Marshall E. Deutsch at TAM??

[Eos of the Eons]

was appalled to see that one of the speakers scheduled for The Amazing Meeting 4 is Marshall E. Deutsch, who is going to repeat the nonsense about cholesterol that he wrote about in Skeptic magazine and that I thought I had demolished in my response in the next issue. He essentially threw out the entire body of medical knowledge and practice in lieu of his own reading of an encyclopedia and of one popular book about cholesterol myths.


http://www.ssr.com/cgi-bin/ezmlm-cgi?1:msp:104897:fbeobbnoeehjaabalggh

The doctor who wrote this will be at TAM. I would hope she fires off some questions to Deutsch.

[The Central Scrutinizer]

Where do you get this? I don't see him listed anywhere.

[Loon]

He's presenting a paper on Sunday.

[The Central Scrutinizer]

I think I'm parked in Room #2 the whole time, so I won't see him.

[cosmic]

One of the great things about skepticism is that sometimes those outside a field can have insights that the practicing body might not see. Randi has many a great story about scientists fooled by magicians for instance.

I'm not saying that Mr. Deutsch has such insight... so now we'll see if he can stand up to critical questioning.

The fact that Skeptic Mag published his article played a role in his invitation on Sunday.

Although, I only saw the heated response letters in the next issue after the invitation was made.

Eos, I agree-- I hope Dr. Hall (the MD) is there to add her perspective.

[kittynh]

yeah....

because it sounds like his thinking is much like that of many an alternative medicine person.

When it comes to medicine, I think I might rather have a doctor than a magician (except in the Phillipines).

I mentioned this theory to my physician and she went balisitic. Just because she said that good health is a matter of hard work, and short cuts are always welcome. She said you check check check and double check through the proper medical journals and avenues before you go out and get that infomercial. She was confusing him with someone else we all know and do NOT love, but the point she was trying to make was that medicine IS playing with human lives, and there is a proper protocol for a reason.

I didn't get it all being an artist. I've found medical care that I trust and seeing that my doctor is in Vermont I drive by about 4 different alternative practices to get to her office. She HAS to keep up on this stuff as the use of alternative medicine is so pervasive in Vermont. So she was glad I brought this to her attention.

My husband had a cousin that smoked only an important brand of Asian cigarettes because the people that smoked this brand (from a small part of China) did not suffer from lung disease or lung cancer. She read a few studies that "proved" these were safe. She died in her 40's from lung cancer. She knew smoking was bad, but since quitting was so hard she found an alternative.

Sorry side rant. But throwing out medical advice even if you add in "this is just my theory" can be sometimes dangerous. There is a reason for the system as slow and ponderous as it seems at times.

[Eos of the Eons]

Thank you kitty, and to all those who responded. Will anyone try with questions if the mic doesn't make it to Dr. Hall? Her response is in the link I provided. Please read it if you haven't already, and go prepared.

Another response from the origination:

Now I wish I got tickets to TAM4. The Q&A after this lecture alone
would be worth the price of admission.
http://www.ssr.com/cgi-bin/ezmlm-cgi?1:mss:104913:fbeobbnoeehjaabalggh
:)

[Eos of the Eons]

*Bump*

So, how did it go?

[geni]

One of the great things about skepticism is that sometimes those outside a field can have insights that the practicing body might not see. Randi has many a great story about scientists fooled by magicians for instance.


Equaly those out side the field can produce a load of rubish. While Randi is in a far better position to deal with magicians than me I doubt he is going to be able to match my knowlage of say organic synthesis.

[Mercutio]

*Bump*

So, how did it go?
Paper presentations are on Sunday, I think. So the question is "how will it have gone?"...or maybe not. I think I need to go to sleep.

[Eos of the Eons]

Oh yeahhhh.

Man, one more day, then we can razz those brats!

[Loon]

There was one question asked of Dr. Deutsch. It was probably by the MD mentioned in the opening post. She had a prepared question that was very long and was more of a challenge than a question. To the best of my recollection, it consisted of her saying "you never responded to our criticisms and lots of people disagree with you." It sounded much like a supreme court confirmation hearing.

