the problem is our "food supply" and how it fails to supply actual real food to most Americans.

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  15. I'm stumped as to how to express my agreement and appreciation as succinctly as possible. I guess I'll just go with 'thanks'.

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  16. Thanks for the article Emily!!

    I used to like Dr Mercola, but then this happened:

    I read on Dr Mercola's website that a way to treat dandruff is to apply some anti-dandruff shampoo, let it work during the night, and then wash it in the morning. It was horrible. I woke up in the middle of the night in a lot of pain. I had to wash my hair immediately. It was in a terrible condition. I had to wait 2 weeks or something before it was normal again. All the skin peeled completely.

    So after that I simply couldn't see Mercola as a responsible person because that recomendation is completely stupid! (And I'm also responsable for adopting it).

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  17. I have really enjoyed your posts and your knack for making research accessible for those of us not mostly reading the primary sources (or reading primary sources in other fields).

    The motivation for this post is a bit elusive to me. Why f*ck supplements as a categorical statement you'd support while also arguing for the importance of a measured, science-based, approach to assessing the safety zone for making clinical recommendations?

    I'm uncomfortable with the idea that you have more delicate (or valuable?) professional territory to defend because you are a Harvard-trained MD.

    The tone to this post is tough to line up with what seems to be an appeal to scientific rigor.

    So much good and bad science has been upheld under the same banner of "Science"; and so much good and bad has been DONE in the name of science.

    It's a tough stance I think to propose that there's "science" and then there's "quackery" and not a whole lot of overlap historically between these two categories.

    There's a righteous tone to this post that suggests there is a clarity in your mind about boundaries where I think the clarity doesn't so much exist.

    Licensed professionals loudly protesting conventional wisdom (to the point of losing their licenses) has at some key moments nudged social change forward, no? I'm not saying that should be your job -- only that your stance here is one of many possible good ones while it sounds like you're saying it's The Good One. Standing behind one's prestigious license and saying "I can't go THERE" as if THERE existed on the other side of a bright line is a kind of fantasy I think.

    I still really really like your blog, having said all that. I'm more mystified than anything.

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  18. Dr. Deans,

    This is excellent. Thank you.

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  19. Emily, I applaud your stand and the fact that you removed the Perfect Health Diet blog from your 'Of Like Minds' list. I stopped reading the Perfect Health Diet blog after Paul endorsed Dr. Mercola because he was a "nice guy", etc. Some very dangerous people are incredibly charming, and a critical mind must know how to separate quackery from one's demeanor. However, it seems that Paul is more interested in driving traffic and may be blinded by his self-interest in this matter.

    There were many, many people who thought Bernie Madoff was a wonderful person who cared about his community and admired his philanthropy, to their great detriment. A harsher and extreme example - Harry Truman, whom I happen to admire greatly, preferred Stalin to Churchill, but I'm pretty sure starch wasn't involved.

    It may be time to reread 'Blink', and 'Mistakes Were Made, But Not by Me'.

    I purchased the Perfect Health Diet book and though I quite agree with most of the diet recommendations, I cannot recommend it to people who think critically and have not been exposed to ancestral health type philosophy. The book starts with logical fallicies that should be presented in bold as hypothesis at the very outset. For example, to claim that breast milk should be considered evidence that Paul's diet ratios are based on sound thinking is not so different than the type of pretzel logic used by Ancel Keys. It could be right, but there is no science to back up the claim that we should base our diet on the ratio. I am personally more comfortable with 'Life Without Bread' as a thought provoking piece to help those who might want to understand better why they have health issues.

    I also feel that providing references to opinions held by Barry Groves is a slippery slope that seems to try to create the impression that the references are providing fact, when in reality they are really more circular. Don't get me wrong, I like Barry, and he may be right about a lot of the opinions he espouses. But his opinions are far from uncontroversial and are just that, opinions that are designed to have us question the conventional wisdom and use our critical thinking skills.

    I have been following the paleo blogs ever since I found Jenny Ruhl's Blood Sugar 101 site over three years ago. I still haven't found a site that discusses diet and critical thinking better than she does. I noticed that she questioned Dr. Davis' woo early on, and also was willing to call BS on Dr. Eades when his confirmation bias was showing. I have seen many bloggers, including Stephen at Whole Health Source and Kurt Harris make what seemed like factual declarations that were later recounted, in some cases quite significantly. This is in no means a criticism of Stephen or Kurt, just a reminder that many of the followers of the blogs in the paleoshere tend to participate in 'hand waving' and diet ideology rather than take each post with a grain of salt and remain humble about having had some success with health issues or weight problems after changing their diet, without really knowing how the science might really work.

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  20. "The color scheme? The whole site is intolerable."

    LOL, you're right, the color scheme of Mercola's site is pretty intolerable. hehe

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  21. 1) Quackwatch.com has a little to say about Dr. Mercola: http://www.quackwatch.org/11Ind/mercola.html.
    I don't pay any attention to him.

    2) I signed the Taubes petition. Tara Parker-Pope's NYT article is unnecessarily discouraging and obfuscating. I'll admit the petition over-simplifies a complicated situation, but it has to because it's written (I think) for a general population, not scientists. The hoi polloi read on an 8th grade level, if they read at all. They don't have a chance of understanging Dr. Guyenet's post on palatability/reward theory.

    3) Regarding palatability/reward theory. I agree it's got some validity. Perhaps a lot. Anecdote isn't worth much, but take my word for it, I could gain 20 pounds of fat weight in a year by over-eating Cinnabon cinnamon rolls. Yes, they are that tasty. The carbohydrate/insulin and palatabiliy/reward theories of obesity are not mutually exclusive. In other words, they may both come into play.

    4) Regarding the carbohydrate/insulin theory of obesity. It makes a lot of sense to me when I think about all the type 1 diabetics who lost dramatic amounts of weight before diagnosis of their insulin deficiency, and gained weight (fat and muscle) when they started insulin injections. Anecdotally (again), the overweight type 1 diabetics I see are typically taking more insulin than slender diabetics. (I haven't studied their diet macronutrient breakdown in detail.) It's also well documented that type 2 diabetics gain an average of 8 to 14 pounds (of fat) simply when insulin is added to their treatment regimens.

    5) Here's a thought experiment. What if concentrated refined sugars and starches (especially grains) disappeared from Western diets? I bet overweight and obesity rates would decline. Population-wide insulin secretion would be lower, as would food palatablity/reward.

    6) Great post, Emily. I count on you to be a straight shooter.

    -Steve

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  22. I just love how the whole paleosphere jumped on the food reward bandwagon. I think this aligns with what mat lalonde said repeatedly - the whole movement doesn't really base itself on science. And this time took the first chance abandon the idea that insulin has something to do with obesity, an action that sounded more like "yey i can haz carbs!!1" and "taubes was mean to my friend guyenet so he is wrong!!1" than a cold consideration of the evidence.
    While there are certainly problems with the theory of obesity ala taubes, the "destroying" of the hypothesis that guyenet attempted was very ... sad. His feelings obviously got hurt at the ahs11 and now he relies on strawman arguments and misunderstanding/misrepresenting of studies.
    And after he reversed his view on insulin, I wonder how much guidance by his mentor it will take until he sees the light and starts believing that saturated fat is bad after all.

    Sorry for the rant. Have a good day, enjoy your unrewarding food, and remember, insulin is helpful for weightloss..
    (I dont like mercola either, btw. and the belief that all modern diseases are caused by pathogens troubles me too)

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  23. Problem with paleo is that it isn't defined, it's more like a religion than a practical therapy. People define it however they want to define it, and it's usually more emotionally motivated than a logical approach to addressing/controlling/resolving any health condition. Paleo is like vegetarianism - it's an emotionally driven ideology which is subjectively defined by whomever practices it.

    For example, we often hear of people losing weight when they start a paleo diet, but why do they lose weight? They lose weight, usually, because they stop eating sugars and starches and start eating protein and vegetables and mixed nuts. In other words, they attenuate their insulin production reduce dietary glucose, reduce total calorie intakes (usually), and most importantly they start oxidizing body fat normally. This leads to a loss of body fat.

    Is it the "paleo", or is it the intelligent healthful diet that cut carbs ? If the person adds in sucralose, or something else non-"Paleo", will they gain weight? Probalby not. It seems as if the paleo idea/feelings had nothing at all to do with the weight loss, and it had much more to do with eating in a way that attenuated glucose levels/insulin responses.

    Paleo will never be a reasonable therapy, because it's NOT a therapy. It is not at all defined. It's just this wishy washy idea/feeling that we should live like our ancestors... just as vegetarians have similar feelings that using animals for our own ends is wrong, but each individual vegetarian type applies that feeling differently.

