NOAKES: ‘DOG DID NOT BARK’ – PROOF OF HIS INNOCENCE?
By Marika Sboros
There was more drama, intrigue and “silent dogs” on day one of the trial of South African scientist Prof Tim Noakes in Cape Town on October 17. Noakes resumed his evidence-in-chief and began to untangle what he believes the case against him is really about.
He also started to reveal just who he believes may be behind the Health Professions Council of SA (HPCSA) case against him. For “DNA” proof, Noakes pointed to “the dog did not bark”. He fingered some usual suspects and more:
The dog reference is Arthur Conan Doyle’s classic Sherlock Holmes story. (Click here to read Silver Blaze.) It is a metaphor for what Noakes says is the existence of “negative facts” – the “absence of expected facts”. These initially prevented him from seeing the “bigger picture” in the case against him and who is behind it. Until now.
Noakes led evidence that was highly entertaining to lay out his theory of what and who are behind this trial. Lest you think the strain of the hearing is showing, Noakes was relaxed, upbeat and making a compelling case.
The HPCSA has charged Noakes with “unprofessional conduct for giving unconventional advice to a breastfeeding mother on a social network (Twitter)”. That was for a single tweet in February 2014 saying good first foods for infant weaning are low-carb, high-fat (LCHF).
(For more background, click here to read: The real beef dietitians have with him.)
If you asked Noakes right now what he thinks is behind this case, he’d probably answer with a flourish worthy of Doyle’s fictional detective: “Elementary”.
Prof Tim Noakes (left), attorney Adam Pike, and Dr ‘Rocky’ Ramdass (right) at the February 2016 hearing. Picture: ROB TATE
First off, advocate Dr Ravin “Rocky” Ramdass asked Noakes if the HPCSA had ever given him guidelines on what health professionals conduct on social media. Noakes said no, “to my knowledge the HPCSA does not have any guidelines”.
Noakes then presented his first “negative fact”. The breastfeeding mother involved in the case against him, Pippa Leenstra, had not given evidence at the hearing.
Leenstra was “technically the wronged party”, Noakes said. If his words had harmed her or her infant, she should have laid the complaint with the HPCSA. The HPCSA’s own expert witness acknowledged there was no harm to Leenstra or her infant. Leenstra submitted an affidavit saying she had not followed his advice. She also described the case against him as “a circus”.
Had this hearing really been about his advice on Twitter, Noakes said he would have expected Leenstra to be “barking very loudly”. Instead, her silence is “a very telling negative fact”.
The second “negative fact” is that the HPCSA charged Noakes with “unconventional advice” on breastfeeding in the contested tweet.
“I did not give advice that was either conventional or unconventional about breastfeeding,” he said. “My tweet contained no information about breastfeeding other than that breast milk is full-fat and healthy.”
Thus Noakes said the HPCSA has charged him for something he didn’t do.
Click here to read: Could cardiologists be at the heart of HPCSA trial of Noakes?
It’s by now common cause that Johannesburg dietitian Claire Julsing Strydom complained to the HPCSA about Noakes. Strydom was then head of the Association for Dietetics in SA (ADSA). Noakes said he always wondered why Strydom and ADSA had become involved at all.
Their involvement becomes clearer, he said, after publication of a study by researchers at two of South Africa’s top universities, the University of Cape Town (UCT) and Stellenbosch University, in the PLoS (Public Library of Science) One journal in July 2014.
In effect, this paper is to the HPCSA hearing what the dog that did not bark was to Sherlock Holmes in solving the Silver Blaze case. Noakes said it is clear that the HPCSA has built its whole case around this study. It also happens to be “fundamentally flawed”.
His first expert witness, British obesity researcher, Dr Zoe Harcombe, will give all the details, but Noakes presented a slide showing some of the many errors.
Dr Celeste Naude
The study is titled Low carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk: a systematic review and meta-analysis. It is a review of 19 studies, including randomised controlled trials (RCTs).
It has become known as the “Naude Review”, after lead author Dr Celeste Naude of Stellenbosch University’s Centre for Evidence-based Health Care. However, is actually a Stellenbosch-UCT-Cochrane Collaboration review.
Co-authors include Dr Marjanne Senekal, associate professor of nutrition at the University of Cape Town, who is now a consultant for the HPCSA against Noakes. Senekal is also co-author of the “UCT academics letter” to the media in 2014. In it, she and colleagues attack Noakes for making “outrageous and dangerous” unscientific claims about diet. (Click here to read the academics letter and Noakes’ response.)
