Is This the Right Room for an Argument?

As the resident “scientific advisor” here at ultimatefatburner.com, I occasionally get called on to comment on issues unrelated to my primary tasks (writing bodybuilding supp and functional food reviews; blogging).  Thus, it was no surprise to find an e-mail from Paul in this morning’s messages, asking for my feedback on an exchange he had with Dr. Ben Gonzalez, over his (negative) review on hCG for weight loss.

OMFG!

There’s a ton o’words hiding behind the above links.  Click on ‘em if you’d like the long version, but here’s the gist of it… Dr. Gonzalez owns/operates a wellness/anti-aging clinic: the Atlantis Medical Wellness Center in Washington, DC.  He uses the hCG Protocol – a rigid, 500 calorie diet in conjunction with hCG injections – in his practice, and feels that it has been outstandingly successful on the selected, obese patients (over 200 patients and counting) it’s been used on.  So he posted some (lengthy) comments over at Real-Customer-Comments.com to protest the negative tone of Paul’s review.

Now personally, I think Paul’s response to Dr. Gonzalez’s comments was spot on:

Our job is to look at the existing data, compare it to the claims, and report on the results. That’s exactly what we did here. Looking at the published data, how could you come to any other conclusion? As you say yourself, even the positive results you have obtained are anecdotal. In other words, even you have no real evidence.

Badda-bing, badda-boom.  Short. Sweet. To the point.  I honestly can’t improve on that.  The evidence shows that a highly restrictive diet + hCG is no better than the same diet + placebo.  This is precisely what Paul reported…and Dr. Gonzalez presented ZERO evidence to to the contrary.

So why am I piling on?  It’s pretty simple, really.  In his (very extensive) comments, Dr. Gonzalez makes certain points that virtually scream for rebuttal. The word of an MD carries a lot of weight with the general public, so the flaws in his argument(s) need to be addressed in more detail than Paul was able to provide in the hCG comment thread.

So let’s take Dr. Gonzalez’s points from the top…

1. I made the same mistake every other traditionally trained health professional does when looking at the protocol. I looked at it from a narrow minded view. “It’s not FDA approved, anyone can lose weight on 500 Kcalories a day, there are no studies proving it, you can’t live on 500 calories, anecdotal reports are worthless, etc.”

Sigh. The “narrow-minded, traditionally-trained expert” schtick is an old, overused rhetorical device exploited by virtually every “alternative health” provider on the face of the planet –  not to mention proponents of other pseudoscientific beliefs, like Creation Science.

It’s a straw man here, as it posits a false dichotomy between the clinical, “ivory tower” view of the researcher, and personal, “real world” experience – otherwise known as “anecdotal evidence”.  But as cancer surgeon/researcher/skeptic/med-blogger ORAC points out:

In science- and evidence-based medicine, anecdotes are indeed the raw material from which we as medical scientists derive hypotheses, and “anecdotes” are published all the time in the medical literature. They’re called “case reports.” We do not dismiss them out of hand just because they are “anecdotes.” When appropriate, we dismiss “anecdotes” because frequently they are “testimonials” and not controlled observations or because anecdotes themselves, even when the observations are controlled, are often deceiving, which is why further study in the form of more controlled trials is always necessary before science-based medicine will accept a claim.  Anecdotes are not enough…

In science, there are hierarchies of evidence, thus, being “open-minded” does not require us to give all of them equal weight. Anecdotes are acceptable as evidence, although we are NOT going to rank them above controlled studies unless there is a compelling reason to do so.  In addition, as ORAC notes, there’s a difference between “anecdotes” and “testimonials”.  While Dr. Gonzalez claims to have anecdotal evidence that refutes the studies, he provides no details; nor does he link to any published case reports.  This places his “anecdotes” at the level of “testimonials”, which are scientifically worthless.

But I digress:  the process of enlightenment – as described by Dr. Gonzalez –  is completely compatible with “traditional training”.  It’s his reasoning and conclusions that are suspect.

This is highlighted by his story.  I gotta ask: why is it that skeptics are invariably accused of being “narrow-minded” for demanding good evidence, while proponents of questionable therapies applaud themselves for their “open-mindedness”?  As philosopher of science Phillip Kitcher points out in his book, Abusing Science:

Open-mindedness is not incompatible with having opinions…what is crucial to open-mindedness is the way in which opinions are held.

Bingo: a rational skeptic bases his or her opinion on the evidence, but will change it if solid reasons are offered – the essence of “open-mindedness”.  Many proponents, on the other hand, refuse to consider – or brush aside – evidence that contradicts what they want (or want others) to believe…which is pretty “narrow-minded”, if you ask me. 

Paul and I are rational skeptics.  As for Dr. Gonzalez…well, as you read what follows, you can decide for yourselves.

2. A myth concerning this protocol is that you live off 500 calories…

Well, I suppose Dr. Gonzalez is correct, if we parse the words “live off”…but the process he describes:

Actuality is that you live off the 500 calories you ingest PLUS the calories you burn from your fat…

…could be used to describe ANY weight loss diet.  If you take in less energy than your body requires to fuel its activities, then yes, it will tap into its stored energy to make up the difference.  This is no less true for a conventional, 1500 calorie diet than it is for an unconventional, 500 calorie one. 

Despite the dramatic “myth/fact” flourish, this strikes me as a pretty banal observation.

3. Another myth: Fat only stores fat soluble vitamins. Nope. Fat stores many other minerals and hormones and in fact, is part of the endocrine system in making certain hormones. So as you burn fat it releases nutrition that your body uses for metabolism.

I honestly don’t know how to evaluate this.  Beyond the rather dubious equation of “hormones” with “nutrition”, he also points out that adipose tissue contains some stored micronutrients – another perfectly unremarkable observation.  So what? 

As stated above, it’s well-established that stored body fat is a source of energy (or “nutrition” if you will).  Since VLCDs (very low calorie diets) are sanctioned by “traditional” medicine, I’m really at a loss to understand why he’s making this argument…even people who are fasting can persist for quite some time.  BFD.

This brings up a related point: what I find disturbing about Dr. Gonzalez’s recitation of these “myths”, is his failure to specify just who the hell believes them in the first place.  They don’t appear anywhere in Paul’s review.  Is he claiming that medical professionals are perpetuating these myths?  If so, then they might be worth refuting in his comments; otherwise this is a red herring.

4. Did you know the hCG hormone is similar to thyroid hormone and acts to stimulate the thyroid?

No, I did NOT know this at all, and still don’t.  hCG is a large-ish glycoprotein composed of 244 amino acids.  By contrast, thyroxine (T4) and triiodothyronine (T3) are very small molecules, synthesized from a single amino acid: l-tyrosine. They are completely and utterly dissimilar.

Ok, in fairness, what Dr. Gonzalez actually MEANT to write, was that there is some resemblance between hCG and TSH – thyroid stimulating hormone (they share a subunit).  Thyroid hormones are made by the thyroid.  That’s why they’re called thyroid hormones. Thyroid STIMULATING hormone, on the other hand, is made in the pituitary gland. It’s a small point, perhaps, but telling…the level of precision I’m describing should be as natural as breathing to a technically-trained person claiming expertise in such matters in a public venue.

