Video Presentations on Medical Corruption and Evidence-Based Medicine

"The Mess: The Money vs. the Evidence" - Dr. Zoë Harcombe

Zoë Harcombe, Ph.D., is an independent author, researcher, and speaker in the fields of diet, health, and nutrition. Over the years, research for her books and speaking engagements has made her an expert in the corruption and error plaguing the health sciences — a dire situation that she, like CrossFit Founder Greg Glassman, refers to as “The Mess.”

Harcombe defines “The Mess” as “the escalating disease (and) the escalating medical costs, which many people are profiting from but none are combatting effectively.” During a presentation delivered on July 31 at the 2019 CrossFit Health Conference, Harcombe outlined many factors that contribute to this growing problem — specifically, the role of dietitians and the food and beverage industry in influencing how and what we eat, accreditation that regulates who can offer dietary advice, and the disparity between what we are told to eat and what the evidence suggests we should eat.

Early in her talk, Harcombe shares her research on the dubious back-door maneuvers multibillion-dollar food companies use to promote their products, including paying for studies that tout their products’ health benefits and adding public health advisors to the payroll. She observes that the only thing that would make their marketing efforts easier would be if these paid advisors had a monopoly on doling out dietary advice — which is precisely what they have sought to do in many states in the U.S. by joining forces with the Commission on Dietetic Registration (CDR) and the Academy for Nutrition and Dietetics (AND).

Harcombe shares the story of Steve Cooksey to offer one telling example of how these organizations and others like them try to maintain a monopoly over nutrition advice. Cooksey was diagnosed with Type 2 diabetes, but rather than following the medical advice he received to eat a low-fat, high-carb diet, he ate the opposite way and lost 70 lb. He started a blog, sharing his story and offering free advice to others, and was promptly rebuked by the North Carolina Board of Dietetics and Nutrition, which claimed he was “practicing without a license.” CrossFit and the Institute of Justice helped Cooksey with his case, developing a defense based upon the First Amendment’s protection of freedom of speech. Cooksey won.

Nevertheless, industry-backed organizations continue to pursue sole rights to offering nutrition advice — advice that proves convenient for the companies that support the organizations financially. To demonstrate how problematic this system is, Harcombe compares the AND’s food recommendations to scientific research on nutrition.

Apart from the AND’s tendency to confuse macronutrients with food groups, Harcombe also points to its support of the overconsumption of carbohydrates. Citing a 2005 government panel on macronutrients, Harcombe notes, “The lower limit of dietary carbohydrate compatible with life apparently is zero, provided that adequate amounts of protein and fat are consumed.” “There is no essential carbohydrate,” she explains. “There are essential proteins, and there are essential fats.”

Harcombe discusses how to evaluate the credibility of a scientific paper then brings this to bear on the nutrition recommendations promoted by the Evidence for Dietary Guidelines for Americans (DGA) and the AND. She finds their evidence entirely inadequate.

Nutrition advice provided by the AND, DGA, and CDR “is not evidence-informed, let alone evidence-based,” she argues. These credentialing organizations “need to be countered with an equal and opposite force.” 

"Evidence-Based Medicine Has Been Hijacked" - Dr. Aseem Malhotra

Dr Aseem Malhotra is an NHS Trained Consultant Cardiologist, and visiting Professor of Evidence Based Medicine, Bahiana School of Medicine and Public Health, Salvador, Brazil. He is a world renowned expert in the prevention, diagnosis and management of heart disease. He is honorary council member to the Metabolic Psychiatry Clinic at Stanford University school of medicine California, and is Cardiology MSc examiner at the University of Hertfordshire, UK. He is a founding member of Action on Sugar and was the lead campaigner highlighting the harm caused by excess sugar consumption in the United Kingdom, particularly its role in type 2 diabetes and obesity.

In 2015 he helped co-ordinate the Choosing Wisely campaign by the Academy of Medical Royal Colleges as lead author in a BMJ paper to highlight the risks of overuse of medical treatments. In the same year, he became the youngest member to be appointed to the board of trustees of UK health think tank, The King’s Fund that advises the government on health policy.

