Dr. Malcolm Kendrick on Doctoring Data


thank you very much as I feel very
honored to to be invited to this meeting and met up with some people that haven’t
met up with before which is fantastic and I was given this some of you may
know it’s been mentioned that I managed to get deleted from Wikipedia
last week and they made this t-shirt for me I feel honored to I say about being
on Wikipedia I didn’t I was actually on it until I was doing I was gonna be
taking off it so I’m so I haven’t been haven’t been crushed yeah it but
everyone seems to think it’s great honor because it means that I’m never
considered dangerous enough to be removed for public consumption so what
I’m going to talk today about is is doctoring data my son claims he came up
with the title because I said I’m writing this book about how data are all
manipulated and we had a little family brainstorm and he said call it doctoring
data so so everybody else thinks I called it doctoring data because it’s a
really good title it’s not mine what I’m hoping to talk to you about here are
just starting actually though as John Locke is a British philosopher he said
is that no man can be forced to be helpful whether he will or not in a free
society individuals must judge for themselves what information they choose
to heed and what they ignore and I think that’s very true and I’m always very
concerned that people must make their own minds up that’s the only way you’re
going to get change you can’t force things onto people it’s
a little bit about me I graduated from Aberdeen University in Scotland many
years ago many many years ago many many many years ago even more than that I
think now I work as a GP not a cardiologist although I am probably
considered to know a bit about cardiology in England I wrote the great
cholesterol corn which was my first attempt to say to people cholesterol
does not cause heart disease fools and of course everyone has now
agreed with me in the whole world no it doesn’t take any statins and and in fact
believe everything I have to say I wrote and doctoring data which is there’s
someone copies around outside which is really some of which I’m talking about
today I run a blog dr. Malcolm Kendrick org
and a new book statin Nation I did bring a few copies here I was going to bring
quite a lot of copies but but somebody locked my garage before I came out so I
couldn’t get any copies there and I recently removed from Wikipedia
it’s a fantastic thing and you know it’s the most famous thing about me now so
I’m not sure that’s a good thing or not because of my ideas of plenty people
think I’m a bit like this the Mad Hatter Hatter’s weren’t mad because they used
lead to make felt and when you take in too much lead you go mad so there really
were Mad Hatter’s that’s where the idea from Alice in Wonderland comes from I’ve
not yet been referred to the General Medical Council you don’t know what that
is but there are the people that say you can’t be a doctor any longer because
you’re saying such ridiculous things a number of people find that a bit
surprising and and say how on earth can you keep practicing because you’re
saying all these things don’t you get reported well actually no you don’t get
reported unless you give advice to people online on the Internet something
I have ruthlessly never done so when people say my mother is 92 or whatever
and she’s on statins what do you advise I say advise you don’t ask me why did I
write this book to show how data from clinical studies are distorted to allow
people to make informed decisions about and in the intervention and drugs they
receive and to highlight some of the really bad advice were given I’m not
going to go through all that today but a lot of people I’m not only think that
statins are terrible cholesterol doesn’t cause heart disease I also think we
should go out to the Sun a lot more and get lots of sun exposure because it’s
incredibly healthy and good for you and studies in Scandinavia has shown that if
you avoid the Sun it is as bad for you in total health
effects as smoking takes approximately six years of your life expectancy sorry
go back again also you know the bad advice avoid saturated fat I’ve been
going about this for 35 years you lot are all newcomers did as well some of
you weren’t even born when I was saying saturated fat is healthy he eat the
ridiculous advice of eating more carbohydrates I mean who came up with
this one oh I tell you what people can’t control their blood sugar levels if
they’ve got diabetes for example let’s get them to eat sugar yeah sorry cuz you
tell me that again because alright now I’m having trouble understanding it eat
more sugar okay subject yourself to cancer screening this is perhaps more
controversial I’m a great non-believer in cancer screening and stop believing
experts know what they’re doing or saying and I want to reduce the fear and
anxiety people are terrified of the cholesterol level people are terrified
as a PSA level people are terrified of their whatever it is they’re currently
measuring level and people are very anxious about their health you know your
health your body looks after itself most of the time you will be fit and healthy
you don’t need to worry about all this stuff
you’re just being drawn into an over medicalized world so now we’re in fake
news that’s just because I’m in America so it’s a fake news I have no idea who
said they said that well you know fake news has been around a lot longer than
Donald the Donald who came from Scotland can you imagine what his mother did but
if two people present a diverging view on a subject who should one trust this
is a very difficult issue I don’t know the answer to it I don’t think anyone
does how do you know that someone’s telling you stuff that is true correct
whatever word you want to use how can you tell there’s so much evidence out
there I was going to write a paper on cholesterol where I was going to
reference with 50 references saying high cholesterol is bad for you and I was
going to write another paper reference with 50 other people with 50 other
papers saying cholesterol is good for you or bad for you whichever is the
other way around I’d like you to written two completely
different papers using two completely lots of different evidence fully
referenced and I could have made the point in other direction I wanted to you
can find evidence to support any view you want out there there is nothing you
can’t find evidence for but clearly some of its rubbish how do you know which is
rubbish well I’ve tried to help people to understand this we’ve had some of
these quotes so I’m just going to whiz through the Mitch Selma and Marcia and
Yale did you get the you’ve got the Richard Horton one as well did you
the case against science is straightforward much of the scientific
literature perhaps a half maybe simply untrue science has taken a turn towards
darkness this is a really difficult issue I don’t know how we get out of
this place I think I’ve decided a nuclear bomb is the only answer because
it’s just a huge I look at research and I say that’s rubbish that’s rubbish
rubbish my daughter who’s doing medicine says well how do you know that rubbish I
said look at the author certain authors they look at a paper in fact there’s
certain things that people say in papers one of them is the word paradox if I see
the word paradox in the paper that’s it I’m not reading it if I see there were
an explanation of this is someone trying to explain why the current Dogma is