    Things will only improve when we get over this paleo religion thing, and deal with individual diseases/disorders related to modernity.

    I can eat wheat and do just fine,m eanwhile a wheat intolerant person cannot.
    I can NOT eat glucose and do well, meanwhile a glucose tolerant individual can eat a big plate of low reward potatoes and thrive.

    I see no reason to even apply paleo ideas as they define nothing and only help by incident/accident; better to identify real dysfunctions and address those logically, perhaps using evolutionarily logical principles to inform our therapies. If I ate a "paleo" lifestyle I would not be anywhere near as well as I am by focusing on the disorders I have and specifically controlling them, whether or not the intervention is paleo.



    PS Mercola is a ridiculous quack, that is a sure fire truth.

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  24. @Jaminent
    Mercola says so much nonsense, I mean tinfoil hat you're off your haldol again type insanity... how can you take for serious anything he told you about his health and how it has been affected by various dietary practices?

    It's nice that he actually believes his insanity. That makes him merely sad/pitiable because it suggests he is suffering from an uncontrolled mental illness, rather than abjectly deplorable narcissistic psychopath trying to bilk elderly sick people out of their retirement money, which is the interpretation most of us would have otherwise come to.

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  25. @Cate's Folly
    Agree. Why "f*ck" supplements?

    We are dealing with real disorders, dysfunctions, syndromes. Again, this goes back to the "paleo is a religion, not science" idea I was speaking of.

    If it is shown that a certain health condition benefits from boosting a certain nutrient, why on earth would we not take supplements for that? Oh, forgot, supplements aren't "paleo".

    This is a perfect example of why paleo really isn't scientific, is NOT science, will never be a therapy, etc. It's sort of like vegetarianism, the only difference is the ideology/emotions/morality is different.

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  26. "Doctors are conservative because we have to be conservative."

    A good friend of mine went through med school, we were both kind of science geeks, fascinated by physics. He said that med school is pretty much the opposite of science. We do it this way because this is the way we do it. There's so much to basically memorize that it beats the sense of wonder out of a student. And of course there's no forming of hypotheses and testing them experimentally as one might do in a physics lab. Although I assume diagnosis is something of the same heuristic. Anyway, it's like that for good reason, doctors and hospitals must follow the conventional treatments this includes the most recent version of the conventional treatment. At the time my friend was in med school, they were successfully sued (UNM Hospital) for not using the latest conventional treatment for a certain form of children's leukemia. They were using a two-dose treatment(?) whereas as the accepted three-dose treatment had a very high cure rate. So basically children died because they were doing it wrong. Ouch. Anyway, medicine is a bit more like case law in that respect than science. Which means you guys are really like a bunch of lawyers!!!

    "I think Paul and Shou-Ching are amazing and thoughtful, but they never went through the humbling experience of clinical medicine training. As many times as we are right, we are wrong."

    Okay, this I have to take issue with. I am ridiculously good at problem solving. I say this not out of arrogance because the reason for it probably has a lot more to do with my degree in electrical engineering than innate ability. I never actually worked as an engineer, mostly in computers and even as an auto mechanic. I was really, really good at figuring out the strange car problems. Better than the 20 year veterans. I was also really good at figuring out bizarre computer problems. Whether it was hardware, software, didn't matter. My point is that engineering and the hard sciences do nothing if not teach the humility that is necessary to critical thinking and problem solving. I've never gone through clinical medicine training but I doubt it can be any more humbling than getting a PhD in astrophysics (which I would've liked to do in an alternate timeline). One of my big weaknesses in the business world is a lack of dogmatism. Everyone is supposed to be sure of themselves in that domain and someone whose first response to most things is 'I don't know' is seen as weak. It's usually something like, 'I don't know, *stare at the ceiling* but it's likely that...', but that's not how one makes CEO. And no one strikes me as less dogmatic than Paul Jaminet. So I don't know, but I think it's likely that you went a bit overboard there ;)

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    1. If, by "problem solving" you mean "talking at great length about myself" then yes, I would have to agree. You are a great "problem solver". However, what that has to do with your final conclusion ("no one is less dogmatic than Paul Jaminet"), I haven't a clue. For anyone not willing to read Pragestepchild's long comment, I'll summarize: "I am great. I am smart. I am a problem solver. I am a smarty pants. Name drop. Profession drop. Experience drop. More of the same ol' same ol... (on for 3 long-ish paragraph). And no on strikes me as less dogmatic than Paul Jaminet. Basically, you're an idiot, Emily." The end.

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  27. @Gonçalo

    You know what worked wonders for my dandruff was vinegar. I guess there are several types/causes but the main one, or the theory at least is a high sensitivity to the fungus that lives in the human scalp. Apparently we all have this fungus, a different species is adapted to living in the eyebrows (different heat and humidity). But some of us are more sensitive or allergic than others. I use straight 5% vinegar (note be very careful not to get this in your eyes, wash face thouroughly or dunk several time before opening eyes). I rarely use shampoo but I do use it and the vinegar acts as a great conditioner, countering the alkaline of the shampoo. If I stop the vinegar treatment for a few days the symptoms start to creep back.

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  28. Interesting post and comments. I can only say two things: (1) stick to the science & communicate it without favour or prejudice (and this blog does that very well) and (2) understand that there are no global theories of anything - people, their health and ill-health are very complicated creatures, no one-size fits all and health issues rarely cluster in isolation. Just keep going!

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  29. Resorting to ad hominems and guilt by association fallacies isn't helping anyone.

    Obesity is but one phenotypic expression of insulin resistance and poor glucose control. There are plenty of non-obese people with symptoms of insulin resistance and poor glucose control.

    Insulin may not be the only factor, but it's probably the dominant one, i.e. the first order effect.

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  30. one kind of person that can be attracted to mercolas site is one that uses the precautionary principle heavily.But if you use this principle just a little in al the parts of your life, instead of using it only in a few parts (and to much in them), then staying away from this site makes sense.Information flood is evolutionarily novel (In my opinion much more novel than BPA in the cans and pesticide residues in the fruits,and maybe more novel from GMOs).If you are afraid of crosing the boundaries of species with genetic enginiring why not being afraid of crossing the boundary between cultures like internet does.I am afraid of the unintended concequences of reading blogs.However some of the bloggers are clever (and the paleosphere has some clever ones)and I believe it worth reading them and facing the side effects of information flood.But even if you want to apply just a little bit of precautionary principle it makes sense to stay as far away as possible from this guy

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  31. I'm afraid you've lost me here Emily. To my English ear this sounds somewhat of a rant.

    We all need to be aware that every one of us is partial, some more partial than others.

    To dismiss many of the Paleosphere protagonists on the basis they sell product is somewhat rich given much of the 'science' of the last 50 years (that all trained medics study) is funded by large corporations with very large vested interests.

    It struck me as I read GCBC a few years back that had the missionary doctors had access to each other's findings via the internet the whole diet/health debate would have been very different.

    Obviously each one of us should use our critical thinking when reviewing any research, blog or other and that includes an eye to who has funded the work.

    Nowhere here is a mention of Mark Sisson. He makes his living selling nutritional supplements and his books but he also writes extremely balanced pieces and regularly reviews his stand on various issues related to diet as the new data becomes available.

    I understand some of the comments here are friendly banter but to imply you might feel differently when less emotional isn't really a great selling feature for a psychiatrist, Harvard trained or otherwise; although probably very honest!

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  32. "1) Quackwatch.com has a little to say about Dr. Mercola..."

    I don't think much of Mercola, but I think even less of Quackwatch. Barrett has never applied the kinds of standards of proof to conventional techniques that he applies to anything that in the least smacks to him of alternative medicine.

    In addition, Barrett is one of the champion cherry-pickers of all time. Check out his condemnation of "Organic Food" for a taste of his tactics.

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  33. "Cardiovascular disease has been dropping with the advent of the vegetable oil."

    What?

    I like this better:

    "Cardiovascular disease has been dropping with the advent of plasma TV's."

    Not much science in either statement.

    Better guess:

    "Cardiovascular disease has been dropping with the decline in cigarette smoking".

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  34. Hah! I certainly wasn't suggesting causation there. Just an uncomfortable fact that those of us who loathe veggie oil have to deal with thoughtfully when we present the data.

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  35. Good post, Emily.

    There seems to me to be two main types of people within this paleo/evo movement - those who reside within the current system and those who are on the outside. Those of us on the outside, as you rightly point out, can virtually say and do what they like, without much in the way of blow-back from our peers and the system - particularly if we get it wrong. We have the advantage of pushing the envelope and boundaries - we don't have to wait for bigger and better studies to do what we do.