Aseem is a frequent expert commentator in print and broadcast media and he has written scores of articles for a number of publications including the BMJ, British Journal of Sports Medicine, BMJ Open Heart, JAMA Internal Medicine, Prescriber, The Pharmaceutical Journal, European Scientist, The Guardian and Observer, BBC online, Huffington Post, The Daily Mirror, Daily Mail, The Daily Telegraph and the Washington Post. He is an international guest editor of the journal of evidence-based healthcare. Aseem has appeared in the Health Service Journal’s list of top 50 BME pioneers, and has won a number of awards for his work to raise awareness of diet-related illness both in the UK and internationally. He is a pioneer of the lifestyle medicine movement in the UK and has had feature articles written about him in the New York Times, The Guardian, The Telegraph, and Healthcare Leader. In 2018 he was ranked by software company Onalytica as the number 1 doctor in the world influencing obesity thinking.

In 2016 he was named in the Sunday Times Debrett’s list as one of the most influential people in science and medicine in the UK in a list that included Professor Stephen Hawking. His total Altmetric score (measure of impact and reach) of his medical journal publications since 2013 is over 10,000 making it one of the highest in the World for a clinical doctor during this period. His first book co-authored with Donal O’ Neill, The Pioppi Diet, has become an international bestseller.

"Too Much Medicine & the Great Statin Con" - Dr. Aseem Malhotra

Filmed at the Public Health Collaboration Conference 2017

"Dietary Guidelines & Scientific Evidence" - Nina Teicholz

Nina Teicholz is a New York Times bestselling investigative science journalist who has played a pivotal role in challenging the conventional wisdom on dietary fat. Her groundbreaking work, 'The Big Fat Surprise', which The Economist named as the #1 science book of 2014, has led to a profound rethinking on whether we have been wrong to think that fat, including saturated fat, causes disease.

Nina continues to explore the political, institutional, and industry forces that prevent better thinking on issues related to nutrition and science. She has been published in the New York Times, the New Yorker, the British Medical Journal, Gourmet, the Los Angeles Times and many other outlets.

"Real Food Politics: Institutional Defense of the Status Quo" - Nina Teicholz

"The Real Food Politics" - Nina Teicholz

Big Fat Nutrition Policy - Nina Teicholz

The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet

Featuring Nina Teicholz, Author, The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet; director of the Nutrition Coalition; adjunct professor, New York University Wagner School of Public Policy; moderated by Terence Kealey, Visiting Senior Fellow, Cato Institute; author, Breakfast is a Dangerous Meal: Why You Should Ditch Your Morning Meal For Health and Wellbeing.

Nina Teicholz is the investigative journalist who, in her book The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet, overturned 40 years of official dietary advice and showed that meat, cheese, and butter are nutritious and need not be avoided.

At this event, Ms. Teicholz will tell of her discovery of the systematic distortion of dietary advice by expert scientists, government and big business to the detriment of the health of Americans. She will chronicle the succession of unfortunate discoveries she made, and she will describe how the Nutrition Coalition, a non-profit, bipartisan group which she founded and directs, works to educate policy makers about the need for reform of nutrition policy so that it is evidence-based.

"Science and Politics of Red Meat in 2021" - Nina Teicholz

"Financial Conflicts of Interests and the End of Evidence-Based Medicine" - Dr. Jason Fung

“Evidence-based medicine is actually so corrupt as to be useless or harmful,” Marcia Angell wrote in 2009. The statement was less a revelation than something many already knew, but it made waves because of its source. Angell, a medical insider, had spent two decades as the editor-in-chief of the New England Journal of Medicine.

Dr. Jason Fung is also a medical insider who has become wary of scientific research that purports to be “evidence based.” A well-known nephrologist and author, Fung often speaks about Type-2 diabetes reversal and the metabolic effects of intermittent fasting, but in this presentation from Dec. 15, 2018, he turns his focus toward the many ways the foundations of evidence-based medicine have become corrupted by financial conflicts of interest.

The first conflicts of interest he highlights pertain to the corruption of doctors. Practicing physicians who accept gifts from Big Pharma are 225-335% more likely to prescribe drugs from the gift-giving company than those who do not, Fung explains.

The corruption of doctors in prestigious universities is even worse, he claims. “There's a clear correlation: The more prestigious a doctor, the more money they're getting from the pharmaceutical.” Anecdotally, he says, this means you may be better off seeking medical advice from a family physician than from a Harvard professor; the former probably just accepted a $10 pen from Big Pharma while the latter is on the take for $500,000. “It just is a terrible system,” he says. “Yet, these people are the people that are in the newspaper. They're the ones that are teaching medical students, are the ones who are teaching the — the dietitians, the pharmacist — everybody.”

