Showing posts sorted by relevance for query malhotra. Sort by date Show all posts
Showing posts sorted by relevance for query malhotra. Sort by date Show all posts

Saturday, 2 August 2014

Peer review in action

I mentioned in May that the British Medical Journal had issued corrections to two articles, one of which was written by Aseem Malhotra, and had also set up an expert panel to decide whether the articles should be retracted altogether. Malhotra article was about saturated fat, statins and heart disease. Malhotra portrayed the former as being largely irrelevant (indeed, he called sat fats 'protective') while portraying statins are virtually useless and frequently dangerous.

Sat fats have probably been wrongly demonised (sceptics have been saying this for decades despite the medical establishment's consensus) and statins are probably over-prescribed. Malhotra's basic conclusions were therefore fairly sensible by his standards but, as usual, he overcooked his argument by exaggerating and cherry-picking evidence. In particular, he relied on one weak, uncontrolled study to make the claim that 20 per cent of statin users experience 'unacceptable' side effects. This is what led to the BMJ's correction and investigation.

The panel has now decided that the article should not be retracted. This seems to me to be a reasonable decision. It was, after all, only an opinion piece. If journals retracted every article that cited a questionable piece of research there wouldn't be much left.

More interesting than the article itself is the correspondence that has been published in the course of the investigation. Malhotra's initial pitch the BMJ can be read here and the peer review comments can be read here. Both are illuminating. Here is his initial e-mail:

From: aseem malhotra
Date: Friday, September 27, 2013
Subject: Re: Request to peer review a column for the BMJ

To: Rebecca Coombes

Hi Rebecca, I am in the final stages of a potentially game changing and much needed piece busting the myth of saturated fat and heart disease. It is well referenced including a strong evidence base for why all calories are not the same and I also briefly question statins in primary prevention and provide an explanation why the evidence is weak for benefit here. This is something I have conceived and looked into for over a year now. I can and was planning to do it for the Observations column but it's close to 1600 words and thought it may be more suitable as a feature? But I don't know what your requirements/usual process is for feature pieces? I have a heads up that the WHO is going to announce a revision on dietary guidelines on sugar at the end of October and the Scientific advisory committee on nutrition is currently reviewing dietary guidelines on carbs. But I am not confident that they will be totally impartial as one of their lead scientists has recently been exposed as being on the pay roll of Coca Cola! I therefore ideally want to publish this in the next few weeks but if it is not something you see as viable for features then I would shorten it down and do it for Observations but just thought it was worth asking you first!

Best

AseemAseem

Firstly, note the title of the e-mail. It reveals that the BMJ had previously asked this guy to be a peer reviewer. Of what, we don't know, but let's hope it didn't have anything to do with diet, sugar or obesity, as Malhotra has a long track record of getting the facts hopelessly wrong. Malhotra's previous contributions to the BMJ had been generic rants about sugar and 'junk food' so it is odd that the journal should have considered him to have any particular expertise other than as a rank-and-file medic.

Secondly, note the delusions of grandeur ("game changing", "busting the myth"). Malhotra's 'myth-busting' is not news to anyone who is familiar with the literature, including the popular literature. James Lefanu, for example, explained it much better in The Rise and Fall of Modern Medicine (1999).

Thirdly, note the motivation for the article which Malhotra openly gives the BMJ. He's in a rush to get it published because he had a "heads up that the WHO is going to announce a revision on dietary guidelines on sugar at the end of October and the Scientific advisory committee on nutrition is currently reviewing dietary guidelines on carbs." The article is therefore explicitly policy-based, as he confirms a few days later once he has been passed on to the journal's deputy editor, Trevor Jackson.

Hi Trevor,
I also wanted to give you a heads up and check that it's ok that I'll be submitting an Observations piece in the next couple of days that I've been putting together for some time. I am just editing it down from 1600 words.

It essentially busts the myth of saturated fat and heart disease, why all calories are not the same and also seriously questions statins for primary prevention. It's provocative and timely with the SACN currently reviewing their advice on carbs but as Sarah Bosely has recently exposed a leading scientist on the board has been co-opted by Coca Cola. Don't worry there's nothing potentially libelous this time!

Potentially libelous? I wonder what the story is there.

I believe it will definitely trigger a debate.

I know this is very short notice but do you think there's possibly space time for next week's October 12th issue? It's partly because I think we'll be ahead of the game before the WHO make an announcement on sugar at the end of October but also I happen to be off next week in case the press are interested.

What is the BMJ's response to this? Do they tell Malhotra that they are a serious medical journal and will not be exploited by single-issue political campaigners? Do they tell him to quit it with the Coca-Cola conspiracy theory? (I think Malhotra must be referring to Ian MacDonald, a man who has forgotten more than Malhotra will ever know about the scientific evidence on sugar.)

They do not. Instead, they immediately commission the article which Malhotra sends over the following day. Jackson tells Malhotra that he "really likes it" and mentions that the editor-in-chief, Fiona Godlee, is "particularly interested in this subject".

So begins the peer review process, such as it is. The first potential reviewer doesn't want to do it, the second reviewer can't do it and so it ends up being reviewed by just one person, John Abramson. He agrees to do it on 11 October and by 15 October Malhotra is already starting to get impatient...

From: aseem malhotra  
Date: 15 October 2013 16:16 
Subject: Re: Statins and heart disease trends 
To: Trevor Jackson

Hi Trevor, 
Hope you're well! Am I correct in presuming you've not heard back from the reviewers yet? 

Best 
AseemAseem 


From: Trevor Jackson
Date: Wed, 16 Oct 2013 11:18:04

Subject: Re: Statins and heart disease trends

Dear Aseem

Yes, that's correct. One reviewer denied, one said he couldn't go it until November, but I am expecting the third ASAP. Today, I hope. I am keen to include your piece in 26 Sept [sic - he means 26 Oct.] issue, and there is plenty of time for that, but Fiona is keen that all pieces like yours are externally peer reviewed, and I agree with her.