Deutsch said that two responses were forthcoming in the next issue of Skeptic.

Because the question was so long, there was no time for others to ask questions. I think it would have been better if she hadn't been there.

[Eos of the Eons]

Thanks Loon, as much as it seems to be bad news. I'll be looking forward to the issues of Skeptic then as well.

And, I'll happily report that at least 3 out of 5 fellow co-workers are skeptical of chiros at work! My boss's last trip to one was also not satisfactory. She noted that her massage therapist did more for her. She may yet be one that stops going to see one :)

[Eos of the Eons]

I found Harriet Hall's version of things, and I find it good news:

http://www.ssr.com/cgi-bin/ezmlm-cgi?1:mss:105167:ddchaeoommpdnhogpdgf

I said that multiple systematic reviews of the literature all agreed that (1) cholesterol is an independent risk factor for heart disease, (2) lowering cholesterol lowers risk of heart attacks, and (3) if you already have heart disease, lowering cholesterol not only reduces your risk of heart attack, but also reduces your risk of death.

I also recommended that no one change their diet and medication on the basis of what they had just heard without first contacting their personal physician about their individual case...

I think there are two issues:
what the evidence shows about cholesterol as a risk factor,
and what recommendations are made (which is more a matter of opinion).

I think he is so upset about what he perceives as bad recommendations that it has impaired his ability to view the evidence objectively.

He belongs to the International Network of Cholesterol Skeptics. A visit to their website might be of interest to listmembers: http://www.thincs.org/index.htm.
It reminds me a bit of the anti-vax and other websites that collect lots of
evidence on one side but fail to provide any balance.


As laypersons it is hard to get the pertinent information out of such an exchange. It would be hard to evaluate Deutsch's information as well. I just wondered why Deutsch even wanted to present, I guess as a skeptic of medical information? What are his credentials? I can't even dig up where he was educated or works/worked. He is listed as a chemist/inventor. I took organic chemistry in college...but I don't think that would allow the title of chemist, so I wonder how he adopted the title.

I find it an interesting chance to exercise critical thinking though. What would happen if an anti-vaccination person presented? It would be interesting!

[Loon]

His credentials were mentioned in his intro, and they seemed fairly impressive (and are probably true, since the lady who challenged him didn't challenge his credentials). He's an analytical chemist, not an MD.

Of course, Dr. (?) Hall's stating her opinion doesn't really help things much since us layfolk are just watching what is essentially dualling authorities. I would much have prefered if she had just asked him a single question to poke a hole in his theory.

[The SkepDoc]

Credentials are irrelevant; authorities are irrelevant; opinions are irrelevant. What matters is what the evidence shows. Deutsch got some of his facts wrong and misinterpreted others. For the record, I am the lady who challenged him. I am a long-time skeptic, an MD, and have written several articles for Skeptical Inquirer and Skeptic magazine, including a rebuttal to Deutsch in the issue following his article. I have contacted Deutsch by e-mail to start a discussion which I hope to bring to this forum. I will post my initial e-mail to Deutsch under a new thread: Cholesterol Myths. I am doing this to attract people who are interested in the cholesterol issue who may not read this thread because they don't recognize Deutsch's name.

[Eos of the Eons]

Hi! And welcome! I'm so excited to see your post and will look forward to that awesome thread:thumbsup:

[geni]

Credentials are irrelevant; authorities are irrelevant;

That would depend on the situation.

[HawkeyeMD]

I was at the meeting, heard the paper and spoke to that doctor afterwards.

I'm new here, but I'm a second-year medical student and I'd like to say just a couple of things because I think I can provide a middle-ground perspective:

First, the gentleman's credentials were not terribly impressive to me. I'm sure he has the degrees he says he has and that's great. He certainly knows more about chemistry than I'm ever going to. But what you all who so capably participate on this site can do that he cannot is pretty simple: he can't think critically. (See Randi's great line about the limitations of people with PhDs.)

