I read an article in Nature magazine a couple of years ago which has nagged at me ever since. It highlighted the sobering fact there has been a collapse in disruptive science.
‘Disruptive’ science has declined — and no one knows why
04 January 2023
The proportion of publications that send a field in a new direction has plummeted over the past half-century.
I recently watched the film Oppenheimer where scientists argued about new ideas. Debating, pushing forward their thinking in exciting new ways. Niels Bohr, Heisenberg, Einstein, Van Neumann, Oppenheimer himself. They seemed like true intellectual giants whose names still echo through history.
In the same era Isaac Asimov was developing new ideas in his novels – the three laws of robotics. Foundation and Empire. Then there was Philip K Dick, Harlan Ellison, Ursula K Le Guin. Where are these giants now? Where is the new thinking? Why has it all got so … dull?
As a child I watched the Apollo moon landings, but when was the last time I woke up to the news that something earth shattering had just taken place in a scientific field? Some form of major disruption. Everything we thought we knew just got turned upside down. New directions …
Although it could seem a little on the trivial side, for me it was with graphene. Two scientists in Manchester were, essentially, larking about in the lab, trying to find out how thin a layer of graphite they could create by wrapping Sellotape round pencil lead. Turns out, you could get a monolayer of graphite. Allowing me to misquote Asimov who reckoned that the most exciting phrase in science is. ‘Well, I never expected that.’
I fully believe that graphene will change the world in many different ways, mainly for the better. A completely unexpected breakthrough in material science. I love this type of thing.
Medical science
Unfortunately, in my world of cardiovascular disease, you could go back fifty years and find almost exactly the same ideas remain in use, about virtually everything. It is hard to think of anything remotely disruptive, or even remotely novel. Cholesterol causes heart disease, check. Diabetics should eat a high carbohydrate diet, check…
Looking specifically at raised blood pressure. What causes it? In ninety-five per cent of people we have no idea. We didn’t know then, and we don’t know now. We still call it “essential hypertension” as we always did, which means – in plain English – a raised blood pressure of no known cause. The proposed management then, and now is … Lower it. Sorted. And we call this progress? Ahem (I say). No disruption here …check.
In this blog I want to look at one, specific area. The use of salt/sodium restriction to lower blood pressure and reduce the risk of dying early? An idea that has been around since before the second world war. Bonkers then, bonkers now. Unchanged …check.
Once some proper scientists managed to fully establish the neurohormonal system that controls blood pressure. Including the renin, angiotensin, aldosterone system (RAAS), it should have become clear to anyone with a functioning brain that restricting salt intake could very well do far more harm than good. An area that is both complicated and fascinating. But this new knowledge had no effect. Nothing was disrupted.
What about the evidence on salt intake. Below, I give you a graph of overall mortality [all cause death] vs. sodium intake 1.
I do love a graph, but I know a lot of people don’t. So, I shall attempt to explain it in a little more detail.
The bars that rise, and fall, from left to right, represent the percentage of people consuming different amounts of sodium. With most people it falls around the two-to-four-gram mark, or thereabouts. [Which is approximately the same as four to eight grams of table salt, sodium chloride. Most of our sodium intake comes from ‘salt’ but not all].
The solid line, heading down from left to right, shows the risk of death associated with different levels of sodium intake. The shaded area, around the line, represents the spread of ‘probability’. Or, to put it another way, the likelihood that the risk of death at various levels represents a statistically significant finding – at increasing levels of sodium intake. Got that? There will be an exam at the end of this blog.
In essence, though, this graph is very simple to understand. Namely, the more salt you eat, the longer you will live. And, or course, vice-versa. Which is the exact opposite of everything you are constantly told.
I shall repeat this to emphasize the point:
If you eat more salt, you will live longer.
And this benefit continues right up to twenty grams of salt a day. I don’t think they could find anyone who consumed more than that. Although me, swimming in a choppy sea on a sunny day, might manage.
I know what you may be thinking. I have cherry picked one study to make a point. Well yes, this is just one study. However, it is the biggest and longest ever done. It represents one small part of the National Health and Nutrition Examination Survey (NHANES).
And, although it is only a small part, it represents very nearly ‘one-million-person years’ of observation. Of course, like all nutritional studies it has its weaknesses, but you will find nothing bigger, longer, or better than this. And if you want to find one that contradicts it – feel free – and good luck.
