Monthly Archives: June 2014

You are intelligent.

You are a scientist.

You, yeah you, the one reading this.

You, the one who failed the chemistry test everyone else easily got an "A" on. Or you, the one who got in way over your head taking Physics AP in high school for some god-forsaken reason. Or maybe you, who tried to major in Biology but couldn't pass Chem 102, coming to the conclusion that you are just shitty at all things science.

...Oh wait, those were all me. 

The fact that I would randomly and uncontrollably fall asleep in all of my classes probably didn't help.

The fact that I would randomly and uncontrollably fall asleep in all of my classes probably didn't help.

So maybe I'm not innately talented in passing Chemistry tests I never studied for. Maybe I needed to take a regular-level physics class before trying an AP level. And maybe it's not best to try and learn Chemistry beside 150+ other kids in a giant lecture hall, especially when it's not your strong suit.

In fact, I think that NOT being a natural scientific genius may be why I look for so many different ways to try and explain its principles. Because whatever way they tried in school didn't work for me.

And if you're like a lot of other people I know, it didn't work for you either.

Our brains tend to grasp things easier if we put a human spin on them - if we add a social element to it. My goal today is to explain how many scientific studies are formatted in an interesting and understandable way. I think it will help to shed some light onto some of their more subtle points:

  1. Why the context the study was conducted in is very important
  2. Why, a good deal of the time, if you're not already in the field the study is looking at, you won't understand it 100%
  3. How to work around #1 and #2

So, here's our fake scenario:

You have a fussy 4 year-old who hates going to bed at bedtime. If you want to retain your sanity, you need to figure out a way to get him to go to sleep consistently and reliably.

Never thought I'd find a reason to post this video on my blog...

Efficacy of Bed-Time Stories on Sleep-Induction in 4-year-old Male

Abstract

Objective: To determine the efficacy of reading stories at bed-time on the time it takes to fall asleep (TTS) in our 4-year-old male subject.

Methods: The subject was exposed to 3 different treatments:

  1. Bed-Time Story: Goodnight Moon 
  2. Bed-Time Story: Where the Wild Things Are 
  3. Control (No story)

Each treatment was done for 2 weeks, followed by a 2-week wash-out period between each treatment where no books were read.

TTS was recorded each night and averaged using the mode.

Results: TTS results varied from 4 to 97 minutes.  The treatment with the lowest average TTS was treatment #2 with an average of 13 minutes.  

Conclusion: Treatment #2 was significantly more effective than treatments 1 and 3 on TTS. However, one of the TTS values for treatment #2 was 97 minutes - the highest value of any treatments.  This suggests that factors outside of the story read and the bedtime may be affecting TTS values.

It is clear that further study must be done on this subject to arrive at the optimal treatment outcome.  

So that all seems pretty succinct, right?  Well let's move onto the FULL study and see if we're missing any crucial context...

Full Study

Background: Having children fall asleep in a timely fashion is of paramount importance for the child's development.  Well-rested caregivers have been shown in previous studies to have higher levels of patience, are better able to work to provide for their children, and are more apt to be involved with their children when they are at home.

Better sleep benefits the child by making them more attentive; performing better at tasks required intellect or motor coordination.  As well, they are better able to express their wants and emotions to their caregivers.  

Some previous treatments have been tried on the subject with negligible improvement. Such treatments included a warm bath before bedtime, use of a nightlight, and turning off the television at 8:00 PM. 

However, other treatment options were promising.  Pushing bed-time back from 8:30 PM to 9:00 decreased time till sleep (TTS) by an average of 19 minutes.  However, benefits reversed after 10:00 PM.  

The treatment with the highest success rate was allowing the subject to sleep with his caregivers.  However, this treatment has dangerous side-effects for the caregivers and thus is not a suitable long-term treatment.  More options must be made available. 

In this study, we hope to combine the proven-successful treatment of a 9:00 PM bed-time with 2 other options in search for the best treatment option for the subject. 

So we've learned two important things from the background of this study:

  1. This study is being done to improve the overall well-being of the child.
  2. Previous treatments have been attempted, some less and some more successful.  The successful treatments affected what was done in this study.

Why is this important?  Well, it's not hard to imagine someone reading the abstract and completely dismissing the study by saying 9:00 is a horrible time to put a child to sleep, 8:30 is a much better time.  Except by reading the background, you discover that's already been attempted and found not to work.  Whoops!

Can't you imagine this study being posted on Facebook, and someone commenting "Everyone knows a warm bath works best to relax you and put you to sleep. What a stupid study. I can't believe we're wasting taxpayer money on this. Thanks Obama!!" ...except that was also attempted, and found not to work, if you had read the background.

Let me be clear...this research it's...it's about our children. It's about...the future of our great country. Which is America, just to be clear.

As well, the background gave the "big picture" idea of why this study is being done. If the purpose of the study was to find out what would benefit the caregivers most, you could arguably propose the best treatment would be putting the child up for adoption! But now that you have the context of the study, you know that's not a viable option.

Methods: The subject was exposed to 2 different treatments and 1 control over the course of 16 weeks.  