Best wishes
Trevor

 
From: aseem malhotra  
Date: 16 October 2013 13:20 
Subject: Re: Statins and heart disease trends 
To: Trevor Jackson 

Thanks Trevor, I am also happy that the piece is peer reviewed also. Better not to give any ammunition to detractors with vested interests! 
Best Aseem


Despite waiting for the reviewer's comments, Malhotra immediately starts planning his media assault.

From: aseem malhotra  
Date: 17 October 2013 14:10 
Subject: Re: Statins and heart disease trends 
To: Trevor Jackson  

Hi Trevor, 

Just to let you know that BBC Breakfast have pencilled me in to discuss busting the myth of saturated fat/heart disease for next wednesday morning. I have taken the day off as annual leave. I hope that yourself and Emma will be happy to press release (I can chat to her directly as I know you've got plenty on your plate to do!) early next week if we don't get a response till Monday from the peer reviewer. 

I am sorry if I appear over indulgent but for such an interesting and important public health message it would be fantastic opportunity to spread the message and maximise impact.

After a poke from the BMJ, John Abramson sends his comments over and the BMJ forwards them to Malhotra, giving him the name of the reviewer. Abramson also knows the identity of the author (ie. it wasn't a blind, let alone a double-blind, peer review). Abramson has a much better grasp of the science than Malhotra but he was unlikely to be very critical of the article since he also believes that statins are heavily over-prescribed and have serious side effects. Nevertheless, he offers several suggestions and corrections, most of which Malhotra ignores. 

 Malhotra gets the comments at 10.11pm and sends the final draft to the BMJ at 5.14am the following day. He does nothing more than change one statistic and a handful of words. When Abramson describes one of Malhotra's assertions as "a stretch... a weak and tangential argument", Malhotra responds to the BMJ saying "Just his opinion - no change". Elsewhere, when Malhotra portrays a controversial theory as a fact, Abramson says "This is one theory about the mechanism of benefit, but certainly not proven" to which Malhotra simply replies "He agrees it's a theory - No change".

 Although Abramson makes some substantive criticisms, he does not pick up on the dodgy reference which led to the retraction that got Malhotra in hot water. This is not surprising. Remember that Malhotra's article was one of two papers from the October 26th issue to be flagged up with a correction and be investigated by an expert panel. Both articles claimed that 20 per cent of statin users suffered serious side effects and they both cited the same study. 

 And who was the lead author of the other study? Step forward John Abramson.

 So here we have two peer-reviewed articles, both of which have caused the BMJ some embarrassment. At least one of the articles was reviewed by the author of the other and by no one else. This reviewer was known by the BMJ to be someone who agreed with Malhotra's argument but even if he hadn't it would scarcely have mattered since the BMJ clearly doesn't expect its authors to take heed of what reviewers say anyway. Both Malhotra and the BMJ were more focused on having the articles rushed out so that they could influence policy and make a splash in the media. Which, of course, they did.

 Viva science.


Posted by Christopher Snowdon at 6:21 pm 3 comments

Friday, 29 September 2017

"Completely mad" - Action on Sugar on Aseem Malhotra

How crazy do you have to be to get kicked out of Action on Sugar? Let's find out.

I'm grateful to Blair Spowart for sharing some e-mails between Action on Sugar and Public Health England which he received under the Freedom of Information Act. If you recall how closely PHE works with the UK Temperance Alliance (AKA Institute of Alcohol Studies) you won't be surprised to hear that PHE and Action on Sugar have a cosy relationship and exchange many e-mails. PHE appear to be using them as outriders for their sugar reformulation programme and, for reasons that have never been adequately explained, Action on Sugar - a pressure group - are invited to the meetings between PHE and the food industry.

But the most amusing correspondence involves someone whose name has been redacted but is quite clearly Aseem Malhotra.

When AoS was launched in January 2014, Malhotra was the group's scientific director and he was the smug little face of the organisation. But his relationship with the group gradually faded and he has been written out of AoS's history.

As others have noted, Action on Sugar's claims were hysterical nonsense from the outset. It takes a special kind of pseudo-scientific bullshit to get excluded from such company but Malhotra managed it by going off the deep end. Despite being a cardiologist, he recommends that people eat lots of saturated fat and avoid statins. He also reckons that exercising doesn't help people lose weight.

AoS have never spoken publicly about their divorce from Malhotra, but the FOI e-mails reveal what they think of him. In March last year someone from Action on Sugar wrote to PHE's Alison Tedstone to reassure her that Malhotra had nothing to do with the group...


It's not clear what the trigger for these e-mails was. At the time, Malhotra was all over the media claiming that 'type 2 diabetes is a condition of carbohydrate intolerance' and getting in trouble for a flawed (and retracted) journal article about statins. But he was in the media for all sorts of reasons, none of which were scientifically robust, so it could have been anything.

Things got worse in May 2016 when Malhotra and his new low carb chums released a ridiculous report with the National Obesity Forum telling the public: ‘Eat fat to get slim, don’t fear fat, fat is your friend'. It was near-fatal for the National Obesity Forum's credibility. Various board members walked out and the organisation released a statement saying:

The rest of the Board of the NOF wish to make it completely and transparently clear that they were not given the opportunity to see the document, or give any input into it and some members opinions differ from those specifically presented in the document.

On May 23rd, with PHE openly describing Malhotra's advice as 'irresponsible', Action on Sugar contacted the agency again to confirm that they had nothing to do with him. They not only said that Malhotra's report was 'ridiculous' but also noted that he was 'completely mad' on the issue of statins. He or she expressed relief that Malhotra had 'at least given up saying that he is a Founder Member of Action on Sugar, which was completely untrue'.



In fact, Malhotra still describes himself as 'Founding member and advisor to campaign group Action on Sugar' on his hilarious website and it seems to me that Malhotra has a decent claim for saying he was a founding member. He was certainly a member when it was founded - indeed, he was its scientific director - but it is understandable that MacGregor and his AoS colleagues want to distance themselves from him. With his thirst for fame, he has gone too far even for his fellow zealots. It seems that Action on Sugar now agree with what I said about Malhotra way back in April 2012 when I first became aware of him and wrote a piece entitled 'Aseem Malhotra doesn't know what he's talking about'.

Four years later, on the very same day that AoS e-mailed PHE to call Malhotra 'mad', I asked on this blog 'Is this the end for Aseem Malhotra?' and predicted...

