Unethical Diet

A number of my students in CFB/PHY 3333 [1] decided to write research papers about the hCG Diet. I was particularly interested in their papers because an acquaintance of mine told me last year that they had decided to try the diet. At the time, I did not know what it was and thought little of it. After reading the research papers my students produced, I became more worried.

The hCG Diet was invented by an endocrinologist named Albert T. Simeons [2]. He combined a 500-calorie restricted diet with the Human Chorionic Gonadotropin hormone. The claim is that the hormone negates the feelings of hunger induced by a dangerously low calorie diet, while also forcing the body to burn stored fat instead of protein for energy.

A number of studies have been done to assess the claim. Some of those studies claimed that the diet worked, and others find no benefit of combining hCG and a 500-calorie diet over using a placebo and the same 500-calorie diet [3]. How do we decide who is right? One group of authors did a “meta-analysis” [4] of these publications and assessed scores to the studies based on  the quality of the research (e.g. was a given study randomized-controlled or not?). They set in advance a score of 50 (out of 100) as the cutoff for higher-quality analyses. They found that of the 14 studies that scored above 50 (all of which included randomly controlled trials), 1 of the 14 found confirming evidence supporting the claims of the hCG diet. The others all found disconfirming evidence. The weight of reliable, scientific evidence is strongly against the effectiveness of the hCG diet.

From this we can conclude the following:

  1. Any doctor that prescribes the hCG diet is not making a decision using evidence-based medicine. Medicine without evidence supporting its claims is quack medicine. The doctor is, at the very least, not keeping up with the research in their own field and at worst is willfully ignoring evidence.

But it gets worse. The Food and Drug Administration has strong words [5] regarding the sale of hCG as a diet supplement:

The Food and Drug Administration (FDA) is advising consumers to steer clear of these “homeopathic” human chorionic gonadotropin (HCG) weight-loss products.  They are sold in the form of oral drops, pellets and sprays and can be found online and in some retail stores. [5]

FDA and the Federal Trade Commission (FTC) have issued seven letters to companies warning them that they are selling illegal homeopathic HCG weight-loss drugs that have not been approved by FDA, and that make unsupported claims. [5]

Not only is the hCG diet not science-based medicine – selling hCG products for the purpose of the diet is ILLEGAL. What about physicians that prescribe them? According to a news report by local Dallas WFAA [6],

HCG is FDA-approved for fertility treatments — not weight loss. Doctors, however, can prescribe HCG legally for an “off-label” use. [6]

So it’s currently legally okay for a doctor to use hCG in a way not intended, which is ethically murky. (Note: the above article claims that the “science is unclear” about the benefits of hCG, but this is likely because if you just count the number of studies there are equally many that find and don’t find benefits. WFAA was ill-equipped to understand good experiments and bad experiments, and likely misunderstood completely that the weight of reliable evidence is AGAINST the benefits of hCG).

From this, we can conclude that any doctor who prescribes this is practicing  unethical quack medicine. It might not be illegal to use hCG for a purpose not intended, but it flies in the face of evidence-based medicine. Evidence-based medicine is the only reliable kind of medicine. Everything else is wishful thinking or lies.

I tried to explain to my acquaintance that hCG has been clearly shown to be no more effective than placebo. I also tried to explain that the FDA has warned companies selling hCG for weight loss that they are conducting an illegal activity. However, they were adamant. They had lost weight (they were on it three times in the last year, gaining weight back after each time), they had heard anecdotes that said it worked, and that they had their beliefs and that science had its beliefs. Pretty much the spectrum of denial. This acquaintance of mine is a very bright person, so it pained me to know that they couldn’t be convinced of the evidence. They were actually willing to pay for the placebo effect (and said as much).

As a scientist, it’s hard to listen to that.

 

[1] http://www.physics.smu.edu/pseudo/

[2] http://en.wikipedia.org/wiki/Human_chorionic_gonadotropin

[3] Published studies of hCG and weight loss:

CARNE S. The action of chorionic gonadotrophin in the obese. Lancet. 1961 Dec 9;2(7215):1282–1284.

LEBON P. Treatment of overweight patients with chorionic gonadotropin. J Am Geriatr Soc. 1961 Nov;9:998–1002.

Stein MR, Julis RE, Peck CC, Hinshaw W, Sawicki JE, Deller JJ., Jr Ineffectiveness of human chorionic gonadotropin in weight reduction: a double-blind study. Am J Clin Nutr. 1976 Sep;29(9):940–948.

Young RL, Fuchs RJ, Woltjen MJ. Chorionic gonadotropin in weight control. A double-blind crossover study. JAMA. 1976 Nov 29;236(22):2495–2497.

Shetty KR, Kalkhoff RK. Human chorionic gonadotropin (HCG) treatment of obesity. Arch Intern Med. 1977 Feb;137(2):151–155.

