REFERENCES FOR UNCOVERING WEIGHT STIGMA IN SCIENTIFIC LITERATURE

Minority Dissent and Team Innovation: The Importance of Participating in Decision Making

Referenced on the topic of minority dissent and its importance in falsifying hypotheses, as the foundation of scientific inquiry.

Compliance with non-pharmaceutical recommendations and outcome in heart failure patients

Referenced in the first example provided as a way to practice using the three cards of techniques to uncover bias in scientific literature.

There are 191 deaths from heart failure per 100,000 people in the United States today. That’s (rounding up) 2 in 100 people. By failing to comply with non-pharmaceutical treatment recommendations, actual mortality risk is raised to 2.6 in 100 people. Or, a 98% chance of not dying following the recommendations and a 97.4% chance of not dying when ignoring the recommendations.

The relative risk increase is 60% (sounds scary)

The actual risk increase is 0.6% (sounds silly).

CDC Centers for Disease Control and Prevention Heart Failure Fact Sheet
Intake of sugar-sweetened beverage and weight gain: a systematic review

Referenced as the second example provided as a way to practice using the three cards of techniques ot uncover bias in scientific literature.

The correlation that the researchers identify that for every additional soda beverage consumed there is a 0.04 BMI increase year over year (duration 3 years) is all but wiped out when they adjust the correlation (correctly) to encompass the natural commensurate increase in energy requirements that coincide with body mass.

Sitting time and mortality from all causes, cardiovascular disease, and cancer.

Referenced in the third example provided as a way to practice using the three cards of techniques to uncover bias in scientific literature.

While highly cited and referred to as a high-quality and definitive study that confirms a sedentary lifestyle increases all cause mortality, with the exceptinon of cancer, its dependence on the PAR-Q to single-handedly remove the risk of having already ill (and therfore increasingly sedentary individuals) within the study group likely lowers the hazard mortality ratio provided in the results to a point that may even generate statistical insignificance.

Obesity and Mortality in Critically Ill Adults: A Systematic Review and Meta-analysis

Referenced for the final example provided as a way to practice using the three cards of techniques to uncover bias in scientific literature.

The systematic review confirmed that being either obese or overweight while critically ill conferred lower mortality rates than to be of average or below-average size. The researchers highlight the sub-group of severe obesity (>BMI 40) stating that this inverse relationship was not significantly related to this outcome.

However, the odds ratio for the sub-group of those above BMI 40 had a pooled result of 0.94 (1.00 would mean that the chance of dying while critically ill was not more or less likely to occur, anything below one means it's less likely to occur and above will mean more likely to occur). The assumption is that those between BMI 18.5-24.9 would have an odds ratio of 1.00. However, when looking at the pooled results, the odds ratio for that BMI range is 1.33. As such, an odds ratio of 0.94 actually becomes more significant in relation to a baseline of 1.33 and not 1.00.

Cochrane Collaboration

First stop for looking out systematic reviews on whatever biomedical research is of interest to you.

Retraction Watch.com

An excellent site for staying up-to-date on what scientific published papers have been retracted.

Top Class Actions.com

One of several sites that lists class action lawsuits, this link is specific to pharmaceutical and medical devices.

Robert Rosenthal

Experimenter expectancy effect.


BASIC STATISTICS REFRESHER

The following are links to various entries that will more than suffice for explaining some basic statistics concepts you regularly come across in peer-reviewed published scientific literature.

Standardized Mortality Ratio (SMR)

Hazard Ratio

Hazard Ratios do not always reflect mortality, but events associated with the trial group in question. An HMR (hazard mortality ratio) specifically looks at the risk of mortality for the trial group in question for the trial duration under review.