correct and this researchers disproved it is wrong so if you see a paper that
says an explanation for the paradox then you might as well just set fire to that
paper immediately Richard Smith this is the this is the BMJ he’s done a lot of
work on telling you how useless journals are and how rubbish the evidence is the
poor quality of medical research is widely acknowledged yet disturbingly the
leaders of the medical profession seem only minimally concerned about the
problems and make no apparent effort to find a solution this is true everybody
in this world knows the research is rubbish it’s dreadful
it’s just I mean at what point would you say that the amount of research that is
wrong clearly wrong and manipulated in terms of bias would destroy your your
ability to sort of trust any paper is it 10% is it 5% if you pick up something
and say I don’t know whether to believe this or not this is a terrible situation
to be in if this is a situation which we find ourselves
but why our data doctored it’s not all money I know that Jason talks about
money money money money money and I agree money is a big draw
for a lot of the research data to be double published to be distorted the
people also get attached to ideas but no one ever puts in a conflict of interest
I really believe that saturated fat causes heart disease and I believe this
for 20 years and then my entire career is based on it they don’t do this
because the only conflicts that people seem to think are important are monetary
but there are far more important conflicts of interest in this the
seventh-day Adventist Church is driving a great deal of the vegan doctrine and
dogma but you’ll never see anyone saying I am a member of the seventh-day
Adventist Church we don’t expect people to disclose the evidence doing yeah I
think that’s far more important if somebody said to me I’m a whatever they
have in the seventh-day Adventist Church or I’m a vegan then you could say well I
know where you’re coming from but they don’t tell you these things because
people also they defend their ideas and opinions with such ferocity this is
another thing people once they get an ID and they like an idea it’s incredibly
difficult to shift it why do people insist on defending their ideas and
opinions with such ferocity if it’s defending honor itself what could be
easier to change than an idea ideas are the most difficult things to change that
there are and there are mortal as well because you can kill the person holding
an idea no idea can carry on and on and on and they’re emotionally attached to
us as well facts have very little effect on what people believe I have found I
can give you a hundred fights the million fact I can you know somebody
says safety what fact what fact would change your mind and they tell me and I
give them the fact that still it makes no difference there’s a famous story of
a psychiatrist whose patient thinks they’re dead so cats are kind the
patient’s think so dead and the psychiatrist tried for years to get them
to change their idea said oh you’re not dead you’re clearly not dead you’re
walking around in stuff no I’m dead so he said psychiatrist has this fantastic
idea said well there’s going to prick your finger with a needle it says
because he asked do dead people bleed and then she says no I’m dead people
don’t believe so the psychiatrist gets a needle pricks his finger and he bleeds
in it and there’s the patient looks down and goes well I guess dead people do
bleed and I you know it’s like this all idea
we all look at the data we all look at this at the fat and the high carb and
all this and we think well look at the data look at the science you know look
at what happens in the body I mean come on I think they just go no no well it’s
clear that it’s still clear that we’re right and you’re wrong and you just you
realize that you’re bouncing off something here that is incredibly
difficult to change anyone seen the film favorite dice is now my favorite film
ever Inception you’ve seen it little spinny thing is it gonna fall over or
not who said things yes it’s gonna fall over
who thinks no it’s not gonna fall over the most resilient parasite is an idea
it’s true it is the most resilient parasite you can’t get it out of
people’s heads I used to have a picture of a plane flying into the one of the
twin towers see that was an idea that did that was an idea that did that
somebody’s willing to sit in a plane and fly it into a building at 500 miles an
hour and kill themselves everyone else on board because of an idea try shifting
that one why date a doctor because people like to
be together they like to think in the same groups we’re all sort of thinking
here in the same group and it would be very difficult for us to think otherwise
and now if I was to stand up here and say I think you’re all wrong
I think carbohydrates a wonderful year beginning boo but of course we’re
minority aren’t we but the conformity hazard why did a doctor
this is contains possibly new information which may stimulate
independent thought people don’t like to stand out they like to fit in being part
of a group is usually important and for doctors its enormous ly important well I
know this because they don’t like me very much sometimes I like this this is
also this confirmation bias I like this because it was doing about Donald Trump
and it was in the Washington Post and it was October the 24th and basically a
group of people had decided Donald Trump can’t possibly win this election it is
impossible for him to win this election and anyone the election but I mean where
I live in the UK we voted brexit to leave the European Union
and everyone that voted to remain is in a circle and we all speak to each other
about how stupid all the people would it breaks it were and all the people who
voted breaks it saying how winds of winning moaning lefty elitist bastards
we all are and we all confirm and conform what we’re believing all right
this is how we do things this is an example of groupthink I watched the
program about the Challenger and there was a guy involved in designing the
o-ring for one of the solid fuel boosters who said if you take this thing
off when it’s zero degrees the o-ring will not expand well it will not have
contracted properly 42 seconds and to take off the Challenger will blow up 42
seconds after takeoff the Challenger blew up now a lot of people spent a lot
of time going oh how did that happen we’ve no idea how that happened and
eventually this guy stood up and said well I’m going to tell you how it
happened took great courage to do that but in those meetings it was basically
we’re going off we’re going into the we’re going to launch we’re not going to
stop this launch and it became this thing and everyone’s like yeah we’re
gonna launch we’re gonna launch we’re gonna launch who would stand up and say
no so there’s huge pressures on people to conform why did a doctor
another reason is people become more and more extreme you know katzenstein visor
Obama on how to win the election nudge and this thing is if you want to become
an extremist hang around with people you agree with so all the people who do the
guidelines all the people on the other side they’ve become more and more
extreme it’s like with with the cholesterol
when I was at medical school high cholesterol was 7.5 then it was 6 then
it’s 5.5 I’ve just read a paper where we now have a zero hypothesis the only
healthy level of LDL is zero zero this I’m not making that up
