Hoorah

The article below was just sent to me be a fellow GP, who shares my concerns about the prescribing of statins to everyone with a pulse. In fact it was he (I am being coy about naming him here) who led the protest against the over-prescribing of statins within the Royal College of General Practice (RCGP). He also led the protest within the General Practice Committee (GPC), which is the part of the British Medical Association (BMA) that negotiates on behalf of General Practitioners. Yes, the structures of medical politics are byzantine indeed.

Anyway, for those who believe that doctors are unthinking drones who stare at computer screens and merely follow the guidelines they see there, tonight you may raise a glass of beer, or wine, or even whisky, to them.

Short warning. Before you read this article, which appeared in PULSE magazine (the most widely read medical magazine for UK GPs) I feel I need to quickly flick through the acronyms.

  • RCGP = Royal College of General Practitioners
  • NICE = the National Institute of Health and Care Excellence (they look at all the evidence in a medical area, then create the guidelines for treatment that doctors are commanded to follow)
  • QOF = Quality Outcome Framework. A system of payments designed to incentivise General Practitioners to meet various targets e.g. lower blood pressure, measure weight, put people on statins.
  • QRISK = A risk calculator, designed to determine your risk of having a heart attack or stroke in the next five or ten years.

‘The RCGP and the GPC have rejected NICE’s plan to introduce QOF indicators that would see practices rewarded for prescribing statins to patients with a QRISK score above 10%, warning the move threatened the ‘credibility of QOF’.

The move comes as NICE advisors on QOF are due to meet early next week to discuss potential new indicators – including two that would reward practices for prescribing statins to patients newly diagnosed with diabetes or hypertension at a 10% estimated 10-year cardiovascular risk level – which will be up for negotiation for next year’s contract if approved.

The GPC said that it was ‘vital for the credibility of QOF’ that indicators have a robust evidence base, make significant difference to patients and are backed for the profession, adding that these proposals ‘fail on all these counts’.

The RCGP warned that the proposals risked ‘the loss of professional confidence in the healthcare targets they are being asked to meet’.

NICE launched the consultation on proposed new QOF indicators earlier in the year, which included another potential new indicator would pay practices to set up a register of patients with a 10-year risk of 10% or higher, alongside the hypertension and diabetes indicators.

The proposals were made in order to reflect updated NICE lipid modification guidelines, which lowered the 10-year cardiovascular risk threshold at which GPs prescribe interventions, including statin therapy, from 20% to 10%.

This was despite opposition from GP leaders and other leading clinicians concerned about the potential for over-medicalisation of healthy people and diversion of resources away from the sick onto the ‘worried well’.1

‘Get in!’ as they say. I am, to put it mildly, delighted.

1:         http://www.pulsetoday.co.uk/your-practice/qof/gp-leaders-unite-to-reject-nice-proposal-to-put-10-statin-threshold-in-the-qof/20010096.article#.VWh-r8-6eUk

96 thoughts on “Hoorah

  1. scegg@comcast.net

    You might find a YouTube video I made last year of interest.   Thank you for your books and blog,  Sam

    Reply
  2. dearieme

    “the guidelines for treatment that doctors are commanded to follow”: if you are commanded to follow them they are not guidelines but instructions. Did some lying liar decide to call them “guidelines” to disguise this fact? Toads!

    Reply
    1. mikecawdery

      As I have said many times the word “guidelines” is used to protect the authors from legal suit; but G** help the docs that do not follow them exactly. The GMC and the courts await to charge them of negligence or whatever.

      Reply
    2. S Jones

      Sometimes the professional medical associations/colleges use words that give them wiggle room, and cover them in Teflon at the same time. For instance, the British Thyroid Association has recently (May 2015) produced a “statement”, (NOT a guideline), on the management of primary hypothyroidism :

      http://www.ncbi.nlm.nih.gov/pubmed/26010808

      The Royal College of Physicians has also, in the past, produced “statements” not guidelines, on the diagnosis and management of primary hypothyroidism. Read the title page and see how many medical groups jumped on the bandwagon too. :

      http://www.british-thyroid-association.org/news/Docs/hypothyroidism_statement.pdf

      If anyone tackles either the RCP or the BTA on the subject of their hypothyroidism “guidelines”, the response is always to point out that their documents are not guidelines, they are statements, and doctors are not obliged to follow them. Any doctor who takes this literally is likely to get hauled up on a Fitness To Practice charge, or whatever doctors call their kangaroo court charges.

      Going back to the first link, second sentence, could I also point out that TSH only rises when Free T4 and Free T3 drop. If the BTA doesn’t know that TSH responds to Free T3 and Free T4 rather than the other way around, then thyroid patients are forever doomed.

      Reply
  3. mr Chris

    Pretty frightening 1984 stuff. I could spin out the usual tale here, muscular pains, digestion trouble, low Vitamin D etc, took myslf off Crestor and Ezetrol, and feel a new man.
    After all, whats the point if you don’t live longer?
    prefer to be one of the worried well.

    Reply
  4. Vinay keesara MD

    Statins alter Vitamin K2, Selenium, CoQ10—you decide (here is the 2015 research you decide)

    Abstract
    In contrast to the current belief that cholesterol reduction with statins decreases atherosclerosis, we present a perspective that statins may be causative in coronary artery calcification and can function as mitochondrial toxins that impair muscle function in the heart and blood vessels through the depletion of coenzyme Q10 and ‘heme A’, and thereby ATP generation.

    Statins inhibit the synthesis of vitamin K2, the cofactor for matrix Gla-protein activation, which in turn protects arteries from calcification. Statins inhibit the biosynthesis of selenium containing proteins, one of which is glutathione peroxidase serving to suppress peroxidative stress.

    An impairment of selenoprotein biosynthesis may be a factor in congestive heart failure, reminiscent of the dilated cardiomyopathies seen with selenium deficiency.

    Thus, the epidemic of heart failure and atherosclerosis that plagues the modern world may paradoxically be aggravated by the pervasive use of statin drugs. We propose that current statin treatment guidelines be critically reevaluated.

    Expert Rev Clin Pharmacol. 2015 Mar;8(2):189-99.

    Reply
    1. mikecawdery

      Dr Keesay
      Many thanks for the reference; a nice one for my collection. I note that a 24 hour access to the full paper is $89.00. Open access be da*****. Dr Goldacre has to be supported in his attempt to get transparency in medicine.

