Conflict of interest – not just about money

There is a major spat going on at present around Conflict of Interest. The New England Journal of Medicine (NEJM) appears to be backtracking on the issue, and they are talking about relaxing their rules. The British Medical Journal (BMJ) is very ‘heavy’ on Conflict of Interest (COI) and has been somewhat critical of the NEJM approach – to say the least. See 13th June edition of BMJ.

To give you a flavour, one article in the BMJ has the title ‘Backtracking on conflicts of interest: a very bad idea… A series of articles in the New England Journal of Medicine has questioned whether the conflict of interest movement has gone too far in its campaign to stop the drug industry influencing the medical profession. Here three former NEJM editors respond with dismay.’

My sympathies are almost entirely with the three former editors: Robert Steinbrook, Jerome Kassirer and Marcia Angell. I think bias, and resultant distortion of medical research is a massive problem. So massive that it has become difficult to believe most of the research that is published. I am not alone in my concerns. Here is what Richard Horton (Editor of the Lancet), has to say on the matter:

‘The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.’

A half of medical scientific research may be untrue… think on the implications of that for a moment. However, before you focus all your efforts on trying to expose financial conflicts of interest as the solution to all problems, you need to take several steps back. Here are just two of the elephants in the room:

  • Just because someone is getting paid, does not mean they are saying or doing anything that is biased, or distorted. So, by introducing punitive rules on payment from the industry, you could be punishing everyone who has ever received any money, when many of them have done nothing wrong.
  • It is incredibly simple to set up structures that allow money to be paid to a ‘charity’, or a University Department, that can then be filtered down to an opinion leader who can then state, quite truthfully, that they receive no money from the industry. So, if you are going to look for conflicts, you are going to have a dig considerably deeper than looking for a direct transfer of money from pharmaceutical company to doctor. And that is tricky to enforce.

There is also another major issue here, which no-one seems to have discussed at all. Which is that money is most definitely not the only currency available when it comes to ‘bribes.’

At present, COI is seen in very simple terms. A conflict of interest is that someone (usually an international expert in, say, psychiatry) is paid lots of money by a pharmaceutical company. They then say exactly what the pharmaceutical company has written down on a piece of paper for them to say e.g. ‘This new product depressagon is completely safe, highly effective, has no side-effects, and I believe that depressagon should be use, first line, in anyone with depression. Thank you, where’s my cheque.’ The last three words are usually silent.

The International expert then sits on a guidelines committee for depression, and encourages all the other members of the panel to put depressagon on the list of first line drugs to be used in depression – and any other mental illnesses they can think of. At which point the Acme Pharmaceutical Company Inc. makes twenty billion dollars a year from depressagon. Which means that the one hundred million paid to the offshore account of said expert can be considered money well spent.

Of course, it is never as crude as this. Paying people money to say what you want them to say is considerably more subtle and nuanced. A raised eyebrow here, a small cough in the correct place there, an embarrassed silence round the table… the rules of playing the game are complex and never written down anywhere. In fact, if you have to ask how to take part, you don’t get invited.

However, urbane, crude, or not, there is still an assumption that the currency of COI is money, specifically money that ends up the experts bank account (directly, or indirectly). This is nonsense. There are many other things on offer. The most important of which is…power.

If you can work with the industry to attract several hundred million to your University for research; if you can be the lead investigator in several major international studies, then you will gain prestige, influence and power. The University may create an entire department as your plaything. You can have fifty new staff members, you will be asked to sit on prestigious committees. You can advise Governments on health policy.

Money….money. Who needs that? To quote Kevin Spacey playing Francis Underwood in House of Cards:

‘Such a waste of talent. He choses money over power. In this town, a mistake nearly everyone makes. Money is the Mc-mansion in Sarasota that starts falling apart after 10 years. Power is the old stone building that stands for centuries. I cannot respect someone who doesn’t see the difference.’

Up to now, all discussions about Conflict of Interest have focussed purely on payment in money. As if this is the only reason why someone may, ever, be influenced. When a medical expert states proudly they are not paid by pharmaceutical companies this may or may not be true. Tracking the flow of money into and out of Universities and medical charities is a complex old game.

However, no-one seems to have grasped a very important concept. You don’t have to pay someone money to manipulate them. They can be rewarded, instead, with power and influence. Conflict of Interest is about far more than money, and we should stop pretending otherwise.

101 thoughts on “Conflict of interest – not just about money

    1. Helen

      Interesting you should mention this, Lorraine. I remember listening to a BBC R4 programme one evening around 8 years ago about precisely this scandal at Sheffield University. It was a programme in either the File on 4 or Analysis strand, but it appears to have disappeared from the BBC archive, though a You and Yours report on the subject still exists. I paid close attention, because I used to know the city well and had some indirect connections with that institution. The name of a Prof W kept cropping up in an unflattering light. Little did I know then that the NHS-wide ineffective T4 protocol I was being obliged to follow for my hypothyroidism was being influenced by that same man.

      Reply
  1. Professor Göran Sjöberg

    When I now think if it is possible to ‘eradicate’ these people I make perhaps a weird association.

    I just came in from my daily garden tour where I this morning eridacated of about 200 slugs who are constantly trying to ruin the health of my plants. It is about the same number each day.

    Reply
  2. Fr Raphael Hawkes

    Have you read about Prof Tim Noakes, who used to run the Sports Science Institute in Cape Town in SA. Recently he and others ran a Conference in CT on HFLC diet . He pulled out of sponsorship from a sports drink company as he eventually disagreed with what it promoted by his science. He has co-authoured a book “Real Meal Revolution,” he is promoting HFLC diet. See http://www.realmealrevolution.com. Zoe Harcombe and many other well know writers and researchers spoke.