how did how did you get to that point of mind-boggling stupidity because everyone
around you goes yeah yeah the lower the better we’ll keep going well can you get
lower than zero well that would be good idea with it we can get to minus four so
here I am I’m going to suggest minus four is a correct healthy level of
cholesterol because people just go mad in groups they
just become this thing and why did data doctored well we have we have key
opinion leaders and I would say this is this is me discussing cholesterol was a
key opinion leader I’m the little guy on the left keeping leader is the one on
the right they get very angry get very upset and won’t change their mind their
status is dependent on it you can imagine you you’ve been an opinion
leader in lipid research or whatever it is you for the last 30 years and you get
taken to conferences and you get given awards and Gong’s and money and
everything and then someone’s asking you to say you know what you’re wrong I
think oh you know I think you might be right I think I am wrong in fact I have
been wrong about everything for the last thirty years I’ve really been stupid
haven’t I you’re right you’ve convinced me I’m
going to change my mind and how many times has that happened one might ask
and the answer in my experience is it never happens as Max Planck said Max
Planck who was the man who actually decided to publish Einstein’s first
papers on special relativity a new scientific truth does not triumph by
convincing its opponents and making them see the lights but rather because it’s
bullets eventually die and a new generation grows up that’s familiar with
it now all scientists who lived in the 19th century all looked like this there
no one had big beers and they looked real fun guys didn’t they always think
that might be Max Planck it might be someone else I’m just making out
probably now and this is Sackett talking about the power of experts experts
become too powerful he founded evidence-based medicine he was from a
master university I met him a few times fantastic guy I was working with him at
one point and then realized that evidence-based medicine was going to be
taken over by the pharmaceutical industry and we were all doomed and when
you’re Scottish youth always think we’re doomed so in that sense that’s our
default you know and as he said he would never again lecture right or referee
anything to do with evidence-based clinical practice because he said I had
become too influential normal challenged me alright so if I say you do this I
won’t did that so he retired himself unfortunately because of doing that
he was one person that should never have retired himself where’s all the others
who think I should carry on forever he said uh you know an opinion leader
should be given three years and then retired something like a president or
something you’re off you can no longer get in the way he’s not doing this
because he ceased to believe in it evidence-based practice because he’s
worried about the power of experts and stifling new ideas he wants the
retirement of experts to be made compulsory any luck with that well the
only people who would ever vote and that would be the experts themselves so I
can’t see that one not going really well why are day two dr. T is another one
money we’ve talked about it a bit I’ll just give you one example because it
always makes me laugh is dr. Robert Califf was the Obama’s nominee for the
for the head rather than the heart I mean it might be the heart of the FDA
the Republican who chairs the committee said Calif had been through an
exhaustive vetting process to make sure he had no conflicts of interests no
conflicts of interests all right my staff tell me they haven’t found
anything that would call it de sorry I’m laughing because I know what comes next
a joke sure does a joke something anyway who knows and there he
is he looks like the kind of guy who who statins wouldn’t melt in his mouth or
whatever so here was his conflict of interest statement Merck gosh I’ve never
heard of a tear of X Bo Johnson Eli Lilly and Company shooting plow Novartis
Amal ncos bristol-myers Squibb blah blah blah blah blah blah this is a man who
according to the vetting committee has no conflicts of interest well this is
his conflict of interesting do you know how long it took me to find that thirty
seconds so what was their exhaustive vetting thing I mean what were they
doing going do you think he has conferred some interest no do you know
do you know none of us here I think he has conflicts of interest we don’t even
like to go and find out if he has a conflict of interest no yeah so no well
I wouldn’t call these conflicts of interests ladies and gentlemen this is a
perfectly acceptable whatever it might be acceptable for so my stuff I mean
this is like we haven’t found anything that would call into doubt your ability
to lead the FDA fairly and impartially say I’m sorry rosebud I’m only doing the
world to live I mean it’s just so released ordinarily sort of ridiculously
to give up don’t you well he’s still smiling that’s that’s that’s the smile
you make when someone inserts $50,000 up your backside so what happens when data
are doctored this is Johnny and artists who keeps saying really really
heavy-duty things about data it never quite gets stroppy enough in my opinion
because he says this is his thing lies damn lies and medical science moreover
from any current scientific fields claimed research findings may often
simply be accurate measures of the prevailing bias it is more likely for a
research claim to be false and true this papers a 2005 the most read paper in the
history of medical research so as a lot of doctors out there who believe this is
true but everyone’s keeping rather quiet so this is why most published research
findings are false and it’s true well maybe that’s false for me to say it’s
true maybe I’ve resulted in a paradox here
can I ever get out of it I don’t know so things are not what they seem now I
thought I’d show you this this is things are not what you seem cuz every morning
I lie in bed and I’ve got two wardrobes and one this bit longer than the other
one they’re both the same height but you know I look at them and I think that
one’s definitely higher than that one I can’t I can’t see it as being the same
height here’s two tables one of them is long and thin and one of them is short
and fat correct you’ve seen this before let’s take you through it this is how
they start this is what you do you change them in in twist one through
ninety degrees then you shade one in a bit then you shade it in a bit more
input legs on it and my goodness that’s changing shape in front of your very
eyes you can’t trust your own eyes there we are back again to the start
things are not what they seem and we see things here’s a little question for you
this is my terrible drawing fast thinking slow thinking things I don’t we
see we see things we have to think about them differently there’s a baseball bat
and a baseball very badly drawn between the two of them they cost more
dollar and ten cents the bat costs the dollar more than the ball quickly what
does each one cost how much does the bat cost that much does the ball cost and
you’re thinking I know a lot of you thinking this is a trick question
because I’m not asking it otherwise no it is not a dollar and ten cents because
I’ve just told you that the bat costs a dollar more than the ball so that can’t