Greenway FL, Bray GA. Human chorionic gonadotropin (HCG) in the treatment of obesity: a critical assessment of the Simeons method. West J Med. 1977 Dec;127(6):461–463. [PMC free article]

Asher WL, Harper HW. Effect of human chorionic gonadotrophin on weight loss, hunger, and feeling of well-being. Am J Clin Nutr. 1973 Feb;26(2):211–218.

CRAIG LS, RAY RE, WAXLER SH, MADIGAN H. Chorionic gonadotropin in the treatment of obese women. Am J Clin Nutr. 1963 Mar;12:230–234.

Miller R, Schneiderman LJ. A clinical study of the use of human chorionic gonadotrophin in weight reduction. J Fam Pract. 1977 Mar;4(3):445–448.

FRANK BW. THE USE OF CHORIONIC GONADOTROPIN HORMONE IN THE TREATMENT OF OBESITY. A DOUBLE-BLIND STUDY. Am J Clin Nutr. 1964 Mar;14:133–136.

SOHAR E. A forty-day-550 calorie diet in the treatment of obese outpatients. Am J Clin Nutr. 1959 Sep–Oct;7:514–518.

HASTRUP B, NIELSEN B, SKOUBY AP. Chorionic gonadotropin and the treatment of obesity. Acta Med Scand. 1960 Sep 21;168:25–27.

Veilleux H, Fortin Z. Effets gonadiques et extragonadiques, chez l’humain, de 3500 U.I. de HCG (gonadotrophine chorionique humaine) en doses fractionnées. Vie Med Can Fr. 1972 Sep;1(9):862–871.

Gusman HA. Chorionic gonadotropin in obesity. Further clinical observations. Am J Clin Nutr. 1969 Jun;22(6):686–695.

SIMEONS AT. CHORIONIC GONADOTROPHIN IN THE TREATMENT OF OBESITY. Am J Clin Nutr. 1964 Sep;15:188–190.

HARRIS JM, WARSAW E. OBESITY: A PROBLEM WITH MANY FACETS: OBSERVATIONS ON TREATMENT WITH CHORIONIC GONADOTROPIN AS AN ADJUNCT TO DIETARY MEASURES. J Am Geriatr Soc. 1964 Oct;12:987–995.

[4] Lijesen GK, Theeuwen I, Assendelft WJ, Van Der Wal G (September 1995). “The effect of human chorionic gonadotropin (HCG) in the treatment of obesity by means of the Simeons therapy: a criteria-based meta-analysis”Br J Clin Pharmacol 40 (3): 237–43. PMC 1365103.PMID 8527285

[5] http://www.fda.gov/forconsumers/consumerupdates/ucm281333.htm

[6] http://www.wfaa.com/news/health/HCG–Popular-Diet-Now-Faces-Legal-Controversy-139739033.html

This Week in Propaganda and Pseudoscience (May 5 Edition)

I still believe in the law of gravity. Do you?
From grist.org, a program that lets you generate your own "Heartland Billboard"!

This was a good week for prime examples of propaganda and pseudoscience. Let’s get started.

49 Cherry-Picked Questionable Authorities Can’t Be Wrong

There was some recent buzz about “49 authorities” who sent a letter [1] to NASA’s chief and asked the agency to stop promoting the idea of human-induced climate change. A blog, “Scholars and Rogues,” noted a number of serious instances of pseudoscience, mis-information, and logical fallacies in the letter [2]. “Scholars and Rogues” is a blog site that has a number of contributors; this particular article was contributed by Brian Angliss, a working electrical engineer (BSEE and MSEE) and the science editor and climate/energy writer for the blog. What makes him credible here is that he is careful to cite multiple examples of peer-reviewed, published scientific research to back up his arguments, and he demonstrates a clear mastery of the fundamentals of argument analysis (ala [4]) and a recognition of the use of logical fallacies to distract the reader of the “49 authorities” letter from an otherwise weak argument.

Here are a few good examples (you should read the letter and the criticism for a more complete picture):

  1. The authors of the letter cited “hundreds” [1] of climate scientists who disagree with the conclusion that climate change is human-induced. An investigation reveals that this statement is based solely on information from Senator James Inhofe’s (R-OK) own 2008 minority report (Inhofe is a well-documented and proud climate change denier). Of the 700 scientists on the list provided by Inhofe, only 70 of 700 are practicing climate scientists; 680 of them have no publication record on climate science. And, in a funny twist, about 28 of 700 actually have been convinced by the scientific evidence of the reality of human-induced climate change. Whoops.
  2. The letter points to “tens of thousands” [1] of other scientists who disagree with the conclusion that climate change is human-induced. That sounds impressive, until you breakdown the numbers (which themselves come from the Oregon Institute for Science and Medicine, a non-profit private organization that denies the existence of human-induced climate change). First, the list is compiled using the loosest possible definition of “scientist” – it doesn’t even constrain itself to practicing scientists, just to anyone with a Bachelor of Science degree. By that definition, US institutions have produced over 10 million “scientists” since 1970; the 31000 “scientists” on the OISM’s list represents only 0.3% of all “scientists” produced since 1970. Take a room full of people, and you’re guaranteed to find that at least 0.3% of them disagree with the other 99.7% of people in the room (on any issue, for any reason, right or not).

