Extra Credits
Published on 11 Aug 2018Why did everyone forget about the flu pandemic so fast? Partly because its effects were intermingled with the death and depression of World War I, and partly because we chose to forget.
August 12, 2018
1918 Flu Pandemic – The Forgotten Plague – Extra History – #6
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June 28, 2018
Mary Seacole – II: Mother Seacole in the Crimea – Extra History
Extra Credits
Published on 16 Jan 2016Unable to find any official sponsors, Mary Seacole decided to send herself to the Crimea. She recruited her husband’s cousin, a fellow business person, and the two of them set off for the war zone. Unlike London, where she’d met a chilly reception, Mary’s help was welcomed by the overworked doctors and suffering soldiers. She built a new version of her British Hotel and invited officers to dine or shop there, using their money to buy medical supplies and creature comforts for the poorer soldiers. She had set herself up next to the army camp, and during battles she helped provide emergency care. But when at last the city of Sevastopol fell, Mary’s medical services were no longer in much demand. She enjoyed a few months of prosperity as the soldiers celebrated their newfound time off, but in March of 1856, a treaty was signed and troops began returning home. Many of them left unpaid debts, and Mary could no longer sell her supplies, so she and her business partner were forced to return home to London and declare bankruptcy. When that news got out, the soldiers she’d cared for rallied to her aid, donating money to help pay her debts. Although Mary tried to continue serving soldiers in warzones, the government never recognized her and in the end, only her homeland of Jamaica remembered her contributions after her death. In the 2000s, her story came back to light in the United Kingdom and she was recognized in 2004 as the Greatest Black Briton.
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June 27, 2018
Mary Seacole – I: A Bold Front to Fortune – Extra History
Extra Credits
Published on 9 Jan 2016Mary Seacole treated soldiers during the Crimean War – but she took a long path to get there. She grew up in Jamaica, the daughter of a local hotel owner and a Scottish soldier. She admired her doctress mother and wanted to be like her, but she also yearned to travel and see the world. In 1821 she accepted a relative’s invitation to visit London, and turned herself from a tourist to a businesswoman by importing Jamaican food preserves. She traveled with her business for several years before returning home to Jamaica, where she married a white man named Edwin Seacole and started a general store. Their venture failed, and disaster struck: fire destroyed most of Kingstown, and both Mary’s husband and her mother died in 1843. Mary survived and rebuilt the hotel, but she set out to start a new life in Panama and was immediately greeted by a cholera epidemic. She helped contain it, and earned a reputation that helped her start her own business across the street from her half-brother’s. When word reached her that the Crimean War back in Europe needed nurses, she left her business behind and went to sign up. Both the War Office and Florence Nightingale’s expedition rejected her, but Mary determined to find her own way there.
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May 13, 2018
Marie Curie in WW1 – Who Killed The Red Baron? I OUT OF THE TRENCHES
The Great War
Published on 12 May 2018Chair of Wisdom Time!
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April 30, 2018
QotD: Gandhi versus Gandhi
I had the singular honor of attending an early private screening of Gandhi with an audience of invited guests from the National Council of Churches. At the end of the three-hour movie there was hardly, as they say, a dry eye in the house. When the lights came up I fell into conversation with a young woman who observed, reverently, that Gandhi’s last words were “Oh, God,” causing me to remark regretfully that the real Gandhi had not spoken in English, but had cried, Hai Rama! (“Oh, Rama”). Well, Rama was just Indian for God, she replied, at which I felt compelled to explain that, alas, Rama, collectively with his three half-brothers, represented the seventh reincarnation of Vishnu. The young woman, who seemed to have been under the impression that Hinduism was Christianity under another name, sensed somehow that she had fallen on an uncongenial spirit, and the conversation ended.