be the answer so what’s the answer one dollar five and five cents that’s from
Daniel Kahneman fast thinking slow thinking we jumped to conclusions very
quickly about what we see and then we’re stuck with those ideas and this partly
what this what I’m talking about but a moment I’m gonna ask you to stand
by I would do sound effects that’s good thank you because you were about to
enter not the twilight zone the outer limits you can do the sound effect now
and then for a bit of high-powered graphics and as William Shatner would
attest this is all going to be rather shocking and that is acting isn’t it
that’s really good acting as he is he frightened skin things are not what they
seem right here’s a guy he’s a sumo wrestler the the one in front of him is
thinking what that the this doesn’t mean he’s a chicken no are these little
aerials that make sure is anal sphincter doesn’t release yeah I’m gonna ask you a
quick question you know I’ll just hit your hand in air if you don’t want to
okay how many people think the beastie causes type 2 diabetes how many people
think obesity causes type 2 diabetes so if you do that guy he’s got type 2
diabetes there’s body mass index is I don’t know what it is I’ve never asked
him untrue frightened only about 60 fights he fighting him
here’s another picture he’s a young man look at him
body mass index 16 15 prophets what we’re all aiming for in life isn’t it super fit I don’t know what he does I’m
going to tell you something I’m gonna ask you a question which one of these
ones do you think has type 2 diabetes and you know you’re going to be told
it’s something slightly strange one on the left will definitely not have type 2
diabetes because he’s a sumo wrestler and no sumo wrestlers have type 2
diabetes no matter how fat they get one of the right will have type 2 diabetes
very severely we’ll probably have non-alcoholic steatohepatitis well I’ve
tried glycerides through the roof and we’ll die quite young because he is
metabolically up shit creek without a paddle how do I know this because he has
this condition that most of you will never have heard of some of you may burn
Denalis yep my dystrophy other one is known as generalized it’s congenital
generalized lipodystrophy he has no fat cells
he has no fat cells at all in his body and because of that he will definitely
have type 2 diabetes he must have type 2 diabetes and this is
what happens to people with this condition they have hepatomegaly they
have hyperinsulinemia they have a consistent I cans followed by onset of
diabetes they have extreme hypertriglyceridemia they have insulin
resistant diabetes pancreatitis hepatic steatosis cirrhosis and liver failure so
you have absolutely no fat cells in your body and you definitely won’t have type
2 diabetes you can’t avoid it why does this happen there’s a very simple answer
to it obviously you can’t store any energy so what are you going to put it
so after you’ve eaten a meal and your liver is full of fat and your liver is
full of glycogen in your muscles are full of glycogen it’s going into the
bloodstream as triglycerides the insulin is going through the roof it’s trying to
store your food it’s trying to store its energy and it can’t
type two diabetes is caused by not being able to store energy and so you’ll get
people who are like a hundred stone who are not diabetic because by god they can
store energy you’ll get ten people who are diabetic because they have reached a
limit of their energy storage systems that is why you get type two diabetes so
there are things are not what they seem but now I’m going to talk to you about
more about the doctoring data we’re just trying to switch your brains around
there a bit to thinking about different things well it’s a risk versus absolute
risk this is one of the ways that the industry uses to manipulate data so we
have lipitor which was advertised as reducing the risk of heart attack by 36
percent absolutely fantastic what idiot wouldn’t prescribe statins given that
well well I’m one obviously relative versus absolute risk to screening tools
for prostate cancer screening to a reduces the risk of dying of prostate
cancer by twenty to thirty percent screening tool B saves one life for
every 10,000 person years of screening which one would you choose we’ll get
into that later A or B relative risk versus absolute
risk something all doctor should know something everybody should know but most
people don’t and whenever I’ve asked the doctor whether they know the difference
I’ve never got any single one of them to tell me the answer obviously everyone
here knows and I’m just going to refresh your memories about the thing you
already know treat a hundred people with a blood pressure lowering agent for one
year versus placebo and of the study one person dies in the treatment arm to die
in the placebo arm ninety nine percent are still alive in the treatment arm
ninety eight percent are still alive in a placebo arm the absolute risk
reduction is one percent to ninety nine versus ninety eight percent of people
the relative risk reduction is fifty percent one versus two okay next treat a
thousand people same thing at the end of the study one person dies in the
treatment arm to die in the placebo arm ninety nine point nine percent of people
are still alive in the treatment arm ninety nine point eight percent of
people in the placebo arm absolute risk reduction not 0.1% ninety nine point
nine percent versus ninety nine point eight percent relative risk reduction
50% one versus two that’s how they do it okay relative risk
may or may not mean anything in fact it means nothing it means nothing unless
you know what the absolute risk was they don’t tell you this they don’t give you
those figures so have a wild guess as to whether or not the 36 percent was a
relative or an absolute risk reduction well you know the answer to that clearly
because I’ve told you it inadvertently so what did it mean in this study was 36
percent or else of an absolute risk what was the absolute risk reduction after a
five-year trial ninety-eight point one of those ticking atorvastatin did not
have a heart attack versus 97 percent who did not have a heart attack in the
placebo arm is everyone following this and think I’m losing myself enough I do
this so often I’ve made a horrible mistake and one of the slides I didn’t
notice that I’m given this protector that particular site of about ten times
that no one’s ever said that’s wrong so obviously no one’s paying any attention
pay attention there’s a deliberate mistake coming up so one point nine
percent of those taking atorvastatin did have a heart attack three percent of
those plates taking placebo did have a heart attack the absolute difference was
one point one percent the relative difference was one point nine versus
three percent is 36 percent okay so that’s how they present the data to
everybody it they present it in a way that sounds fantastic so what was the
difference in fatal heart attack because you’ll notice they said heart attack
there’s another thing they do they say things is like a magic trick you think
how did they do that what was the difference in overall mortality are the
risk of dying of anything which is the thing you really take a tablet for isn’t
it oh it’s okay I didn’t die of a heart attack but you died 10 years earlier
because you died of liver failure as I say I can prevent everybody in this room
from dying from a heart attack I can guarantee that I’m going to push