Nonetheless, it is true that hCG can have mild, thyroid stimulating effects – at least in pregnant women.  Once again, this is a well-known medical fact.  But the key term here is “mild”.  While it’s possible this could provide some metabolic boost under conditions of reduced calorie intake, I haven’t seen any info on this.  Dr. Gonzalez, of course, is certainly in a position to make the relevant measurements on his patients – that way, he can back up statements like “I am willing to bet this is part of the reason why it works in this protocol” with actual data.

5. I find it interesting that the FDA will approve a procedure that has a 300 plus people a year death rate (gastric bypass) not to mention a very high co-morbidity (associated problems) rate and physicians who will approve of this procedure. Yet, place a “black box” on hCG saying no approval for weight loss when there has been ZERO noted issues in over 50 years in hCG use in weight loss.

Dr. Gonzalez is being rather disingenuous here.  For the record, I am not “for” gastric bypass surgery…quite the contrary.  I consider it a “when all else has really, really failed” approach. But I also can’t argue with the data: despite the very real risks Dr. Gonzalez describes, study after study documents significant metabolic improvements (example here). And many patients undergoing the surgery insist that – despite the hardships – they’d do it all over again.

So, at its most basic level, we need to look at costs vs. benefits. As much as I hate to admit it (and I do), we know bariatric surgery WORKS for the majority. This is an established, completely unambiguous fact. It sucks, but there you go.

Now hCG treatment is undoubtedly pretty safe…and I’m not inclined to argue with Dr. Gonzalez’s contention that it’s much safer than bariatric surgery.  But its effectiveness is precisely what we’re debating here – while the issue may be settled in Dr. Gonzalez’s mind, it isn’t out here in the real world I inhabit.  I could just as easily argue that – say – cha de bugre is perfectly safe as a treatment for obesity…I’ve used it myself and rather like it.  But in the absence of proof that it works BETTER THAN PLACEBO (more on this below), it’s preposterous to laud it as a superior alternative to bariatric surgery; or to twit the FDA (for all its faults) for placing a “black box” on it.

Sorry Doc, but the point of making an argument is to CONVINCE me.  You can’t assume the truth of your conclusion in the process of proving it.  You have to present me with evidence independent of your assumption, if you want me (or Paul) to credit your opinion on the matter.

6. The “extensive studies” that are cited on both sides of the argument are very small studies (Greenway, etc.) and old and are equivocal when they are all looked at together. No study follows up on long term weight loss.

“Small” and “old” are also red herring arguments.  Small and old don’t add up to “wrong”. 

In addition, a 1995 meta-analysis does not support Dr. Gonzalez’s contention that the results are “equivocal when they are all looked at together.”  Looking at all the studies together is what meta-analyses are designed to do, after all.  Needless to state, the conclusion of the meta-analysis isn’t “equivocal” – it’s flat-out negative.

We conclude that there is no scientific evidence that hCG is effective in the treatment of obesity; it does not bring about weight-loss or fat-redistribution, nor does it reduce hunger or induce a feeling of well-being.

If Dr. Gonzalez has a quarrel with the methods or conclusions of this paper, then he is should make his case in front of a jury of his peers. To reiterate an earlier point: case reports are a perfectly valid way to share ideas and observations with other doctors, with an eye towards changing the consensus opinion. Hell, even “letters to the editor” printed in a respected journal carry some weight with other professionals.

7.  Why don’t I do a large study? Because it costs money and I am unable to get a grant to do so. No pharmaceutical will give money for a large study again, because there is no money to be made.

Ummmm…sorry Doc, but I spent nearly 8 years living (and working) on the NIH (National Institutes of Health) dole.  That dawg don’t hunt.

Grants don’t grow on trees, nor are there various scientifically-inclined philanthropists walking around with sacks of money to hand over to earnest-minded, would-be researchers in the absence of detailed grant proposals. Needless to state, the proposal and budget COME FIRST.  To say he’s “unable to get a grant” implies he’s actually made the effort, yet  – once again – no evidence of this is offered.  Presumably, Dr. Gonzalez is aware that “Big Pharma” isn’t the only potential source of funds…there’s the guvmint and private foundations to consider, too.  And surely he could locate various university or other institutional co-authors to lend some “establishment cred” to his proposal.  Either he has compelling data that will attract their interest or he doesn’t.

Yes, I’ll be the first to admit, putting together a serious, competitive grant proposal is one hell of a lot of work. It’s work that has to be done by SOMEONE, however, if Dr. Gonzalez is truly committed to establishing hCG therapy as a credible treatment for obesity. And, to be honest, it’s probably a better use of his time than duking it out with consumer advocates in the comments sections of public supplement review sites.

8. The hCG is not for everybody. It is not a “weight loss cure” and it must be physician directed and supervised. It cannot be applied to the general public as many diets are. A full health evaluation is imperative prior to beginning such a diet. I have saved many from gastric bypass, been able to get diabetics off their medications, get patients off blood pressure meds, antidepression meds, and cholesterol meds because of this protocol.

What the reader wading through the original comments may not see, is that Dr. Gonzalez continually blurs the distinction between “hCG” and “hCG Protocol.”  What Paul’s review, AND the studies he cites are grappling with, is the effectiveness of hCG as an adjunct to what physicians and researchers refer to as a VLCD (very low calorie diet).  Bells and whistles in the original protocol aside, that’s what it boils down to.

The point Dr. Gonzalez appears unable (or unwilling) to confront, is that NO ONE – least of all me or Paul – is arguing that VLCDs are ineffective for weight loss.  What Dr. Gonzalez has failed to demonstrate, is that a VLCD program is more effective WITH hCG than without it.  The patient restrictions and corresponding benefits he mentions, for example, are NOT unique to hCG treatment at all.  Even small amounts of weight/fat loss can produce measureable benefits to health.  It’s great that some of his patients have been able to drop their meds…but this is not a unique or unexpected result.  It could happen to anyone losing a lot of weight, on any number of reasonable diets.

Once again, the key point of contention is whether hCG treatment is BETTER THAN PLACEBO for producing these benefits.  This is the thrust of Paul’s review.  Now, I have to give Paul 30 lashes with a wet noodle for failing to put this distinction between “hCG” and “hCG Protocol” front and center in his review.  Nonetheless, Dr. Gonzalez claims to have read the studies Paul links to, so he damn well knows what the real issue is here, even if it’s a little “fuzzy” for the average reader.

10. True balance needs to be impartial and truly objective. Your reviews seem skewed.Example of that is the persistent citation of Trudeau as a scam artist as a reason for hCG ineffectiveness in your reviews.

This one was picked up by Paul already, but I’ll put in my two cents in too.  There is no “persistent citation” of Kevin Trudeau in his review, nor does Paul even remotely imply that Trudeau’s lack of credibility is the reason hCG is ineffective.  Paul simply draws the connection between Trudeau’s book, and the upsurge in interest in the diet protocol in the led to his review. His conclusion is clearly based on the lack of scientific evidence – not on Kevin Trudeau’s status as a scam artist.

In the end, Dr. Gonzalez needs to make a case that the HCG protocol is a superior alternative to competing, conventional VLCD programs such as the RFO Program offered in places like the UCLA medical center.