Potential variables that were controlled for included:

  • Time when reading began (9:00 PM)
  • Pre-bedtime ritual for up to an hour before bedtime
  • Sugar and caffeine intake after 2:00 PM 
  • Bedroom temperature
  • Bed-sheet color
  • Level of lighting in bedroom during readings 
  • Caregiver doing the reading 

Each treatment was attempted for 2 weeks, with 2 weeks in between each treatment method so that the subject would not become accustomed to the routine. 

During the control periods, the same caregiver would be present in the room, but without reading a story.

The treatments involved rotating 2 different books: Where the Wild Things Are - a more action-packed thriller compared to Goodnight Moon. We wanted to test if the level of excitement in the books affected TTS values.  We hope that this data will help the caregivers select appropriate bed-time books in the future. 

TTS values were collected every day, for a total of 14 data points for each treatment.  The mode was selected as the average for each treatment, as there were typically one or two extreme outliers for each one. 

The methods section is very important! This shows you how the researchers conducted the study in the first place, which tells you if the study is a good one or not.

If the methods were, "our intuition and common sense told us Goodnight Moon was a superior book choice, then we flipped a coin to decide whether it was better than the control," you'd say it was a poorly-done study, wouldn't you?! I hope so!

We're also shown how the researchers tried to make sure nothing else could possibly be affecting the outcome of the study besides the book being read. Maybe they missed some possible other variables, or were unable to control for some, (such as the time of year, it's hard to get kids to sleep around Christmas!) affecting the validity of the results?

Results: It was found that reading Where the Wild Things Are resulted in the lowest average TTS compared to Goodnight Moon and no book. (Figure 1)  The average TTS values for each treatment were:

  1. Goodnight Moon - 21 minutes
  2. Where the Wild Things Are - 13 minutes
  3. Control (no book) - 27 minutes

These findings show a significant difference between TTS in each group.  

ToddlerStudy

Figure 1: Average TTS scores across various 2-week treatments

The findings appear to suggest that a bed-time story is a better treatment than nothing, however further research involving a wider variety of stories is necessary to draw any conclusions. 

Results sections can be pretty cut-and-dry. They tell you what happened, which is pretty important though!

Discussion: Reading of Where the Wild Things Are showed a dramatic decrease in the time it took for the subject to fall asleep as compared to Goodnight Moon and Control treatments. As well, aside from boredom on the part of the caregivers from reading the same book over and over, side-effects were non-existent.  

It is believed that the excitement of the story-line, followed by a slow, soothing ending is what made Where the Wild Things Are the best choice. The subject has a history of enjoying action-packed media, so it is possible this history influenced the outcome of the research.

It is possible that pushing back reading time to 9:30 PM would have influenced the efficacy of the Goodnight Moon treatment, when the subject would be more apt to being sleepy, and more receptive to a low-action story. Further research will be necessary. 

There are many limitations in this study. First, only two books were chosen as treatments - one as a more "action-based" story, and one as a "low-stress" story. However, the subject owns many other books and it is possible their outcomes will be unpredictable. 

As well, we were unable to control for the time of year this study was conducted.  The beginning of December occurred around the same time as the Goodnight Moon treatment. The subject loves Christmas, so his excitement may have adversely affected this treatment's outcomes. 

This study only included one subject, which is another large limitation for general use of this research. Further research with more subjects and a wider variety of treatments will be necessary for public relevance. 

Man, we got a load of information from the discussion section! (That one is always my favorite) The researchers owned up to the fact that this study has little relevance outside of the one subject they studied. Even then, there were many possible alternative explanations.

The researchers are basically straight-up telling us that a headline like, say...

"Scientists show storybook, Where the Wild Things Are, a better sedative than a bottle of Benadryl!"

...just may be a tad inaccurate.

We also learned some limitations we would have had NO IDEA about unless we knew the subject well beforehand, such as Christmas-time is a large confounding variable for him. Realize that important contextual data like this is not always included in the study itself.

This means unless you had been following and studying the subject for a long time prior, you wouldn't be able to grasp the importance of everything going on in the study.

This of course doesn't mean that it's pointless for you to read a study.  Hell, if you read any part of the actual study being discussed in the internet article du jour, you're doing better than 99.9% of the people commenting, and potentially even the person who wrote the damn thing.

If I imagine ignorant commenters like this instead, my soul is much happier.

Being able to point out limitations isn't being critical about what another person believes, it's pointing out how the study they're basing said beliefs on has the potential to be wrong.

At the same time, you need to be able to apply that same idea to yourself and your beliefs.

It's always possible that one study had too many confounding variables and limitations to be useful. So what if we did 99 more studies, and 98 of them showed that Where the Wild Things Are, read at 9:00 PM was the most effective treatment, with just 1 of them showing Goodnight Moon was a slightly better choice?

99% of studies came to one conclusion, 1% came to another. Using this data, which of these statements is more evidence based?

  • "Based on the current evidence, Where the Wild Things Are is the best choice for getting this subject to fall asleep the quickest. Should more studies come out showing otherwise, we will reconsider this stance."
  • "Where the Wild Things Are shows all manner of unnatural things that are not good for a child's developing brain. Here is a study that shows Goodnight Moon is the best choice. The other studies are funded by lobbyists pushing a pro-monster agenda."