you all off the edge of a cliff right well you might have a heart attack on
the way down I suppose not many would be dead though of a heart attack before
they hit the ground I have to make it quite short cliff El Capitan Stu hi but
what was the difference in absolute and cardiovascular mortality in that same
trial that is presented as being wonderful there is the answer it was
zero there were no lives saved there was no one who’s presented from having a
fatal cardiovascular or having a heart attack or cardiovascular death so there
you are 36% turns into zero it’s amazing isn’t it so now you’ve got one tool for
understanding the bullshit they come out with okay and people say to me on statin
save millions of lives and only wonderful I go no Jupiter this was a
really mega influential trial it was in primary prevention ie people who hadn’t
had a heart attack or a stroke whereas a lot of others had shown some benefits of
this size in secondary prevention this changed practice around the world
possibly resulted in the greatest number of new prescriptions for anything in the
history as well Steven Nissen who’s been mentioned
before in my opinion you could stick a corkscrew in him and straighten it out
but other people quite like him he just anyway before I get compared to
those who received placebo patients receiving the drug Rose you verse 13 had
48 percent reduction in stroke 46 percent reduction they need for
interventions to reopen block the blood vessels and a 20 percent drop in all
cause mortality there you are all cause mortality that did I agree the extent of
reduction in deaths heart attacks and strokes in larger than we’ve ever seen
in any trial I can remember I’ve lost count of the number of times that first
Stephen listen say that about a trial by the way so I I was advised not to do
this but I’m going to do this because I have a little song about Jupiter that
goes like this because justification for the use of a
statin in prevention and interventional trial evaluating Rover’s
she was statin now that is a real so it goes like this J a joke
a great big joke but you are going to take this drug P a lot it causes
diabetes I do not think it works T it up and cut them money enormous profits to
be made that was a different one to get right Oh
it stands for you versed at it Rosie first RN which takes us back to Jake
thank you very much okay so let’s have a look a little bit more detail there what
8901 in the placebo arm at the start of the trial 8901 in staten arm so it was
completely matched they probably all have the same same hair color and
everything a number of those dying in each eye was 235 versus 190 I’ll get to
that in a minute which is 2.6 four percent versus two point one four
percent is an absolute difference of naught point five percent and this could
be resent represented as a number needed to treat to get and a benefit of 200
over two years of treatment or an N NT of 400 for one year so you had to treat
400 people to get any form of benefit you can try try that with antibiotics
and see how far you get oh I traded 400 people and one of them
got better well that’s just fantastic that drug is just the best drug I’ve
ever come across what after that’s a really nice design well they all died so I tried to new they’d done something
with this trial because it was so weird it was beyond weird and I didn’t do this
analysis because I couldn’t work it out it took em Mike Michele de la Jerome who
did the original Leon study Mediterranean diet in France professor
of de la general bright guy scary so what he found was in the placebo arm and
this is interesting and of itself the possible arm there was 68 myocardial
infarctions resulting in six deaths in a Jupiter setting arm there’s 31
myocardial infarctions resulting in nine deaths so there’s a lot more myocardial
infarction but apparently statins can stop you
dying of em ice or something no no they don’t they increase your risk of dying
if you have an mi stroke difference between stroke placebo sixty four
strokes resulting in six death statin thirty three strokes resulting in three
deaths so if you look at stroke plus mi and these are deaths and the placebo
twelve deaths from stroke and MI and the statin twelve deaths from stroke and mi
that was the Jupiter study those are the figures so what did people not die off
in a jiffy to study on the stat and they didn’t die of cancer
a finding not found in any other study ever before or since so you’d have to
say hmm interesting if you look at the actual graph of deaths yes there are two
lines here it’s like so extraordinary it’s like overwhelming isn’t it and and
you see they had to expand it by 10 or 100 times or whatever it is the placebo
average reviews receive a statin arm you just see just as we reach the lines were
beginning to come back together again one thing let me stop the trial because
it was so beneficial and then just at that point and just at that point the
placebo I’m ticked up with the receiver statin arm went flat mmm you mean after
you’ve broken the trial you managed to make the graphs go in different
directions right you know if this wasn’t been recorded I’d say what I really felt
but I might get sued by by someone for saying I think this date is a bit
suspect call me old-fashioned if you will anyway back to Stephen listen
compared to the house it’s like the extent of reduction in deaths heart
attacks and strokes is larger than we’ve seen in any trial I can remember well
the reduction in cardiovascular this was nothing nothing at all and yet this is
presented as a wonder trial just amazing is I mean but the problem is to explain
that this is Michele DeLozier all said it’s quite unusual that the burden of
calculating cardiovascular mortality is placed on the readers all methods used
lead to the same conclusion there’s no different significant difference in
cardiovascular mortality between the two groups he sat and worked that out I
actually once he pointed out to me I could see what they’ve done but it’s so
cleverly done sometimes she you can’t work it out or it takes you
days weeks I’ve had people who have had to look at for two weeks and think what
have they done and eventually you find out relative versus absolute risk and
going back to cardiovascular screening this is because I think sometimes
doctors are not that clever and that’s tweedledee and tweedledum the screening
tool a reduces the risk of dying of prostate cancer about 20 to 30 percent
screening tool B saves one life for every 10,000 person years of screening
which one would you choose well obviously the answer is these are both
the same study and these figures are both the same figures just presented in
a different way because when I say about doctors that
they ask do do physicians understand cancer screening statistics well doctors
this is a study doctors were told that prostate cancer screening improved
five-year survival from 68 to 99 percent a 31% improvement now that sounds
fantastic half the doctors responded if a thousand men were screened this was
result in 300 to 310 lives saved okay guys I think we’re not understanding
mathematics here are we the actual reduction in cancer mortality was naught
point four per 1,000 patients over five years these are the same figures now
I’ve mixed up a couple of studies because no one ever comes up with the
same figures of studies it’s impossible to sometimes calculate what they’re
doing so I looked at the UK it in the UK about one in a thousand men develop
