HealthInsightUK

About:
The idea behind HealthInsightUK is to create a forum for campaigners/academics/clinicians/ journalists who are critical of current approaches to preventing and treating the big five metabolic disorders – obesity, diabetes, heart disease, Alzheimer’s and cancer. Some are challenging the idea that increasing drug prescribing is the solution, others are writing about how best to stay healthy

But we all broadly agree that there is a need for a radical change. To move from top down medicine – take your pills – to a system that allows patients to become well enough informed to take much more responsibility for their own health.

We believe that good medicine should aim to treat the underlying cause of a disorder rather than simply help to control the symptoms. That promising treatments should be properly tested, regardless of whether they have a large commercial potential.

That just as drugs can often be the sensible option when we are sick, that diet, an adequate level of nutrients and lifestyle changes are a sensible starting point for staying well. Everyone agrees lifestyle is important in health; however the fact that the vast bulk research funds goes on drug development drugs for the metabolic Big Five shows money is not where the mouth is.

Sustaining health rather than treating sickness is a worthwhile aim in itself. What is not economically sustainable is continuing to rely on drugs to treat the growing burden of metabolic disease, let alone as a way of treating the rapidly rising number of old people with multiple drug regimes that have no evidence base.

At the moment we have a small number of contributors who are skilled in analysing the shortcomings of the existing treatments and proposing what a more balanced approach to health might involve. We hope more will agree to write for us as the site becomes more established

Some have concentrated on exposing the shortcomings of various drugs, showing how they can be far less effective or much less safe than claimed. This makes the case for a lifestyle approach more compelling. Others are directly challenging conventional ideas of what a healthy lifestyle should involve.

Here you will find detailed critiques of the widespread us of various drugs, such as statins, for prevention as well as strong arguments for rejecting the notion that the healthy diet should be based on a low fat, high carbohydrate intake. There will be challenges to the idea that saturated fat is harmful or the claim that reducing calorie intake is the only way to lose weight.

Articles will be informed, backed by evidence and references where relevant but the style will be intelligent journalism rather than academic treatise. By providing a platform for experts in different areas but with a broadly similar outlook we hope to stimulate discussion and new connections. We also hope to develop a clearer and more informed picture of how we might need less medicine rather than more.

Details from here:
http://healthinsightuk.org/about/

They have some interesting articles ...

Low Carb Revolt : Start Of A Brave New Medical Future?

Article by Jerome Burne 6/6/16 (from HealthinsightUK)

"Last week the front page of The Times carried a story that was an opening shot in a revolution. I’m sure that the editors didn’t intend it as that and that the readers didn’t see it that way either. It was a story about shifting from the long recommended low fat diet to one that cut back on carbohydrates instead. Standard fare for the cuddly lifestyle pages, hardly material for social upheaval.

But I don’t think it is too fanciful to suggest that this may come to be seen as a Martin Luther moment for medicine. It may not split the profession as Luther’s divided the church but it does have the potential to dramatically change the way medicine is practiced.  To begin with it is significant that doctors were involved; nutritionists would never have made the front page. Insiders, such as the monk Luther or the aristocrats who signed the Tennis Court Oath before the French revolution, are often key to giving revolutionary change lift off.

The doctors had largely been convinced of the benefits of low carbs by trying it themselves and seeing the effect on their patients. But this is more than just another of those irritating nutritional U-turns: ‘Last year we had to avoid eggs because they were packed with cholesterol, now we can safely have six a week. Can’t they make up their minds?’

If there is a U-turn in official advice about fat/carb quantities, and the physiological case seems to me to be unarguable, the knock on effect would be far reaching; it could be the tug on a loose strand of wool that unravels a whole sweater.

The revolutionary charge of low carb
To begin with it would involve admitting that nutrition can be a safe, effective and cheaper treatment for some lifestyle disorders than drugs. One of the campaigners, Dr Unwin, has already cut 40,000 pounds a year from his practice’s drug bill as a result of the drop in diabetic drug prescriptions. Inevitably there would be pressure to make greater use of other nutritional approaches such as the Mediterranean diet to cut the risk of heart disease.  

Such developments seem sensible and unthreatening but they carry a revolutionary charge.  At the moment diet is regarded as a useful but relatively ineffective handmaiden to real medicine. But if diet is going to start growing medical muscles, that raises fascinating regulatory problems, that doctors, who may well have emerged from medical school with only a few hours of nutritional classes, are probably unaware of.

First there is what might be called a legal falsehood about food. The official position is that it cannot modify physiology – ludicrous and patently untrue but that’s fundamental assumption about diet that all nutritionist have to learn to tip-toe around. Even a skilled theological debater such as Martin Luther might have a problem with some of tangled food and medicine orthodoxy.

