There is another strange medical thing making the Internet rounds again.
People are asking me what I think, so I will tell them, and anyone else who cares.
These are useful things to review not because they are particularly sophisticated bits of media (they aren’t) but because we can learn things about how to assess such material for ourselves.
The first is called “Heart surgeon speaks out on what really causes heart disease.” I’m going to address this according to the various rhetorical tricks or tactics that the article uses, which is authored by a Dr. Luddell.
Right off the top, consider the source. The same webpage tells us that “Strong evidence links vaccines to autism.” As readers of this on-line rag have learned before, this is fear-mongering nonsense. Such evidence simply does not exist. Anyone who claims it does is either misinformed, lying, or incapable of assessing scientific evidence.
But, leaving that aside, let’s consider the arguments and tactics.
Tactic #1: The argument from authority
In the first place, we should be wary because this is what is called the “argument from authority”—it tells us to listen to someone because of their credentials.
Now, being a doctor myself, I obviously think that credentials are worthwhile. But, the question is not, “Does this guy have credentials?” but “Does this guy have credentials and is he reflecting the evidence that other people with credentials would also appeal to?”
Pause for a minute and ask yourselves—is a “heart surgeon” really an expert on what causes heart disease?
That might seem a strange question. But, you don’t go for heart surgery until you have heart disease. We aren’t told what kind of open-heart surgeries he’s performed. Maybe they were all valve replacements, or maybe he spent all his time repairing pediatric hearts born with defects. These surgeries have nothing to do with cholesterol or fats or anything else he’s talking about, and so his “authority” at replacing my valve might apply very little to teaching me about fat biochemistry.
But, if this was a court of law, and Dr. Luddell was offered as an expert witness, we’d be entitled to evaluate both his credentials (i.e., what makes him an expert) and his record (i.e., whether he is a reliable witness). Let’s do this.
Court Test A: The argument from irrelevant authority
In the interest of bending over backwards to be fair, let’s be generous and assume Dr. Luddell has performed 5,000 cardiac bypass operations—this is rerouting blood to the heart past blocked arteries. Well and good—if I need it done, I’d probably want someone like him (but not him—see below in the next section!) to do it. But, the fact that he might be technically very good at doing so doesn’t mean he knows the first thing about what causes the blockages he’s repairing. He has not spent his career with people coming to him with healthy hearts saying, “Please, Mr. Heart surgeon, tell me how not to need your services in twenty years.”
So, even though he is an authority—of sorts—is he qualified to pronounce on the matter at hand? To me, not at first blush. I’ll bet a family practice doctor does far more of that in a year than he has in his whole career.
Court Test B: Compromised authority
The article also does not tell us that Dr. Lundell lost his medical license, and was subjected to a number of regulatory actions. But, he’s the one who brought up his credentials and experience, so we’re entitled to check.
The Arizona Medical Board had numerous problems with him:
- In 2000, the board concluded that his postoperative management of a patient who had died following carotid artery surgery was substandard and insufficiently documented. He was censured for unprofessional conduct, assessed a $2,500 civil penalty, and placed on probation during which he was required to take continuing medical education courses in carotid artery surgery and medical recordkeeping. He was also required to submit to monitoring of his patient records .
- In 2003, the board noted that 13 out of 20 charts reviewed by the consultant were deficient because they did not include adequate initial evaluations of the patients. Lundell was censured again and was placed on probation that included quarterly chart reviews .
- In 2004, the board found fault with his management of two patients and concluded that his records for these patients were inadequate. He was reprimanded and ordered to serve two more years of probation, during which he was required to undergo an extensive evaluation of his fitness to continue practicing medicine .
- In 2006, the board sent him an advisory letter for failure to maintain adequate records and for a technical surgical error .
- In 2008, the board reviewed Lundell’s management of several more patients and revoked his medical license. The board’s order mentioned that the board was investigating his care of seven patients because the Banner Desert Medical Hospital had suspended Lundell’s surgical privileges.