    People like yourself, however, are constrained by the system you operate in - a system that views the rest of us as being on or near the lunatic fringe (whether we like it or not). In order for this movement, whatever it is, to gain traction within the dominant system, we need the conservative Emily's in the world - those who are forced to gently nudge the boundaries. This system will respect that more than those of us who punch through them with little regard.

    We need the conservative Dr Dean's, the Mat Lalondes, etc, if we ever want to be taken seriously and be perceived as a viable option rather than a new wave of hippies/hipsters on the latest fad. The likes of Emily - a graduate of the Harvard system - playing within the rules dictated by the hand that feeds her, becomes one of our greatest allies. Should she bite the hand that feeds, I have no doubt that her peers - the very ones we want to influence - will cast her out to the same fringe that they already see the Mercola's, Jaminet's, etc, as occupying.

    Keep doing what you do so well, Emily. You are conservative (and that can be frustrating for those of us who don't have to be), but that is both your strength and something which strengthens our movement.

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  36. The Insulin Hypothesis should have been stillborn and should have never made it to print. As late as 2011, Taubes response to all the Asians eating white rice (insulinogenic refined starch) was: 1) they really eat brown rice, 2) they don’t eat sugar.

    #1 shows he is a much bigger idiot than the scientists he bashes. #2 is disputed, but even if true would contradict the insulin theory of obesity – it would be the Sugar Theory of obesity. But he wants science and medical types to sign a petition saying it is really the insulin.

    Taubes’ number one supporter online (Jimmy Moore) doesn’t even believe in evolution. Insulin Theory is becoming like Creation Science. The Bible says that that the world must be 10,000 years old, so the “science” used to support this must be true. Carb restriction “works” for someone personally, so therefore the crayon science that Taubes uses to explain it must be true (but never mind half the world eating white rice – just pretend the rice is really brown).

    Atkins once claimed that low carb diets worked because the extra calories were urinated out. Insulin theory is just more of the same – wild speculation pretending to be science.

    Hopefully the people that sign his petition will wake up one day and realize how easily they were duped.

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  37. I totally understand the hesitancy to associate with friends of ol' biophoton Mercola. But there's also the paradigm of taking the good with the bad. I have learned a thing or two from his website, and it's nice that he's nice in person.

    It's all part of growing, especially since our worlds are really all about us and not our endorsements. See the theme song to Facts of Life for further details...

    You take the good,
    You take the bad,
    You take them both and there you have the facts of life.
    The facts of life.

    There's a time you gotta go and show
    You're growin' now,
    You know about the facts of life.
    The facts of life.

    When the world never seems,
    To be living up to your dreams.
    And suddenly you're finding out,
    The facts of life are all about you.

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  38. Good rant. I appreciated it.
    Thanks :-)

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  39. That was a good article, I've always been vary of Dr. Mercola because he gives out a lot of questionable alarmist advice, even though the majority of what he says seems reasonable.

    But I wouldn't bash someone just because they have a product to sell. Mark Sisson sells products, Michael Eades sells books, Chris Kresser sells information products and consultations. These guys are also on your "of like minds" list, they love what they do and want to make a living of it and improve other peoples lives in the meantime.

    I have some ads on my blog and they are providing me with a full-time income with med school, I definitely do not feel that the ads are clouding my judgement in any way.

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  40. Great post, and glad to have discovered your blog. Thanks to Steve Parker for tweeting me this way.

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  41. I did not sign the petition either, and will have more to say about it once I finish my amazing weekend. I, too, was puzzled by the Mercola/Jaminet interview, but I just LOVE Mercola. Maybe its because I don't have the Harvard reputation to uphold, or at least here on these interwebs, but Mercola has always been a great source of information I can enjoy, take, or leave. I read WWS, Harris and PHD in the same light.

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  42. @ Steve Parker, M.D.
    I agree with the assessment "Tara Parker-Pope's NYT article is unnecessarily discouraging and obfuscating". After reading the article, I had the feeling that the main reason for the article was an explanation of inconvenient situation that an expert in a health field could be still fat. She tried to take care of her professional credibility.

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  43. Rudolph,

    I definitely agree. More and more bloggers are moving further and further away from what attracted me to their sites in the first place. Instead of working through ideas by presenting clear information and analyzing, which Masterjohn does great, too many are just spewing out farfetched speculations and showing obsessions with continually "debunking" others, no matter how out-of-context or worthless the debunking is. There are few blog authors left that write coherent posts with clearly supportive references.

    Praguestepchild,

    A similar story happened with one of my best friends. Both us of had interests in math and physics, but whereas I chose to continue that path (math), he decided to go to medical school. He hates the education & authoritative environment and the lack of science (he's in his third year). Unfortunately, he is somewhat stuck in that path, as he went to Westpoint and therefore owes 9 years to the army.

    I agree about Jaminet being non-dogmatic, and cautious, which is why I think he/they should not receive some of the harsh criticisms they do. They continually review their ideas and always attempt to support them properly. I remember Lucas Tarfur posting good counter-evidence to their ideas, but both sides went about the situation in the right manner, which seems to be rare now.

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  44. On one hand I appreciate that Paul is non-dogmatic and open-minded. On the other hand I feel it is deceptively… dangerous. There are some issues where one must take a firm stance. To not do so as a clinician is to do harm.

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  45. "On one hand I appreciate that Paul is non-dogmatic and open-minded. On the other hand I feel it is deceptively… dangerous. There are some issues where one must take a firm stance. To not do so as a clinician is to do harm."

    In my comment above I tried to defend the fact that a clinician must make tough decisions and necessarily err on the side of accepted treatment, whilst humbly pointing out that I doubt "the humbling experience of clinical medicine training" is unique in the learning of critical thinking. I'm not aware of any knowledge being 'deceptively dangerous' and you'll have to excuse me if that seems more like a term coined by Orwell than something you would write without tongue placed in cheek.

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  46. Really, Sean? It all seems very reasonable because it is said with such moderation and equanimity.

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  47. Emily
    I am glad you wrote this piece, but I would love to hear your thoughts about the quackery practiced in conventional medicine daily too. Most evidence based recipes are based upon false assumptions. This reductive manner of thinking allows for the piling up of tremendous amounts of information on top of these falsehoods. Information is not knowledge. Many in medicine and research science think the more information we add the better we get. That is not true. We found that our in the Pfizer trials on the CETP drugs. When phase 3 trials were complete no one in medicine or research science could explain a 50% death rate. The answer was simple. The premise that lipids cause heart disease was and is dead wrong. Pfizer lost 21 billion dollars in a day. They made over 400 billion dollars from all statins over the years. Where is your outrage and blog posts about that atrocity? If making money on something is the hurdle for criticism you will be writing many blog posts about this issue. People/patients feel the the cognitive dissonance that allopathic medicine displays daily.

    Still, I fully support this post. Because it's correct. But the covert message is more sinister. You need to be totally balanced and go after your own when you see the same bullshit being served up to millions.

    I think medicine performs more than its own far share of its quackery on the public and it gets "a pass" that others do not. I think much of what makes up the "core treatments" for chronic diseases in this country today will be proven ridiculous in the next 100 years. I think mental illness is one of those areas particularly. I think evolutionary medicine will be the way medicine is led back to the correct path of science. 2 million years of natures best RCT is better than any trial ever done by any researcher to date in my own opinion.
    Where medicine excels is in the treatment of acute injuries. I think while you are calling out others, you need to be careful of your own glass house at Harvard as well. This is not meant to be mean spirited at all, but I would hope you reflect upon the quackery that is done daily in medical and dental clinics across america with equal rancor.
    I had serious problems with the Jaminet/Mercola interview as well, for other reasons, but I have decided that there are better ways to discuss those down the road. I really do enjoy the fact that you had the guts to call a spade a spade here. I fully agree with it in this context.
    I just wish you might be fair and balanced with some of the things that come out of Harvard that are complete utter bullshit that have hurt millions of Americans over the last 50 years. Let's just start with the recommendations of the nutrition, oncology and cardiology departments, for instance.

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  48. Heh. Jack , all that is mostly at the beginning of my blog. I was full of righteous anger and frustration back then. Now I am a bit tired. But the most recent stuff would be in my post about "Conventional Wisdom and the Lunatic Fringe" where I was AGHAST at Walter Willett.

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  49. To be honest, the disgusting waste and death and pain visited upon people by conventional medicine is so upsetting that I can hardly bear to think about it. But that doesn't mean that alternative medicine gets a buy with less evidence (which is often the case).

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  50. just the fact that you said it says enough. I thought it was in you. But I just had to know for sure. Thanks for the confirmation.