Second I have to take gentle exception to the person who said it would have been better had the MD not posed her question. She was exactly the right person to address him. I was ready to jump up, but he probably would have demolished me because I wasn't prepared with citations (or an advanced degree). She asked him to reply to any of (I think) four succinct and direct challenges to his paper. He didn't. He just rambled on and avoided the questions. Which goes to show you, right there. He *knew* he couldn't bluster through it, because she knew both his evidence and her own. This is why it's problematic to get scientists to go up against creationists, too, but I digress.

Last, it is not that difficult to evaluate the evidence for yourself, whether you're a doctor or a med student or an artist. (And I was an actress before I went back to school, so I should know. ;) ) The difference is whether you think critically about what you're reading or not. I'm not in any privileged position and neither is an MD--the literature is out there.

I have to say, one great way to boost the sales of your book is to "explode a myth". If you can claim something that everyone "knows is true" isn't, you get a lot of attention. It seems to me that this guy has just found the joys of tapping into that market. (Or maybe not. I have no idea what he did before he showed up at TAM4.)

Anyway. Long-winded way of saying it, but the further I go in med school, the more tired I get of the paranoia that revolves around health care. Okay, off to read the other thread.

[Eos of the Eons]

Thank you so much for that HawkeyeMD.

I have to say, one great way to boost the sales of your book is to "explode a myth".

He's selling a book? Sounds typical. He does remind me of the anti-vaccine crowd as well. Take something that helps people (reducing cholesterol) and tell them they are wasting their time watching what they eat, take something to lower cholestrol, etc.

What is his alternative? What does he suggest to reduce heart attacks?

I'm kind of a normal size, not skinny, not fat, but cholesterol is high, and so is other family members'. We just don't have a high rate of heart attacks in the family, and live a very long time, for the most part, without ever having a heart attack.

Thing is, everyone is an individual, and I think my cholesterol measurement may be high because it's not clogging up my arteries (stationary) and can come out with my blood? Is that crazy thinking, or where can I go to read up on individual cholestrol levels?

We do eat healthy for the most part, and stay active, and don't store a lot of fat (high metabolisms).

The only person I've met with heart related problems does love a high fat diet, smokes, and drinks quite a bit. He has gotten healthier and fitter since taking on a better diet, eating more fibre and walking. You now can barely tell he's had a surgery for a clogged artery.

So what is the alternative if we ignore cholesterol levels? What is Deutsch suggesting exactly?

[The SkepDoc]

He didn't write his own book; he's just promoting a book by Ravnskov. He's also a member of the International Network of Cholesterol Skeptics. They have a website, if you're interested. So far I haven't heard him say anything positive; he seems only interested in debunking.

As for personal medical advice, doctors don't have crystal balls and can only predict risk of heart attack based on statistics for known risk factors. This is best sorted out with your personal physician. Generally, the evidence shows that whether your cholesterol level is high or relatively low, you can probably reduce your chances of a heart attack by lowering your cholesterol further. The greater your overall risk, the greater the benefit of lowering cholesterol. See the thread on "Cholesterol Myths."

[HawkeyeMD]

Indeed, apologies; I didn't mean to insinuate he was selling his own book. He was clear about a number of other books, most particularly "The Cholesterol Myth", not being his own.

That said, it would not surprise me if that is in his plans. I do think that alternate or opposing viewpoints are valuable and should be included in skeptical events, but it does concern me that this guy will be getting a lot of mileage out of "I was published in Skeptic Magazine" and "I gave my paper at TAM4", as if those were endorsements.

My last post was running waaaay too long already, so I'll just say that apart from the other thread and The SkepDoc's excellent summary above, it wasn't that hard to see what was wrong with the guy's arguments. He did a lot of citing of articles and then used the results as arguments for entirely different and unwarranted conclusions; he used obfuscatory jargon (continually referring to 'total blood cholesterol', for example, when it is now considered to be HDL/LDL ratios that are more significant) and he did a lot of setting up of straw men. It was a truly classic performance.

[exarch]

I saw his lecture (because I remembered Eos posting this thread).

