Saturday, January 4, 2014

Credit is Due to Uffe Ravnskov, et al.

“I have lived to see a diffusion of knowledge, which has undermined superstition and error…”
  - Richard Price

“I can now rejoice even in the falsification of a cherished theory, because even this is a scientific success.”
  – John Carew Eccles

“One of the first duties of the physician is to educate the masses not to take medicine.”
  - Sir William Osler, Aphorisms, 1961

Although there is a steadily growing number of health providers adhering to and promulgating the benevolent cholesterol paradigm—cholesterol and its protein carriers benefit humanity—few recognize the paradigm’s main proponents.  Credit where credit is due: the foremost proponents of the benevolent cholesterol paradigm are Drs. Uffe Ravnskov, et al.,[1] adherents of Karl Popper’s philosophy of science.

But first a tale of science must be told—veering occasionally toward context—entitled “What was Old is New Again.”  Our story explains Karl Popper’s approach.

The post-postmodern view of science is comprised of three methods: observation, modeling and making predictions based upon that model.  According to one such theoretician, B.K. Jennings, the view is that Sir Karl “Popper is essentially correct but with predictive power replacing naïve falsification.  The distinguishing feature of any scientific model is that it must make predictions that can be tested against careful reproducible observations.”[2]  Without dismissing this “new” view, proponents like Jennings must not have thoroughly read Popper’s books.

Popper wrote that, in fact, the belief that we can start with pure observations alone, without anything in the nature of a theory, is absurd; as may be illustrated by the story of the man who dedicated his life to natural science, wrote down everything he could observe, and bequeathed his priceless collection of observations to the Royal Society to be used as inductive evidence.  This story should show us that though beetles may profitably be collected, observations may not.[3]

Further, the problem “Which comes first, the hypothesis or the observation?” is soluble; as is the problem, “Which comes first, the hen or the egg?”  The reply to the latter is, “An earlier kind of egg”; to the former, “An earlier kind of hypothesis.”  It is quite true that any particular hypothesis we choose will have been preceded by observations—the observations, for example, which it is designed to explain.  But these observations, in their turn, presupposed the adoption of a frame of reference: a frame of expectations: a frame of theories.  If they were significant, if they created a need for explanation and thus gave rise to the invention of a hypothesis, it was because they could not be explained within the old theoretical framework, the old horizon of expectations.  There is no danger here of an infinite regress.  Going back more and more primitive theories and myths we shall in the end find unconscious, inborn expectations.[4]

Before Thomas Kuhn, Karl Popper (1902-1994) was the most influential philosopher of science—the most widely read, and to some extent believed, by practicing scientists.  Popper had come of age during the second quantum revolution.  It taught him that science proceeds by conjectures and refutations, to use the title of one of his books.  It was moralistic methodology that Popper claimed was exemplified by the history of science.  First we frame bold conjectures, as testable as possible, and inevitably find them wanting.  They are refuted, and a new conjecture must be found to fit the facts.  Hypotheses can count as scientific only if they are falsifiable.  This purist vision of science would have been unthinkable before the great turn-of-the-century revolutions.  Kuhn’s emphasis on revolutions can be seen as the next stage after Popper's refutations.[5]

Popper had made refutation the core of his philosophy.  Kuhn was at pains to say that there is seldom such a thing as simple refutation.  We have a tendency to see what we expect, even when it is not there.  It often takes a long time for an anomaly to be seen for what it is, something contrary to the established order.  Some may never see it.[6]  To quote Heraclitus, “He who does not expect the unexpected will not detect it: for him it will remain undetectable, and unapproachable.”

Kuhn’s writings embodied the way things are, especially in his description of scientific revolutions, and it is from Kuhn’s template that I explained the conflict between those that support the lipid hypothesis and the adherents of a more rational school, each competing paradigms of cholesterol in “Cholesterol and the Structure of Scientific Revolutions.”  But the benevolent cholesterol paradigm is only one in a long line of movements, e.g., heliocentrism, evolution, germ theory of disease, sanitation, suffrage, equal rights, water supply de-fluoridation, ending the use of dental amalgam as filling material, milk pasteurization in the early 20th century, the raw milk movement in the early 21st, enabling better athletic performance and treating diabetes, epilepsy, cancer, Alzheimer’s, etc., through a ketogenic diet, un-refrigerating eggs, et al., pitting rationalists against tradition.  And although Popper the purest best defined the way things ought to be, it is Popper, not Kuhn, nor any post-postmodernist writer that provides a best-fit framework.