It goes on. Have a look. The above is a great example of  “equivocation,” a key logical fallacy. The authors rely on the vague term “scientist,” which means something very different to the public than it means to the scientific community, to fool the reader into thinking they have found some very impressive numbers. They rely on vagaries and mis-direction to try to skirt your critical thinking defenses and trick you into agreeing with them.

In life, no “white knight” is going to save you from propaganda and mis-information. You have to learn to recognize good and weak arguments and think for yourself.

How would you have spotted the weaknesses in the “49 experts” letter? First, ask what are the vague terms. Believe it or not, “scientist” is a vague term unless it’s qualified (“practicing scientist,” “publishing scientist,” “actively publishing climate scientist” – these are all the minimum required qualifications needed into order to clarify the meaning of the vague term “scientist”).  Second, check their reasons. When they cite figures on the numbers of “scientists” that agree or disagree with a position, then it’s incumbent upon you to ask questions like:

  1. Where did they get these numbers? Are they published? Are they peer reviewed? A quick check (which the blog above has done for us) reveals that the sources are neither published (in a respectable journal) or peer-reviewed. For a list of primary, peer-reviewed and published sources that help to understand the real number of climate scientists that have been convinced by the scientific evidence, see Naomi Oreskes’s essay in the journal “Science” [3].

Serial Killers Sleep, Poop, Eat, and Believe in Climate Change

Heartland Institute Propaganda
The heartland Institute paid for billboards intended to use the principles of propaganda to scare you into denying the evidence for climate change.

This one goes under the “propaganda” header. The Heartland Institute, a non-profit private thinktank that originally partnered with the tobacco industry in the 1980s to fight medical research pointing to the dangers of tobacco, posted billboards this week that sought to terrify readers into being against the evidence for climate change. I’ve placed an example of this billboard to the left.

Propaganda is described at length (with examples) on our SMU course page for PHY/CFB 3333 [5].  In short, propaganda is any message that is delivered with the intent to “alter public perceptions and/or induce action” [5]. Everybody uses propaganda, from personal workplace politics to national politics. The key is to recognize that what is being used is propaganda. As Joseph Goebbels, the Nazi father of modern propaganda, noted, “Propaganda becomes ineffective the moment we are aware of it.”

So let’s make you aware of it. The above billboard is propaganda. It uses emotion – fear, in this case – to spur you to disagree with the scientific fact of global warming. It uses a convicted serial murderer – Ted Kaczynski – to do this. Basically, it implies that if you agree with the fact of global warming, you are no better than a serial murderer. You are then directed to the Heartland Institute’s website.

In order to see that this is propaganda, you need to understand that it is built on a logical fallacy: “Appeal to Questionable Authority” and an implicit “Ad Hominem Attack.” The Ad Hominem attack is on you; basically, if you believe in the fact of global warming, you are a serial murderer. The appeal is the use of Kaczynski’s photograph, implicitly linking acceptance of the fact of global warming with being a crazed genius murderer. The intent is purely to scare you, forcing your rational mind to be subsumed by your irrational mind. To deconstruct the propaganda, you should always change the words in the sign to something that is easier to understand and see if the argument still works. For example, imagine instead the sign read, “I still go to the bathroom. Do you?” The implication here is, “Ted Kaczynski poops. Ted Kaczynski is a crazed serial murderer. Only crazed serial murderers poop. You don’t want to be a crazed serial murderer, do you?” Of course that’s ridiculous; pooping has nothing whatsoever to do with being a crazed serial murdered. Neither does acceptance of a fact, like the fact that the Earth’s average temperature has shot up exponentially for the last 150 years.

Once you recognize and then deconstruct the propaganda (I find that using absurdity helps to take away the power of propaganda), then you find this billboard is a toothless fallacy. You are not weak-minded. Don’t let propagandists like the Heartland Institute try to treat you like a weak-minded person.

 

[1] http://sppiblog.org/news/former-nasa-scientists-astronauts-admonish-agency-on-climate-change-position

[2] http://www.scholarsandrogues.com/2012/04/25/errors-shortcomings-void-nasa-climate-letter/

[3] Oreskes, Naomi. “Beyond the Ivory Tower, The Scientific Consensus on Climate Change (including corrections)”Science.  2005.

[4] Browne, M and Keeley, S. “Asking the Right Questions: A Guide to Critical Thinking (10th Edition).” ISBN-10: 0205111165. ISBN-13: 978-0205111169. Amazon URL: http://www.amazon.com/Asking-Right-Questions-Critical-Thinking/dp/0205111165/ref=dp_ob_title_bk

[5] http://www.physics.smu.edu/pseudo/Propaganda/