Noakes said it was only after he and Harcombe decided to submit Naude’s meta-analysis to a “very thorough review” that the truth “popped out”.
Naude and co-authors concluded that:
- Trials show weight loss in the short-term irrespective of whether the diet is low (carbohydrate) or balanced.
- There is probably little or no difference in weight loss and changes in cardiovascular risk factors on either diet.
In so doing, the researchers appeared to have succeeded spectacularly where top scientists internationally failed for decades.
Dr Marjanne Senekal
Noakes presented evidence on instant media responses to the study from ADSA, the Heart and Stroke Foundation of SA (HSFSA), even the HPCSA’s own dietetics board and Stellenbosch university journalists. All quickly hailed Naude’s review as proof of the dangers of “Banting”, as LCHF is known in South Africa.
The HPCSA’s own witnesses, including Strydom, have said they waited for the study to be published before charging him. It bears mentioning that Strydom laid her complaint before the study was published.
Noakes quoted from Strydom’s evidence in which she refers to “big organisations” and “big associations” that were “waiting for this study”.
He asked rhetorically: “Who are these big organisations and associations and why were they waiting for this study?”
Other academics were clearly also waiting – and for what can seem like an inordinately long time – before going after Noakes. Noakes pointed to an article in the SAMJ (South African Medical Journal) by journalist Chris Bateman. That was on UCT’s Great Centenary Debate between Noakes and Prof Jacques Rossouw of the National Institute of Health (NIH) Women’s Health Initiative (WHI).
Rossouw is a particularly vociferous opponent of LCHF – and Noakes. He also has what some scientists say is the dubious distinction of spending more than $700 million funding trying and failing to prove that low-fat diets reduce the risk of heart disease in post-menopausal women. Consequently, he is clearly not an objective voice in this debate.
Prof Jacques Rossouw
The HPCSA tried to call Rossouw as an expert witness against Noakes at its February 2016 hearing session. Rossouw initially agreed but failed to turn up on the day, citing difficulties getting permission from the NIH. Both the NIH and Rossouw have consistently declined to comment.
Noakes pointed to evidence showing that other UCT professors, Krisela Steyn and Naomi (Dinky) Levitt, both ardent critics of Noakes and LCHF, were waiting for the Naude Review.
That raises the question, he said, just why it took so long for the researchers to publish their. He suggested it was because their data did not show what they wanted it to show.
But the really big question around the study, Noakes said, is why the HPCSA used the Stellenbosch review at all, since it identifies a third “negative effect”. The most important body of scientific evidence Strydom, and the HPCSA have used to prosecute him is not about breastfeeding, weaning, children, or infants. It is and always has been about low-carb, high-fat (LCHF) for adults.
Noakes presented a meta-analysis of the evidence published in the British Journal of Clinical Nutrition in 2013, that conflicts with Naude’s review. He presented more current research, a joint Canadian-South African study published in the South African Medical Journal (SAMJ) in September 2016. Click here to read the full text of: A successful lifestyle intervention model replicated in diverse clinical settings.
Lead author is South African Dr Stefan Du Toit who now works in remote rural areas of Canada. Noakes is third co-author. Du Toit’s research did not start out as a study on LCHF but morphed into one over time.
On the motivation behind the study and its conclusions, Du Toit has said:
“As a physician, you give prescriptions every month for chronic conditions and you don’t see any improvements in health. Actually, things tend to get worse over time.
“So we started to question: as physicians practising recommended guidelines, why aren’t we seeing the desired improvements in health? Why is evidence-based medicine not working?
“We started these group-based lifestyle interventions with obese, pre-diabetic and diabetic patients. We tracked patient outcomes with the electronic medical record data -practice based evidence. What we found was participants’ health improved; they reduced their need for medication and their control improved. Then things took off from there.”
Noakes said Du Toit’s data show positive outcomes that are “very different from those that conventional medical management using standard pharmacotherapy achieves in diabetic and weight loss patients”.
This clearly is an important study even as critics were quick to knock it. It goes straight to the heart of what’s wrong with “evidence-based medicine”, Noakes said. Or as Du Toit and his researchers put it, medicine that “no longer cures”.
They say the staunch faith most doctors still have in classic RCTs is “misplaced”. “Evidence-based medicine” that doctors are supposed to rely on simply “isn’t working” to treat or beat the diabesity pandemics.
Therefore, a question all doctors should ask is: Why isn’t it working and what can we do better?”
They should also keep an ear out for scientific “dogs that don’t bark”.