      Reply
      1. robert lipp

        Health science must be available to everyone. It affects all our lives and medical doctors should not have exclusive rights.

    2. mikecawdery

      Many years ago on both the US CDC and NHBLI websites I found an article on the “epidemic of congestive heart failure” It did not last long and was removed lock stock and barrel. it was on Deaths from CHD in US.

      http://library.thinkquest.org/27533/facts.html This web site has since been archived

      It seems that the “authorities” wanted nothing to do with this “epidemic” which continues to rise.

      Unfortunately I don’t know how to include an image.

      Reply
      1. dearieme

        When my GP was trying to persuade me to take statins, I got him to admit that they can cause muscle weakness. “My heart is a muscle” said I. “No, no, no, quite different” said he. And that was the scientific depth of his argument. “No, no, no.”

      2. BobM

        I believe the epidemic in heart failure also correlates with high blood sugar/insulin resistance. I would guess the epidemic is probably more related to insulin resistance than statins, but it’s hard to tell.

      3. mikecawdery

        BobM
        If your suggestion is right, why did these huge research outfits not give this explanation and leave the web page intact? An epidemic is just that and it does not simply disappear

  5. Maureen H

    It’s very good to hear this, so many of us are ticked off and disillusioned with the medical profession as a whole and even though we know there must be some good doctors around, we don’t get to hear of what exactly is going on in the background, and how G.Ps are starting to stand up against N.I.C.E., who appear to have the same attitude in the upper eschelons as FIFA.

    Reply
  6. celia

    I am very pleased to read this. My question, however, is if the doctors have voted to reject the NICE guidelines, can they nevertheless be forced to implement them? I sincerely hope NICE will take the medical profession’s opinions into account. Otherwise they risk doctors being able to perform their jobs efficiently and with conviction, not to mention clogging up waiting rooms with currently well people, many of whom do not want to be over medicalised.

    Reply
    1. Dr. Malcolm Kendrick Post author

      I don’t know what will happen. NICE has no process to reevaluate what they do. They do guidelines, guidelines go out. Doctors must follow (in theory you can decide not to, but significant pressure will be applied). If doctors say ‘bollocks to that’ then what? An extremely interesting case study in non-elected power structures. I suspect NICE and the RCGP will sort of pass through each other without touching. If GPs don’t do QOF, they don’t get paid. So, perhaps a weird sort of stand off will occur. It will be fascinating to see what happens. In the end, of course, if NICE insist on producing guidelines that the profession think are absolute nonsense something is going to break, somewhere. I am just not sure where, or how.

      Reply
      1. mikecawdery

        Dr Kendrick,

        No method for re-evaluating? How UNSCIENTIFIC can NICE get?

        I download one guideline on acute heart failure and it was huge and supported by a huge appendix and references. To read and CHECK it would take days which GPs and WORKING consultants just do not have.

        My own experience in contacting them is that they are totally uninterested in the squadrons of “black swan” reports that are contrary to their “faith and beliefs”. It used to be called “snake oil philosophy”

        if NICE insist on producing guidelines that the profession think are absolute nonsense something is going to break, somewhere. I am just not sure where, or how.

        If that is true (and I believe it to be) where has integrity and science gone in the administration of medicine. In the US it causes 100,000 deaths a year from properly prescribed and properly used drugs; equivalent to 20,000-30,000 in the UK.
        A statement that has never been denied as far as I know and there are other reports that put this cause of death far higher!

      2. celia

        Dr Kendrick, thank you for teasing this one out. Well, if David Cameron wants more doctors to work more hours, maybe he could re-evaluate the usefulness or otherwise of NICE?

      3. Jennifer

        Dr Kendrick. Your recent topics are excellent news to those of us concerned at over medicalisation of wealthy societies. There are problems in ill-health ridden societies, the likes of which many of us are unlikely to ever encounter, which puts the current practice of over-indulgence of the worried well to be nothing short of immoral.
        But not to worry Big Pharma——once the informed populations turn their backs on your toxins…..you will no doubt find vulnerable markets in which to ply your wares, in much the same way as the tobacco industry did, when the tide changed against cigarettes.

  7. Brian Jutson

    Am I right in assuming that we in the UK can refuse to be tested for QOF and refuse to take part in the QRISK?

    Reply
      1. Helen

        Hmm, that may be so, but a patient may end up being labelled a ‘persistent refuser’, with implications for one’s general medical care. Been there, done that, been obliged to pay for private treatment…

      2. Pat

        Are you aware of any plans NICE or others in the NHS might have to force us to have tests done or to force us to take medicines like statins or for BP lowering?

  8. Gay Corran

    Thank you once again Dr Kendrick for letting us know about this further step in the right direction. I fear we’re not there yet though! Those of us who did not fare well on simvastatin and candesartan will have to continue bravely to defy our doctors.

    Reply
  9. mikecawdery

    ‘vital for the credibility of QOF’ that indicators have a robust evidence base

    Is there any such evidence?

    You mentioned Dr Spence’s “criticism” on QOF in the past in relation to polypharmacy and all its problems.

    Surely NICE should resolve the issue of polypharmacy with respect to the EMA’s position on “combination products”.

    Reply
  10. SJ

    “The move comes as NICE advisors on QOF are due to meet early next week to discuss potential new indicators – including two that would reward practices for prescribing statins to patients newly diagnosed with diabetes or hypertension at a 10% estimated 10-year cardiovascular risk level – which will be up for negotiation for next year’s contract if approved.”

    I’ll admit that my brain ain’t firing on all cylinders at the mo (lack of dietary saturated fat is to blame, methinks…), but that doesn’t seem much of a victory to me – am I misunderstanding/misinterpreting it…?

    Reply
  11. TJ Huber

    Thank you Dr. Kendrick for your unwavering encouragement to those of us who do not want to take statins. I am a retired orthopedic surgeon who was put on statins about 12 hers ago. Gradually my, not normally that sharp, brain became further obtunded and I started having significant memory problems. Unlike the proverbial frog, I realized what was happening, discontinued the use of statins and, over 2-3 years have gotten my faculties back. In order to keep my doctor out of trouble I wrote him a lengthy letter explaining my problem and notifying him officially that I would not ever willingly take statins again. I like and respect the man and owed him that much.

    Reply
    1. maryl@2015

      TJ, having interfaced with mostly orthopedic and neurologic physicians for most of my career, I have a great deal of respect for your job. I believe you did the most intelligent and kind thing you could have toward your physician. I liked and respected my both GP’s one retired and one still working. They did what they thought they were SUPPOSED to do. I respect that job as it cannot be easy.

