Saturday, December 31, 2016

ANS -- The Forgotten Topic of the 2016 Elections. Or How Echidne Almost Got Gaslighted.

This is a blog post on the role of gaslighting in the election.  It's about sexism and other ways we keep women out of high positions.  It's good, but a trifle long.  Read it.  

Thursday, December 29, 2016

The Forgotten Topic of the 2016 Elections. Or How Echidne Almost Got Gaslighted.

We hardly discuss one of the most interesting aspects of the  2016 US presidential elections:  That the long picture gallery of all American presidents remained hundred-percent male.  Neither do we discuss why so many of us, both women and men, failed to see anything wrong with that, even while some others celebrated  the Trump victory by open pussy-grabbing or its verbal equivalents.

Imagine some other demographic groups, more than half of all citizens, calmly accepting (1) that none of its members has ever governed the country, and is very unlikely to do so in the near future!  It's not possible, my friends, except when it comes to women.

But when it comes to women, the majority of Americans,  equal representation is not an important goal.  Rather, it's outdated identity politics, at best only of symbolic worth.  The strength of that message  is mind-boggling, unprecedented and unpresidented.

How did it come about?

I argue that it is the result of gaslighting, a term which the American linguistic left adopted from psychological literature, and then adapted to political speech, often to silence someone.  Gaslighting is 

manipulation through persistent denial, misdirection, contradiction, and lying in an attempt to destabilize and delegitimize a target. Its intent to is sow seeds of doubt in the subject, hoping to make them question their own memory, perception, and sanity.

My friends, we have been gaslighted, through denial, misdirection, contradiction, lying and more.  It is particularly easy to gaslight those who are prone to self-inspection, to careful scrutiny of their own ideas and to careful attention to how others criticize them.  Indeed, I have eagerly abetted my own gaslighting!

It took Mark Lilla's New York Times article "The End of Identity Liberalism," on the horrors that is identity politics inside the Democratic Party to drop the scales from my eyes. He wrote:

Recently I performed a little experiment during a sabbatical in France: For a full year I read only European publications, not American ones. My thought was to try seeing the world as European readers did. But it was far more instructive to return home and realize how the lens of identity has transformed American reporting in recent years. How often, for example, the laziest story in American journalism — about the "first X to do Y" — is told and retold.
Notice the gaslighting in the sentence I have bolded:  The story of, say, the first female president, ever, would be a lazy story.  If we pick from the terms of the quote which defines gaslighting, this would be misdirection.  Yet nobody would have stated that the story of, say,  the first black president in South Africa would have been a lazy story.   

Later, in an uplifting appeal, Lilla wrote about the values we all can share:

We need a post-identity liberalism, and it should draw from the past successes of pre-identity liberalism. Such a liberalism would concentrate on widening its base by appealing to Americans as Americans and emphasizing the issues that affect a vast majority of them. It would speak to the nation as a nation of citizens who are in this together and must help one another.

That might qualify as a lie, using the list of terms which define gaslighting,  because pre-identity liberalism was identity liberalism of the type where Lilla's own group had all the power, and because most issues do not affect the vast majority of Americans in exactly the same way.

Take Trump's infrastructure improvement promises (which he might renege on, as is his wont):  Those jobs are not going to go to all American adults, in their population proportions, but overwhelmingly to men, because construction industries are almost completely male (2).

My heartfelt thanks to Mark Lilla.  He opened my eyes and then I directed them to all the other material which almost got me gaslighted into believing that it doesn't really matter if women hold political power on the highest levels.  The rest of this post addresses some of them.

Let's begin by pointing out three important aspects of this topic:

First, the gaslighting comes from both sides of the political aisle and even from people not that easily categorized.  Not all is intended to damage women's equality goals, though some of it certainly is (3).  But all of it damages the idea that women's high-level political power might matter.

Second, and related to the previous point, valid criticisms have been made about assigning too much weight to the idea of a female president, about expecting too much from one person who, after all, would be among the most privileged in the world.  But those criticisms, too, gaslight us into a blindness about what a fair society would look like and how to work towards it.

Third, the story about the first woman who almost became the president of the United States is unavoidably the Hillary Clinton story.  I have struggled in the past, and in vain, against the knee-jerk assumption by many that if I write about topics such as this one I'm a fanatic for Hillary Clinton and am really writing in her defense.

The fault, my friends, is in the stars.  Or, rather, in that powerful and prominent women in American politics are almost as rare as hen's teeth.  That makes writing about their treatment as women impossibly intertwined with them as individuals.  A bizarre consequence of that rarity (which in itself is linked to the gaslighting) is that the few who do hold real power are in the news so often that their actual rarity becomes obscured.

Thus, I cannot avoid addressing Hillary Clinton as a politician in this post.  But my goal is much wider than that, and has to do with the question why we suddenly don't find the idea of the first female president at all important, while others  (including one Vladimir Putin) find that idea so frightening.

My central explanation for the successful gaslighting of so many is this:

1.  The first viable female candidate for the presidency was simultaneously "normalized" and "abnormalized" (4). 

Hillary Clinton became the candidate of the Democratic establishment, the candidate of status quo, the Wall Street candidate, the face of the powers-that-be in the Democratic Party.  She was "normalized" by her long presence in Democratic politics, she was even normalized in the traditional sense of entering it first as the sidekick of a man, using the one global avenue which has long been open for some women to reach political power: family connections.

By the time the 2016 elections came by, Hillary Clinton stood for nothing new.  She was a known figure, a distrusted figure, the last representative of the dying centrist policies of the Democratic Party, the corrupt and crooked opponent for the Republicans.  She seemed to have nothing exciting to offer, in terms of women's rights, several feminists told me.  Her achievements in that field were somehow hidden from view, her age and her privilege worked against her.  For young women, she seemed to have always been around, on top, with power, and that might have made the lack of women in politics disappear from their sight.

In short, she became a run-of-the-mill politician in that normalization process.