    Reply
  3. abamji

    It’s difficult indeed to know when you are being manipulated. I have taken drug company shillings before now which puts me in a bad place; my justifications are several and varied (1) sometimes a drug has been assessed wrongly (I can recall one by NICE which failed to appreciate the significantly different mode of action and lumped it as a “me-too” drug (2) I gave a talk to a group of GPs and was paid by a pharma company to give it; I rubbished their drug on the evidence (it was rofecoxib and look what happened to that) (3) I have been funded to go to conferences which otherwise I would not have afforded, and on one occasion severely criticised the science in the sponsoring pharma’s presentation (4) I took steps, years before people got exercised by pharma donations to patient groups, to get the one I was involved with to stop taking pharma money.

    That said there is no doubt that some of the conferences heavily subsidised by pharma companies, even those of international high status, are, frankly, rubbish, with the same people talking about the same results with the same drugs.

    Reply
    1. Andy

      Check the book “Cracked, Why Psychiatry is doing more harm than good” by James Davies. It gives a great explanation of the manufacture of experts called “Key Opinion Leaders” by Pharma.
      The money trails and the influence are quite complex.

      (The greatest effect of their activity has been massive off label overprescribing of second generation antipsychotics, which, incidentally cause severe obesity and very high cholesterol levels).

      However I know the books are true- as a GP I have been to dinners held by advertising companies where we are quizzed at length about what ads and what experts we found influential. I used to rather enjoy having a nice dinner and then telling them at length that I always moved past the advertisements as quickly as possible, so I could never remember them.

      Reply
  4. Anne Hay

    I’m not a professional, just an individual with health problems who has twice been made worse by prescribed drugs. Your blog and books have confirmed what I’ve learned from experience, that you have to: monitor your symptoms to build up sufficient data; spend hours on websites educating yourself about the human body, your own health problems and medical vocab; and rate your experience above what the doctor tells you. I’m not knocking doctors, but there is a limit to what they can do in a ten minute appointment and they are, quite reasonably, not as interested in me as I am! I hope you look at Omeprazole soon. Many thanks,

    Reply
    1. takykatinka

      Absolutely with you, Anne. Recent tragic case of a 19-year-old who died of an admittedly rare cancer but was told by doctors not to look it up on the Internet. Good doctors know that patients will, and are well informed and want to take responsibility for their conditions. I know more about my condition than most doctors I see. But I still have to tread on eggshells with them. Thank God for Dr Kendrick, et al who are helping us to trust ourselves.

      Reply
  5. Doug Allitt

    Science is now the New Religion and one dare not be a “Science Denier”. The medical profession is all about treating the symptoms. The cure (or what you have been doing wrong) is always to be found in diet, exercise, your thoughts and your lifestyle.

    Reply
    1. Jean

      I disagree with Doug Allitts comment “The medical profession is all about treating the symptoms” I find that Drs today treat blood results. I had multiple symptoms but the blood test result said “No!”

      Reply
      1. Doug Allitt

        Hi Jean,
        I have had the same thing happen with a UTI. I know what it feels like but the blood test said nothing to see here, move along. As soon as he gave me the correct antibiotics, no more UTI. They are looking for the symptoms in your blood and not listening to the owner of the body who has lived in it for 63 years (in my case). It all boils down to the fact that barring tragic accidents, the ball (responsibility) is really in our court. We must do our own research and take a holistic view of our health. Our problem may be due to any number of lifestyle issues which with due diligence we can magerly impact with correct adjustments. These issues may creep up on us over long stretches of time, almost imperceptibly (may have spelt that one wrong) until the body finally says enough is enough. Smoking is a great case in point.
        When visiting a doctor you have to take control of the interview – who’s the customer? Who’s paying the bill? If your current doctor is not listening – get a new one. Contrary to popular belief, they are not God – in fact some are downright evil. Shop around until you find one that’s listening.
        That’s my 2 cents worth!
        Cheers, Doug.

    2. Fergus

      I am uncomfortable about blaming the individual for their illness. Can add a lot of guilt and angst to an already difficult situation. Not all illnesses are caused by your list.

      Reply
      1. Doug Allitt

        Hi Fergus,
        No they are probably not – I left one out, and it’s a biggy – and no longer in vogue – FAITH. Why would you be uncomfortable with accepting responsibility for your health. Something always causes something. Find the something. It WILL be there.

    3. David Bailey

      Whenever I read that expression – “Science Denier” – I immediately suspect the user of the phrase is trying to cover up some dodgy aspect of the orthodox position.

      Reply
      1. Fergus

        Hi Doug

        “Why would you be uncomfortable with accepting responsibility for your health”. I never said that. I am completely comfortable with accepting resposibility for your health.

        The problem I have with your position which implies that all ailments can be prevented, is that they can’t. Some can some can’t and for those people who are sick through no fault of their own I would not add to their problems by implying they caused their illness by some omission on their part. (Actually I wouldn’t like to say that to anyone even if their lifestyle did cause their illness).

  6. Hugh Mannity

    Excellent. Money is nice, but power… Now that’s a real intoxicant.

    (One minor quibble, it’s House of Cards. And although the US version is good the original UK one was much better.)

    Reply
  7. dearieme

    Ancel Keys is presumably an example of someone corrupted by the search for power.

    I must say I’m far more worried by academics seeking power than by companies’ antics. Companies just want to make money; if the corrupt doctors and gullible governments decide that the populace will be indoctrinated to eat low-fat food, the companies will supply that food. If a new food fashion is propagandised by government, the companies will turn on a sixpence and sell the newly fashionable foods.

    The only defence is free speech, which is everywhere under attack.