      Reply
  12. Maureen Berry

    So, on the ‘Atkins forum’ I frequent, tonight a member who is enjoying the diet and the food and has lost a stone and a half in 4 weeks has been told by his GP, ‘the expert’, that the diet is hazardous and he needs to change. The juggernaut may be slowing down, but getting it to stop and change direction will take decades. It’s so sad. So many people, so much bad advice.

    Reply
    1. maryl@2015

      Maureen, don’t lose faith…I don’t think it will take decades. I think it has changed already and I look forward to see this put to rest. There has to be accountability and those conflicts of interest need to be dealt with. You will see it. Dr. Atkins was one of the first I heard of who advocated that kind of diet. When he died, people said he died of his own diet. We did not understand near what we do today. And as I understand, he based his opinions about high fat, low carb on one study from 1958. Now, if this mentality had taken off based on one study alone, it may not have had any credibility. It takes a long time to gather evidence review studies, both longitudinal and short term. So, I think from all those I am seeing in this debate that there is ample evidence out there to disprove the diet heart hypothesis and the widespread use of statins (the one size fits all mentality) as a way to decrease the incidence of heart disease and death from heart disease. I am still amazed at how well the anti smoking campaigns have done in the states. But…it happened. On the whole, we are healthier in terms of the number of those who quit smoking. You have to admit that was a big one to overcome!!!

      Reply
    2. chris c

      Oh that’s nothing! I recently heard of a DIABETIC, who had achieved the usual near normalisation of blood glucose, blood pressure and lipids, and on hearing how she had achieved this her doctor told her she MUST eat a high carb low fat diet or she would receive no more treatment “and we can tell if you are complying because your trigs will go up!” words fail me . . .

      My story is not dissimilar though not so extreme, having DOUBLED my HDL and reduced my trigs to 1/10 of their previous value, I decided to drop my statin for a month to see how much was down to the drug and how much down to the diet (I never actually had a problem from it, it dropped my LDL but did nowt for the other factors). The nurse went ballistic, decided not to give me the results of my lipid panel and told me I couldn’t have any further lipid panels as “we don’t test your cholesterol again once you’re on your statin!”

      At least she wasn’t one of the fat ones – and even one of the GPs is the size of a small building yet has totally failed to notice her low fat diet hasn’t “cured” her. I find it almost incomprehensible that supposedly intelligent people rate dogma over outcomes, in themselves as well as in patients. Well, this intervention failed in the last hundred cases, this time’s the charm . . . it’s good to see increasing numbers of doctors noticing the smoke and mirrors in recent times, pity you can’t be cloned.

      Reply
  13. Professor Göran Sjöberg

    As I understand the human history the medial authority has never been easy to challenge.

    Still, I remember that Montaigne somewhere in his Essays mentions that a Roman emperor got sick and tired of apparent medical abuse and ordered the beheading of all GPs. Although a top-down action the effect did not last for very long according to Montaigne.

    Reply
    1. mikecawdery

      Sorry Professor

      but I cannot agree with “…..ordered the beheading of all GPs.”

      It is NOT the GPs that are at fault! They are DIRECTED and, in some cases BRIANWASHED by the medical establishment on pain of legal action if they divert from the “revealed truth” set out in the guidelines.

      There was the “”Polderman affair” where possibly as many as 800,000 died as a consequence of this EU “guideline” based on faith, fabricated evidence and probably other flawed studies.

      I am left wondering how many other “Polderman-like” guidelines are out there. The 100,000 people killed each year in the US (Incidence of Adverse Drug Reactions in Hospitalized Patients, Lazarou, J, Pomeranz, B., Corey, P., JAMA, April 15, 1998, p. 1200; http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/DrugInteractionsLabeling/ucm114848.htm +++)
      To quote:
      Why Learn about Adverse Drug Reactions (ADR)?
      Institute of Medicine, National Academy Press, 2000
      Lazarou J et al. JAMA 1998;279(15):1200–1205
      Gurwitz JH et al. Am J Med 2000;109(2):87–94

      Over 2 MILLION serious ADRs yearly
      100,000 DEATHS yearly
      ADRs 4th leading cause of death ahead of pulmonary disease, diabetes, AIDS, pneumonia, accidents and automobile deaths
      Ambulatory patients ADR rate—unknown
      Nursing home patients ADR rate— 350,000 yearly

      Frightening!

      Reply
      1. Professor Göran Sjöberg

        mikecawdery

        Of course you are right!

        Individual GP’s are not to be blamed for a faulty system. And exceptional, courageous members, like ‘our’ Malcolm, who really take the fight against a corrupt system is worth our highest esteem.

        My point was only an anecdotal, metaphoric one reflecting how historically the authority of the medical profession has been questioned by patients of different calibre.

  14. David Bailey

    Maybe doctors should specify some maximum NNT beyond which it would be inappropriate to prescribe any treatment.

    They should also start to tell every patient the approximate NNT for their treatment given their condition.

    Just thinking about the concept of NNT’s changes one’s perspective!

    I think very few patients are aware of just how ineffective some medicines are.

    Reply
    1. Stephen Town

      Well said, David. I asked my doctor about NNT when she said NICE guidelines indicated medication for blood pressure. It’s a useful tool for understanding what’s going on.

      Reply
    2. mikecawdery

      Or more easily and honestly understood as the probability of NO BENEFIT but then NICE does not do Honesty, only flogging drugs.