Except that she was also "abnormalized" by the Republican message industry.  This abnormalization began during her years as First Lady in Bill Clinton's realm, initially because she was an uppity woman, too big for her breeches, too mouthy, liable to push into places where she was not wanted.

The Republican propaganda industry of the 1990s blamed her for everything imaginable, including for murder and for acting as a procurer of rape victims for Bill Clinton.  The plots against her came so fast that they were impossible to respond to.  Only tedious research in the annals of history tells us how many of them were built out of foul-smelling air and ultimately fell flat.

But the taint remained, and later, when circumstances changed, that label of "abnormal" stuck to her.  She was crooked and corrupt, as one Donald Trump told us repeatedly, she should be Locked Up, as Trump's supporters still believe.

Rush Limbaugh and other similar conservative pundits spent years building up a picture of Hillary Clinton as very much resembling Pol Pot, Stalin and Hitler, as something utterly out of the normal in politics.  Even the email scandal was seen through some enormous magnifying glass, one which was not applied to earlier email scandals of very similar nature.

There is no doubt in my mind that this abnormalization would not have been so vigorously and viciously applied to an otherwise identical politician with the name Harry Clinton.  No, Hillary Clinton's sex mattered, her role as the prominent public specimen of the uppity woman mattered, because of the fears that provoked in the hind-brains of many.

None of this means that she was an angel, that she doesn't make idiotic political mistakes, that she couldn't use power wrong,  that she is not good at campaigning or that she wouldn't hold policy positions with which I differ.  But her girl cooties did play a role in how that abnormalization was allowed to become common wisdom.

One example of that are the frequent mentions of her "naked and self-serving ambition" in the comments sections of even left-wing political blogs, and the common meme that she felt entitled to the presidency, that it was Her Turn.

But the political arena is the one where naked and self-serving ambition is usually rewarded!  Just look at Donald Trump.  And surely Jed Bush acted as if it was His Turn?  In terms of family dynasties in American politics?  Accusing Hillary Clinton of naked and self-serving ambition works particularly well, whether she indeed holds such ambition, because as a woman she is not supposed to.

The combination of normalization and abnormalization made Hillary Clinton's potential role as the first female president of the United States more than invisible from most:  It was in poor taste even to mention, because then one might be accused of defending a horrible, untrustworthy and corrupt candidate. (See why it took me so long to write this post?  But this post is not about her, it's about women with political power, so onwards and upwards.)

2.  The Value Of Having Women In Political Power Is Questioned 

The conservatives have never seen much value in having women in politics.  The Evangelicals in the party believe that women belong in the home, under male guardianship, and the free market conservatives believe that women can get into politics if they fight hard enough, despite any discriminatory barriers that might stand in their way.  Well, as long as they do that after having done all the hands-on child-rearing.

Thus, this device for gaslighting came mainly from the left side of the aisle.  It ranged from the arguments that such a victory is purely symbolic, signifying nothing for the majority of women, to carefully constructed (and valid) arguments about the need for more than having women at the helm: (5)

For real economic policies which help women, including poor women and women of color, and for policies which do not privilege only the already (relatively) privileged, educated, wealthy and predominantly white women, the group which is most likely to be close enough to political power.

But those arguments can be misused to argue that, say, an all-male US Congress would be perfectly fine, forevermore,  what with the possibility that women in high places wouldn't help women in general.  If we use that argument by going down the power ladders, rung by rung, at what point would the presence of women start mattering?  At the floor level?  But what kind of power would those women then have?  And how likely is it that an all-male Congress or Supreme Court, say, would understand everything about those aspects of life which women generally share with each other?  That the correct laws would be created about, say, rape, or the need for subsidized childcare or better parental leaves?

This was the point with which I had a lot of sympathy, the point at which I was almost gaslighted (though not intentionally by anyone else), because surely it was true that Margaret Thatcher as Britain's Prime Minister didn't do anything for women's rights?  Rather the reverse, given how she once stated that she owes nothing to the feminist movement?  (Except, of course, the right to stand for office...)

In other words, having a woman run the country doesn't, by itself, turn it into a paradise of equal rights.

But reverse that sentence:  Would a paradise of equal rights have all political power in men's hands?  I doubt that, even if most men intended to be fair in their decisions.

And what would we deduce about some other country which had never had a woman president?  We would certainly not see it as a wonderfully gender-egalitarian place, but would like to know why there's such a dearth of women in politics.

These arguments need a more nuanced treatment:  Having women in political power is not a sufficient condition for improvements in women's position, but I believe that it is a necessary condition, that we must strive for equal representation, and not only for that reason, but for the reason that the slight majority of its people should play a bigger role in how a country is run than is the case today in the United States.

Or take the "merely a symbolic victory" argument:  Many symbols are tremendously important.  Think of the Christian cross or the American flag.  A symbolic victory is not nothing.  At least it would give future generations a different image of what a president might look like, who is capable of that job.  It could be used as a counterargument in those nasty conversations I still  have which are all about how women cannot be in charge, for various religious or evolutionary psychology reasons.

Some arguments that fall under this category were explicitly about Hillary Clinton, not about having a woman governing the country.  Those tended to argue that she is the wrong type of woman for the job, that her victory would not be a victory for feminism, that she is an establishment candidate, that she is a faux feminist, that of course it's a disgrace that all US presidents have been (and are going to be, in January) men, and of course one would very much wish to see a woman in that role, only the right kind of woman, one day, when someone else has worked very hard for that goal.  Perhaps in our grandchildren's time?

This point angers me.  It angers me not because someone wouldn't want to vote for Hillary Clinton and not because someone would view her as a bad candidate.  

No.  I'm angry at the facile way the very idea of a woman at the helm is discounted in so many of these conversations, with the promises of some far-distant future era when a woman good enough will be unearthed (and somehow left pristine after the expected attacks from the other side), even though we currently have great difficulty even getting women to run for office.  