Research results from the RFO program have been published in the medical literature and have documented weight loss ranging from 50 to 250 pounds, depending upon the patients’ initial weight. Eighty five percent of patients successfully achieved their weight loss goals, and three years later sixty percent of them had maintained all or most of their lost weight. Accompanying this weight loss, there were marked reductions in blood pressure, improvement of diabetes control, improvement of serum cholesterol and lipid levels, and greater psychological well-being.

Looks like the bar is set pretty high.  If Dr. Gonzalez can top that, I think both Paul and I would be delighted to change our (skeptical – not “narrow”) minds, and give hCG a “thumbs up” for weight loss.

But until better data shows up, the verdict stands…

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Comments

  1. Ben Gonzalez, MD says

    Interesting. I did not mean for this to be a comprehensive teaching or argumentative exchange. Nor did I sense that this was a personal discussion (not sure what ‘OMFG!’ meant in your opening here). Up to this point I actually liked your web site as a general review of OTC products and my office manager was initially going to link your site to ours as we are updating our website. I do not believe, nor did I say you have a “narrow mind.” I apologise if you feel I made a personal attack on you.

    Your selectiveness in this last response only highlights why I began (what I thought) was going to be a productive exchange. I invite you to contact me personally through my clinic. I think you will see my response in a different and more positive light.

    You (selectively?) left out an important final conclusion that I repeatedly made: I DO NOT recommend hCG protocol for the general public for weight loss. I stand by that conclusion. I am wondering if you will publish this response. Interesting.

    Sincerely and without personal attack,

    DrG

  2. says

    Dr. Gonzalez:

    First of all, thank you for your response. For the record, I did not take your comment about “narrow mindedness” personally. Rather, I highlighted this because it’s a trope often used to (mis)characterize people with “traditional” training – as a way of deflecting criticism and creating a rosy glow about unscientific beliefs and claims. Since you made use of it in your original comments, I took advantage of the opportunity you created to debunk it. This is part of the site’s mission, after all: to reveal and explain various rhetorical (and visual) maneuvers that “tug on the heartstrings” (so to speak) and influence purchasing decisions.

    I certainly accept the possibility that you feel you were “narrow-minded” in your initial rejection of the hCG Protocol. And, perhaps, you were, if your initial arguments against it were as dogmatic as you characterized them. But – as a former staff researcher in a university medical school (Dept. of Medical Pathology, University of California at Davis), I see that as something intrinsic to YOU, not medical/scientific training. I’ve brainstormed over brewskis with too many Ph.D.s, MDs and DVMs to believe otherwise. ;-)

    So, no apologies necessary for this. Likewise, nothing personal on this end, either: my response to this portion of your comments was triggered by the ubiquity of this characterization; I make no particular judgement w/respect to your intent.

    As far as my selectivity is concerned: I chose to leave that portion of your comment out of my post as I felt there was no need to include it – I would simply have been repeating myself in the discussion. Nonetheless, I will address it here.

    To make a short story long: you and I have somewhat different perspectives, and I suspect I understand yours better than you understand mine. I’d like to explore this first, to make sure we’re not talking past each other.

    I’ve been a lab geek, so I’m quite familiar with “protocols” – used ‘em all the time to do Western blots, CAT assays, protein purifications and the like. Most of these were “borrowed” from other authors, as they worked well, and there was no need to reinvent the wheel with larger objectives at stake. Perhaps there were superfluous reagents…perhaps there were redundant steps…perhaps there were even better ways to perform each technique. Doesn’t matter, though…there are LOTS of ways to skin a cat, after all, but there’s no need to search for others when the one you have at hand will do.

    This is how I understand your defense of the hCG Protocol: you accept it whole, as it works for you and your clients. You’re dealing with individuals.

    But in the world of the consumer advocate – my frame of reference – the issues are far more nuanced. We’re dealing with populations – not individuals – and a vast array of products advertised as the bestest ways to skin cats ever invented! And it’s true that:

    1. Some don’t really work at all.
    2. Some may work better than others
    3. Some may work, but are not cost-effective, relative to others

    As you can see from points 2 and 3, “does it work?” can’t be the sole arbiter of whether something gets a “thumbs up” verdict. To take a somewhat crass example, a cream marketed as “100% proven to facilitate erections…all you have to do is rub it in slowly, using long, firm strokes over a 5 minute period” is likely to work amazingly well. Nonetheless, it ain’t worth paying $39.95 for when a less expensive bottle of Vaseline Intensive Care lotion will yield the exact same results.

    With this in mind, let’s return to hCG and the hCG Protocol. As has now been established, this is a complicated bit of business as,

    1. there are unscrupulous operators preying on people
    2. even in the hands of scrupulous professionals (which presumably includes you), it’s an unproven and unapproved therapy.

    Now, Paul’s review was tilted towards the first proposition, since the wide distribution of the Trudeau book put the issue front and center with the general public, and it’s not so easy to discern who’s a scammer and who isn’t.

    But this is where the second proposition entered in, since hCG is alleged to be critical to the success of the program – regardless of who’s administering it. Since the most reliable evidence we have states it has no special weight loss properties, that’s how Paul reported it. This served two purposes: 1) to demystify hCG, and 2) inoculate readers against the scammers.

    Now, neither Paul nor I are claiming that the entire hCG protocol, closely supervised by a competent medical professional in a supportive and caring environment cannot “work” to help people lose weight. I have no reason to doubt your claims that your patients have been helped.

    BUT…what I am contending (and I believe Paul would agree with me), is that their success is based on:

    1. the VLCD part of the Protocol
    2. daily (or near daily) contact with supportive, caring professionals, thanks to all those shots.
    3. a strong belief that hCG is facilitating their weight loss, above and beyond 1 & 2.

    Where you and I disagree is on point 3. You may believe hCG possesses special properties, but the evidence we have shows it’s basically an expensive placebo; and there is nothing in any of your observations that is inconsistent with the latter explanation.

    Now, we could have an interesting philosophical discussion sometime on the value of placebos…and believe it or not, I’m not unsympathetic to their use on a very basic level. My favorite analogy is Dumbo’s Magic Feather: Dumbo didn’t need it to fly, but he never would have left the ground without it. As noted in this NYT article, placebos often work for individuals – which is why some doctors actually prescribe them. This is precisely why placebo-controlled trials are MANDATORY when assessing the efficacy of a drug or nutraceutical.

    Nonetheless, it is against professional ethics to prescribe or – in our case – recommend placebos, which is why our verdict against hCG, and – by extension – the hCG protocol, stands. The fact that some providers are also caring, responsible practitioners isn’t a factor in this decision, as we have no basis for helping readers decide who is, and who isn’t one – especially since a “responsible” provider is less likely to be marketing a placebo treatment in the first place.

    To be blunt: since hCG is the “bait” used by the responsible and irresponsible alike; and since the evidence – to date – demonstrates it doesn’t work…

    Then, case closed…at least until better evidence emerges.

    This is why I passed the issue of “it’s not for the general public” by…it’s irrelevant. The larger issue is “hCG = expensive placebo”; not “does the Protocol work for selected patients under close medical supervision.” IMHO, any highly restricted diet is – by definition – not for the general public. This is why programs like the one offered at UCLA offer a range of plans and have selection criteria.