Within a year or two Malhotra will be earning his living selling diet books and delivering cherry-picked presentations to credulous low carb cultists on cruise ships. Mark my words. 

His diet book came out a few weeks ago. I'm not aware that he has done any work on a cruise ship yet, but he is on the low carb conference circuit so it can only be a matter of time.

Posted by Christopher Snowdon at 5:00 pm 0 comments

Monday, 17 March 2014

Hysterical anti-sugar campaigner complains about anti-sugar hysteria

In the Observer yesterday, Action on Sugar's scientific director, Aseem Malhotra, tried to strike a conciliatory note..

Our aim is to press the food industry into reducing added sugar in processed foods. We are not telling you – despite some of the screaming "sugar is toxic" headlines – that bananas and oranges are evil.


Where did all these irresponsible newspapers get the "screaming 'sugar is toxic' headlines" from? Step forward, Dr Aseem Malhotra...

Aseem Malhotra, October 2012: "There is mounting scientific evidence that not only is sugar toxic to the body..."
Aseem Malhotra, January 2013: "A paediatric endocrinologist, Prof Robert Lustig, has highlighted the toxic, addictive and appetite-driving properties of sugar."

Aseem Malhotra, February 2013: “It’s not only toxic to the liver but it increases the risk of Type 2 diabetes.”

Aseem Malhotra, March 2014: "Scientific studies reveal that the fructose component of added sugar is toxic..."

As for oranges and bananas being evil, no one is saying that, but since Malhotra thinks that "fructose is a poison", that would be his logical conclusion. Or it would be if he understood that fructose in the intrinsic sugar in fruit. Which he doesn't.



UPDATE

A few more examples of the good doctor definitely not encouraging people to believe that 'sugar is toxic'...




















Posted by Christopher Snowdon at 4:00 pm 0 comments

Sunday, 23 September 2018

The martyrdom of Aseem Malhotra

Aseem Malhotra's bid to become famous and sell his diet book protect the health of the nation has provided this blog with some hilarious content over the years, but he hits new heights of comedic gold in the Sunday Times today.

The low carb/LCHF movement to which Malhotra belongs is ultra-conspiratorial. Being essentially a cult based on magical thinking, it blames other people's failure to share their beliefs on a vast and growing network of corrupt scientists and government agencies. You might wonder what motivates so many scientists, dietitians and bureaucrats to hide the truth about killer carbs, thereby condemning millions of people to 'diabesity', but the answer is obvious: they're all in the pay of Big Food/Big Soda/Big Grain/Big Ag! Wake up sheeple.

Malhotra denounced the British Dietetic Association as Big Food puppets after they dissed his diet book. He has since added the British Heart Foundation and the American Heart Association to his list.


Now it's Public Health England's turn. In a barking mad op-ed for the Sunday Times, he claims that the quango is trying to silence him. 

For decades, powerful food companies have profited from promoting misleading health information and aggressively marketing junk food to children and the most vulnerable members of society. Public Health England is charged with help to protect and improve the nation’s health. My experience is that its officials undermine public debate and behave more like a front group for the processed food industry rather than an independent and trustworthy body that welcomes public debate.

Really?! To put it mildly, that is not my experience.

In an effort to combat the epidemic of health misinformation I co-wrote a book, The Pioppi Diet, which brings together the evidence on what individuals and policy-makers can do to rapidly improve health and reverse the twin epidemics of obesity and type 2 diabetes. I was pleasantly surprised when the deputy leader of the Labour Party, Tom Watson, contacted me a few months ago to let me know he had “relatively easily” lost 94lb and improved his health by specifically following the diet.

Good for him. By his own account, Watson 'basically stopped taking sugar, refined sugar, and then I started walking 10,000 steps a day and walking up staircases and when a bit more weight came off I started to jog and cycle.' You don't need to spend £8.99 on Malhotra's ludicrous book to know that a regime like that is going to lead to weight loss.

The most important message in the book — which recommends a Mediterranean-style diet low in refined carbohydrate — is how lifestyle changes are more powerful than any drug in preventing and treating heart disease; these also come without side effects.

A diet low in refined carbohydrate is not a Mediterranean diet and Malhotra's 'Pioppi diet' is not the diet of people who live in Pioppi. Malhotra's diet takes bits of the Mediterranean diet, removes the bread and pasta and adds in lashings of saturated fat and an assortment of his own bizarre LCHF recipes, such as boiled and eggs and soldiers with the soldiers replaced with bits of asparagus wrapped in bacon.

For inexplicable reasons, according to one prominent healthcare leader (who has asked not to be identified), Public Health England tried to “sabotage” the launch and press coverage of the book last year. I was told by one eminent doctor that he had been contacted by a senior official from the body and warned from attending the launch in London, to be held at the headquarters of Penguin Random House. To his credit, he did attend.

Another health leader, who heads a national charity, did not attend, and said he had been “poisoned” against the book. Andy Burnham, the mayor of Manchester and a former health secretary, endorsed the book and attended a launch in Manchester. His office also received a call from Public Health England, warning him against showing public support of the diet.

Assuming Malhotra isn't making this up to get attention (who knows?), it wouldn't be wholly surprising if one of PHE's many employees suggested to 'health leaders' that it might not be in their interests to be associated with a man whom even Action on Sugar regards as being 'completely mad' and who has a track record of embarrassing journals with his error-strewn articles. Public Health England has criticised Malhotra's version of the Atkins Diet in public. It stands to reason that they would also criticise it in private.

I was shocked by these attempts to try and undermine a healthy eating plan, to stifle debate and to damage my credibility.

"Credibility"

😂


Public Health England’s own recommendations for healthy eating — which are promoted by the Eatwell Plate, a diet guide backed by the Department of Health, which includes chocolate, crisps and cakes to eat “less often” — was drawn up in consultation with the food industry.

Firstly, the Eatwell Plate was replaced by the Eatwell Guide in 2016. You'd think a self-proclaimed expert would know that.