But if you would like some more data. Here is the Scottish Heart Health Study. In this case the researchers looked at twenty-seven factors associated – in one direction or another – with cardiovascular disease [although they only mentioned 26?].
They also incorporated overall mortality (risk of dying of anything), and I reproduce their graph, for men, below. The graph for woman was pretty much identical. This was the first time I noticed that increased sodium intake may be beneficial, not harmful 2.
Again, a little more explanation is probably required to make sense of this chart. The numbers at the bottom 0 – 4 represent the Hazard Ratio (HR). A hazard ratio of one means the risk of a ‘factor’ is neither raised nor lowered. It is average. Two means risk is doubled, three means risk is trebled etc.
At the top of this chart lies ‘Previous myocardial infarction’ [Previous heart attack]. No surprise to find that having had a heart attack is a pretty good indication of serious problems and a potentially much-shortened lifespan.
There is another thing I need to explain here. You will notice that ‘Previous myocardial infarction’ is ranked +01 – the 01 = the most important factor. The plus sign in front of 01 means that risk of death is increased. If you go down to number five ‘Urine Potassium’, you will see – 05 (minus 05). The minus sign means risk is reduced…ergo, the hazard ratio is reduced. [I shall cover potassium at some point in the future].
If you keep going down the list, you arrive at sodium, at number eleven. As you can see, greater sodium excretion, which is directly related to greater sodium intake, is protective. Sitting at -11. And these researchers actually did a measurement – urinary sodium. Rather than asking people how much salt they consumed each day, because who has any idea about that?
As a further aside if you keep going down you will see the letters NS and NL.
NS = not statistically significant (probably not important one way or the other)
NL = non-linear (there is no consistent association at different levels – risk goes up and down randomly. Definitely not important)
Amongst the NS and NL ‘risk factors’ we find the following:
- High Density Lipoprotein (HDL) a.k.a. ‘good’ cholesterol
- Triglycerides (now considered a form of ‘bad’ cholesterol)
- Total Cholesterol a.k.a. ‘bad’ cholesterol
- Body mass index
- Weight
- Energy intake
- Alcohol
- Blood glucose
None of these things were found to have any effect on the risk of death. Sorry, possibly a bit too much disruptive evidence in one graph for easy digestion. In truth, I could talk about this graph all night, and still have time for more. But I do want to loop back to the start.
‘Disruptive’ science has declined — and no one knows why.’
Both of the studies here could have been, should have been, extremely disruptive. However, they have had no discernible impact whatsoever. Nothing has changed. Here, for example, is what the British Heart Foundation continues to say about sodium:
‘Some food labels call salt, sodium instead. Salt and sodium are measured differently. Adults should have less than 2.5 grams of sodium per day.’ [Approx 5 grams of ‘salt’]
Here is what the CDC has to say, as of today:
‘The CDC recommends that adults and teens consume less than 2,300 mg of sodium per day, which is about one teaspoon of salt.’
[There are many different salts. The one we generally call ‘salt’, table salt, is sodium chloride. NaCl. This is the form of salt from which we obtain most of our sodium. Sodium makes up, very close to, one half of the weight of ‘salt’. So, five grams of salt is around two and a half grams of sodium. No-one eats sodium alone, and it is certainly not recommended. There would be a rather large explosion].
Reading the CDC recommendation did cause my irony meter to reach its maximum recorded level, then break. How so? Because the NHANES graph that I showed earlier comes from research that is funded by, and run by, the Centres for Disease Control and Prevention (the CDC).
Yes, their very own study utterly contradicts their very own advice. Despite this, the CDC continue to harangue us to consume less sodium. Which is not merely health neutral, it is actively damaging. Why don’t they advise people to start smoking while they’re at it?
‘Our studies tell us cigarette smoking damages health. We advise cigarette smoking for all adults. At least ten a day should be tickety boo.’
Sound crazy? Yup.
Now, I know that it is bloody difficult to change an idea. And this has always been the case. To quote Leo Tolstoy from many moons ago:
‘The most difficult subjects can be explained to the most slow-witted man if he has not formed any idea of them already. But the simplest thing cannot be made clear to the most intelligent man if he is firmly persuaded that he knows already, without a shadow of doubt, what is laid before him.’