According to Popper, the anti-rationalist’s attitude is to accept tradition as something just given.  You have to take it, you cannot rationalize it; it plays an important role in society, and you can only understand its significance and accept it.  The most important name associated with this anti-rationalist view is that of Edmund Burke.  He fought against the ideas of the French Revolution in retrospect, and his most effective weapon was his analysis of the importance of that irrational power which we call “tradition.”  Undoubtedly there is a traditional hostility between rationalism and traditionalism.  Rationalists are inclined to adopt the attitude: “I am not interested in tradition.  I want to judge everything on its own merits; I want to find out its merits and demerits, and I want to do this quite independently of any tradition.  I want to judge it with my own brain, and not with the brains of other people who lived long ago.”[7]

That the matter is not quite so simple as this attitude assumes emerges from the fact that the rationalist who says such things is himself very much bound by a rationalist tradition which traditionally says them.  This shows the weakness of certain traditional attitudes toward the problem of tradition.[8]

It should be clearly understood that there are two main attitudes possible towards tradition.  One is to accept a tradition uncritically, often without even being aware of it.  In many cases we cannot escape this; for we often just do not realize that we are faced with a tradition.  If I wear a watch on my left wrist, I need not be conscious that I am accepting a tradition.  Every day we do hundreds of things under the influence of traditions of which we are unaware.  But if we do not know that we are acting under the influence of a tradition, then we cannot help accepting the tradition uncritically.[9]

The other possibility is a critical attitude, which may result either in acceptance or in rejection, or perhaps a compromise.  Yet we have to know of and to understand a tradition before we can criticize it, before we can say: “We reject this tradition on rational grounds.”  Now I do not think that we could ever free ourselves entirely from the bonds of tradition.  The so-called freeing is really only a change from one tradition to another.  But we can free ourselves from the taboos of a tradition; and we can do that not only by rejecting it, but also by critically accepting it.  We free ourselves from the taboo if we think about it, and if we ask ourselves whether we should accept it or reject it.  In order to do that we first have to have the tradition clearly before us, and we have to understand in a general way what may be the function and significance of a tradition.  That is why it is so important for rationalists to deal with this problem, for rationalists are those people who are ready to challenge and to criticize everything, including, I hope, their own tradition.  They are ready to put question marks to anything, at least in their minds.  They will not submit blindly to any tradition.[10]

Quantitatively and qualitatively by far the most important source of our knowledge—apart from inborn knowledge—is tradition.  Most things we know we have learnt by example, by being told, by reading books, by learning to criticize, how to take and to accept criticism, how to respect truth.[11]

The fact that most of the sources of our knowledge are traditional condemns anti-traditionalism as futile.  But this fact must not be held to support a traditionalist attitude: every bit of our traditional knowledge is open to critical examination and may be overthrown.  Nevertheless, without tradition, knowledge would be impossible.[12]

Knowledge cannot start from nothing—from a tabula rosa—nor yet from observation.  The advance of knowledge consists, mainly, in the modification of earlier knowledge.  Although we may sometimes, for example in archaeology, advance through a chance observation, the significance of the discovery will usually depend upon its power to modify our earlier theories.[13]

Here, then, is Popper’s discussion of theories:

  1. It is easy to obtain confirmations, or verification, for nearly every theory—if we look for confirmations.
  2. Confirmations should count only if they are the result of risky predictions; that is to say, if, unenlightened by the theory in question, we should have expected an event which was incompatible with the theory—an event which would have refuted the theory.
  3. Every ‘good’ scientific theory is a prohibition: it forbids certain things to happen.  The more a theory forbids, the better it is.
  4. A theory which is not refutable by any conceivable event is nonscientific.  Irrefutability is not a virtue of a theory, as people often think, but a vice.
  5. Every genuine test of a theory is an attempt to falsify it, or to refute it.  Testability is falsifiability; but there are degrees of testability: some theories are more testable, more exposed to refutation, than others; they take, as it were, greater risks.
  6. Confirming evidence should not count except when it is the result of a genuine test of the theory; and this means that it can be presented as a serious but unsuccessful attempt to falsify the theory.
  7. Some genuinely testable theories, when found to be false, are still upheld by their admirers—for example by introducing as hoc some auxiliary assumption, or by re-interpreting the theory ad hoc in such a way that it escapes refutation.  Such a procedure is always possible, but it rescues the theory from refutation only at the price of destroying, or at least lowering, its scientific status.[14]