    I hope this makes sense to you. And believe me: none of this is meant as a personal attack either. I have nothing against you personally – and if I lived in the DC area, and wanted some body sculpting or other anatomical tweaks, I’d probably look you up. But I also stand by the point I made in my post…the word of an MD carries a lot of weight with the general public. When that word runs counter to our educational mission and philosophy, then a thorough critique and analysis is called for.

  3. Ben Gonzalez, MD says

    I believe we are saying similar things. And I am not trying to “top ” anything as you mentioned. More discussion needs to occur. More studies need to be done. I appreciate your background. I think you would be surprised by mine. I appreciate your last post. It did a pretty good job in clarifying your position than my initial post did. And, as you can read from the very first sentence I wrote in my first posting, I am not surprised by the exchange. As you can see, it takes great and lengthy discussion. There is a great deal more to say and more clarification needs to occur but I think for the purposes of this forum, enough has been said.

    Again, keep up the good work on your blog.

    DrG

  4. Robert says

    I do believe Kevin Trudeau is a bit of a con artist. That being said…I was on the HCG injections for 40 days and I lost 42 pounds. I did this more than 18 months ago and I did NOT gain the weight back! You PhD’s and MD’s with all your cute little initials behind your name where unable to HELP ME!!! and for years I lived with a body I had suffered with. I am not blaming you for my body but the HCG injections worked for me. So you can just go back to your nice books that support what DOES NOT WORK. Thank God for those you are able to think outside the box. I’ll stay with RESULTS!!!

  5. says

    Hi Robert:

    First of all – congratulations on your weight loss.

    You seem to be assuming, however, that I have no direct experience in helping people lose weight, and that what I know comes strictly from “nice books.” Not quite. Apart from UltimateFatBurner.com, I do extensive nutrition/supplementation counseling, and thus, know a fair number of people – including my own husband – who’ve lost as much, and even more weight/fat, than you have… without resorting to hCG either, I might add.

    So yes, I do know more than a bit about what DOES WORK. And a major part of what works is a) structure and b) support – both of which are features of the hCG protocol, yet have nada to do with hCG itself, as my example of the RFO program at UCLA (linked above) demonstrates. It’s basically the hCG protocol, minus the hCG, and is equally, if not more, successful.

    That an intensively supportive, structured intervention works better than a half-hour session with a GP + a prescription for silbutramine comes as no surprise to me. Nonetheless, this is not a point in favor of hCG…rather it’s a point against the current, indifferent system of “managed care”. While this may come as a shock to you, I’m no fan of the current system, either, and believe that those “PhD’s and MD’s” could be doing far more to help people than they are.

    Be that as it may, the truth is what it is, as much as you do not want to believe it.

  6. Robert says

    Hi Elissa

    I am happy that you have helped so many people with their individual health concerns. Frankly, health care professionals work in a field I could not.

    Perhaps if I had run into you before my, what seemed to be endless, doctor office visits. (One of which prescribed pills that was Yohimbe on steroids). I would have a different take on the situation.

    I remember reading about a situation during World War II where doctors were critically short of pain medicine. The doctors faked giving soldiers medicine telling them that “this stuff was powerful and would knock them out” it did’t work for all the soldiers but it did work for some. The direct science would not uphold the process but the soldiers who were able to sleep will swear to the effective sugar water they were injected with.

    Truth is relative. Just look at the wars in human history fought over which God was greater. Or look at modern science 1000 years ago that stated the world was flat and the center of the universe. People will go to what works for them.

    In the final analysis. I was the one suffering from doctors with big titles.

    I will stick with results. HCG worked for me and that is my truth. Believe it.

  7. delmem says

    The STEIN study. 28 doses, hCG group mean loss 9.5% of total body mass. It WAS called a negative study, and I embrace it. 48% lost more than 10% of their mass in 28 days. Mean starting weight 165.9, mean loss in just 28 days 15.8 – I’ll take that kind of “negative” result any day. (another often missed fact, all of the patients in the Asher Harper and Stein studies were females – men tend to lose weight at a faster rate)

    Please explain how you can use the meta as your “proof” when it included a study that simply added hCG to a diet and was in no other way following Simeons protocol ?

    Evidence – noun: that which tends to prove or disprove something.

    There’s your scientific evidence: they’re clearly mixed, several showing no benefit (other than the weight loss) two showing significantly better results over placebo. If you want to use a term such as “overwhelmingly negative” at least that’d be honest but to continually throw out superlatives which are factually incorrect is wrong.

    Clinical/anecdotal/empiracal evidence: Average loss in 30 days of 9.5-14% of starting body weight for over 85% of participants, 600 people and 18,000 lbs lost. That IS evidence. It ISN’T “scientific proof” via DB study.

    Going from the abstract of the meta anyone would have a negative view on hCG but I’d expect better from someone with experience at UC Davis.

    How about questioning the negative studies? (and yes, I will tell you why) Explain how DH in the Frank study could possibly only lose 4 lbs with a caloric deficit of approx 75,000 cals… while someone half DH’s starting weight lost 3 times as much in the Stein study.

    If you bother to dig into the negative studies and read the data quiet a bit of it doesn’t add up… and some is actually quite positive if taking the changes in weight alone.

    Placebo effect? I personally substituted normal saline for hCG for 3 days in protocol participants (all with prior consent of exploratory treatment) and all of them had hunger complaints and less weight loss than they did previously or after. hCG JUST a placebo – not at all.

    For a moment imagine there’s PROOF hCG does in fact effect fat metabolism, would it be so hard to surmise that the effect could be either adipogenic or adipolylic, depending on caloric intake?

    http://joe.endocrinology-journals.org/cgi/content/abstract/194/2/313

    As far as stand alone VLCD’s “working” –

    “… (those) who had used a VLCD regained significantly more weight than the other two groups and by six months, there were no significant differences in overall percent weight loss…”

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2666007/?tool=pubmed

    A Dr Gusman took the time to write a rebuttal letter to one of the negative studies citing the studies were poorly designed as they gave no long term follow up stats. An Australian doctor’s (Bradley AJCN May ‘77) letter in which he DID track patients after a study – 6 months post: the HCG Group: 14% gained some weight while 86% lost on average 12.5 lbs more. Placebo group: 57% regained weight, 75% of those became heavier than prior to the VLCD.

    If you consider the time frame (no internet, no commercial value) these were physicians reaching out to their peers with real life results. No WWW to put cash in their pockets, at that time very few except other physicians would be reading the American Journal of Clinical Nutrition. They actually took the time to write and mail responses, and due respect should be given to their observations.

    As far as Harper running an hCG clinic… so what ? If anything proving it effective would be presumably detrimental to his business, as he wouldn’t be able to charge high prices, would lose clients if their primary care physicians became aware and were administering it. Dr Asher on the other hand, was Executive Director of the American Society of Bariatric Physicians Research Council. Sure wouldn’t do his reputation any good to falsify a study, and would reflect badly on the Council.

    If this site really was about disclosing all data available matter of factly I wouldn’t have an issue with it, it’s that you don’t simply state the available data but still interject opinion, factually incorrect and negatively slanted comments.