For instance: it logically follows from this that no food or natural substance can “prevent, treat or cure’ any disorder. Equally ridiculous, you cry, and ask: but what about if you run a big trial and show that low carb or curcumin or vitamin C can do just that? Well yes good point. Interestingly even the government healthy eating campaigns ran into problems here with their five-a-day fruit and vegetable promotion. It verged on claiming this was a way to prevent disease.

How food is transformed into a drug
Officially the only substances that can prevent, cure or treat are drugs/medicines. The implication of this is that if you do demonstrate the effectiveness of a diet, food or supplement – say curcumin for inflammation or B vitamins to lower the homocysteine linked with Alzheimer’s  - then it is logically a drug. This is a claim that requires a greater leap of faith than transubstantiation – the Catholic doctrine that the bread and wine given in communion literally turn into flesh and blood when eaten, which Luther thought profoundly wrong .

But then the substance has to be licenced which involves large and expensive trials, which are almost never done because food and natural substances are not patentable. Even doctors cannot properly prescribe non-drug remedies however good the evidence.

So the revolutionary potential should be becoming a bit clearer. Suppose a 100 or so GPs started using nutrition to treat their diabetic patients? What might come next? Once they start investigating nutrition physiology it would become clear that vitamins, minerals and other supplements also play a vital role in health. In the case of diabetes, for instance, there is quite a bit of good evidence that chromium and cinnamon help to improve blood sugar control.

Checking for vitamin and mineral deficiencies and topping up if needed would start to seem sensible. Could they all be hauled in front of the GMC for using unlicensed treatments or might the common slogan that you can get all the minerals and vitamins you need from a healthy balanced diet start to look as implausible as the low fat orthodoxy?  

But talking about a low carb diet and suggesting some supplements along with specific exercise regimes is still just splashing about on the surface of lifestyle treatments. If a growing number of doctors stay on the low carb path they will start to encounter much more interesting and unfamiliar dietary territory.

Generating a different form of energy
How low, for instance, should you go with your carbs? At the moment the definition of low carbs is pretty elastic. Compared to 300 or more grams of carbs that a conventional diabetic diet can provide, getting that down to 100 grams seems pretty low. But what if you go down to 50, 20 grams?

What we know for certain is that once you get below about 20 your metabolism makes a step change, like the transition from water to ice. It stops relying on carbohydrates (blood sugar) for energy – because you aren’t getting enough – and it starts to release fat from your fat stores (you can see why this would be popular) to provide a different source of energy. The fat is transported to the liver where it is turned into ketones which the brain and muscles can also use as fuel.

There are all sorts of debates around this – it’s hard to get enough food for your gut bacteria on very low carbs. So some claim a low glycaemic diet is preferable; fasting may be able to get you all the benefits of very low carbs. But I’m going ignore those for now and just mention a very radical but very plausible idea  – the ketogenic diet might one way to help you fight cancer.

It is a perfectly logical follow on from the idea that low carbs should help with diabetes. Low carbs makes sense for diabetes because it does what the drugs do – brings down blood glucose and insulin, because carbs get turned into blood sugar. And there are links between diabetes and cancer – having diabetes raises your risk of cancer and being treated with the diabetes drug metformin cuts that risk.

From low carbs to a new theory of cancer
So what is link between cancer and blood glucose and insulin? Simply that cancers use up a lot of glucose, far more than normal healthy cells. This makes very low carbs a reasonable option for cutting a tumour’s energy supply. Then insulin is a hormone involved in cell growth – not what you want too much of when you are tackling cancer. Known as the metabolic theory of cancer, this is out in the left field at the moment but it is generating a lot of fascinating research. It presents a challenge to the mainstream theory that cancer is all about genetic mutations. I’ve written about it here.

I bring it up to show that the physiology that makes treating diabetes with low carbs also applies to trying it to help with cancer. It would of course mean venturing into an area of medicine where the dogma that only medicines and medical procedures can prevent, treat or cure disease is enshrined in law in the form of the Cancer Act.

However there is preliminary but promising research to show that a ketogenic diet can make chemotherapy and radiotherapy more effective. What might be the effect of GPs using their new found nutritional confidence to start trespassing on the jealously guarded territory of oncologists? Would legal sanctions be rolled out?

Of course the usual response to such an incursion is to cry “quack” and “selling false hope” on the grounds that the required randomised trials aren’t there. But this is not quite the trump card that it was since a key part of the radical doctors case is that the trials showing the benefits of low carb are there but they are simply ignored. Certainly oncologists are not known for their interest in investigating any evidence for the dietary route in cancer treatment.

How the heresy might spread
This challenge to the Manichean division between scientific medicine and the other fake stuff may be one of the biggest effects of a switch to low carbs. The idea that medicine is evidence based and scientific is fundamental to modern medicine. This means that trials are done openly and fairly and that practice changes when the evidence changes.