    Reply
    1. maryl@2015

      I still do not understand how Ancel Keys lived to be 101. I guess it is the meglomaniacal paradox!!! Either it is that or, he did not take his own dietary advice.

      Reply
  8. Brian Wadsworth

    Malcolm,

    I sometimes wonder whether there is a draining of general belief in the healthcare system?

    Do you see increasing skepticism in your dealings with patients and fellow practitioners? I hope you do!

    Reply
      1. Brian Wadsworth

        Pity. I was hoping your would say otherwise. Experts, such as your good self, would greatly benefit from a more questioning consumer.

        Let us hope that skepticism grows stronger roots!

    1. Stephen Town

      Brian, Dame Sally Davies, NHS Chief Medical Officer, spoke this week about the public’s distrust of medications and advice. She specifically mentioned statins and ordered some sort of inquiry. Is this an opportunity for the sceptics to influence this lady who appears to have an open mind?

      Reply
      1. Brian Wadsworth

        Hope so. But it is hard to see the influence of money reducing by action from within the system without some dramatic exposing event – the shock/horror effect. I do not see much if any self-healing going on within healthcare other than brave voices such as our host’s.

        My own theory is that pharmaceuticals as a technology have run their course. It has become more and more expensive to develop products with fewer and fewer benefits which is helping motivate the “organized crime” behaviors we see. Like the last flailing gasps of a dying industry that has so much money and residual profit it does not notice it is dying. Think Kodak and film.

        At some point the patents expire, the generics drive down profits and the money starts running out. Meanwhile, the public becomes more and more aware of the reality (thank the internet) and demand falls.

        Common sense emerges.

        A fine little theory huh?

      2. James Alexander

        I was unhappy and pessimistic, listening to her on a news bulletin (an unreliable context, certainly). Her mindset sounded an exemplar for Dr K’s ‘medicine-is-more-religion-than-science’ argument. She seemed to be saying, in a Pope-like tone, that the big worry is declining faith, not that there may be good reason for it. She seemed to want her enquiry to defend the faith, not improve the science. And the man she has appointed to head her inquiry has unfortunate form: in 1979 he provided a research report on school effectiveness (“15,000 Hours”). His preferred research style, aims and methodology (OK in the abstract) happened at the time to provide rich meat and drink to the new-utilitarian, instrumentalist, statistical clock political and intellectual right, then newly-triumphant, still rampant. In education they drew strength from it as they charged down the path of “tables”, “effectveness”, narrowily defined statistical outcomes as the sole measure of worth, and ticked-boxies as proof of virtue, the path that has carried our schools, teachers and schoolchildren into the inhuman desert they occupy today, and will not escape from for a generation at best. We know that GP surgeries are already being pushed down the same path. This new enquiry needs to be narrowily watched. I fear the worst. I had hoped, and still hope, that it will come under Dr Kendrik’s scrutiny. And all of us.

    2. thetinfoilhatsociety

      I don’t know what the climate is like in the UK but here in the US there are two general types of patients: 1. The ones who don’t take care of themselves, who eat crap for food, and who think there should be a pill for everything (so they don’t have to take personal responsibility for their own health), and 2. The ones who are very aware of their own responsibility for their health, who question everything, who look for alternatives, and who do their own research. There doesn’t seem to be much of an in-between.

      Reply
      1. Brian Wadsworth

        To be fair to group 1 they are told frequently by those in authority, whether business or not, that they are doing the right thing. The real failing is their trust in institutional goodness. Is physical health really any different from financial or professional health? Should you trust your bank or stockbroker to really really care for you? There are many fine and reputable people in the world who will serve your interests. The trick is knowing who they are.

        If a relatively unsophisticated person with a limited education takes a statin under doctor’s orders, who is to blame?

      2. David Bailey

        I think I am in definitely group 2, but I have a lot of sympathy for those in group 1. After all, they are told to exercise and then given statins – and boy when those kick in, exercise is very hard or impossible.

        They get told eating a low fat diet will protect them from obesity and T2D, when it would seem the reverse is true!

        They get told not to eat a “crap” diet, but then they discover that the very definition of “crap” diet is up for grabs! Maybe some group 1 folk discovered that they felt better and kept slimmer eating bacon and eggs – and were regularly told by the doctor that if they were eating themselves into the grave! Fortunately some of them carried on regardless!

      3. thetinfoilhatsociety

        Ah, I see there are differences in the definition of crap diet. What you speak of isn’t healthy either, but I was thinking of the typical diet I see around me – corn dogs, frozen dinners, soda in 2 liter bottles, cakes and candies, few veggies, lax parenting when it comes to feeding children healthy foods.

  9. Nigella Pressland

    Trouble is, the nod & a wink stuff is so much harder to quantify. It is how people like Jimmy Saville get access to vulnerable people, how I imagine organisations like FIFA may operate (when they are not only receiving huge bank transfers) and one only has to remember the hilarity of Yes Minister and The Thick of It or the intrigue of House of Cards to know that careful positioning & cunning manoeuvres have long played an important role in government. I see it in minor ways in my own workplace all the time. People will change their minds because it becomes expedient or advantageous to do so – regardless of their original beliefs. At the end of the day it boils down to vested interests and the fact that almost everyone has a price – be that financial or otherwise!
    Sorry, that’s not of any help at all.

    Reply
    1. Dr. Malcolm Kendrick Post author

      Not everyone has a price. If I thought that I would give up. I think that many people would gladly follow someone trying to do the right thing – if only they could find such a person.

