This is from my archive, but it suits this subject:
________________________________________________________________
http://abundantbrain.com/2010/09/why-de ... -is-wrong/
THE BLOG
It was an interesting read, in more ways than one.
The blog was well written, and seemed to make a logical case that Ornish was either dishonest, or failed to really look at the underlying data.
I've learned that literature debates are much like jury trials: no matter how compelling the prosecutor's opening statement may seem at first glance, the opera ain't even begun till the defense makes it's counter statement. Then there's the meat of both cases: witnesses, evidence, cross and recross.
Preston's blog about Ornish would be the prosecutor's opening statement. And I'm not well versed enough in observational studies to critique his argument just on it's face value.
Nothing there to disagree with. On the subject of blogging, there's an interesting reference to Ornish in the following:
http://www.cholesterol-and-health.com/China-Study.html
THE COUNTER
Since the prosecutor's (Preston) case was posted in an obscure blog, rather than a prestigious, peer-reviewed medical journal, it's unlikely Ornish will address him directly.
But if there's enough outcry on the blogosphere, Ornish may respond in a more public form, like the Huffington Post.
I found an interesting quote on Ornish by Anthony Colpo, who calls himself an "independent researcher":
"The Multicenter Lifestyle Demonstration Project sought to apply the intervention in Ornish's original trial to a larger group of patients recruited from clinics across the US.(40) Practitioners from eight medical centers around the country were trained in all aspects of the Lifestyle program, which they proceeded to administer to patients with coronary artery disease. The study was not a randomized, controlled trial; instead, outcomes in the 194 patients who completed the intervention were compared with 139 patients who did not take part in the Lifestyle program.
After 3 years, there were no significant differences in cardiac event rates nor mortality between patients in the intervention and control groups. The number of cardiac events per patient year of follow-up when comparing the experimental group with the control group was as follows: 0.012 versus 0.012 for myocardial infarction, 0.014 versus 0.006 for stroke, 0.006 versus 0.012 for non-cardiac deaths, and 0.014 versus 0.012 for cardiac deaths (none of the differences were statistically significant)."
FINDING PRESTON
Failing a direct mano a mano, it's worthwhile taking a closer look at the contenders.
The blog was written by someone named "Preston". This person ran his blog from May to November of 2010, then stopped.
Typically, most science bloggers are delighted to feature their full names and CVs.
Not Preston.
Clicking on the blog's "About", "Bio" or "Contact" tabs brings up blank pages. Rather strange.
I had to do a bit of Googling detective work until I was able to figure out who Preston is and what his credentials are.
It's listed in exactly one webpage, an MCAT prep course outfit called The Princeton Review. At the bottom of the page, in tiny print, they mention they're not affiliated with Princeton University.
http://www.princetonreview.com/medical/ ... go-ca.aspx
IN THIS CORNER, FIGHTING AT FLYWEIGHT, PRESTON SWIRNOFF
Preston Swirnoff, Ph.D.
"Preston has been teaching MCAT Biology for The Princeton Review since 2000 and has been a consistent student favorite. He received his Ph.D. in neuroscience from UCSD where he studied neurodegenerative disease and brain metabolism. Preston has conducted post–doctoral research at the Stein Institute for Research on Aging and currently runs his own nutrition and wellness consulting practice."
Sounds qualified enough.
BUT WHERE'S THE BEEF?
Since he has a Ph.D in nueroscience, and has conducted post–doctoral research at the Stein Institute, I eagerly turned to Google Scholar to read his published papers.
I tried and tried, but no matter how I entered his name or field of science, I came up with . . . zilch.
Not even a short letter in an obscure, non-peer reviewed journal, not a book, not a pamphlet, nothing.
http://scholar.google.com/scholar?hl=en ... =&as_vis=0
(Hit search scholar button)
A Ph.D researcher without a single word in Literature Land? Hmm . . .
Using my wife's name, position and NYU Medical email addy, I sent off an email to The Stein Institute for Research on Aging asking if Preston ever conducted research for them. That was early this morning, and they haven't gotten back to me yet.
Let me know if you do find out anything.
AND IN THIS CORNER, FIGHTING AT HEAVYWEIGHT, DEAN ORNISH
Ornish holds a Bachelor of Arts from the University of Texas at Austin and earned his M.D. from the Baylor College of Medicine. He served a medical internship and residency at Massachusetts General Hospital.
He has received several awards, including the Kellermann Memorial Award for distinguished contribution in the field of cardiovascular disease prevention from the International Academy of Cardiology, and the Beckmann Medal from the German Society for Prevention and Rehabilitation of Cardiovascular Diseases
ORNISH'S PAPERS
Ornish's initial study was a randomized controlled trial known as the Lifestyle Heart Trial, with data published in the Lancet in 1990. The Lancet is the most prestigious medical journal in Europe, comparable to The New England Journal of Medicine here in the states.
His follow-up studies were published in the Journal of the American Medical Association, and the American Journal of Cardiology, equally prestigious journals. The competition to be published in any of these world-class journals is intense, and they only publish the cream of the crop of medical papers. It goes without saying that the published papers are thoroughly peer-reviewed.
I AIN'T GONNA LIE
It's been a while since I reviewed Ornish's work, so I re-reviewed his old papers and closely read two studies of his I wasn't familiar with.
As I said, I ain't gonna lie: I was blown away.
Except for population size, his studies are, imho, impeccable and utterly groundbreaking.
Although he fully randomized his patient selections, in two of his studies, his experimental groups (the ones doing the Ornish lifestyle changes) were far sicker than his control groups.
All patients had severe cardiovascular disease. Their disease was monitored by invasive angiogram, the gold standard for cardiac imaging.
I've had an angio done, and while not painful, the concept is hair-raising: the surgeon threads a wire up your leg or your arm and directly into your heart. The wire injects a radioactive contrast medium and then the results are sharply imaged.
DA SKINNY
I'll just cut to the skinny. In all Ornish's experimental patients, the lifestyle changes simply reversed their heart disease.
The degree of change was directly related to how closely each patient followed his protocol.
None of the experimental patients in one study took any anti-lipid medications for 5 years, a huge leap of faith on their part, while the control groups took the standard medications for CHD patients. Both groups exercised.
After 1 and 5 year intervals, the control patients also received angiograms. Their heart disease had progressed, as expected in all previous studies of patients with CHD taking the standard batch of medicines (anti-hypertensives and anti-lipids).
Other doctors have done similar studies (Caldwell Esselstyn and K. Lance Gould) and confirmed Ornish's incredible findings: heart disease can be reversed.
Currently, Ornish is working on cancer patients, and the preliminary—and I do emphasize the word preliminary—results are positive and need to be followed up with larger studies.
SO WHAT DOES THIS PROVE?
Nothing.
It's entirely possible that in posting on the Huffington Post, and not a peer-reviewed journal, Ornish got sloppy, and didn't review the observational study in depth.
Preston Swirnoff may or may not be a complete fraud, but I don't care if a scientific argument comes from a complete lunatic: if an argument is valid, it's valid.
Regardless of the source.
