By Rob Verkerk PhD, founder, scientific and executive director

‘Fake news’ and ‘deniers’ are two terms we now hear every day. They’ve largely replaced the term ‘conspiracy theorist’ that was long used as a smokescreen intended to stop people distinguishing those who had no evidence of conspiracy, say between governments and corporations, as compared with those whose evidence would be better ignored by the establishment as and when it was advantageous for the conspirators. No surprise this is generally at the public’s or the natural environment’s expense. Did you ever meet a ‘conspiracy theorist’ who was subsequently revered as a ‘conspiracy realist’? This dilemma was something that occupied the mind of our late friend, Liam Scheff, who wrote about it in his 2012 book ‘Official Stories: Counter-Arguments for a Culture in Need’.

Now the vocabulary has changed. Climate deniers were the first to get the new tag. Given the science for human-induced climate change is now so persuasive, it’s increasingly hard for the public to take seriously those who believe either that the current climate change events are normal or that human activity has played no role in contributing to them. Let’s of course not confuse recognition of the problem (climate change) with the validity or otherwise of proposed solutions (e.g. natural gas fracking vs renewable energy sources).

So on the subject of climate change, the deniers - most would agree - got it wrong. So why not apply this negative label to those who deny that drugs are a necessity in overcoming major contemporary health challenges like heart disease, cancer, type 2 diabetes and obesity? Well that’s just what’s happened.

Three of the big areas where ‘deniers’ are now being singled out and discredited on the basis of being deniers of mainstream health policy are:

1. Statin deniers – those who suggest that prophylactic prescription of statins to the over-50s, regardless of their risk of heart disease, is neither the most effective nor the least harmful way of reducing heart disease deaths and related illness. They also generally claim that the science underpinning prescription of statins to 8 million Britons is non-transparent and that side-effects (e.g. muscle pain, new-onset diabetes, fatigue, loss of libido) from statins are under-emphasised by prescribers. The attacks on these deniers become more intense when such statin deniers also propose a dietary solution that opposes current government eating guidelines, notably being ‘low carbohydrate’ or ‘low carb high fat’ (LCHF)
2. Diet-Heart-Cholesterol Hypothesis deniers – these are closely related to the above category of denier. Such deniers challenge the hypothesis proposing that lowering levels of circulating cholesterol (e.g. by taking statins or substituting saturated fats with polyunsaturated fats rich in linoleic acid) does not cause a reduction in risk of heart disease.
3. High carb deniers – governments and even the latest international assessment by EAT-Lancet propose that 50-60% of all dietary energy consumed per day should come from carbohydrates. The ‘low carb community’, including a rapidly growing group of doctors, other clinicians and members of the public who have generated evidence, witnessed many cases of reversal of obesity and type 2 diabetes among patients by drastically lowering carbohydrates intake, or experienced it themselves, are portrayed as issuers of fake news. That is regardless of the quality or volume of evidence provided. Lack of proper scientific engagement or debate by the accusers characterizes most of the attacks on the deniers.

The current crop of statin, cholesterol hypothesis and high carb deniers are not left-field, anti-establishment people who live on the margins of society. They are high profile doctors or scientists who were until recently widely revered, particularly for publicising the risks with over-consumptions of sugar.

Mail on Sunday attack on 'statin deniers'

In the UK, two doctors and one PhD obesity researcher have found themselves accused of being ‘statin deniers’ in a “devastating investigation” by Britain’s Mail on Sunday. The targets were Dr Aseem Malhotra (cardiologist), Dr Malcolm Kendrick (GP) and Zöe Harcombe PhD (researcher).

So what do they have in common?

The named individuals all fit comfortably into all three of the above categories (as we do at ANH-Intl). They have all condemned existing government dietary guidelines. They all propose that there is no plausible evidence in support of the diet-heart-cholesterol hypothesis, which proposes that heart attack and stroke rates can be lowered significantly by reducing levels of cholesterol in the blood irrespective of heart disease risk. They’ve all published their views both within and outside the rarified environment of peer reviewed academic journals. They’ve all written books that have become bestsellers that encourage people to use dietary change – not drugs – to deal with preventable diseases such as most forms of heart disease, obesity and diabetes.