      Reply
      1. Nigella Pressland

        I think it is possible that the right thing isn’t always clear. So, sometimes the “right thing” is done and can cause a greater harm. I often wonder where the balance lies on this with taking children into care. Other times someone will deliberately do something wrong because they know it will bring about the right outcome. I am self-medicating with NDT against my doctor’s guidance because I know it results in overall better health. Not the strongest example but you can see what I’m saying. Where does the right & wrong lie with global warming? Where does the right & wrong lie with high carb low fat diets vs low carb high fat diets? Where is the right & wrong on immigration? Where is the right & wrong on whether we should have a nuclear deterrent? Where is the right & wrong on Scottish Independence?
        Possibly the rights & wrongs in medical science are clearer – maybe true scientific rigour & impartiality can be obtained somehow, somewhere. I would like to think so in my less jaundiced moments.

      2. Bil

        Is it time to consider making the NHS a chartered organisation along the lines of the BBC? Not in any way ideal given the BBC’s slavish adherence to the ‘party line’ but perhaps, with the right constitutional set up protected from daily interference by politicians, ‘experts’, the media and idiotic studies.

      3. mikecawdery

        I agree BUT it is the people who have a price gain the money and/or status that end up with the power to influence. The skeptics like those of Thincs.org do their best and sometimes win a point but it is all too infrequent.

    2. robert lipp

      There is a good argument that many/most governments have too much power. Constitutions should limit government power – which many do but which controls inevitably fail. Therefore governments should be limited by: budget %gdp, borrowings % of budget, number of ministers, and total ministerial cost limit. Dream on, no government will commit self immolation.

      Reply
  10. Thomas E. Baldwin, DDS, MS, MAGD, F/AIAOMT

    Great column, Dr. K! In my field of Dentistry, we have found dishonesty and obfuscation in the use of fluoride (doesn’t work and is toxic), and in the use of periodontal surgery (treat only signs and symptoms, not causes) as opposed to Biocompatible Periodontal Therapy along with Nutritional Principles to cure the condition. The bottom line reasoning: money!
    Thanks for what you do!

    Reply
    1. Marjorie Daw

      Check out momsagainstfluoridation.org to learn more. Also check out and like Moms Against Fluoridation Facebook page. Moms Against Fluoridation is an organization of Moms and others who have banded together for the sole purpose of ending chemical water fluoridation. There is no greater force to be reckoned with than Moms protecting our kids. We will not rest until fluoridation takes its place on the dung heap alongside aesbestos and lead paint.

      Thank you Drs Kendrick and Baldwin.

      Reply
  11. Mary Jo

    You are so right. One of the biggest influences in the medical profession is to be accepted and not called a OMG “quack.”

    Reply
  12. Mark Waters

    Most interesting..when a student of applied social studies in 1976 I read Medical Nemesis
    by Ivan Illich…still an essential book about the medical world which you describe recommend it .

    Reply
    1. Professor Göran Sjöberg

      Mark,

      Medical Nemesis is a great book which I recently read for a second time and by coincidence the book now happens to be by my bed side. In the Swedish translation the title is “The Dangerous Health Care” which I think is a very apt one.

      Reply
      1. Dr Liz Stansbridge

        Samuel Shem wrote a couple of savage novels concerning the medical profession, ‘The House of God’ and ‘Mount Misery’. I was a houseman at the time and they resonated with my colleagues to some extent, mainly the concept of ‘GOMERS’. Didn’t seem to change anyone’s attitude. I suppose they all thought ‘that’s American medicine for you’. Mount Misery is an extraordinary critique of psychiatry, it’s fashions and the influence of the pharmaceutical industry and research. After a career in psychiatry I can say, that is exactly how it works. If you like ‘House of Cards’ and ‘Yes Minister’, you will like these books.
        I loaned ‘The House of God’ to an extremely high up consultant, highly enmeshed in his power and ego although I admired him for his compassion. He gave it back saying ‘how peculiar’. The higher up you are, the more you have invested in your status and life. Stepping back and tacking a critical look around you is extraordinarily hard.
        Doctors aren’t bad, the system is.
        May I say, commerce isn’t bad either per se (been reading Matt Ridley’s blog thanks to Dr K. Never thought I would be agreeing with a Conservative politician!). It is again system failures.

      2. mikecawdery

        Nice idea! Unfortunately the a-ethical money men directing big companies are only interested in spending money to make a profit; to increase sales, stock value and the share holders.. Altruism does not exist in their vocabulary!

      3. mikecawdery

        Dr Stansbridge

        Doctors aren’t bad, the system is.

        I wholeheartedly agree BUT the “system” is run by a-ethical money makers, bought and paid for status seeking doctors and administrators (those who write and determine the “Directives” and QoOF programmes). As I have written before the working docs and consultants who face patients every day do their best but are severely restricted by their directives etc. Sorry but as a vet I could not work under those restrictions.

      4. Professor Göran Sjöberg

        Dr Liz,

        You mention:

        “After a career in psychiatry I can say, that is exactly how it works. If you like ‘House of Cards’ and ‘Yes Minister’, you will like these books.”

        I am not familiar with these book but I have read the scientific journalist Robert Whitaker’s books about psychiatry and then I realised that psychiatry is just another branch of the medical religious belief system without any scientific foundation. Psycopharmaca against ‘mental illness’ or statins against ‘heart disease’ is about the same to me – here you have to believe to prescribe or to put the pills in your mouth!

  13. Kay

    When I read your statement, “a half of medical scientific research may be untrue…,” I was reminded of another scary thing I read in an old magazine I picked up this week: A lot of research is done on cell cultures that are actually something other than what they’re purported to be.

    I found the article online:
    http://discovermagazine.com/2014/nov/20-trial-and-error

    A quote from the above:
    “Today, cell lines known for nearly 50 years to be imposters are still in wide use under their assumed names — wrong identities regularly invoked in peer-reviewed publications.”