The most insidious corruption affects the published research on particular drugs. Fung highlights the influence industry can have when it finds a medical journal editor willing to take its money. Another problem arises in the form of industry-funded medical research. This conflict of interest leads to the selective publication of positive trials, which can skew the science on particular drugs and lead to unnecessary or even dangerous overprescription. Fung notes how statin prescriptions illustrate the scope of this particular problem.

“We accept this of drug companies … but the problem is that people die,” Fung says. He later adds: “You can make arguments that sugar is a health food, that opioids are good for you … but it harms patients, and we always have to remember that at the end of the day, this is not why we became doctors. The reason we became doctors was to help people, but we're not until we kind of set those same rules as everybody else.”

"What Are the Barriers to Health?" - Dr. Pran Yoganathan

Dr. Pran Yoganathan graduated in medicine from the University of Otago in New Zealand. His training in internal medicine was undertaken in the Westmead Public Hospital. His Advanced training in Gastroenterology was completed in major teaching hospitals in Sydney.  

Dr. Yoganathan has a strong interest in the field of human nutrition.  He practices an approach to healthcare that assesses the lifestyle of the patient to see how it impacts on their gastrointestinal and metabolic health. Dr. Yoganathan believes that the current day nutritional guidelines may not be based on perfect evidence and he passionately strives to provide the most up to date literature in healthcare and science to provide “Evidence-Based Medicine”.  He Is a strong motivator and aims to empower his patients to embark on a journey of self-healing using the philosophy of “let food be thy medicine”.

Dr. Yoganathan has a special interest in conditions such as Gastro-esophageal Reflux Disease (GERD), Irritable Bowel Syndrome (IBS) and abdominal bloating. He takes a very thorough approach to resolve these issues using dietary manipulation in conjunction with an accredited highly qualified dietician rather than resort to long-term medications. 

"The Failure of Medical Education: Why is LCHF Not Being Shouted From Rooftops?" - Dr. Gary Fettke

"LCHF: Health, Performance and Politics" - Dr. Peter Brukner

"Medical Corruption: How Your Doctor Was Bought" - Dr. Jason Fung

How financial conflicts of interest have corrupted modern medicine, from the medical journals to the universities. Studies that support drugs are published where those that don't are not, producing a corrupted version of reality.

"Finding the Truth in Nutrition: an Epidemiologist's Perspective" - Dr. Simon Thornley

Dr Simon Thornley is an epidemiologist, lecturer, researcher and public health physician working at the University of Auckland in the section of Epidemiology and Biostatistics. He graduated from the University of Auckland with a Bachelor of Human Biology in 1997, a Bachelor of Medicine and Bachelor of Surgery in May 2000 a Master of Public Health with First Class Honours in 2006 and a Doctor of Philosophy in Medicine in 2015. 

Dr. Thornley's research interests include tobacco dependence, food addiction and obesity, cardiovascular disease, diabetes, psychiatric disease, injury and environmental epidemiology. He has completed a PhD on cardiovascular risk factors and has a particular interest in the health effects of sugar and low carb lifestyles.

"Statin Wars: Have We Been Misled By the Evidence?" - Dr. Maryanne Demasi

Dr. Maryanne Demasi is a former medical scientist who completed her PhD in Medicine at the University of Adelaide. Her research focused on the pathology of Rheumatoid arthritis and potential therapies. Her innovative research has appeared in several internationally published medical journals.

Leaving her lab coat behind, Maryanne accepted a position as a political advisor and speechwriter for the South Australian Minister for Science and Information technology portfolios. She advised on issues concerning Intellectual Property and commercialisation of research.

Maryanne was headhunted by the ABC ‘s Catalyst program in 2006 and gained a reputation for reporting on relevant and sometimes controversial medical stories. She has won numerous accolades for her work and in 2008, 2009 and 2011 was awarded the National Press Club of Australia’s prize for her excellence in health journalism.

"The Corruption of our Nutritional and Medical Guidelines" - Dr. Anthony Chaffee

Dr Anthony Chaffee is a practicing Neurosurgical registrar, host of the PlantFreeMD podcast, former professional rugby player and long term adherent and advocate of the Carnivore diet.

In this talk he outlines the pervasive influences behind the nutritional and medical guidelines from the Seventh Day Adventist church, big food corporations and pharmaceutical industries.

