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    The Death of the Reference By Dr. Malcolm Kendrick (Why The Scientific Machine Is Close To Meltdown)

    Posted by .(JavaScript must be enabled to view this email address)
    Tuesday, February 02, 2010 7:28 am Email this article
    References are very much a double edged sword, or perhaps a bazooka. In the wrong hands they can do far more harm than good. And in the, essentially, unchecked system that we now have, one careless reference can end up taking on a life of its own. It gets stuck in the medical information ‘machine' replicating itself like some malevolent computer virus, gradually infecting all data and turning it into useless mush.

    (This article was written by Malcolm Kendrick, MD, author of the wonderful, eye-opening, paradigm-shifting book The Great Cholesterol Con: The Truth About What Really Causes Heart Disease and How to Avoid It .) Scientists Use References Like a Drunk Uses a Lamp-Post

    Scientists use references like a drunk uses a lamp-post, for support rather than illumination

    It is often said of statistics that scientists use them like a drunk uses a lamp-post, for support rather than illumination.


    Abuse of References

    Abuse of references— can’t be sure if what I read is true anymore

    I suppose the whole point of a scientific reference is that it is used, primarily, to provide support, so I can’t really complain about the lack of illumination. However, I can complain about the fact that the abuse of references has led to the point where I have found that, increasingly, I can’t be sure if what I read is true anymore.


    Bold Statements Made About Heart Disease

    Some bold statements made about heart disease don’t stand up to scrutiny

    As some readers will know I have a particular fascination with heart disease. Some would call it an obsession, but I prefer the word, fascination. It’s that old Y chromosome thing. Anyway what I have found, as I have researched away, is that a number of bold statements of fact, even those referenced to the gunnels, when exposed to a bit of scrutiny, crumble to dust.


    Bold Statement #1 That is NOT True

    Bold statement #1 that is NOT true: Women are protected from heart disease by their sex hormones

    For example, at one stage I was interested why women, in most Western Countries, suffer a much lower rate of heart disease than men - at least until about sixty five or seventy. Women usually have very similar risk factors to men therefore, according to conventional wisdom, there should be little difference in deaths from heart disease.

    I suspect I know what you are thinking. Women are protected against heart disease by their sex hormones. This was what I used to think as well as well. Probably because I had seen this fact stated so many times, in so many papers, that I had been brainwashed into believing that it was true. This belief was reinforced by the ‘knowledge’ that female protection seemed to disappear not long after the menopause, so I didn’t really think to question it.

    Nor, it seemed, did anyone else. Just to quote from one study, which accurately reflected mainstream thinking a few years back:

    ‘A protective effect of estrogen is the most obvious reason for the substantial and consistent favored status of women vs. men with regard to coronary heart disease.’
    —Barrett-Connor E. Postmenopausal estrogen and heart disease. Atherosclerosis. 1995 Dec, 118 Suppl:S7-10.


    Female Sex Hormones Do NOT Protect Men

    Female sex hormones given to men dramatically increase coronary heart disease

    However, I started to find out a number of facts about women and heart disease that made me begin to question things. Firstly, it was clear that if you gave female sex hormones to men, their rate of CHD [coronary heart disease] increased dramatically. Which doesn’t prove anything for sure, but it does give pause for thought. After all, there is no reason why a chemical that protects women shouldn’t also protect men.


    In Some Populations, Younger Women Suffered The Same Rate Of Heart Disease As Men

    Young females with type 2 diabetes suffer same rate of heart disease as men, but their female hormones are still there

    Then I found that there were some populations where younger women suffered the same rate of heart disease as men, such as women in Brazil. In addition to this, the Framingham study showed that, when women developed type II diabetes their relative protection against heart disease disappeared, even at a young age. Diabetes doesn’t wipe out sex hormones, so where did the protection go?