But science, if it is to be about anything, is the acceptance of new ideas. Disruptive evidence should not be attacked and silenced. Or, in this case, simply ignored. It should be welcomed with open arms. It is the very ground upon which science rests. To quote AI Google on Richard Feynman.,
‘Richard Feynman’s quote, “Science is the belief in the ignorance of experts,” means that genuine science is a process of constant questioning and scepticism, not a blind acceptance of authority. It emphasizes that knowledge is provisional and that experts, while valuable, are limited by their current understanding and should be questioned rather than treated as unquestionable authorities.’
Yes, every ‘scientist’ nods sagely when you say things like this. They then rush off to slam the doors in their minds and carry on regardless.
Were things this bad in the past? I don’t believe so. My sense is that disruptive science has been declining the last fifty years or so …. ‘And no-one knows why?’ But is it true that no-one knows why. Or is that almost everyone does know why, but no-one wants to say it out loud. Or even admit it to themselves. For myself, I believe the answer is, as is usually the case, staring us in the face.
It is money. Or to be more accurate, disruptive science is dying a death due to the enormous effect that financial considerations now have on research. Directly, or in the case of salt, indirectly.
I use the word indirectly because, as you have probably recognised, the impact of money cannot be straightforward with salt. The salt industry, if there is such a thing, can hardly be pushing for a reduction in salt consumption, and who else could get rich from this? So, why do we continue to be bombarded with anti-salt messages. And how can this possibly relate to money?
Next, let me take you on a long and winding golden paved road.
1: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-023-17582-8
2: ‘Comparison of the prediction by 27 different factors of coronary heart disease and death in men and women of the Scottish heart health study:cohort study.’ BMJ 1997;315:722
Dr. Malcolm Kendrick 
Bill,
A very interesting article from Dr. Malcolm Kendrick on blood pressure and salt.
Denis
Sent from my iPad
Thank you, Dr. Malcolm, for the informative article. Keep up the good work and … duck! Don’t let ‘em getcha. We common folks need you.
MK thinks like a scientist. Evidence-Based Medicine should be the foundation of medical practice.
Experts create guidelines based on “opinion” and not on science.
And as in any religion, faith is the criterion…
1 – You might want to read a stats book by Dr. (ph’d type) William Briggs – he blogs at
https://wmbriggs.substack.com/ . Don’t be put off by the religious stuff, on science and, particularly stats, he’s solid.
2 – I think disruptive science has become seemingly rare for two reasons: first it’s hard to find nuggets in the daily deluge of, umm, umm, well, brown stuff falling from bulls; and, second, the easy stuff has been done. Want to improve on Dirac? you have to know more, and be smarter, than him – and good luck with that.
William Briggs does write good stuff about science, especially how statistics is abused.
I think your Point 2 is well taken, but it doesn’t explain everything, of course. As Dr. Kendrick implies, anything “disruptive” is suppressed because it will be disruptive not so much to science, but to existing careers and funding streams. Dogmas too, although that might not be as important as the money.
To take the example that Dr Kendrick emphasises, I don’t believe you have to be smarter than Dirac to understand that the risk of death falls steadily with increasing salt intake – especially if you can read a graph and you happen to see the study to which he refers.
Which one might hope someone (at least) at the CDC might have done. Since they paid for the project.
“the risk of death falls steadily with increasing salt intake – especially if you can read a graph and you happen to see the study to which he refers.”
It doesn’t. Kendrick blatently misled you but I’m convinced he doesn’t really understand it himself. In age 60+ increasing sodium intake predicts higher mortality, naturally because this is the age where hypertension actually kills you. No one age 40-60 dies of hypertension, so that Kendrick would furnish that graph here is completely idiotic.
If you wish to have a debate then please use non, personally insulting language. Then we can take the heat out of it. You may first wish to read my book Doctoring Data where I cover a wide range of statistical manipulation techniques used in medical research.
You have to use data manipulation to perform apples to apples comparisons that eliminate reverse causation and residual confounding.
So if you have 2 people with the same grip stength, the lower LDL and lower salt intake has longer life and better prognosis.
Example: https://www.sciencedirect.com/science/article/pii/S0261561422000371
You insist that all the people with low grip strength and low LDL be compared directly to good grip strength with high LDL at the ecological level, and then insist this is an indictment of diet-heart. That’s why your research is low-impact, not some grand conspiracy, but because it is juvenile reasoning ability.