"The corrupt history of the food pyramid" - Dr. Paul Mason

Scholarly/News Articles on Medical Corruption and Evidence-Based Medicine

Payments by US pharmaceutical and medical device manufacturers to US medical journal editors: retrospective observational studyObjective  To estimate financial payments from industry to US journal editors. Design  Retrospective observational study. Setting  52 influential (high impact factor for their specialty) US medical journals from 26 specialties and US Open Payments database, 2014. Participants  713 editors at the associate level and above identified from each journal’s online masthead. Main outcome measures  All general payments (eg, personal income) and research related payments from pharmaceutical and medical device manufacturers to eligible physicians in 2014. Percentages of editors receiving payments and the magnitude of such payments were compared across journals and by specialty. Journal websites were also reviewed to determine if conflict of interest policies for editors were readily accessible. Results  Of 713 eligible editors, 361 (50.6%) received some (>$0) general payments in 2014, and 139 (19.5%) received research payments. The median general payment was $11 (£8; €9) (interquartile range $0-2923) and the median research payment was $0 ($0-0). The mean general payment was $28 136 (SD $415 045), and the mean research payment was $37 963 (SD $175 239). The highest median general payments were received by journal editors from endocrinology ($7207, $0-85 816), cardiology ($2664, $0-12 912), gastroenterology ($696, $0-20 002), rheumatology ($515, $0-14 280), and urology ($480, $90-669). For high impact general medicine journals, median payments were $0 ($0-14). A review of the 52 journal websites revealed that editor conflict of interest policies were readily accessible (ie, within five minutes) for 17/52 (32.7%) of journals. Conclusions  Industry payments to journal editors are common and often large, particularly for certain subspecialties. Journals should consider the potential impact of such payments on public trust in published research.
Influence of pharmaceutical marketing on Medicare prescriptions in the District of ColumbiaImportance Gifts from pharmaceutical companies are believed to influence prescribing behavior, but few studies have addressed the association between industry gifts to physicians and drug costs, prescription volume, or preference for generic drugs. Even less research addresses the effect of gifts on the prescribing behavior of nurse practitioners (NPs), physician assistants (PAs), and podiatrists. Objective To analyze the association between gifts provided by pharmaceutical companies to individual prescribers in Washington DC and the number of prescriptions, cost of prescriptions, and proportion of branded prescriptions for each prescriber. Design Gifts data from the District of Columbia’s (DC) AccessRx program and the federal Center for Medicare and Medicaid Services (CMS) Open Payments program were analyzed with claims data from the CMS 2013 Medicare Provider Utilization and Payment Data. Setting Washington DC, 2013 Participants Physicians, nurse practitioners, physician assistants, podiatrists, and other licensed Medicare Part D prescribers who participated in Medicare Part D (a Federal prescription drug program that covers patients over age 65 or who are disabled). Exposure(s) Gifts to healthcare prescribers (including cash, meals, and ownership interests) from pharmaceutical companies. Main outcomes and measures Average number of Medicare Part D claims per prescriber, number of claims per patient, cost per claim, and proportion of branded claims. Results In 2013, 1,122 (39.1%) of 2,873 Medicare Part D prescribers received gifts from pharmaceutical companies totaling $3.9 million in 2013. Compared to non-gift recipients, gift recipients prescribed 2.3 more claims per patient, prescribed medications costing $50 more per claim, and prescribed 7.8% more branded drugs. In six specialties (General Internal Medicine, Family Medicine, Obstetrics/Gynecology, Urology, Ophthalmology, and Dermatology), gifts were associated with a significantly increased average cost of claims. For Internal Medicine, Family Medicine, and Ophthalmology, gifts were associated with more branded claims. Gift acceptance was associated with increased average cost per claim for PAs and NPs. Gift acceptance was also associated with higher proportion of branded claims for PAs but not NPs. Physicians who received small gifts (less than $500 annually) had more expensive claims ($114 vs. $85) and more branded claims (30.3% vs. 25.7%) than physicians who received no gifts. Those receiving large gifts (greater than $500 annually) had the highest average costs per claim ($189) and branded claims (39.9%) than other groups. All differences were statistically significant (p<0.05). Conclusions and relevance Gifts from pharmaceutical companies are associated with more prescriptions per patient, more costly prescriptions, and a higher proportion of branded prescriptions with variation across specialties. Gifts of any size had an effect and larger gifts elicited a larger impact on prescribing behaviors. Our study confirms and expands on previous work showing that industry gifts are associated with more expensive prescriptions and more branded prescriptions. Industry gifts influence prescribing behavior, may have adverse public health implications, and should be banned.
