{"id":1795,"date":"2009-05-14T04:20:59","date_gmt":"2009-05-14T02:20:59","guid":{"rendered":"http:\/\/blog.ultimatefatburner.com\/?p=1795"},"modified":"2015-12-03T11:16:29","modified_gmt":"2015-12-03T16:16:29","slug":"is-this-the-right-room-for-an-argument","status":"publish","type":"post","link":"https:\/\/www.ultimatefatburner.com\/ufb-blog\/is-this-the-right-room-for-an-argument\/","title":{"rendered":"Is This the Right Room for an Argument?"},"content":{"rendered":"

As the resident “scientific advisor” here at ultimatefatburner.com, I occasionally get called on to comment on\u00a0issues unrelated to my primary tasks (writing bodybuilding supp and functional food reviews; blogging).\u00a0 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<\/a>.<\/p>\n

OMFG!<\/p>\n

There’s a ton o’words hiding behind the above links.\u00a0 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.\u00a0 He uses the hCG Protocol – a rigid, 500 calorie diet in conjunction with\u00a0hCG injections –\u00a0in his practice, and feels that it has been outstandingly successful on the selected, obese\u00a0patients (over 200 patients and counting<\/em>) it’s been used on.\u00a0\u00a0So he posted some\u00a0(lengthy) comments over at\u00a0Real-Customer-Comments.com<\/a>\u00a0to protest\u00a0the negative tone of Paul’s review.<\/p>\n

Now personally, I think Paul’s response to Dr. Gonzalez’s comments was spot on:<\/p>\n

Our job is to look at the existing data, compare it to the claims, and report on the results. That\u2019s 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.<\/p><\/blockquote>\n

Badda-bing, badda-boom.\u00a0 Short. Sweet. To the point.\u00a0 I honestly can’t improve on that.\u00a0 The\u00a0evidence shows that a highly restrictive diet\u00a0+ hCG is no better than the same diet + placebo.\u00a0 This is precisely what\u00a0Paul reported…and Dr. Gonzalez presented\u00a0ZERO evidence to to the contrary.<\/p>\n

So why am I piling on?\u00a0 It’s pretty simple, really.\u00a0 In his (very extensive) comments, Dr. Gonzalez makes certain points that virtually scream for rebuttal. The word of an MD\u00a0carries a lot of weight with the general public, so the\u00a0flaws in his argument(s) need to be addressed in more detail than Paul was able to provide in\u00a0the hCG\u00a0comment thread.<\/p>\n

So let’s\u00a0take Dr. Gonzalez’s points\u00a0from the top…<\/p>\n

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. \u201cIt\u2019s not FDA approved, anyone can lose weight on 500 Kcalories a day, there are no studies proving it, you can\u2019t live on 500 calories, anecdotal reports are worthless, etc.\u201d<\/strong><\/p>\n

Sigh. The “narrow-minded, traditionally-trained expert” schtick is an old, overused rhetorical\u00a0device exploited by virtually every “alternative health” provider on the face of the planet –\u00a0 not to mention proponents of other pseudoscientific beliefs, like Creation Science.<\/p>\n

It’s\u00a0a straw man here, as it\u00a0posits a false dichotomy between the clinical, “ivory tower” view of the researcher, and personal, “real world” experience –\u00a0otherwise known as\u00a0“anecdotal evidence”.\u00a0 But as cancer surgeon\/researcher\/skeptic\/med-blogger ORAC points out<\/a>:<\/p>\n

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.\u00a0 Anecdotes are not enough…<\/p><\/blockquote>\n

In science, there are hierarchies of evidence,\u00a0thus, 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.\u00a0 In addition, as ORAC notes, there’s a difference between “anecdotes” and “testimonials”.\u00a0 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.\u00a0 This places his “anecdotes” at the level of “testimonials”, which are scientifically worthless.<\/p>\n

But I digress:\u00a0\u00a0the process of enlightenment\u00a0– as described by Dr. Gonzalez – \u00a0is completely compatible with “traditional training”.\u00a0 It’s his reasoning and conclusions that are suspect.<\/p>\n

This is highlighted by his story.\u00a0 I gotta ask: why is it that skeptics are invariably accused of being “narrow-minded” for demanding good evidence, while proponents of questionable therapies\u00a0applaud themselves for their “open-mindedness”?\u00a0 As philosopher of science Phillip Kitcher points out in his book, Abusing Science<\/a>:<\/p>\n

Open-mindedness is not incompatible with having opinions…what is crucial to open-mindedness is the way in which opinions are held.<\/p><\/blockquote>\n

Bingo: a rational skeptic bases his or her\u00a0opinion on the evidence,\u00a0but will change it\u00a0if\u00a0solid reasons are\u00a0offered\u00a0– the essence of “open-mindedness”.\u00a0 Many proponents, on the other hand,\u00a0refuse to consider – or brush aside – evidence that contradicts what they want (or want others) to believe…which is\u00a0pretty “narrow-minded”, if you ask me.\u00a0<\/p>\n