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  51. Emily
    I believe you are unduly harsh on Paul Jaminet’ views. Paul presents a logical and informed framework on which to base and develop personal health experiments; to believe that there exists (at this time) an exact and accurate prescription is naïve if not irrational. Paul’s open mindedness and grace under criticism is in stark contrast to the almost pathological attitude of most bloggers who seem primarily concerned with fault finding. I hope you will reconsider your view as Paul deserves accolades for his efforts.

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  52. I think same level of evidence is not required for procedures with different level of side-effects.

    I mean that a medicine or procedure with significant dangers should require very convincing evidence of effectiveness. While something like food that does not have the same dangers should require very less evidence of effectiveness.

    The problem is everybody is different, so everybody must try what works for them, if we have the same level of evidence required for non-threatening procedures, then people cannot try them out to see if they work for them.

    Yes the problem is lost time, where more effective strategies would help more. Doctors will have to distinguish the cases where they must recommend some strategies and be aware of their effectiveness and side-effects.

    The current situation is very bad. The doctors mostly have no idea of nutrition and its effects.

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  53. "Really, Sean? It all seems very reasonable because it is said with such moderation and equanimity."

    What I really meant to write, Emily, was, "Nanny-nanny boo-boo, hard scientists are way smarter than you liberal arts majors." Isn't a psychiatry degree like the world's most advanced liberal arts degree ;)?

    Actually, Mercola's site gives me the heebie-jeebies also but I just glanced at it briefly. It wasn't the colors so much as the crass commercialism and pop-up crap. Sisson might sell supplements but he doesn't push them on his blog AFAIK and he presents a ton of info in a straightforward manner. Mark mentions his book a lot but it is pretty much an encapsulation of his blog and a great starting point for paleo types.

    Also, the American "Revolution" was technically a war of independence, and I'm saying this as an (sort of ex) American. But revolution sounds cooler, of course.

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  54. Medical and Pharma business are very strange. Their aim is supposed to be to drive their client base to 0, but luckily for them the opposite is happening (of course not their fault). What an internal conflict they live in, and I wonder if there is a single medical doctor working for free.

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  55. @Emily

    Ceteris paribus, anyone who is a critical thinker, or an engineer, or otherwise smart enough to read medical papers will only be much, much better at medical criticism for having spent, say, an entire additional decade in medical training, to say nothing of years of clinical practice.

    I'm tired of anyone who thinks all of medicine is nothing but some corrupt false consciousness that practically handicaps real progress in science, dietary or otherwise.

    "To be honest, the disgusting waste and death and pain visited upon people by conventional medicine is so upsetting that I can hardly bear to think about it. But that doesn't mean that alternative medicine gets a buy with less evidence (which is often the case)."

    I feel the same way.

    I am reminded of Churchill's characterization of democracy as being the worst form of government, except for all the others...

    Conventional medicine is the same. It is fantastically expensive, exploited by politically connected commercial interests, and has jewels of amazing treatments distributed in a minefield of poorly documented lore that is often dangerous, futile, or downright cruel.

    But the notion that "alternative" or "complementary" medicine is superior in some way to conventional medicine is just stupid.

    Chiropractic, acupuncture, homeopathy, naturopathy, "chinese" medicine ( I wonder, is there a peculiarly chinese science of immunology or anatomy???) acupuncture, etc. Though there may be nuggets of useful therapy gleaned from these traditions, as "systems" they are all basically bullshit.

    Mercola is a total quack. I am suspicious of anyone who is even willing to be remotely associated with him. Such an association implies either credulity or cynicism.

    His site has informed me that one must not shower in order to avoid vitamin D being washed from your skin after sun exposure, that dietary choices should be based on blood type, and that thermography is a reasonable alternative to mammography.

    Regarding this last, I walked into a pharmacy that has a supplement section and the woman working there was all excited about thermography for detection of breast cancer. I explained that she could go online and buy a thermography device that is used to look for thermal leaks in your home. It is precisely the same device. Nothing more than a heat map of the surface of the imaged object.

    The idea that this can tells us a damned thing about the presence of cancer inside the body is ludicrous and this whole technology was thoroughly debunked over 25 years ago in radiology.

    But the supplement woman was recommending this as an alternative to mammography based on the pecuniary efforts of assholes like Mercola.

    Primum non nocere indeed.

    @Paul

    You are very nice, and as Emily says that is what makes you a bit dangerous. Unless you are selling something, it is much more important to be GOOD than to be NICE. People are giving your opinions great weight based on how pleasant and even handed you are. This might in some cases not be as good for people as if you were more discriminating and critical.

    It is not GOOD to lend assistance to quacks who are harming people.

    PS

    Taubes' petition explicitly invokes the CIH as the explanation for obesity. Now that it is 2012, I think this can be fairly characterized as dietary quackery.

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  56. Just to add to my comment above:

    "More than half the coronary heart disease mortality decrease in Britain between 1981 and 2000 was attributable to reductions in major risk factors, principally smoking"

    Only a small percentage was attributed to a reduction in cholesterol.

    http://www.ncbi.nlm.nih.gov/sites/entrez/14993137?dopt=Abstract&holding=f1000,f1000m,isrctn

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  57. Hi Kurt,

    I do not believe that my interview lends assistance to Dr. Mercola, except insofar as it corrected some faulty views he held and enabled him to improve his own health, which he was damaging with a dangerously low-carb diet.

    I do believe my interview may bring a lot of help to Dr. Mercola's audience. The audience is large, eager to find natural ways to improve their health, and I believe the advice I gave is an improvement on what they had been given before.

    I can see that niceness, like charisma and other attractive traits, could have harmful effects if coupled to error and misinformation. But it would have good effects if coupled to truth and insight. If you think I'm dispensing error and misinformation, please let me know what that is. If not, why criticize me for being nice?

    I said a little more about my view of the morality of interacting with Mercola and his audience on my blog: http://perfecthealthdiet.com/?p=5407#comment-49055. I don't think the opportunity to explain to Mercola's audience how they can improve their health is one that I can in good conscience turn down. Let me add one bit to what I said there: when Jesus sent his disciples into the world "as sheep among wolves", to go into the world but be unspotted by it, the implication is that associating with sinners does not in and of itself result in sin. Avoiding sin may require, as Jesus said, to be "wise as serpents and harmless as doves"; but it is possible, and so merely associating with publicans and sinners is not by itself sufficient to show fault.

    In the context of modern technology, where we can have hundreds or thousands of relationships via the Internet, I think this kind of guilt-by-association makes even less sense than it did in Jesus's day. Sociology experiments have shown that 6 degrees separate every person on earth from every other person; with the Internet, that has probably come down to 5, and in a restrictive community like the medical/health field it is probably no more than 3 connections from everyone to everyone. So if 3-degree chains like PCP -- Emily -- me -- Mercola are intolerable, the only solution is to become a recluse and hermit. It is very hard for me to get my head around a morality that requires abandoning relationships because of these kind of tenuous links to disapproved behavior.

    Well, enough said. Emily, as I said in that comment on my blog, you're a terrific blogger and a great asset to medicine, so I'm happy that you're looking out for your reputation. I'm just surprised that I'm the threat to it!

    Best, Paul

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  58. Kurt, do you consider Chris Kresser as a quack? He is a licensed acupuncturist after all and that is "bullshit" (I agree).

    How is Paul Jaminet conducting an interview with Dr Mercola different to your appearance on The Healthy Skeptic podcast?

    Is Dr Mercola's heavier commercial activity the problem?

    I am not being flippant, just genuinely interested in the degrees of difference and who you decide to stop communicating with.

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  59. SimonM

    Are you serious?

    You are equating Mercola to Kresser?

    Please link a single post by Chris that contains something you think is quackery or that I might think is quackery. Acupuncture as a system of medicine alternative to western medicine is not something Chris ascribes to. He was trained in it as a technique and uses it as a tool for pain relief, etc. Nothing I said about chiropractic or chinese medicine as a SYSTEM negates its possible value as a technique.

    Some chiropractors believe that adjusting the spine can affect organ or overall metabolic function, which is nonsense.

    Some think adjusting the spine can make your back feel better, which it can.

    If by simply reading Kresser and Mercola for their scientific content you cannot tell the difference, I am afraid I can't help you any further.

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    1. How about Kresser's categorical statement that antidepressants are placebos? It goes against the evidence and could be extremely harmful if vulnerable people go off their meds because they believe he's right. I stopped reading his material because I don't entirely trust his views - if he is so dogmatic about antidepressants, what else is he being dogmatic about? And he's not an MD either.

      Delete
  60. @Paul

    "So if 3-degree chains like PCP -- Emily -- me -- Mercola are intolerable, the only solution is to become a recluse and hermit."