    I Started To Doubt That Females Are Protected by Sex Hormones

    I set out to track down the original source of this hypothesis

    As this type of information began to pile up, I started to suspect that women may not be protected by sex hormones after all. And so I was galvanised into action and set out to track down the study, or studies, that had been carried out proving that women are protected by sex hormones. In effect I went on the quest to track down the original source of this hypothesis. Which I knew from previous experience can be very hard work.

    Just because it states in a recent scientific paper that female sex hormones are protective, doesn’t mean that the authors did a study. They are usually just quoting from another paper, which has quoted from another paper, which quoted from another paper, which quoted from… sometimes it seems ad-infinitum. Trying to track backwards in time to find that very first study from which all other studies sprang is not the work of a single day.

    You can, it sometimes seems, find yourself late at night reading manuscripts with illuminated script, penned by Monks in the early fourteenth century. ‘ And it has been rightly noted by the good physics of this borough that the clutching disease of the breast is more common in the male than the female, and that the protection of fair lady folk be due to the most strange substance of eastrogenne found in the most fecund of ye womanne .’

    Well, not quite, but I once chased down a reference linking heart disease to impotence and found the source reference from a study in Germany in 1928 (In German).


    Sometimes There Is No Original Study

    Sometimes repeated statements of fact have sprung from the scientific equivalent of rumour and gossip

    Other times I have found that there is no source study at all. The whole thing has sprung to life from thin air. On bad days I sometimes think that references are no more than the scientific equivalent of rumour and gossip.

    ‘Ooooh, you’ll never guess what, sex hormones protect against heart disease.’

    ‘Who told you that.’
    ‘The Mayo clinic did a study, I think. Or at least that’s what Harvard said.’
    ‘And I read it in the Lancet too.’
    ‘Oh well, it must be true. I’ll have to go off and tell all my students.’

    And then they’ll go off and tell all their students. Some of whom will write papers starting with the comment. ‘It is known that women are protected against heart disease by their sex hormones.’ Then other people will use their papers as references, then…


    Rumours Become Unquestioned Truth

    Rumours that are repeated enough become unquestioned truth

    After a while this rumour reaches the point where it becomes an unquestioned truth because so many people have said it so many times, and it has been written in hundreds of papers. In addition, experts stand up at conferences and re-affirm it. Which means that when you write ‘Sex hormones protect women against CHD,’ you are then able to support this with hundreds and hundreds of references from major journals?


    There Never Was A Study Proving Female Sex Hormones Protect Against Heart Disease

    There never was an original study showing that female sex hormones protect against coronary heart disease

    But in this case, where was that original study, the source reference? What was it all based on? Well, gentle readers, it was based on nothing at all. Because there never was an original study. Or if there was, it is so damned well hidden that I have never able to find it (he said covering himself from the inevitable pedant who will no doubt triumphantly unfurl the 1936 trial done in Serbia-Montenegro).


    Papers Reference Other Papers That Reference Other Papers

    A study has never been done to determine if female sex hormones protect against heart disease

    All I could find were papers referring to other papers that referred to other papers. Yes, it is true that a number of studies were done which showed that estrogen raised HDL levels and reduced LDL levels and protected the endothelium, and all sorts of other ‘test-tube’ effects. But in the end, if you wanted to prove that female sex hormones protect against CHD, there are only two direct ways to do it.

    1. Remove sex hormones from younger women, and see if the rate of heart disease goes up.
    2. Add sex hormones to women who no longer produce them, and see if the rate of heart disease goes down.

    Had anyone done this? No.


    1963 Study Found Women With Ovaries Removed (No Sex Hormones) Had The Same Rate of Heart Disease As Women With Ovaries

    Women who had hysterectomies with both ovaries removed (no sex hormones) had the same rate of heart disease as women with hysterectomies who did not have their ovaries removed

    Actually I lie, the correct answer is yes. In 1963, a study was done in which women who had hysterectomies were matched with women who had hysterectomies with removal of both ovaries (no sex hormones). And the result of this study was…..?

    As you might have guessed, the result of this study was that there was no difference in the rate of heart disease between the two groups.