I wouldn't be surprised if the way the 2016 elections went made many young women and girls decide never to voluntarily undergo the kind of treatment they saw doled out at women in American politics:  Pussy-grabbing was just locker-room talk, the female candidate was repeatedly called crooked and even a nasty woman in televised debates.  Yet the media treated the two candidates as equally flawed.

3.  A Female Candidate Is Held To Higher Standards And Then Found Wanting

In one sense this is almost self-evident:   "The firsts" in anything will be held to higher standards, because of the added uncertainty their appointment or election entails (6).  They come without precedent.

But in another sense women are often held to higher standards of behavior in the public sphere than men, and that comes from our deeply ingrained beliefs about gender:  Women are the cleaning sex, if you like, and historically have been allowed entry into politics in that role, to clean out some moral mess or other.

If you doubt me, just think of how the media would have treated a female presidential candidate who had children by three different men.  Yet even the Evangelist fundamentalists preferred the man who has children by three different women and who openly admits to sexual escapades.

Where gaslighting enters is in the views from the left that Hillary Clinton had to prove her feminist credentials, over and above any kind of proof demanded from male candidates.  I read about this in 2008 and again in 2016, and noticed the different standard she was held to.

I also noticed that the economic privilege of almost all politicians, their high incomes and their considerable perks, were only grist for concern when it came to Hillary Clinton but not when it came to your general run-of-the-mill politician.  From that angle women who run better be very poor, or they fail the test.  Given the way American politics is currently financed, passing that test would be difficult.

If we hold women to higher standards than we hold men, women are going to fail more often than men, and the very idea of women in political power becomes tainted with the feeling that there aren't any good ones, out there, that the project of having more women in politics is likely to fail.

Or consider the warning that one shouldn't vote for a woman just because she is a woman.  I'm sure you have heard that, and in a trivial sense it is of course a good reminder.  

But we don't hear that warning about male candidates; that we should check if we prefer one just because he is a man.  

And that difference matters.  The dance floor is slanted already, and Ginger Rogers is dancing backwards and in high heels, but we should still ask ourselves if we like her dancing just because she is female, whereas Fred Astaire doesn't provoke such questioning.

In Conclusion

The central message of this very long post is a very simple one: Do not be gaslighted by the interpretations swirling around the 2016 presidential elections or by whatever you thought about Hillary Clinton as a candidate.

This country has never had a female president, only 27 states have had female governors, some states have not yet sent a woman to the US Congress, and the US Senate, with a hundred members in each term, has had a total of 46 women over its history.

Indeed, that is one of the main reasons why the United States ranks only 45th in the Global Gender Gap Report for 2016:  It ranks 73rd on the political empowerment subindex, right behind LeSotho, Tunisia and Indonesia.

This is not acceptable. 



(1)  Or perhaps not.  We shall see.  

(2)  This doesn't mean that women wouldn't benefit from them at all, though most seem to assume that it's sufficient to consider the benefits to the wives of the men who get the work.  But any infrastructure project will benefit more men directly, just as any project aimed at improving nursing homes or schools or hospitals would benefit more women directly.  To ask us not to see the gendered nature of the "shovel-ready" projects is to ask us not to see identity politics at work.

(3) The messages from the extreme right were intended to not only damage Hillary Clinton's candidacy, but to keep women away from the public sector.  Messages from Rush Limbaugh veered across that spectrum, and so did the messages from the white male supremacists, politely called Alt Right.  The messages from the left had varying purposes, depending on the time they appeared, but most of them were not directly aimed at making us blind to the pictures depicted in that gallery of American presidents.

(4)  She contributed to this herself, of course.  My point is that her position as the first woman who had a chance at the US presidency became invisible.  She didn't look like an outsider, she didn't gain her position in ways which looked like outsider ways, and in the primaries she campaigned against someone who was seen as the real outsider candidate in terms of issues.  Yet at the same time Bernie Sanders belonged to the very ancient male establishment, Hillary Clinton did not.  That latter aspect lost in much of the media coverage.

(5)  This link is meant for the economic policies part of the article, the need to support unions and labor market policies which benefit all women, including the poorest.  

I dislike the trickle-down feminism meme in that article, for several reasons:
1.   I have now met it several times online, wielded by conservatives.
2.   It feeds right into the keyboards of those who wish to take female candidates down in the future.
3.   And because its father is the "trickle-down economics" meme, which is about something quite different:  The idea that income given to the wealthy (and not to the poor) will have trickle-down effects through job creation and the purchasing power of the rich.  If we apply the same logic to the "trickle-down feminism" meme, then it would only apply to patriarchal countries where the masses don't want gender equality.  That's not quite the case in the US, though gaslighting might make it a better fit. 

(6)  The breaking of the color barrier in American major leagues baseball in 1947 is an example of that.  Jackie Robinson was carefully chosen, not only because of his great talent as a player, but also because he was a generally talented and emotionally mature individual who had the ability not to react to racist slurs or incidents.  In that sense he was probably superior to most of his new team-mates who were never going to be tested in the same way, and that superiority helped in integrating the game.

Thursday, December 29, 2016

ANS -- Mysterious illness tied to marijuana use on the rise in states with legal weed

Know anyone who is having severe stomach problems that the doctors can't figure out?  This is one possibility.  

Mysterious illness tied to marijuana use on the rise in states with legal weed

By Jonathan Lapook | 

NEW YORK (CBS) - For more than two years, Lance Crowder was having severe abdominal pain and vomiting, and no local doctor could figure out why. Finally, an emergency room physician in Indianapolis had an idea.

"The first question he asked was if I was taking hot showers to find relief. When he asked me that question, I basically fell into tears because I knew he had an answer," Crowder said.

The answer was cannabinoid hyperemesis syndrome, or CHS. It's caused by heavy, long-term use of various forms of marijuana. For unclear reasons, the nausea and vomiting are relieved by hot showers or baths.