Paul and I are rational skeptics.\u00a0 As for Dr. Gonzalez…well, as you read what follows, you can decide for yourselves.<\/p>\n

2. A myth concerning this protocol is that you live off 500 calories…<\/strong><\/p>\n

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

Actuality is that you live off the 500 calories you ingest PLUS the calories you burn from your fat…<\/p><\/blockquote>\n

…could be used to describe ANY weight loss diet.\u00a0 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.\u00a0 This is no less true for a conventional, 1500 calorie diet than it is for an unconventional,\u00a0500 calorie one.\u00a0<\/p>\n

Despite the dramatic “myth\/fact” flourish, this strikes me as\u00a0a pretty banal observation.<\/p>\n

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.<\/strong><\/p>\n

I honestly don’t know how to evaluate this.\u00a0 Beyond the rather dubious equation of “hormones” with “nutrition”, he also points out that adipose tissue contains some stored micronutrients – another perfectly unremarkable observation.\u00a0 So what?\u00a0<\/p>\n

As\u00a0stated above, it’s well-established that stored body fat is a source of energy (or “nutrition” if you will).\u00a0 Since VLCDs (very low calorie diets) are sanctioned by “traditional” medicine<\/a>, 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.\u00a0 BFD.<\/p>\n

This brings up a related point: what I find disturbing about Dr. Gonzalez’s recitation of these “myths”, is his failure to\u00a0specify just who the hell believes them in the first place.\u00a0 They don’t appear anywhere in Paul’s review.\u00a0 Is he claiming that medical professionals are perpetuating these myths?\u00a0 If so, then they might be worth refuting in his comments; otherwise this is a red herring.<\/p>\n

4. Did you know the hCG hormone is similar to thyroid hormone and acts to stimulate the thyroid?<\/strong><\/p>\n

No, I did NOT know this at all, and still don’t.\u00a0 hCG is a large-ish glycoprotein composed of 244 amino acids.\u00a0 By contrast, thyroxine (T4) and triiodothyronine (T3) are very small molecules, synthesized from a single amino acid: l-tyrosine. They are completely and utterly dis<\/strong>similar.<\/p>\n

Ok, in fairness, what\u00a0Dr. Gonzalez\u00a0actually MEANT to write, was that there is some resemblance between hCG and TSH<\/strong> – thyroid stimulating hormone (they share\u00a0a subunit).\u00a0 Thyroid hormones are made by the thyroid.\u00a0 That’s why they’re called thyroid<\/strong> hormones<\/a>. Thyroid STIMULATING<\/strong> hormone, on the other hand, is made in the pituitary gland<\/a>. It’s a small point, perhaps, but telling…the level\u00a0of precision I’m describing\u00a0should be as natural as breathing to a technically-trained person claiming expertise in such matters in a public venue.<\/p>\n

Nonetheless, it is true that hCG can have mild, thyroid stimulating effects<\/a>\u00a0– at least in pregnant women.\u00a0 Once again, this is a well-known medical fact.\u00a0 But the key term here is “mild”.\u00a0 While it’s possible this could provide some metabolic boost\u00a0under conditions of reduced calorie intake, I haven’t seen any\u00a0info on this.\u00a0 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<\/em>” with actual data.<\/p>\n

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 \u201cblack box\u201d 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.<\/strong><\/p>\n

Dr. Gonzalez is being rather disingenuous here.\u00a0 For the record, I am not “for” gastric bypass surgery…quite the contrary.\u00a0 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<\/a>). And many patients undergoing the surgery insist that – despite the hardships – they’d do it all over again<\/a>.<\/p>\n

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<\/a>. It sucks, but there you go.<\/p>\n

Now hCG treatment is undoubtedly pretty safe…and I’m not inclined to argue\u00a0with Dr. Gonzalez’s contention\u00a0that it’s much safer than bariatric surgery.\u00a0 But its effectiveness<\/strong> is precisely what\u00a0we’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.\u00a0 I could just as easily argue that\u00a0– say – cha de bugre<\/a>\u00a0is perfectly safe as a treatment for obesity…I’ve used it myself and rather like it.\u00a0 But in the absence of proof that it works BETTER THAN PLACEBO (more on this below), it’s preposterous to\u00a0laud it as a superior alternative to bariatric surgery; or to twit the FDA (for all its faults) for placing a “black box” on it.<\/p>\n

Sorry Doc, but the point of making an argument is to CONVINCE me.\u00a0 You can’t assume the truth of your conclusion in the process of proving it.\u00a0 You have to present me with evidence independent of your assumption, if you want me (or Paul) to credit your opinion on the matter.<\/p>\n

6. The \u201cextensive studies\u201d 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.<\/strong><\/p>\n

“Small” and “old” are also red herring arguments.\u00a0 Small and old don’t add up to “wrong”.\u00a0<\/p>\n

