by Zoë Harcombe
However – the ultimate irresponsibility must surely be that a pregnant woman can walk into a burger bar, day and night, and, if this bunch of drug pushers get their way, she can pick up a statin as well as a ketchup sachet and risk deforming her unborn child. Drugs are not tested on pregnant women for a reason. Cholesterol levels rise in pregnant women because it takes a lot of cholesterol to make a healthy baby (this is why eggs are relatively high in cholesterol – it takes a lot of cholesterol to make a healthy chicken or duck etc). To lower a woman’s cholesterol levels while she is trying to make a healthy baby is medical malpractice in my view. Check out the patient info for Lipitor - the statin worth about $12 billion (last time Ben Goldacre kindly quantified it for us).
“Do not take Lipitor if you are pregnant or think you may be pregnant or are planning to become pregnant. Lipitor may harm your unborn baby.”
“If you get pregnant stop taking Lipitor and call your doctor right away.”
“Do not take Lipitor if you are breastfeeding. Lipitor can pass into your breast milk and harm your baby.”
“Do not take Lipitor if you have liver problems.” (presumably because it’s going to harm your liver, so you’d better have a strong one?)
Dear people of the world – your doctor may be conflicted, your heart charity may be conflicted. Anyone who tells you that statins are the wonder drug and should be given out like sachets of ketchup had better be conflicted, because I cannot think of any other reason for being so irresponsible.
“Surgery is better than dieting,
says conflicted doctor”
September 13, 2010
I often write about conflict of interest and advise that we should all read articles with the approach – who stands to gain from this article?
The Sunday Times printed a story on the front page on 12 September 2010 of which they should be ashamed. It was entitled “Surgery is better than dieting, says top doctor.” The article quoted Nick Finer, indeed a well known and respected obesity expert, as saying “The only answer to Britain’s obesity epidemic is to offer surgery to anyone suffering from severe weight problems.” He suggested starting with the 1 million people with a body mass index greater than 35 and presumably working down from there. This would be phenomenally lucrative for pharmaceutical companies providing gastric bands, surgical equipment for the operations, drugs taken around the time of the operation, liquid diets (a pre-operation and often post-operation requirement) and, of course, the surgeons who perform these operations.
The real story is that a number of our national obesity experts (most that I have come across) have fundamental conflicts of interest, which should invalidate any so called expertise that they come out with. Why did the article not list Finer’s conflicts of interests? They are easy to find – they were listed in a February 2010 journal declaration:
“Nicholas Finer: Consultant for Novartis, Shionogi, Merck, Abbott, sanofi-aventis, Amylin Pharmaceuticals Ajinomoto and GSK; received lectureship fees from Abbott, sanofi-aventis, Roche and Novo-Nordisk; received grant support from Merck, Novartis, Roche, Alizyme, Pfizer, Johnson and Johnson, Abbott and sanofi-aventis; member of the SCOUT ESC receiving payment from Abbott (honoraria/travel expenses).”
Novartis (Novartis Nutrition) make Optifast : “OPTIFAST® is now being used to induce weight loss as needed before bariatric surgery in several bariatric surgery facilities. Novartis Nutrition has also introduced a brand new line of products, OPTISOURCE™, to help patients meet their special nutritional needs after bariatric surgery. Most of these patients require lifelong protein and vitamin/mineral supplementation after the surgical procedure.” This stuff costs $2500-3500 for a one year programme for one person – not sure if that was factored in to the cost benefit analysis?
Shionogi have two obesity drugs at various stages of R&D.
Merck, Pfizer and Sanofi-Aventis have Cannabinoid Antagonist products. These act to block the cannadinoid receptor 1 (CB1) and are claimed to decrease food intake and help regulate weight. (These try to work on the opposite basis of cannabis ‘giving the munchies’ and the psychological side effects are a concern).