At a dinner party shortly afterward, a friend of mine, who had visited India many times and even gone to the trouble of learning Hindi, objected strenuously that the picture of Gandhi that emerges in the movie is grossly inaccurate, omitting, as one of many examples, that when Gandhi’s wife lay dying of pneumonia and British doctors insisted that a shot of penicillin would save her, Gandhi refused to have this alien medicine injected in her body and simply let her die. (It must be noted that when Gandhi contracted malaria shortly afterward he accepted for himself the alien medicine quinine, and that when he had appendicitis he allowed British doctors to perform on him the alien outrage of an appendectomy.) All of this produced a wistful mooing from an editor of a major newspaper and a recalcitrant, “But still …” I would prefer to explicate things more substantial than a wistful mooing, but there is little doubt it meant the editor in question felt that even if the real Mohandas K. Gandhi had been different from the Gandhi of the movie it would have been nice if he had been like the movie-Gandhi, and that presenting him in this admittedly false manner was beautiful, stirring, and perhaps socially beneficial.
Richard Grenier, “The Gandhi Nobody Knows”, Commentary, 1983-03-01.
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April 19, 2018
Freedom of speech and scientific inquiry
Adam Perkins on the critical importance of free speech in the scientific world:
A quick Google search suggests that free speech is a regarded as an important virtue for a functional, enlightened society. For example, according to George Orwell: “If liberty means anything at all, it means the right to tell people what they do not want to hear.” Likewise, Ayaan Hirsi Ali remarked: “Free speech is the bedrock of liberty and a free society, and yes, it includes the right to blaspheme and offend.” In a similar vein, Bill Hicks declared: “Freedom of speech means you support the right of people to say exactly those ideas which you do not agree with”.
But why do we specifically need free speech in science? Surely we just take measurements and publish our data? No chit chat required. We need free speech in science because science is not really about microscopes, or pipettes, or test tubes, or even Large Hadron Colliders. These are merely tools that help us to accomplish a far greater mission, which is to choose between rival narratives, in the vicious, no-holds-barred battle of ideas that we call “science”.
For example, stomach problems such as gastritis and ulcers were historically viewed as the products of stress. This opinion was challenged in the late 1970s by the Australian doctors Robin Warren and Barry Marshall, who suspected that stomach problems were caused by infection with the bacteria Helicobacter pylori. Frustrated by skepticism from the medical establishment and by difficulties publishing his academic papers, in 1984, Barry Marshall appointed himself his own experimental subject and drank a Petri dish full of H. pylori culture. He promptly developed gastritis which was then cured with antibiotics, suggesting that H. pylori has a causal role in this type of illness. You would have thought that given this clear-cut evidence supporting Warren and Marshall’s opinion, their opponents would immediately concede defeat. But scientists are only human and opposition to Warren and Marshall persisted. In the end it was two decades before their crucial work on H. pylori gained the recognition it deserved, with the award of the 2005 Nobel Prize in Physiology or Medicine.
From this episode we can see that even in situations where laboratory experiments can provide clear evidence in favour of a particular scientific opinion, opponents will typically refuse to accept it. Instead scientists tend cling so stubbornly to their pet theories that no amount of evidence will change their minds and only death can bring an end to the argument, as famously observed by Max Planck:
A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.
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March 9, 2018
Bad news about the Peltzman Effect and opiate use
Megan McArdle recounts the US federal government’s attempt to improve automobile safety in the 1960s and the surprisingly mixed results of those efforts on overall safety for drivers (better), pedestrians (worse) and the frequency of non-fatal accidents (higher). Those results were summarized by Sam Peltzman as indicating that most of us have an innate tendency to take more risks when we’re less likely to suffer the costs of those risks (hence, the “Peltzman Effect”). She then talks about a tragic new instance of this in the opiate crisis:
A chemical called naloxone acts as an “opioid antagonist” — which is to say, it reverses the drug’s effects on the body. It can thus save people who have overdosed.
As opioid usage has worsened in the United States, more and more jurisdictions have acted to increase access to naloxone. Not only first responders but also friends, family and even librarians have started to administer it. These state laws were passed at different times, giving researchers Jennifer Doleac and Anita Mukherjee a sort of a natural experiment: They could look at what happened to overdoses in areas that liberalized naloxone access and compare the trends there to places that hadn’t changed their laws.