I have never made a correlation between grip strength and low LDL, although I am aware that grip strength is a good indicator of frailty and increased risk of death. Confounding variables represent the ultimate fudge pool. You can add and remove variables to your heart’s content to see which of them has the strongest impact on outcomes. But, before you treat them all as independent, or co-dependent, you have to provide some reason why, and how, the variables may interact.
If, for example, you understand that ‘stress’ can lead to high blood pressure, central obesity, raised blood sugar, low HDL etc. etc. you cannot then remove stress from your model and state that is has no impact on CVD, because the other variables e.g. blood pressure, HDL, blood sugar, central obesity can fully explain the increase in risk. Yes, but if there was no stress, the others factors would not exist. Mathematical co-variate models which simply churn though the data like some blind arithmetical behemoth stomping through the data countryside churn out complete nonsense. You need a causal model, and an understanding of the underlying pathophysiology before you can plug in a great big counting machine, using which, you can include or dismiss any factor you wish. Residual confounding sounds clever, but it is just a way that can be used to dismiss data you don’t like.
I (almost always) eliminate reverse causation because I know where it came from, and why (and who). It is the ultimate post-hoc rationalisation to attempt to explain away data that would otherwise puncture the balloon. I ignore residual confounding unless the authors can explain exactly how the factor confounds the data, rather than just stating that it just does, because our model says so.
“I have never made a correlation between grip strength and low LDL, although I am aware that grip strength is a good indicator of frailty and increased risk of death. Confounding variables represent the ultimate fudge pool. You can add and remove variables to your heart’s content to see which of them has the strongest impact on outcomes. But, before you treat them all as independent, or co-dependent, you have to provide some reason why, and how, the variables may interact.”
Right so if someone can’t squeeze a ball, they have bigger more pertinent problems than any biomarker you could test. At the ecological level, reasonably healthy people are the minority. You have to segregate the reasonable healthy people by their grip strength, and then you can test biomarkers with meaninful results.
And it’s not just cholesterol and salt. Diabetes looks good at the ecological level. blood sugar produces a U-shaped curve where optimal blood sugar has the highest mortality. So if you’re going to argue high cholesterol is misunderstood, you would need in the same vein to argue that diabetes is healthy.
Of course we know diabetes is not healthy, because once you sort these people out by their grip strength or nutritional status, optimal blood sugar lives the longest, just like lowest cholesterol lives the longest. The reverse causation theory replicates across all biomarkers. Even fat people seem healthier before you control for grip strength…Because half of the thin people are in a coma or similar vegetative state which also produces optimal cholesterol, blood sugar etc.
The graph from the study you cited is accompanied by other graphs. Why did you not use the graph of all subjects, regardless of age or the graph of subjects aged 60-80? They do not support what you claim, though they do support that the salt intake recommendations are wrong.
How much sodium is administered after a cardiac arrest?
I look forward to the next installment, although it’s not hard to guess the general idea.
Gary Taubes wrote a couple of articles about salt, the first in 1998. At the time he was focusing on bad science (this is before he got interested in nutrition and low-carb).
Science, 1998: https://garytaubes.com/wp-content/uploads/2011/08/science-political-science-of-salt1.pdf
New York Times, 2012: https://archive.li/ZxiBw
Interestingly, it seems that when Gary Taubes wrote that article in 1998, he was unable to conclude whether the evidence supported a link between salt consumption and blood pressure, and if so in which direction. Yet that was after decades of fairly intensive research and a great deal of money spent on studies.
I wonder why the intervening 27 years have seen scientific opinion (or at least evidence) change so drastically? While the excellent Mr Taubes wasn’t sure about the relationship between salt and blood pressure, the great majority of scientific and medical opinion still stood behind a positive link.
If the entire global scientific community can be so utterly wrong for so long, can we rely on any scientific reports before a long enough time has gone by for the truth to emerge from behind the thick wall of self-interest, money, pride, and refusal to admit mistakes? Since that time is apparently comparable to the individual lifetime.
I can’t help wondering what this info might do for homeopaths. In my experience some remedies are based on the “fact” that salt is a bad thing.
Any comments welcome!
PS thanks for this article Dr K. I relished it.
Which remedies, Sally, are based not the “fact” that salt is a bad thing?
None, but lack of data never prevented an attack on homeopathy
A very interesting article. It is sadly a fact that the people with the most money stifle dissent. This seems to apply to everything, not just medicine.