    Reply
    1. David Bailey

      Here is a BBC Radio program on this subject:
      http://news.bbc.co.uk/1/hi/programmes/file_on_4/7098882.stm
      The researchers were very reluctant to test their cell lines because:

      1) The test was expensive.
      2) The test might show that previous published work was rubbish!

      There was a follow up program about 3 years later which showed that nothing had changed!

      Somehow all this corruption seems to be partly exposed in the public domain, and yet never acted on – it is crazy!

      Reply
      1. Kay

        At what point, I wonder, does willingly or negligently working on a cell line that isn’t what you say it is become just plain fraud? Why do it at all?

      1. David Bailey

        Don’t forget this is about current research, not the accumulation of all medical research.

        Think of all the medical stories you can see in the newspapers. Every one will correspond to some research effort or paper. How many of them contradict each other? Then think of all the research on cholesterol, statins, saturated fat, etc, that has been corrupted over 50 years or so!

        Alternatively, think about the fact (just above) that a great many research papers were based on the wrong cell cultures! Think of it, scientists spent vast sums of (quite probably Cancer Research) money studying possible drugs to treat thyroid cancer, without realising that the cells they were using were actually cervical cancer, or whatever! Do read Kay’s link:

        http://discovermagazine.com/2014/nov/20-trial-and-error

    2. Dr Liz Stansbridge

      Mike Cawdery: the ‘Money Men’ are allowed to get away with it because of lobbying and the ‘Old boys network’. Government pushes pharmaceutical interests. Medicine is ruled by guidelines dictated by these people. Your bog standard GP just does what he is told.
      This could be stamped on if the politicians cared about probity. They don’t. The pharmaceutical industry has a powerful voice in politics. Our lives could be transformed by nutritional and holistic guidelines. Instead we are encouraged to take a pill to treat a symptom of our bad lifestyles.
      Our health is incredibly within our control. Taking pills to perhaps defer some extraordinary outcome (ref. statin benefit) is ludicrous.
      Our health is under our control if we want it.

      Reply
      1. mikecawdery

        Dr Stansbridge

        Exactly my interpretation of what is happening in medicine today. Your confirmation gives me hope.

        I suspect that many, if not most, working docs would agree but the mortgage has to be paid along with all the other expenses of life – a strong inducement to keep one’s head below the parapet. Dr Kendrick in “Doctoring Data” records what happened to a Dr Myhill for trying to raise issues. Not a pleasant outcome. Incidentally, the US CDC withheld data of a trial for fifteen years which showed a strong association between autism and vaccination. WHY?

      2. Helen

        Sarah Myhill has been attacked, with consequent GMC actions, so many times over the years – always (AFAIK) by professional colleagues. Other doctors working outside the mainstream in related fields, like Dr Barry Durrant Peatfield, have been similarly attacked. In his case, he could not afford to mount a legal defence and so resigned his GMC registration. I have seen his resignation referred to by mainstream thyroid medics as evidence of his supposed ‘guilt’. He cannot prescribe any more, but he remains an intellectually engaged, utterly dedicated doctor of a type one rarely encounters nowadays.

  14. Orpheline1

    NHS Please invest in more good quality doctors, research and make it your mission to get people well and off the cheap or unnecessary medications. Wellness and less visits to surgeries. Educate us please. We are not cattle or headless chickens.

    Reply
    1. mikecawdery

      Currently I believe that most NHS doctors meet your requirement but are effectively told how to treat via “Guidelines” (aka DIRECTIVES) and Quality of Outcome Framework programmes in pain of negligence charges by the GMC if they default from the “approved” line, however wrong that might be. Dr Kendrick regularly highlights the “errors” of some of the “approved” practices.

      Reply
  15. Dr Robin Willcourt

    One solution to this is to offer incentives, such as tax-breaks, to companies that donate money or other useful resources into pools that independent boards/committees can use to fund research. It is then possible to isolate the donors from the recipients. Of course, many of these organizations escape from paying approriate taxes but given their lobbying power, it is unlikely that our corrupted political systems would enforce the same tax laws that apply to others, given the massive tax breaks that the politicians have already put in place to relieve these industries of disincentivising tax ‘burdens!’ Perhaps a combination of the two revenue raisers is the answer. Non-biased economists might give us some guidance on this.

    An isolated pool of money, no matter the means of constructing it, would effectively stop the meddling and corruption that currently exists, because the donors would have no idea where their money was going. Imagine if real research into cardiovascular disease had taken place over the last 30 years instead of study after corrupted study proving over and over again how life-saving statins are. We might have made some real headway…

    Reply
    1. David Bailey

      I think governments should pay for pure research. Then pay other companies to deliver the final product.

      Reply
    2. mikecawdery

      Nice idea! Unfortunately the a-ethical money men directing big companies are only interested in spending money to make a profit; to increase sales, stock value and the share holders.. Altruism does not exist in their vocabulary!

      Reply
      1. David Bailey

        Mike,

        The point is, if we paid for pure research, that is what we would get.

        At the moment we ask drug companies to pay for the research on a potential drug, and forfeit all if the drug fails in late testing. It is a crazy deal, and it almost invites companies to cheat.

        That doesn’t absolve the companies of guilt, and what would really sober them up would be if executives and/or researchers were liable to face GBH or manslaughter charges. Nevertheless, I think we need to separate the research from the manufacture of the end result.

      2. mikecawdery

        David

        Yes a nice idea but who decides on how that money is spent? Politicians looking after corporate interests or the medical establishment protecting its own interests. Examples are numerous: Helicobacter pylori, Saturated fat, six week strict bed rest, etc.,etc. The list goes on and on. “Doctoring Data”, “the Rise and Fall of Modern Medicine” (LeFanu) and “Deadly Medicines………..” for starters It just goes on and on!