However the gap between doctrine and practice that drove Luther to action is equally wide in today’s medicine. There are strong suspicions that official food guidelines owe more to the influence of Big Food than to research evidence. Something similar is going on with increasing scepticism about, for example, the statin risk/benefit ratio and the value of treating elderly people with a number of disorders simply by stacking up the number of prescriptions.

This opens the door for doctors to interpret guidelines far more flexibly and focus on individual patients and their symptoms rather than blood tests. This is certainly not going to happen overnight but already there is a handful of doctors involved in the low carb campaign who are doing just that. Two of them are the TV doctor Rangan Chatterjee and GP Joanne McCormack, and there have been HIUK posts on both of them (Chatterjee post and McCormack post).

Dr McCormack described how she became increasingly disenchanted with the official low fat advice and then spent two years educating herself about nutrition. She now enjoys the extreme challenge of trying to do the same for Public Health England. Dr Chatterjee’s TV series was based on the idea, never tested in an RCT, that the best way to begin treating a patients’ chronic disease was to find out what their home life was like.

The princes of the medical church will disapprove of such heresy but the response of the parishioners seems much more favourable."


http://healthinsightuk.org/2016/06/06/low-carb-revolt-start-of-a-brave-new-medical-future/

How senior medics use strong arm tactics to close down the debate on statin side effects

This article by Jerome Burne:

"One of the alarming and intriguing things about the cholesterol lowering drugs statins is the vigour and ferocity with which supporters defend them. It’s alarming because it makes it almost impossible for both doctors and patients to get accurate information about their risks and benefits. Intriguing because it is so unscientific.

In fact, even though these drugs have been around for 24 years and prescriptions are still being written in their billions, we still don’t know for sure how well they work or how safe they are.

Researchers who suggest that they may not be as safe as routinely claimed have been accused of killing patients by frightening them into stopping taking the drugs given to cut their risk of heart disease. And it is not just researchers who are attacked; the integrity of a top journal has recently been questioned too.

At the end of last month Professor Peter Weissberg medical director of the British Heart Foundation made the remarkable allegation that critical articles about statins had been published in The BMJ (British Medical Journal) two years earlier had not really been intended to report on scientific research but simply with the aim of selling more copies.

Arch statin defender infuriated
He claimed that the journal was not interested in objective reporting. ‘The best way for them to sell copies, he told a newspaper ‘is by creating a bit of controversy,’

Regular readers will be aware that there has been a long running debate about the effectiveness and safety of these drugs. On the one side is the majority of the medical establishment which claims that nearly 30 large trials have shown that these drugs save thousands every year from dying of heart disease and that the side-effects such as muscle pain, a certain mental fogginess or cataracts are usually mild and only affect a small percentage of patients.  

On the other are doctors and researchers who claim that the trials run by drug companies are unreliable, that large numbers of people have to take statins for one to benefit and that the side-effects are far more serious and common than admitted. A raised risk of diabetes, detected recently, is a particular concern.

This debate first received widespread media attention two years ago when The BMJ published two features on the higher rate of side effects. This infuriated arch statin defender Professor Sir Rory Collins of Oxford University who pointed out both papers contained an error of a couple of percentage points and demanded they be withdrawn.  The BMJ published a correction but didn’t withdraw them when a committee concluded it wasn’t necessary.  

An additional 2000 heart attacks and strokes
Sir Rory then went on a media offensive and claimed in print and on the airwaves that thousands would die if such research kept ‘creating misleading levels of uncertainty’. This was widely seen as highly over-dramatic way of correcting an error.

The pro-statin camp seemed to receive a fillip two weeks ago when a new study, also published in the BMJ,  found that the widespread coverage of the raised side effect risk two years reported two ago – had coincided with over 200,000 patients stopping taking statins for a while.

The researchers at the London School of Hygiene and Tropical Medicine calculated that this could have resulted in an additional 2000 heart attacks and strokes over the next ten years.

The paper made no attempt to consider what benefits might have followed from stopping statins and so avoiding side effects. In effect it effectively assumed that statins are perfectly safe and effective – precisely what was being disputed. The study report also ignored the irony that the controversy Professor Weissman was complaining about was entirely due to the media blitz about the BMJ articles conducted by fellow statin supporter Sir Rory Collins.

Mixing up correlation with causation
If you didn’t know any of this background you might think that the London School study represented something of a vindication for the pro statin lobby in general and for Sir Rory Collins’ warning in particular. Sir Rory certainly appeared to see it in this light. When it came out he was reported as calling on the BMJ to: ‘stop hiding behind the spurious argument that debate is warranted’ and to ‘take responsibility for the harm it has caused.’