Their results are grim, to say the least: “We find that broadening Naloxone access led to more opioid-related emergency room visits and more opioid-related theft, with no reduction in opioid-related mortality.”
You can never assume that the results of one study, however well done, are correct. But these results look pretty robust. If they hold up, they would mean that naloxone is not saving lives; all we’re doing is spending a lot of money on naloxone to generate some increase in crime.
It makes a certain amount of sense that the Peltzman Effect would show up particularly strongly in drug users; after all, drugs hijack the brain’s reward system, redirecting it toward drug-seeking even at high personal risk. Drug users, one would think, would be highly likely to recalibrate their risk-taking so that the risk of death remains constant, while the frequency and potency of drug use increases.
The coldly logical response to this would seem to be to discontinue naloxone use. But there’s something repulsive about that conclusion, and Doleac and Mukherjee can’t bring themselves to go there. “Our findings do not necessarily imply that we should stop making Naloxone available to individuals suffering from opioid addiction,” they write, “or those who are at risk of overdose. They do imply that the public health community should acknowledge and prepare for the behavioral effects we find here.”
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February 18, 2018
The legal loophole that allows profiteering scumbags like Martin Shkreli to gouge the public
The US pharmaceutical market is a long way from a freely competitive environment, largely due to the amount of regulatory oversight required by lawmakers and enforced by the Food and Drug Administration (FDA). Among all the regulatory checks and balances, there’s one weird trick that allows predatory companies to reap excess profits legally — the “restricted distribution” loophole:
For immunocompromised adult patients who have the toxoplasmosis parasite, the FDA recommends taking 50 to 75 milligrams of Daraprim a day for up to three weeks, followed by half that dosage for an additional four to five weeks. So at the high end, an adult course of Daraprim therapy for a U.S. patient used to cost around $1,350 total.
While that might not seem cheap, it was a drop in the bucket compared to the cost after Turing Pharmaceuticals, Shkreli’s company, bought the rights to Daraprim and jacked the price up to $750 per pill in 2015. That move increased the cost of one course of treatment to around $75,000.
At that point you might have expected another company to jump in and start offering a generic version of the drug. But Shkreli used a regulatory loophole to keep that from happening.
You see, when a generic manufacturer wants to create a cheap version of a branded drug, it has to buy thousands of doses from the manufacturer in order to run comparison tests. Generic manufacturers use the results of these tests to prove to the FDA that their version is identical to the branded drug that the agency has already approved.
More often than not, the company that holds the marketing and distribution rights to a branded drug will sell those comparison doses to the generic manufacturer without being obstructionist, because that’s the trade-off for receiving a 20-year monopoly by way of a drug patent: The branded manufacturer gets to charge whatever they want for years and years without facing competition, and in exchange for that government-backed monopoly, it’s supposed to sell equivalency samples to generic companies.
But what if the company is run by an unscrupulous asshole like Martin Shkreli? Then it might opt to put the drug into what’s called “restricted distribution,” which means no distributor anywhere can sell comparison samples to a generic manufacturer.
The FDA originally created the concept of restricted distribution to limit the availability of drugs that might be dangerous. Methadone, for instance, was first approved in the 1940s as a painkiller. In the 1970s, the FDA restricted its availability because regulators didn’t want the opioid used for anything other than the treatment of opioid dependence. Even today, methadone can be dispensed only in highly regulated settings and only for one approved reason.
In 2007, Congress empowered the FDA to create an entire system of safety controls beyond restricted distribution, and the agency now requires the manufacturers of certain substances to develop Risk Evaluation and Mitigation Strategies (REMS) to prevent misuse and abuse of potentially problematic compounds.