    I don’t recommend the protocol to anyone less than 30 lbs overweight or who hasn’t unsuccessfully tried less invasive methods, but for someone clinically obese (especially with physical limitations) it can provide incredible weight loss.

    So, as far as your “educational mission and philosophy” – exactly how deep into the data from the “negative” studies did you bother to go? And please do explain for me how a 300 lb person with a 75,000 calorie deficit over a 6 week period could possibly lose just 4 lbs. (and if Franks had actually USED Simeons diet restriction the deficit would be more than double that) You’ve repeatedly stated VLCDs work regardless of hCG – if that’s true, even if in the placebo group he should have lost over 20 lbs.

    ALL studies and ALL data isn’t negative – and the Stein study, albeit called negative, is actually quite positive – the losses achieved in 28 doses make 3 “diet drugs” in phase 3 trials currently look like candy… one of them containing phentermine, and I think you all remember how well that worked out the last time it was used in a combitnation drug for weight loss.

    So, I’ll ask (though don’t expect a legit response) factually hCG has andro effects & is used to increase natural testosterone production – fallacy to then totally decouple that FACT from hCG when used in weight loss. (and it should be fairly obvious to even you all THIS would be one of the reasons it WOULD in fact be more effective than placebo – they ARE giving lose dose hCG therapy to men with low testosterone – are you aware of placebo increasing testosterone?)

    From this month’s issue of Journal of Endo Metabolism: “In addition, hCG stimulated the proliferation of…smooth muscle cells.”

    hCG is also used for Prader-Willi syndrome – “During hCG therapy, testosterone levels and lean mass significantly increased”.

    hCG has been used in Europe for about a decade to prevent muscle wasting and proliferation of the virus in AIDS patients & is also used in localized treatment of KS lesions.

    One more placebo question – does placebo effect release of leptin, and isn’t leptin kind of important when it comes to energy expendeture? Metabolism, hunger… you know, things that might cause someone to lose more weight than a placebo?

    http://jcem.endojournals.org/cgi/reprint/85/11/4298.pdf

    It’s against the AMA’s code of ethics to deny a patient a requested treatment unless doing so would be considered unsafe. That would include off label use of hCG for weight loss.

    There are plenty of hCG mills claiming they’re physician supervised, charging $1900, while the customer never sees a physician. In my opinion they’re predatory, unethical, and give the profession a bad name. Anyone paying more than $250 for a basic round of the protocol is being gouged. It’s only expensive because people don’t know better. The cost could be slightly higher if real services were provided such as nutritional counciling, body analysis, etc.

    You might be trying to help – but as things stand as they are now, you either have people being taken advantage of, or you have people taking the use of hCG into their own hands… neither is exactly an ideal situation. I sincerely think that isn’t your intent to prolong the current options. The problem is, you think from the double blind studies it’s no better than placebo, and I know from real life experience it is. Obviously talking negative about it isn’t working, with about twice as many high priced hCG centers nation wide as there were a year ago.

    To me, the only real option is legitimizing the protocol and having it available for the price of a co-pay, from a family physician who actually cares about the well being of the patient and isn’t just after a payday. And anyone wishing to do the protocol should ask their family doctor to put them on it. Out of pocket for a month’s worth of hCG can be delivered for about $50 from a compounding pharmacy in Florida. Maybe if doctors knew, and prospective patients knew, they wouldn’t be throwing away good money to someone just about money, and work with a doctor they already know.

  8. says

    ROFLMAO – after Paul showed me your post from RCC.com, I figured you’d end up over here. Ok, since this is “the right room for an argument”, and you’re obviously spoiling for one, I’ll indulge you (for now).

    “Clinical/anecdotal/empiracal evidence: Average loss in 30 days of 9.5-14% of starting body weight for over 85% of participants, 600 people and 18,000 lbs lost. That IS evidence. It ISN’T “scientific proof” via DB study.”

    No, it isn’t “evidence” – it is YOUR completely unsourced assertion. It is NOT “evidence” if the “anecdotal” and “empiracal” [sic] data cannot be independently checked and verified. I could claim to have “evidence” that my maternal grandmother was the Grand Duchess Anastasia, but until that claim is independently and objectively tested, it remains exactly that: a claim.

    And this is precisely your problem: you’re so obsessed with the alleged motes in our eyes that you can’t see the beam in your own. Your inability to see clearly is reflected in the overall hostile tone of your posts. You don’t hesitate to impute bad faith and/or malign motives to us, all the while taking full advantage of the fact that we’re providing you with a forum for your “feedback.”

    For the record, ALL comments to this site are held in a moderation queue. The fact that your condescending, attitude-laden screeds are even seeing the light of day (unedited!) is de facto proof that we’re committed to providing our readers with as much information as we possibly can. Even when it comes from people like you, who like to turn every disagreement into a pissing contest.

    So you can take your snarky comments like “(but I don’t expect a legit response)” and stick ‘em where the sun don’t shine. YOU DON’T DESERVE A LEGIT RESPONSE. In internet parlance, you’re a troll.

    After all, if you were a legit practitioner interested in establishing the legitimacy of hCG as a weight loss therapy, you wouldn’t be pitching hissy fits on independent consumer advocacy sites: you would be putting together case reports and/or making some attempt to impose genuine controls on your “experiments.” But it’s quite obvious you don’t understand the concept – for example:

    “Placebo effect? I personally substituted normal saline for hCG for 3 days in protocol participants (all with prior consent of exploratory treatment) and all of them had hunger complaints and less weight loss than they did previously or after. hCG JUST a placebo – not at all.”

    This was hardly a blind experiment – YOU knew what you were doing (experimenter bias), and – since your patients gave consent – at the very least, they understood something was up. And did you try this on a sufficient number of patients to actually test if the effect was significant? I seriously doubt this. Yet you have the cojones to proffer this anecdote – which amply demonstrates you don’t have a clue about how/why DB, placebo-controlled tests are performed, as proof that hCG is not a placebo.

    Even someone as irony-impaired as you obviously are, should be able to see the irony in that.

    Here’s another example:

    “So, I’ll ask (though don’t expect a legit response) factually hCG has andro effects & is used to increase natural testosterone production – fallacy to then totally decouple that FACT from hCG when used in weight loss. (and it should be fairly obvious to even you all THIS would be one of the reasons it WOULD in fact be more effective than placebo – they ARE giving lose dose hCG therapy to men with low testosterone – are you aware of placebo increasing testosterone?)”

    I work in bodybuilding, Bucko, so yes I am very much aware that hCG has “andro” effects. But I am also very much aware that DOSE and other external factors dictate how individuals respond. NONE of your examples involve people in severe negative calorie balance. Underfeeding is a T and muscle-killer.

    I hate to point this out, but the shoe is on the other foot, once again. Instead of charging in here, screeching like a wounded banshee about the andro effects of hCG and how it facilitates the claimed effects, how about some direct proof? Y’know, case reports and such. If you’re sticking needles into people, then you’re also in a position to perform blood tests (or send samples to a clinical lab for analysis).