Association between industry affiliation and position on cardiovascular risk with rosiglitazone: cross sectional systematic reviewObjective To explore a possible link between authors’ financial conflicts of interest and their position on the association of rosiglitazone with increased risk of myocardial infarction in patients with diabetes. Data sources On 10 April 2009, we searched Web of Science and Scopus for articles citing and commenting on either of two index publications that contributed key data to the controversy (a meta-analysis of small trials and a subsequent large trial). Data selection Articles had to comment on rosiglitazone and the risk of myocardial infarction. Guidelines, meta-analyses, reviews, clinical trials, letters, commentaries, and editorials were included. Data extraction For each article, we sought information about the authors’ financial conflicts of interest in the report itself and elsewhere (that is, in all publications within two years of the original publication and online). Two reviewers blinded to the authors’ financial relationships independently classified each article as presenting a favourable (that is, rosiglitazone does not increase the risk of myocardial infarction), neutral, or unfavourable view on the risk of myocardial infarction with rosiglitazone and on recommendations on the use of the drug. Results Of the 202 included articles, 108 (53%) had a conflict of interest statement. Ninety authors (45%) had financial conflicts of interest. Authors who had a favourable view of the risk of myocardial infarction with rosiglitazone were more likely to have financial conflicts of interest with manufacturers of antihyperglycaemic agents in general, and with rosiglitazone manufacturers in particular, than authors who had an unfavourable view (rate ratio 3.38, 95% CI 2.26 to 5.06 and 4.29, 2.63 to 7.02, respectively). There was likewise a strong association between favourable recommendations on the use of rosiglitazone and financial conflicts of interest (3.36, 1.94 to 5.83). These links persisted when articles rather than authors were used as the unit of analysis (4.69, 2.84 to 7.72), when the analysis was restricted to opinion articles (6.29, 2.15 to 18.38) or to articles in which the rosiglitazone controversy was the main focus (6.50, 2.56 to 16.53), and both in articles published before and after the Food and Drug Administration issued a safety warning for rosiglitazone (3.43, 0.99 to 11.82 and 4.95, 2.87 to 8.53, respectively). Conclusions Disclosure rates for financial conflicts of interest were unexpectedly low, and there was a clear and strong link between the orientation of authors’ expressed views on the rosiglitazone controversy and their financial conflicts of interest with pharmaceutical companies. Although these findings do not necessarily indicate a causal link between the position taken on the cardiac risk of rosiglitazone in patients with diabetes and the authors’ financial conflicts of interest, they underscore the need for further changes in disclosure procedures in order for the scientific record to be trusted.
Hiding unhealthy heart outcomes in a low-fat diet trial: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial finds that postmenopausal women with established coronary heart disease were at increased risk of an adverse outcome if they consumed a low-fat ‘heart-healthy’ dietThe Women’s Health Initiative Randomized Controlled Dietary Modification Trial (WHIRCDMT) was designed to test whether the US Department of Agriculture’s 1977 Dietary Guidelines for Americans protects against coronary heart disease (CHD) and other chronic diseases. The only significant finding in the original 2006 WHIRCDMT publication was that postmenopausal women with CHD randomised to a low-fat ‘heart-healthy’ diet in 1993 were at 26% greater risk of developing additional CHD events compared with women with CHD eating the control diet. A 2017 WHIRCDMT publication includes data for an additional 5 years of follow-up. It finds that CHD risk in this subgroup of postmenopausal women had increased further to 47%–61%. The authors present three post-hoc rationalisations to explain why this finding is ‘inadmissible’: (1) only women in this subgroup were less likely to adhere to the prescribed dietary intervention; (2) their failure to follow the intervention diet increased their CHD risk; and (3) only these women were more likely to not have received cholesterol-lowering drugs. These rationalisations appear spurious. Rather these findings are better explained as a direct consequence of postmenopausal women with features of insulin resistance (IR) eating a low-fat high-carbohydrate diet for 13 years. All the worst clinical features of IR, including type 2 diabetes mellitus (T2DM) in some, can be ‘reversed’ by the prescription of a high-fat low-carbohydrate diet. The Women’s Health Study has recently reported that T2DM (10.71-fold increased risk) and other markers of IR including metabolic syndrome (6.09-fold increased risk) were the most powerful predictors of future CHD development in women; blood low-density lipoprotein-cholesterol concentration was a poor predictor (1.38-fold increased risk). These studies challenge the prescription of the low-fat high-carbohydrate heart-healthy diet, at least in postmenopausal women with IR, especially T2DM. According to the medical principle of ‘first do no harm’, this practice is now shown to be not evidence-based, making it scientifically unjustifiable, perhaps unethical. The publication makes use of data already published in the scientific literature.