The list of approved drugs that the FDA says must have an REMS is here. Daraprim is not on that list. You can’t get high off it. It’s not habit forming. Yes, the FDA label says it can be carcinogenic after long periods of use, and that it might cause birth defects if used in high doses by pregnant women. These potential effects are serious, but there is no post-market data suggesting that Daraprim is causing more harm than benefit in the intended patient population. Shkreli’s company put Daraprim into restricted distribution to boost their profits, not protect patients.
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January 13, 2018
The common factor of the Net Neutrality fight and the EpiPen price gouging scandal
Lili Carneglia explains what these two examples of “capitalist excess” are actually the result of regulatory failures:
Without net neutrality, regulations that prevent internet service providers (ISPs) from charging more for priority speeds and higher bandwidth-use sites would disappear. Most Americans are pretty confused by the revised rules but highly skeptical that this action could have any benefits. Many people, especially those living in the rural south where choices are limited, feel like these companies have been taking advantage of their customers for years, and loosening regulatory constraints on these companies seems like a terrible idea.
Net neutrality was a regulatory policy set under the Obama administration in 2015 that mandated ISPs to treat the internet like other utilities, such as highways and railroads, under laws established before most people had TVs. Under these rules, companies must act as neutral gateways to the internet without controlling the content or the speed of the content that passes through that gateway. Supporters of the rule argue that these regulations ensure the free flow of information, while those against the policy see net neutrality as a misapplication that stifles an industry that is more dynamic than other public utilities.
[…]
Yes, a handful of industry giants can and have abused their market power. Most consumers have limited ISPs to choose from in a given area, and options are more limited outside of big cities, where “three-quarters of American homes have no competitive choice for the essential infrastructure for 21st-century economics and democracy,” according to the former FCC chairman Tom Wheeler. It is important to consider how these circumstances came about before deciding that federal regulation might help consumers.
Governments, by and large, prefer to have fewer players in a given market as it makes that market easier to regulate, and the easiest market to regulate is a monopoly. When cable networks were beginning to spread across North America, many local governments were persuaded that a single cable provider would be the best option for their jurisdiction and the broadband internet market that came later was heavily shaped by the already carved-up markets for cable TV. For many, there were no competitive options because the local government had precluded the chance of competition for their already entrenched cable monopoly (or, in a few cases, tight oligopoly).
Competition is the best answer to monopolistic abuse of customers … if you get shitty service from the Blue Cable Company, you’ll be more likely to switch to the Red Cable Company. If you only have Red and Blue to choose from, your leverage is small, but if you have a full rainbow of competing options, Red and Blue are forced to make their services at least comparable to what Orange and Pink and Magenta are offering, or they lose too many customers. If there’s no threat of a competitor scooping up unhappy customers, there’s no incentive for the existing company to do more than the absolute minimum to keep customer complaints down to a dull roar. The customer’s only recourse — other than giving up the service or moving to a different jurisdiction — is to complain to the regulator.
The base problem with Mylan’s EpiPen price gouging is the same: an effective monopoly supported by the government:
The arguments against net neutrality repeals center around fears about what producers will do without regulation since they have significant market power and the ability to raise prices to levels that would not be sustainable under more competitive conditions. The concern about increased internet prices is similar to what happened in 2016 when a pharmaceutical company with market power, Mylan, increased the price of life-saving EpiPens by about 400 percent.
The “greedy” pharmaceutical companies were hung out to dry as Congress berated Mylan representatives in hearing after hearing. There were similar cries of outrage and demands that the federal government do something to prevent such selfish price-gouging, similar to what many consumers fear ISPs will do absent regulations.
Even (supposed) free-market advocates started supporting further regulation during the EpiPen debate. Most notably, then fiscal hawk representative and now Trump budget director Mick Mulvaney, defended further market intervention on the condition that, “If you want to come to the state capitols and lobby us to make us buy your stuff, this is what you get. You get a level of scrutiny and a level of treatment that would ordinarily curl my hair.”