I am a qualified accountant and I had a book published: Accounting and Business Valuation Methods (Elsevier, 2008). In this book, I demonstrated that the new accounting system IFRS which replaced UK GAAP could lead to false accounting. One reason was that Directors were made solely responsible for their published accounts so that auditors now tick boxes rather that carry out detailed audits. We have had some spectacular false accounts, Carillion plc and Patisserie Holdings plc as examples. In the latter case a first year student could see that what was published was nonsense, yet they had been approved by auditors in three consecutive years. So it goes on; nothing get changed.
Best regards
Malcolm Howard
During the bank meltdowns of 2008 it was noted that the auditors had of course signed off on the various banks’ accounts, including Anglo Irish bank – an absolute basket case. When the proverbial stuff hit the fan the audit company changed it’s name to EY – yes, from Ernst & Young – We have no idea what the marketting geniuses were paid for this sleight of hand.
During the bank meltdowns of 2008 it was noted that the auditors had of course signed off on the various banks’ accounts, including Anglo Irish bank – an absolute basket case. When the proverbial stuff hit the fan the audit company changed it’s name to EY – yes, from Ernst & Young – We have no idea what the marketting geniuses were paid for this sleight of hand.
It turns out that graphene is quite difficult to make in commercial quantities and exfoliation by sellotape is particularly inefficient. A number of graphene development companies have been spun out of universities, hyped by investors and eventually failed. There are hopes for a new breed of electrochemical reactor, one of which I’ve invested in. Konstantin Novoselov now spends most of his time at the National University of Singapore and is at the frontier of new materials discovery by AI.
The measurement of the universe’s accelerating expansion in 1998 was disruptive. Other than that, I can’t think of anything in my lifetime.
The COVID clown show utterly crushing dissenting opinions deviating from the NIH/FDA/CDC/Pharma dogma was a good example of why thinking outside the box is dangerous to one’s career. My recent readings have led me to believe fraud & corruption is a better way to profit & advance one’s career.
Good news for me! I have been ignoring the official advice on salt, cholesterol and blood pressure for years. Still, I would like to know what causes high blood pressure even if it is not dangerous. Stress certainly has an effect and it is always higher in the doctor’s surgery than at home.
Wow!
Thank you Malcolm, as always. An informative and thought provoking piece.
This is a copy of a note I made after hearing this (Graham MacGregor) person talking on the radio:
“Graham MacGregor, Professor of Cardiovascular Medicine, Wolfson Institute, Barts Hospital
Randomised Controlled Double Blind Crossover Study Study of Salt Reduction
Group of people with high blood pressure off medication put on low salt diet for a while to halve their salt intake,
then split into randomised groups 6 weeks slow sodium tablets or placebo difference in 10grams on the normal
salt 5 grams on the lower salt and caused a large BP reduction.
High BP ‘biggest killer in the world’ as a predictor for death. Preventing the rise that occurs with age also very beneficial.
Really?? Might be worth trying to find this study?”
It was a couple of years now IIRC and I’m afraid I still haven’t found myself with the bandwidth to follow it up, but maybe someone else can throw some light on it?
Thanks, Dr. Kendrick. I hadn’t thought about this issue for some time, and now realize I probably haven’t been eating enough salt. I think you’re correct that money is the main factor in the degradation of science, but I think another important factor is the increase in stupid, due to the effects of schooling. It’s obvious on this side of the pond, and I suspect upon yours as well.
Yay! Break out the bacon, cheese, mackerel, and crisps!
And we may need something to wash them down with…
On the issue of blood pressure, the powers that be, in the U.S. at least, have now lowered once again what is “normal” for blood pressure.
Now, 120/80 is considered ”elevated.“ One must have a number less than 120/80 to be considered normal.
A doctor friend of mine said this gives the green light (and is necessary for malpractice insurance purposes) to now give BP prescriptions to everyone with a BP of 120/80 or over… lest they be considered negligent and not following the standard of care.
I also saw that upon hearing the news, the BP pharma stocks all went up! Yippee!
Thank you very much. The reason disruptive science has declined is because there has been an ass-salt (sic) on those who do research, making asses out of them and their studies!
More seriously, if people’s health is affected by low salt then there is profit to be made by trying to ‘cure’ them over a long period of time, the longer the better.
And if they die, there is always the benefit of making money from the funeral.