    ‘We found no difference in the prevalence of Coronary Heart Disease in the oopherectomised (both ovaries removed) and hysterectomised (no ovaries removed) women.’
    —Ritterband A, Jaffe I, Densen P, Magagna J, Reed E. Gonadal function and the development of coronary heart disease. Circulation. 1963 Feb, 27:237-51.


    Pure Speculation Became ‘Fact’ Through The Process Of Endless Repetition And Cross-Referencing

    Millions of women prescribed hormone replacement therapy to protect against heart disease based on pure speculation

    Okay, it’s only one study, but it was totally negative, and no-one had ever done a study that was positive. Yet, despite a complete lack of evidence, the sex hormones theory had built to the point where millions of women around the world were being prescribed HRT [hormone replacement therapy] in order to prevent heart disease. All this, resting on a piece of pure speculation that only became ‘fact’ through the process of endless repetition and cross-referencing.


    Study Found Estrogen Plus Progestin May Increase the Risk of CHD

    Study found estrogen plus progestin does not confer cardiac protection and may increase the risk of CHD

    And when, finally, researchers decided it was time to see if HRT did actually protect against HRT, what did they find? Well, a few large studies were done, and if I may quote from the New England Journal of Medicine on the matter:

    ‘Estrogen plus progestin does not confer cardiac protection and may increase the risk of CHD among generally healthy postmenopausal women, especially during the first year after the initiation of hormone use. This treatment should not be prescribed for the prevention of cardiovascular disease.’
    —Manson J, Hsia J, Johnson K, Rossouw J, Assaf A, Lasser N, Trevisan M, Black H, Heckbert S, Detrano R, Strickland O, Wong N, Crouse J, Stein E, Cushman M. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med. 2003 Aug 7, 349(6):523-34.


    References Are A Double-Edged Sword

    In the wrong hands, references can do more harm than good

    Now then, at this point, some of you may have picked up on the gentle irony that I am using references to support my argument that references are a load of rubbish. But of course, references used properly, are a good thing. (I mean the way I use them, of course.)

    However, references are very much a double-edged sword, or perhaps a bazooka.

    In the wrong hands they can do far more harm than good. And in the, essentially, unchecked system that we now have, one careless reference can end up taking on a life of its own. It gets stuck in the medical information ‘machine’ replicating itself like some malevolent computer virus, gradually infecting all data and turning it into useless mush.

    I don’t know what the answer to this problem is. Wipe the whole database clean and start again? Set up a system to hunt down and check all references, and remove those that are found to be wrong. Then remove all references to those references. The mind boggles at the size of that task.


    You Must Read The Original Paper

    To know the truth, you must go back and read the original paper for yourself

    In the meantime, until someone does something (he said passing the buck), I find that when I want to know what the truth may be, or to get as close to the truth as is possible, the only solution is to go back, get the original paper used as a reference, and read it for myself. Which is an enormous time consuming pain. But I believe that references are now so badly corrupted that it is virtually impossible to trust them, or the papers based on them, anymore. In effect this means that the entire medical research machine is close to meltdown. If it hasn’t melted down already.


    The Truth Is Out There

    The truth is out there. It is just difficult to know what it is anymore

    In the meantime, remember that the truth is out there. It is just extremely difficult to know what it is any more.



    Article Previous Published on THINCS.org

    This article was previously published on THINCS.org

    This article was previously published on THINCS.org (The International Network of Cholesterol Skeptics).

    I republished the article here with Dr. Kendrick’s permission.


    Malcolm Kendrick’s Contact Info

    Malcolm Kendrick’s Email Address—.(JavaScript must be enabled to view this email address)

    Dr. Malcolm Kendrick can be reached at .(JavaScript must be enabled to view this email address).

    Malcolm Kendrick, MD is the author of the wonderful, eye-opening, paradigm-shifting book book The Great Cholesterol Con: The Truth About What Really Causes Heart Disease and How to Avoid It .)


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