But perhaps most significantly, they all have written or spoken out on the subject of statins being heavily oversold to the public without sufficient information being given to patients to make informed choices.

The Mail on Sunday included quotes from high level influencers, including none other than the UK Secretary of State Matt Hancock MP, claiming that the views of Malhotra, Kendrick and Harcombe were “pernicious lies”, "conspiracy theory", “reckless and ignorant misinformation”, and that “fake news about statins may have prompted 200,000 patients in Britain alone to quit the drug over a single six-month period – and thousands of heart attacks and strokes may occur as a result”. Such is the underhand nature of the Mail on Sunday’s smear campaign, Aseem Malhotra revealed in an interview on Talk Radio with Eamonn Holmes that Matt Hancock told him earlier this week he had no idea that Dr Maholtra was going to be one of the named doctors. One wonders who the Health Minister thought was going to be smeared…

During Holmes’ interview with Dr Malhotra, Holmes also revealed, clearly unexpectedly, a startling improvement in his health after coming off statins. #Oopsie-daisy!

As their messages continue to influence more and more people, ‘the establishment’ has seen fit to try to discredit these messengers and whistleblowers. The conspiracy, it seems, must be protected at all costs. It’s never easy to isolate individuals who are responsible for the discrediting efforts. Obviously the newspaper or news channel that carries the story is just the tip of the iceberg.

In this case, there is no consistent trend - and appears that the Mail on Sunday smear campaign was specifically orchestrated through its journalist, and the thrust runs in complete contrast with many articles disclosing concerns about statins published in the Daily Mail, including one published today, and another in December 2018.

Prof Rory Collins, the controversial, long-standing pro-statin academic ringleader from Oxford University, definitely means business too, having pulled the MMR/Andrew Wakefield ‘tainting card’ claiming in the Mail on Sunday that, “in terms of death and disability that could have been prevented, this could be far worse than we saw with MMR.”

The editors sought to use type fonts and imagery that positioned the words "...MMR scare" directly over the image of "Denier Three", Dr Malhotra. Balanced in very large font above Mail on Sunday Health Editor Barney Calman's piece were the words: "There is a special place in hell for the doctors who claim statins don't work".

The three 'deniers' who had previously exchanged information freely with Barney Calman were given notice that their positions were going to be challenged by the Mail on Sunday and were given less than 24 hours to respond. Zoe Harcombe has published the letter received along with her responses on her website.  

Two conclusions can be drawn: there was no attempt by the Mail on Sunday to deliver balanced journalism and all efforts were directed at creating the biggest possible smear. 

Exposing the rot

Former editors of the New England Journal of Medicine and British Medical Journal, Drs Marcia Angell and Richard Smith respectively, were amongst the first to expose Big Pharma-induced rot well over a decade ago. It was laid out clearly, as you would expect from journal editors, in their respective books, “The Truth about the Drug Companies: How They Deceive Us and What To Do About It” (2005) and “The Trouble with Medical Journals” (2006).

The extraordinary thing is that the rot’s still very much there and the witch hunts targeting those who dare speak out are, if anything, ramping up. Dr Peter Gøtzsche recently got expelled from Cochrane, the medical evidence curation service that he co-founded, because he dared to voice views the establishment didn’t like.   

Google, Facebook, Wikipedia and other digital giants are censoring content that doesn’t concur with the mainstream view.

Attempts to censor the views of diet-heart-cholesterol hypothesis 'deniers' have been in operation for a few years, as shown in a blog by Zoë Harcombe from 2014. Oxford University’s pro-statin ringleader, Prof Rory Collins, told the Guardian back then that the deniers “eroded public confidence”. He could have as easily claimed that the deniers eroded pharma profits or his research funding.