      Incidentally something seems to have gone wrong with the “notify” request tick boxes

      Reply
      1. Dr. Malcolm Kendrick Post author

        NICE has been told by the Government to be more supportive of pharmaceutical companies. Aseem Malhotra has seen the evidence on this matter. In other words pharma company lobbying has led to politicians putting pressure on NICE to approve and support the more widespread use of drugs – allegedly

  15. Barbara B

    Over a year ago I told my doctor that I just couldn’t take statins anymore, after I’d tried at least 3 or 4 versions, as the pain was more than I could bear. I also discovered once I stopped them that other symptoms I had never thought of associating with statins gradually disappeared as well. At least m y doctor respected my wishes to stop these drugs but although I offered him a copy of your book, Dr. Kenrick (“the Great Cholesterol Con”) he politely refuse it, saying he hadn’t the time to read it (which I felt was a perfectly valid point). Maybe I was being a bit cheeky! 😏 Anyway, as far as he was concerned, he believed that statins were import for preventing heart attacks, etc., etc. He is a really good, sensible doctor whom I like very much (and with whom I can be honest) but if he is toeing the line with regard to statins then what chance is there for other good doctors to rebel and NOT prescribe statins either? The fear of litigation must loom large in their minds! Well, at least my doctor has never badgered me to go back on them again. 😀

    Reply
  16. Roger A

    Q RISK CALCULATOR
    Clinical information
    Male
    Age 71
    Smoking status: former former
    Diabetes status:
    Angina 1st degree relative < 60? yes yes
    Chronic kidney disease?
    Atrial fibrillation?
    On blood pressure treatment?
    Rheumatoid arthritis?
    Cholesterol/HDL ratio: 5.3 (8.5/1.6) 2 (3.2/1.6)
    Systolic blood pressure (mmHg): 115 210
    Body mass index 25.5
    Height (cm): 177
    Weight (kg): 80
    My Risk 31% 27.1%
    Average risk 20.1% 20.1%
    Relative risk 1.6 1.3
    Heart age 79 76
    No medication taken
    Results produced by Q risk for two differing scenarios
    Now ask yourselves, which set of results would you be happier with –
    My situation of high chol and good systolic BP or the hypothetical scenario 2
    Low chol and high BP ?
    Family history
    Father stable angina from age 57 to 85
    Mother survived to almost 105

    Reply
  17. Janknitz

    I am so sad to see the profession of medicine come to this. Unless brave doctors take it upon themselves to resist (at great personal risk), we might as well get our pills dispensed from the same machine that reads our laboratory tests and body metrics. It will all be the same anyway I got out of an allied health profession after 20 years because I could not suspend my own judgment and observation to make money for my employer–that’s not why I went into that field. Cheers to doctors like you and your fellow GP for refusing to swallow the Kool Aid.

    Reply
  18. Carolyn

    The unthinking drones are still alive & kicking in thyroid medicine, unfortunately. ‘Computer says no’ is still the name of the game there. And the ones who resist and make people better get hounded out. Appalling

    Reply
  19. lindaccd

    pnightingale100@btinternet.com

    Sent from Yahoo Mail on Android

    From:”Dr. Malcolm Kendrick” Date:Fri, 29 May, 2015 at 4:41 pm Subject:[New post] Hoorah

    Dr. Malcolm Kendrick posted: “The article below was just sent to me be a fellow GP, who shares my concerns about the prescribing of statins to everyone with a pulse. In fact it was he (I am being coy about naming him here) who led the protest against the over-prescribing of statins wi”

    Reply
  20. maryl@2015

    Jankinitz and all…that is the key: courage, study, and a regard for others as well as the self. I am so happy for all of you in the UK. And, I am seeing things in the U.S. as well.

    Dr. Kendrick, again, I cannot say enough about you and your struggles to find the truth. You were among those pioneers who had faith in the math and the message, taught us all to see things more clearly (i.e. absolute vs. relative risk) and helped us enjoy learning along the way.

    My life would be very different had I not, by pure fate, happened upon your book and blog.

    Hip Hip Hoorah!!!
    Congrats Dr. Kendrick!!!

    Reply
    1. David Bailey

      Mary,

      At the risk of making Dr K blush, I agree very strongly! There are so many people here, including myself, who are going against the official advice of the medical profession, and it is vital for them to be able to come to a blog like this, run by a medically qualified doctor working for the NHS.

      One of the great benefits of this blog, is that practically nothing is censored, so if those in the medical establishment wished to respond here, they could do – indeed one thread was given over to such an individual. However, on the whole the silence from the other ‘side’ is deafening.

      Reply
  21. Professor Göran Sjöberg

    Today I wonder if the medical establishment is at a turning point after all.

    The whole foundation of this statin ‘craziness’, sixty years back in time, is as I understand it based on the very simplistic assumption that saturated fats and cholesterol in your food is dangerous and as such ends up in your clogged arteries.

    I now read everywhere that the ‘high priests’ are jumping off this sinking ship or am I misunderstanding the whole situation?

    E.g the ‘trial’ , scheduled for this week, against South African Professor Noakes who has been accused of misconduct when suggesting the benefits of saturated fats for weaning infants has now taken a dramatic turn since the very president who made the charge against him has now announced that her dietician organisation actually EMBRACE the very same dietary advice Noakes is accused of having suggested.

    Please, read the update at the end of this blog post.

    http://www.biznews.com/lchf-health-summit/2015/04/28/is-tim-noakes-really-sas-new-dr-death-big-fat-surprise-banting-lchf/

    Reply
    1. David Bailey

      Göran,

      That is a great find, and I think this interview (within your link) with Dr Anthony Dalby is priceless:

      quote……………………………………………

      Dalby, at least, was prepared to have a phone chat with me, albeit brief. He says LCHF is dangerous, not because of low-carb or weight-loss issues, but because it “contravenes the best medical advice we have” in its high saturated fat recommendations.

      “We have recorded that patients develop very high, or moderately high cholesterol levels,” Dalby says.

      The results won’t play out in the short term that “this diet has been pushed around”, he says. It will play out in 10, 20 years: “You can feel great, lose weight, have less diabetes, but the long-term effects are unknown, and appear to be adverse.”

      In response to whether long-term effects are seen in traditional societies, such as the Inuit who ate LCHF for centuries without a high incidence of heart disease, Dalby says: “That’s not proof.”

      “Japanese traditional diets have protein and carbohydrates but very little saturated fat, and also show little heart disease,” Dalby says. “We need a lot more evidence in every respect, in relation to recommended diets, and these off-the-wall diets that we see.

      “At the moment the best advice is guided by experts who advise that saturated fat should be reduced to no more than 10% in the diet.”

      Saturated fat is “not a great thing to recommend”, Dalby says.

      In response to my suggestion there is evidence to show saturated fat does not cause heart disease after all, Dalby ended the conversation, saying: “If you believe that, I leave it to you.”
      end quote………………………………………………………………..

      So you can feel great, lose weight, and fix your diabetes, but do yourself enormous harm in the long term just by changing your diet! You would really need some evidence for that, and he doesn’t seem to have much! Indeed some of those with diabetes might even trade death in the long run (cue for a joke) for a life without limb amputations, failing eyesight, etc!

      I think the medical science establishment is starting to sound really rattled – all it takes is some reporters to mug up on a few facts, and not back down when interviewing ‘experts’.