Secondly, I know of no evidence that the Eatwell Guide was drawn up 'in consultation with the food industry'. This claim seems to be based on a wafer-thin article by Malhotra's friend and fellow low carb zealot Zoe Harcombe. Harcombe claims that the Eatwell Guide 'was formulated by a group appointed by Public Health England, consisting primarily of members of the food and drink industry rather than independent experts.' She provides no evidence for this assertion. Public Health England says it commissioned experts from Oxford University to develop the Eatwell Guide. Indeed it did. Their work can be seen here. None of them report any relevant conflicts of interest.

Thirdly, you'd have to be on drugs to think that Public Health England encourages people to eat chocolate, crisps and cakes. Indeed, one of main differences between the old Eatwell Plate and the new Eatwell Guide is these foods were taken off the plate altogether because, as the British Nutrition Foundation explains...

Foods high in fat, salt and/or sugars, which previously featured in the purple section of the Eatwell plate, have been moved outside the main image.

This has been done to clarify consumer understanding of the role of these foods and drinks in the diet. They are not a necessary part of a healthy diet but such products can be included, although they should only be consumed infrequently and in small amounts.

Their inclusion in the guide may help consumers feel that moving towards such healthy guidelines is an achievable and realistic target.

The Eatwell Guide therefore recommends food that is entirely healthy, unless you are a low carb nutter who thinks that bread and rice cause diabetes. It doesn't say that sweet treats should never be consumed because that would be extreme and unrealistic, but it clearly doesn't endorse them.



Malhotra continues...

I have not seen any statements from the organisation’s health officials saying we should be eating less of the sort of ultra-processed food that now makes up half of the British diet. 

Has he been living in a cave for the last few years or does a high fat diet cause amnesia? How did he miss this, this and this, for example? Public Health England never stops haranguing people about sugar, snacks and processed food. 

Public Health England makes different dietary recommendations to the Pioppi diet. It recommends placing starchy carbohydrates, such as bread, pasta, rice and potatoes, at the base of the diet, and to reduce consumption of saturated fats.

Now we're getting down to brass tacks. Malhotra's problem with the Eatwell Guide isn't that it encourages people to eat 'ultra-processed food' (it doesn't) but that it encourages people to eat starchy carbohydrates, presumably because of the nefarious influence of Big Bread, Big Pasta, Big Rice and Big Potatoes.

The reason Public Health England - and every other health agency in the world - makes different dietary recommendations to the 'Pioppi diet' because the 'Pioppi Diet' is a load of unscientific, low carb toot created by an attention-seeking cardiologist whose slogan is 'fat is your friend'.

I have published evidence reviews showing no association between consumption of saturated fat and a heightened risk of cardiovascular disease, diabetes and death, but Public Health England doesn’t want to debate the issues.

Malhotra has never published anything resembling an evidence review. He writes comment pieces in which he references a few cherry-picked studies, such as this and this. That is not the same thing at all.

We want to trust government dietary guidelines, but Public Health England must give a clear commitment to systematic reviews of the evidence. It must stop engaging in dirty tricks to try and censor and silence those who want to engage in legitimate debate.

Far be it from me to defend Public Health England, but they have no more reason to engage in debate with a diet book salesman on the make than with any other random conspiracy theorist. They have already responded to his rubbish once, saying in 2016: 'In the face of all the evidence, calling for people to eat more fat, cut out carbs and ignore calories is irresponsible.'

What more is there to say? Scientific issues are not resolved by Public Health England debating with people. They are resolved through the accumulation of evidence in peer-reviewed journals. Malhotra has never conducted any primary research and has never published anything but op-eds in journals (usually the Z-list British Journal of Sports Medicine). It is quite possible to accept - as I do - that fears about saturated fat have been over-hyped without relying on a patently unreliable narrator like Malhotra to design a healthy diet.

Inevitably, Malhotra's response to PHE's criticism of his dietary theories was to accuse them of incompetence and corruption (see tweets below). It's his response to everything. Why would anyone want to engage in debate with such a person?





Posted by Christopher Snowdon at 4:07 pm 0 comments

Thursday, 15 May 2014

Aseem Malhotra's comeuppance

Well, well, well. Look who's in trouble...

Articles published by the British Medical Journal suggesting that statins may be harmful are to be investigated.

The journal will set up an expert panel to decide if it should retract two articles saying the cholesterol-reducing drugs had harmful side-effects.

The papers were criticised when they were published in October.

Statins are offered to seven million people in the UK who have a 20% chance of heart disease in the next decade.

The BMJ said Dr John Abramson from Harvard Medical School and UK cardiologist Dr Aseem Malhotra had already withdrawn statements from the articles after some figures proved to be incorrect.

The use of incorrect figures is Malhotra's calling card and the chickens are coming home to roost for Action on Sugar's scientific director. Longtime readers of this blog will fondly recall him from such posts as Aseem Malhotra doesn't know what he's talking about, Aseem Malhotra: Still clueless and Aseem Malhotra: quackery's buddy.

Errors were not picked up at the time by the journal's editors or the experts who peer-reviewed the work, the BMJ said.

Gosh, there's a shock.

The journal said Dr Abramson's paper cited data from an "uncontrolled observational study" and "incorrectly concluded" that statin side-effects occur in 18-20% of patients.

The same mistake was made by Dr Malhotra in the same edition of the BMJ and it is these statements that have been withdrawn, the journal said.

Malhotra has not only made this claim in the BMJ, he has said the same in the more widely read Daily Mail. And, as a practising cardiologist, he is in a position to practice what he preaches...

I often stop patients taking statins when I believe they are causing distressing side effects, which happens in about one in five of those I see... Last month the Annals Of Internal Medicine reported that 20 per cent of those on statins suffered a significant side effect

As I tweeted at the the time...



It remains to be seen whether the BMJ settles for withdrawing the specific errors or retracting the whole articles. The complaint about the journal's articles was made by Prof Rory Collins who said in March...

“It is a serious disservice to British and international medicine," he said, claiming that it was probably killing more people than had been harmed as a result of the paper on the MMR vaccine by Andrew Wakefield. “I would think the papers on statins are far worse in terms of the harm they have done.”

It's good to see Malhotra in the news for the right reasons at last.