One can sum up all this by saying that the criterion of the scientific status of a theory is its falsifiability, or refutability, or testability.[15]

From the point of view here developed, all laws, all theories, remain essentially tentative, or conjectural, or hypothetical, even when we feel unable to doubt them any longer.  Before a theory has been refuted we can never know in what way it may have to be modified.  That the Sun will always rise and set within twenty-four hours is still proverbial as a law “established by induction beyond reasonable doubt.”[16]

False theories, however, often serve well enough: most formulae used in engineering or navigation are known to be false, although they may be excellent approximations and easy to handle; and they are used with confidence by people who know them to be false.[17]

Even the flat Earth and Geocentric hypotheses may make sense to, say, a farmer making a living off a small plot of land with only a level and compass to guide her theories.  She can reap harvest after harvest orienting her crops in such a way as to maximize their sun exposure while minimizing light to weeds, assuming the Sun rises and sets east-west, with each harvest confirming the theory.  She may be dismayed, however, at the inadvertent falsification of her hypothesis when, do to her success, she purchases land to grow crops at a different latitude.

Too, from an altogether different motivation—create, maintain and dominate a market—a pharmaceutical manufacturer might adhere to and promulgate the malevolent cholesterol paradigm, aka the lipid hypothesis, so long as their marketed product commands revenue greater than costs.  No markets have perfect knowledge, however, in pharmaceutical markets, very few people can or want to make sense of the information provided; thus, traditional target customers do as their traditional doctors prescribe.  Payment for services rendered via dis-interested third-parties, where providers are coerced to place the needs of a collective over the needs of an individual,[18] and inbred bias, where mostly agents of treatment manufacturers write treatment guidelines,[19] serve as an effective, lasting barrier to innovation.

What is important about a theory is its explanatory power, and whether it stands up to criticism and to tests.  The question of its origin, of how it is arrived at—whether by an “inductive procedure,” as some say, or by an act of intuition—may be extremely interesting, especially for the biographer of the man who invented the theory, but it has little to do with its scientific status or character.[20]

The rationalist tradition, the tradition of critical discussion, represents the only practical way of expanding our knowledge—conjectural or hypothetical knowledge, of course.  There is no other way.  More especially, there is no way that starts from observation or experiment.  In the development of science observations and experiments play only the role of critical arguments.  And they play this role alongside other, non-observational arguments.  It is an important role; but the significance of observations and experiments depends entirely upon the question whether or not they may be used to criticize theories.[21]

For Popper, science has nothing to do with the quest for certainty or probability or reliability.  We are not interested in establishing scientific theories as secure, or certain, or probable.  Conscious of our fallibility we are only interested in criticizing them and testing them, hoping to find out where we are mistaken; of learning from our mistakes; and, if we are lucky, of proceeding to better theories.[22]

Progress in science means progress towards more interesting, less trivial, and therefore less “probable” theories and this means, as a rule, progress towards less familiar and less comfortable or plausible theories.[23]

We are trying to get nearer to the truth—to the search for theories that agree better with the facts.  What is the general problem situation in which the scientist finds himself?  He has before him a scientific problem: he wants to find a new theory capable of explaining certain experimental facts; facts which the earlier theories successfully explained; others which they could not explain; and some by which they were actually falsified. The new theory should also resolve, if possible, some theoretical difficulties.  Now if he manages to produce a theory which is a solution to all these problems, his achievement will be very great.[24]

Yet it is not enough.  According to Popper, there are three such requirements.[25]  The first requirement is this.  The new theory should proceed from some simple, new, and powerful, unifying idea about some connection or relation between hitherto unconnected things or facts or new theoretical entities.  This requirement of simplicity is a bit vague, and it seems difficult to formulate it very clearly.  It seems to be intimately connected with the idea that our theories should describe the structural properties of the world—an idea which it is hard to think out fully without getting involved in an infinite regress.  Yet one important ingredient in the idea of simplicity can be logically analyzed.  It is the idea of testability.  This leads us to our second requirement.[26]