      Reply
      1. chris c

        The “evidence” appears to suggest that adding more (saturated) fat to a high carb diet may be marginally worse than adding more carbs.
        Evidence from the recent decades of research showing no evidence of harm from fats *in the absence of excess carbs* is what hadn’t yet sunk in.

  22. Nigella Pressland

    The more I hear about NICE, the more nervous I become. I understand that NICE is going to issue guidelines to doctors about treating the menopause. I wonder how much of this will be fulfulling their aim to encourage doctors to be “more supportive of pharmaceutical companies” by encouraging women to take HRT? I presume that there is big money to be made here. I also can’t help wondering if the reluctance to prescribe natural desiccated thyroid (NDT) is because there is no money in it?
    Ho hum! Keep up the good work Dr Kendrick – you are genuinely inspiring.

    Reply
  23. Stephen Town

    Great link, Goran. Thank you.

    The case against professor Noakes is like a medieval trial for heresy. I suspect he’ll welcome the hearing and slaughter the ‘prosecution’. I wonder if they’ll find some excuse to drop the case rather than let the formidable professor take them apart?

    The South African article about Professor Noakes provided a link to Health Insight UK, an interesting site carrying some excellent articles.

    Reply
  24. Sally Macgregor

    I’m just about to print out this great post, for the diabetic nurse at my GP surgery whom I have just seen for the first time…without wanting to be personal, she was the size of a house and I had trouble hearing her clearly because she was wheezing. Being fat myself I’m not keen on pointing the finger at fatties but it was a slight case of pots and kettles..
    Opening question:
    Nurse: ‘What spread do you use’
    Me: (after a short pause while I worked out what she was talking about) ‘Butter’
    Nurse: ‘in which case, I recommend Utterly Butterly’
    Me: Well, I understood that recent evidence suggests that dairy fat is OK. So long as you don’t eat too much.
    Nurse: As I said, try Utterly Butterly.

    Gave up on that one: dodging the statins was far more tricky.

    Nurse: your cholesterol level is exceedingly high and you must take a statin.
    Me: (having worked my response to this one out in advance) Well, the evidence around statins is so …muddy that I haven’t decided yet. I’ll think about it.
    Nurse: You don’t have to worry about evidence. The government has an organisation called NICE. The experts read all the evidence and make the decisions so you don’t have to worry about it.
    Me: Well, I would still rather think about it..
    Nurse: (sharply, with pen poised over prescription pad); ‘If you don’t get your cholesterol under control immediately you could well drop dead tomorrow’.

    I applaud Dr Kendrick wholeheartedly – but I still have to face the nurse and be marked down as ‘non-compliant’. AKA bolshie, awkward, pain in the arse…

    Reply
    1. David Bailey

      Sally,

      Unfortunately, this is a problem that many of us face. I found it much easier to talk to a doctor than a nurse, because nurses have no option other than to repeat the party line – at least doctors react a bit more in my (limited) experience.

      I went to a diet clinic when my blood sugar was raised (presumably because of simvastatin) and the waiting room was full of huge people – probably all at least twice my weight! The dietician appeared, and she looked more like a ballet dancer! I got the usual message about eating mainly carbohydrates (other than sugar, of course). This was before I knew about this blog, so I didn’t contradict, but I translated the advice into just cutting down on things with sugar in them.

      As a former chemist, I was rather bemused by the idea that sugar was dangerous, but other carbohydrates were good – because they all get digested into glucose and fructose. I was given a sort of rationale – that good foods were carbohydrates that digested slowly – thus avoiding a glucose spike.

      I suggest you arm yourself with a printout of the change of guidlines in the US. It doesn’t cover statins, but at least you can demonstrate that you are not pointlessly stroppy! You should also point out that statins DO increase the risk of diabetes, so maybe print out something like this:

      http://circ.ahajournals.org/content/126/18/e282.full

      Next time you go, I would take a modest number of printouts from the web that are obviously authored by medical doctors. She won’t read them, but she might discuss them with the doctors. In any case, taking some evidence, makes it much easier to confront medical staff.

      If I suffered from T2-diabetes now, I would try the HFLC diet. BTW, you don’t need to tell the whole truth to the nurse, if you prefer not to! With luck you might start to recover on HFLC, and then maybe tell her after she complimented you on your adherence to her diet!

      Reply
      1. Dr. Malcolm Kendrick Post author

        David. Of course a sugar spike may be better than a prolonged release. In that a prolonged release means constantly elevated blood sugar levels and, thus, constantly elevated insulin levels. In which physiological state, fat can never be released from adipose tissue, only stored/built up. This is my own personal hypothesis for which I have no evidence….yet.

      2. Jennifer

        The slow digestion of complex carbs is the reason why we were advised to eat them, unfortunately in inappropriate quantities, rather than eating the so called dangerous, glucose spiking, hyper-hypo inducing simple carbs. At least with fast release carbs the body would, theoretically, get a break from being awash with fat storing insulin…..but unfortunately, few of us have worked out when/how to refrain from indulging in the next slice of scrumptious toast or bag of salty crisps. If we want to eat just a few carbs, believing that they supply adventagious vitamins and minerals, then they have to come from the complex veggies…..oh no, not another plate of kale! Pass me the bag of crisps.

      3. David Bailey

        That is a very interesting perspective on the sugar spike hypothesis, and of course in addition, a decent serving of potatoes or pasta would probably contain considerably more glucose than most people would be likely to consume as sugar!

        Is there any chance of testing your hypothesis? My gut feeling (sorry) is that studies relating diet to health are utterly useless for all the reasons you have discussed, unless perhaps you can persuade a group of people to consume a standard diet for a limited amount of time.

        The interesting thing is that people used to eat a mixed diet – which did include quite a lot of carbs. I do wonder if there is a danger of forgetting the virtues of a *normal* diet! Perhaps what used to happen was that if someone put on a little weight, they reduced their intake of potatoes (say) and they kept control of the situation.