Absolute vs. Relative Risk

Statistical Significance

Statistical vs. Clinical Significance

Statistical Significance and Clinical Importance

Statistical Terms: A Primer for Media

This is a great short article that covers off all the most frequently used statistical terms found in scientific literature


WHITE, GREY AND BLACK HAT BIASES

White hat bias: examples of its presence in obesity research and a call for renewed commitment to faithfulness in research reporting

A particularly frequent form of bias to be found in obesity research as scientists live within our sociocultural frameworks as much as any of us do. Because it is assumed obeity is bad, it can lead researchers to feel that their moral responsibility would be to avoid publication of material that might suggest obesity is benign or, heaven help us, actually beneficial.

The Impact of Disclosing Financial Ties in Research and Clinical Care

Fascinating that despite the fact there is plenty of evidence that funding ties (whether stated or not) do sway the results, it appears as though as human beings we fall prey to believing that honest discolsure of funding ties will somehow nullify this bias, even though it does not.

Identifying and Avoiding Bias in Research

Although framed within the context of surgical trials, this is a synopsis of all the types of bias classified under grey-hat bias (pre-trial, trial and post-trial)

Everyone has a bias blind spot, researchers find

This is a mainstream article (to see the research on which this article is based, check the link at the bottom of the article).

"When physicians receive gifts from pharmaceutical companies, they may claim that the gifts do not affect their decisions about what medicine to prescribe because they have no memory of the gifts biasing their prescriptions. However, if you ask them whether a gift might unconsciously bias the decisions of other physicians, most will agree that other physicians are unconsciously biased by the gifts, while continuing to believe that their own decisions are not. This disparity is the bias blind spot, and occurs for everyone, for many different types of judgments and decisions," said Erin McCormick, an author and Ph.D. student in behavioral decision research in CMU's Dietrich College of Humanities and Social Sciences.
Failure to discount for conflict of interest when evaluating medical literature: a randomised trial of physicians

While physicians believe that they should discount the value of information from conflicted sources, they did not do so in the absence of a direct comparison between two studies. This brings into question the effectiveness of merely disclosing the funding sources of published studies.

Mandatory Prospective Trial Registration Working to Prevent Publication of Unregistered Trials and Selective Outcome Reporting? An Observational Study of Five Psychiatry Journals That Mandate Prospective Clinical Trial Registration

"To address the bias occurring in the medical literature associated with selective outcome reporting, in 2005, the International Committee of Medical Journal Editors (ICMJE) introduced mandatory trial registration guidelines and member journals required prospective registration of trials prior to patient enrolment as a condition of publication."

It will not surprise anyone who has checked out the material thus far, that the researchers found that the publications were for the most part not enforcing this new guideline.


BLOG POSTS OF POSSIBLE INTEREST


ADDITIONAL READING

These books are not all specific to the topic of obesity research, but they provide the reader with multiple perspectives that can greatly enhance anyone's ability to identify bias in peer-reviewed published scientific papers.

A Mind of Its Own: How Your Brain Distorts and Deceives

by Cordelia Fine

Cordelia Fine is such a brilliant and humorous writer that it would be easy to overlook that this is a very well-turned out and definitive meta-analysis on all things self-delusional (and healthy) about our brains. When the mildly-depressed are the ones who have an objective take on things, you begin to grasp that mental illness is not illness but perhaps altered brain function that serves an overall purpose for group survival.

In relation to the workshop Uncovering Weight Stigma In Scientific Literature: How to Find It to Combat It (3rd Weight Stigma Conferences Sep. 18-19 2015), the material of interest in this book will be an explanation on priming schemas and experimenter effect.

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Mad Science: Psychiatric Coercion, Diagnosis, and Drugs

by Stuart A. Kirk, Tomi Gomory, & David Cohen

This book is one of several that provide a good example of minority dissent within scientific research, although it reflects dissent within the field of psychiatric research and not obesity research.

The back jacket description excerpt: When it comes to understanding and treating mental illness, distortions of research are not rare, misinterpretation of data is not isolated, and bogus claims of success are not voiced by isolated researchers seeking aggrandizement. This book’s detailed analysis of coercion and community treatment, diagnosis, and psychopharmacology reveals that these characteristics are endemic, institutional, and protected in psychiatry. They are not just bad science, but mad science.