prostate cancer every year the incidence rate it’s actually point 99 rather one
in a thousand so and this is one of my mistake happened if you picked up every
one you pick up one in a thousand a point zero nine nine percent if they
survived this is where I made mistake so if they all survived the mortality rate
will be zero won’t it but 0.99 percent of them will still be alive okay and and
of course the other problem the cancer screening is a big issue of five-year
survival because if you’ve survived for five years that’s considered to be a
cure so if you pick something up earlier this is the travelling on the train from
one town a to town B to town see you’ve got on the train an eight and you arrive
at C that would be when your prostate cancer starts that’s when you die well
if you screen early you might have another that amount of the journey to go
if it’s picked up through symptoms you have
amount of the journey to go it looks like you survived for an extra six years
but actually all you’ve done is get your cancer picked up six years earlier does
that make sense to people okay because this is one of the problems of the
cancer screening stuff you pick up a cancer earlier and your statistics on
cancer survival look fantastic but have you actually achieved anything in
overall survival so if your cancer appears through through symptoms then
0.68 of them will survive for five years and this is the difference therefore the
relative difference is 31% point zero zero six eight two point two zero zero
nine nine and the absolute difference is that which is the difference of point
zero zero nine nine two point zero six six 8 which is 0.03 one percent so
that’s where the figures do their thing so when someone says cancer screening
protects you against dying by X what were the absolute figures the absolute
figures are very very small so the differences are very small differences
in very small numbers and you get to the point where I lost track and obviously
got it wrong which is not unusual for me I must say it’s a very cool cats all
right look at this there was another study coming up showing Swedish study
found a 92 percent cure rate after smear diagnosis so if you had a smear and
cancer was picked up 92 percent survival versus 66 percent so people women
appeared to say in terminal bleeding there was a 66 percent cure rate for
symptoms based for symptoms based diagnosis remember cure means living for
five years it doesn’t actually mean you’re cured so what were the absolute
difference is when I had to look this up because these figures weren’t provided
and this was in Sweden and number two and a half million women eligible for
screening in that population the total number of deaths from cancer cervical
cancer in total was 176 the difference between regularly screened and not
screened or regularly screened was 35 and people who are right irregularly
screened or not screen tend to be women who live make more chaotic unhealthy
lives so they were not matched population so this difference may be
complete artifact but even if you believe that’s a real difference this
means there’s a 1 in 70,000 chance that that screening was benefits we’d have to
do 70,000 smears to get a potential and not definite benefit and yet this was
presented as an absolutely wonderful study of wonderfulness
and I thought you know I’m not sure if you look at the costs of that I mean if
you did just did a strict analysis doing a smear following up etc it would
probably cost you about $500 a time so we’re talking millions of dollars for
something that may not even exist yes William
and you should be as shocked as he is so the figures I’m hoping to give you some
idea of how the figures are manipulated here now I know that five minutes after
this you’ll think what was that thing again about absolute but you try and
look it up try and try and look at the data for yourself because it takes me
such a long time I need some help because every time I look at these
studies they look at a study like that cervical cancer screening took me I
think three weeks effectively just going through all the data the Swedish the
women alive between the ages of this at this time and it just takes forever so
it’s a use of confusing statistics which I like from Alice in Wonderland can you
do addition the Queen White Queen us what’s one on one and one and one and
one and one and one and one and one and one one I don’t know I can’t I lost
count that’s where we all are there’s these
people have got armies of statisticians putting this stuff together and then
there’s a little me sitting in my front of my computer thinking oh no another
study yeah I can’t it’s just ridiculous and the manipulations and statistics can
be very well hidden but they’re there and unfortunately they’re almost always
there is it downright lying and here’s the big one saving lives and other
nonsense heart protection study secondary prevention study again it was
presented as well the reduction in LDLs reduce the risk of death by 13% due to
reduction in death from vascular causes it was 18% no adverse effects on non
cardiovascular causes and it was presented again is an absolutely
magnificent thing this is the group from Oxford in this trial 10,000 people were
on a statin if now an extra 10 million high risk people worldwide went on to
statin treatment this would save 50,000 lives a year which they don’t might not
say as a thousand a week I think I could have worked that out if you look at it
some but I’m going to show you a graph in this graph
unfortunate I couldn’t get rid of – it wouldn’t let me take this 200 I
said 102 percent of people can’t be alive at the start of the year so unless
on this index 100 percent of people are always he alive at the start of this
trial otherwise it wouldn’t be in a match denis allows the trial went on
they there were deaths but of course this is 86 percent of people alive and
the full graph would go 10 people of the ground here so you can see that people
are gradually dying there are more people dying in a placebo arm than they
are dying in the simvastatin arm yes 9 at the end of five years ninety point
eight percent were alive on placebo 92.6% one alive on the statin the
difference was one point eight percent after five years which is naught point
three percent a year so that would be 36,000 lifesaver year for starters so
it’s not nearly 50,000 is it but what’s 14000 between you me and Sir Rory
Collins but when I look at this graph now the thing they do in oncology
studies is they say is min crease in median survival you’ve heard this
something here that’s caused by drawing a horizontal line say the 94% line there
and you can see that on the placebo arm 94% are dead after about three years how
long does it take for that same number of people to die on the symbol Saturn
all right well it takes about they’ll be about six months wouldn’t it so I’ve
expanded it out to make it more obvious it is around about that so I’ve drawn
you join you two lines here of when basically all the people more people who
are alive we’re now all dead alright because one thing is not going
to happen when you take a statin is you’re not going to become immortal I
know they say you are but you’re not and when they say life saved you say life
saves is a stupid thing to say because you’re not saving anybody’s life you may
be delaying their death that’s what you’re doing you’re not saving anything