    2. Jennifer

      Sally, I am 2 years on from politely discussing the same senario with my GP. Threatened with impending doom, I decided to go it alone as I had decided the mantra from GP and diabetic ‘nurse specialist’ was baloney.
      I am completely drug-free, fit and healthy, with no signs or symptoms of diabetes, heart failure, or a spreading waistline.
      I have not been to the surgery for any tests, measurements or the deaded ‘talking down-to’s’ either.
      The one exception I make is my yearly retinal screening, but even then, my eyesight has dramatically improved in the 2 years of HFLC regime. I trust my eye health is also good, but as I cannot check it myself, and the fact that I almost lost my sight to measles 62 years ago, I do not wish to risk it ….after all….the high carb mantra imposed for 30 odd years may have caused damage, but I sincerely hope not.
      ( the only other test I submit to is faecal occult blood screening…..one never knows what damage all the poor dietary advice I followed to the letter, may have caused)

      Reply
    3. chris c

      One of our GPs was the size of a bungalow. She told me haughtily that “diabetes is always progressive, it’s the nature of the disease” without understanding that only applies to UNCONTROLLED diabetes. Her “evidence based” medicine is of course based on studies that routinely EXCLUDE well controlled diabetics. Many studies exclude all subjects with HbA1c below 8%, some only exclude patients below 6.5%, so obviously she has no knowledge that well controlled diabetics even exist let alone how they achieve it. She also informed me that “everyone has to eat carbs or you have no energy”.
      Well stop press, I was recently informed by one of her patients that she found she was “prediabetic” and has since lost over 40kg. I have absolutely no doubt she could not have done this by following her low fat diet so she must be a closet low carber. Whether this will affect her or her colleagues’ advice to patients remains to be seen. Perhaps I will make an appointment to see her and give her some advice

      Reply
  25. Stephen Town

    Sally, that was brilliant. Who cares if they think you’re bolshie. I’m always polite, but ask questions. Put your health first and be a pain. I have a friend who takes the prescription and never takes the tablets. A bit cowardly for me.

    There seems to be a rule that only overweight nurses can give dietary advice. That might be because they’re following their own advice.

    Reply
  26. Maureen Berry

    Sally, my advice to you is simple, don’t go to see the nurse. Buy the Diabetes Bible – can’t remember it’s real name, but Google Dr Bernstein Diabetes. It’s a weighty tome, but read it, you will then know more about diabetes than 90% of doctors, diabetes nurses and dietitians. Buy a blood sugar meter (if you haven’t already got one) and go it alone. You will get much better control of your blood sugar than the medics even try to achieve. Dr Bernstein is absolutely inspirational, read his website, watch his videos – quite remarkable man.

    Reply
    1. Gay Corran

      I absolutely agree about Dr Bernstein. Saved my life. Also Jenny Ruhl, Blood Sugar 101: full of excellent practical advice. If you do as these authors advise you won’t need pharmaceuticals.

      Reply
      1. chris c

        This is also worth a look
        http://loraldiabetes.blogspot.co.uk/2009/04/test-test-test.html
        TEN years ago I was so prediabetic that I was nearly diagnosable, except of course there is a huge difference between a postprandial BG of 10.8 (not diabetic) and 11.1 (diabetic), yeah right, truly normal people have BG which seldom strays from 5 ± 0.5 and when that starts going south you are On The Diabetic Progression. By following that method of BG control I effectively normalised my BG, reduced my BP, lost the 15 kg I had only put on as the result of a dietician, doubled my HDL and reduced my trigs to 1/10 of what they were. This is so commonplace as to be unremarkable. When you can see stuff happening in real time you can learn to control it.
        I have recently been told there was never anything wrong with me as my A1c was never over 6.5%. When I die soon from CVD of course this will be blamed on “not eating enough starch” and not on the FIFTY years I now know I spent with disrupted glucose metabolism. GPs all seem to have been told about ACCORD and how it proves that tight BG control is dangerous. They have never heard of EPIC-Norfolk or the huge New Zealand study which show a linear correlation between HbA1c and CVD, starting with normal values of under 5%, nor the studies which correlate microvascular complications with A12c and macrovascular complications with BG peaks, let alone the harms caused by hyperinsulinemia/insulin resistance. Or Gerald Reaven. Or Ron Krauss. Or Westman, Volek, Phinney, Feinman et al. All of this is “hidden in plain sight” on PubMed but not part of “evidence-based” medicine. Which is more like dumbed down one size fits all dogma-based medicine, but hey, it sells lots of profitable low fat foods and expensive drugs.

      2. Dr. Malcolm Kendrick Post author

        True. Only one thing I would add. Having a low HbA1c is not the same thing as driving it down artificially with medication. So ACCORD does not contradict research showing that a ‘naturally’ low HbA1c is a good thing.

      3. chris c

        Exactly! Using a high carb diet and heroic amounts of medication to tweak the end result doesn’t make the neccessary changes to the broken metabolism. Likewise lipids may remain “atherogenic” – or at least indicators of atherogenic processes – even though statins have reduced the LDL. Unless the processes – inflammation etc. – are controlled, risk is not improved. There’s an order of magnitude effect too, most “antidiabetic” drugs, especially the new very profitable ones, make minimal changes to A1c, like 1 – 2%, whereas low carbing may reduce A1c by 5 – 8% and I have even seen over 10%. My statin, which I took religiously for years along with the low fat diet, dropped my LDL but left the HDL low and the trigs still sky high. Eating pretty much the exact opposite of what the dietician prescribed did the business. It’s good to finally see a small but increasing number of doctors have noticed, but I and millions of others will be prematurely dead before Official Recommendations are changed to reflect this.

  27. Paul Travis

    Correlation or causation? I came across this link recently: http://www.tylervigen.com/spurious-correlations
    You might find it amusing. The author (there is an accompanying book) has designed software that scours enormous data sets to find unlikely statistical correlations, regardless of relevance. They are ridiculous of course and make no sense (e.g. Per capita cheese consumption correlates with the number of people who died from becoming tangled in their bedsheets), but I suspect some doctors and scientists working in the fields of cholesterol/fat/sugar/salt etc may also be leaping to illogical conclusions in a similar way (I’m looking at you Ancel Keys).

    Reply
    1. Sally Macgregor

      That is absolutely brilliant – what a find. I sometimes gets a tad depressed about all the appalling tests, screening, the pressure us patients are subjected to, woeful media articles about health – but ‘spurious correlations’ puts it all into perspective and makes me laugh. Thanks

      Reply
      1. Helen

        What a find, indeed. All sorts of ideas for idiotic articles, books or films based on these correlations ran through my mind. Possibly my favourite, ‘Age of Miss America correlates with murders by steam, hot vapours and hot objects’ could surely be the plot of a badly-written novel in a new crime/soft porn sub-genre. Perhaps I’ll give it a go…

    2. Stephen Rhodes

      “Per capita cheese consumption correlates with the number of people who died from becoming tangled in their bedsheets”

      Maybe not as silly as you might think.