For, secondly, we require that the new theory should be independently testable.  That is to say, apart from explaining all the explicanda—a fact, thing, or expression that is to be explained—which the new theory was designed to explain, it must have new and testable consequences; it must lead to the prediction of phenomena which have not so far been observed.[27]

If our second requirement is satisfied then our new theory will represent a potential step forward, whatever the outcome of the new tests may be.  For it will be better testable than the previous theory: the fact that it explains all the explicanda of the previous theory, and that, in addition, it gives rise to new tests, suffices to ensure this.[28]

Moreover, the second requirement also ensures that our new theory will, to some extent, be fruitful as an instrument of exploration.  That is to say, it will suggest to us new experiments, and even if these should at once lead to the refutation of the theory, our factual knowledge will have grown through the unexpected results of the new experiments.  Moreover, they will confront us with new problems to be solved by new explanatory theories.[29]

The third requirement?  Popper requires that the theory should pass some new, and severe, tests.[30]

The first reason why our third requirement is so important is this.  We know that if we had an independently testable theory which was, moreover, true, then it would provide us with successful predictions, and only successful ones.  Successful predictions—though they are not, of course, sufficient conditions for the truth of a theory—are therefore at least necessary conditions for the truth of an independently testable theory.  In this sense—and only this sense—our third requirement may even be said to be necessary, if we seriously accept truth has a regulative idea.[31]

The second reason is this.  If it is our aim to strengthen the verisimilitude of our theories, or to get nearer to the truth, then we should be anxious not only to reduce the falsity-content of our theories but also to strengthen their truth-content.[32]

And so we have come to the end of our tale.  To adhere to Karl Popper’s philosophy of science is to note observations that have been described—modeled—and predicted by a theory.  If the predictions aren’t particularly good, then neither is the theory.  And it is incumbent upon the scientist to search for ways to falsify the theory. If the theory can pass his or her stringent tests, then it is tentatively true.  But even in falsifying the theory, the scientist should be happy, because as Popper wrote, our falsifications indicate the points where we have touched reality.[33]

We do not have to accept tradition.  On the contrary, according to Popper, we are not passive receptors of sense data, but active organisms.  Because we react to our environment not always merely instinctively, but sometimes consciously and freely.  Because we can invent myths, stories, theories; because we have a thirst for explanation, an insatiable curiosity, a wish to know.  Because we not only invent stories and theories, but try them out and see whether they work and how they work.  Because by a great effort, by trying hard and making many mistakes, we may sometimes, if we are lucky, succeed in hitting upon a story, an explanation, which “saves the phenomena”; perhaps by making up a myth about “invisibles,” such as atoms or gravitational forces, which explain the visible.  Because knowledge is an adventure of ideas.  For the overwhelming majority of our theories, of our freely invented ideas, are unsuccessful; they do not stand up to searching tests, and are discarded as falsified by experience.  Only a very few of them succeed, for a time, in the competitive struggle for survival.[34]

One of the things a philosopher may do, still according to Popper, and one of those that may rank among his highest achievements, is to see a riddle, a problem, or a paradox, not previously see by anyone else.  This is an even greater achievement than resolving the riddle.  The philosopher who first sees and understands a new problem disturbs our laziness and complacency.  He rouses us from our “dogmatic slumber.”  He opens out a new horizon before us.[35]

There have been other proponents of a benevolent cholesterol paradigm that engaged the forming malevolent tradition.  The first was Edward R. Pinckney, M.D., author of The Cholesterol Controversy (1973).  This book was followed up by the compendious Diet, Blood Cholesterol and Coronary Heart Disease, A Critical Review of the Literature (1991) in conjunction with Russell L. Smith, Ph.D.[36]  Other notable advocates include Michael Gurr,[37] George Mann,[38] Thomas Moore,[39] Raymond Reiser,[40] Ray Rosenman,[41] William Stehbens,[42] and Lars Werkö.[43]

More famously, John Yudkin, of Pure White and Deadly (1972) fame, was a proponent of the benevolent cholesterol paradigm.[44]  So too were Dr. Robert E. Olson, principal author of a report entitled Toward Healthful Diets by the Food and Nutrition Board of the National Research Council, individual members of that committee, and, the more fervent proponent, Philip Handler, President, National Academy of Sciences.[45]  These proponents, however, were not successful in attracting an enduring group of adherents.

