Doctoring Data by Dr Malcolm Kendrick
Kendrick is one of those contrarian folks I like to follow and read. He is still a scientist at heart and one that likes to question the orthodoxy. Which is why he has been vilified and hated upon by many, but like others of his ilk not proven wrong. This book is an older one that covers his journey through discovery of how medicine, and more the pharma industry, play very fast and loose with their data. Kendrick shows the tricks of the trade and gives you plenty of evidence along the way.
You may not like what he has to say, but I do recommend reading this to arm yourself with the ah ha moment tools to question what ‘expert’ driven, hubris laden, 100% confident information you are being given.
Flyability
Its just under 300 pages, and only took me a few days to read. Definitely something that could be done on a pair of domestic return flights…although be warned some of the stats he chucks in there may need a re-read to understand what is happening.
The truth toolkit1…these are things to help, for Kendrick, in the sense of a medical story, but I think are good heuristics in general are:
Association does not mean causation
Lives cannot be saved; we’re all going to die
Relative mountains are made out of absolute molehills
Things that are not true are often held to be true
Reducing numbers does not equal reducing risk
Challenges to the status quo are crushed – and how!
Games are played and the players are…
Doctors can seriously damage your health
Never believe that something is impossible
‘Facts’ can be, and often are, plucked from thin air
The book is based on these ten headings and divides nicely into ten or so chapters.
Quotes
“When a man finds a conclusion agreeable, he accepts it without argument, but when he finds it disagreeable, he will bring against it all the forces of logic and reason.” Thucydides2
“I know that most men, including those at ease with problems of the greatest complexity, can seldom accept even the simplest and most obvious truth, it be such as would oblige them to admit the falsity of conclusions which they have delighted in explaining to colleagues, which they have proudly taught others, and which they have woven, thread by thread, into the fabric of their lives.” Leo Tolstoy3
“Truth never triumphs – its opponents just die out. Science advances one funeral at a time.” Max Plank4
“For every complex problem there is an answer that is clear, simple, and wrong.” H. L. Mencken5
Ah ha moments
Too often we have a bias to action, you don’t think you just act6:
The need to do something/anything;
Grabbing the simple/easy hypothesis too early;
Being so certain your hypothesis is correct you don’t do any study to prove that it is beneficial – you just get on with it.
When it is medicine you can understand why such events happen…you could die of <insert disease / problem> if you don’t do something. But is that really true? Kendrick continues:
‘One of my core philosophies is ‘Don’t just do something, stand there.’ However, a significant majority of the medical profession appears overwhelmed with the need to rush around doing things, no matter what.’7
Now I’m not going to delve into the many, many areas that Kendrick calls out in the book, but many a shibboleth should be questioned rather than taken at face value.
Also whenever you see relative risk as opposed to absolute risk then:
‘My advice is to look for absolute risk every time. If the absolute risk is hidden away, then you can confidently assume that it is so vanishingly small that the authors chose not to highlight it, as it would significantly weaken their message.’8
And what does this mean in terms that makes sense9…
Let’s try this again, with numbers that are 10 times as big. 1,000 people start taking a blood pressure medication and 1,000 do not.
At the end of a year, 1 person taking medication has died, and 2 people not taking the medication have died.
The absolute difference in deaths is 1 person per 1,000 or 0.1%.
The relative difference is 1 vs. 2 (½ = 50%).
I shall now also claim that if you take my medication, your risk of dying has been reduced by 50% (which is also true – sort of).
Drug study design and execution is a major bug bear of Kendrick:
‘To which I would say, have you not been paying attention at the back. The benefits of blood-pressure lowering, whatever the level, became so widely accepted years ago that it has not been possible, ethically,[viii] to do a placebo-controlled study for a long time. I am not aware of any placebo-controlled trials that have been done in the last twenty years, or so.
This means the only ‘new’ studies done are to use one type of drug vs. another, or one drug vs. two, or three. Or different combinations in different medical conditions.’10
And the last one I will focus on is this wonderful graph; which sort of puts a hole in the whole being overweight thing:
Maybe that extra fat you are carrying will be the thing that saves your life.
Five Stars
My bias here is I think Kendrick is right. And it will take quite heroic forces to make me drop my support for Kendrick and Dr authors like him. So of course it gets five stars.
But what I will do is leave you with a conundrum that stems from such questioning. Now I don’t know if this position is right or wrong, but what I would say is you should be questioning everything with the lenses Kendrick gives you. Oh and Kendrick has the best part of a chapter on this topic too…
Does the Flu vaccine ‘work?’
Now remember from Kendrick you can only die once. So the end point of any medical intervention is whether the intervention stops you dying of the thing. Which makes this a very curious graph of flu mortality for the United States11:
Why curious? The flu vaccine was developed in the forties…after the massive drop in mortality…and even then for 40 years or so the vaccination level of the people most in need, the olds, remained pitifully low. Which gets this curious passage:
‘Observational studies report that influenza vaccination reduces winter mortality risk from any cause by 50% among the elderly. Influenza vaccination coverage among elderly persons (≥65 years) in the United States increased from between 15% and 20% before 1980 to 65% in 2001. Unexpectedly, estimates of influenza-related mortality in this age group also increased during this period.’12
Massive increase in vaccine uptake. Not a massive, arguably no change at all, in mortality from flu. So lets leave the cui bono here:
‘The global influenza vaccine market was valued at US$ 8.78 billion in 2023. The global market is projected to hit the market valuation of US$ 22.71 billion by 2032, growing at a CAGR of 11.07% during the forecast period from 2024 to 2032.’13
P. 26
P. 79
P. 80
P. 132. Funny thing is Plank helped publish Einstein and his Special Theory of Relativity against the objections of the editorial board. So he did advance science without a funeral. Second funny thing is Einstein said that the theory of plate tectonics was nonsense. Which Kendrick uses to point out clever people get things wrong too.
P. 196
P. 184
Ibid.
P. 46
P. 43
P. 105…this is also known in anti-vax circles as turtles all the way down, were drug trials compare two drugs rather than a placebo and the drug, and then the next trial is based on the new drug, and so on.
https://pmc.ncbi.nlm.nih.gov/articles/PMC2374803/
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/486407
https://www.biospace.com/influenza-vaccine-market-is-forecasted-to-worth-us-22-71-billion-by-2032