Posted by Christopher Snowdon at 10:25 am 3 comments

Wednesday, 16 March 2022

The further decline of Aseem Malhotra

"I'm with stupid"

This blog is proud to be the first place where the dubious claims of Aseem Malhotra were picked apart. It is nearly a decade since I wrote a post with the prescient title Dr Aseem Malhotra doesn't know what he's talking about. Back then the Croydon cardiologist was all about 'demonising' junk food (his word) and he was already displaying a relaxed attitude towards facts.

He then transformed into an anti-sugar campaigner before being kicked out of Action on Sugar (where a former colleague described him as "completely mad"). His next move was to jump aboard the low carb gravy train where he was involved in a hostile takeover of the National Obesity Forum which soon led to the organisation's destruction. 

Meanwhile, he became a regular at Retraction Watch after filing a series of dodgy articles to academic journals. Editors had their hands full retrospectively correcting his errors and slurs. 
 
He has written several books, including the execrable Pioppi Diet and the hastily written 21 Day Immunity Plan to cash in on COVID-19 in 2020 ("a cheap, shoddily produced work, written by a cheap, shoddy man" - Anthony Warner). In 2017, the British Dietetic Association named his Pioppi Diet as one of the 'Top 5 Celeb Diets to Avoid in 2018'.
 
Malhotra does not take criticism well. He denounced the British Dietetic Association as Big Food puppets after they dissed his diet book. He then added the British Heart Foundation and the American Heart Association to his list. He claimed that Public Health England was in the pocket of the food industry.
 
As far I can tell, he no longer practises in the NHS, although he seems to do a bit of work for private healthcare companies and, inevitably, he now has a Patreon. Frankly, it's a wonder he's allowed to practise anywhere. His main contribution to the field of cardiology has been to tell people that exercise won't help them lose weight, they shouldn't take statins and they should eat more saturated fat (he was described as "irresponsible" by Public Health England for the latter advice.)
 
I have often asked what it would take for Malhotra to get struck off. That question has become more urgent in the last six months as he has become the Pied Piper of the anti-vaxxers. In November he went on GB News to misrepresent the findings of unpublished study abstract, pandering to those who think the Covid vaccines have created an epidemic of heart attacks. 
 
 
It is at this point that Malhotra stopped being a grifting buffoon and became a dangerous grifting buffoon. His Twitter account has become a sewer of anti-vax dogwhistles and yesterday he appeared on GB News to give his worthless opinion about the death of the great Shane Warne.
 
 
Being an arrogant sociopath, he couldn't resist starting his answer with a reference to what a great cricketer he was in his youth and how he could have played at the same level as Warne if he hadn't been attracted by the glamour of being a cardiologist in Croydon hospital. He goes on say, with zero evidence, that "the [Covid] vaccine may well have played a part" in Warne's death.

Shane Warne died in Thailand of a heart attack at the age of 52. His love of junk food and his yo-yo dieting were legendary. His obituary in the Economist begins as follows... 

If someone invited him to a fancy restaurant, Shane Warne could tell them there wasn’t much point. A white-bread cheese sandwich or a bag of chips was just as good for him. Spaghetti bolognese was as far as he went in the gourmet department. And there wasn’t much to beat those warm pies you could buy at stalls, the ones he could demolish in about 30 seconds, with that sauce that inevitably ran down his chin and dribbled all over his jacket.

He drank, too. Not only Castlemaine, Foster’s and other patriotic brews, but the pints he downed in England in his winter seasons, when he discovered pubs. Those really put the weight on. He smoked like a chimney, lighting up a fag as soon as the dawn broke. His credo was “Eat. Go. Party!”, and there were plenty of high jinks to keep the tabloids happy. “Two drinks and two girls later,” began a sentence in his autobiography, and it could have started dozens.

 
Warne was a prolific smoker and had suffered from COVID-19 twice, being seriously ill on the first occasion. At the time of his death, he was on an extreme two week liquid diet.

I'm not going to speculate on what, exactly, caused his heart attack, but there is no doubt that if Malhotra had been talking about this two years ago, he would have blamed his diet. Malhotra even blamed his own mother's death on "her regular consumption of starchy carbohydrates and ultra-processed snack foods of biscuits, crisps and chocolate" (everything is a media opportunity for him).

This is a guy who, in that article which first grabbed my attention ten years ago, claimed (falsely) that "diet-related diseases are responsible for 35 million deaths worldwide". A guy who made himself a laughing stock early in the pandemic with his infamous attack on doughnuts.


But when it comes to Shane Warne, all the lifestyle factors go out the window because he's found a new grift. "He had no risk factors," he says. And so - wink, wink - it may have been the vaccine.

Despicable.
 

UPDATE
 
Some details on Malhotra's school cricketing career.



Posted by Christopher Snowdon at 12:09 pm 0 comments

Saturday, 11 January 2014

Action on Sugar

This week saw Consensus Action on Salt and Health (CASH) morph into Action on Sugar. Perhaps this was a recognition that the panic over salt "has little basis in science" and the real money now lies in the anti-sugar crusade. In a few years they will be called Action on Cheese.

CASH's abrupt change of direction has meant that we have been able to watch campaigners switch between bandwagons in real time. The screenshot below shows the CASH website at that awkward halfway house between the salt shaker and the sugar bowl




Fortunately for Action on Sugar, their new enemy is also a white crystal so they can keep most of their images. All they need is a web designer to delete the word 'salt' and replace it with 'sugar'.

As I mentioned on Wednesday, Action on Sugar got proceedings underway with a frenzied media blitz that revolved around their claim that "sugar is the new tobacco". Within 24 hours, scientists were lining up to criticise this absurd hyperbole—calling it "nuts", "inaccurate" and "quite crazy"—but the damage had been done and Aseem Malhotra (for it is he) had got his smug little face on television countless times.

Malhotra is Action on Sugar's Science Director. Says it all, really. As Slipp Digby notes in a must-read post that fisks the group's erroneous claims, "appointing him as Science Director when he has no experience in the field and has published no research is a really bad idea."

It has been less than three years since Malhotra burst onto the scene. I had him down as a know-nothing wannabe celebrity on the make from his very first Observer articles. He made incredible schoolboy errors on very basic facts from the outset, although it is interesting to note that his early articles about Big Food did not mention sugar and his ideas appeared to have evolved by reading sensationalist anti-sugar books and becoming a disciple of Robert Lustig.

