Talk:Lipid hypothesis

From Wikipedia, the free encyclopedia

This is the talk page for discussing improvements to the Lipid hypothesis article.
Article policies
WikiProject Medicine This article is within the scope of WikiProject Medicine. Please visit the project page for details or ask questions at the doctor's mess.
B This page has been rated as B-Class on the quality assessment scale
Mid This article has been rated as Mid-importance on the importance assessment scale
Articles for deletion This article was nominated for deletion in the past. The result of the discussion was Keep.

Contents

[edit] Spelling

Seeing how I misspelled it and it is more commonly called the cholesterol hypothesis I agree the best way forward would be to delete the article. Apologies to any mods/admins for the extra work! --Starquin 13:18, 31 July 2006 (UTC)

Ha, I hadn't even noticed the misspelling in the title. Moved to "hypothesis." With the change to NPOV article text, this is a perfectly legitimate article. It has a significant number of hits in Google, so it's deserving of an article. I'll leave it to people who know what they're talking about to make it more than a stub. eaolson 14:28, 31 July 2006 (UTC)

[edit] NPOV

According to the AfD discussion, this is a nonneutral term. It's used by one side in the debate to convey a particular POV. We can still have an article about it, but, like other such articles (e.g., Chickenhawk (politics)), this one must make clear that the term proceeds from a particular orientation. I've rewritten it along those lines. JamesMLane t c 10:55, 27 February 2007 (UTC)

"Lipid hypothesis" is a term used in peer-reviewed scientific literature describing a hypothesis proposed by Virchow in 1856. As such, it is a perfectly valid scientific term and the article could have a section on the development of the hypothesis from a science history perspective. As scientific hypotheses go, they make testable predictions that can be proven or disproven by studies. Therefore, the article should contain a section on studies that have been done to address this question. In the case of the lipid hypothesis, controversial discussion started in the 1970s and 1980s that questioned the interpretation of data that some scientists consider to be solid proof of the lipid hypothesis. This could be worked into a controversy section. It appears that the term was "hijacked" into this discussion by people arguing that the "proof" for the hypothesis is flawed and unscientific and therefore it is still nothing but a theory, but that doesn't change the validity of the term itself.

What this article needs is solid, scientific references from peer-reviewed publications. There are scientific papers that question the lipid hypothesis, but from what I can tell right now, they appear to be mostly single-author review papers written by one person in the scientific community whose main point of argument is that other scientists and NIH are working unscientifically and misinterpreting the data. As such, I feel the controversy section should not be the main part of the article as it does not reflect "mainstream" view. The critical articles are counter-balanced by a number of reviews detailing proof for the lipid hypothesis, which should be part of the article as well, if not its main body.

Looking over the article history, I have to agree that apparently this article was originally created on Wikipedia to support a certain POV. I do believe though that it could be worked into a neutral and informative article about a 150-year-old scientific hypothesis that became a controversial topic towards the end of the 20th century. The article should aim at allowing readers to understand the data produced in studies based on predictions made by the hypothesis and form an educated opinion about its conflicting interpretations. - tameeria 16:57, 27 February 2007 (UTC)

[edit] NPOV tag

What are the reasons for the NPOV tag? Currently the intro IS POV, in that it doesn't state that the "lipid hypothesis" is accepted by scientific consensus and only a small number of scientists hold a dissenting view. Please see WP:WEIGHT, which this article is violating by presenting the "lipid hypothesis" and its detractors as if they had somewhere near equal footing in the scientific community. They don't. The article needs to make clear the relative acceptance of the "lipid hypothesis" vs its alternatives, particularly in the lead, which User:Bezapt has removed. MastCell Talk 15:48, 15 April 2007 (UTC)