"They'll often present to the emergency department three, four, five different times before we can sort this out," said Dr. Kennon Heard, an emergency room physician in Aurora, Colorado.

He co-authored a study showing that since 2009, when medical marijuana became widely available, emergency room visits diagnoses for CHS in two Colorado hospitals nearly doubled. In 2012, the state legalized recreational marijuana.

"It is certainly something that, before legalization, we almost never saw," Heard said. "Now we are seeing it quite frequently."

Outside of Colorado, when patients do end up in an emergency room, the diagnosis is often missed. Partly because doctors don't know about CHS, and partly because patients don't want to admit to using a substance that's illegal.

CHS can lead to dehydration and kidney failure, but usually resolves within days of stopping drug use. That's what happened with Crowder, who has been off all forms of marijuana for seven months.

"Now all kinds of ambition has come back. I desire so much more in life and, at 37 years old, it's a little late to do it, but better now than never,"he said.

CHS has only been recognized for about the past decade, and nobody knows exactly how many people suffer from it. But as more states move towards the legalization of marijuana, emergency room physicians like Dr. Heard are eager to make sure both doctors and patients have CHS on their radar.

© 2016 CBS Interactive Inc. All Rights Reserved.

Wednesday, December 28, 2016

ANS -- In Praise of Ignorance

This article is irritating but true.  As you can imagine, the discussion on the site is interesting.  
It's about how we all have opinions on things we do not know much about.  

 comments 34

In Praise of Ignorance

I recently had a discussion with a very intelligent woman, a Ph.D fresh from an Ivy League university. We met after the third Clinton-Trump debate, so the conversation naturally turned to race in America, a topic about which my interlocutor felt strongly. She explained that the United States' criminal justice system is an oppressive apparatus of state racism. Mass incarceration, she told me, is in large measure the product of a war on drugs that unfairly targets African Americans. She painted a picture of prisons overfilled with African American men locked away for nonviolent drug offenses. She was convinced that the US criminal justice system requires dramatic reform or complete dismantling.

My question for her was simple: approximately what fraction of US prisoners are incarcerated for possession — as opposed to pushing or smuggling?

She did not know.

It is worth pausing to reflect on this. There is hardly a fact about the war on drugs that could be more basic. But my interlocutor did not know the answer to this simple question, despite her passionate moral convictions on the topic. As it happens, under 4% of prisoners in state and federal prisons are incarcerated for drug possession. If all of these prisoners were released tomorrow, the total number of people incarcerated in federal and state prisons would fall from approximately 1,560,000 to approximately 1,500,000. By comparison, more than 50% of prisoners are incarcerated for committing violent crimes — crimes like aggravated assault, rape and murder. This information is easily accessible to anyone who wants to find it — they need only Google "national prisoner statistics."

To take one more example, consider recent popular opposition to the TransPacific Partnership, or TPP. Negotiating and ratifying this trade agreement has been a central goal of the Obama administration. Now if one thing is true about the TPP, it is that the TPP is an enormously complex agreement. Not only does it touch on a huge number of international trade issues — it is over 5,000 pages long — the question of whether ratifying the TPP will promote prosperity in the US and its partner nations is fundamentally an empirical question in economics. But in the recent election, supporters of Bernie Sanders and Donald Trump often claimed, sincerely, that they could never vote for a candidate who supported the TPP.

The fact that few Trump or Sanders supporters could pass Econ 101 tomorrow if their lives depended on it was apparently no deterrent to making opposition to the TPP a litmus test of the candidates' presidential qualifications. Similarly irrelevant was the near-universal agreement among the world's top economists, liberal and conservative, that U.S. citizens are better off on average thanks to trade. And this is to say nothing about the benefits of trade to the global poor. In 1990, 37% of the world's population lived in absolute poverty, i.e., on the equivalent of 1.25 US dollars or less per day. (For comparison, in the United States, the poverty line is set at over $30 per day.) In 2016, the proportion of the world's population living in absolute poverty fell below 10% for the first time. This historic achievement owes relatively little to charitable donations from wealthy individuals and nations — which is not to say that wealthy individuals and nations ought not provide aid for the global poor, but only that we who know little about economics ought to be far more cautious in our opposition to free trade.

This is a situation we all find ourselves in: we sincerely hold strong moral beliefs on topics about which we are almost completely ignorant. Knowledge about difficult empirical questions has become so utterly irrelevant to whether we feel entitled to our opinions, often we do not even notice our own dramatic ignorance. In lieu of the facts we have not bothered to learn, we go to dazzling lengths to justify our opinions with ideology. When I told my interlocutor about the incarceration statistics mentioned above, her reaction was to question the veracity of the Department of Justice statistics. When I told her that multiple data sources present the same picture, she explained that reality is socially constructed.

The world is such a big and messy place, all anyone can do is focus on understanding a tiny slice of it. So most of us can be forgiven our ignorance about empirical questions as complex as the causes of racial disparities in the criminal justice system, the likely effects of a particular international trade deal, the costs and benefits of raising the federal minimum wage to $15, and so forth. These questions are so enormously complex, thoughtful people who devote their lives to investigating them do not always reach consensus. But what cannot be forgiven is holding passionate opinions on issues of immense practical significance when we are almost completely ignorant of the facts. It does not matter how strongly we may believe we are factually correct or that we are fighting the darkest forces of evil, when we choose to address a topic that may seriously affect the lives of other people, we incur a correspondingly serious obligation to discharge onerous epistemic duties.

If we do not bother to acquaint ourselves with the most basic facts, to expose ourselves openly to people with whom we are inclined to disagree, and especially to those who have thought the longest and hardest about these topics, then we are not entitled to any opinion. As J.S. Mill wrote in On Liberty, "He who knows only his own side of the case knows little of that." For most of us, the only defensible attitude on most issues is perfect agnosticism.