Just as the governments of Western nations, such as the USA and UK, have increasingly been encouraging “policy-led intelligence”. When he was trying to stir up support for the attack on Iraq, Tony Blair let the British intelligence people know in advance exactly what “intelligence” he wanted from them. The same has happened, more often and on a vastly greater scale, in Washington where there is far more money at stake. Currently Mr Trump posts to social media that the Venezuelan government is a cover for drug smuggling – although Venezuela has never been a significant source of drugs – and the experts in the 16 intelligence agencies are told either to agree or keep quiet.
As Tom Naughton used to remind us in his brilliant and amusing videos, “Follow the money!” Unfortunately research depends on money, and that money mostly comes from people with a powerful interest in research publishing “the right” results.
We can’t get honest science back until some way is found completely to exclude the corrupting influence of money and other forms of corruption. One serious difficulty is that you can’t trust people to choose other people who ar4e honest, unless the choosers are themselves honest. “Quis custodiet ipsos custodes?”
I always think of cancer research. How long has it been going on and how many billions/trillions has been spent on it. It’s a veritable industry. A cure would destroy the livelihoods of millions, and at the end of the day all they can do is get out the knives and cut bits off. The medical industry is built on a foundation of perpetual sickness.
Yes Steve. And greatly funded by kind, well-meaning people in their wills, in funeral service donations, exploits in aid of charity, charity shops manned by volunteers…all quite unaware.
“Disruptive science”
Very interesting. And, of course, putting “the” in front of Science makes it a religion whose ideas cannot be challenged – death to disruption.
Very interesting. And putting “The” in front of science makes it a religion whose ideas cannot be challenged – death to disruption
There you go again, Malcolm, overturning the establishment. Love it ! 😀
Dear Malcolm,
Brilliant! Keep doing what you do. Another unfettered, disruptive thinker is Steven Pinker. His latest book explores group think and “common knowledge”. https://stevenpinker.com/publications/when-everyone-knows-everyone-knows-common-knowledge-and-mysteries-money-power-and
Sent from Outlook for Androidhttps://aka.ms/AAb9ysg
Thanks so much for your writing it is always very informative, clear, humorous and needed. I really think your books are brilliant too and i managed to get my hospital library to order the clot thickens which is magic! I’m hopeful that some medics see it there and read it. Andrew h Physio
Dear Malcolm,
Brilliant! Keep doing what you do. Another unfettered, disruptive thinker is Steven Pinker. His latest book explores group think and “common knowledge”. https://stevenpinker.com/publications/when-everyone-knows-everyone-knows-common-knowledge-and-mysteries-money-power-and
Thank you so much for this Malcolm!
Good to know that my always insisting on extra salt on my fish and chips has finally been vindicated!
Seriously, I always feel worse when my salt intake has been reduced and I run the gauntlet of sideways looks from those who would ‘educate’ me on the ‘dangers of salt’ each time I ask for the salt pot when I eat… now I can refer them to some real science to shut them up!
Fascinating, as usual.
It was well known in the town where I grew up that workers at the local ICI Salt Works enjoyed better health than anybody.
I do wonder, however, about the role of iodine in all this. Not all salt has iodine, which appears to be beneficial for thyroid disorders.
A bit confused… the plus sign tells us whether the relationship is direct (more factor, more risk); the minus sign is inverse (more factor, less risk). Is that correct?
Hi Malcolm,
The big burning question I have for you (or anyone else who read this) is whether, in the Scottish study, can the plusses and minuses cancel each other out and leave a neutral effect ? So, for example I have high systolic BP (+10), so can this increased risk be negated by a substantial increase in my salt intake (-11) ? If so, this would be consistent with what my doctor (GP) told me 10 years ago with regard to my high cholestrol : Your Total cholestrol is too high, my boy, but no worries since your HDL (“good cholestrol”) is also high.
I’ve read all of your books and I’m a total convert to the cholestrol bunkum, so no need to re-invent the wheel for me in your reply. My question is simply academic.
In any case, many thanks for this excellent blog and all the hard work that would have gone into it !
Hello, you definitely need to explain the second graph as there are many “disruptive” data :-)))
Malcolm,
Thanks for your usual thought provoking ideas. I wonder would you care to comment on this rebuttal of the NHANES study:
Lancet Volume 352, Issue 9132, p987-988, Sept 19, 1998
This claims the study is deeply flawed due to the way the participants were chosen, i.e. people with CVD and other risk factors were over-represented in the quartile with the lowest sodium consumption.