  16. Stephen Town

    An item in today’s Times quotes a paper from John Ioannidis from Stanford in the U.S. It says that 97% of trials sponsored by drug companies are ‘positive’. Can we realistically expect anything else? These are the trials that doctors rely on to make decisions. We need independence and real scrutiny. We need penalties that make the drug companies wary of such behaviour.

    The public’s trust is being eroded to a degree that is undermining the system.

    Reply
    1. mikecawdery

      Another example of how the press misrepresents the truth. Ioannidis has,found that many medical research reports are flawed through study design, selection of data, misuse or misinterpretation of statistics, or bias (JAMA. 2005;294:218-228; PLoS Med 2(8): e 124; Arch Gen Psychiatry. 2011 Apr 4.; J Clin Epidemiol. 2011 Mar 29). This is a serious indictment which is confirmed by some of the massive fines imposed by the FDA on Big Pharma companies (none by the MHRA or EMA).

      Reply
  17. mikecawdery

    Dr Kendrick,

    Once again thank you for raising this important issue. The following quote sums up this very real issue.

    If you can work with the industry to attract several hundred million to your University for research; if you can be the lead investigator in several major international studies, then you will gain prestige, influence and power. The University may create an entire department as your plaything. You can have fifty new staff members, you will be asked to sit on prestigious committees. You can advise Governments on health policy.

    Who would have thought it?

    I have worked with and for drug companies for some 60 years. If for example one is writing an expert report to get a product authorized, it has to be in general favourable but it should include the disadvantages such as toxicity details, adverse reactions etc. Reporting the results of trials is simply factual – they can lump it or like it. Sometimes, to my certain knowledge, unfavourable results never see the light of day!

    When I started research (1956) the association with drug companies was what it should be – open and honest. It is really only since circa the 1980s when the direction of pharma companies was taken over by the money men with no medical training and absolutely no ethics (a-ethical, if I may coin a word) and PROFIT was the sole target, objective, whatever.

    Then, unsurprisingly, the personal benefits of working for pharma companies (that provided money for research – always short) resulted in recognition that lead to professorships, honours, knighthoods and even peerages. As you say this status enhancement is a very strong inducement to “play the game” of inflating benefits while downplaying/ignoring disadvantages.

    The number killed by pharma drugs (estimated as 200,000 per annum in the US – Stanfield B: Is US health really the best in the world? JAMA. 2000 Jul 26;284(4):483-5.) is simply ignored – nothing is done about it despite that it is about 3rd in rank of deaths in the US. I find this frightening but some researchers seem intent on following this philosophy for the huge benefits of STATUS

    Reply
    1. mikecawdery

      Thank you for the links! The truth will out despite officialdom.

      There are others who have fallen foul of the “medical establishment” and their vindictive actions to maintain the “official” line irrespective of the fact that the said “official” view was simply wrong.

      Check http://www.doctormyhill.co.uk/

      Reply
  18. Dr Liz Stansbridge

    Conflict of interest?
    Do the politicians care? A bit of profit for their mates in the drug industry, ha, ha!
    Who cares about healthy lifestyle? They trot out the old ‘low fat’ and ‘5 a day’ nonsense.
    I have T2DM. I control it by diet. The medications are totally unsatisfactory. Diet is overwhelmingly the most effective treatment. Do they promote it? Not on your life!
    Who can understand what kind of self control this requires?
    Don’t talk to me about reducing my sugars! I can’t eat bread, pasta, rice, beans, many veg., never mind wholemeal!
    I don’t like meat but I have to eat meat, eggs, cheese, non starchy veg.
    Even my chili, I have to choose between toms and onions. Kidney beans are out of the question. Haven’t eaten yogurt for a year or even a carrot!. Milk in my coffee is a major component of the carbs in my diet, just can’t do without something in my coffee.
    You who can eat anything be eternally grateful you don’t have to do this. It is miserable. I go round the supermarket or a cafe smelling the carbs, wishing I could.
    Our society is based on carb. It is where all the profit is made in the food industry, empty calories, not needed. Carbs put the pleasure into food. How they seduce us!
    Yet I will.I will have a healthy old age despite it all.
    I will do this!
    20 years ago there was the knowledge to help me, but no one did.
    On diagnosis I was told, ‘reduce the sugars, but no need to go mad’ by a junior doctor.
    That was the sum total of my education as a diabetic.
    Maybe my T2 could have been arrested before it got to this? Who knows?
    Now my T2 is so bad that 10g carb pushes my BG too high.
    Do you know what 10g carb looks like?
    2 tomatoes
    1 onion
    1 carrot
    1/2 slice bread
    1/6 slice cake
    large salad.
    If i eat this much, I have to leave 2-3 hour before my BG comes down again.
    So, sorry to moan, but no one understands this.
    Carb intolerance is more than you could ever think possible.
    And there are so many of us.
    And no one is doing anything about it!

    Reply
    1. Stephen Town

      Liz, that does sound difficult and I’ve always thought the advice given to diabetics is unforgivably stupid. Eat carbs and take insulin defies explanation.

      Have you seen the paper called ‘Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base’? There are a number of distinguished authors beginning with Richard D. Feinman and Wendy Pogozelski.

      http://www.nutritionjrnl.com/article/S0899-9007(14)00332-3/fulltext

      It must have been immensely difficult twenty years ago, but there’s now plenty of good advice available online for diabetics. I don’t know how successful this is in getting through to the mainstream? Dr Sarah Hallberg is prominent in her treatment with a low carb diet and doesn’t mince her words.

      I’m lucky that I don’t miss carbs, probably because I’ve felt so much better physically and mentally without them. I stopped eating bread, cereals, rice, pasta and potatoes. I eat lots more eggs, whole yoghurt, cheese, cottage cheese and fish. I eat about the same amount of meat.