you’re not preventing anything you are delaying something so in oncology they
agree that they say the increase in median survival is nine months a year
whatever it is okay you never get that in cardiovascular trials do you they
never tell you this what they do is they take the line this line vertically and
they say point ninety point eight versus ninety
one point whatever it is those lives have been safe that’s what they tell you
well that’s clear nonsense isn’t it because their lives have not been saved
what matters is how much longer are you going to live for
that’s why anyone takes a medication okay doc how much milonga would I get no
one asked that question of statins which is always interesting me but if you’re
on a cancer drugs they’ll say how much longer have I got why is there’s this
difference between cancer and cardiovascular disease it’s weird in a
way isn’t it this drug may give you six months extra life oh that’s not much
good is it I said well compared to a statin it’s bloody brilliant because if
we draw another way and that’s the average increase in survival right
that’s the thing they would do in county in in cancer studies isn’t it so what
you then do is you say okay so what does it come to so at one point eight percent
of those on the statin would live for around four months longer on average
that’s the difference in those two those two lines but the four months is only
for one point eight percent of the population so the average increases for
months times 0.01 eight so which is 110 twenty days times a 0.018
so that’s two point one seven days so that is how much longer you live okay
and that’s what you should be interested in if you’re taking a drug isn’t it in
fact I was going to publish this but somebody beat me to it and did it in the
what you’re saying you cannot save lives you can only delay death or extend life
you don’t know if you’ve been 1.8% the BMJ open did the study and said they
looked at the studies in primary prevention and secondary prevention was
that long enough follow-up death was postponed between minus five in other
words those people died five days earlier and 19 days in primary
prevention in between minus ten and twenty seven days and secondary
prevention trials the median postponement of death for primary and
secondary prevention trials was 3.2 and 4.1 days this is after five years of
treatment so basically you get slightly less than a day for a year of statin
treatment best possible scenario that’s the best sooner
so when people say to me oh my god your patients are all gonna die oh well maybe
they’ll die on Tuesday and said on Wednesday 2029 but maybe all that time
they spent going and picking up the statins and worrying about their
cholesterol and getting adverse effects from these drugs maybe they think it’s
worth not taking these bloody things these horrible poisons which do this
this is it all right 60% of people taking a statin 60% increase in type 2
diabetes 15 fold increase in amyotrophic lateral sclerosis did you know that
wrote a blog about this people came out recently 300 percent increase in the
risk of Parkinson’s disease these drugs are poisons of course
they’re poisons every driven every dog there’s poisonous they are some drugs
are more poisonous than others all right these ones are particularly on poison
and yet whatever you say statins cause adverse affects the entire community and
the other side goes off and one and then writes a 300 page review of the fact
there’s no adverse effects of statins there is a group called the cholesterol
treatment trial is collaboration there in Oxford they gathered all the data
from all the stats and trials together speak saying to the pharmaceutical
companies we will keep it all me won’t reveal anyone any because it’s come from
confidential when they’re asked to reveal the data on
drug related adverse events by many people have asked this do you know what
their answer was its secret its you can’t see it
data on serious adverse events you can’t see it it’s ours no one else can see it
the Cochrane Collaboration had a go they weren’t allowed to see it no one can see
it so they’ve got all the data in the girl they don’t cause adverse effects
and then when they were really pushed and I pushed him at a few other people
they then said well why should we don’t have this data but you’ve just written a
paper saying they don’t cause any adverse effects it’s all I’m just SIBO
effect nocebo being I believe in things gonna
cause me harm therefore the thing will cause me harm the opposite of the
placebo so we have a group who’ve gained 300
million pounds which is fine for it used to be 500 million dollars in funding
from the pharmaceutical industry primarily on cholesterol-lowering who
hold all the data who continuously tell everyone how wonderful these drugs are
and they won’t let anyone else see the data go figure
so you think maybe I feel a bit annoyed about this you’d be right it’s
absolutely extraordinary and just beyond belief frankly so I just finished with
the same statements again it’s just not possible to believe much of the clinical
research is published I see and then the case against science is straightforward
half of it simply aren’t true it should dismiss the poor quality of medical
research is widely acknowledged and we’re all having to deal with this we
have to do with this how can we deal with this what can we do gather our
pitchforks and go around the castle and demand that they come out where’s the
ogre what was it Shrek – you know they’re not
listening what will make them listen what can make them listen I I don’t I
just said don’t know what will happen is is the public are suddenly aware somehow
we can create enough awareness of this utterly desolate world that we live in
now I hate to use the word desolate I’ll I don’t believe any medical research I
read anymore not directly I just don’t I can’t and I look at a lot of medical
research as you may imagine and then I have this problem is well I believe this
is a good piece of research and how can I prove that for sure how do I know I
don’t I just I mean I kind of lost really but but the doctoring of data is
part of the game maybe you’ve seen some of this you’ll think I didn’t know any
of this and Jason talks about other things and
we’ve we’ve talked and discuss things it’s just what is the word terrible
awful dreadful I didn’t go into medicine for this I think I wanted medicine so
people would tell me to prescribe drugs that bugger people up
and don’t do any real good I didn’t that’s not why I did this I think going
to medicine some people would say oh tell all your people to eat high
carbohydrate diets and then anything all diabetes and go on insulin die and yet
if you stand up and try and say these things the Wikipedia does this to you
says you’re a cook you know quack you don’t know what you’re talking about
yeah well maybe I don’t know what talking maybe I’m wrong maybe all these
people are right maybe that’s the case maybe I’m just a deluded fool
maybe we’re all deluded fools sitting in these rooms and wondering what the hell
is going on but it but I don’t think so because because when I speak to these
other people I can see the shift in their eyes and they know that they’re
telling lies you know stunned go and look it up let’s
in there go to Google statins the the lipid soluble statins seem to be
worse they’re definitely worse for amyotrophic lateral sclerosis because
those across the blood-brain barrier you would think would be worse for damaging