      I suspect that I am not alone in experiencing vivid dreams/nightmares on fermented dairy products waking up in a ‘wrecked’ bed.

      Reply
    3. David Bailey

      I too had toyed with introducing this link to the discussion – you beat me to it!

      The really insidious thing is to imagine a similar database of spurious correlations compiled from purely medical information. Imagine the top correlation on that site, translated into US consumption of meat/alcohol/fish/canabis/pretzels plotted against deaths from CVD/cancer/suicide/etc.

      Somewhere among all those options you would get a wonderful – but totally meaningless – correlation.

      If you can demonstrate that there is only a 5% probability of your result being due to chance, you can publish it. However, what you are not meant to do, but many do, is trawl for a significant result. So for example, suppose you test jelly beans to see if they cause acne, here is a cartoon that illustrates what happens:

      http://languagelog.ldc.upenn.edu/nll/?p=3074

      I.e. testing jelly beans as a whole produces a non-significant result, but if you trawl through all the different colours, you are all but certain to find a correlation! This sums up a lot about modern science!

      Reply
  28. Dr Liz Stansbridge

    Sally, just go with the good advice from these folks. Ignore the nurse.
    Exactly 1 year ago I was 21.5 stone and my HbA1c was over 70 and I had early retinopathy.
    I went LCHF. Now I have just hit 13 stone and my HbA1c is 31. 31! The lipid profile is perfect.
    When I started, a small portion of kidney beans, a piece of fruit, a large onion pushed my blood glucose over 10. GI was nonsense for me, complex carbs acted just like pure sugar.
    Now the richness of my diet astounds me, my diabetes is so much better. I will never be able to gorge on a plate of mash or crispy roast potatoes or doorstep peanut butter sandwiches again, but I can eat all these things in moderation. The trick is to ‘eat to your meter’. It is all you have to do. Go to Blood Sugar 101 on the web. Jenny Ruhl will tell you everything you need to know.
    I am going to stop at 12.5 stone, to keep my BMI in the ‘overweight’ range, as Dr K. has pointed out, it is the healthiest.
    It is unbelievable and delightful what has happened to me. I have wrestled with my weight all my life. Now I feel totally in control and I can do this for life. All without drugs!

    Reply
    1. Jennifer

      Liz, I think your story is truly wonderful. I just wish more people could know about your experience and follow suit.
      My BMI just tipped into the over-weight when I was put on all manner of drugs, ( I ought never have gone to that ‘well woman’ clinic, because I was already well enough, thank you), and like a sheep I just did as I was told, little thinking that the ‘raised cholesterol’, was nothing of the sort, that the ‘raised blood glucose’ was of no cosequence what so ever, and my ‘high B/P’, which I experienced on surgery visits, was due to undue stress that all the tests etc were putting me through….catch 22 you could say.
      I maintain I was over-medicalised to the point of mal-practice, (and the threat of being started on insulin the following week), but when I asked for help to review the situation, it caused a nasty reaction from the GP. So….I have gone it alone, with support from my husband.
      What a shame the medical and Nursing professions have come to this state, and I speak from the point of view of a retired RGN.

      Reply
      1. Jennifer

        I certainly agree, David. I understand that the notion of BMI is a false figure churned up by some American Insurance actuary working out health insurance payouts based on average lifespans and life styles. In fact very little to do with the realities of dietary intake, body fat distribution, etc etc….you get my jist.
        The point I made about being lured into attending a well women clinic when I had not a jot to worry about, goes to show that, as my lovely Mother always said….keep away from the medics…, they will find something to treat…..and my goodness, they did….throwing the book at me!
        I would not advocate actually choosing to being grossly overweight, or unduly thin, but I think we all agree that one size does not fit all, and surely genetics must play a major part.
        Blooming heck…..just watching The Papers……The Mirror is extolling the use of statins to help overcome cancer….is there any end to this madness!

      2. Professor Göran Sjöberg

        Jennifer,

        “What a shame the medical and Nursing professions have come to this state”

        I fully agree!

        My wife, who on her own realised (after in vain having consulted the ‘health care system’ several times) that she was a severely T2 diabetic has now ‘cured’ herself on a strict LCHF-diet, now on the sixth year, and would never dream of consulting the ignorant medical ‘professionals’ any more – a true waste of time, money and her good temper.

        On the strict LCHF-diet as her only ‘medicine’ she immediately (actually in three days) recovered from most of her 30 years of IBS, her night vision returned after half a year, her glaucoma could no longer be diagnosed and her serious peripheral neuropathy was completely resolved within one year.

        As an added bonus she lost 12 kg and is now ‘normal’ weight.

        Just imagine the ‘medical’ alternative!

    2. chris c

      Ten years here. I know others who have been doing this for thirty years or more and whose diabetes has failed to progress. Of course in those days low carb was standard treatment, The record holder I knew was 89 when he died, admittedly of kidney failure, but prior to that he had shown no progression for 42 or 43 years. Current diabetics WILL NOT live to that age or suffer a lack of progression and lack of symptoms if they follow current advice, of that I am certain. Eugenics comes to mind.

      Reply
  29. Stephen Rhodes

    How difficult would it be to get tested for number of copies of the AMY1 gene.
    There is research showing an inverse relationship between the number of copies and the likelihood of becoming obese.

    Reply
    1. Leigh Gold

      More astounding revelations! Statins halve the risk of dying from cancer according to the World’s biggest cancer conference in Chicago. Experts were extremely excited by the news…blah..blah…blah. The doctors knew not how the statins reduced the risk but, nevertheless, it was known that cholesterol was responsible for spreading cancer in the body…blah…blah…blah. Any one for statins? Me, me, me, I hear everyone shout, jumping up and down ecstatically. Holy cow, it’s such a wonder drug, surely it should be prescribed for everyone from birth to death! What’s that I also hear? Ching,ching, ching? Quick buy more Big Pharma shares……….PS Do you think statins would help Liverpool FC win a few trophies for a change?

      Reply
  30. Gillian Mc

    Has anyone ever heard of this combo of drugs for “treating” a mildly puffy leg?
    The directive recommended by the hospital “nurse specialist” when I accompanied an elderly relative for a doppler scan of the lower leg was, wait for it… aspirin and a statin. (I was quite dumbfounded for a few seconds, to say the least). I was going to ask why on earth the nurse “specialist” would want to write / refer for such a prescription, but I instantly realised the complete pointlessness of venturing down such a route.