    The point is not that they are intolerable. The point is that people - not just me - will make assumptions about the trustworthiness of your advice based on who you affiliate with and promote on your website. And yes, saying nice things about someone like Mercola promotes him and supports him.

    No one is arguing you should not do it. We are just pointing out that it may mean that others who desire no chain of affiliation with Mercola may affiliate less with you as a result, out of concern for their own credibility and message.

    So your choice is less about how to be friends with everyone than how to choose between being affiliated with folks like Emily and Mercola, perhaps.

    And why the absolutist posture? Is any level of promiscuity total whoredom? Of course not. My blogroll contains only those that I would trust my own family to read if I were dead and could not answer their questions about it. And it is not zero in length and I am not a hermit or a recluse.


    "It is very hard for me to get my head around a morality that requires abandoning relationships because of these kind of tenuous links to disapproved behavior."

    If indicating approval of Mercola on your blog does not bother you, fine. It is not a moral judgement for me, just a practical one.

    I would not steer traffic to someone on the chance that they call me to ask about thermography. This is because I don't want to wast time correcting misinformation more than any kind of moral judgement.

    Mercola is free to earn a living and I am free to avoid helping him.

    But all's fair in reputation land.

    No one can tell you to be repelled by characters like Mercola, nor should they.

    But you cannot expect people to read Christian charity into your approval of him rather than credulity either.

    PS

    If Mercola were to offer to interview me, I would refuse. And I actually regret doing interviews with Jimmy Moore and participating in the "starchfest". Jimmy's show is a way to reach people but it has all the morality of a TV reality show these days, and I'd rather not be someone's entertainment when their whole message is based on mass deceit and selling low carb garbage.

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  61. Kurt -- I wasn't equating Kresser with Mercola, I have never read anything written by Mercola so I couldn't say.

    My knowledge of what Mercola says comes entirely from this post and your response.

    I wasn't denigrating Chris Kresser -- just knew he was an acupuncturist and you had just described acupuncture as bullshit.

    If one person peddles what you call quackery and another qualifies in a bullshit system then I couldn't see the difference in interviewing with them.

    You have made your position quite clear!

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  62. @SimonM

    It was a fair question if you haven't read Mercola or what Kresser says about acupuncture.

    You don't have to have 100% agreement with everyone, but at some point not showing alarm or disapproval looks like tacit approval.

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  63. Kurt -- for what it's worth (very little) if what is being said about Dr Mercola is true then I agree with your and Emily's stance.

    I think Paul's blog and book are full of interesting and useful advice but by engaging with Dr Mercola it does give support to him.

    Anyway, off to Chris Kresser's blog and will read up on his acupuncture as homework.

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  64. SimonM

    I would not have any comment about who Paul associates with if I did not like him and find many of his ideas and writings quite valuable.

    It should also be noted I think very highly of Chris and he is also a personal friend.

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  65. @ Kurt, Paul and all others who have a specific POV. All of you - us - me - have biases and conflicts of interest. THe best we can do is to learn to be rigorous in identifying them and admitting them to others. But if our conflicts might or actually lead to potential or actual harm to others, then the burden is on us to recognize, admit and attempt to compensate for them so as to negate or at least mitigate that harm.

    Kurt - your weakness is in the assumption that readers know your associations, biases and beliefs across your web writings. If one is not your acolyte, one would have a high degree of risk in not knowing and/or understanding your beliefs and assertions. Consider me in this group. Moreover, your irritability and ad hominem attacks on people with whom you disagree make it that much more difficult for me to get beyond that to the rationale and evidence underlying your disagreements. In other words, lay off the insults.

    Chris Kresser also comes across to me in his blog comments as one who prickles when he perceives questions or criticism of his assertions. He routinely bristles to the extent that I quit reading his blog posts.

    Paul Jaminet largely follows the evidence and science in his mutrition assertions, but my concenrs about his inability to distinguish affability with endorsement of those who have obvious conflicts of interest in presenting nutrition assertions has led me to distance myself from his blog and related activities.

    I don't often comment and so don't expect acknowledgements or responses to my comments. But it is teeling that they are almost always ignored. Since very few blog readers comment across the blogosphere, it is salient to point out that by ignoring someone who gets up the gumption to comment and doesn't receive the time of day for it gets communicated to the majority of readers who do not engage and comment at all. For who wants to expose themselves to the likely ad hominem attacks of a Kurt Harris or the insults of a Jimmy Moore?

    Maybe someday the science will begin to catch up to the pressing needs of the populace. In the meantime, snake oil sales are robust, and there doesn't seem to be much progress in promoting critical thinking by those of us in need of chronic illness management and education for self management.

    In the end, it's always, "buyer beware".

    Caveat emptor versus primum no nocere.

    I'm skeptical of each and every one of you because there is no ability to know intent and no reason to trust.

    Best--

    aek

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  66. "We are the last bastion of sense against shark cartilage injections and calcium as the cure for everything."

    Yeah, maybe for that sort of stuff, but I wouldn't say doctors who prescribe statins freely and liberally have any sense at all either, would you? I think I would be more careful who you include among you as having good sense.

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  67. i find this back and forth here, the contemptuousness the personal attacks, the foot stomping and the ad nauseam assertions that, "but im a doctor! a REAL doctor!" to be just a gross display of hubris, petulance, and insecurity. clearly they dont teach manners and professionalism at haaaaaaahvahhhhhd. its going to take a lot more than an appeal to your authority to convince me. mercola is not one i would ever seek out for advice, but frankly this display here is not endearing you to me, either. "hes nice...and thats why hes DANGEROUS!" really? REALLY?? you lost me.

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    Replies
    1. I stumbled upon this comment section...just listened to Denise Minger hosting one of Jimmy Moore's podcasts: you can listen for free (though it is about what she wrote in her new book)
      http://www.thelivinlowcarbshow.com/shownotes/
      AJ
      http://lowcarboptometrist.blogspot.com/

      Delete
  68. @Perished

    I am indifferent to your opinion or admonishment or whatever it is exactly.

    Be assured I shall not be "laying off" anything at your command in any case.

    -best

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  69. Dr Deans,

    Since Mark Sisson was interviewed by Mercola (http://www.youtube.com/watch?v=USif6reDTBc) and Mark referenced the nice chat he had with him (http://www.marksdailyapple.com/weekend-link-love-142/#axzz1j1cu6837), does this change your opinion about Mark and linking to his blog also?

    Regards,
    Aravind

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  70. Emily-

    I guess you'll have to take Mark Sisson and Chris Masterjohn off your blogroll as well. Two more Mercola interviewees :)

    http://www.youtube.com/watch?v=USif6reDTBc
    http://www.youtube.com/watch?v=E5gNzBNgZas&feature=relmfu

    To be fair, the comments under the Sisson video do highlight the potential dangers of association:

    "mercola and sisson are batman and robin of health. forget the rest and watch these two."
    --doggieman1961

    So basically, what I'm trying to say is that you can be the Catwoman of health if you too get interviewed by Mercola.

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  71. And a comment about evidence-based medicine, as discussed above by Jack/John...

    ...I've worked at two of the fourteen federally-designated evidence-based practice centers (Tufts and Johns Hopkins), and they're not really so malevolent. Here's the scoop, from the perspective of a peon (me).

    Most centers have a specialty, like medical devices, cancer, or whatever. There is very little emphasis placed on preventive medicine, and especially nutrition. The bulk of funding for evidence-based medicine reviews is in this big federal project.

    When there is a nutrition project, they tend to be fairly dry, yet a good review of the evidence. Here is our vitamin D report from 2009:
    http://www.ncbi.nlm.nih.gov/books/NBK32603/

    So at least from this side, evidence-based medicine isn't even really trying to address nutrition. My last three projects were about PET/CT scans for colorectal cancer, blood pressure monitoring devices, and correlation issues in biostatistics.

    That being said, the unofficial center of nutritional evidence-based medicine, at Harvard, is really quite a publication machine more than anything else. As you know, much of this is just junk cohort studies and dumb proclamations of some nutrient being bad or good for you. There is some good though. For example, Frank Hu, a professor there, was co-author on the famous series of pro-saturated fat meta-analyses.
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824152/?tool=pmcentrez

    Some of the younger workers at my center have been interested in the way I eat and think. But definitely not the bigwigs. I attribute most of this to age and busy-ness. Also, many people have never even heard of paleo (gasp!).

    I do have one very tenuous connection though -- the director of the federal evidence-based medicine program lived above me in a dorm once upon a time. She probably forgets the weird dude who asked tangential questions in nutrition class. But if I ever get to talk to her, and develop a good elevator pitch for paleo, there's a .00001% chance of more funding for paleo nutrition research!