OK point taken re the lead paragraph and have added balance there. However the article certainly contains POV. See section "The lipid hypothesis and cholesterol controversy of atherogenesis": in answer to "lack of proof that lowering blood cholesterol levels results in decreased risk for atherosclerosis", article quotes NIH consensus development conference as squashing all objections. Truth by decree is not truth by scientific questioning, research and impartial argument about the observations. The pronouncement of that conference was criticised by several scientists at the time, and notes criticising the proceedings published by Thomas J Moore, Heart Failure, (Random House NY, 1989). He asserts criticism from the conference audience was ignored, critics were cut off by panel chairman Daniel Steinberg, and that there was no unanimity about the treatment the conference was to recommend - so it recommended all three proposals. Ravnskov notes that while violently criticised by his opponents, Moore's description of the events at the conference was not questioned. The article then breezes on with "Nonetheless, criticism persisted.." as if this contentious conference decree had actually proved something scientifically. Quite frankly: weasel words. While yes, I acknowledge WP:WEIGHT, the case for the majority should be more convincing than the poor effort that presently stands. There should be references to scientific studies, not a politically charged conference. The article also makes no reference to important considerations such as the traditional diets of the Masai and the Inuit, which are laden with animal fats, the so-called "French Paradox", or the interesting case of Ancel Key's fundamental 1953 paper which examined the correlation of fat consumption with heart disease mortality in six countries - when at the time data was available from 22 countries: inclusion of the omitted contemporary data has been shown by Ravnskov to seriously undermine Keys' conclusions. But be this as it may, perhaps the subject of debate is best moved to a new page entitled "Cholesterol controversy", while this article is reduced to a more neutral description, with a wiki-link to the controversy page if the reader wishes to follow it. Bezapt 16:43, 15 April 2007 (UTC)
Re the dispute on neutrality of the title brought up again by User:MastCell, tameeria has already commented on this: "Lipid hypothesis is a term used in peer-reviewed scientific literature describing a hypothesis proposed by Virchow in 1856. As such, it is a perfectly valid scientific term". Are you proposing to censor an historical term simply because it is still used by a minority of scientists and others? Bezapt 17:17, 15 April 2007 (UTC)
The NIH conference consensus is actually a secondary source from a reliable entity, which is the preferred source even for medical articles (as opposed to citing the primary literature and giving our own interpretation). It's only "politically charged" because a small number of contrarians refuse to accept it. NIH consensus documents carry a lot of weight on Wikipedia, as well they should per our sourcing policies and guidelines. As to the title, I guess it's a bit of a gray area, as it was once a widely used term, but my point was this: "lipid hypothesis" is no longer used in the scientific literature, except by the small minority who vehemently disagree with it. It's like referring to the pro-choice movement as the "anti-life movement" - it's a POV title because it's been appropriated by one side of the debate to try and cast doubt on the acceptance of the idea, which has moved beyond a "hypothesis". MastCell Talk 20:56, 15 April 2007 (UTC)
On researching the matter a little further I must admit I was wrong to be influenced by the unverified assertion that the term "lipid hypothesis" is only used by a minority who oppose it. Here is a selection of URLs pointing to publications made by those supporting and indeed currently investigating the hypothesis, who actually use the term. You will note that there is still an open trial, with further results due in 2010, which currently adds to the 18 or so other trials mentioned by Colpo in his book which indicated no statistical significance. With regard to your NIH conference remarks, an "appeal to authority" argument doesn't hold the same scientific weight as the actual examination of the research data. A committee can decree what it likes and rely on its aura of respectability to push an agenda over the criticisms of individual detractors. An appeal to authority is not science. Ad hominem attacks are not science. And yet detractors are dismissed as "a small minority" with the implication that they are misguided. The Wright Brothers were members of a small minority - powered flight was not possible. Christopher Columbus was a member of a small minority - of course the earth was flat. Of course ships made out of metal would sink - metal cannot float. For well over a century the proponents of the idea that citrus fruits and fresh food would combat scurvy were vehemently opposed by members of the medical profession who had ideas which had also "moved beyond an hypothesis" - and yet sailors still died from their officially approved treatments. Can you see my point? The number of detractors is immaterial if a valid scientific question is asked of an hypothesis. To suppress an idea, as you seem to be suggesting, can be contrarian to the advancement of human knowledge. The resolution of scientific argument should be settled with science - not with dogma. The term "lipid hypothesis" as seen below is used by both sides of the argument. If the lipid hypothesis is beyond doubt, and has moved beyond being an hypothesis to a "law", then trial results surely should be overwhelmingly convincing - but as shown again by the 2007 paper mentioned below, they are not even statistically significant.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2073909&dopt=Abstract
Dec 1990
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2182981&dopt=Abstract
Feb 1990
http://www.cardiosource.com/rapidnewssummaries/index.asp?EID=15&DoW=Mon&SumID=98
refers to "the prevailing lipid hypothesis" - 7 Mar 2005
http://www.eurekah.com/chapter/3070
chapter in a book published (December 12, 2006)
http://www.jpands.org/vol12no1/ottoboni.pdf
Journal of American Physicians and Surgeons Volume 12 Number 1 Spring 2007
Abstract from the Women's Health Initiative Randomized Controlled Dietary Modification Trial (trial still open with further results due in 2010). Results puzzlingly inconclusive - no statistically significant benefits found deriving from a low fat diet. Lipid hypothesis is specifically mentioned, indeed used as the title of a section. (authors of this one are members of THINCS, just included this as it is a trial still in progress). Bezapt 03:19, 16 April 2007 (UTC)