I would value your views on this.
Medical science is static because there are so many long established beliefs and practices that cater to the big money men. Like cancer can be cured with chemo, cholesterol causes heart attacks, high blood pressure must be drug controlled, mental illness is a lack of brain chemicals, vaccines save lives, germ theory forever and everything, drugs cure everything…etc. The ways and means of the modern stone age medical mafia is etched in granite because most people are now fully indoctrinated and doctors and medical systems can make a fortune.
Please delete if a duplicate. (Struggling with WordPress)
I was in hospital recently for a minor operation. The admitting nurse connected me to a blood pressure machine, then wandered off for a couple of hours. So for the next couple of hours I had nothing better to do but lie in bed while the machine puffed up the cuff and took my blood pressure every 20 minutes.
I was amazed at how much the pressure varied. I forget the exact numbers, but it was from fairly high to fairly low. And I was just lying there, not exerting myself or getting excited or worrying or doing anything that might influence my blood pressure.
So to determine your blood pressure from a single reading appears to me to be ludicrous. An hour later it could be completely different. I have no idea how one would determine a single number that accurately reflects your blood pressure. In the meantime I take as much salt as I want, I would refuse blood pressure medication if offered, and I don’t worry about my blood pressure.
Malcolm when you cite these graphs for sodium intake, or cholesterol etc. (and the reason no one takes you seriously) you’re not understanding reverse causation and residual confounding. That data sample is loaded with comatose patients fed through a tube with very little salt intake and guaranteed to die soon. It is incredibly stupid for you to cite it like this.
In high quality data with relevant covariate analysis there is no paradoxical associations, for anything you complain about.
https://www.sciencedirect.com/science/article/pii/S0261561422000371
Reverse causation is a conjecture first pushed by Stamler to explain why low cholesterol was associated with increased mortality in those over, around 65. It has never been proven correct in any study, and was disproven in a very large Japanese analysis which I may dig out, but have discussed many times in the past. Stamler never had any data to support his conjecture, but it is widely believed to be true, by those who find it convenient for it to be so.
The reverse causality concept has been widely adapted to immunise against all disruptive data. It never requires proof, it just needs to be said and the disruption goes away.
Reverse causation has been proven. When you control for the covariates that drive reverse causation (grip strength, malnutrition etc.) you achieve linear trends between LDL and mortality. The U-shape goes away. The U-shape was caused by undiagnosed debilitating conditions which in turn caused low LDL in a statistically significant portion of the subjects. That is reverse causation. The failure to capture the actual health status of the sample by which to make apples to apples comparisons with. Grip strength is an excellent mediator of that. You might have undiagnosed lung cancer, but your failure to squeeze the ball will quickly reveal that your are not healthy and have no business being compared to say an athlete with similar blood pressure, cholesterol, salt intake, glucose etc.
I’m 74. 4 kids & 8 g’kids. Historically, I have eaten a lot of salt, and butter. Over the last 10 years I have eaten much more. My diet is basically high fat, low carb. I do physical work most days of the week working (hard!) in a forest golf club, and I play golf 3/4 times a week (course handicap of 9, Index of 11.4). I also cycle everywhere, and have no car (last 4 years). I have what could be considered perfect metrics, and I take zero medications. I am also none mRNA vaxxed. Recently, I have also taken to adding salt sub substitute (potassium chloride) in my coffee, as well as turmeric, black pepper, salt, crushed cardamom, and a 1/2 teaspoon of coconut oil. Sometimes a few extra spices also. I drink too much beer as well, and I’m not crazy.
If you were to read Dr Kendrick’s books – especially “Doctoring Data” – you would find that he knows a great deal about statistics and mathematical conjuring tricks.
Hopefully it’s OK to leave an anecdote here. My father loved his salt, but had low blood pressure, occasionally becoming faint. My doctor daughter told him to eat more salt – hooray he thought. Eating more salt made no difference. He lived to be 92. We are all different, one piece of indoctrinated advice from “scientists” and/or pharmaceutical companies doesn’t fit everyone. Follow the money…
“If you eat more salt, you will live longer.“
That isn’t supported by the study you cite. The graph you showed is only for the 40-60 year age group. There is also a 60-80 year age group graph which shows something very different (though is still counter to the recommendations for salt) with decreasing hazard ration only until about 3.5g per day of sodium, then the HR increases with more sodium intake. The graph of all ages also shows a slowly increasing HR after about 3.2g sodium per day.