And if you read an article that cited the ONE study out of 99 on the subject showing Goodnight Moon was the best choice, not knowing the other studies existed, you might believe it.

This is why if the scientific community comes to a general consensus on a subject matter, you really ought to lend it some credence. They likely know more than you do because they know:

  • The context the studies are done in
  • The entire giant SCOPE of research being done on the subject
  • What limitations and variables really matter
  • The specific scientific jargon used in said studies

If you were the parent of the child in our fake study, you'd roll your eyes at someone telling you that a warm bath is the one true answer. (and maybe start yelling at your television when an ignorant, uninformed pundit started calling you an idiot for believing otherwise)

Now imagine the same thing happening, except you're a scientist who has devoted the past 12 years of your life to studying one specific subject matter for meager pay of about $20,000/yr, and some random person from the internet calls you a Big Industry shill for your findings. I'd probably need to be restrained.

Moral

You use a crude version of the scientific method everyday. Anytime you use logic and information to figure out why your child won't go to bed at night, that's an un-refined version of the scientific method.

When you actually set up an experiment and record the results, that's getting a bit more refined. Trying to control for variables that affect the outcome, considering the context in which you're doing the experiment - that's refining it more and more.

There is A LOT that goes into a full scientific study. You cannot rely only on the abstract of one single study to tell you everything you need to know about a subject.

If anything, read the entire, full study before trying to form any kind of conclusion. If you don't understand the study, don't worry - just don't come to any hard conclusions and be open to the idea that your interpretation is wrong!

Oh, and when the scientific community forms a near-unanimous consensus, you should probably listen to them.

6 Comments

So, if you haven't heard, something pretty cool went down this week:

Dr. Oz was called in by Senator Claire McCaskill to testify at a hearing about weight-loss scams.  Many people in the fitness industry were outraged, assuming that McCaskill was calling on him as an expert witness.

What ensued was much more entertaining.

Claire "I'm so bored of your bullshit" McCaskill vs. Mehment "I have a sweet head of hair" Oz

Claire "I'm so bored of your bullshit" McCaskill vs. Mehment "I have a sweet head of hair" Oz

McCaskill blasted Oz for irresponsible conduct on his show - of promoting several sham products as "miracle" weight-loss cures.  It was pretty glorious to watch.

When I listened to their conversation the first time through, I was struck by how good Oz was at saying a lot of words that sounded like a good defense, yet weren't coherent enough for me to register what he was actually saying.

So, I decided to write a transcript of the entire thing so I could analyze exactly what his defense was.  I inject my commentary below, but if you just want the transcript, you can get it from the following link:

Transcript

Senator McCaskill: "I can't figure this out Dr. Oz...I get that you do a lot of good on your show.  I understand that you give a lot of information that's great information about health, and you do it in a way that's understandable.  You're very talented, you're obviously very bright. You've been trained in science-based medicine."

The above is all true.  Just watch a couple of episodes of Dr. Oz's show; you can find most segments online for free.  Here's a modest clip - no product pushing, just giving out information and advice.  This clip is pretty tame, yet he presents typically 'boring' information in a way that's entertaining for his audience.  Yes, he has a knack for grabbing your attention.  He's very compelling, seemingly genuine, and personable.  Give the man credit where it's due.

It's also true that he has a background in science and science-based medicine.  He got his MD from the University of Pennsylvania, and has been a professor of surgery at Columbia University for 13 years.  He's practiced actual real medicine and been named in actual real studies.  I mean just look at this resume, seriously.

So this is why I have a hard time believing his defense of promoting 'miracle cures' below...

Senator McCaskill: "Now, here are three statements you've made on your show:

  1. 'You may think magic is make-believe, but this little bean has scientists saying they've found the magic weight-loss cure for every body type.  It's Green Coffee Extract.'
  2. 'I've got the number one miracle in a bottle to burn your fat!  It's Raspberry Ketones.'
  3. 'Garcinia Cambogia: it may be the simple solution you've been looking for to bust your body fat for good.'

I don't get why you need to say this stuff, because you know it's not true!  So why, when you have this amazing megaphone, and this amazing ability to communicate, why would you cheapen your show by saying things like that?"

You may have heard about some of these products.  If you have, it's probably from crap advertisements like these from Facebook:

Pulled from the BS Detector handbook.  Hard to find working links to these sites because the domains expire quickly.  Because they're scams.

Pulled from the BS Detector handbook. Hard to find working links to these sites because the domains expire quickly. Because they're scams.

Dr. Oz agreed to come to Senator McCaskill because he does not appreciate his name being used to endorse these specific products.

It's true that he didn't endorse those specific brands, and it's wrong for the products to say that they themselves have been endorsed by Dr. Oz.  He has an acceptable complaint, though he doesn't garner much sympathy from me or Senator McCaskill.  But more on that much later down the page.

Dr. Oz: "Well, if I could disagree about whether they work or not, and I'll move on to the issue of the words that I used.

