I had to stop and comment after the first paragraph. It should be printed and framed, and copies should hang on the walls of research institutions. Biological plausibility comes first. It has to be strong. You don't clinical trial in order to generate plausibility hypotheses. Most of all, you have to weigh the marginal effect of your "intervention" in the clinical scenario BEFORE you clinical trial. Please go to https://thethoughtfulintensivist.substack.com/
If I may ask a clarifying question: how was the red meat and diabetes study not pursuing a meaningful question? Or more generally, are you saying that before you use a statistical test you should already have a more intuitive way of determining that what you measure is not just noise?
I will provide several posts on the subject. It is at the heart of how much harm is being done by the current state of nutritional medicine. Other posts here make an analogy with courts of law. Here, the authors are indicting high dietary protein. What are the grounds for such an indictment? The biology is established that, of macronutrients, diabetes is about carbohydrate intolerance. Protein is a far more complicated stimulus and no good suggestive evidence exists. In the current case, however, there is contradictory evidence shown in one my posts. (Red meat consumption is reduced over last 50 years and diabetes went up — to dramatic degree in both cases). I pointed this out to the authors in a previous paper but they ignored it. My post this week will describe exculpatory evidence in law. Courts have ruled that prosecution must seek out exculpatory evidence. Remember, as in law, you cannot be found innocent, only not guilty. Establishing suspicion is dangerous The popular media like NY Times jumped on attributing blame to high protein. This is irresponsible and misleads the public.
More later but yes, you should have suggestive evidence, intuition, or generally a reason before you assign cause to a nutritional stimulus. And you have to ask yourself whether you need statistics.
This is a serious health problem but the encouraging factor is that much information is out there and many people see through studies like this. So there is advancement although it still like Macbeth’s doctor said “Therein the patient must minister to himself.”
Sorry but the "keto hole" you have carefully dug yourself into is NOT serving you or Mr. Taubes. I am sorry for you, but I have to get back to my real focus.
this is a question and a comment that needs explanation. I appreciate the sympathy even if it is not your real focus. However, explanation would be good.
The solution to Mukherjee's diagnostic puzzle is in the below excerpt from his book "The Laws of Medicine," as follows:
"Over the next four weeks, we scoured his body for signs of cancer. CAT scans were negative. A colonoscopy, looking for an occult colon cancer, revealed nothing except for an occasional polyp. He saw a rheumatologist—for the fleeting arthritic pains in his fingers—but again, nothing was diagnosed. I sent out another volley of lab tests. The technician in the blood lab complained that Mr. Carlton's veins were so pinched that she could hardly draw any blood.
"For a while nothing happened. It felt like a diagnostic stalemate. More tests came back negative. Mr. Carlton was frustrated; his weight kept dropping, threatening to go all the way down to zero. Then, one evening, returning home from the hospital, I witnessed an event that changed my entire perspective on the case.
"Boston is a small town—and the geography of illness tracks the geography of its neighborhoods (I'll risk admonishment here, but this is how medical interns think). To the northeast lie the Italian neighborhoods of the North End and the rough-and-tumble shipyards of Charlestown and Dorchester, with high densities of smokers and asbestos-exposed ship workers (think lung cancer, emphysema, asbestosis). To the south are desperately poor neighborhoods overrun by heroin and cocaine. Beacon Hill and Brookline, sitting somewhere in the middle, are firmly middle-class bastions, with the spectra of chronic illnesses that generally affect the middle class.
"What happened that evening amounted to this: around six o'clock as I left the hospital after rounds, I saw Mr. Carlton in the lobby, by the Coffee Exchange, conversing with a man whom I had admitted months ago with a severe skin infection related to a heroin needle inserted incorrectly into a vein. The conversation could not have lasted for more than a few minutes. It may have involved something as innocuous as change for a twenty-dollar bill, or directions to the nearest ATM. But on my way home on the train, the image kept haunting me: the Beacon Hill scion chatting with the Mission Hill addict. There was a dissonant familiarity in their body language that I could not shake off—a violation of geography, of accent, of ancestry, of dress code, of class. By the time I reached my station, I knew the answer. Boston is a small town. It should have been obvious all along: Mr. Carlton was a heroin user. Perhaps the man at the Coffee Exchange was his sometime dealer, or an acquaintance of an acquaintance. In retrospect, I should also have listened to the blood-lab worker who had had such a hard time drawing Mr. Carlton's blood: his veins were likely scarred from habitual use.
"The next week, I matter-of-factly offered Mr. Carlton an HIV test. I told him nothing of the meeting that I had witnessed. Nor did I ever confirm that he knew the man from Mission Hill. The test was strikingly positive. By the time the requisite viral-load and the CD4 counts had been completed, we had clinched the diagnosis: Mr. Carlton had AIDS."