The claim that calling for debate over the safety of statins was spurious and unwarranted would be unexceptional in a faith based system but this is supposed to be about the science. While Sir Rory is scrupulous and unforgiving about an error of a few percentage points by his opponents, he appears happy to casually brush aside one of the pillars of evidence based medicine in defence of his own position. The pillar is the principle that correlation does not equal causation. In other words when two things appear together – such as firemen and fires – you can’t assume one caused the other.

This is precisely the objection that Sir Rory and others have used to question the evidence from observational trials of statins which find that patients report many more side-effects than the low rate that is officially claimed. They claim that only randomised controlled trials give you certainty about causation.

Yet the London School study is also an observational study. It looked at the period when the media reports on statin side effects were most frequent. Then it looked at the rate patients discontinued statins in the period. But Sir Rory assumes that one caused the other.  As Gary Switzer, an expert in health care journalism wrote last week in an editorial on this latest study in the BMJ: ‘The authors provide no patient survey data to support the belief that people stopped because of news reports.’

Stopping statins less risky than taking them?
Presumably the hope behind the publication of the London School paper was that it would strongly discourage newspapers from writing about statin risks on the grounds that thousands would die as a result. But the main effect has been to raise yet more doubts about the benefits and risks of these drugs.

To begin with there was the formula that the London School used to calculate the number of deaths that would result from statin withdrawal. According to leading statin sceptic and Cheshire GP Dr Malcom Kendrick, the way heart attack risks are commonly calculated is highly unreliable.

‘Using an updated formula the number of heart attacks and stroke you’d expect over ten years from 200,000 people stopping statins is actually about 500,’he says.  Now one of the things about balancing risks and benefits is that when the benefits go down the risks of side effects stays the same. What this means is the benefit from stopping goes up.  

Kendrick illustrates what this means as far as your chances of developing one of statins’ most serious side effects – diabetes.  A reliable estimate of the diabetes risk is that for every 150 people on statins one person will develop it.’ he says.  ‘Using that rate to calculate the benefits from stopping statins reveals that there could be 4000 fewer case of diabetes if 200,000 people stopped taking them.’ Suddenly the claims that warning about the dangers of statins is killing people seems highly misleading

Statin supporters never actually tested their claims
But the irresponsibility of the statin establishment’s use of strong-arm tactics to close down any debate on side-effects doesn’t stop there.  Two years ago Professor Collins claimed that reported side-effects such as joint pain and memory loss affected only a few percent of patients – not closer to 20 per cent as the articles The BMJ had just published were suggesting.

But as Dr Fiona Godlee, the editor of the BMJ has pointed out, there are serious problems with the evidence that Professor Collins relies on to dismiss this higher rate. Neither Sir Rory and his team nor any independent researchers has ever conducted any analysis of the rate of such side effects.

That’s because all the data from the trials on statins are not available for independent scrutiny, Dr Godlee said in response to the London School study. Statins have been subject to nearly 30 major trials run by drug companies and the  full results – all the records of how patients responded, which is what you need for a proper assessment of side-effects – are held by an institution called the Cholesterol Treatment Trialists (CTT)  in  Oxford headed by Professor Collins. No independent researcher has ever seen any of this data.

‘This situation should shock people,’ said Dr Godlee. ‘It continues to shock me.’ Last year she was informed by CTT that not only had no outsider seen the data but that the Trialists themselves had never analysed the data for side-effects either. The CTT’s explanation was that this was not part of the original agreement that they had made with the pharmaceutical companies to hold all their data in 1995.

This makes it hard to understand how Professor Collins and the big heart disease charities were able to be so confident that statin side effects were not such a serious issue or that the benefit of taking the drugs always outweighed the risks.

This attitude among senior medical figures – that research and data that challenges an official position should not be engaged with but dismissed  -is clearly not in the interests of patients. It could have serious repercussions very soon.
A new and more powerful cholesterol lowering drug has recently been given the green light by NICE. What will happen when studies come out indicating that side-effects are more serious than originally thought? Will that too be dismissed as ‘a spurious argument that debate is warranted?’"

From here
http://healthinsightuk.org/2016/07/12/how-senior-medics-use-strong-arm-tactics-to-close-down-the-debate-on-statin-side-effects/

Good stuff - and the previous posts too. However so long that I had to stop halfway through and eat a buttered oatcake with a huge hunk of Brie.

Even if people DO die from going off their statins, the numbers will be minuscule compared to the number of people harmed unto premature death by low fat diets.

chris c wrote:Good stuff - and the previous posts too. However so long that I had to stop halfway through and eat a buttered oatcake with a huge hunk of Brie.

Even if people DO die from going off their statins, the numbers will be minuscule compared to the number of people harmed unto premature death by low fat diets.

Yes, they are interesting to read ...

Now for longer articles I often find a refreshing cuppa is just what is needed ... also goes great with a small slice of low carb strawberry cake!
http://thelowcarbdiabetic.blogspot.co.uk/2015/06/strawberries-some-interesting-facts-and.html



All the best Jan