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  72. Fantastic post Emily!

    (and yeah, the Mercola stuff bothers me too)

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  73. I think after re-reading the post and comments that I agree with the overall perception of Amanda relative to the overt and covert contempt for non-physicians, those not of the Harvard brand (and that's exactly what it is),& those who question received wisdom by those with product to sell. Product ranging from supplements to Porsches to Harvard reputations.

    Consider me disappointed, but not surprised.

    Emily, I appreciate that you published my comments. Thank you.

    I will take my worthless unhealthy self back to my proper place out of sight/out of mind and will not contaminate the Paleosphere with it again.

    aek

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  74. Kamal /Aravind - that does surprise me and it does lower my esteem for them considerably. I suppose I am not surprised by Chris Masterjohn as he is very associated with WAPF and they had Mercola as the keynote speaker for their conference, which boggles the mind. However, I didn't remove PHD from the list with the first Mercola-linked post, or the second, or the third… I think it was the 4th or 5th when I finally got fed up. So if there is a scientific measure for how much Mercola is too much Mercola, I guess that is it.

    Travis - you haven't been a regular follower of my blog for long (if at all) or you might have seen the 15 or so posts on dementia and the other well-read posts on low cholesterol and links to suicide and violence where I consider statins to be very shady indeed.

    Amanda - I suppose I don't consider taking a stand against quackery to be gross hubris. It seems more like a no-brainer. I find the stance of saying it is a moral and Christian obligation to accept the invitation to write and be interviewed on a website where so much terrible advice is given out to be puzzling. I think cardiologists and psychiatrists and all of us MDs have a lot to answer for, but that's why I write the blog, to try to figure out what is outrageous and what is sober and real. If the outrageous is on the side of the "good guys," I'm going to call that out too. If I don't, or Mat LaLonde doesn't, or Kurt Harris doesn't, or Richard Feinman doesn't, then who will?

    I have no personal beef with Paul. I like him. I think he has valuable ideas and many parts of his book are some of the best from a "paleo" book anywhere. There is quite a bit I disagree with or haven't made up my mind about - the breastmilk as the basis for adult dietary macronutrient ratios being one of them, the aggressive treatment of pathogens in all cases another (not without more data, particularly with long term antibiotics because they can have devastating and unexpected side effects), and even the supposed glucose deficiency idea. None of those are a reason not to read his blog and I'm sure he's more than open to having a conversation about it.

    Perished - not sure I'm following the thread of your emotional journey here through the comments. Feel free to comment or not as you choose.

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  75. I don't follow the reasoning as to the disassociation with Jaminte, Sisson or Masterjohn. I read the post a couple of days ago and the subsequent comments last night. I fully understand why those 3 gentleman would go on Mercola, or a Gary Taubes would go on Dr Oz. If you believe in what you're preaching you're going to try to reach as wide of an audience as possible. Those three individuals get decent traffic I'm sure but I'm just as certain that it pales in comparison to a Mercola. What seems to have gotten the short shrift in this discussion is the types of people who make up Mercola's audience. I would imagine that many of them are like myself and many others in the paleosphere who have had many physicians- Ivy league trained and otherwise- fail them miserably. As many of us subsequently found out, in medical school, these physicians get a horrifically miniscule amount of training in nutrition. In the book Death by Prescription, M.D Ray Strand notes

    “In medical school I had not received any significant instruction on the subject. I was not alone. Only approximately 6 percent of the graduating physicians in the United States have any training in nutrition. Medical students may take elective courses on the topic, but few actually do… the education of most physicians is disease-oriented with a heavy emphasis on pharmaceuticals — we learn about drugs and why and when to use them.”

    With regards to how many of us have been failed by the medical establishment, is it any wonder that some of them end up with the fisherman who casts the widest net? I'm not a Mercola reader or fan but one thing I have noticed during my journey back to health is that when I google specific questions concerning diet in an ancestral eating context, Mercola articles often pop up. From those that I've read, many of them are well written and line up with what I've read on various paleo blogs and sites. As for the woo, I can't speak on it because I haven't gone there looking for it. That type of thing I don't have time for, however, I would caution though, that he who is without sin should cast the first stone. Off the top of my head, just in the past couple of years I've seen many prominent paleo bloggers and the overall zeitgeist change on many issues- from low-carb being the default paleo diet to fish oil calculators to potatoes and rice, to acid balance theories.

    I say all of that to support the notion that Paul, Chris and Mark are indeed right to try to reach the widest audience possible. I would look at them cock-eyed if they didn't. Like him or not, Mercola has a wide net and he has people who listen to him and if showing up on his show enriches people's understanding, then it's a net positive.

    PS. I found it disheartening that P Jaminet felt the need to defend himself for being too nice. Really? I've only been reading Paul for a few months- prior to that I read Archevore religiously, and still do when KGH posts- but he strikes me as one of the most level-headed and intellectually honest nutrition bloggers out there. He has the type of personality that can, and I predict will, reach many out there who have found Mercola.

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  76. @Emily: I wasn't lumping you in with the statin machine. My bigger concern is for all sorts of quackery, including that which the medical community status-quo embraces. For example, to me, the diet that the American Heart Association recommends is pure quackery. I am relatively new to your blog, but I am very aware of the horrible side-effects of statins. I'll have a look at your posts.

    My more general question is how does one carefully define "good sense" when it comes to doctors? What truly defines the measure of a good doctor? Are doctors today actually healers or detached specimen observers? My experience has been that too many are in the latter category. Unless I can make a human connection with a doctor, I don't return for another visit. I expect professionalism and clinical expertise, but I don't care for emotionless doctors with cookie-cutter solutions who do not listen.

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  77. >They were excited by B vitamins lowering homocysteine. Then it turns out that vitamin E made everything worse. Lowering homocysteine didn't prevent heart problems. Chromium maybe hurts the liver.

    Is this conclusive? I did not know vit Bs did not lower homocysteine or that Cr was bad for the liver (I thought all those problems were ruled out).

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  78. "I think he has valuable ideas and many parts of his book are some of the best from a "paleo" book anywhere" - I completely concur. I think Paul Jaminet is one of the most intelligent and thoughtful scientists in the Paleo community.

    Regarding PHD and optimal macronutrients, human breast milk is ONLY ONE of the considerations that led to the development of his macronutrient recommendations. I, for one, eat very high carb but still find PHD overall to be excellent. Reasonable people can disagree without throwing the baby out with the bathwater.

    Moreover, to date Kurt Harris has been my go-to guy and I have not been shy to mention this on the Internet. At a pragmatic level, the Archevore and PHD approaches are virtually indistinguishable, a few subtleties notwithstanding.

    To quote Kurt -

    http://perfecthealthdiet.com/?p=4802
    "I think our readers should be reassured by the convergence or coincidence in the substance of our recommendations because they do arise from different approaches."

    http://www.archevore.com/panu-weblog/2011/9/29/jimmy-moore-inquires-about-safe-starches.html
    "My arguments are based more on ethnography and anthropology than some of Paul's theorizing, but I arrive at pretty much the same place that he does"

    And the argument with Jack Kruse here - http://livinlavidalowcarb.com/blog/is-there-any-such-thing-as-safe-starches-on-a-low-carb-diet/11809
    "Try sticking to your crackpot theorizing rather than knocking a radiologist and physicist for the "madness" of thinking you might not die if you eat a potato....".

    Regarding the last quote, I think there are a few other quacks that are directly associated with Paleo/Ancestral Health that seem to be getting a "bye". They are of much greater concern to me than Mercola.

    For the record - Paul Jaminet is a class act and pretty damn intelligent. The fact that he is a nice guy is an asset, not a liability IMO. I hope to grow up to be like him. Not likely but one can hope.

    Regards,
    Aravind

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  79. Dr. Deans, it was a thoughtful and important post, and I enjoyed reading it. In regards to the petition about article in the NYtimes, I signed it basically for the same reason that outlined by Dr. Parker. I guess sometimes my personal preference is to allow more latitude in accepting ideas because maintaining extreme scientific purity can be limiting, especially when there significant paradigm shifts, at least from my perspective.

    I think the jury is still out in regards to the exact, exact undeniable cause or causes of obesity. Insulin seems like a real reasonable argument, and likewise, I am also willing to toss that out should new information become available that works better. It has, I understand, but I don't think insulin will never be a player. Does anybody think that? Maybe that's the question to ask.

    I also think one of the reasons people didn't sign the petition is because of Gary and Stephan's exchange at the AHS, and Gary subsequently making what Kurt Harris rightly called the contrapositive error regarding carbs. So signing the petition becomes then for many a referendum on Gary Taubes, etc. That may be as problematic as a simplified petition.