This is a pattern that appears to be severe, repeated misbehavior and gross clinical negligence. He lost his surgical privileges, and then lost his medical license. So, not only is Dr. Lundell’s authority not particularly relevant to the case at hand, but his peers and regulatory body have found that he is not professionally adequate in those areas in which he is supposedly an expert—i.e., cardiac surgery.
Now, why do you suppose we weren’t told this when he trotted out his 25 years’ experience? Probably because “I’m a cardiac surgeon who got repeatedly reprimanded, placed on probation, and lost my license and operating privileges” doesn’t sound quite as convincing.
Tactic #2: The conspiracy
Dr. Lundell tells us that he’s finally going to come clean; doctors “often acquire a rather large ego that tends to make it difficult to admit we are wrong.” Fair enough. Most people have that problem, it seems to me.
But, he’s going to tell you what everyone else is supposedly hiding from you.
The problem with conspiracy thinking is that it is impossible to disprove. If I disagree with him, then I’m either part of the conspiracy (and should be ignored) or I’ve been misled by it (and so should not be trusted to get it right). Note how to disagree with him has been subtly made to mean that it’s because of my ego. This distracts us from the evidence.
And besides, if he’s been wrong and misleading people for 25 years, and has only now decided to come out with the truth, why should we believe him now?
How do I know if his ego won’t let him admit that he’s wrong now? Or, if he was deceived and misled before, why should we trust him now?
Or, was he ignoring the truth because it made him money before? If so, how do I know he isn’t doing the same thing now?
You see, he was doing heart surgery in what appears to have been a dangerous and inadequate way. He can’t do that any more.
Now that he can’t make money doing that, he’s making money doing something else in the medical realm—he sells and book and flogs other products talking about cholesterol.
Tactic #3: Ignore your own economic biases; blame everyone else for theirs
Dr. Luddell also does not tell us that he has been found guilty of breaking tax laws by refusing to file income taxes—so, he has been found to be dishonest with the government. He’s also declared bankruptcy a few times—which ought to at least raise the issue of whether he’s speaking to us simply out of disinterested scientific honesty, or whether he stands to gain from selling books and supplements about cholesterol:
- In 1990 Lundell filed for bankruptcy. At that time, there were several lawsuits pending in state court on the theory that he was a partner in a construction business called West Coast Construction in which he had invested. [We] don’t know the outcome of these suits, but he ultimately wound up owing at least $20 million dollars.
- In 2005, he again filed for bankruptcy, claiming to have assets of $12,990 and liabilities of $20,185,769.60. The liabilities included $74,264.77 in credit card debts, $78,932.48 for accounting services, the $20 million debt related to the previous bankruptcy, and “unknown amounts” of state and federal taxes owed. The financial statement also listed his earnings as $0 for 2005, $0 for $2004, and $288,436 for 2003.
- In 2004, Lundell pleaded guilty in federal court to three counts of willful failure to file income tax returns. A newspaper report indicates that he had become a client of “tax protester” Wayne C. Bentson after a long-running dispute with the IRS and that rather than filing tax returns from 1992 to 1996, Lundell had filed affidavits contesting the government’s right to levy taxes . In 2005, Lundell was sentenced to three years’ probation, but the probation was terminated after 16 months. Bentson was ordered to pay $1,129,937 to the Internal Revenue Service and was sentenced to four years in prison, to be followed by three years of supervised release.
Tactic #4: Appeals to “evidence” that never gets cited
So, Dr. Lundell’s status as a competent, reliable, and disinterested witness about these matters is subject, in my opinion, to question.
Let’s turn now to the evidence he offers. After all, if he offers us reliable evidence, it doesn’t matter if he’s been unreliable before. Good evidence is good evidence.
Unfortunately, while he promises us reliable evidence, he never actually provides any. He makes statements like this:
- The long-established dietary recommendations have created epidemics of obesity and diabetes, the consequences of which dwarf any historical plague in terms of mortality, human suffering and dire economic consequences.
But, he never cites any evidence. No references, nothing. We’re supposed to believe on his authority alone. And, I think we’ve seen that that authority is questionable.
