TELEOANALYSIS — OR WHEN I FINALLY REALIZED THAT I HAD FALLEN DOWN THE RABBIT HOLE

[Guest guest]

TELEOANALYSIS — OR WHEN I FINALLY REALIZED THAT I HAD FALLEN DOWN THE RABBIT

HOLE

The first step in teleoanalysis, as demonstrated in a paper just published in

the British Medical Journal, apparently, is to condemn all clinical trials that

fail to show you what you want…. And it appears that this method of analysis

provides the answers to questions that would be obtained from studies that have

not been done or cannot be done….This way you can always get the results you

want….When I read this I thought it must be a joke….But it was not a joke….

By RFD Columnist, Dr. Malcolm Kendrick

 

http://www.redflagsweekly.com/extra/2003_sept17.html

 

 

September 17, 2003

 

TELEOANALYSIS — OR WHEN I FINALLY REALIZED THAT I HAD FALLEN DOWN THE RABBIT

HOLE

 

By Malcolm Kendrick MbChB, MRCGP (email - malcolm )

 

After reading a paper in the British Medical Journal which appeared a few days

ago, I didn’t know whether to laugh or cry, or stand at the edge of a cliff and

scream. Instead I thought I would write a column, so that you may share my sense

that the world has finally gone completely bonkers.

 

The paper was called:

 

‘Teleoanalysis — combining data from different types of study’

 

Which sounds pretty unremarkable, and contains seemingly sensible remarks, such

as: ‘Teleoanalysis can be defined as the synthesis of different categories of

evidence to obtain a quantitative general summary of (a) the relation between a

cause of a disease and the risk of the disease and (b) the extent to which the

disease can be prevented.’

 

My, how reasonable this seems. Yes, of course, carry on — carry on. This is

mathematics isn’t it, or something of the sort? So, what comes next?

 

‘It may also be necessary to quantify the individual effects that relate to

separate steps in a causal pathway–that is, the effect of factor A on disease C

is determined from the estimate of the effect of A on an intermediate factor B

and the estimate of the effect of B on C, rather than by directly measuring the

effect of A on C. The exercise is like putting together the pieces in a jigsaw

puzzle.’

 

I see, so A causes B, and B causes C. So it can be deduced that A causes C.

Bravo…. Well done. How simply splendid.

 

Therefore, we can use the following reasoning.

 

A high saturated fat intake (A) causes an increase in cholesterol levels (B) (A

causes B), a raised cholesterol level (B) causes heart disease © (B causes C).

Ergo, we know that a high saturated fat intake causes heart disease (A causes

C).

 

You may not think that there is anything much wrong with this. It sounds utterly

logical — doesn’t it. So, why is anyone bothering to write this article?

 

Well, you see there is a problem with the ‘saturated fat caused heart disease’

hypothesis. Namely, that no interventional trial has ever shown that reduced

saturated fat intake has any impact whatsoever on heart disease rates. (An

interventional trial is one where you ‘intervene’ and change something, such as

dietary fat intake — these are normally considered ‘gold standard’ clinical

trials). As admitted by the authors:

 

‘A meta-analysis of randomised trials suggested that a low dietary fat intake

had little effect on the risk of ischaemic heart disease.’

 

So we have a problem. We ‘know’ that saturated fat raises cholesterol levels,

and we ‘know’ that raised cholesterol levels cause CHD. We just can’t seem to

show that if you lower the saturated fat intake you have a reduction in the rate

of CHD. Which would kind of suggest to most people that A doesn’t cause B, and B

doesn’t cause C.

 

But no, this cannot be true, this is wrong! Therefore, any results contradicting

this must be wrong. So there! It’s always reassuring when a scientist just

‘knows’ that something is true. It avoids all those tedious clinical trials that

are sometimes needed for proof.

 

Anyway, in order to prove that the interventional trials are wrong we use

teleoanalysis. The first step in teleoanalysis, apparently, is to condemn all

the trials that fail to show what you want, using statements such as: ‘But the

effect of a significant reduction in dietary fat can easily be underestimated,

even when it is based on the results of randomised trials.’

 

Then we use the second step in teleoanalysis, which is that we to look at the

studies we want (A causes B, and B causes C — carefully ignoring all studies

that showed the complete opposite), and from that extrapolate the answer to

studies that have not been done, but had they been done, would have shown

exactly what we already know to be true. You think I am joking?

 

‘…teleoanalysis provides the answer to questions that would be obtained from

studies that have not been done and often, for ethical and financial reasons,

could never be done.’

 

It is so much better, I find, to rely on answers from studies THAT HAVE NOT BEEN

DONE, and COULD NEVER BE DONE. In this way you can always get the results that

you want, and you never ever need to carry out any more studies that might

contradict the things you already know to be true because for ethical and

financial reasons these trials never can be done.

 

Truly… I mean. Gasp….thud. When I read this, I thought it must be a joke. But

this was written by one of the authors of the infamous Polypill article,

suggesting a one-trick multiple pill could prevent heart disease. The man who

also wrote the ‘time-lag hypothesis,’ explaining that the French don’t have much

CHD because they haven’t been eating as much saturated fat as people in the UK

and USA, at least not before 1970.

 

Are there any limits to the double-speak that can be used to prop up the

diet-heart hypothesis? Apparently not. Perhaps I will wake up and find this is

all a dream, for right now I do feel as if I have fallen down the rabbit hole.

 

P.S. If you think I have made this up as a joke, I refer you to the BMJ article

(below).

 

http://bmj.bmjjournals.com/cgi/content/full/327/7415/616

 

 

 

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