The problem is, we have little tolerance for agnosticism. A politician who admitted that she held no opinion on the TPP might expect mockery, even though it is as unreasonable to expect the average politician to know about the difficult empirical questions raised by such agreements as it is to expect the average doctor or nurse. And we should all be alive to the possibility that most politicians would not do much better than the rest of us if they had to pass Econ 101 tomorrow. It is even worse that we ordinary people suffer disapprobation when we express agnosticism towards issues about which we know nothing. This intolerance of ignorance threatens to sever both policy makers and ordinary people from reality, harming our best chance at improving our world — scientific knowledge combined with careful, open-minded moral thinking.

Our intolerance of ignorance hides questions of great practical significance behind veils of ideology, turning these questions, and the human lives that ride on them, into mere opportunities to signal our group membership. To have a chance at solving our problems we must not condemn each other for openly stating our ignorance. Those with the audacity to admit that they have nothing intelligent to say about a difficult topic should be praised for refusing to further erode our common epistemic standards, not scorned for failing to toe some party line. To paraphrase Woody Allen, the most beautiful words in the English language are not "I love you," but "I don't know."


Simon Cullen writes about psychology, morality, and improving the quality of public discourse.


Tuesday, December 27, 2016

ANS -- In defence of cholesterol

This piece is two years old, but it's good.  It's about a review of the evidence that cholesterol (in your diet or your blood) causes heart attacks, and concludes that the evidence just isn't there.  See the end where it discusses Lipitor.  

Post navigation

Autumn Seminar 2014 (post 1) – In defence of cholesterol

Francesca_GreenstreetOur 2014 Autumn Seminar with Dr Malcolm Kendrick entitled "Why cholesterol does not and cannot cause heart disease" was opened by Francesca Greenstreet, an undergraduate biomedical student from University College London.

When Francesca was a 6th form student at Westminster School she became interested in the cholesterol hypothesis and read Dr Kendrick's book 'The Great Cholesterol Con'. After undertaking her own research she used what she had learned to write an essay 'In defence of cholesterol' which much to her surprise, considering its controversial message, won her school essay competition.

When he heard about this Dr Kendrick commented that "her essay is extremely well written and makes all the points that I have been making for years. It is just gratifying to see that the evidence on cholesterol and heart disease is clear to anyone with a brain."

As promised to all of you who attended the Autumn Seminar, here is her essay in full:


In Defence of Cholesterol
by Francesca Greenstreet

The American government, the British government and the NHS, three venerable bodies respected as sources of dietary advice, currently recommend a diet low in saturated fat and cholesterol.[1] The predominant  reason this advice is given is the accepted belief held within the scientific community that high serum cholesterol levels are linked causally with the accumulation and build up of atheromas which lead to atherosclerosis and Coronary Heart Disease (CHD).

The commonly accepted and taught theory which links cholesterol to heart disease, the Lipid Hypothesis, states that cholesterol is carried from the liver to the rest of the body's cells in Low Density Lipoproteins (LDLs) and carried back from the rest of the body's cells to the liver in High Density Lipoproteins (HDLs). After being transported back to the liver by HDLs, Cholesterol is broken down by the liver or passes out of the body as a waste product. The Lipid Hypothesis states that eating saturated fat raises LDL levels. The cholesterol from LDLs forms fatty deposits, atheromas, which build up beneath the endothelium of the arteries. The build up of atheromas narrows the arteries and pieces of the atheromas can break off and become lodged in narrower arteries. Clots can form in the narrowed arteries which prevent blood flow and can starve organs of oxygen and nutrients. When clots or blockages form in the coronary arteries, necrosis occurs. This leaves part of the heart muscle not contracting and relaxing and can lead to a myocardial infarction.[2]

rabbit_aortaFigure 1: Sudan-stained aorta of a rabbit fed 61 egg yolks over a 70-day period, showing lesions in red.

The Lipid Hypothesis was brought to attention following a series of studies, the first of which was carried out by Anitschkow, a Russian scientist, in 1913. Anitschkow fed rabbits a diet of purified cholesterol dissolved in sunflower oil and examined the cells and the arteries of the rabbits after killing them. [3] Rabbits which were fed the purified cholesterol were found to have vascular lesions which bore a close resemblance to atheromas found in humans (Figure 1). Following Anitschkow's study, Dr John Gofman led a team to similar findings and hypothesized that serum cholesterol was the cause of the lesions developing.[4] The similarity of the lesions to those found in humans suffering from CHD was catalytic in the formation of theories that a high cholesterol diet might be linked to CHD in humans.

The ideas behind the Lipid Hypothesis were formalised by Ancel Keys when, in a study in 1953, he used data from six countries to show a direct link between the percentage calories from fat in the average diet and the number of CHD deaths per 1000.[5] Furthermore, he found the incidence of CHD deaths in those six countries was best predicted by the intake of saturated fat.[6]

However, not all scientists and physicians are in agreement with the Lipid Hypothesis. Regarding Anitschkow's rabbit study, it has been pointed out that cholesterol does not form part of the natural diet of a rabbit and thus it is possible that the rabbits had an allergic reaction to the high cholesterol diet, or that they were otherwise incapable of processing the chemical. It is significant to note that similar experiments carried out on dogs and rats showed that a rise in blood cholesterol did not lead to a rise in atherosclerosis.[7] This is potentially due to the fact that dogs and rats, unlike rabbits, consume cholesterol as part of their natural diet. The lack of cholesterol in a rabbit's natural diet, combined with the failure to replicate the findings in dogs or rats, whose natural diets are much more similar to our own, is a significant flaw in the reasoning behind Anitschkow and Gofman's conclusion: that a high cholesterol diet is linked to atherosclerosis in humans.

keys_graphFigure 2: Keys' (1953) selection to show relationship of fat intake to heart disease deaths of 55–59 yr. old men in 1951–53 (open circles left) and the 15 other available countries (closed circles). The relation of heart diseases to animal protein intake is on the right (Mann, 1993). (Adapted from WHO Ann. Epid. and Vital Statistics).