      Is whole yoghurt with just 3% or 4% sugar no good for you? The St Helens Yoghurt sold by Sainsbury’s is just 3.2% carb. Aldi sell a cheaper version that’s just 4%.

      Reply
      1. robert

        Regarding the carb content of yoghurt… As long as you’re not afflicted with either of the two major “sugar illnesses” (or the often played-down “pre” stage of T2), then yoghurt with 4g CHO per 100g is probably harmless and certainly much much better than any of the processed & “all natural” ready-to-eat fruit-yoghurts out there (a.k.a. sugar-bombs).

        Video: https://www.youtube.com/watch?v=HUPMAlNHBiU (ABC checkout)

        However, once you suffer from extreme insulin resistance and maybe even ß-cell insufficiency on top of that, anything that raises blood glucose is a problem. The body simply has no capacity to deal with any extra glucose coming from diet. There is enough to do already to keep the liver from pouring out glucose in an uncontrolled manner, if that still works. As there is no need for any form of dietary carbohydrate, eating them in that situation would be quite insane.

        It still puzzles me how most people “get” that eating say peanuts is avoided at all cost, if a person has a severe nut allergy. What is it with carbohydrates that makes a lot of people not understand that some just have to stay clear of them? It is as if carbohydrates somehow automatically carry the attributes: plant-based, healthy, harmless…

        Personally, I’m lucky enough not to be afflicted by full-bown “D”, but if I’m honest, I’m certainly part of the ever-growing mass of the “pre” flock. Therefore I have decided to avoid the carbs as if my life depended upon that (and it probably does), but I still eat plain full-fat yoghurt 😉

        It would be interesting to get a detailed insulin-assay [1], but I don’t see how I could convince a GP to do it.

        [1]: “Detection of Diabetes Mellitus In Situ (Occult Diabetes)”, Joseph R. Kraft, M.D. (http://meridianvalleylab.com/wp-content/uploads/2012/08/GITT-Article-Re-type1.pdf)

      2. mikecawdery

        Robert

        I requested an insulin blood level check but was told that the the biochemis at local NHS Trust Hospital did not do it because the treatment was the same whatever the insulin level. Same treatment for high and low to negligible insulin levels? I wonder but it probably accounts for the continued advice to use a hicarb/lofat diet for diabetics.

        I too eat homemade yoghurt but I strain it to get rid of as much of the remaining lactose and lactic acid. And I also lace it with coconut oil to increase the saturated fat level. The odd heart attack for nutritionists not intended.

    2. Maureen H

      Dr. Liz, I don’t think many people have your determination and courage…I was taken aback by the low amount of carbs you can tolerate. I tried to stay at 20g daily when I started eating the low carb way and it was incredibly hard, but 10g?
      I have such admiration for what you are doing for yourself. And sometimes a good old moan is just what is needed!

      Reply
    3. Steve Gold

      20 years ago there was the knowledge to help me, but no one did.
      On diagnosis I was told, ‘reduce the sugars, but no need to go mad’ by a junior doctor.
      That was the sum total of my education as a diabetic.
      Maybe my T2 could have been arrested before it got to this? Who knows?>/b>

      Sadly that junior doctor of 20 years ago will (most likely) still be repeating the same nonsense to countless more patients’ whose lives shouldn’t have to revolve around constant blood testing and popping pills / injecting. The inevitable spiral into diabetic complications is the unhappy but almost inevitable consequence for these people.

      Unfortunately Liz, it’s very likely that your T2 could have been arrested before it got to where it is now. But it’s never too late and you are/i> on the right path now. Well done!

      Reply
    4. Flyinthesky

      Liz, I don’t think it’s a case of “A bit of profit for their mates in the drug industry,” I think it’s more of the government doesn’t have access to anyone, untainted, the has the knowledge and gravitas to contradict the pharmas’.
      I think the governing bodies are so naïve they have accepted the testimony and advice of the pharmas, if they invest millions in their products many more millions will be saved further down the line by people being more healthy and a lesser drain on the NHS.

      Reply
    5. mikecawdery

      Dr Stansbridge,

      Yes, my problem too. And it has so many consequences. I note that the FDA have finally decided to bann trans fats. That is about 60 years after a Dr Kummerow (now 100 years old) originally raised the issue and supported by the work of Dr Mary Enigk. This appears to be the time taken to reverse “Official advice” – horrible.

      There is a diet known as the restricted ketogenic diet (R-KD) which apparently has benefits in mitochondrial damage and malfunction and with possible benefit in such conditions as cancer. Apparently Dr Tom Watson (DNA fame) has recently come out in support of Dr Seyfried’s hypothesis that cancer is predominately a metabolic disease related to dysfunction of mitochondria. A really interesting thought!

      Reply
      1. Helen

        If cancer is really a metabolic disease with its roots in mitochondrial dysfunction, then it’s a significant concern for people like myself, in poor health for many years already, who have tested their mitochondrial function via Dr Myhill. My score was 23% and I suspect it has fallen further since (I’ve yet to re-test).

    6. Marijke

      You can ferment all the sugars out of yoghurt by putting it in a 35 C oven for about 24 hours. Adding full fat cream before fermenting makes it taste even better.

      Or google SCD yoghurt.

      Reply
      1. mikecawdery

        Thanks for the tip

        I use a Lakeland Yoghurt maker – Chinese – I will try a full 24 hours next time. I use a greek yoghurt for a starter and finally sieve it to get rid of most of the soluble lactose/lactic acid. Will try adding cream as well – more fat!