A report about the USA obesity drug and bariatric surgery market lists:
– Alizyme as developing a lipase inhibitor (the goal of this is to stop fat being absorbed – as with the drug Orlistat/Alli. Absorption of fat soluble vitamins is impaired);
– GlaxoSmithKline under emerging drugs for a melanin-concentrating hormone antagonist;
– Amylin Pharmaceuticals as having an emerging Peptide YY3-36 drug;
– Amylin Pharamceuticals and Johnson & Johnson are listed as having other emerging drugs;
– Johnson & Johnson, Merck and Pfizer are listed as having delayed or discontinued drugs in this arena.
The companies profiled in the obesity drug and bariatric surgery market report are Abbott, GSK, Merck, Pfizer and Sanofi-Aventis. Roche make the drug sibutramine (withdrawn from Europe, earlier this year, following an investigation into heart disease amongst people taking the drug. It is still available in the USA). The report where Finer declared his interests was a study of the drug sibutramine and the conclusion was very favourable (would it be reasonable to suggest one would not be supported by a company if one were not supportive of their products?)
I saw Nick Finer present at the Wales National Obesity Conference in June 2010. He introduced me to a graph, for which I am most grateful, done by Marion Franz in 2007. This study reviewed 80 other weight loss studies based on the “eat less and/or do more” principle and this is where Finer gets his statistic quoted in the Sunday Times article: “the average long-term weight loss achieved by most obese adults who diet is 2-3%, so small as to be almost irrelevant.” This is correct. I have seen the study and I am hugely grateful to Elsevier for permission to reproduce the chart in my book “The Obesity Epidemic“. However, this evidence is for low calorie/calorie deficit dieting – it is not for low carb dieting and my own findings (reproduced in the book) are similar to those of Gary Taubes – an unavoidable conclusion that carbohydrate consumption is solely responsible for both fat storage (weight gain) and fat ‘un-stored’ (weight loss).
Finer is quoted in the article as saying “Humans evolved in unpredictable environments where food was scarce and our bodies are programmed to maintain our body weight at all costs.” From this comes the recommendation that we should operate on 1 million of our fellow humans (for starters) to cut them open and make it such that they will never be able to eat normally, digest normally or absorb vitamins normally ever again.
There is no logic in this conclusion. Man and our ancestors have been on this planet since Australopithecus Lucy first walked upright an estimated 3.5 million years ago. We have had an obesity epidemic for about 35 years. Surely our first plan should be to return to what we ate for the 3 million, 499 thousand, 965 years before we got so fat we had to invent bariatric surgery?! How about humans return to eating what we evolved to eat? Meat, fish, eggs, vegetables, nuts, seeds and sporadic fruits if we were lucky?
The trouble is – there is no money to be made in advising the above. The ‘expert’ who advises a return to eating food – we shouldn’t need to call it real food – will receive no funding from food, drink or drug companies. The whole reason we have the processed food industry is because of the margin that can be made from man-made food in contrast to that which can’t be made from mother-nature’s food. And with the modern illness accompanying modern food and drink we have modern drugs – continually being developed to ‘treat’ the diabetes, obesity, cancer, heart disease, indigestion, irritable bowel syndrome, blood pressure problems and so on, which I am convinced are the result of that modern drink and food. What a wonderful symbiotic relationship between the food, drink and drug industries.
This is why the real story for Sunday’s paper should have been – citizens of the UK will never receive the right advice until so called experts cease to be conflicted. Or, at the very least, have to declare their i
nterest up front so that we can see the promotion for what it is.
P.S. you may like to see another blog I did with death rates for bariatric surgery. I’m not sure if the funeral costs were also factored in to the cost benefit analysis study.
P.P.S. Ajinomoto markets aspartame. Here’s Finer promoting aspartame. Here’s what an independent person has to say about aspartame:
Dr. Ralph Walton, Professor and chairman of the Department of Psychiatry Northeastern Ohio University Colleges of Medicine, undertook a comprehensive review of studies available for just one sweetener: aspartame. It was called “Survey of aspartame studies: correlation of outcome and funding sources.” The summary of the report stated: “Of the 166 studies felt to have relevance for questions of human safety, 74 had Nutrasweet® industry related funding and 92 were independently funded. One hundred percent of the industry funded research attested to aspartame’s safety, whereas 92% of the independently funded research identified a problem.” Walton’s overall conclusion was “We have also become much more sophisticated about the impact of a variety of toxins on psychological processes. I am convinced that one such toxin is aspartame.”