What I particularly remember was:
The guy was picking highly inaccurate numbers (like death rates from heart attack?) out of an encyclopedia I think, and then picking more inaccurate numbers from another source. And then he proceeded to plot those on a graph trying to show how apparently death rates and cholesterol levels didn't seem related.
Then what also really struck me was when during his flustered response to Dr. Hall's (?) question, he at one point started saying how his own cholesterol was really high but he'd never had a heart attack before. I mean, wow, anecdotal evidence, a sample size of one. On a skeptics convention that's the equivalent of shooting yourself in the foot repeatedly.

Perhaps there were some valid observations in his presentation, but he lost most of his credibility along the way just with all the fallacies he made.

[Eos of the Eons]

Really good observations exarch, and the most detailed one we've seen here on how he presented. It sounds rather unusual, to plot a graph based on those kinds of data sets in front of an audience. I would be left to think the guy doesn't know to, or doesn't choose to take relevant data from a clinical study with a discussion relevant to his subject?

It would be like myself taking disease rates for malaria from a book, and then saying the vaccination doesn't work...ignoring the fact that the folks haven't had the vaccine because it doesn't exist yet. You just have no way to assess the variables when someone takes on random numbers like that.

I'm just glad this guy didn't get away with quietly blathering on to an audience that would have been left scratching their heads as to what his point actually was in all that. I would think his "published" material in the one magazine is what got him a spot to present?

Thanks to all those who went and got to experience a rather unusual situation. It's an exercise in evaluating what is presented, no matter when and where.

[med41]

[QUOTE=Eos of the Eons;

The doctor who wrote this will be at TAM. I would hope she fires off some questions to Deutsch.[/QUOTE]
Dr. Hall and I have been corresponding about her criticisms of my talk, and she has not yet replied to my pointing out that the recent widely publicized study from the Journal of the American Medical Association on 48835 women, some of whom were fed a low-fat diet high in vegetables, fruits and grains and the rest of whom continued their usual diets showed the following results. The low-fat diet group showed a significant reduction (by 3.55 mg/dl) in LDL (the so-called bad cholesterol). The low-fat group showed "no significant effects on incidence of CHD [coronary heart disease]". This, the largest study of its kind, shows no relationship between LDL and CHD.
The first thing that Dr. Hall pounced on was a statement in my talk that you cannot produce atherosclerosis in rabbits (which normally eat a cholestero-free diet) simply by feeding them cholesterol; you also have to give them an antithyroid drug. I should have said that you can't produce atherosclerosis in rabbits by feeding them any amount of cholesterol which can be obtained in a normal diet. The food with the highest cholesterol content is egg yolk, which contains slightly less than 1.5% cholesterol. To give rabbits atherosclerosis, they are fed 2% cholesterol, more that would be supplied by a diet of only egg yolks.
I expect that the few criticisms which my SKEPTIC article elicited will be answered in the next edition of SKEPTIC. I invite dialogue with those who have actually read the article and can make substantive criticisms of my facts and reasoning. I have no economic stake in this unlike the pharmaceutical companies and the beneficiaries of their extensive "educational" programs.

[The SkepDoc]

I most certainly have replied. See the thread on Cholesterol Myths. Exchange #5.

[Eos of the Eons]

Thank you for the clarification again SkepDoc.

I'm working on another analogy for that scenairo to see if I understand this.

Let's say we take a group of people from the population with a low incidence of milk allergies, and see if not drinking milk decreases their chances of getting a rash.

Since the non-allergic folks had a low rate of rashes, and got rashes for reasons other than milk allergies, then we would EXPECT that not drinking milk would have no significant reduction in rash rates.

Now take a group of people with known milk allergies who currently drink milk and have rashes. Then get 1/2 of them to stop drinking milk. We would EXPECT a significant decrease in the amount of rashes they get, especially if the rashes are caused by the milk ingestion.

So a better CHD study would include people with high fat diets of similar ages and see if their decreased fat intake lowered cholestrol and rate of CHD? If a person already has a healthy and balanced diet, then a reduced fat diet may not show much of an effect. This shows the importance of a control group, so you can see what exactly is different in the two study groups. We don't know if the women if the "non-reduced" fat intake group had any significantly higher intake of fat or cholesterol, to the rate that they would have a higher CHD risk than the women on the reduced fat diet. Maybe the other half were all younger than the reduced fat diet group, and at lower risk of CHD no matter what their diet was. It just wasn't a good study, and really is useless to draw conclusions from.