Another flaw in the Lipid Hypothesis is that Ancel Keys selected with purpose the countries for which he presented data in his study in 1953, rather than choosing them at random. "Yerushalmy and Hilleboe (1957) observed that Keys would have had available data from 22 countries, which would have given a much weaker correlation "(Figure 2).[8]

Figure 2 shows a very weak correlation between deaths per 1000 (from CHD) and percentage of calories from fat when all 22 countries are plotted on the same graph. It is interesting to note that the correlation between deaths per 1000 (from CHD) and percentage of calories from animal protein has a similar and even slightly stronger correlation than between deaths per 1000 (from CHD) and percentage of calories from fat.  All of this data would have been available to Keys, so his focus on the link between percentage of calories from fat and the number of deaths per 1000 (from CHD) is curious.

The data sample presented by Keys gives a correlation of coefficient of +0.84, a strong positive correlation, whereas "in the simulation study by Wood (1981) on the consumption statistics of 21 countries a total of 116280 different samples of six countries were found, and the correlation between consumption of animal fat and CHD mortality varied from -0.9 to +0.9, the average being    -0.04."[9] Such a difference in correlation coefficients between similar studies indicates some bias in Keys' selection of the six countries or insufficient data, since Wood's study uses many more countries and therefore is more likely to be accurate. As it is obvious that Keys had sufficient access to data from the 22 countries, it seems that his selection was biased.

There have also been many studies which investigate serum cholesterol level in relation to atherosclerosis and CHD in Humans rather than in animals. A notable example is the study led by Paterson entitled: "Serum Cholesterol Levels in Human Atherosclerosis". 800 patients who were permanently confined to hospitals and 100 war veterans who were in hospital for domiciliary care were given 2500-3000 calories a day in their daily diet, of which 25 to 35% was derived from fat. Serum cholesterol was determined annually or semi-annually and when any patients died, the severity of atherosclerosis was determined using six different criteria: crude morphological grading, measurement of the thickness of the largest plaque, determinations of the total lipid content, lipid concentration, total calcium content and calcium concentration. Figure 3 shows a graph showing the absence of a correlation between Serum Cholesterol in mg.% and Total Lipid in Mg. This shows that for the criterion of total lipid content, there is no correlation in the age group of 60-69 years.

lipid_cholesterol_graphFigure 3: Total coronary artery lipid and serum cholesterol levels in patients 60-69 years. The open circles represent cases without complications of coronary atherosclerosis; the closed circles, cases with complications.

Similar findings were observed in the other age groups with a significant number of participants (70-79 and 80-89). The study concludes: "In the 58 cases in the age group 60-69 years, significant relationships between the serum cholesterol and the severity of the disease were found only once in 40 statistical analyses, and the complications of atherosclerosis were just as frequent in cases with low serum cholesterol levels (150-199 mg. %) as in cases with moderately high ones (250-299 mg. %)."[10]Considering the emphasis from the government and the NHS to reduce cholesterol and saturated fat intake because cholesterol causes heart attacks, this seems to be a remarkably weak correlation.

The Paterson study was not alone in its findings: Sigurd Nitter-Hauge and Ivar Enge published a study in The British Heart Journal in 1973 which reported: "No significant correlation was found when total coronary arterial score was correlated to serum cholesterol values or to triglycerides."[11]

Not only is there strong evidence to show that serum cholesterol levels have no link to atherosclerosis, but there is also strong evidence to suggest that high cholesterol consumption does not raise blood cholesterol levels. The Framingham Heart Study, which set out to prove that eating more cholesterol in your diet increases your blood cholesterol levels, in fact showed that there was minimal difference in the blood cholesterol levels of the subjects despite subjects consuming cholesterol in widely varying amounts. [12] Scientists working on the Framingham Heart Study also studied the intake of saturated fats but eventually concluded: "There is, in short, no suggestion of any relation between diet and the subsequent development of CHD in the study group."[13] It is difficult to stress the importance of this finding enough: there was no connection found whatsoever between diet and the development of CHD.

Further evidence that eating a diet high in saturated fat does not lead to CHD was published in The American Journal of Clinical Nutrition in 1981. The study compared the diets of two populations of Polynesians living on atolls near the equator. It also assesses the effect the diets have on the serum cholesterol levels in the populations. One of the populations, the Tokelauans, obtained a very high percentage of energy from coconut (high in saturated fat) compared to the Pukapukans, 63% compared with 34%. The Tokelauans had serum cholesterol levels 35-40mg higher than the Pukapukans. However, "vascular disease is uncommon in both populations and there is no evidence of the high saturated fat intake having a harmful effect in these populations."[14]

Taking all these studies into account, it would appear that not only does having a high serum cholesterol level not have any connection to CHD, but that a diet high in cholesterol does not lead to high blood cholesterol levels and that a diet high in saturated fat does not have any link to CHD.

One final argument used to support the Lipid Hypothesis is the apparent effectiveness of statins in treating CHD. If, so the argument goes, statins reduce levels of serum cholesterol and they also reduce the risk of CHD, then reducing serum cholesterol levels must be the reason for the lower incidence of CHD. However, this reasoning contains two fallacies: firstly it assumes that statins have been shown to reduce the risk of CHD, and secondly it assumes that lowering serum cholesterol levels is the only effect of statins that could lower the incidence of CHD.