    7. BobM

      Liz, consider intermittent fasting, and eating fewer meals. I recommend this website:

      https://intensivedietarymanagement.com/blog/

      Watch the videos that are on point and read the blog. His argument is that you can “cure” type 2 diabetes by fasting, which increases insulin sensitivity.

      I hate to agree with him, as that’s one more thing I thought was correct that’s not: “you have to eat breakfast” is wrong; “you have to eat many small meals through the day” is wrong; etc. I tried LCHF, which helped a lot, but I stopped losing weight after a while. I started intermittent fasting, and I’ve really started losing weight again.

      My wife has joined me in intermittent fasting. She has not lost as much as I have, but the weight is slowly coming off her, too.

      Reply
  19. mikecawdery

    I loved this report:

    How is this for a an insight

    By Alleyne, R. Telegraph today

    Researchers have found that the ability to tell fibs at the age of two is a sign of a fast developing brain and means they are more likely to have successful lives.

    They found that the more plausible the lie, the more quick witted they will be in later years and the better their ability to think on their feet. It also means that they have developed “executive function” – the ability to invent a convincing lie by keeping the truth at the back of their mind.

    “Almost all children lie. Those who have better cognitive development lie better because they can cover up their tracks. They may make bankers in later life. or corporate leaders of politics, pharma or medicine perhaps???,

    Reply
    1. David Bailey

      That is a great video that illustrates an incredible parallel with say the cholesterol theory of heart disease – where counter evidence just gets ignored or explained away.

      I’d like to be able to discuss a couple of aspects of the electric universe concept, and obviously this is not the place to do that, but my email is my-name-1 dot my-name-2 dot co dot uk.

      Reply
  20. Maureen H

    With so many people interested in low carb high fat eating, the organisers of the Low Carb High Fat Convention held in Cape Town this year, have made the whole Convention available on line for $69 U.S. I have bought it and it is very very good. The speakers are the movers and shakers in this area and although some of us have bemoaned the fact that authorities don’t seem to be “getting it”, in fact it is very encouraging to learn that in fact, many have got it. There are about 30 hours of presentations. It’s wonderful value and the talks are rivetting. Here’s the link:
    http://lchfconvention.com/

    Reply
    1. mikecawdery

      Thanks for the link

      The low-fat diet is probably the worst mistake we’ve ever made in the history of human medicine
      – Prof Tim Noakes MBCHB, MD, PHD

      Now that is some statement given the seriousness and number of past “official” mistakes so ably shown by Dr Kendrick in his books; by Prof. Gotzsche, Drs Ravnskov, Graveline et al.

      Reply
      1. Professor Göran Sjöberg

        Mike

        I fully agree with you!

        You may ask what is left in the official medical ‘belief system’ in your mind after having read these books.

        Now with six years as ‘converted’ LCHF (Low Carb High Fat) adherents me and my wife have lost almost all our confidence in the official medical dogmas. And for sure and encouraging, in general today, the pendulum is swinging away from the high carb side to the low carb one.

        Still it is expected the the ’empire’ will strike back since it is evident that there are people who can thrive on a moderate carb eating and I guess they don’t care.

        My own belief is now that it is not until you have been ‘hit’ by the metabolic syndrome after long time with excess carbs and often when you have turned 50, you got ‘allergic’ to the carbs and consequently will benefit (without guaranties) from keeping away from them – it is like with excess alcohol consumption. Another guess of mine is that the harder you have to abstain from the carb the harder you have been hit in the syndrome and the more you have to gain if you will succeed in keeping away.

  21. Stephen Town

    Maureen, I’m sure the content of the low carb conference in Cape Town is very good, but it’s a real pity that they have to charge to view it. This will very much restrict who sees the talks when the widest possible viewing should be the aim. The current low fat orthodoxy will cling on until it is utterly and widely discredited. Or perhaps until the NHS bill for obesity and diabetes is simply unbearable.

    Reply
    1. Maureen H

      I see your point Stephen, it will restrict the number of people viewing it. However, being on quite a limited pension myself I didn’t think it was something I couldn’t afford personally, a lot of people are better off than me. What i am learning from it, plus getting enjoyment and inspiration from the speakers is worth a lot, and comes down to about $2.50 per presentation. way cheaper than going to the movies ($16 for two people for 2 hours in my town) or indeed than going to the actual Conference which was waaaay out of my league.

      Reply
      1. David Bailey

        I agree with Stephen on this. You are trying to reach those who could benefit from LCHF, but are still unsure. They may also be unsure whether they will be able to understand the presentations. If at all possible financially, I think it would be better if they made this material freely available – or as easily available as “Doctoring Data”.

  22. mikecawdery

    A little off topic but recently relevant

    NICE released new “guidelines” on cancer diagnosis at GP level in two sections
    a) full guidance &
    b) all appendices a sum total of some 2,000 pages. Haven’t had time to read it yet.

    http://www.nice.org.uk/guidance/ng12/evidence/full-guidance-65700685

    But following my usual practice looking at key authors and words I found the following:

    Re Cancer Guidelines

    Names

    Watson T (DNA fame) Not referenced in main document. And not his current view on metabolic involvement in cancer.
    Seyfried T. Not mentioned anywhere
    Pedersen P. Not mentioned anywhere
    Darlington Not mentioned anywhere
    Warburg Not mentioned anywhere
    Vogelstein Not mentioned in main document

    Words
    ketogenic and allied words (ketog….) not mentioned
    metabolism and allied words (metabol….) not mentioned in main document
    petscan Not mentioned
    pet/ct not mentioned in main document. Found in References
    mitochondria Not mentioned in references.

    Is this not an example of clear bias in favour of the “Genetic Theory” (Dr James LeFanu) and a total ignoring of metabolic/mitochondrial damage involvement?

    Reply

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