The hearing continues in Cape Town until October 26.
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When will we get the next update here on the trial? Loving your coverage. Thanks
Here’s one, more to follow: http://foodmed.net/2016/10/20/noakes-hpcsa-hopes-nail-him-lchf-banting/
Thany you for the brilliant feedback! Nailbiting … Yesterday but today pfff. Clearly case of the “pot calling the kettle black” They worried about the witnesses waiting for their turn. They not only Tim Noakes’ Angels but Global Angels.
You may also be interested to read this recently published in the UK.
https://drmalcolmkendrick.org/2015/02/16/a-humiliating-climb-down-or-a-machiavellian-move/
“The truth will out”. (Winston Churchill)
Both heads of food and drug industries are complicit in this debacle.
On the food side, heads of industry know full well that the foods they sell are responsible for multiple health failures, but market share and revenue are more important. One might feel the pharmaceutical industry should be jumping up and down saying; “NO don’t eat that”…. But then stop, step back and consider; if the heads of the pharmaceutical industry did that, what would happen to the need for medicines that counteract (not cure) conditions like, blood pressure, raised cholesterol, clot formations, stroke, diabetes, depression, dementia, Alzheimer’s, cancer and all the ‘side issues’ linked to all these conditions – a minefield of conditions that provide Billions of; Dollars and Euros and Pounds profit. For them to do that would be like blowing off their feet with a shotgun. So with that in mind, does the silence and dogs not barking start to make sense? As far as I’m concerned they can keep quiet. I’ll just wait until I can hear the “dogs squealing” as they fork out vast amounts once found complicit and responsible for disease and suffering of millions of patients who trusted them. As I started; “The truth will out”.
Go Noakes!!!! Love your work!!! A revolution in food is here. Problem is that some doctors and nutritionists still think the world is flat….
Whenever I see the phrase “evidence-based medicine” I tend to think of those nation states back in the 1970s who used to describe themselves as “The People’s Democratic Republic of Whatever”. It was a sure sign that one was dealing with a polity that was not democratic and that had no interest in the wishes of the people. More briefly, if you think you need to say it, then you’re not.
You can’t do “Evidence-Based” medicine when half the evidence is missing. Well it’s all there hidden in plain sight on PubMed but The Authorities ignore it.
The HPCSA’s desire not to comment might be influenced by the fact that whenever they say anthing, they look ever more incompetent.
How do the numerous critical public comments from cardiologists and dietitians about Tim Noakes comply with their own policies? Yet this hearing follows two tweets. It is the establishment defending the established position. Its utter failure seems to have escaped them.
The history of medicine shows how often the orthodoxy and ‘top people’ have turned out to be wrong. From disease transmission in 1840s Vienna to the disastrous treatment of enforced bedrest for people who’d suffered a heart attack, which was still hapening in the 1960s. The low-fat, high carbohydrate diet will at some point go on that list and its current defenders are going to look as foolish and stubborn as those who criticised Ignaz Semmelweiss in Vienna for suggesting that washing hands between patients might be a good idea. After all, those infallible top people knew that disease was spread by miasma (bad air) and derided Semmelweiss. If you added up the deaths from just these two medical disasters, it runs to millions and some humility is in order. But it’s in very short supply in the medical world. They’re certain they’re exactly right, all the way up to the day when they’re proved wrong. Science is about correcting mistakes, not clinging to them.
Well said!
While we’re pontificating upon, and pointing accusatory fingers at, those who would allegedly love to see Noakes fall, their bias and their agendas, would it not be fair for the author to admit her own somewhat one-sided opinions on this subject and her heartthrob professor?
It would only be fair.
I’m all for being fair. Everyone mentioned or criticised has right of reply. I regularly ask for comment from both sides. Would love to opine more on the other side of this case, only they’re not talking. Have refused to do so from the start. Keep claiming “sub judice”, which doesn’t apply as HPCSA is not a court of law. You’re entitled to your opinions, as I am to mine. Facts are another matter. No one is entitled to his or her own set of facts. Any facts you care to contest here? BTW, have never heard Prof Noakes described as “heartthrob professor”. I’ll let him know you are a not-so-secret admirer!
I would respond NJ with a quote from the great politician Benjamin Disraeli: “There is no act of treachery or meanness of which a political party is not capable; for in politics there is no honour.”
These people at HPCSA are deploying a heady mixture of politics and bad science; they are unsurprisingly devoid of any honour whatsoever.
Well said, Oh Eminent One!