    And it goes without saying (but I’ll say it anyway) that if this is the mechanism by which hCG supposedly “works”, then HRT would be a far more reliable way to go about it. This is, of course, yet another testable hypothesis that, alas, people like you will never test. Why bother? Making noise is much more satisfying.

    I love posts like yours because there’s so much low-hanging fruit to pick. Here’s another ripe one:

    “As far as stand alone VLCD’s “working”…

    Did you even bother to click the link I posted above about the UCLA RFO program? Here’s the money quote (again):

    “Research results from the RFO program have been published in the medical literature and have documented weight loss ranging from 50 to 250 pounds, depending upon the patients’ initial weight. Eighty five percent of patients successfully achieved their weight loss goals, and three years later sixty percent of them had maintained all or most of their lost weight. Accompanying this weight loss, there were marked reductions in blood pressure, improvement of diabetes control, improvement of serum cholesterol and lipid levels, and greater psychological well-being.”

    There’s a REASON I posted this link: it has all the features of a (supposedly) “good” hCG program… except for the hCG part.

    If you don’t agree with their data or conclusions, feel free to take it up with them – they’re ostensibly responsible members of the community of researchers and medical practitioners, after all. And THAT is where scientific debates are supposed to take place.

    Let’s go one more round:

    “There are plenty of hCG mills claiming they’re physician supervised, charging $1900, while the customer never sees a physician. In my opinion they’re predatory, unethical, and give the profession a bad name. Anyone paying more than $250 for a basic round of the protocol is being gouged. It’s only expensive because people don’t know better. The cost could be slightly higher if real services were provided such as nutritional counciling, body analysis, etc.

    You might be trying to help – but as things stand as they are now, you either have people being taken advantage of, or you have people taking the use of hCG into their own hands… neither is exactly an ideal situation. I sincerely think that isn’t your intent to prolong the current options.”

    If you process nothing else in this message, get a grip on this: WE ARE NOT PROLONGING CURRENT OPTIONS. We are conveying the evidence that exists (such as it is) and the scientific consensus, as best we can. But we do not and CANNOT actively influence what is – or is not – considered to be the standard of care.

    That’s YOUR job, whether you understand it or not.

    I’ve spent a good chunk of my adult life in science, and I have a pretty good understanding of how it works. Sometimes it’s tough to change the consensus, but inevitably, it does shift when enough data piles up. That’s data – NOT anecdotes. Only objective data can provide a rationale for larger scale controlled studies.

    You yourself have pointed out the obvious: there are “plenty of hCG mills” that are “predatory, unethical, and give the profession a bad name.” Ok, riddle me this, Batman: how on earth are prospective patients supposed to weed out the allegedly legitimate practitioners (such as Dr. Gonzalez and – presumably – yourself) from the scammers?

    Assuming you’re capable of doing so, look at the situation from our POV. Paul and I are – first and foremost – consumer advocates. As such, IT IS OUR JOB TO BE SKEPTICAL and put claims to the test. Thus, we are NOT going to spend time cherry-picking studies, searching for reasons to discard their conclusions in favor of… what, exactly? A therapeutic option that – as you affirm – is plagued with predatory operators and has virtually zilch going for it w/respect to positive, (reasonably) objective, published data?

    Get real.

    This takes us right back to a point I made above… as noted, you’re not the least bit interested in actually “legitimizing the protocol.” If you were, your tactics would be quite different. In fact, the structure of your argument is right out of the “Creation Science”/”Intelligent Design,” playbook:

    1. You’re attempting to make a case for your pet cause negatively rather than positively (i.e., shooting holes in existing studies and standards of practice, vs. actually making a sincere attempt to collect acceptable evidence and presenting it in a professional manner).

    2. You’re trying to make your case in the public sphere – where it does not belong – vs. in the medical/scientific one – where it does. And yes, I’m sure you’re quite prepared with various Creationist/I.D.-style comebacks: “hCG has been prejudged… the establishment won’t listen to us… there’s no money in it for Big Pharma…” yadda, yadda, yadda. In reality, you guys haven’t even tried to make a good case. It’s been scattershot at best.

    Well, here’s the deal, delmem: since you’re evidently a doc, you damn well know that NO experimental therapy is legitimized this way. Passion isn’t an argument. The plural of anecdote is NOT data. If you want hCG to be accepted as a legit alternative, then there’s a process involved. If you’re serious about this, I suggest you stop wasting time duking it out with perceived enemies in the comments sections of public web sites and apply some self-discipline, rational thought and some good old fashioned “elbow grease” to the issue.

    You wanna convince me and Paul? Fine: get off your high horse, and start publishing some case reports that can be treated with respect by your peers. Citing 30+ year old letters to journal editors and unrelated, experimental therapeutic uses of hCG ain’t good enough.

  9. delmem says

    Ding, ding. Round 3 ?

    The RFO program was the second program in the world to use a VLCD, what was the 1st?
    Simeons hCG protocol. Looking at the RFO, have to think it has a mortality rate involved whether they admit it or not. Previously providing Fen-Phen and Meridia.

    Do you know if they’re still prescribing Meridia in conjuction with the RFO ? 1997-2003, the FDA received reports of 30 Meridia users who died of cardiovascular problems and 224 other reports of nonfatal strokes, heart attacks and other cardiovascular ailments.

    Simeons Protocol – around since 1954 – 0 confirmed kills.

    RFO maintains that at least 80% of the weight loss will be from fat? That’s a possible boatload of muscle loss. Only aware of a handful who did body comp scans or hydro testing post protocol – no one reported a loss of more than 5% lean muscle mass. Then again the protocol achieves the loss in much less time, the hCG hastens the onset of ketosis, and there’s adequate carb intake to maintain positive nitrogen balance.

    As far as your comment about me just throwing a claim out there – use the negative Stein study mean loss of 9.5% if it makes you feel better. Assuming you being in the field and having some stats on percentage weight loss between men and women would expect the mean loss somewhere in the 9.5-14% range I previously mentioned if the Stein DB study had a co-ed even split of participants.

    The initial visit cost for the RFO is more than a complete 30 day round of the protocol. By comparison (using the Stein 9.5% mass loss) the RFO at it’s quoted 1% mass loss per week – would cost over $1600 for the same loss.

    I don’t doubt RFOs results – but will submit that some are in such dire shape that time is of the essence and they might not have the amount of time needed to lose 1% per week if in imminent risk of a cardiac event. Simeons stated 60-70% able to maintain loss, inline with the RFO.

    As far as the “unrelated uses” – if the effect of those uses influences metabolism regardless of a VLCD, would that not cast doubts on “just placebo” claim ?

    QoL should have financial considerations though most doctors and clinics neglect to include it. Even if just placebo the same loss in a month at a cost of $225 online, or better still through your own doc for the office visit and $50 for the hCG through a compounding pharmacy vs. RFO at twice the time frame and 700% more expensive.

    There’s a very good reason I mentioned the Bradley letter to the editor, and I think you know it. Presuming he was being honest as he had no incentive not to be & applying similar longer term stats he provided to the existing data, if ANY of the DB studies had included follow up, longer term stats in their summations – we wouldn’t be having this discussion right now as the majority would reflect extremely positive results vs. placebo. It’s never been denied the huge, quick, dramatic losses, only how those compare with placebo that has been the issue.

