Less lore and more science, please. A rebuttal by Noakes & Sboros

Here, I respond to assessments of our book by medical doctors. One is by Cape Town paediatrician Alastair McAlpine, which Medical Brief published on 10 January. The other is by Iceland cardiologist Axel Sigurdsson, published on his blog, Doc’s Opinion, on 27 November.

Noakes has responded to McAlpine’s claims from medical and scientific perspectives. I look at what McAlpine says and doesn’t say. Thereafter, I compare his statements with Sigurdsson’s.

In both, I draw conclusions based on the evidence on these doctors’ motivations to conclude whether they have approached the subject in good or bad faith.

The reality is that some reviewers don’t actually review a book. So strongly do they oppose its message – and the author/s – that they simply cherry pick to buttress their own prejudices and ignore the science.

They usually resort to unsubstantiated negative opinion, a tactic known in the trade as ad hominem. That’s Latin for attacking an opponents’ character or personal traits in an attempt to undermine their argument.

In other words, they indulge in eristic argument. Eristic is from Eris, the Greek goddess of discord and strife. In this case, it means writers who are just out to cause trouble. They aim to sow discord and attack and discredit the author/s. They are on a mission that is not about truth. They are polar opposite of good-faith reviewers.

Noakes and I can probably count ourselves lucky that we have had mostly good-faith reviews so far. And that reviewers have been medical doctors, scientists, academics and more ordinary mortals. Most have raved about our book.

But Noakes and I don’t think it’s just luck that brought us so many good-faith reviews. We believe that’s it more likely good faith and good judgement on reviewers’ part.

The backdrop to our book is Noakes’s challenge to orthodoxy on nutrition. That put him on a collision path with medical and dietetic professions and academics who support conventional dietary guidelines. He also comes up against food and drug industries who promote the low-fat, high-carb status quo.

We cover in depth the Health Professions Council of South Africa (HPCSA) hearing against Noakes. We give evidence for how and why the HPCSA made it into a full-scale multimillion-rand trial now approaching its fourth year. We name all the doctors, dietitians and academics involved directly or indirectly in the case against Noakes. And all the attacks that preceded the trial.

But our book is about much more than an unprecedented prosecution and persecution of a distinguished scientist simply for his views on butter, eggs, bacon and broccoli.

Lore Of Nutrition is also about academic bullying, professional and ethical misconduct, scientific misconduct and undeclared conflicts of interests among doctors, dieticians and academics. And the consequences for personal and public health. It is a salutary warning to all those brave enough to challenge dogma and who powerful interests.

These are global phenomena, as we show in the book. Thus, while the focus is South African, the messages in Lore Of Nutrition have global relevance. Noakes and I provide extensive and compelling evidence to back up all our views.

McAlpine omits comment on all the serious issues and evidence we present. The list of his omissions is not exhaustive. If it were, this response would be more than double the word length.

For example, he refers to letters by University of Cape Town (UCT) cardiologists in 2012 and another by four UCT medical and dietetic professors in 2014 attacking Noakes publicly. However, he says nothing about the language used in these letters or the absence of any evidence for claims made against Noakes. Or that legal experts describe the language as inflammatory and defamatory.

McAlpine says little to nothing about extensive coverage of the trial in our book other than to claim that he always found the trial to be “silly”. His Twitter feed tells a very different story. He ignores all the evidence of what Noakes’s lawyers diplomatically refer to as “highly irregular conduct” of doctors, dietitians and academics involved in the trial.

One example: an email chain that fell into the hands of Noakes’s legal team quite by chance. The chain is between members of the HPCSA’s Preliminary Inquiry Committee tasked with deciding whether there were grounds to charge Noakes.

Committee chair was University of the Witwatersrand professor of medical ethics, Professor Amaboo “Ames” Dhai. Emails show that Dhai and two UCT professors went far beyond their remit to ensure that the HPCSA charged Noakes.

Noakes’s lawyer uncovered a second email chain only after a PAIA (Protection of Access to Information Act) request to the Association for Dietetics in SA (ADSA) after conclusion of the trial. We refer to it briefly, with examples in our book.