Both of these assumptions are false. A study was carried out by the University of British Columbia, part of the not-for-profit Cochrane collaboration, which concluded: "If cardiovascular serious adverse effects are viewed in isolation, 71 primary prevention patients have to be treated with a statin for 3 to 5 years to prevent one myocardial infarction or stroke."[15] Small mortality benefits from statins have been shown for high-risk middle aged men.[16], [17] However, these trends are not seen in women and the elderly.15, 16 Even an advertisement for LIPITOR (atorvastatin calcium), one of the best-selling statins in America, has a disclaimer which includes: "LIPTOR has not been shown to prevent heart disease or heart attacks."[18]

For the small minority of people who are protected by statins, there is another explanation. Statins have been repeatedly shown to act as "potent anti-inflammatory" agents in patients with cardio vascular disease [19]. The reason for their effects in reducing incidence of CHD could be due to those effects rather than the reduction of serum cholesterol levels. This means that it is inappropriate to use the limited protection against CHD by statins as evidence for high serum cholesterol levels being a cause of CHD.

Gathering together the arguments made in this essay, we can conclude that it is very likely that there is absolutely no causal correlation between high cholesterol, either in the serum or in the diet, and CHD. Nor is there any causal correlation between a diet high in saturated fat and CHD. The emphasis placed on the Lipid Hypothesis by the government and other organisations concerned with public health is potentially due to the inital panic after the publication of Keys' and Anitschkow's studies. The feeling of urgency to act in order to prevent ever increasing numbers of deaths from CHD led to premature acceptance of the Lipid Hypothesis without sufficient evidence. The long term effect of this view has been the demonization of diets high in saturated fat and cholesterol without sufficient justification from otherwise reputable organisations for the past thirty years.


[3] Daniel Steinberg, 2004. Review series: The Pathogenesis of Atherosclerosis. An interpretive history of the cholesterol controversy: part I, The Journal of Lipid Research, 45, 1583-1593.

[4] GOFMAN, J.W.;LINDGREN, F.; ELLIOT, H.; MANTZ, W.; HEWITT, J.; STRISOWER,B.; HERRING, V.; LYON, T.P., 1950.The role of lipids and lipoproteins in atherosclerosis,  American Association for the Advancement of Science  Vol. 111pp. 166-171; 186

[5] "Trick and Treat" (Barry Groves, 2008, p.61-62)

[6] "The Cholesterol Myths" (Uffe Ravnskov, M.D., Ph.D., 2000, out of print – available at:

[7] "Trick and Treat" (Barry Groves, 2008, p.59)

[8] Kalle Maijala, Cow milk and human development and well-being, Livestock Production Science 65 (2000) 1–18

[9] Kalle Maijala, 2000. Cow milk and human development and well-being. Livestock Production Science 65 1–18

[10] J.C. PATERSON, M.D., LUCY DYER, M.Sc. and E.C. ARMSTRONG, M.D., London, Ont., 1960. Serum Cholesterol Levels in Human Atherosclerosis. Canad. M. A. J., 1960, vol. 82

[11] Sigurd Nitter-Hauge, Ivar Enge, 1973.  Relation between blood lipid levels and angiographically evaluated obstructions in coronary arteries British Heart Journal. 35, 791-795.

[12]"Trick and Treat" (Barry Groves, 2008, p.63)

[13] Kannel WB, Gordon T., 1970.The Framingham Diet Study: diet and the regulations of serum cholesterol (Sect 24). Washington DC, Dept of Health, Education and Welfare.

[14] Ian A. Prior, M.D., F.R.C.P., F.R.A.C.P., Flora Davidson, B.H.Sc., Clare E. Salmond, M.Sc., and Z. Czochanska, DIP.AG., 1981. Cholesterol, coconuts, and diet on Polynesian atolls: a natural experiment: the Pukapuka and Tokelau Island studies. The American Journal of Clinical Nutrition 34, pp. 1552-1561.

[15] "The Great Cholesterol Con" (Dr Malcolm Kendrick, 2007, p.164-165)

[16] "Trick and Treat (Barry Groves, 2008, p.52)

[17] Scandinavian Simvastatin Survival Study Group, 1994. Randomised trial of cholesterol lowering in 4444 patients with CHD: the Scandinavian Simvastatin Survival Study (4S). Lancet; 344: 1383-1389


[19] Mukesh K. Jain, Paul M. Ridker, 2005. Anti-Inflammatory Effects of Statins: Clinical Evidence and Basic Mechanisms, Nature Reviews Drug Discovery 4. 977-987

ANS -- On Obamacare repeal, GOP ideology is colliding with reality

If you want to know a bit about why re-doing Obamacare will be hard, read this.  


On Obamacare repeal, GOP ideology is colliding with reality

If there weren't so much at stake, one would be amused at the spectacle of Republican politicians writhing as they try to make good on their ideological promise to "repeal and replace" Obamacare without ruining the lives of millions of their own constituents.

In the few short weeks since the GOP added control of the White House to its existing control of both houses of Congress, the GOP has been grappling with the recognition that taking potshots at the Affordable Care Act and weakening its consumer protection provisions is no longer just a parlor game, but actions that could have genuine consequences. 


Not only are they conceding that conjuring up a replacement for the ACA will take much longer than they promised — years, even — but they're also talking about reinstating provisions of the law that they undermined during their six-year campaign to hobble it. They're forced to acknowledge that America's pre-ACA system of health insurance for individuals was so awful that they can't justify returning to it.

Many proposals the GOP has offered as replacements end up looking very much like Obamacare, though with more costs shifted to consumers. A repeal bill passed by the Republican House in February would have eliminated the mandate that all individuals have coverage, the subsidies that made it affordable, and $346 billion in taxes (over 10 years) that funded Obamacare but hit wealthy taxpayers. This would certainly have destroyed the ACA, but it was easy for the GOP to pass, because it was 100% certain to be vetoed by President Obama. Such symbolic votes can't be taken any more.

Let's examine some aspects of the new reality.

1. There aren't actually many alternatives to the ACA mandates. The one ACA provision that shows up in every GOP proposal calls for protection of customers with pre-existing medical conditions. This was a prime category of insurer abuse before the ACA: Individuals with injury or illness in their histories were routinely denied coverage, or offered plans with stratospheric premiums or that excluded their condition. Insurers routinely investigated customers who fell sick, looking for undisclosed past conditions that justified rescinding the policies just when they were needed. 