However, in all of those hearings, almost no one bothered to unearth the problem that Mulvaney hinted at: Why was Mylan able to increase that price in the first place? Government intervention. Burdensome FDA regulations and other laws pressuring public schools to buy the drug essentially granted Mylan a monopoly. It was as misguided then as it is now to think that these same institutions can be trusted to clean up the mess they created.
Mylan had no effective competition, so there was nothing to stop the price gouging until it got so bad that even the regulator had to pay attention. If there were other pharmaceutical companies allowed to compete, do you think Mylan would have risked jacking up the price only to watch their competitors gaining market share?
Scott Alexander explained the Mylan monopoly quite expansively in 2016.
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December 10, 2017
QotD: Failures of scientific consensus
In past centuries, the greatest killer of women was fever following childbirth. One woman in six died of this fever. In 1795, Alexander Gordon of Aberdeen suggested that the fevers were infectious processes, and he was able to cure them. The consensus said no. In 1843, Oliver Wendell Holmes claimed puerperal fever was contagious, and presented compelling evidence. The consensus said no. In 1849, Semmelweiss demonstrated that sanitary techniques virtually eliminated puerperal fever in hospitals under his management. The consensus said he was a Jew, ignored him, and dismissed him from his post. There was in fact no agreement on puerperal fever until the start of the twentieth century. Thus the consensus took one hundred and twenty five years to arrive at the right conclusion despite the efforts of the prominent “skeptics” around the world, skeptics who were demeaned and ignored. And despite the constant ongoing deaths of women.
There is no shortage of other examples. In the 1920s in America, tens of thousands of people, mostly poor, were dying of a disease called pellagra. The consensus of scientists said it was infectious, and what was necessary was to find the “pellagra germ.” The US government asked a brilliant young investigator, Dr. Joseph Goldberger, to find the cause. Goldberger concluded that diet was the crucial factor. The consensus remained wedded to the germ theory. Goldberger demonstrated that he could induce the disease through diet. He demonstrated that the disease was not infectious by injecting the blood of a pellagra patient into himself, and his assistant. They and other volunteers swabbed their noses with swabs from pellagra patients, and swallowed capsules containing scabs from pellagra rashes in what were called “Goldberger’s filth parties.” Nobody contracted pellagra. The consensus continued to disagree with him. There was, in addition, a social factor — southern States disliked the idea of poor diet as the cause, because it meant that social reform was required. They continued to deny it until the 1920s. Result — despite a twentieth century epidemic, the consensus took years to see the light.
Probably every schoolchild notices that South America and Africa seem to fit together rather snugly, and Alfred Wegener proposed, in 1912, that the continents had in fact drifted apart. The consensus sneered at continental drift for fifty years. The theory was most vigorously denied by the great names of geology — until 1961, when it began to seem as if the sea floors were spreading. The result: it took the consensus fifty years to acknowledge what any schoolchild sees.
And shall we go on? The examples can be multiplied endlessly. Jenner and smallpox, Pasteur and germ theory. Saccharine, margarine, repressed memory, fiber and colon cancer, hormone replacement therapy. The list of consensus errors goes on and on.
Finally, I would remind you to notice where the claim of consensus is invoked. Consensus is invoked only in situations where the science is not solid enough. Nobody says the consensus of scientists agrees that E=mc2. Nobody says the consensus is that the sun is 93 million miles away. It would never occur to anyone to speak that way.
Michael Crichton, “Aliens Cause Global Warming”: the Caltech Michelin Lecture, 2003-01-17.
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October 6, 2017
Are Branded Drugs Better? – Earth Lab
BBC Earth Lab
Published on 22 Jun 2017When you’ve got a cold and need some medicine, do you ever wonder if there’s a difference between branded and non-branded drugs? Greg Foot explains the world of pharmaceuticals, backed up with some stonking examples and unexpected findings!