It shows HPCSA member, North-West University nutrition professor Edelweiss Wentzel-Viljoen, communicating with and actively encouraging dietitians Claire Julsing Strydom and other dietitians. They do so before Strydom reported him (Noakes) for his tweet in 2014 suggesting collusion and a set-up.

McAlpine makes the bizarre claim that we mention these emails only “tantalisingly … at one point”. And that “we (presumably by that he means readers) are never actually exposed to these, making it difficult to know how damning they are”.

Perhaps if McAlpine had read the whole book, he would have come across excerpts from the emails that we give. He might then have seen how damning they are, in fact. If he did read the whole book, then his comment on the email chains is nonsensical.

McAlpine also says nothing about the many phantom charges the HPCSA’s so-called “expert” witnesses made up and gave evidence on against Noakes. Among these were that Noakes had advised the breastfeeding mother to put her baby on a “dangerous” ketogenic diet.

A ketogenic diet is on the extreme end of the spectrum of LCHF diets. Noakes did not advise that in his tweet. Nor did the HPCSA charge him with advising a ketogenic diet, dangerous or otherwise.

Interestingly, After Medical Brief published his column, McAlpine recently tweeted his support for Strydom. Noakes is “scandalously nasty about you (in Lore of Nutrition)”, he tells her.

Nowhere in our book are we gratuitously nasty about Strydom. Or any of the other dietitians, doctors and academics who have tried hard and failed miserably to discredit Noakes. We simply set out the facts, give the evidence on the record and considered opinion based on that evidence. In that way, readers can make up their own minds.

McAlpine omits any comment on the extensive evidence we present on genuinely scandalous conduct by Strydom: collusion with dietitians for years to “get Noakes”; colluding with Wentzel-Viljoen to silence him. And for the vexatious complaint against him that led to the trial.

All the evidence we present speaks for itself.

McAlpine also says nothing about the HPCSA’s own expert witnesses’ admissions in evidence that LCHF aligns closely with South Africa’s official paediatric dietary guidelines. I find that peculiar from a paediatrician.

He doesn’t address the claim of possible scientific misconduct (a euphemism for fraud) surrounding a study on which the HPCSA based its whole case against Noakes. Known as the Naudé or Stellenbosch Review, after lead researcher, Stellenbosch University lecturer Dr Celeste Naudé, PLoS One published it in June 2014. Co-authors are Stellenbosch dean of medical school Professor Jimmy Volmink and UCT nutrition professor Marjanne Senekal.

Noakes and British obesity and public health researcher Dr Zoë Harcombe published a study titled The universities of Stellenbosch/Cape Town low-carbohydrate diet review: Mistake or mischief? in the SAMJ in November 2016. It is a re-analysis of the Naudé Review. They claimed the Naudé Review to have so many errors as to be fatally flawed. They have called for retraction.

McAlpine ignores the fact that the authors have yet to answer all the errors that Noakes and Harcombe have identified.

He says nothing about the fact the HPCSA prosecution lawyers allowed all the scientific evidence that Noakes and his three experts witnesses presented to go unchallenged.

He says nothing of the HPCSA’s use of a secret report to build a case against Noakes without letting him see it before being charged. That is a clear breach of the common law principle of audi alteram partem rule (let the other side be heard as well).

He also ignores extensive closing legal arguments from both sides on the HPCSA trial that I present. He ignores in its entirety the HPCSA’s own panel’s comprehensive vindication of Noakes in April 2017. The independent chair of the panel, Pretoria advocate Joan Adams read a 60-page verdict finding Noakes not guilty on all aspects of 10 points of the charge against him.

Predictably by now, McAlpine says nothing about the HPCSA appeal – not only against the verdict but going for a whole new hearing. Legal experts have described it as malicious and groundless.

Just as significantly, McAlpine ignores evidence of the omertà still in place. Lore Of Nutrition went on sale locally and internationally in November. Since then, there has been deafening silence from all the doctors, dietitians and nutrition academics we name in the book.

None has responded or refuted any of the science for LCHF or evidence for the serious claims we make against them in the book.