    I DID come with ‘tude – in no small part because I respect Dr Gonzalez a great deal and thought he’d been beaten up pretty badly without cause.

    I’ll admit I’m a strange bird – get into brawls over the protocol quite a bit – most of the time with the clinics who paint an unrealistic positive picture. Most claim it’s a “cure” when that’s not the case, 100% effective – when it isn’t, many gloss over the negative side effects or claim there are NO side effects. Pounds and Inches mentions several including gallstones, gout attack, thinning hair, headaches… additionally there’s either insomnia or lethargy, possible hot flashes or chills, metallic taste in mouth, skin (detox) rash, extremely rare hypersensitivity, for women changes in menses, and all the annoyances of being in benign dietary ketosis. (bad breath, pungent sweat and urine)

    Go ahead, take your swings. (just not the face!) And yes, I will commend you for posting as written – and for tempering your comment about the protocol to “virtually zilch”, at least that’s a move in the right direction.

    For the record – I do have baseline blood test on 4 patients and will have interim and post results in the next few months. Really sad we’ve been dickering around for more than 55 years over IF it works when I believe a few hundred dollars of blood tests will prove beyond doubt why it does. If my hypothesis is correct, it is HRT therapy, introducing a small amount of hCG that brings equilibrium to a hormone imbalance when combined with a VLCD. Will let you know if T is elevated even with restrictive diet, if you’re interested. The cake is in the oven so to speak, so I’ve got time to kill waiting for the timer to go off.

    When it comes to your “riddle me this” question – it’s pretty cut and dry. FAMILY PHYSICIANS are charged with “do no harm” and the well being of their patients – and the protocol aint exactly rocket science. (no offense Ben) It’s much safer than any bariatric surgery, and has fewer possible serious adverse effects. Patients can play hard ball with their doc and demand it – if that happens enough things will change.

    • says

      LOL – Yes, you DID come in with ‘tude – and for no particularly good reason, either. It’s good that you respect Dr. Gonzalez – and for the record, he seems like a nice guy whose heart is in the right place. But if you read our exchange carefully, I did not “beat” him “without cause.” Just because we provide a forum for commenters to post their ideas and/or information, does not imply that they get a “free pass.” Freedom of speech does NOT mean freedom from criticism. I made my rationale abundantly clear in my post:

      “The word of an MD carries a lot of weight with the general public, so the flaws in his argument(s) need to be addressed in more detail than Paul was able to provide in the hCG comment thread.”

      And there was plenty to critique. As I explained to Dr. G in the comments, it was nothing personal, nor is it now.

      I also made the following point:

      “Yes, I’ll be the first to admit, putting together a serious, competitive grant proposal is one hell of a lot of work. It’s work that has to be done by SOMEONE, however, if Dr. Gonzalez is truly committed to establishing hCG therapy as a credible treatment for obesity. And, to be honest, it’s probably a better use of his time than duking it out with consumer advocates in the comments sections of public supplement review sites.”

      I made a very similar point to you, in our previous exchange.

      So it’s good to see you’re striking a more reasonable tone – and I’m happy to respond in kind – but it’s apparent that you still don’t “get” above point… which is about the need for professional credibility and respect. Your response is riddled with yet more unsourced claims (i.e., speculation about RFO mortality rates; how hCG hastens the onset of ketosis; the results of a “handful” of body comp scans). This is the heart of the problem: there is no good science on display here. Yet THAT is what it will take to convince me.

      Despite what you (or Dr. Gonzalez) may believe, neither Paul nor I are dogmatically opposed to hCG as a therapy for weight loss – in principle. All we are asking for is some decent, peer-reviewed scientific evidence. Needless to state, this is not synonymous with, “cobble some circumstantial evidence, speculation and anecdotes together.” To repeat: when it comes to science, there is a process involved. The people you need to convince are your PEERS.

      You want my respect and a “worth a try” recommendation for hCG from this site? Then you – and your other accredited colleagues – need to a) collect your data in a systematic, organized fashion; and b) submit your findings as case reports to peer-reviewed journals (as well as make use of other professional channels of communication, such as conference presentations). You can “let me know” of your results ad infinitum if you like, but until those results are VALIDATED via the approval of at least a significant minority of your non-hCG-believing peers, it’s basically hot air. When they concede perhaps there’s something to it, I’ll be delighted to concede with them… but not before. “Playing to the gallery” is futile: your job is to convince a jury.

      To put it another way, these guys: http://scienceblogs.com/denialism/2008/04/is_injecting_yourself_with_a_h.php are representative of the folks you need to make a rational, methodical effort to convince… your fellow M.D.s. This isn’t the place for it.

      I hate to repeat myself ad nauseam, but I guess that’s what it takes: if you wish to have hCG/the hCG protocol viewed as a legitimate therapeutic and – above all, scientific – option for weight loss, then you cannot neglect this process. It’s a painful and often messy one, to be sure, but that is the path you must take, if you want professional approval. You cannot – as you did in your original post – demand legitimacy up front. This is putting the cart in front of the horse.

      This is important, since – just because a procedure “works” – it does not follow that the explanation advanced for it is valid. A perfect example of this is another controversial, popular diet: Peter J. D’Adamo’s “Eat Right 4 Your Type.” The underlying rationale for his program is sheer pseudoscience, yet people often report great results! But it’s not difficult to see why: every one of the proposed diets is balanced and based on whole, nutrient-dense foods. Thus, it stands to reason that someone moving from your typical, high-processed food American diet to one of d’Adamo’s diets would experience substantial improvements to his/her health and body composition. And – needless to state – there is nothing unique or radical about the beneficial effects of eating a balanced diet of whole or minimally-processed foods.

      This example is also a good illustration of how “Occam’s Razor” works: when there are two competing explanations for a phenomenon, the simplest one (or the one that requires the fewest assumptions) is the one most likely to be correct. We need not accept d’Adamo’s re-writing of human evolution and physiology as an explanation, when a simpler one – which agrees with what we know about how the world works – is at hand.

      We can apply the exact same reasoning to hCG and the hCG protocol. For all the anecdotes, speculation on mechanisms and critiques of the flaws inherent in various studies, you have little in the way of direct and acceptable evidence in support of your proposition that the metabolic effects of hCG have a substantial effect on fat loss or body composition above and beyond the results obtainable with a medically-supervised VLCD. On the flip side, there IS published evidence to the contrary, not to mention a simpler explanation to explain how weight loss is achieved. Thus, you have a bar to clear before you can make your claims stick.

      There are two obvious counters to the “even if just placebo” argument – and both lie in the long vs. the short term view. As is evident from the above, the protocol can work… no one is disputing this. So – why not recommend it, gaps and all?

      1. Because a belief in placebo treatments makes people that much more credulous and willing to believe in other unproven treatments. The world of health and fitness is rife with pseudoscience… some relatively benign, and others not so much. In some cases, it only costs people time and money. In other cases, it can cost them their lives. The fact that hCG therapy is (apparently) benign, doesn’t justify your evident disdain for the process needed to validate your claims for it.