And just with regards to whether they work or not - take green coffee bean extract as an example - I'm not going to argue that it would pass FDA muster if it was a pharmaceutical drug seeking approval.  But among the natural products that are out there, this is a product that has several clinical trials.  There was one large one, one very good quality one, that was done the year we talked about this in 2012."

I know that everyone loves to hate on the government and especially the FDA. Certainly there are some legitimate criticisms.

But one of the less legitimate criticisms is that the FDA is suppressing cures for cancer and weight loss because of the heartless cancer / diet industries lobbying them.  Yes, the FDA can take a long time approving things.  But is this out of malice or out of being backlogged, under-staffed and under-funded?

In any case, to get a drug approved by the FDA, the following steps must happen:

  1. Test on animals to show reasonable expectation of safety
  2. Get approved to be tested on humans
  3. Go through several phases of testing to discover side effects, ensure safety, show that it works, and figure out appropriate use and dosage on varying populations.  This is the hard part.
  4. The FDA reviews the findings and can approve the drug for market

So when Dr. Oz says that the drug wouldn't pass FDA muster, that means that the drug does not have sufficient evidence to show it works.  Because he literally just admitted this, he is willingly promoting a product as a "miracle cure" to millions of viewers when he knows good and well it has not been shown to work.

Good thing that supplements don't have to be approved by the FDA then, huh?  

Senator McCaskill: "I want to know about that clinical trial.  Because the only one I know was 16 people in India that was paid for by the company that was...at the point in time you initially talked about this being a 'miracle,' the only study that was out there was the one with 16 people in India that was written up by somebody who was being paid by the company who was producing it."

Dr. Oz: "Well this paper argued that there was no one paying for it, but I have the four papers...five papers actually, plus a series of basic science papers on it as well.

Here is the study that McCaskill is referring to.  It's funny that the paper claims no conflicts of interest, but was paid for by the company selling the supplement - Applied Food Sciences, Inc. in Austin, Texas.  If you're interested in a detailed review of this study, I recommend checking out Science-Based Pharmacy's review.

I'm uncertain what other papers Dr. Oz is referring to.  If I knew, I'd look them up. Unfortunately I can't find much research on green coffee bean extract in the first place.  In fact, I've only found papers showing that the supplement is far from a miracle drug; at best promoting only modest loss of a couple pounds, if that.

There just isn't enough good evidence out there that green coffee extract is worth taking.  It's therefore irresponsible to tout it as a "miracle cure."  It's like trying to convict a man of a crime before the evidence has been analyzed because it's merely possible he did it.

"Well, sir, you did live in same area code where the crime happened so..."

"Dr. Oz: But, Senator McCaskill, we can spend a lot of time arguing the merits of whether green coffee bean extract is worth trying or not worth trying.  Many of the things that we argue that you do with regard to your diet are likewise criticizeable.

Should you be on a low-fat diet, a low-carb diet...I spent a good part of my career recommending that folks have a low fat diet.  We've come full circle in that argument now and no longer recommend that.  Many of us who practice medicine, because we realized it wasn't working for our patients."

Here Dr. Oz is attempting to deflect the fact that there is little evidence coffee bean extract is worth buying.  He is doing this by changing the subject to the current low-carb / low-fat diet controversies.  The fact is, low-fat diets aren't inherently "bad" diets anyway.  It's just that you can't tell a patient to go on a low-fat diet and expect them to understand you don't mean to gorge on Snackwell cookies...if they follow your advice at all.

Going on a low-fat or low-carb diet, however, is free and doesn't require buying products.  So there's yet another difference.

Dr. Oz: "So it is remarkably complex, as you know, to figure out what works out for most people even, in a dietary program.  In the practice of medicine we evolve by looking at new ideas challenging orthodoxy and evolving them."

Yes, you challenge orthodoxy with great evidence.

When debating something controversial, I often see people argue, "Galileo was right, but he was punished for his ideas at the time," or, "Barry Marshall was a laughing stock when he said stomach ulcers were caused by bacteria, but he ended up being right," as if those situations are comparable to what they're doing.

But the difference is that these men had evidence on their side to back up their statements, not just a hunch.  That this evidence was initially feared or ignored is human folly, yes.  And it was eventually corrected.

But there is not currently good evidence that these "weight loss miracles" are actually miracles.  This is why we don't believe in unproven cures - not because we're willfully ignoring claims or just being ignorant.  If solid evidence came out that they were useful, we'd change our minds.

Extraordinary claims require extraordinary evidence...and a little bit of time to ponder its merits and re-adjust our worldviews accordingly.

Dr. Oz: "So...these are the five papers, these are clinical papers.  And we can argue about the quality of them, very justifiably.  I can pick apart papers that show no benefit as well.  But at the end of the day, if I have clinical subjects, real people having undergone trials - and in this case I actually gave it to members of my audience.  It wasn't a formal trial..."

Senator McCaskill: "Which wouldn't pass...the trial you did with your audience, you would not say that would ever pass scientific muster?"

Dr. Oz: "No, I would never publish the paper, but it wasn't done under the appropriate IRB guidance - that wasn't the purpose of it. The purpose of it was for me to get a thumbnail sketch of, 'is this worth talking to people about or not?'