Tactic #5: Half-truths and straw men
Some statements are true, in so far as they go, but don’t tell the whole story. For example:
- Simply stated, without inflammation being present in the body, there is no way that cholesterol would accumulate in the wall of the blood vessel and cause heart disease and strokes. Without inflammation, cholesterol would move freely throughout the body as nature intended. It is inflammation that causes cholesterol to become trapped.
It is true that inflammation is necessary for the formation of cholesterol deposits. But, such deposits also require other things—it is not as simple as “inflammation” = problems. The deposit of cholesterol is called atherosclerosis. Here’s what a genuine medical source says about it:
Atherosclerosis is a multifactorial disease that usually develops many years before any clinical symptoms are manifest….
“Multifactorial” means “caused by lots of things”—a “multitude of factors.”
The same author even talks about how inflammation is “central” to the whole process of atherosclerosis, but puts it in a much broader context, unlike Luddell. So, scientists or doctors aren’t denying this link either. That’s a “straw man”—a false argument that’s easy to beat up. Straw men look like real fighters, but they don’t hit back.
- “The rest of us have simply followed the recommended mainstream diet that is low in fat and high in polyunsaturated fats and carbohydrates, not knowing we were causing repeated injury to our blood vessels. This repeated injury creates chronic inflammation leading to heart disease, stroke, diabetes and obesity.”
Well, part of the problem is that many of “the rest of us” have not followed the mainstream diet recommendations that are low in fat. Most people don’t follow good dietary habits at all. And, if Dr. Lundell doesn’t know that after 30 years as a cardiac surgeon, one simply has to throw up one’s hands in utter despair. Such blindness or stupidity can’t be cured, only pitied.
One of the best analyses of all good studies of diet modifications found that dietary fat modification doesn’t change the number of people that die, or the number that die from heart attacks. It does, however, reduce the number of people who have heart attacks. So, if you’d have died of your heart attack, your diet won’t fix that. But, diet can help you avoid a heart attack and live with the consequences all together by about 14% overall (in men; there aren’t enough trials in women to know for sure). Here’s the plain language summary:
Modifying fat in our food (replacing some saturated (animal) fats with plant oils and unsaturated spreads) may reduce risk of heart and vascular disease, but it is not clear whether monounsaturated or polyunsaturated fats are more beneficial. There are no clear health benefits of replacing saturated fats with starchy foods (reducing the total amount of fat we eat). Heart and vascular disease includes heart attacks, angina, strokes, sudden cardiovascular death and the need for heart surgery. Modifying the fat we eat seems to protect us better if we adhere in doing so for at least two years. It is not clear whether people who are currently healthy benefit as much as those at increased risk of cardiovascular disease (people with hypertension, raised serum lipids or diabetes for example) and people who already have heart disease, but the suggestion is that they would all benefit to some extent.
So, rather than the silver bullet Dr. Luddell promises us, this scientific evidence is measured, balanced, and provides some benefits but isn’t the whole story.
Dr. Luddell also fails to mention hypertension (high blood pressure) as a cause of atherosclerosis. Note this genuine scientific review that notes:
Hypertension is a risk factor for the development of atherosclerosis, although the mechanisms have not been well elucidated. As the cellular and molecular mechanisms of the pathogenesis of atherosclerosis and the effects of hypertension are being more clearly defined, it becomes apparent that the two processes have certain common mechanisms. The endothelium is a likely central focus for the effect of both diseases. There is increasing evidence that atherosclerosis should be viewed fundamentally as an inflammatory disease. [What do you know, doctors aren’t lying or hiding it! And, this goes all the way back to an article from 1995. Maybe the conspiracy Dr. Luddell talks about isn’t quite as he claims.But, read on….]
… there is evidence that hypertension may also exert oxidative stress on the arterial wall. This article reviews evidence that leads to the postulate that hypertension predisposes to and accelerates atherosclerosis at least in part because of synergy between elevated blood pressure and other atherogenic stimuli to induce oxidative stress on the arterial wall.
So, it isn’t just inflammation. Hypertension plays an important role, for example (and there are other things besides).
Once again, the story just isn’t as simple as Dr. Luddell claims, and “mainstream” physicians and scientists have been talking about it since the mid-1990s at least. We certainly heard about it when I was in medical school, and I graduated in 2000.