Lustig's theories focus on High Fructose Corn Syrup, which he thinks is the primary cause of obesity in the USA. This has no relevance to the UK because there is hardly any High Fructose Corn Syrup in the EU (as usual, Malhotra seems to be unaware of this fact). Lustig might have a point or he might not, but at least he is a scientist who has put forward a testable hypothesis. Malhotra is not a scientist, he is a medic, and whilst that is enough for him to play the 'trust me, I'm a doctor' card, he is a prime example of why trusting medics on issues that are outside their immediate field of competence ends in tears.

If you don't believe me, take a look at this interview with him on Sky News this week.



Let's leave aside his usual claim that sugar has "no nutritional value whatsoever". People don't drink Coca-Cola because they think it's nutritious, they drink it because they like it. Let's also leave aside his claim that "poor diet is responsible for more disease than smoking, alcohol and physical inactivity combined" because I've written about that little fib before.

Instead, let's look at this nugget:

"Even if you are of normal weight and you have excess sugar in your diet, and you exercise, you are still increasing your risk potentially of getting Type 2 diabetes".

What Malhotra has done here is mangle the results from a controversial and tentative study by Robert Lustig (there's a good discussion about it here) that found that sugar availability correlates with diabetes. That is not terribly surprising, perhaps, and it is even less surprising that obesity correlates with diabetes.

The obvious explanation for both these findings is that excessive sugar consumption can lead to obesity and obesity can lead to diabetes. However, Lustig suggests that sugar consumption may have an effect on diabetes that is independent of its effect on obesity. In other words, he hypothesises that sugar consumption adds to diabetes risk of being obese. Whilst that is not impossible, the evidence he has presented so far is far from compelling.  That's only my opinion, but it also happens to be the opinion of Diabetes UK, who put out a statement in response to Action on Sugar's media blitz.

“... it is important to be clear that we want to reduce sugar consumption because having too much can easily lead to weight gain, as is true with foods high in fat. So reducing the amount of sugar in our diets is not all that we need to do to reduce our risk of Type 2 diabetes.

"The evidence that sugar has a specific further role in causing Type 2 diabetes, other than by increasing our weight, is not clear. We look forward to the conclusions of the Scientific Advisory Committee on Nutrition, which is due to report this year.”


Malhotra presents Lustig's theory as if it were proven fact and then further embellishes it by asserting that slim, physically active people are at greater risk of developing diabetes if they consume sugar. This goes beyond even Lustig's theory and enters the realm of outright quackery.

And then there is this gob-smacking comment...

"Intrinsic sugars within food like fruit and vegetables: not a problem, that's glucose. But what added sugar has is fructose and that is completely unnecessary in your diet."

Malhotra has fallen for the naturalistic fallacy, implying that "intrinsic sugars" are healthy because they are "natural" whereas added sugars are not. In fact, there is no reason to think that 200 calories from a smoothie are any less fattening than 200 calories from a Coke.

More incredibly, Malhotra thinks that glucose is the main sugar in fruit. Of course it isn't. Fructose is the main "intrinsic" sugar in most fruit (and some vegetables), hence the word fructose.



This howler of Malhotra's is equivalent to a temperance campaigner thinking that beer is stronger than whisky. It is like an anti-smoking campaigner not knowing the difference between a pipe and a cigarette. It does not bode well for Action on Sugar that their Science Director doesn't have even a GCSE-level understanding of the subject about which he claims to be an expert.

I foresee entertaining times ahead.

Posted by Christopher Snowdon at 5:54 pm 8 comments

Thursday, 14 May 2015

Aseem Malhotra screws up again

Our old friend Aseem Malhotra is starting to become a regular at Retraction Watch. A year after sparking an investigation at the British Medical Journal, Malhotra found himself in hot water with the British Journal of Sports Medicine.

You almost certainly heard about Malhotra's article in the BJSM attacking the 'myth' that exercise helps people lose weight. This risible claim was broadcast around the world. What you probably did not hear is that the article was taken offline within 48 hours and only reappeared last week.

Why was it suspended? Any number of factual inaccuracies could have been responsible (see here for an example), but rumour had it that undisclosed conflicts of interest were the main reason. As I mentioned at the time, Malhotra's co-authors are neck deep in the low-carb/Atkins/banting diet and one of them has a book to sell. This is a fairly mild competing interest, but it is typical of a BMJ publication to be more concerned about an author receiving an indirect financial benefit than about his article being truthful.

The competing interest was not the only reason, however. The article has been subtly altered and the following notice has been added...

Correction notice This article has been amended from the original published on 29th April 2015. The body of the text was slightly edited and a reference removed. Competing interests have been added.

The edited part looked like this in the original...



It now looks like this...




As you can see, the journal has removed the part about the tobacco industry "buying the loyalty of bent scientists". This is important because the paragraph in question accuses the food industry of using "tactics chillingly similar to those of big tobacco."

And, in case anybody was in any doubt that Malhotra et al. are accusing the food industry of hiring 'bent scientists', reference 5 (which has now also been removed) was 'Sugar: spinning a web of influence' by Jonathan Gornall. I wrote about Gornall's article (which was published in the BMJ) a few months ago.

A theme is emerging in his hatchet jobs. First, he takes a policy which is controversial with the public but which has legitimate arguments for and against. He then treats the policy as a no-brainer which could only possibly be opposed by vested interests. He then looks for any kind of funding from business to civil society and the public sector; if he cannot find any he implies that it exists. Finally, he pads out his articles with quotes from activists and presents their failure to persuade government to bring in the controversial policy as being the result of 'webs of influence'.
Last year it was minimum pricing with the Alcohol Health Alliance. This time it's food reformulation with Action on Sugar.

Gornall's articles for the BMJ have all been of a very low quality and the journal embarrassed itself by publishing the sugar article, in particular. Gornall failed to understand that collaborations between the government and the food industry are not a dirty secret. On the contrary, they are the norm, and everybody who works in the field understands this.