But this latest assault by the Mail on Sunday ups the ante. Barney Calman seemed intent to broaden the smear beyond the named “trio”. He also fingered “Dr John Abramson at Harvard, author of the misleading ‘20 per cent side effect’ BMJ study; Joseph Mercola, a discredited anti-medicine campaigner who claims to have millions of website views a day; [and] Dr Uffe Ravnskov in Denmark, founder of The International Network of Cholesterol Skeptics, and others.”

Knowing the victims of his smear attack are unlikely to remain silent, Calman quipped, “Don’t doubt that our investigation will be giving them fuel for their crackpot conspiracy theories for months to come.”

Dr Malhotra and Zoë Harcombe PhD speak their minds in Westminster

The Mail on Sunday attack came just 5 days after Dr Malhotra and Zoë Harcombe presented to the All Party Parliamentary Group on Diabetes in the UK Houses of Parliament in Westminster. Check out their presentations, ably recorded by Ivor Cummins, aka the 'Fat Emperor'.

Complexity as a device

One of the underlying challenges that faces anyone, regardless of which side of the fence they reside, is uncertainty in the science. This uncertainty provides the perfect basis to confuse and mislead the public. 

Barney Calman found it in him to write in his Mail on Sunday piece “To paraphrase Donald Tusk, there is a special place in hell for the statins deniers who continue to fuel public confusion and a vague perception that the drugs…. ‘don’t really work.’” That would seem to imply to readers that the position of Rory Collins’ and the other ‘cholesterol triallists’ is 100% correct, and that Harcombe, Malhotra and Kendrick's position is 100% fake. Well, if you want fake news – that’s fake!

We’ll save the more detailed genetics and biochemistry for a separate piece, but many of the complexities in the science are the result of very different responses in different people. Some examples are:

• Diet-heart-cholesterol protagonists like to suggest that cholesterol is the problem. It isn't - cholesterol is essential to animal life, being integral to all cell membranes and a precursor of all steroid hormones, amongst other things. There is clear evidence that lowering cholesterol as a prophylactic strategy applicable to the majority of adults over 50 is not based on adequate scientific evidence. There is also solid evidence that the cholesterol profile, rather than total amount of cholesterol or LDL cholesterol (the so-called 'bad' cholesterol), and especially the glycation ('junking') and oxidation ('rusting') of the small, dense LDL or VLDL (very low density LDL) particles, is critical to the development of atherosclerotic plaques (that block arteries) that are a major cause of heart attacks and strokes. LDL particle distribution, glycation and oxidation vary substantially individual to individual and are also strongly affected by diet. The public isn't told, despite ample clinical evidence, that dietary changes can alter, for better or worse, these profiles in a matter of days 
• Most people don’t suffer serious side effects when they take statins – but a highly significant number do. A review of ‘statin intolerance’ found the following rates of reported side effects: myalgias (muscle pain) 3–5%; myopathy (muscle weakness and fatigue) 0.1–0.2%; new-onset diabetes 9–27%, and liver toxicity, usually less than 1%
• There are proven benefits for statins, these being greater among those with a history or high risk of heart disease. However, the life-saving benefits are not nearly as striking as often claimed. The most comprehensive study analysing survival benefits from published trials found the maximum benefit to be 27 days of additional lifespan after 5.8 years of simvastatin therapy in subjects suffering unstable angina or previous heart attack. On average, death was postponed by a maximum of 19 days and 27 days in primary and secondary prevention trials respectively, the averages (median) being a disenchanting 3.2 and 4.1 days for each situation. These figures don’t include any possible benefits from a relatively newly discovered and beneficial side effect of statins, an apparent reduction (up to 40%) in mortality from cancer among postmenopausal women
• Individual responses to high carbohydrate, high fat or high protein diets are highly variable and are dependent on genetic background, metabolic and endocrine system status. This means that some people are able to tolerate carbohydrates, fats and protein better than others and big differences in responses are to be expected. It’s a very good reason for personalised approaches based on tests of metabolic and endocrine status  (e.g. normal dietary pattern and response, body composition, insulin/glucagon ratios). Glucagon, the hormone that opposes the effect of insulin and is responsible for glucose and ketone production in a fasted state, is not generally evaluated in mainstream primary care practice, yet its ratio in comparison with insulin is key to understanding metabolic responses to macronutrients (protein, fats and carbs)
• The evidence strongly suggests that one of the main dietary planks linked to the diet-heart hypothesis is the reduction of saturated fat, as proposed by dietary guidelines. However, a growing body of evidence suggests that saturated fat per se is not in itself dangerous. Dr Paul Mason, an Australian medical doctor who is now a specialist sports medicine and exercise physician, at Sydney University provides an illuminating presentation on this subject which can be viewed below.