The only conclusion I can draw is that the evidence we present in the book speaks for itself. Those opposed to Noakes have no answer for the science we present and the unethical conduct they indulged in to attempt to muzzle him. And neither does McAlpine.

In keeping silent on the evidence of actions of those opposed to Noakes and LCHF, the only inference I can draw is that McAlpine condones it all.

One comment he makes sticks out: “Why so many esteemed and decorated academics would willfully suppress information that could benefit their patients is anyone’s guess.”

There is no need to guess. We provide extensive referenced evidence of a web of industry links that bind many of the doctors, dietitians and academics opposed to Noakes and LCHF. We also present evidence to show that those links are global.

McAlpine ignores it all.

He also ignores what I say on that topic in our book’s closing chapter: “It is tempting to think that there cannot possibly be so many doctors, dietitians and academics out of step except Noakes. But we present compelling evidence to show not just that it is possible – as anything is. We also give the evidence to show that it is highly probable.”

McAlpine also ignores all the evidence on imponderables swirling around the HPCSA trial. These include whether the hearing could have happened at all were it not for the “inordinately large, incestuous web of UCT academics” that spread to Stellenbosch, Wits, North-West University and even the Liverpool School of Tropical Medicine.

I speculate whether the trial would have happened at all were it not for another “incestuous web”: the leadership profile of the Association for Dietetics in South Africa (ADSA). That profile is still predominantly white, privileged, female, from similar middle-class cultural backgrounds. We show that ADSA is run by a “closed shop of mostly friends or friends of friends”.

But perhaps the biggest problem for McAlpine as a columnist is that he does not declare extensive conflicts of interest. For example, he does not declare his connections and friendship with many of the UCT academics named in our book.

He also does not reveal his antagonism to Noakes, me and LCHF that is well-documented and in the public domain. He doesn’t say that he has regularly trolled and defamed us both for years on Twitter and continues to do so.

He does not say that he regularly defames Noakes in his tweets, suggesting that he is a quack and practises pseudoscience. McAlpine does seemingly with impunity in contravention of the HPCSA’s own code of conduct that precludes one health professional from denigrating another in public.

In a recent tweet, McAlpine called me “poison” and said that Noakes should get rid of me. He regularly defames me as a professional.

McAlpine tweeted recently that some have suggested that his review will wound Lore of Nutrition “mortally”. That speaks to his motivation. Proof is right there in his Twitter feed.

Icelandic cardiologist Dr Axel Sigurdsson’s writing is on a different level from McAlpine’s. Sigurdsson does not agree with everything we say. However, his criticisms are reasoned, reasonable and collegial. He does not stoop to ad hominem or eristic argument.

He knows that Lore Of Nutrition is not the first book to challenge accepted medical and scientific dogma. “But, it rises above most of them due to its reliance on scientific evidence, its honesty, and bravery,” he says.

Sigurdsson acknowledges that Lore Of Nutrition is not just about nutrition. “It’s about science, public health, cardiovascular disease, fatty liver disease, diabetes, the food industry, the diet-heart hypothesis, the pharmaceutical industry, obesity, social media, politics, corruption and academic bullying,” he says.

He shows keen awareness of the scientific controversy: “Noakes’s knowledge, passion, and courage allow him to write in a ruthless manner that is shockingly revealing. Of course, this may be too much and too bold for some of his peers.”

To Sigurdsson, Lore Of Nutrition reads “like a novel” that “has it all” – the omertà, courtroom drama, hero and the villain (lots of them). If you’re a cardiologist, he says that our book may read like a Stephen King horror story. “However, this time, the horror is real. You’ll just have to hope for a happy ending.”

Sigurdsson disagrees with Noakes that the cardiology profession is “responsible for initiating and performing more unnecessary, non-evidence based and costly medical interventions than perhaps any other medical discipline”. Noakes “may in fact, be right”, he says. However, Sigurdsson says the he “would like to claim that cardiology is probably the most evidence-based of all medical disciplines”.

My verdict: all the available evidence suggests that Sigurdsson reviews our book in good faith. McAlpine does not. Therefore, MedicalBrief should retract his review.

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