In addition, a 1995 meta-analysis<\/a> does not support Dr. Gonzalez’s contention that the results are “equivocal when they are all looked at together.”\u00a0 Looking at all the studies together\u00a0is what meta-analyses are designed to do, after all.\u00a0 Needless to state, the conclusion of the meta-analysis isn’t “equivocal” – it’s flat-out negative.<\/p>\n

\n

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.<\/p>\n<\/blockquote>\n

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\u00a0valid way to\u00a0share ideas and observations with other doctors, with an eye towards changing the consensus opinion. Hell, even “letters to the editor”\u00a0printed in\u00a0a respected journal carry some weight with other professionals.<\/p>\n

7.\u00a0 Why don\u2019t 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.<\/strong><\/p>\n

Ummmm…sorry Doc, but I spent nearly 8 years living (and working) on the NIH (National Institutes of Health) dole<\/a>.\u00a0 That dawg don’t hunt.<\/p>\n

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.\u00a0 To say he’s “unable to get a grant” implies he’s actually made the effort, yet\u00a0 – once again – no evidence of this is offered.\u00a0 Presumably, Dr. Gonzalez is aware that\u00a0“Big Pharma” isn’t the only potential source of funds…there’s the guvmint and private foundations to consider, too.\u00a0 And surely he could locate various university or other institutional co-authors to lend some “establishment cred” to his proposal.\u00a0 Either he has compelling data that will attract their interest or he doesn’t.<\/p>\n

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.<\/p>\n

8. The hCG is not for everybody. It is not a \u201cweight loss cure\u201d 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.<\/strong><\/p>\n

What the reader wading through the original comments may not see, is that Dr. Gonzalez continually blurs the distinction\u00a0between\u00a0“hCG”\u00a0and “hCG Protocol.”\u00a0 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).\u00a0 Bells and whistles in the original protocol aside<\/a>, that’s what it boils down to.<\/p>\n

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.\u00a0 What Dr. Gonzalez has failed to demonstrate, is that a VLCD program is more effective WITH hCG than without it.\u00a0 The patient restrictions and corresponding benefits he mentions, for example, are NOT unique to hCG treatment at all.\u00a0 Even small amounts of weight\/fat loss can produce measureable benefits to health<\/a>.\u00a0\u00a0It’s great that some of his patients have been able to drop their meds…but this is not\u00a0a unique or unexpected result.\u00a0 It could happen to anyone losing a lot of weight, on any number of reasonable diets.<\/p>\n

Once again, the key point of contention is whether hCG treatment is BETTER THAN PLACEBO for producing these benefits.\u00a0 This is the thrust of Paul’s review.\u00a0 Now, I have to give Paul 30 lashes with a wet noodle for failing to put this distinction between “hCG”\u00a0and “hCG Protocol”\u00a0front and center in his review.\u00a0 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.<\/p>\n

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.<\/strong><\/p>\n

This one was picked up by Paul already, but I’ll put in my two cents in too.\u00a0 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.\u00a0 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\u00a0conclusion is clearly\u00a0based\u00a0on\u00a0the lack of scientific evidence – not on Kevin Trudeau’s status as a scam artist.<\/p>\n

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\u00a0in places like\u00a0the UCLA medical center<\/a>.<\/p>\n

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.<\/p><\/blockquote>\n

Looks like the bar is set pretty high.\u00a0 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.<\/p>\n

But until better data shows up, the verdict stands…<\/p>\n","protected":false},"excerpt":{"rendered":"

As the resident “scientific advisor” here at ultimatefatburner.com, I occasionally get called on to comment on\u00a0issues unrelated to my primary tasks (writing bodybuilding supp and functional food reviews; […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[9,14,28,29],"tags":[539,642,804,805,1372,1474,1867],"_links":{"self":[{"href":"https:\/\/www.ultimatefatburner.com\/ufb-blog\/wp-json\/wp\/v2\/posts\/1795"}],"collection":[{"href":"https:\/\/www.ultimatefatburner.com\/ufb-blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.ultimatefatburner.com\/ufb-blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.ultimatefatburner.com\/ufb-blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ultimatefatburner.com\/ufb-blog\/wp-json\/wp\/v2\/comments?post=1795"}],"version-history":[{"count":5,"href":"https:\/\/www.ultimatefatburner.com\/ufb-blog\/wp-json\/wp\/v2\/posts\/1795\/revisions"}],"predecessor-version":[{"id":10252,"href":"https:\/\/www.ultimatefatburner.com\/ufb-blog\/wp-json\/wp\/v2\/posts\/1795\/revisions\/10252"}],"wp:attachment":[{"href":"https:\/\/www.ultimatefatburner.com\/ufb-blog\/wp-json\/wp\/v2\/media?parent=1795"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.ultimatefatburner.com\/ufb-blog\/wp-json\/wp\/v2\/categories?post=1795"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.ultimatefatburner.com\/ufb-blog\/wp-json\/wp\/v2\/tags?post=1795"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}