For most of the time I was working in general practice, as I was the only female, I saw women with hot flushes and other menopausal symptoms. I advised HRT, which worked fine for the symptoms. Then, as time went on, I was informed by Continuous Professional Development lecturers (to get my “points” for being a good GP) that HRT would prevent heart attacks and strokes in postmenopausal women (over 60) and that I should advise HRT for this group as well. Soon there was an avalanche of stuff from women’s magazines, TV, and newspapers about how good it was, especially at preventing heart problems, and I must have put hundreds of older women on it. Until 2002 that is, when a study¹ showed conclusively that women over 60 had a greater risk of heart attacks (and cancer), when they were on HRT than if they weren’t. So we all had to call the women  in and persuade them to come off the tablets. I felt very bad about it, and wondered how I had been taken in.

The reason was obvious when I looked into it – all the worst bits of scientific manipulation were used to persuade me, such as biased trials, exaggerated results, using surrogate outcomes, wrong controls, conflicts of interest, not registering trials, ghost writers and so on.  I put a lot of detail on this in my book², and of course so did Ben Goldacre in his book Bad Pharma³.

You would think we would learn, or at least science would clean up its act.

But no, it has all started again. Just now we have a very public debate being played out about something very near to our hearts in more ways than one.

Last week we learned that the linchpin of the theory of causation of heart attacks – the cholesterol theory  – is being debunked, by a British cardiologist.⁴

Now we learn from this article that

1. Saturated fats are not bad for you

2. High cholesterol does not cause heart disease; there is only a correlation,  and in Japan researchers noted a correlation between low cholesterol and mortality from stroke heart disease and cancer.  So there is no evidence that high cholesterol causes heart disease.

3. Not eating saturated fats does not reduce the LDL  (bad cholesterol) that matters – that is a new one on me.

4.  Statins have their effect on lowering risk of recurrence of heart attacks (only in those who have already had a heart attack) because of their anti-inflammatory or coronary plaque stabilising effects, not on lowering cholesterol. No other cholesterol-lowering group lowers the risk. I already knew that statins do as much harm as good for those at low risk.

5. Adopting a particular form of a Mediterranean diet (lots of olive oil, nuts and low sugar) after a heart attack is almost three times as powerful in reducing mortality as taking a statin.

6. Heart disease is associated with metabolic syndrome (i.e. insulin resistance) even in thin individuals). This puts sugar in the frame as the bad guy.

So all those years when I was again being a good GP, putting patients on low cholesterol diets, advising against saturated fats, giving statins even to those who weren’t at high risk, I was wasting my time, and my patients’ time and effort. The comparison is striking – there was evidence that HRT helped women going through the menopause, but the scientific establishment didn’t stop there – all post menopausal women were supposed to need HRT, which would increase profits for the drug companies. The same with statins – we don’t stop at putting patients on statins when they have already had a heart attack or severe angina – we must extend it to everybody even if their risk of heart disease is low, and the harms may outweigh the benefits.

It isn’t as if a lot of this stuff is new –  some of it is, but most isn’t. But it is only now that someone is being brave enough to put their heads above the parapet.

The article was highlighted in the general press, but when I think about it, what are people actually going to make of all this?  I can’t but think that everybody is going to shrug their shoulders and lose faith in anything doctors have to say.

It doesn’t help of course when the news stories don’t actually publish what the researchers had to say. The article on the BBC website⁵ leaned so far backwards to give an “impartial” view, that it gave more time to the views of an important subscriber to the “cholesterol hypothesis”, this totally confusing the general public and making them think that this wasn’t actually anything new.  This eminent doctor was speaking for the British Heart Foundation, which is funded by Unilever (which makes Flora margarine).

As readers of this blog must now be aware, I am now convinced, along with a bandwagon of other people, that it is sugar that is the problem in causing obesity, diabetes, and also metabolic syndrome, which is a major cause of heart attacks and strokes.  But how can any of us trust any research now, when the flaws are so obvious? Why would anyone believe one theory over another?

Even The Economist, an ardent promoter of “the market” says that science is going wrong^, and that competition by researchers for readership and economic advantage is damaging research, (although it doesn’t mention the activities of health business interests).⁶ The researchers and prominent cardiologists who have promoted the cholesterol theory, who are supported by the food industry (low fat margarines, low fat meals), and the pharmaceutical industry (statins) that have done so well in the last twenty years aren’t going to give up without a struggle. The media are going to help them, and doctors are still going to be advised to stick to the current status quo. Even last week, doctors were being advised by a review in the Cochrane Collaboration, a respected organisation which concentrates on evidence based medicine, that statins were indeed useful in low risk individuals, as a result of a meta-analysis published recently⁷. For those than can read the BMJ, there is a very good opposing article⁸ pointing out that all the trials in the meta analysis were conducted by Pharma companies with an interest in cardiovascular drugs, and that side effects are regularly underplayed and under-reported.

But some  doctors will continue to be influenced by the power of the medical establishment and media backed by these companies, and the anti-sugar lobby is going to have to fight its case without the luxury of so much funding. However, a poll of doctors yesterday showed that the same number thought that cholesterol  was most important, as thought that sugar was, but about 30% were undecided, so there is everything to play for.

It will undoubtedly be a hard fight, but unfortunately  science is being more and more discredited, at least in medical and biological fields. Most doctors are going to go on being influenced by the power of the medical establishment and media backed by these companies, and the anti-sugar lobby is going to have to fight its case without the luxury of all this money.

And the public? They are going to shrug their shoulders and say “They all change their minds every few years. I don’t trust the scientists so I will eat what I want.” And rates of obesity and diabetes won’t change any time soon.

1. Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women. JAMA: The Journal of the American Medical Association 2002;288:321–333.
2. A Sceptical GP. Elen Samuel. Published by Rheafield Publishing 2013 and available through bookstores and the Welsh Book Council
3. Bad Pharma. Ben Goldacre. Harper Collins, 2013
4. Saturated fat is not the major issue. Aseem Malhotra, BMJ 2013;347:f6340
5. Saturated fat heart disease ‘myth’. BBC News Health 23 October 2013
6. 6. The Economist Oct 19^th– 25^th How Science Goes Wrong
7. 7. Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev2013;1:CD004816.
8. 8. Should people at low risk of cardiovascular disease take a statin? BMJ 2013; 347