According to the originator of term, Thomas Kuhn, a paradigm serves implicitly to define the legitimate problems and methods of a research field for succeeding generations of practitioners.[46]  Dr. Uffe Ravnskov is the foremost proponent of the benevolent cholesterol paradigm because of two essential characteristics in addition to defining the problems and methods.  His achievements—not only falsifying the lipid hypothesis but creating a new hypothesis that has been severely tested, remains un-falsified and makes better predictions—is sufficiently unprecedented to attract an enduring group of adherents away from competing modes of scientific activity.  Simultaneously, his hypotheses are sufficiently open-ended to leave all sorts of problems for the redefined group of practitioners to resolve.  It is Dr. Uffe Ravnskov who has roused us from our dogmatic slumber.

We can now begin to think about Dr. Uffe Ravnskov’s contributions and the brilliant people that—while they work on their own projects—adhere to, criticize, discuss, refine, and promulgate them.

Consider first reviewing “Vulnerable Plaque Formation from Obstruction of Vasa Vasorum,” by Drs. Uffe Ravnskov and Kilmer S. McCully (2009).  Learn here that lipoproteins referred to as good or bad—or even “lousy” by some popular doctors—by anti-rational proponents of the malevolent cholesterol paradigm more likely comprise the body’s secondary immune system. This non-specific immune system binds and inactivates microorganisms and their toxins by complex formation.  Importantly, the article also presents a testable mechanism for developing atherosclerosis and cardiovascular disease more satisfying than inanities such as cholesterol sticks to or penetrates the arteries.  See also the review article Infections May be Causal in the Pathogenesis of Atherosclerosis,” originally published in the American Journal of the Medical Sciences in 2012.

Following up on a problem to solve from the first article, Drs. Ravnskov and McCully published “How Macrophages are Converted to Foam Cells” three years later in 2012.  In their view, oxidized LDL is produced inside the macrophages as a side effect of their oxidation of microorganisms or their toxic products.

“Vulnerable Plaque Formation…” was a logical outgrowth of work dating back to 2003, when Dr. Ravnskov published a review of the many studies that have shown LDL to be protective against infections, and put forward the hypothesis that high cholesterol, rather than promoting atherosclerosis, protects against it.  See “High cholesterol may protect against infections and atherosclerosis.”

Supplementing this hypothesis, a leading adherent showed how neither cholesterol nor its carriers are the cause of familial hypercholesterolemia, a misnomer for LDL receptor deficiency.  See  You are a Very Black Swan Indeed,” by Dr. Malcolm Kendrick.

In “Cholesterol Lowering Trials in Coronary Heart Disease: Frequency of Citation and Outcome,” Dr. Ravnskov demonstrated that coronary mortality was not lowered by cholesterol lowering, but total mortality was increased.

More recently, Dr. Ravnskov published “Is Saturated Fat Bad?  Here Dr. Ravnskov presents the evidence falsifying a long-standing tradition.

For Burke—the anti-rationalist author noted by Karl Popper above—resisting the temptation to construct a society from the ground up on the basis of untested rationality was the beginning of political wisdom and the essence of political prudence.  But after reading the works of Ravnskov, et al., perhaps even Burke would say of adherents of the lipid hypothesis—those traditionalists that continue to say artery-clogging cholesterol causes heart disease—that “Their science is presumptuous ignorance.”[47]  You yourself may come to that same conclusion.  Or you may conclude as I have, similar to how Ludwig Wittgenstein quipped about philosophy: “I have learned the jargon as well as anybody.  It is very clever and captivating.  In fact, it is dangerously captivating; for the simple truth about the matter is that it is much ado about nothing—just a lot of nonsense.”

So what becomes of the lipid hypothesis, of the malevolent cholesterol paradigm?  Growing sentiment leads us to believe that it will infect less and less people over time, serving eventually as just another destructive anachronism that loiters in areas devoid of truth or persisting as a fraud perpetrated by charlatans selling snake oil to local, vulnerable, hopeful, medically naïve, trusting, traditional populations.[48]  But Popper the gifted, visionary optimist provided insight that might help even the most jaded medical and pharmaceutical entrepreneurs let go of their precious though false hypotheses.