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  80. Aravind - it's a jungle out there. I suppose posting material on someone's site, driving traffic there, and makin them money is part of the issue for me.

    Gabriel - b vitamins do lower homocysteine but it doesn't affect cardiovascular risk (except maybe stroke). I need to look more clOsely at chromium to intelligently answer that - in RDA doses with a healthy liver I'm not going to worry.


    Dr ostric - I think there are valid reasons to sign that petition, certainly. I just wish he hadnt been so so specific because it felt to me like a personal vendetta against obesity researchers by Taubes. Maybe I'm reading that wrong but I wanted to err on the side of not signing if I have to be in error.

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    Replies
    1. Dr. Deans, as you know, science is not always a genteel place, there are tete-a-tete battles all the time. Certainly, incivility is not to be tolerated, and you don't, it's your hallmark(and certainly one of the reasons for the passionate readership of your blog, for sure), but the struggle to get ideas out there, even in the most proper ways, is not a sport totally free from contact, though we could probably do without the guerilla warfare that goes on in the blogosphere. I respect your opinion...

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  81. Wow, this discussion is really taking off. Emily, you should do rants more often. I hope you aren't seriously considering dropping comments as you mentioned a while back.

    @Kurt Harris
    "If Mercola were to offer to interview me, I would refuse. And I actually regret doing interviews with Jimmy Moore and participating in the "starchfest". Jimmy's show is a way to reach people but it has all the morality of a TV reality show these days, and I'd rather not be someone's entertainment when their whole message is based on mass deceit and selling low carb garbage."

    Kurt, I think this is the perfect being the enemy of the good. Information just wants to be free, and that works more than ever nowadays. I don't see how it is somehow 'immoral' to have an interview with Jimmy. It's not like he blindsides his intervieweees (like Taubes on Oz), AFAIK he's always cordial whether he's interviewing vegans or hardcore atheist paleos. Obviously he has his viewpoint but he puts the info out there, or lets people put it out there in their own words. It's a great service and it is free because he has sponsors. In my opinion LLVLC is a great example of the free flow of information and the free market.

    And while I'm criticizing one of my heroes I'm gonna take issue with this:

    "Taubes' petition explicitly invokes the CIH as the explanation for obesity. Now that it is 2012, I think this can be fairly characterized as dietary quackery."

    CIH as dietary quackery? I don't necessarily agree with it, I'm rather agnostic on the idea, but I think it is a bit early to relegate CIH to the dustbin of history along with leeches and Boney M.

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  82. I find the little I know about Mercola to be a turn-off. Yet, I did not get the impression Paul Jaminet was endorsing Mercola and all of his ideas.

    Just my 2 cents.

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  83. "There is quite a bit [in Paul's ideas] I disagree with or haven't made up my mind about - the breastmilk as the basis for adult dietary macronutrient ratios being one of them, the aggressive treatment of pathogens in all cases another (not without more data, particularly with long term antibiotics because they can have devastating and unexpected side effects), and even the supposed glucose deficiency idea."

    Emily, I think many of us would be most gratified if you fleshed out these differences of opinion. My interest was piqued when you first alluded to disagreements/reservations in PHD blog comments, and have been quietly waiting for you to eventually address them. TIA :)

    @praguestepchild/Sean - Whatever I may think or have said about your comments elsewhere in the blogosphere, I wholeheartedly agree with your take on applied scientists 'vs.' physicians, or if/why there should even be a 'vs.' at all. Thank you for articulating it so thoughtfully.

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  84. If we are going to go all Biblical on this issue, don't forget the Cleansing of the Temple, where Jesus drives out moneychangers who had set up in the Temple and were profiting exorbitantly from their greedy trade. Jesus told his followers to welcome sinners to worship with them, but he had no issue with calling out people who profited by deception. It puts Jesus squarely in the camp of the many sages of the Old Testament, who risked their lives to call out bullshit. It reminds of a sermon by Horatius Bonar

    "I know that charity covereth a multitude of sins; but it does not call evil good, because a good man has done it; it does not excuse inconsistencies, because the inconsistent brother has a high name and a fervent spirit. Crookedness and worldliness are still crookedness and worldliness, though exhibited in one who seems to have reached no common height of attainment."

    With Mercola, it's clear to me that his desire to make money comes before his integrity and that he profits from scaremongering and sensationalism. I think people in this community are afraid to criticize that kind of behavior because they also know he is a powerful marketer who has brought some good ideas to a wider audience. I would not say that folks that collaborate with him are responsible for his actions and therefore tainted by associations, but they should remember that they are contributing to the profit of his low-quality content farm, which people take seriously enough that they are willing to not vaccinate their kids based on his scare-mongering,

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  85. I don't follow the reasoning as to the disassociation with Jaminet, Sisson or Masterjohn. I read the post a couple of days ago and the subsequent comments last night. I fully understand why those 3 gentleman would go on Mercola, or a Gary Taubes would go on Dr Oz. If you believe in what you're preaching you're going to try to reach as wide of an audience as possible. Those three individuals get decent traffic I'm sure but I'm just as certain that it pales in comparison to a Mercola. What seems to have gotten the short shrift in this discussion is the types of people who make up Mercola's audience. I would imagine that many of them are like myself and many others in the paleosphere who have had many physicians- Ivy league trained and otherwise- fail them miserably. As many of us subsequently found out, in medical school, these physicians get a horrifically miniscule amount of training in nutrition. In the book Death by Prescription, M.D Ray Strand notes

    “In medical school I had not received any significant instruction on the subject. I was not alone. Only approximately 6 percent of the graduating physicians in the United States have any training in nutrition. Medical students may take elective courses on the topic, but few actually do… the education of most physicians is disease-oriented with a heavy emphasis on pharmaceuticals — we learn about drugs and why and when to use them.”

    With regards to how many of us have been failed by the medical establishment, is it any wonder that some of them end up with the fisherman who casts the widest net? I'm not a Mercola reader or fan but one thing I have noticed during my journey back to health is that when I google specific questions concerning diet in an ancestral eating context, Mercola articles often pop up. From those that I've read, many of them are well written and line up with what I've read on various paleo blogs and sites. As for the woo, I can't speak on it because I haven't gone there looking for it. That type of thing I don't have time for, however, I would caution though, that he who is without sin should cast the first stone. Off the top of my head, just in the past couple of years I've seen many prominent paleo bloggers and the overall zeitgeist change on many issues- from low-carb being the default paleo diet to fish oil calculators to potatoes and rice, to acid balance theories.

    I say all of that to support the notion that Paul, Chris and Mark are indeed right to try to reach the widest audience possible. I would look at them cock-eyed if they didn't. Like him or not, Mercola has a wide net and he has people who listen to him and if showing up on his show enriches people's understanding, then it's a net positive.

    PS. I found it disheartening that P Jaminet felt the need to defend himself for being too nice. Really? I've only been reading Paul for a few months- prior to that I read Archevore religiously, and still do when KGH posts- but he strikes me as one of the most level-headed and intellectually honest nutrition bloggers out there. He has the type of personality that can, and I predict will, reach many out there who have found Mercola.

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  86. Wow, you really touched a nerve there!

    As a non-scientist who is following the debate as best I can in the hope that you smart people will figure it out & publish the results so I can just for the sake of all that is holy finally lose some of this godforsaken weight, I can see a couple of viewpoints here. (That sounded sarcastic but it's really not, it's just that I can't follow the science & don't have time to try to figure it out, I need answers & I realize there aren't any at the moment so I read a lot of blogs while I'm waiting. I think you're all almost there so it's exciting.)

    On one hand, do the scientists & doctors in the crowd have a responsibility to disseminate the information they hold as widely as possible, which might involve being interviewed by people they don't like, respect or agree with in order to get said information in front of said unlikeable folks' followers?

    Or would it be better to restrict your thoughts to your own blog & link to a few carefully chosen sites whose philosophies mirror your own, who aren't selling out or who are at least doing so tastefully, and who have nice-looking websites? I think I know which way I'd go, but I don't have a Harvard reputation to protect and to be fair, have no idea what's at stake for those who choose one way or the other.

    I do wonder, though, which approach is more likely to be successful at changing those frustrating, hidebound, silverback attitudes amongst the medical/pharmaceutical/scientific establishments, which includes the Mercola's & Oz' of the world?

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  87. I probably won't be getting a response to this, but Kurt, I was hoping to get a better understanding of this "affiliation-deprecation" situation that you are, more vividly than others, describing.

    "Be assured I shall not be "laying off" anything at your command in any case.
    -best"

    If anything I think a snappy, "I'm gonna get the last word in and make sure he knows it" type of comment is much more solid ground to base your decision on how to view someone, rather than an event such as Paul's attempt to correct misinformation.