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Deadly Medicines and Organized Crime: How big pharma has corrupted healthcare

by Peter Gøtzsche

Another book that looks at various areas of scientific research that have been corrupted by corporate interests.

The version I read I assume was translated from Danish and it had some minor errors in English syntax. Nonetheless, Peter Gøtzsche is one of several well-known minority dissenters within the scientific research community and he is unflinchingly scathing and direct in his review and assessment of the state of scientific research due to the not-so-invisible hand of industry guiding its course.

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White Coat, Black Hat: Adventures on the Dark Side of Medicine

by Carl Elliot

Carl Elliot is a professor of bioethics and I wish he'd been my prof. His exposé on the incestuous relationship between physicians and pharmaceutical companies is both eye-opening and entertaining. I quote him in my series on FAT in the blog: "The best mark is often a person to whom the possibility of a con never occurs, simply because he thinks he is too smart to be tricked. Medical practice is like this. Many doctors know nothing about advertising, salesmanship, or public relations. They believe these are jobs for people who could not get into medical school. This probably why they are so easily fooled."

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Worried Sick: A Prescription for Health in an Overtreated America

by Nortin M. Hadler, MD

Does your doctor know how likely it is that proposed treatments will afford meaningful benefits? And do you? Each chapter covers off the uses and abuses of screening tests and medical and surgical interventions. We all over-estimate the value of having a negative screening test relative to the anxiety and actual risk associated with undertaking the test in the first place. Not many of us goes into all the rote screening recommendations with the following thought in the back of our minds: "Could I be harmed by the test itself? Could I receive an equivocal result that might mean further risky and unnecessary interventions? And what would be the course of action if the test is positive?" This is a good book for getting us to mull all these things over before we face snap decisions in a doctor's office.

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The Obesity Myth: Why America's Obsession with Weight is Hazardous to Your Health

by Paul Campos

Campos' well-researched assessment of how the "War on Fat" has no scientific basis (fat does not kill); may be contributing to increased levels of inactivity; and might be causing increases in weight for the population overall (yo-yo dieting), it is enlightening to even those of us who are naturally suspicious of any public health initiative.

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Body of Truth: How Science, History, and Culture Drive Our Obessions with Weight and What We Can Do About It

by Harriet Brown

Harriet, one of the presenters at the 3rd Weight Stigma Conference Sep. 18-19, 2015, spent some four years amassing and synthesizing the research to develop this book. It is a straightforward read and suitable for those with no prior exposure or background in obesity research – an excellent book to recommend to patients or clients.

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Disease, Diagnoses, and Dollars: Facing the Ever-Expanding Market for Medical Care

by Robert M. Kaplan

Kaplan is professor of both public health and medicine. This book is most intriguing because it addresses the ethics of disease screening and treatment from the perspective of access as well as its value to both the individual and the population at large. Because we keep ratcheting screening guidelines as well as transforming more conditions into disease states, we now have an ever shrinking population of the excessively cared-for alongside the ever burgeoning uninsured and uncared-for. Most fascinating is that even excessive care for the wealthy few does not usually generate better outcomes or longevity for them in any case.

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The Bitterest Pills: The Troubling Story of Antipsychotic Drugs

by Joanna Moncrieff

Atypical antipscyhotics are often prescribed for the off-label treatment of restrictive eating disorders. However a recent systematic review by Jocelyn Lebow and her colleagues confirm that these drugs worsen restrictive behaviors and anxiety symptoms (2013).

In addition to Moncrieff's book The Myth of the Chemical Cure, this book will provide any patient who is either being advised to take, or is taking, atypical antipsychotics with important information on the risks, effects and outcomes of using these drugs for the treatment of restrictive eating disorders.

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