the brain and that seems to be the case from some of the studies you know
remember 25 percent the drive weight of your brain is cholesterol sign apses are
made from cholesterol myelin sheaths contain vast amounts of cholesterol our
brains can’t work with that cholesterol we have special cells in the brain
called glial cells alga tender sites that make cholesterol and transfer it to
support and nurture the brain children who are born with low cholesterol
synthesis and a disease called Smithville Emmett’s opus Smith lemme
open syndrome are born with severe neurological deficit microcephaly truly
developed neurological systems and died very young cholesterol is absolutely
essential for our neurological system and yet and yet we’re told if you take
statins that they reduce the incidence of Alzheimer’s what this is another
manipulation they do they say oh look people take statins are less likely to
get Parkinson’s a multiple sclerosis and Alzheimer’s and everything yeah that’s
because all the studies that people taking the statins were the ones with a
higher cholesterol levels who were less likely to get these things anyway so the
new normos and huge bias is put into these things right from the start and
this is another game that they play is high cholesterol levels alright we did a
paper high cholesterol levels over the age of 50 the higher your cholesterol
level is the longer you will live and that’s true also for LDL and it’s also
true for cardiovascular disease I mean you can find these data you can put it
in a paper you can publish it no one can say you’re wrong because the data are
the data and yet everyone still says all my cholesterol is too high I don’t know
your cholesterol is not high enough so and the answer to that you can look
it up yourself I think it’s better if people do and then you can say well that
person was talking telling the truth if you like I mean there’s always a quarry
to this you’ll get a paper saying statins reduce the incidence of
Parkinson’s disease a permanent spot but you’ve got bear in mind that would be a
study where they would have just looked at people on statins and just said oh
look there’s lysosome of Parkinson’s disease and people not on status but
that’s the huge confounding bias is built into that study away from this
done and as I listened to all of the
speaker’s today I I continue to ask myself the question when will it finally
stopped and I don’t have the answer and I I find myself almost visualizing the
pre 2008 financial crisis I come from the banking industry as a profession for
many years I’ve retired from the industry now but there were
statisticians and there were people on the ground that were questioning what
was going on and it wasn’t until it crashed that federal regulations came in
there was no more money you know and it finally you can have a change and I
think anyone who’s applied for a mortgage or been involved in any sort of
financial instrument since that time sees that the process is different I
don’t think it’s 100% but I guess my larger question is like when will the
volume behind enough for it actually to to stop because we all know what’s going
on well isn’t it you know we have meetings like this people go away the
world changes one conversation at a time as I was told and people come and have
conversations and more conversations I mean I think the truth as I’ve always
said the truth is the good thing about the truth is that it can’t be killed
it’s immortal it’s there is to be found so you just keep have to keep stating it
and it it must it change I don’t know I suppose throughout history they’ve been
people who’ve lived through periods where nothing has changed maybe we just
have to say maybe it won’t change in my lifetime we’ve got one change in my
children’s lifetime you know just have to accept that that sometimes things
just the the forces of Mordor you know they’re the old seeing-eye and
all this that and we’re just we’re just little hobbits you know maybe we will
drop the ring into they might do more whatever but hopefully we will but you
know III all I say is my philosophy is if not you who if not now when when
people say why do you keep going I said well I suppose I have to cuz at the end
and people say you didn’t change anything he said well he’s the bloody
tried give me that I did try you know I didn’t give up
and therefore I suppose I can’t maybe I should get it done better maybe I should
have done more maybe I should have fired leveraged power I will be trying to find
levers to power more in the future maybe we should all do this and and try and
find that lever that finally flips the switch because at the moment it is a
difficult thing to know when it might when it when it might

12 Comments

  1. He makes a compelling case, when I checked some papers sure enough the Absolute Risk benefits are very small, who knew?

  2. You have taught us well to appreciate the difference between absolute and relative risk and how this can distort the impression of benefit from statins, but at 49min you state that statins increase the risk of diabetes by 60%, ALS by 15 fold and Parkinsons disease by 300% . So you are using relative risk figures (followed by an enigmatic pause for effect) to scare doctors off prescribing statins. Can we have the absolute risk figures for these side effects please

  3. they will say Statins and Vaccines are on the same category of not understood drugs: Just saw this Ann Marie Navas article from Duke University – they must be desesperados! . Had to find out on my own that if you take this [email protected]# it will deplete yourmost important nutrient CQ10 your heart needs!! So if you taking this, hurry to get Ubiquinol, complete E, omega 3 (yes, seen people get like zombies with this medication). Vitamin D3 and K2 (always together) and find a better cardiologist!! (and selenium too – statins deplete u from that too)

  4. Try this. Ask your doctor to explain any of the LDL or statin issues raised by Dr. Kendrick. First watch him/her squirm. Second watch the shift in the eyes. Third note the lack of any response. Dr. Kendrick is a rare physician. Wish I could find one like him, but this is a rare breed today. One who questions and thinks. We are all doomed, I fear.

  5. Came here straight from a Paul Saladino & Ali Nadir podcast to listen more about Malcom. I am astounded by what I just heard Malcom say about the Wikipedia thing. Further more I use that baseball example all the time almost weekly and have just watched this episode 1min 7 seconds. I guess he is about to ask how much does the ball cost!!! It is from Kahnemans book and I heard that MIT freshmen got it wrong 50%. I have not met a person in flesh who has given the correct answer just like that. I am biased since I read it printed and understood the mentalist side of the question. More, I was aware of the context of the question and thought slow for once. Do not think fast and Read Peter C. Gøtzsches book. Now back to the program…

  6. Dr Kendrick says he's never met a person who held a long-time belief who changed his mind He obviously never met Prof Tim Noakes who did change his mind and was pilloried for it. Just saying.

  7. Sorry to be pedantic but the condition is called "Berardinelli-Seip Lipodystrophy", not "Beradinelli-Siep lipodystrophy", as appears in the lecture. Thank you for an excellent presentation otherwise.

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