That would be all fine and dandy, except that Dr. Oz talked to people about green coffee extract being a miracle cure before he did this little audience 'experiment'!  (Also check out that clip to hear from Dr. Oz why he came to talk to McCaskill.)

Not to mention, despite admitting that this study would never stand up to any kind of scrutiny, he uses the results as "proof" to his audience that the supplement works.

Dr. Oz: "But again, I don't think this ought to be a referendum on the use of alternative medical therapies.  Because if that's the case then listen, I have been criticized for having folks coming on my show and talking about the power of prayer.  Now again, as a practitioner, I can't prove that prayer helps people survive an illness..."

Senator McCaskill: "It's hard to buy prayer."

Dr. Oz: "Yes, it's hard to buy prayer, that's the difference..."

Senator McCaskill: "Prayer is free."

Dr. Oz: "Yes, prayer is free, that's a very good point!  Thankfully prayer is free...but I see in the hospital, when folks are feeling discomfort in their life, and a lot of it's emotional, when they have people praying for them, it lightens their burden."

Here's the prayer episode in question.  Just skip to 4:10 to get to where they talk about the power of prayer.  I imagine the criticism was about a medical doctor bringing someone on his show suggesting that the supernatural is a reliable method for curing what ails us.

As a funny aside, you can buy prayer if you want, no problem!

prayerlol

Farmer's Almanacs have the BEST advertisements

Dr. Oz: "And so my show is about hope.  And I want - and as you've very kindly stated - we've engaged millions of people in programs, including programs we did with the CDC, to get folks to realize that there are different ways - that they can re-think their future.  That their best years aren't behind them, they're in front of them.  That they actually can lose weight.

So, if I can just get across the big message that actually I do personally believe in the items I talk about in the show, that I passionately study them...I recognize that oftentimes they don't have the scientific muster to present as fact."

This is the most telling part of the transcript, in my opinion.

Dr. Oz realizes that the information he gives is not factual - he just stated that exactly above.  He is literally admitting to deceiving his audience.  You can passionately study the mechanics of a Shake Weight, that doesn't make it work any better.

There are entire schools devoted to witchcraft where you can study for years and spend lots of money if you want.  You can believe with all of your heart that you can cast spells. That doesn't make the witchcraft any more credible.  Reality doesn't change.

He wants to give his audience hope?  Give them the stories of people who lost weight using real, effective, proven methods rather than ineffective pills and expensive supplements.

It's like he doesn't trust his audience with the truth.  Losing weight is hard and requires a lot of effort... but don't tell the common folk, they'll lose hope and give up.  We must lie to them for their own good!

You know a great way to lose hope?  Being told you'll lose weight with a product, spending $50 on it, then not losing any weight.  The bottle then joins six of its brethren in the back of a kitchen cabinet, commemorating all the times you've tried - and failed - to lose weight.

Dr. Oz is right - your best years aren't behind you, and you can lose weight.  Just not by doing nothing other than taking green coffee extract.

Dr. Oz: "But nevertheless I give my audience the advice I give my family all the time.  And I've given my family these products, specifically the ones you mentioned, and I'm comfortable with that part.

Where I do think I've made it more difficult for the FTC is that in an intent to engage viewers, I use flowery language.  I used language that was very passionate.  But it ended up not being helpful, but incendiary. And it provided fodder for unscrupulous advertisers.  And so that clip that you played, which is over two years old, and I've hundreds of segments since then, we have specifically restricted our use of words.

And I'm literally not speaking about things that I would otherwise talk about.  There's a product that I have never talked about in the show that I feel very strongly about, because I know what will happen."

'Flowery' is certainly one way to describe his language.  I'd use 'grossly over-exaggerated' or 'completely incorrect,' but that's just me.

So, he claims he has learned his lesson... but has he?

Here's a segment he did not too long ago about how litramine will "flush fat fast" and "literally helps you poop out unwanted fat fast."  I suppose that's not exactly errr....flowery.  But I'm not seeing any big changes in your game plan going on here, Dr. Oz.

Dr. Oz showing how 'Forskolin' literally burns belly fat on yet another episode.  Flowery?

Dr. Oz showing how 'Forskolin' literally burns belly fat on yet another episode. Flowery?

Dr. Oz: "I'll say something very...in fact we did a show, with yacon syrup, which you did not bring up. It's a South American root that had a big study published on it, I think a very high quality study, where they showed that not only did it help people lose weight but it more importantly helped their health.  It was men and women who were diabetic, done by an academic center down there - it was not funded by industry - and we talked about it.  And I used as careful language as I could, and still there were internet scam ads picking one or two supportive words.

Well of course I support them, I wouldn't be talking about it otherwise, but it still ended up out there."

Here's the segment on Yacon.  Sorry...careful language?  What's careful about this?

  • "The shocking results - how women lost weight with no diet, and no exercise!  The secret syrup revealed!"
  • Bring a clip of a woman on the show saying "I lost 13 pounds with no exercise!"

Not exactly being modest with the words there, I don't think.