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May 23, 2017
QotD: The dangers of career “dualization”
This concept [of dualization] applies much more broadly than just drugs and colleges. I sometimes compare my own career path, medicine, to that of my friends in computer programming. Medicine is very clearly dual – of the millions of pre-med students, some become doctors and at that moment have an almost-guaranteed good career, others can’t make it to that MD and have no relevant whatsoever in the industry. Computer science is very clearly non-dual; if you’re a crappy programmer, you’ll get a crappy job at a crappy company; if you’re a slightly better programmer, you’ll get a slightly better job at a slightly better company; if you’re a great programmer, you’ll get a great job at a great company (ideally). There’s no single bottleneck in computer programming where if you pass you’re set for life but if you fail you might as well find some other career path.
My first instinct is to think of non-dualized fields as healthy and dualized fields as messed up, for a couple of reasons.
First, in the dualized fields, you’re putting in a lot more risk. Sometimes this risk is handled well. For example, in medicine, most pre-med students don’t make it to doctor, but the bottleneck is early – acceptance to medical school. That means they fail fast and can start making alternate career plans. All they’ve lost is whatever time they put into taking pre-med classes in college. In Britain and Ireland, the system’s even better – you apply to med school right out of high school, so if you don’t get in you’ve got your whole college career to pivot to a focus on English or Engineering or whatever. But other fields handle this risk less well. For example, as I understand Law, you go to law school, and if all goes well a big firm offers to hire you around the time you graduate. If no big firm offers to hire you, your options are more limited. Problem is, you’ve sunk three years of your life and a lot of debt into learning that you’re not wanted. So the cost of dualization is littering the streets with the corpses of people who invested a lot of their resources into trying for the higher tier but never made it.
Second, dualized fields offer an inherent opportunity for oppression. We all know the stories of the adjunct professors shuttling between two or three colleges and barely making it on food stamps despite being very intelligent people who ought to be making it into high-paying industries. Likewise, medical residents can be worked 80 hour weeks, and I’ve heard that beginning lawyers have it little better. Because your entire career is concentrated on the hope of making it into the higher-tier, and the idea of not making it into the higher tier is too horrible to contemplate, and your superiors control whether you will make it into the higher tier or not, you will do whatever the heck your superiors say. A computer programmer who was asked to work 80 hour weeks could just say “thanks but no thanks” and find another company with saner policies.
(except in startups, but those bear a lot of the hallmarks of a dualized field with binary outcomes, including the promise of massive wealth for success)
Third, dualized fields are a lot more likely to become politicized. The limited high-tier positions are seen as spoils to be distributed, in contrast to the non-dual fields where good jobs are seen as opportunities to attract the most useful and skilled people.
Scott Alexander, “Non-Dual Awareness”, Slate Star Codex, 2015-07-28.
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May 19, 2017
QotD: Outpatient psychiatry
Now I am halfway done with my residency. I will be switching to outpatient work. Everyone who sees me will be there because they want to see me, or at worst because their parents/spouses/children/friends/voices are pressuring them into it. I will be able to continue seeing people for an amount of time long enough that the medications might, in principle, work. It sounds a lot more pleasant.
I have two equal and opposite concerns about outpatient psychiatry. The first is that I might be useless. Like, if someone comes in complaining of depression, then to a first approximation, after a few basic tests and questions to rule out some rarer causes, you give them an SSRI [Selective serotonin re-uptake inhibitors]. I have a lot of libertarian friends who think psychiatrists are just a made-up guild who survive because it’s legally impossible for depressed people to give themselves SSRIs without paying them money. There’s some truth to that and I’ve previously joked that some doctors could profitably be replaced by SSRI vending machines.
The second concern is that everybody still screws it up. There’s an old saying: “Doctors bury their mistakes, architects cover theirs with vines, teachers send theirs into politics.” Well, outpatient psychiatrists send their mistakes to inpatient psychiatrists, so as an inpatient psychiatrist I’ve gotten to see a lot of them. Yes, to a first approximation when a person comes in saying they’re depressed you can just do a few basic tests and questions and then give them an SSRI. But the number of cases I’ve seen that end in disaster because their outpatient psychiatrist forgot to do the basic tests and questions, or decided that Adderall was the first-line medication of choice for depression – continues to boggle my mind. So either it’s harder than I think, or I’m surrounded by idiots, or I’m an idiot and don’t know it yet. In which case I’m about to learn.