This doesn’t mean that diet changes are a failure or useless, it simply means that atherosclerosis is a complex problem, with complex causes. There is no one magic solution—from medicine or from Dr. Luddell.
We all have to die of something after all, and as the population gets older, atherosclerosis will be a problem regardless. It’s just one of those diseases you get when you get older.
Ironically, the statin drugs (the most commonly prescribed cholesterol medications) may exert some of their effect by anti-inflammatory mechanisms. These drugs have been shown to reduce heart attacks in various clinical trials. They also help “stabilize” plaques so they are less likely to break and cause artery blockages. But, statins are “pooh-poohed” by Dr. Lundell because despite them we still have heart disease. Well, complex diseases are like that—a single treatment won’t cure everything or prevent everything.
It is naïve to think otherwise.
Tactic #6: Silly statements
Some of the statements are just absurd. For example, he concludes with this statement:
- “What you can do is choose whole foods your grandmother served and not those your mom turned to as grocery store aisles filled with manufactured foods. By eliminating inflammatory foods and adding essential nutrients from fresh unprocessed food, you will reverse years of damage in your arteries and throughout your body from consuming the typical American diet.”
But, if things were this simple, then no one in the past (before processed foods) would have died of heart attacks or strokes. But, people did die of heart attacks and stroke, long before Twinkies and Big Macs. This suggests, to anyone who thinks about it for even a minute, that Dr. Lundell’s simplistic “it’s all about inflammation and it’s all from processed foods” claim is just wrong. Not just in error, but absurdly in error.
- Inflammation is not complicated — it is quite simply your body’s natural defence to a foreign invader such as a bacteria, toxin or virus (emphasis added).
This made me laugh. Inflammation is not simple—it is an extraordinarily complex system, that is still imperfectly understood.
Here’s a partial diagram of the system:
This is many things, but “simple” is not one of them. I think it fair to call it “complex”.
And, once the signals show in this diagram reach the cells, there’s a whole bunch of stuff that goes on inside. Here again is part of one pathway in one type of cell:
Why does Dr. Lundell say this is all so simple? Well, he wants you to buy his explanation. He wants you to believe that you understand something that arrogant smart scientists and doctors either ignore or lie about. He’s condescending to you—he’s telling you this is simple stuff and urging you to trust him, when it isn’t simple, and he probably shouldn’t be trusted (in my opinion).
And, if it isn’t simple, then his simple solution probably isn’t the cure-all which he claims it to be.
But then, you won’t pay him for his books (notice the book jacket with him dressed as a surgeon—even though he lost his license and surgical privileges).
So, am I saying inflammation doesn’t matter? No. Am I saying diet doesn’t matter? No. Am I saying doctors have all the answers? No.
But, Luddell’s material is biased, over-simplified, and often simply false. His record and resume do not make him someone I would recommend trusting. And, his article does not prove or provide what it claims.
 Stephen Barrett, “A Skeptical Look at Dwight Lundell, M.D.” (8 February 2013); citing Findings of fact, conclusions of law, and order (decree of censure & probation). In the matter of Dwight C. Lundell. Before the Arizona Board of Medical Examiners, March 20, 2004.
 See Barrett, as cited above.
 Jean Ferrières, “Effects on Coronary Atherosclerosis by Targeting Low-density Lipoprotein Cholesterol with Statins,” American Journal of Cardiovascular Drugs 2009;9(2):109-115.
 Citing K Croce and P Libby “Intertwining of thrombosis and inflammation in atherosclerosis,” Curr Opin Hematol 2007 Jan; 14 (1): 55–61
 Latest Cochrane review on dietary fats and cardiovascular disease, (12 August 2011). Click the links to see the full studies. The Cochrane collaboration is one of the preeminent evidence-based medicine organizations.
 R. Wayne Alexander, “Hypertension and the Pathogenesis of Atherosclerosis, Oxidative Stress and the Mediation of Arterial Inflammatory Response: A New Perspective,” Hypertension 1995; 25: 155-161