I had to stop and comment after the first paragraph. It should be printed and framed, and copies should hang on the walls of research institutions. Biological plausibility comes first. It has to be strong. You don't clinical trial in order to generate plausibility hypotheses. Most of all, you have to weigh the marginal effect of your "intervention" in the clinical scenario BEFORE you clinical trial. Please go to https://thethoughtfulintensivist.substack.com/
If I may ask a clarifying question: how was the red meat and diabetes study not pursuing a meaningful question? Or more generally, are you saying that before you use a statistical test you should already have a more intuitive way of determining that what you measure is not just noise?
I will provide several posts on the subject. It is at the heart of how much harm is being done by the current state of nutritional medicine. Other posts here make an analogy with courts of law. Here, the authors are indicting high dietary protein. What are the grounds for such an indictment? The biology is established that, of macronutrients, diabetes is about carbohydrate intolerance. Protein is a far more complicated stimulus and no good suggestive evidence exists. In the current case, however, there is contradictory evidence shown in one my posts. (Red meat consumption is reduced over last 50 years and diabetes went up — to dramatic degree in both cases). I pointed this out to the authors in a previous paper but they ignored it. My post this week will describe exculpatory evidence in law. Courts have ruled that prosecution must seek out exculpatory evidence. Remember, as in law, you cannot be found innocent, only not guilty. Establishing suspicion is dangerous The popular media like NY Times jumped on attributing blame to high protein. This is irresponsible and misleads the public.
More later but yes, you should have suggestive evidence, intuition, or generally a reason before you assign cause to a nutritional stimulus. And you have to ask yourself whether you need statistics.
This is a serious health problem but the encouraging factor is that much information is out there and many people see through studies like this. So there is advancement although it still like Macbeth’s doctor said “Therein the patient must minister to himself.”
every single post in here?
I have carefully researched.
Sorry but the "keto hole" you have carefully dug yourself into is NOT serving you or Mr. Taubes. I am sorry for you, but I have to get back to my real focus.
this is a question and a comment that needs explanation. I appreciate the sympathy even if it is not your real focus. However, explanation would be good.
The solution to Mukherjee's diagnostic puzzle is in the below excerpt from his book "The Laws of Medicine," as follows:
"Over the next four weeks, we scoured his body for signs of cancer. CAT scans were negative. A colonoscopy, looking for an occult colon cancer, revealed nothing except for an occasional polyp. He saw a rheumatologist—for the fleeting arthritic pains in his fingers—but again, nothing was diagnosed. I sent out another volley of lab tests. The technician in the blood lab complained that Mr. Carlton's veins were so pinched that she could hardly draw any blood.
"For a while nothing happened. It felt like a diagnostic stalemate. More tests came back negative. Mr. Carlton was frustrated; his weight kept dropping, threatening to go all the way down to zero. Then, one evening, returning home from the hospital, I witnessed an event that changed my entire perspective on the case.
"Boston is a small town—and the geography of illness tracks the geography of its neighborhoods (I'll risk admonishment here, but this is how medical interns think). To the northeast lie the Italian neighborhoods of the North End and the rough-and-tumble shipyards of Charlestown and Dorchester, with high densities of smokers and asbestos-exposed ship workers (think lung cancer, emphysema, asbestosis). To the south are desperately poor neighborhoods overrun by heroin and cocaine. Beacon Hill and Brookline, sitting somewhere in the middle, are firmly middle-class bastions, with the spectra of chronic illnesses that generally affect the middle class.
"What happened that evening amounted to this: around six o'clock as I left the hospital after rounds, I saw Mr. Carlton in the lobby, by the Coffee Exchange, conversing with a man whom I had admitted months ago with a severe skin infection related to a heroin needle inserted incorrectly into a vein. The conversation could not have lasted for more than a few minutes. It may have involved something as innocuous as change for a twenty-dollar bill, or directions to the nearest ATM. But on my way home on the train, the image kept haunting me: the Beacon Hill scion chatting with the Mission Hill addict. There was a dissonant familiarity in their body language that I could not shake off—a violation of geography, of accent, of ancestry, of dress code, of class. By the time I reached my station, I knew the answer. Boston is a small town. It should have been obvious all along: Mr. Carlton was a heroin user. Perhaps the man at the Coffee Exchange was his sometime dealer, or an acquaintance of an acquaintance. In retrospect, I should also have listened to the blood-lab worker who had had such a hard time drawing Mr. Carlton's blood: his veins were likely scarred from habitual use.
"The next week, I matter-of-factly offered Mr. Carlton an HIV test. I told him nothing of the meeting that I had witnessed. Nor did I ever confirm that he knew the man from Mission Hill. The test was strikingly positive. By the time the requisite viral-load and the CD4 counts had been completed, we had clinched the diagnosis: Mr. Carlton had AIDS."
Wow, I never would've guessed that. Thanks for the solution.
'The solution is in a Comment for readers who want to think about it first and to avoid spoiler alerts.'
Waiting with bated breath.
The solution is now posted in the comments. Sorry for the wait! Here is the direct link: http://tinyurl.com/29mr28yj
It's from the kindle so I'm trying to convert to text or post as screen shot. Sorry. working on it now.