One in ten adults dangerously obese…
October 25, 2010
This is the headline in the Daily Mail (25 October 2010)
The sub heading is “Wake up call for 5m Britons as diabetes toll also soars.”
When will public health advisors realise that we started this obesity epidemic? When will public health advisors realise that we started this diabetes epidemic?
Since Australopithecus Lucy first walked upright, an estimated 3.5 million years ago, we have eaten food provided by mother nature. For much of that time our main energy intake has necessarily come from animals and their by products (during the ice age this is all that our ancestors would have had; during much of the rest of our evolution animals – especially their fat – would have provided our much needed calories. Nuts, when available, would have been very useful also).
Look at the evidence – in the UK obesity didn’t rise above 2% since time began until the 1970′s. Obesity rates for men and women in the UK were 2.7% in 1972. They had reached 25% by the end of the millennium. So what happened to cause such a catastrophic change in obesity rates? We changed our diet advice. The USA changed in 1977-1980 and the UK followed suit in 1983-84. Obesity has increased up to 10 fold since. You may think that is just a coincidence – I don’t.
We used to know that floury foods were fattening and sugary foods even more so. We now tell people to base their meals on starchy foods. The average Briton eats 400 calories a day of sugar – with no vitamins and minerals of any value whatsoever. The average Briton eats 730 calories a day of flour – with so little nutrition that it is invariably fortified. We are just doing what we have been told to do – basing our meals on starchy food; following the Eatbadly plate advice (I refuse to call it Eatwell because it’s not).
That sub heading – this is a wake up call for 5m Britons. Boy I hope that it isn’t! The only hope Britons have is if they have ignored the dietary advice of the past 25-30 years and they have carried on eating real food, as mum and granny told them to: liver, sardines, eggs, milk, vegetables with butter on etc. Those who are avoiding real food and eating processed food; those who are avoiding fat and eating fattening carbohydrate instead – these people will continue to get fatter and fatter until someone sues the government for making them fat and we realise the horrors of the ‘experiment’ we have done with the ‘developed world’ since the turn of the 1980′s.
Who stands to gain if you think eggs (one of the most nutritious foods on the planet) are bad for you? (Kellogg’s and other cereal manufacturers).
Who stands to gain if you think butter (another wonderfully nutritious food) is bad for you? (Unilever and other margarine and spread manufacturers).
Who stands to gain if you follow the mad advice to snack/eat little and often (the best way to store fat and stay fat) all day long? (Kellogg’s, United Biscuits, makers of snack foods).
Who sponsors the British Nutrition Foundation? Kellogg’s, Unilever, United Biscuits, makers of snack foods and many, many more.
Who stands to gain if you eat what nature has provided for you? No processed food or drink company that’s for sure. No drug company – because you will be healthy. You stand to gain and you need to take charge of your own health and not trust dietary advisors who are conflicted.
If you want to know the full story behind The Obesity Epidemic: What caused it? How can we stop it? – click here.
As for diabetes – diabetes is a condition characterised by the malfunction of the pancreas and blood sugar handling system. In simple terms, type 1 diabetes is characterised by the pancreas no longer producing insulin, so the person needs to administer insulin in some way (usually injection). Type 2 diabetes is often called “insulin resistance”. Some insulin is still produced by the pancreas, but rarely the right amount, as the body has become resistant to insulin and the cells don’t respond to insulin as they should. Both types of diabetes are all about carbohydrates – the macro nutrient we didn’t used to eat much of and are now told to base our meals on, to snack on, to (basically) eat all the time. Our bodies are literally saying “enough is enough”. I can’t cope with this high quantity or low quality of carbohydrate any more – “I, your pancreas, am packing up”. Hence we now have 171 million diabetics world wide – a figure set to rise to 366 million by 2030. 95% of diabetics are type 2 – all pretty much avoidable if we went back to eating food – real food – and not the processed junk that food processing companies make so much money from.