    BTW, the circulation in the leg proved to be fine but the statin suggestion still stood. No other tests were done. Quite astonishing and very, very sad.

    Reply
  31. John Collis

    Of course now that there appears to be evidence that statins reduce the risk of several types of cancer. Is there anything that these drugs cannot achieve?

    Reply
    1. Christopher Palmer

      Be very sceptical towards any individual that claims to have a solution capable of combating the obesity issue unless they make mention or the word ‘insulin’. Likewise be sceptical of the solution itself unless it too references the word ‘insulin’ within the context of each of the several factors that can give rise to hyperinsulinemia. There are at least four or five specific factors to be considered that can contribute to hyperinsulinemia and I am not about to list them, but . .

      . . Enodcrinoligists ought to be leading the fight against obesity. The reason is a simple one and stems from nature coupled to the evolution of our own natural history.

      In nature the numbers of individuals of any species and the density of those numbers rise within the active ecology to the point where they are competing for food. Numbers cannot be sustained if demand for food exceeds supply, so the amount of food available caps the numbers and the ecology finds a balance. Competition gives rise to relative homoeostasis of numbers. But supply of food and water can vary with the seasons. Hence the business of natural selection has rewarded species for finding means to deal with food scarcity. Small mammals tend to squirrel supplies away in hidey-holes, medium sized mammalian species can often secure food reserves as body fat. So . . .,

      . . . The physiology of many a mammal tends to want to make preparations for periodic food privation that tends to come around once a year. Hence physiology encourages the laying down of fat deposits. But periodic (often seasonal) food privation then bears upon the hormones that regulate the deposition and preservation of body-fat such that body-fat can be mobilised to keep body and soul together. Physiology encourages hyperinsulinemia and weight gain. Variation (decline) in food supply gives rise to hypoinsulinemia and permits the mobilisation and burning of fat reserves.

      Theoretically speaking 10 kilos of body fat could supply 1000 calories per day for 90 days. If the energy budget for an individual is 2000 calories per day and only 1000 is available from the food supply then 10 kilos of body fat insures against starvation for 90 days. In a nutshell physiology encourages weight gain while, in the natural setting, environmental factors enforce periodic weight loss. Hibernation is most excellent way to lose weight.

      The human of the present (generally) inhabits a world that has a cash economy built above the principle of agrarianism This is one step removed from natures rules. We supplement our natural energy budget and activities with energy sourced from fossil fuels; and we have natural light. In reality the habits and habitat of homo economicus no longer compare entirely with the habits and habitats of the ‘true’ homo sapiens we once were. The habits and habitat of homo economicus are no longer a perfect match for the physiology of the homo sapiens beneath the skin, and that has consequence for the balance of hormones within our physiology, along with consequence for the rate of attrition originating from oxidative stress.

      The general practitioner, Liz, spends a lot of time diagnosing and treating health conditions in patients that are chronic in their etiology and whose cause(s) are to be found in the contrasting habits and habitats of homo economicus (you and me) compared to those of the behaviourally and culturally ‘true’ homo sapiens we once were. Weston Price directed much the same thing, and so did Hippocrates. Unfortunately the prevalence of tuberculosis and the discovery of penicillin kick started a love affair with magic bullets and the prescription pad.

      Surviving ‘true’ homo sapiens are now few. Best consult an anthropologist. Not much more than the order of 100,000 is my guess. They wear loin cloths (by way of example) and depend upon gathering and hunting. Their rights to their lands do not depend upon the holding of deeds. Title belongs to whole community and origins by birthright. There may be fewer than the order of three hundred specific communities left, and within those communities it is not usual for the numbers of individuals to be greater than a couple-a-hundred. Homo economicus has a history of displacing ‘true’
      homo sapiens form their ‘true’ habitats.

      Biologists try to alert fellow humans to the decline in diversity and threats of extinction amongst species. Yet once we can perceive the decline of cultural diversity amongst homo economicus and think about the habits and habitat of ‘true’ homo sapiens then we might begin to conceive that homo spaiens, that is the ‘true’ homo sapiens, is all but extinct. The ethnographic atlas no longer accounts for so much cultural diversity, so many tribes, or so many individuals as it once did.

      The modern world comes with advantages, true, but harbours some disadvantages too. There is no reason not to enjoy the advantages but there is every reason to ponder the disadvantages. For all the appeal of living the life of homo economicus I preserve a deep rooted melancholy for the plight of true homo sapiens Watch this, and weep as I did:

      http://www.bbc.co.uk/iplayer/episode/b05xxkwx/kate-humble-living-with-nomads-1-nepal

      . . and reserve time for episodes 2 & 3

      Jamie Oliver offerings are a very small step in a much needed expansive and polymath-matical rethink of human needs, along with from what and from whence they came, and what arises as a consequence of not meeting them in entirety. Just look at the case-load of yer average GP.

      Reply
      1. chris c

        Sedge warblers seem relevant here. They DOUBLE their weight by eating high carb insects – plum reed aphids which are full of sugars from the plant sap – then use the stored fat to fuel a trans-Saharan migration. Other insectivorous species switch to berries to gain weight either to fuel their own migrations or to survive cold winter weather and a lack of food. If studied I would expect them to be able to switch on insulin resistance for weight gain, and then switch it off again to utilise the stored fat – which is what people don’t do while eating high carb diets..

  32. Dr Liz Stansbridge

    There are people who don’t read books. Can’t understand it myself, but it doesn’t make them bad people!
    A friend once said to me ‘I never learned one thing from a book’. Floored me. I have learned everything from books and the internet, that vast virtual knowledge (and drivel) repository.
    He is trying to do something good for our kids. His recipes are still too carby for me, but adaptable and would probably suit those less challenged in the carbohydrate realm.

    Reply
    1. Dr. Malcolm Kendrick Post author

      I didn’t say he was a bad person. But if he hasn’t the slightest clue about human physiology or biochemistry…. then why would he know anything about what is healthy, or unhealthy. Or anything very much. I am sure he is very charming and he means well.

      Reply
      1. Nate

        I wonder how our ancestors figured out what to eat without a book and more importantly without a science book – and no nutritionists either.

  33. Richard Mitchell

    Malcolm,
    any comment about the new QoF guidance this week and Professor Daniel Keenan’s assertion that he can’t understand what GPs are worrying about after all “evidence is evidence”??
    Bit depressing really I think!

    Reply

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