According to him, refutations have often been regarded as establishing the failure of a scientist, or at least of his theory.  It should be stressed that this is an error.  Every refutation should be regarded as a great success; not merely a success of the scientist who refuted the theory, but also of the scientist who created the refuted theory and who thus in the first instance suggested, if only indirectly, the refuting experiment.[49]

Even if a new theory should meet an early death, it should not be forgotten; rather its beauty should be remembered, and history should record our gratitude to it—for bequeathing to us new and perhaps still unexplained experimental facts and, with them, new problems; and for the services it has thus rendered to the progress of science during its successful but short life.[50]

Popper believed that it would be worth trying to learn something about the world even if in trying to do so we should merely learn that we do not know much.  This state of learned ignorance might be a help in many of our troubles.  It might be well for all of us to remember that, while differing widely in the various little bits we know, in our infinite ignorance we are all equal.[51]

For Dr. Ravnskov’s biography and a complete listing of his articles, see “My Life and My Work,” and “The Cholesterol Myths.”  For articles by many of the equally brilliant adherents of Dr. Ravnskov’s paradigm, see “Links,” on the THINCS website.  Dr. Ravnskov has also written three accessible books: The Cholesterol Myths (2000), Fat and Cholesterol are Good for You (2009), and Ignore the Awkward (2010).  You are encouraged to read them all. 

The author is grateful to the following people for their kind help in providing sources of information from which to complete this article: Marshall E. Deutsch, Ph.D., Zoë Harcombe, M.A., Lt. Colonel Luca Mascitelli, M.D., Uffe Ravnskov, M.D., Ph.D., Morley Sutter, M.D., Ph.D.