    I like to think of this as the original event that took place between Guyenet and Taubes at the AHS (?). Stephan exerted grace, while Taubes came off like a condescending whatever you wanna call it. It was the classy "thank you" that set Stephan apart from whatever negative spin Gary's criticisms, or just his demeanor, attempted to overshadow the lecture with. Paul's "niceness" is exactly the same in that respect. Better put, it is the dignity with which he conducts himself, and the thoroughness on which his scientific conclusions are based.

    Just as a side note--I understand that we never really outgrow our child like tendencies (i.e. if you hang out with a loser, people will think you are one), and so now that we're aged veterans we can spout off some more sophisticated reasons, like credibility and such... But have you ever come to think of whatever movement this paleo diet started as progressive? Besides the obvious reasoning that dietary dogma is constantly refined based on new research and new criticisms of it? What I mean is I saw Mercola's website way before I knew anything about paleo, and I believed it just about everything that I saw at the time; just like I believed grains were good and fat was bad. But now, after being exposed to quality information and quality critical analysis, I have a new standard with which I discern quality and bunk. Just as this dietary movement has been progressive in what's good and what's bad (e.g. carbs bad...maybe not so bad...depends on the situation..), so has my, and hopefully everyone else's, development. Just as curtailed my credulity in such matters, I have also made sure not to be overzealous. So in short, when I got to Mercola's site now I still fall prey to all the shiny ads, but when something offers me a cure for cancer (or whatever), I make sure to do the diligent research without bias in either direction.

    @Paul-- I had a former professor obsessed with Mercola's dietary advice, all (my) attempts at converting him to a more PhD diet were unsuccessful. When you posted that interview up on his site a little while ago I quickly sent him the link to look to his beloved shrine for guidance. He is now on his second (or so) week on your diet and feeling better than ever. Mission accomplished =)

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  88. I think it's important to distinguish between different scenarios: some people are making money from a site/podcast that provides content to an audience. I think most of us would agree that there is nothing wrong with that. People need to make a living. Some people are MDs, some interview podcast guests, and some write books/blogs. The problem is when the desire to make money is greater than the desire to maintain one's integrity (as Melissa pointed out).

    I'm a long-time listener of Jimmy's podcast, and I think he provides a very valuable educational service. Of course, not all the guests are equal on the quack-pristine integrity continuum, but that doesn't matter to me. Jimmy is basically an interviewer--he allows the guest to put info out there and the listener judges. Of course he has an agenda (based on his personal experience and the brand he has created) but his integrity is not in question, because he is not making himself out to be anything except an interviewer.

    Robb Wolf is in the same category. He is of course making money from his book (and he also sells products, although he doesn't promote them very vigorously ;-), but that does not put his integrity into question. He follows the research, and readily admits that he may have been wrong about a few things in the past. Of course he wants to make a living (just like MDs do) but his integrity is more important to him. He does not claim to be anything that he is not.

    On the other hand, a doctor putting bullshit information or advice out there to make money (or selling a product that is not backed by solid research) is a different story. I am not familiar with Dr. Mercola, but if he is handing out garbage advice in his capacity as a doctor, than obviously his need to make money is greater than his integrity.

    Then there is the question of whether associating (link/interview etc.) with someone in this second camp is enough to damage a person's integrity. I think this is more of an individual call: for Emily, obviously, associating with a person of low integrity via an interview etc. is enough to get you booted off her "Of Like Minds" list. Some people may take a broader view, and consider that reaching a larger audience with a message they believe in is more important. I think both of these approaches are OK, and each person's choice depends on who they are and the approach they have adopted.

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  89. Dr. Deans, good point. I totally respect your decision, and I have the sense you didn't sign it for a very good reason. Wow! What a long comments section! It seems some people here could really benefit from a gluten rich diet, personally, because they could use a little stimulation of their endocannibanoid receptors and chill out. I did write a post on my blog called "Food is Morality" and I think what you see is that you can separate food science from morality in theory, but not in reality. We are passionately morally motivated, and it shows itself in food for sure...

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  90. Well, with several days reflection I think this comment thread has been a valuable discussion, if not always comfortable. The glass house comments are noted - though I didn't mean to mention Harvard to suggest it was perfect. But I have a lot to answer for and a decent background for evaluating information, and I take that background seriously and soberly. Nor do I think an indictment of some bad alternative medicine naturally means that conventional medicine is off scott free. Not by many means. Though I think if one reads the thoughtful literature there is a great deal of caution in the interpreation. How that translates into clinical practice and official guidelines is an entirely different matter. My point in this context is alternative or traditional does not always mean safer.

    Some doctors are jerks. Many are misinformed and haven't bothered to question the status quo - and frankly, due to the pressure to conform to "standard of care" it takes a great deal of confidence to deviate. IF you deviate, you better be damn sure and document very well. These facts do not excuse the misinformation and the ignorance - and I believe I've put this question out as a moral one before - when does ignorance become real evil?

    On the other hand, willfully ignoring and misrepresenting the evidence for profit is far more the mark of a sociopath. Such a circumstance is not pitiable, it is despicable.

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  91. Whoa. Just had to moderate out the first comment in this thread. And3rew (or something like that) - try to make them a little more constructive and less plain mean-spirited.

    Maybe I will close comments for this one anyway. I have to think about it.

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  92. "when does ignorance become real evil"

    It's a great question and an exploration of it tends to put a lot of people outside their comfort zone. Like other important and uncomfortable moral questions such as abortion/when does life start, or the role of government in society.

    "On the other hand, willfully ignoring and misrepresenting the evidence for profit is far more the mark of a sociopath. Such a circumstance is not pitiable, it is despicable."

    I don't think Mercola is willfully ignoring evidence any more than PCRM or CSPI is (not that I know much about Mercola). I think they are all true believers. Whether or not they make a profit or have a non-profit pressure group that pays them salaries and gets them interviews on major news networks I think people are able to rationalize the truth when it suits their circumstances and especially their social status.

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  93. Great post Emily. Greetings from a fellow MD in Finland, trying to walk the same narrow line :)

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  94. Dr. Deans, I am one of those PCP that struggles with the day to day work of treating 3,000 people from cradle to grave. I am the one accountable to these people. I am also judged by insurance companies, my employer, my patients, and the government. I spend countless hours a week doing paperwork. Time that would be much better spent reading primary research. The current system is making primary care docs dumb. I started hearing about Paleo a few years ago and thought of it as misguided to say the least. I finally read a couple of Cordain's books then Wolf's books and was surprised by the well thought out and scientific approach they took. But, when it comes right down to it I have very little time to read so and so's blog and so and so's book. There is dictating, prior authorizations, FMLA forms, refills... that need to be done for real people right now. I get so frustrate listening to podcast and reading so many posts telling me how heartless, dumb, and corrupt us PCPs are. We try to keep up with these things, but we just don't have the time. About 5 months ago I started a small blog mainly for my patients to help explain the Paleo diet and give them an alternative to the Food Plate, but even this little website is putting my neck on the line. Recommending real foods without grains, legumes, and most dairy is heresy. I actually got a complaint from a mother for recommending red meat to her daughter for iron deficiency. I had to respond to my employer for the allegation of giving unsound medical advise. Now I just need to wait for someone to choke on a nut and have their spouse sue me for negligence.
    Anyway, thanks for the forum for the rant. If you want to stop by my blog it is www.paleofamilydoc.com

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  95. Dr. Deans, thank you very much for this post.

    As often happens, I will have a strong hunch about something, and then you articulate the truth of the situation, naming the facts and the difficulties. And, all of that nicely enfolded by your common sense, and care for what matters, which is a rare delight.

    Thank you, too, for leaving in the comments. You and Dr. Harris are so wonderfully adept at separating the chaff from the wheat.

    All the best to you. :)

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  96. Hi, I just wanted to ask you about your link to
    Holistic Adult & Child Psychiatry and specifically her post:
    Planetary Destabilization and the Hummingbird Response
    Do you consider that science?

    Woah.

    I am still a big supporter of your writings,though.
    Kriss

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  97. Is there such thing as a glucose deficiency? Do we really need 200-400 calories from "safe starches" ? Tough I already talked to many docs, you and Dr. Harris are pretty much the only people in the paleo community whose knowledge I trust and value and I would appreciate to know your opinion on the matter. I would also like to know what do you think of the Leptin Reset by Dr. Kruse. You probably won't want to answer and I understand, you may like them as professional collegues but just wanted to know if you respectfully disagree with their thoughts and why. :)
    Greetings from Portugal and please don't stop writing!

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