Then you have Simon O’Neill, from Diabetes UK, saying “we must keep up the mantra of five fruit and veg a day”! More conflict of interest. Five a day was invented by a bunch (ha ha) of fruit and veg companies in California in 1991. Dieticians, nutritionists and now a spokesperson from Diabetes UK are sales reps for the fruit and veg industry. Diabetics should be eating low carb veg (green leafy vegetables, peppers, salads etc) but being very cautious about baked potatoes and fruit – especially tropical fruits. It’s more carbohydrate – it turns into glucose and fructose in the body as if we had eaten sucrose (table sugar – which is one molecule of glucose and one of fructose).
If we are serious about sorting obesity AND diabetes at the same time, we must stop our current diet advice madness and stop telling people to eat carbs virtually every waking minute. Meat, fish, eggs, vegetables (not potatoes), salads and dairy products should be our staples and whole grains, baked potatoes and fruit only if we are slim and not diabetic.
Weight Watchers ProPoints plan –
what’s it all about?
November 1, 2010
Weight Watchers put out a press release “embargoed to 1st November 2010″. The press release that I saw had two pages – each page looked like it was designed to fold into a two sided postcard. One page was called “The SCIENCE behind the Weight Watchers ProPoints Plan” and the other was called “The Weight Watchers ProPoints plan EXPLAINED. I’ll refer to them as the SCIENCE PAGE and the PROPOINTS PLAN EXPLAINED PAGE below…
THE SCIENCE PAGE
The science page essentially says “Calories have been around for nearly 200 years”. The science page notes that the work was developed in the late 1800′s by a chemist called Atwater. Wilbur Atwater was also working with Max Rubner and, between them, they developed the first calorimeter and established that the approximate calorie content of carbohydrate, protein and fat was 4, 4 and 9 respectively. If I share at this stage that, in Rubner’s publication in 1901,[i] carbohydrate, protein and fat were estimated to have 4.1, 4.1 and 9.3 calories per gram respectively – you can see that this has never been a precise science. (Rubner recorded the calorific value for olive oil as 9.4, so even his 9.3 was an average of four fats reviewed).
ProPoints seems to be about taking on board the fact that carbohydrate, protein and fat require different amounts of energy to be turned into energy by
the body. Weight Watchers may think they are leading the way with this ‘new’ science, but they are playing catch up. Indeed on Radio 4 this am, Weight Watchers company dietitian Zoe Hellman opened by saying the science has been there for 10-15 years. Here is my take on the SCIENCE page:
1) The science on carbohydrate, fat and protein being different is right – the obesity world has known this for almost a decade (not 10-15 years). (It’s quite fun to see Weight Watchers acknowledge this, as dieticians have been saying “a calorie is a calorie” since time began and this proves that it isn’t!) Here’s an extract from p23 of my book:
“…Eric Jequier, who works in the Institute of Physiology, University of Lausanne, Switzerland found that the thermic effect of nutrients (thermogenesis – energy used up in making useable energy) is approximately 6-8% for carbohydrate, 2-3% for fat and 25-30% for protein.[iii] I.e. approximately 6-8% of the calories consumed in the form of carbohydrate are used up in digesting the carbohydrate and turning it into fuel available to be used by the body. In contrast, 25-30% of the calories consumed in the form of protein are used up in digesting the protein and turning it into fuel available to be used by the body…
Richard Feinman and Eugene Fine, a biochemist and a nuclear physicist respectively, have done some outstanding research in the area of thermodynamics and metabolic advantage of different diet compositions.[iv] In their 2004 paper, they took Jequier’s mid points (7% for carbohydrate, 2.5% for fat and 27.5% for protein) and applied these to a 2,000 calorie diet comprising 55:30:15 proportions of carbohydrate:fat:protein. This demonstrated that 2,000 calories yielded 1,848 calories available for energy. I repeated the calculation for a 10:30:60 high protein diet, as another example, and the yield drops to 1,641 calories.”