Why didn’t you mention the nuances, since it still argues against the guidelines, but doesn’t support your statement above.
I agree, the 60-80
year age group indicates that there is an optimum sodium intake, slightly higher than the current average
The confidence interval overlaps with 1 in the higher salt consumption groups and is therefore not statistically significant.
Can you expand on what you mean, for which chart in the study paper and what inferences can be drawn from all of the data in the study? It seems clear to me that highlighting one chart for a particular age group and then inferring that more salt intake prolongs one’s life isn’t particularly good science, or thinking.
Malcolm you’re a national treasure in my eyes and your blogs brighten my day. Thank you
Great email Malcolm. I absolutely love your style.
Thank you. Marson
Dr Kendrick, I’m not sure it was better in the old days.
‘Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing ever happened.’
Sir Winston Churchill.
Great to have this information and your insights, thank you highly interesting. Looking forward to the next installment!
Malcolm,
I am extremely pleassed that you are posting 'Disruptive' thoughts again abot medicine in general.
I hope this will appeaar as a comment, because I cannot persuade wordpress comments to work for me after I had to change my email address.
I agree with you about disruptive science in general, but graphene does seem to have been rather over-hyped:
My brother and his wife seemed amazed when I asked for some salt at their table. I have given up trying to persuade people that saturated fat and salt are good for you – because most people think I shouldn't deny medical 'knowledge' without being in that profession.
David
Sent: Friday, November 07, 2025 at 3:32 PM
I’ve never been that much bothered about my salt intake – that’s what my kidneys are for.
But when was something disruptive ever accepted without a fight? Continental drift is pretty sciency, but Wegener was laughed out of society. As late as 1958 Einstein was dissing it. Atoms. Speed of light. Heliobacter pylori.
Then there are the things that science cannot come close to explaining. Quantum time. Twins experiencing each other’s pain. These are just swept aside, not even worthy of being disruptive.
I think that the interesting thing about salt, though, is that unlike statins, or vaccines, there isn’t a huge amount of money involved in salt; yet it still divides people.
I have a theory that some here have touched on, let me give an example.
Theory:
I’m a gung ho (opps, probably not pc) extremely enthusiastic and dedicated new university graduate in (Select field of study here), I’m full of piss and vinegar and I’m about to change the world.
I’ve read Dr. Kendrick and I’m going to prove some of his ideas so I go to the head of the lab and propose my study. He/She listens intently, looks me directly in the eyes and tells me I will be doing no such thing. I will instead prove the cholesterol theory or look for another job.
Since I graduated with my Doctorate and $150,000 debt i slink back to my cubical and tow the line.
Money may speak but debt chains you.
The only “breakthrough” science that has really impressed me in the last few decades is the development of being able to recover and test ancient DNA. It has both settled old speculations and thrown up substantial surprises – Grandpa was a Neanderthal, that sort of thing.
No doubt I’ve overlooked something. Still, the list is going tp be mighty unimpressive when compared to the list of Advances in Ant-Science – Global Boiling, Statination, Covid/Vaccine Fascism, the Cult of Autism, and so on.
Fantastic and hilarious, as ever. And vital to my sanity.
Keep on keeping on.
It is interesting that animals seek out salt deposits e.g.
https://digitalcommons.usf.edu/ijs/vol35/iss1/2/
Beef farmers put out salt licks for their animals too.
My wife has high blood pressure and suffers from a low salt level’
To be more precise her blood pressure varies between 130 / 55 and 180 / 90 and occasionally outside this range. Her sodium levels vary between 125 (whatever) and 130. The generally accepted minimum sodium level is 135 (133 NHS U.K.).
On one occasion her level went down to 117 which took her to the local stroke unit and we think levels of 125 are seriously low.
The conventional approach is to lower sodium levels to lower blood pressure (not convinced that works) and to lower fluid intake to lower sodium.
The issue I face is that low sodium, a small bleed on the brain and infection (UTI) all can show the same resulting reaction = delirium / confusion from which the hospital tries to tell me that she is now suffering from dementia.
Conclusion = low serum sodium is dangerous and not taken seriously enough by the NHS, and, as is pointed out, falls into the same group of mistakes as cholesterol and carbohydrates.