Senator McCaskill: "Well, I...listen.  I'm surprised that you are defending...I mean I've tried to really do a lot of research in preparation for this trial, and the scientific community is almost monolithic against you in terms of the efficacy of the three products that you've called miracles.

And when you call a product a 'miracle' and it's something you can buy, and it's something that gives people false hope, I just don't understand why you need to go there.  You've got so much you do on your show that makes it different and controversial enough that you get lots of views - I understand you're in a business of getting viewers.

But I really implore you to look at the seven...and I would ask you to look at the seven list that the FTC put out on "The Gut Check."  The seven...it's very simple:

Causes weight loss of 2 pounds a week for a month without dieting or exercise; Causes substantial weight loss no matter how much you eat; Causes permanent weight loss, like you said looking to 'bust your body fat for good'

...if you just look at those seven, and if you spend time on your show telling people that this is the seven things you should know, that isn't magic in a bottle, that there isn't a magic pill, that there isn't some kind of magic root or acaii berry or raspberry ketone that's going to all of a sudden make it not matter that you're not moving and eating a lot of sugar and carbohydrates.

I mean...do you disagree with any of these seven?"

Here's a link to "The Gut Check" article in question.  Good stuff.

Dr. Oz: "Senator McCaskill, I know the seven, I say those things on my show all the time."

Senator McCaskill: "Well then why would you say something is a miracle in a bottle?"

Dr. Oz: "My job, I feel, on the show is to be a cheerleader for the audience.  And when they don't think they have hope and when they don't think they can make it happen, I'm willing to look and I do look everywhere, including alternative healing traditions, for any evidence that might be supportive to them.

So you pick on green coffee bean extract.  With the amount of information I have on that, I still am comfortable telling folks that if you can buy a reputable version of it...and I say this all the time: I don't sell it and these are not for long-term use.

And by the way, with green coffee bean extract as an example, it's one pound per week over the duration of the different trials that have been done.  That happens to be the same amount of weight that was lost by the hundred or so folks on the show who came on, and half of them got a placebo.  We've actually got fake pills, gave it to half the people, real pills, to the other half, and it's sort of the same thumbnail.  I'm looking at a rough idea.

Look, we know the answer to the question "How can I lose weight?"  It's eat less and move more.

What makes that difficult, (and complicates an actual useful answer) among many other factors, is the current food and social environment...and people like Dr. Oz who are promoting a new miracle cure every other week, leaving people confused about what does and doesn't work.

If Dr. Oz truly wanted to be helpful to people, he wouldn't be grasping at straws - massively promoting and exaggerating the benefits of anything that has one tiny study to show it might help you lose one extra pound when combined with diet and exercise.

A poorly-constructed study like the ones he does with his audience don't give him a rough idea.  They're worthless - and he admitted that when he said they wouldn't stand up to scientific scrutiny.

Dr. Oz: "If you could lose a pound a week more than you would have lost, doing the things you should be doing already - you can't sprinkle it on cabasa (?) and expect it to work - but if that trial data is what's mimicked in your life and you get a few pounds off, it jumpstarts you and it gives you confidence to keep going.  And then you start to follow the things we talk about every single day, including all of those seven items, I think it makes sense."

If the only thing that people needed to lose weight and keep it off was to lose the first couple of pounds quickly, then low-carb diets or fasts would be the answer to our weight-loss woes, since they will get you to drop weight initially very quickly. Plus, doing that is free and actually proven.  Unfortunately it doesn't always last.

As well, note how he says that you need to be doing the things "you should be doing already." I assume that means eating a sensible diet and exercising.  Why is it that all weight-loss pills or fitness products say you must combine them with diet and exercise for results?

pill

Oh yeah, it's because it's diet and exercise that get you results, not the product.

Senator McCaskill: "Well, I'm going to give time to my colleagues now, and hopefully I'll have a chance to be able to visit with the other witnesses in the next round.

I will just tell you...I know that you feel you are a victim.  But sometimes conduct invites being a victim.  And I think if you would be more careful, maybe you wouldn't be victimized quite as frequently."

Dr. Oz: "Senator McCaskill, those topics you mentioned are over two years old.  I have not been talking about products in that way for two years, and it has not changed at all what I am seeing on the internet, and frankly it is getting worse.  So I completely heed your commentary, and I realize - to my colleagues at the FTC - that I have made their jobs more difficult.  That's why I came today.

I'm cheerleading for this process.  I want to do anything I can to help, but taking away those words doesn't change the problem that's already happened."

As we've shown above, Dr. Oz is still talking about products with 'flowery' and exaggerated language.  He hasn't changed, but recognizes the problem is still occurring.

So Dr. Oz recognizes that it's bad for his name when other companies claim that he has personally endorsed their products, but doesn't want to have to change his actions so that doesn't happen.

He wants to continue peddling ineffective products on his show for...ratings...or money...or whatever, but without suffering the backlash and negative consequences of doing so.

I agree that advertisers should not be allowed to fake Dr. Oz's endorsement.  But honestly, to me that's a different issue.

Dr. Oz should not be allowed to lie to and deceive his audience - which he above has admitted to doing.