A good study would take a population with the same risk of CHD, same age, and same starting LDL levels, and same dietary habits in both groups. Then see if the dietary change in one group from high fat to low low fat decreased their rates of CHD. That way only one variable is changed, and you can get relevant data.

[The SkepDoc]

You have pinned down the essence of good science: control for as many variables as possible. And don't try to draw conclusions about a question that the study was not designed to answer.

[Skeptic Ginger]

I responded to this issue in another forum from which I learned about the exchange at TAM. I read the SkepDic News Letter #55 (http://skepdic.com/news/newsletter55.html#myth71) and the CSICOP Commentary by Lewis Jones, 1995, (http://www.csicop.org/sb/9503/risk.html) and this, (http://www.ssr.com/cgi-bin/ezmlm-cgi?1:msp:104897:fbeobbnoeehjaabalggh) and This, (http://www.ssr.com/cgi-bin/ezmlm-cgi?1:mss:105167:ddchaeoommpdnhogpdgf) Dr Hall's rebuttals to the TAM presentation. I have not yet read the Skeptic article nor did I hear the TAM lecture but I will and will comment further if need be.

The CSICOP article relies heavily on the work of McCormick and Skrabanek. McCormick and Skrabanek have some impressive publications. In fact, after I looked at Peter Skrabanek; James McCormick; Follies and Fallacies of Medicine; third edition, 12/98 (http://www.tcd.ie/Community_Health/Skrabanek/Follies-and-Fallacies-in-Medicine-1up.pdf), I plan to buy a copy. It's out of print but there are copies around. The concepts put forth in the work of these two researchers have the utmost validity and importance in medicine today.

However, their work on coronary artery disease, CAD, risk factors is 20 years old!!!!! Even in the researchers' 12/98 edition of the book I cited above, the chapter on CAD relies on the 1988 investigations. Not knowing all of med41's cited research I need to see what he has to offer. But of all the research I've looked at, the evidence for taking a statin, along with good medical monitoring is very strong.

Bandolier, (http://www.jr2.ox.ac.uk/bandolier/index.html) a web site for evidence based medicine based in the UK, has Statin outcome trials update, (http://www.jr2.ox.ac.uk/bandolier/booth/cardiac/statout.html) a meta analysis of statins trials. You can review their staff members and connections here. (http://www.jr2.ox.ac.uk/bandolier/aboutus.html) The results are unequivocal.

So with that said, I take a statin. Side effects are managed by having a few blood tests every 6 months. Most people don't have side effects and if one does then you simply stop the drug. I expect the drug to not only decrease the chance I will have coronary artery disease (like Mr Randi, BTW) but also to have the same effect of decreasing the arterial plaques in the arteries in my brain. Those of you who know me might guess, I thoroughly researched optimum lipid blood levels, outcomes, risks and side effects of taking a statin before I started one.

My second point is to reiterate, it's nonsense to believe all medical research on CAD is either done by or controlled by pharmaceutical companies, and even worse, to believe those of us in the medical profession are either all drug company puppets or too stupid to recognize and take into account conflict of interest issues in medical research we review.

Dr Hall also noted the similarities between this 'cause du jour' and the anti-vaccine campaign. In my observation, both groups are characterized by people who only consider valid the evidence which agrees with their preconceived convictions and by people who have an unrealistic view of the influence of the pharmaceutical companies. But lest I be guilty of the same thing I will look further at the questions raised here.

And the third point I wish to make is I advocate looking at the correct outcome when reviewing any medical research. The fact Listerine and Lysol kill germs is not evidence either decreases the risk of infectious diseases, which neither does, BTW. So even if I disagree with the conclusions of med41, I don't disagree with the principles involved. In looking at overall decreases in death rates vs decreases in disease, keep in mind as well who cares about the information. If I am deciding to allocate public health investments I may care about decreasing death rates. If I am deciding what to do about my personal health, the outcomes I choose to look at might be considerably different.