Dr Paul Mason, “Saturated fat is not dangerous” presentation, 11 November 2017, University of Sydney

There is so much more to say on this, but we hope the point is made that the science is nowhere near as black and white as the statin/diet-heart hypothesis lobby like to suggest.

Fighting back

Dr Malhotra is not going to lie down and accept the attack levelled by the Mail on Sunday. We’ll have more on this as more concrete details emerge. Aseem Malhotra’s Facebook message to supporters yesterday defiantly said: “I’m all for scientific debate but unfortunately the article was inaccurate, misleading, distorted and defamatory...it’s a sign that Bad Pharma are very very concerned that we’re exposing their misinformation on a massive scale. ...we will not be phased by this intimidating attempt to silence us and stifle any further debate especially on the true rate of side effects of statins. The gloves are off. Bring it on!!”

Dr Peter Gøtzsche is another who is not resigned to doing nothing. He will host the launch of the Institute for Scientific Freedom in Copenhagen on Saturday, at an eagerly anticipated scientific meeting that I will be attending.  We’ll report on this next week.

And as for Zoë Harcombe, who was the first to systematically assemble and analyse the lack of data supporting low fat (un)healthy eating guidelines, her staying power is legendary.

The ‘divide and conquer’ approach that has long been used by corporate, government and media supporters of the status quo will no longer be able to dismiss or censor worthy voices, worthy science and worthy ‘clinical’ experience. These interests and Bad Pharma shills will inevitably continue to depict nay-sayers as ‘conspiracy theorists’ or ‘deniers’ – but it won’t wash with an ever growing group of public supporters and influential politicians.

The inability to fully settle the scientific debate given the prevailing scientific uncertainties comes at a cost – including the loss of lives in cases where people follow advice, whether it be taking a drug or eating in a specific way, that wasn’t necessarily the best option for those individuals. But let’s remind ourselves that prescription drugs, as professed by Peter Gøtzsche, are the third leading cause of death after heart disease and cancer. 

Place your bets

The battle lines are building on either side. But in looking at the totality of published and clinical evidence, it’s becoming ever more clear, despite the inevitable murkiness that is at least in part the result of Big Pharma’s grip on research, in which direction the science is moving.

Our hope is that in 5 short years’ time, witch hunts against those who speak out using solid evidence to support their case will be displaced by more intelligent, constructive scientific debate about the complex issues over how different individuals should best manage their health to ensure the best long-term outcomes.

In the meantime, consider very carefully who’s doing the name calling when you hear, in relation to medicine, terms like ‘denier’, ‘fake news’ or ‘conspiracy theory.’

The end game should be for society at large to do everything it can to ensure that, in relation to medical decision-making and informed choice, that Bad Pharma's bottom line doesn't take precedence over the wellbeing of the public. 

Barney Calman has blotted his copybook. If he values his career as a journalist, let's hope money and fame weren't the reasons for his dereliction of duty as a balanced journalist. Speaking frankly, it looks less and less likely that his lopsidedness was down to the honest naivety of a 39-year-old musician and journalist.