The great and the good of 'public health' nutrition lined up in the Rapid Responses to attack the article. Prof Barry Popkin described it as "not only naïve but misguided" and said that Dr Susan Jebb, who bore the brunt of Gornall's poison pen, was "quite incorrectly impugned". The Chief Executive of the Medical Research Council said "please add my name to your 'tangled web'. It would be an honour to stand alongside scientists such as Susan Jebb, Ann Prentice and Ian Macdonald, who are committed to improving public health through research." It's worth reading the Rapid Responses in full.

This should have been enough for the BMJ to end its association with Gornall but I understand that he is currently carrying out more "research" for the journal. Even Gornall, however, did not describe Susan Jebb, Ian MacDonald et al. as "bent scientists". By using that phrase and citing Gornall's article as proof, Malhotra and his chums came very close to doing so. In the eyes of the libel lawyers, they may actually have done so, hence the retraction and correction.

Here we have two people—Malhotra and Gornall—who should not be allowed within a hundred miles of a medical journal publishing utter tripe, with one referencing the other. This Laurel and Hardy act would be quite amusing if it didn't push, and indeed exceed, the boundaries of what can be printed in a serious magazine. As I have shown time and again on this blog, Malhotra writes down the first thing that comes into his head. He is extremely credulous and not terribly bright. This is the second time in twelve months that he has got a journal into trouble, despite the fact that he rarely writes for journals. How many more chances is he going to be given?

Posted by Christopher Snowdon at 3:21 pm 0 comments

Monday, 19 July 2021

The Pioppi Diet is a superficial lifestyle guide based on distorted evidence

First published by Spectator Health in July 2017

Pioppi is a very small village in southern Italy. It is one of those places where people are reputed to live much longer than average (the authors claim life expectancy is 89 years but do not provide a citation for this claim). The gimmick behind this book is that the authors have travelled to the village, bottled its secrets and are prepared to sell them to you for a small fee.

Since the authors are both advocates of the low carb, high fat (LCHF) regime, everything is seen through the prism of the Atkins diet. They are Aseem Malhotra (a cardiologist, as he never tires of reminding you) and Donal O’Neill (director of internet-only, anti-carbohydrate movies such as Cereal Killers and Run on Fat).

In some respects, Pioppi is a surprising place to find this low carb duo as it was the home of the scientist Ancel Keys who died in 2004 at the age of 100. It was Keys who drew the world’s attention to the villagers’ longevity when he was conducting research into nutrition in the mid-twentieth century. That research helped to create the evidence that linked saturated fat to heart disease, and low carb activists have spent years portraying him as a crackpot and a bully who was probably in the pay of Big Sugar and who definitely blackmailed the scientific community into unfairly ‘demonising’ saturated fat. As a result of his junk science, they say, governments around the world changed their dietary guidelines to encourage the consumption of carbohydrates at the expense of life-saving lard. The general public, slavishly following government advice as always, took this as a green light to stuff their faces with sugar and soon became obese.

It’s a bizarre and ahistorical conspiracy theory which, as Anthony Warner says in The Angry Chef would require ‘paying off the medical establishment, the World Health Organisation, numerous charities, public health bodies and nutrition researchers around the world, and keep producing systematic reviews that show links between consumption of saturated fats and increased risk of heart disease.’ The idea that millions of people have been killed by guidelines which (a) were never followed, and (b) clearly discouraged sugar consumption, is one of the strangest memes in the world of nutritional woo.

Pioppi is at the very centre of the nutritional orthodoxy. Not only did Ancel Keys live there for many years, but it is recognised by UNESCO as the home of the Mediterranean Diet. In a sense, The Pioppi Diet is an attempt to erase the legacy of Keys and reclaim the village for the one true faith of LCHF. Keys attributed the Pioppi residents’ low rates of heart disease to the relative scarcity of saturated fat in the Mediterranean diet, but as far as Malhotra and O’Neill are concerned, saturated fat has been exonerated and their job is to discover what is really going on there.

Reading between the lines of The Pioppi Diet, it’s reasonably obvious what’s going on. It’s a rural farming and fishing community of 200 people who are engaged in manual labour from a young age and remain physically active throughout their lives. The air is clean and the local diet is dominated by fruit, vegetables, fish, pasta, olive oil and wine. The villagers have traditionally been too poor to eat a lot of red meat. Indeed, they have been too poor to eat a lot of anything, hence the low rate of obesity and its associated diseases.

The longevity of the Pioppi people is therefore entirely consistent with mainstream science and yet it forms the backdrop to a book which tells the reader to be ‘prepared for everything you know and believe to be true to be turned on its head’. But it is only a backdrop, a blank screen onto which they project whatever thoughts come to mind. They visit the village but do not conduct any research there. Instead, they stroll around drinking coffee, admiring the noble peasants and making sagelike comments such as ‘There’s not much sign of stress around here, Aseem.’

The first half of the book sees them take it in turns to crowbar in all the LCHF articles of faith: physical activity won’t help you lose weight, saturated fat is good for you, cholesterol is nothing to worry about, sugar is a poison, a calorie is not a calorie, etc. I have neither the time nor inclination to fact-check all of their claims so I will allow for the possibility that they might be right from time to time. I am quite prepared to believe that the dangers of saturated fat have been overstated; better qualified people than Malhotra and O’Neill have been critical of the evidence for years. But whenever they touch on a topic with which I am familiar, I noticed that their discussion of evidence was partial and one-sided, and sometimes totally incorrect. On the occasions when I felt moved to follow up their (rather patchy) references, I nearly always found that there was less to them than meets the eye.

For example, Malhotra cites the PREDIMED study, a well-regarded piece of research which appeared to show significant benefits from the consumption of nuts and olive oil. But it did not, as Malhotra claims, show the superiority of a high-fat diet over a low-fat diet; such a hypothesis was never raised nor tested. He also cites the Lyon Diet Heart Study as evidence that ‘the standard American Heart Association recommended “low-fat diet”‘ causes more heart attacks than the Mediterranean Diet. The study does indeed show benefits from the Mediterranean Diet, but it is only by reading the study that you would see that the Mediterranean Diet was lower in both total fats and saturated fats than the ‘standard’ diet.