Now, I get that there will never be a regulation that doesn't allow him to say whatever he wants on his show.  The real solution then lies in educating his audience.

How we do that is another subject entirely.  But hopefully by showing them something like the analysis above, they can at least recognize he has faults and has given them bad advice at least once.

And if he's done it once...maybe he's done it twice.  And maybe he could do so again.  And maybe his word isn't gold...

4 Comments

Weight loss certainly has been made a bit confusing over the past few decades.

Not only have you had to worry about if you're eating too much fat, now you have to worry if you're eating enough of the right kind of fat. (Olive oil was one of the good ones, right?  But they also say vegetable oils are bad.  Are olives vegetables...?)

More recently, you've been reading that you shouldn't eat too much sugar.  But only certain kinds of sugar.  Processed sugar is bad.  (Which means like...bread and candy, you're pretty sure, but does that also count dark chocolate?  Wasn't that supposed to be good for you?) And fructose is also bad.  But fruits have fructose...so...what are you allowed to eat again?

I like to partake in the occasional internet meme.

Lately you've been reading that people need to make sure they're eating enough food when trying to lose weight.  What does that mean?  Are they talking about how you need to avoid going into "starvation mode"?  So now not only do you have to balance eating the right kinds of foods, you have to make sure you're not eating too little on top of making sure to not eat too much.

Why are you so weird, stock photos? No one smiles when looking at nutrition labels.

Yikes.  No wonder we all seem to struggle with weight loss.

It doesn't have to be so complicated

So the majority of those first two paragraphs is a mixture of bullshit and things you really don't need to worry about. Magazines, newspapers, talk shows and online publications have a LOT of space and air time to kill.  To avoid talking about the exact same thing over and over, they tend to focus on generating a crap ton of small things that none of us would have to think about if we expanded our vegetable intake from shredded iceberg lettuce in Taco Bell tacos to broccoli and eggplants.

Have olive oil.  Eat fruit.  Eat some bread.  Dip your bread into olive oil with a side of grapes. Relax.

But what about that last one?

Up until a few years ago, I was very confused about what people really meant when they would suspect out loud that maybe they weren't eating enough on their diet.  And no wonder it confused me - it's doubtful that they really knew what they meant either.

Usually it's some notion of "you need to eat enough so you don't go into starve mode," and when you ask what starvation mode is, the answer is typically even more confused. Something along the lines of "if you don't eat enough your body thinks it's starving and won't let you lose anymore weight."

How true is that?

Starvation mode probably isn't what you think

"Starvation Mode" is really just a series of metabolic changes that happen when you lose weight.  The changes are twofold:

  1. Your body resisting the fat loss - increasing your hunger, decreasing your subconscious activity levels (such as foot tapping, leg shaking, your motivation to find a really close parking spot - all referred to as NEAT)
  2. As you lose weight, your body just doesn't require as many calories to maintain itself. A 300-pound person will always have a higher metabolism than a 100-pound person if activity levels are similar

The steeper your deficit, it becomes more likely that you will down-regulate your metabolism faster than you should, but you will never reach a point where it is "impossible" to burn fat. You're not likely to get to a spot where you can't lose weight on 1,200 calories a day.

So how do people eat more to lose weight?

Because in the long-term, they're actually eating less.

Tell me if this scenario rings any bells:

Monday: My diet starts today!  I've got my MyFitnessPal account set up.  1,200 calories a day and I'll be losing 2 pounds per week - I'll get this weight off in no time.

I went grocery shopping yesterday and bought fruits, veggies and lean meats - I did the math and bread and chocolate just have too many calories.  I threw away all the junk food in my house despite my partner's protests.  I'm serious this time.  This time I really commit and make a change.

Tuesday / Wednesday: Man, my sugar addiction must have been worse than I thought!  3 days of veggies and meat and I'm DYING for some chocolate and pastries.  But, I must teach my body that FRUIT is my dessert now!  Time to sit down to some blueberries in non-fat plain greek yogurt!  Tastes just like blueberry pie...!

....

...okay, no it doesn't...

Thursday: Today I looked at the instagram of a figure competitor for some motivation. Knowing that there are really hot people out there who eat mainly broccoli, sweet potatoes, and chicken breasts in tupperware containers makes this process more inspiring.

A new take on "food porn"

Friday: My girlfriends went out for dinner tonight, but I know that if I go out I'm just going to drink wine and eat too much bread.  ...worth...it........?

Saturday: I was really depressed after not going out last night, so when my partner wanted to go to brunch this morning I couldn't say no.  I got the egg white omelette, but he got the pancakes and gave me one.  Ugh.  Totally screwed up.

Sunday: Wow, I really fell off the wagon yesterday.  It all went downhill after that pancake.  I couldn't get enough - we went out for dinner and I got a huge dish AND dessert AND wine. Ugh, I feel so fat.  I don't know how I ate that much in one day.

Monday: I went out to the movies yesterday and ate an entire large popcorn almost entirely by myself.  On top of going out to eat twice. Time to get back on the wagon.  I better only eat 1,000 calories per day this week to make up for what I did over the weekend...