[1] A list of adherents of Dr. Ravnskov’s paradigm is available on the website that he founded,  Adherents.
[2] “On the Nature of Science,” B.K. Jennings, Physics in Canada, 63 (2007) 7.  Article.
[3] Popper, Karl.  Conjectures and Refutations.  New York: Routledge Classics, 2002, p. 61.
[4] Ibid, p. 62.
[5] Kuhn, Thomas S.  The Structure of Scientific Revolutions.  The University of Chicago Press, Chicago, IL, 2012, “Introduction,” Hacking, Ian, p. 10-11.
[6] Ibid, p. 10-11.
[7] Popper, Karl.  Conjectures and Refutations.  New York: Routledge Classics, 2002, p. 161-162.
[8] Ibid, p. 162.
[9] Ibid, p. 164.
[10] Ibid, p. 164.
[11] Ibid, p. 36.
[12] Ibid, p. 36.
[13] Ibid, p. 36-37.
[14] Ibid, p. 47-48.
[15] Ibid, p. 48.
[16] Ibid, p. 68.
[17] Ibid, p. 74.
[18] See the video presentation “Fitness, Health and Liberty,” featuring Dr. Doug McGuff.  Video.
[19] See for example “Relationships Between Authors of Clinical Practice Guidelines and the Pharmaceutical Industry,” Choudhry, et al.  JAMA.  2002;287(5):612-617.  Article.
[20] Popper, Karl.  Conjectures and Refutations.  New York: Routledge Classics, 2002, p. 189.
[21] Ibid, p. 204.
[22] Ibid, p. 310.
[23] Ibid, p. 320.
[24] Ibid, p. 326.
[25] Ibid, p. 326.
[26] Ibid, p. 326-327.
[27] Popper, Karl.  Conjectures and Refutations.  New York: Routledge Classics, 2002, p. 327.
[28] Ibid, p. 327.
[29] Ibid, p. 327.
[30] Ibid, p. 327.
[31] Ibid, p. 333.
[32] Ibid, p. 333.
[33] Ibid, p. 156.
[34] Ibid, p. 127-128.
[35] Ibid, p. 249-250.
[36] For a particularly good historical overview of the developing tradition in the United States, see Smith, Russell L. and Pinckney, Edward R.  Diet, Blood Cholesterol and Coronary Heart Disease, A Critical Review of the Literature.  Sherman Oaks: Vector Enterprises, 1991, V. 2, Chapter 2. 
[37] See, for example, Dietary Lipids and Coronary Heart Disease: Old Evidence New Perspective,” Michael I. Gurr, Prog. Lipid Res. Vol. 31, No. 3, pp. 195-243, 1992.  Article.  For something more recent, see Gurr, Michael I.  Lipids in Nutrition and Health: A Reappraisal.  Isles of Scilly, UK: The Oily Press, 1999, 2009.  Book.
[38] See for example “Dr. George Mann Says Low Cholesterol Diets are Useless, but the ‘Heart Mafia’ Disagrees,” by Kent Demaret and Judith Weintraub, People Magazine, January, 1979.  Article.  See also Mann, George V.  Coronary Heart Disease: The Dietary Sense and Nonsense.  London: Janus, 1993.  He is most known for having said, “The diet-heart hypothesis has been repeatedly shown to be wrong, and yet, for complicated reasons of pride, profit and prejudice, the hypothesis continues to be exploited by scientists, fund-raising enterprises, food companies and even governmental agencies. The public is being deceived by the greatest health scam of the century.” There is also the shorter version of the comment: “Saturated fat and cholesterol in the diet are not the cause of coronary heart disease. That myth is the greatest ‘scientific’ deception of the century, and perhaps any century.”  See Diet-Heart: End of an Era,” George V. Mann, Sc.D., M.D., N Engl J Med 1977; 297;644-850, Sept. 22, 1977.  Article.
[39] Although flawed, see Moore, Thomas J.  Heart Failure.  New York: Touchstone Books, 1989.  A chapter from the book was published in the Atlantic Monthly a few months before the book was published.  See “The Cholesterol Myth,” T.J. Moore, The Atlantic, Vol. 264, September, 1989, p. 37(25), ISSN: 0276-9077.  Article.
[40] Keys’s idea that a high intake of saturated fat raises cholesterol was questioned by Raymond Reiser  in 1973.  In a thorough review of 40 trials he pointed at several types of methodological and interpretational errors.  See Reiser, R.  “Saturated fat in the diet and serum cholesterol concentration: a critical examination of the literature.”  Am J Clin Nutr 1973: 26; 524-555.  Article.
[41] In an extensive review, Rosenman found that serum cholesterol is not strongly related to or primarily regulated by diet. He also cited widespread discordant beliefs about a causal role of diet in coronary artery disease.  See Rosenman, RH, “The Independent Roles of Diet and Serum Lipids in the 20th-CenturyRise and Decline of Coronary Heart Disease Mortality.”  Integr Physiol Behav Sci.  1993 Jan-Mar;28(1):84-98.  Abstract: Risk factors are causally related to coronary heart disease (CHD), but in widely varying historic, geographic, socioeconomic, and individual relationships.  Serum cholesterol is only one of many risk factors that, even when considered together in prospective studies, account for well under half of the CHD incidence. It is neither primarily regulated by the diet nor significantly related to it. Many findings discordant with widespread beliefs about a causal role of the diet in CHD are reviewed. It may be concluded that dietary fats are largely not responsible for relationships of serum cholesterol to CHD, or for its 20th-century rise and decline.  Article.
[42] See for example, “Science, Atherosclerosis and the “Age of Unreason”: A Review,” Stehbens, WE, Integr Physiol Behav Sci. 1993, Oct-Dec;28(4):388-95.  Article.
[43] See for example “Risk factors and coronary heart disease—facts or fancy?”  Werkö, Lars.  American Heart Journal.  Volume 91, Issue 1, Pages 87-98, January 1976.  Article.
[44] See, for example, Dr. Yudkin’s letter published in the British Medical Journal, October 3, 1964, p. 874.  Letter.
[45] For an interesting summary of the issues between Toward Healthful Diets and Diet, Nutrition, and Cancer, see the National Academy of Sciences’ Reports on Diet and Health—Are They Credible and Consistent?   Report by the U.S. General Accounting Office, August 1, 1984.  FullText.
[46] Kuhn, Thomas S.  The Structure of Scientific Revolutions.  The University of Chicago Press, Chicago, IL, 2012, p. 10-11.
[47] Burke, Edmund.  Reflections on the Revolution in France.  New Haven and London: Yale University Press, 2003, p. 68.   Originally published 1790.
[48] I say this in deference to the suborder Serpentes, comprised of a wondrous variety of some 3,400+ species of lean snakes that mostly mind their own business, brumate when cold, seek warmth, food and a mate.  Some snake oil, contrary to idiomatic expression, is quite healthy to ingest.  See for example “Snake Oil,” RA Kunin.  West J Med.  1989, August; 151(2): 208.  Article.
[49] Popper, Karl.  Conjectures and Refutations.  New York: Routledge Classics, 2002, p. 329.
[50] Ibid, p. 329.
[51] Ibid, p. 38.