Some of the errors in the book are risible, such as when they claim that in ‘industrialised countries between 5 and 10 per cent of GDP is spent treating dental disease’ (the entire NHS budget takes up 9 per cent of GDP). Others are just sloppy, such as when they use a graphic from a newspaper to prove that poor diets cause 35 per cent of deaths (they don’t). Nearly all of them are consistent with a systematic bias towards a desired conclusion.

The reader should not have to look up the references in a book to find out what is being concealed. The nutritional epidemiology literature is enormous. Thousands of studies have been conducted and they do not all agree with one another. If one ignores the totality of the evidence and cherry-picks a handful of studies, it is possible to argue almost anything. If the reader cannot trust the author to play with a straight bat, he might as well save his money and go on a Google binge.

Take the chapter on sugar, for instance. The scientific consensus says that obesity is a risk factor for diabetes. Insofar as there is a link between sugar and diabetes, it is the same as the link between cheese and diabetes, ie. if you eat to much of it, you will become obese and therefore be at greater risk of diabetes. It is indirect.

A handful of dissenters claim that there is a direct link and that sugar can cause diabetes even in the absence of obesity. The most famous of them is Robert Lustig, a Californian endocrinologist who has views on sugar that are extreme by any standard. He has made various wild claims about sugar being ‘toxic’ and ‘addictive’. He calls it ‘the alcohol of the child’. Amongst other strange assertions, he has said that breast milk is not sweet and that pasta was invented in America. His published research on sugar is, in my view, third rate and I don’t think anybody should take him too seriously. But he is on the low carb bandwagon and is one of Malhotra’s chums. Consequently, while the chapter on sugar only references five studies, four of them are by Lustig and his colleagues, although this is not obvious from the text.

Even if the scientific consensus is wrong and Lustig turns out to be a sort of Galileo, shouldn’t Malhotra at least acknowledge the totality of the evidence, even if only to argue against it? And if there is an independent association between sugar and diabetes, why do organisations that want people to eat less sugar – such as SACN and Diabetes UK – continue to deny it? Is everybody in the pay of Big Sugar?

Malhotra’s credentials as a cardiologist are not sufficient to persuade me to ignore so many scientists. He says himself that ‘the majority of doctors are not equipped with even basic training to give specific, evidence-based lifestyle advice’ and admits that he doesn’t recall receiving ‘a single lecture at medical school on the impact of nutrition and lifestyle on preventing and treating disease’. All of his conclusions, he says, are based on ‘my own research’. But there are experts in this field who have received ample training and have been given many lectures on nutrition. They are called dieticians, and I have yet to meet one who endorses Malhotra’s message.

It soon becomes clear that The Pioppi Diet is not a serious review of the evidence. It provides a distorted and superficial account of a tiny fraction of the evidence. It does not really attempt to overturn the scientific consensus, it simply ignores it. Meanwhile, it devotes page after page to a handful of low carb activists who are portrayed as world-leading authorities, such as Zoe Harcombe, Tim Noakes, Nina Teicholz, Jason Fung and Robert Lustig. While all these people have books to sell, Malhotra and O’Neill accuse ‘many scientists and doctors’, as well as the media, of being ‘under the financial influence of the food and pharmaceutical industry’. This, we are told, is why they ‘disseminate selected, biased and outdated information’. When your best evidence is a single study from 1956 which has never been replicated, this is a bit rich.

So what is this Pioppi Diet that promises a ‘life-changing journey taking just 21 days’? The first thing to understand is that it is not a diet, it is a lifestyle. From wandering around Pioppi, Malhotra and O’Neill come to the profound conclusion that it is important to socialise with friends, take plenty of exercise, be relaxed and get some sleep. They can’t help you with socialising or stress relief, but they suggest you get at least seven hours sleep (which is also what the National Sleep Foundation recommends). With regards to exercise, O’Neill spends several pages waxing lyrical about high intensity interval training, but is forced to admit that they don’t do that kind of thing in Pioppi and so recommends getting up from your desk every 45 minutes to stretch your legs.

So much for the lifestyle. What about the food? Malhotra and O’Neill recommend that you avoid desserts, all sugars (including fruit juice and honey) and many of the most common sources of calories, including bread, rice, pasta, cereals, potatoes, noodles, couscous and ‘anything flour based’. You should also fast for 24 hours once a week and think about skipping breakfast every day (because the authors were told that Pioppi people used to be so poor that they sometimes went to work hungry). If you do all this, plus lots of walking and go to the gym five times a week (as Malhotra does) or engage in regular high intensity training (as O’Neill does), they reckon you will lose weight. And do you know what? I think they might be right. Behold the miracle of the Pioppi Diet!

The trouble with this whole concept is that Malhotra and O’Neill’s interpretation of the Pioppi Diet does not reflect what the people of Pioppi eat. It is basically an ultra-low carb version of the Mediterranean Diet with a few trendy ingredients, such as coconut oil, thrown in. Coconuts have never been part of the Italian diet and nor have ‘full-fat fermented dairy products’ but the authors include the latter anyway because – as they say – ‘the Greek cohort in Ancel Keys’s original studies enjoyed [them] … so there is no reason we shouldn’t be doing likewise!’

Do you know what the people of Pioppi actually eat? Processed carbohydrates. Farm workers in rural Italy do not – could not – survive on a diet of fish and seasonal vegetables. Pasta is as central to the Italian diet as potatoes are to Britain’s. So too is bread. This is the elephant in the room for anyone trying to pretend that Italians eat a low carb diet. As a 94 year old Pioppi resident said last year: ‘Pasta is my favourite food. I don’t understand why so many people try to cut that and bread out of their diets – it is like medicine for the heart and it is silly not to eat it.’

Once you accept that pasta and bread are important elements of Mediterranean cuisine, the actual Pioppi diet involves lots of fruit, vegetables, fish, starchy carbohydrates, mushrooms, nuts and eggs, but little or no cake, biscuits, processed meat, crisps and red meat. In other words, it is the UK government’s Eatwell Guide with extra virgin olive oil. Maybe those official dietary guidelines are not so deadly after all?




Posted by Christopher Snowdon at 11:15 am 0 comments
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