Still, if it’s a disaster, it will be a different type of disaster.
Scott Alexander, “Reflections From The Halfway Point”, Slate Star Codex, 2015-06-29.
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May 13, 2017
Psychedelic Drugs: The Future of Mental Health
Published on 12 May 2017
LSD, mushrooms, and ecstasy are finally getting attention from serious medical researchers. And their findings are astounding.
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A recent study found that MDMA-assisted therapy could help veterans suffering from PTSD. Another paper from Johns Hopkins presented evidence that therapy in conjunction with psilocybin mushrooms can help ease the mental suffering of terminal cancer patients.These findings, among others, were presented at the 2017 Psychedelic Science Conference in Oakland, California, where researchers gather every few years to discuss the potential medical applications of psychedelics, including LSD, psilocybin mushrooms, and MDMA. The field has exploded thanks to reforms at the Food and Drug Administration that allow researchers, for the first time in decades, to study the effects of these drugs.
The organizer of the conference was the Multidisciplinary Association for Psychedelic Studies (MAPS), which is also funding much of this breakthrough research.
“It’s a fundamental right to explore one’s own consciousness,” says MAPS founder Rick Doblin. “We have the freedom of the press, the freedom of assembly, and the freedom of religion, and all those are based on the freedom of thought.”
At this year’s conference, Reason talked to researchers about the past, present, and future of this controversial and promising area of medical research.
Produced by Zach Weissmueller. Shot by Alex Manning and Weissmueller. Music by Kai Engel, Selva de Mar, and Lee Rosevere.
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April 29, 2017
“Don’t count fat; don’t fret over what kind of fat you’re getting, per se. Just go for walks and eat real food”
Earlier this week, Colby Cosh rounded up some recent re-evaluations of “settled food science”:
Their first target was the Sydney Diet Heart Study (1966-73), in which 458 middle-aged coronary patients were split into a control group and an experimental group. The latter group was fed loads of “healthy” safflower oil and safflower margarine in place of saturated fats. Even at the time it was noticed that the margarine-eaters died sooner, although their total cholesterol levels went down: the investigators sort of shrugged and wrote that heart patients “are not a good choice for testing the lipid hypothesis.” Their data, looked at now, shows that the increased mortality in the margarine group was attributable specifically to heart problems.
The team’s reanalysis of the Minnesota Coronary Experiment (1968-73) is more hair-raising. This study involved nearly 10,000 Minnesotans at old-age homes and mental hospitals. The investigators had near-complete control of the subjects’ diets, and were able to autopsy the ones who died. But much of their data, including the autopsy results, ended up misplaced or ignored. Some of it disappeared into a master’s thesis by a young statistician, now a retired older chap, who helped with the 2016 paper and is named at its head as one of the authors.
In the Minnesota study, replacement of saturated fats with corn oil led, again, to reductions in total cholesterol. This finding was touted at major conferences, and it became one of the key moments in the creation of the classic diet-heart myth. This time nobody but the guy who wrote the thesis even noticed that the patients in the corn oil group were, overall, dying a little faster. The 2016 re-analysis uncovered a dose-response relationship: the more the patients’ total cholesterol decreased, the faster they died.
The Sydney and Minnesota studies themselves may have caused a few premature deaths, which is a possibility we accept as the price of science. But the limitations and omissions of the researchers, and the premature commitment of doctors to a total-cholesterol model, helped create a suspicion of saturated fats. This flooded into frontline medical advice and the wider culture, and it put margarine on millions of tables, pushed consumers toward deadly trans fats, and put millions of people with innately high cholesterol levels through useless diet austerity. The scale of the error is numbing, unfathomable.
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