Repeat week in, week out.  Let's look at this in number form.  Suppose your TDEE (the total amount of calories your body needs to maintain its weight) is about 2,000 calories per day.

That means to maintain your weight, you need to eat 14,000 calories per week.  If you want to lose weight, you need to eat less than that.  Even if you go a little overboard on the weekend, you should still be losing weight, right?

  • Monday - Friday: 1,200 x 5 = 6,000
  • Saturday - Sunday: 4,000 x 2 = 8,000
  • Total: 14,000

Suddenly no more deficit.

You may be thinking "there's no way in hell I eat 4,000 calories in one day!"  Sadly, it's a lot easier than you might think:

  • Breakfast: Starbucks Vanilla Frappucino (Grande) & Blueberry Scone - 800 calories
  • Snack: Granola Bar - 200 calories
  • Lunch: Subway foot-long Chicken Teriyaki with chips and a sprite - 1,090 calories
  • Snack: Gas station slushie - 300 calories
  • Dinner: 1/2 Rack Outback Baby Back Ribs, mashed potatoes, 1/3rd of a piece of chocolate cake & 2 glasses of red wine - 1,800 calories
  • Total: 4190 calories.  Whooooopsie.

It doesn't even have to be in concentrated meals.  Maybe you eat the entirety of a tub of icecream over 2 days.  Maybe it's a bag of M&M's you have beside you while you're watching TV.  Maybe it's getting all the fixings plus a crap ton of dressing on your salad.

1,690 calories right there.

I've done this.  I know the feeling of eating more than you ever thought possible but still finding room - and the motivation - to eat more.  It's almost depressing.

But the solution for me wasn't to cut more calories during the week to "make up" for binges that I thought were just inevitable.  My solution was to eat more during the week so that binges never happened.  

"Eat more to lose weight" needs to be re-phrased

A more appropriate, but much less sound-bite-worthy phrase would be "eat more calories throughout the week instead of at huge deficits so that over the course of a week or two you are actually eating less overall."

Instead of shooting for a huge deficit, why not try a much smaller one?  See if this week plan sounds better to you:

Monday: Today I'm going to make a lifestyle change.  I'm not going to starve myself this time around - but if I'm honest with myself I really don't need as much food as I've been eating.  I can reasonably cut my portions by a quarter or a fifth and lose weight.  It won't be as quick, but I'm in this for the long haul.

Tuesday - Thursday: This is actually going a bit easier than I thought.  It takes some conscious effort, but I think over the long-term I won't have to think about it so much.

For dinner, I am eating just a little bit less of my usual steak and potatoes.  I usually crave sugar around 3 PM and cave into some Oreos, but instead I just added some chocolate squares or my favorite kind of granola bar onto lunch, and I found that the craving was gone.

Friday: I went out with my girlfriends for dinner tonight!  I usually try to "save up" calories throughout the day when I know I'm about to go out to eat, but I decided to eat normally. I was able to stick to 1 slice of bread from the basket, and I wasn't starving so I was able to enjoy my steak without going overboard.  I actually couldn't finish the whole thing.

Saturday: Went out to brunch with my partner.  Got some eggs benedict and snuck a couple of bites of the pancakes he got!  Wasn't super hungry at lunch after that, so I stuck to the 6-inch sub.  Dinner was delicious - but the chocolate cake was so rich I could only stand a few bites.  They were AMAZING though!

Sunday:  Went to the movies and got a small popcorn.  I basically always eat the whole thing while I'm there - I've heard mindless eating is a huge thing at the movies.  But thankfully there wasn't too much in the small, and I wasn't as hungry for the rest of the day.

Monday: The scale didn't change too much.  But it's only been one week, and I know I ate less than I normally do.  And the best part is, this is the first week on any diet I've ever been on where I haven't been tempted to binge.  I think I can keep this up.  I'm proud of myself!

So taking our same person with a 2,000 calorie TDEE (14,000 calories per week) who is shooting for 1,800 calories per day.  Hell, I'll even say on that Saturday she ate more:

  • Monday-Friday: 1,800 x 5 = 9,000
  • Saturday: 2,100
  • Sunday: 1,900
  • Total: 13,000

You've suddenly gone from a miserable week with no deficit to a fairly sustainable week with a 1,000 calorie deficit.  It's not huge, but it's better than nothing and more likely to be sustainable in the long-term.

Moral:

Eat more to lose weight means:

  1. Eating at a small deficit rather than a huge one.  This is to avoid the intense hunger pangs and binging that lead to a halt or reverse in your weight-loss progress.
  2. Your NEAT activities won't decrease as much, meaning that your TDEE doesn't decline so sharply.
  3. You will have more level and sustained energy for your workouts instead of swinging from "no energy" on your low-calorie days to "too bloated to move" on binge days.

All of these things lead to a more enjoyable weight-loss experience - one that is more sustainable and successful over the long term.

I hope that this clears things up a bit - if you've got more questions or comments, leave them below or give me a shout on Facebook!

P.S. I'd feel remiss if I didn't mention Leigh Peele's book "Starve Mode" if you're interested in more details about the metabolic changes that can happen when you lose weight.