What Republicans have discovered is that retaining the ban on exclusion for pre-existing conditions means retaining other provisions that they've campaigned against. The only way to require insurers to cover all applicants regardless of health status is to force everybody into the pool, healthy or sick, young or old. The ACA did so via the individual mandate, which imposed a tax or fee on individuals without coverage.

The mandate is immensely unpopular, but necessary medicine often is. GOP alternative plans use a different means to achieve the same end: "continuous coverage," meaning that pre-existing conditions must be covered without premium increases if the consumer has maintained insurance without a significant lapse. Some healthcare wonks, including Andrew Sprung of Xpostfactoid, argue that there isn't enough difference in these two coercive methods for ACA supporters to draw a line in the sand over, but that's questionable. By its nature, a continuous coverage rule is less flexible than the individual mandate. It overlooks the fact that the main reason for coverage lapses is that customers don't have the money for insurance. That makes adequate subsidies for the purchase of insurance even more important — but the GOP plans typically cut back on subsidies, as Sprung himself has reported: He calculates that the repeal-and-replace proposal from Rep. Tom Price (R-Ga.), who Donald Trump has nominated as secretary of Health and Human Services, would cut the subsidy effectively in half. 

2. Repeal-and-delay will drive insurers out of the system, raising prices. Some Republicans are hoping to finesse their dilemma by repealing as much of the ACA as they can without inspiring a Democratic filibuster in the Senate, but deferring its effectiveness for several years. The idea is to make good on their campaign promise, but give themselves time to craft a workable solution. 

"We're talking about a three-year transition now that we actually have a president who's likely to sign the repeal into the law," Senate Majority Whip John Cornyn (R-Texas) told Politico. "People are being understandably cautious, to make sure nobody's dropped through the cracks."

The problem with this is that it injects uncertainty into the survival of the individual insurance marketplaces. Insurance companies hate that. Big insurers who have stayed in the market say they've done so because they're confident that the insurance pool will eventually stabilize, so that the risk profile of the customer pool and therefore the proper level of premiums will become more predictable and therefore profitable.

Putting off replacement for three years or even more eliminates that certainty. There will be little reason for the remaining insurers not to follow such big firms as Aetna and UnitedHealth out of the exchanges. That means less competition and higher prices. If the GOP really wanted to subject the exchanges to a "death spiral" of ever-rising premiums and therefore an ever-sicker customer base, this is the way to do it.

Consequently, congressional Republicans are talking with the insurance lobby about ways to moderate the risk, according to The Hill. That brings us to the next point.

3. Past GOP actions undermining the ACA are coming home to roost. What's most telling about these discussions is that they involve restoring a risk management program that was written into the Affordable Care Act, but eviscerated by the Republican Congress in 2014. Under the program, which aimed to stabilize insurance premiums in the first few years of the ACA, insurers that set prices more than 3% below a set target would get a reimbursement from the government, and those that overpriced by the same margin would pay some of the windfall to the government. If the two sides didn't net out exactly, the difference would be made up from government funds.

Congress approved a change sponsored by Sen. Marco Rubio (R-Fla.) prohibiting the use of government funds for the purpose. The result was that health plans due a payment were shortchanged; in 2014 they got only 12.6 cents on the dollar of what they're owed -- $362 million to cover claims of $2.87 billion. Eventually they'd get paid, but no one was sure when. In the event, several co-op plans needing money to bridge their early, financially shaky years had to shut down instead, hurting tens of thousands of their enrollees.

Rubio has been inordinately proud of this mindless act of vandalism, like a puppy seeking praise for soiling the carpet. He even built his presidential campaign around his achievement of having done "significant damage to Obamacare." He plainly figured there was no risk to him: Any chaos that resulted would be blamed on Obamacare itself, not on GOP machinations. He was correct.

As we pointed out earlier, Rubio's real victims weren't insurance companies, but their customers. In other words: consumers, who lost the benefits of competition among plans because some of the most popular new plans were rendered insolvent because the government couldn't provide their promised reimbursements. Nice work, Mario.

And now the Republicans are talking about putting the program back in. This is what happens when you actually have to care about the consequences of your vandalism.

4. The neediest constituents are most vulnerable to repeal proposals. Those receiving insurance through the ACA exchanges and its expansion of Medicaid are disproportionately lower income. That creates a quandary for Republican officeholders, especially in red states in the Southeast and Midwest, which are hotbeds of Obamacare hostility in Congress.

survey just released by the Kaiser Family Foundation and reported by my colleague David Lauter shows that big Republican states are heavily dependent on Obamacare subsidies. Rubio's home state of Florida, for example, is home to 1.4 million subsidized enrollees receiving an average $305 a month for a total of $5.2 billion a year, the largest total of any state. Cornyn's Texas is home to 913,000 residents receiving an average $271 a month, or $3 billion a year in all.

Blue states aren't immune. California reports more than 1.2 million subsidized insurance buyers, receiving an average $309 a month, or $4.6 billion a year. Reliance on these subsidies is especially heavy in counties such as Kern, where 93% of the 17,900 enrollees receive subsidies averaging $447 per month, and Tulare, where 96% of the 10,880 enrollees are subsidized to the tune of $592 per month. These happen to be in the congressional district of House Majority Leader Kevin McCarthy, one of the leaders of the Obamacare repeal movement. As we mentioned recently, residents of McCarthy's district also are heavily dependent on Medi-Cal, the state's version of Medicaid, which is also a Republican target. If McCarthy and his colleagues screw up healthcare, they will have a lot of explaining to do. So far, their ideas tend to point to more chaos and more costs for consumers, not to improvement.

Healthcare is complicated, which is why it took years of negotiating to cobble the Affordable Care Act into shape. Complaining about its shortcomings is easy, as the GOP has shown over the last six years. Scrapping it and coming up with something better will be very, very hard.