      2. There are a number of unscrupulous operators out there (this will be discussed more below).

      3. There are other ways to lose excess weight/fat that produce as good – if not better – results. As also noted in response to another commenter:

      “Apart from UltimateFatBurner.com, I do extensive nutrition/supplementation counseling, and thus, know a fair number of people – including my own husband – who’ve lost as much, and even more weight/fat, than you have… without resorting to hCG either, I might add.”

      I do not pretend to special knowledge, nor am I selling a system… I and the others I work with are simply mentors, passing on what we know, so that many of the people we guide end up with six-packs, vs. being smaller versions of their former selves.

      Yes, it takes longer. However, I favor conservative, “tried-and-true” approaches known to work by established mechanisms, vs. those that – at best – are firmly mired in a “gray area.” The activity of a particular therapy in one milieu does not preclude it from acting as a placebo in others. Aspirin, for example, is a physiologically active ingredient that likely provides very little support towards the efficacy of the well-known “ECA stack.” Despite the theoretical justification, EC (without the A) appears to work just as well (this is not – btw – to be construed as a recommendation for EC – it is simply an example of an active ingredient with a known mechanism that does not appear to provide any direct benefit within a particular context). That the ECA stack works does not “prove” the “A” part is essential to the process. This still remains to be established.

      As far as your comment about “family physicians” go – yes, I am aware of the maxim (specifically, “primum non nocere”). I am also uncomfortably aware that there are M.D.s who – in all sincerity – jump down the rabbit hole into “Alternative Wonderland.” The differences between them, and those who employ unapproved, experimental therapies aren’t so easy to distinguish – particularly if both simultaneously a) demand legitimacy; and b) reject (implicitly or explicitly) the process by which legitimacy is conferred. And people looking for weight loss solutions are not necessarily going to look at the credentials of the supervising clinician before signing on the dotted line. I can appreciate the fact that you and Dr. Gonzalez possess the appropriate credentials and have criteria in place for accepting patients… but once again, where are these principles being articulated? In the comments section of a relatively obscure blog!

      Words fail. Why aren’t you guys screaming long and loud in the media about the unethical operators and cautioning the general public about credentials, gouging, qualifications about who/who isn’t a good candidate for the therapy, and potential negative side effects? Once again, this is behavior I would expect to see from dedicated professionals who live by strong ethical standards, regardless of the merits of hCG as an active therapeutic or placebo. The disclaimer on Dr. Gonzalez’s site (about not being affiliated with Kevin Trudeau) is hardly sufficient.

      In other words, you and Dr. G. may be caring professionals, but you are NOT behaving in a professional manner. You may be awesome one-on-one with your patients, but you cannot demand the respect of those of us outside the walls of your clinic(s), without displaying at least some of the standards needed to get it.

      Thus, it is not nearly so “cut and dried” as you would have it. Until the larger pool of potential consumers is provided with a framework for choosing a provider, then many of them will be babes in the woods.

      For the record, you may enjoy getting into brawls over the protocol, but I do not. I have a life and other responsibilities… time is – quite literally – money. You have had your (unedited) say, and have presented no new information – so it really is time to call it a day. You are welcome, of course, to return and post links to any data you – or your colleagues – publish in respectable venues (and no, I don’t mean “Medical Hypotheses” or “The International Journal of Anti-Aging Medicine”). At that point, I believe both Paul and I would be happy to take official note of it, and update our material accordingly. But until then, I bid you adieu.

  10. scorpiofredi says

    As I’ve taken the time to read this entire blog (and I read fast!)I’ll say a few short things. While looking for places to do my residency in family practice, one clinic in an un-named state was quite excited to hire me and this hcg protocol apparently provided the base of their entire practice. I hadn’t heard much about it until my interview there, and decided to do a good bit more research on the topic, not because I was interested in the job, but simply because I was intrigued with the topic. I’m not convinced it is scientifically sound. I am however, quite sure there is a significant amount of anecdotal evidence stumbling around that no one can quite get a handle on which doesn’t help anyone much.

    I certainly have a large amount of respect for good empirical research, and Elissa makes some great points regarding gold standard studies and what makes “good evidence”, after all. I appreciated the dialogue in general, but wonder did it have to be, particularly on the part of the “consumer advocates”, interspersed throughout with such a tone of sarcasm, lack of good grammer, (however intentional), and downright bad language. It would have read much better had there been a tone of respect throughout, it being a given that you can’t control what gets sent in from those with an ax to grind.

    If you’re advocating for the general public,the use of offensive language and grammatically incorrect writing simply doesn’t show that you care as much as you claim you do. That’s my feedback for the day.

  11. says

    All I can say is that my “grammer” is better than that of many others. :-D

    Sorry – couldn’t resist. Y’know, people in glass houses, etc.

    At any rate, you’re certainly entitled to your opinion, but I have a difficult time understanding how you arrived at your conclusion. I’ve written literally thousands of words on this page, and arranged them in generally detailed, well-constructed arguments (considering the time constraints I’m under, this is no mean feat, either). If that doesn’t demonstrate how much I care – then I’m afraid that we’re just going to have to (respectfully) agree to disagree on this point.

    Personally, I find poor, unscientific reasoning on the part of professionals far more offensive than the random expletive used to describe it. If you think that I’ve been unkind, I suggest you avoid the various med/research/skeptical blogs over at Scienceblogs.com. The blogosphere is no place for the easily offended, I’m afraid.

  12. Mike says

    The dialogue on this page demonstrates very well why Chiropractors, Iridologists, reflexologists, and Know-how-to talk-to-people-ologists will continue to do well, and the scientists will continue to be frustrated and shake their heads.

    When I was an engineer working on the Posiedon submarine program, my department head was a mid-50’s male with a BSEE from Georgetown. One day while we were driving to Crystal City to give a proposal to NAVSEC, he told me something that has stuck with me for 33 years. He said: Mike, do you ever wonder why I am the Head of a department full of PhD’s and I only have a bachelor’s degree? It’s because the people I have to communicate with don’t have PhD’s, and when I explain something to them they understand it to the level that they want. However when most scientists try to explain things, they are so full of facts and data that people tend to become suspicious about their agenda. Communication is the name of the game.

    It is very easy to see why Dr. G is very successful in his HcG weight loss program. He probably is very much like my department head. And Elissa is just like those poor frustrated PhD’s!

    • says

      LOL – Mike… I understand where you’re coming from completely. But don’t feel too sorry for me: I’m not the least bit frustrated. ;-)

  13. DT says

    All I can say is that I have used it for 14 days and have lost 16 pounds of fat. How do I know? Caliper measurements and strength testing. I ahve followed FLR and BBR and got to a certain point and then could not lose fat in certain areas. Wigh HCG that is exactly where I have lost the majority of fat. I am not a scientific study but I can see first hand what has trnapired.

  14. says

    Interesting, supposed people of science dropping all the known basic rules of science when there’s $$$ to me made, then act like first year bio students when taken to task by someone like Elissa. The problem is, general non science trained readers will have a hard time knowing who is sticking to the factual objective data (or lack there of) and who is blowing smoke. Dr G et al, you should be ashamed of yourselves, you give all medical professionals a black eye here. Elissa, as usual, shows what real scientists report given the actual info/data that exists.

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