No. The article doesn't dismiss the views of the minority - it presents them in the context of their acceptance by the scientific community, per WP:WEIGHT - or at least it should. You're essentially describing core Wikipedia policies like WP:V and WP:RS derisively as "appeal to authority". Citing papers from 16 years ago using the phrase "lipid hypothesis" only proves my point - this term used to be widely used (say, 16 years ago), but as the "hypothesis" is now considered proven, the term is loaded and used primarily by the minority who dispute it. Arguing that there's some kind of equivalence to Christopher Columbus or the Wright Brothers is off-topic - this is about how Wikipedia presents the topic, and it needs to be based on WP:V, WP:RS, and WP:WEIGHT. Citing the Journal of American Physicians and Surgeons pretty much proves conclusively that the idea in question is fringe and outside the mainstream - you may want to look beyond the vanilla title at what that particular journal actually represents, and why it's not indexed on MEDLINE or anywhere else. MastCell Talk 03:35, 16 April 2007 (UTC)

I fail to see how an NIH consensus development conference that set out to critically examine the available scientific data at the time and invited experts to present this data to a panel of yet more experts can be construed as having "decreed" something. As far as I can see, it merely confirmed an already existing consensus as a guideline for NIH. As for disregarding the voice of skeptics during the conference: Three of the invited speakers were actually known critics of the lipid hypothesis, which means that the critical side was even overrepresented (on purpose and by invitation) in comparison to the 1-8% of experts skeptical of the lipid hypothesis in the survey of 1978. Regardless of the conference outcome and its criticism, both are now just historical anecdotes two decades into the past and superseded by newer studies. While there is no doubt that skepticism still persists, it appears to come from a vocal minority of maybe 1% or even fewer "experts" within the medical community that rely on popular literature, news stories and interviews, and their own websites to make their points. I have yet to find any truly critical papers within the scientific community (PubMed) published within the last five years. - tameeria 13:48, 16 April 2007 (UTC)
OK, separating the text from the argument, yes, the NIH matter is verifiable, and yes reliable journal sources are quoted. In that respect WP:V and WP:RS are satisfied. A concern however is that the construction of the article places an odd prominence on reports of academic "consensus", rather than the results of the medical trials. In fact there is a lacuna from 1953 and the survey from 1978. No studies are mentioned. The article states "During the 70s and 80s, a fair number of researchers and practitioners were questioning the lipid hypothesis", and "Predictions were made that further research during the 80s and 90s would help settle this controversy". These statements are inconsistent with the verifiable fact from a reliable source which states that in 1978 an overwhelming majority of surveyed researchers and practitioners supported the lipid hypothesis by an impressive vote of 189 to 2. Why the 70s & 80s questioning if the general mood was so supportive? Colpo cites 18 trials and studies which were conducted during the period from 1955 to 2006, 12 of which did not produce statistically significant results (total mortality benefit from intervention), and 1 which had mixed results. the remaining 5 supporting the lipid hypothesis are not beyond query, and include the Finnish Mental Hospitals trial of 1972, which was extensively criticised in The Lancet in 1973 by staff of the NHBLI. Perhaps these are factors which could explain the "questioning" of the 70s and 80s? Regarding reference dates, the article states the lipid hypothesis was considered validated by the end of the 1980s. The articles that are 16 years or so old are around or just after the time of lipid hypothesis "validation" (per article). While I only supplied a small selection of more recent references, I am sure as you are familiar with www.pubmed.gov you could easily find the 72 hits for that text string. Note that 10 of these respectable articles, many of which support the lipid hypothesis, are using the term from 2002 (a date with relevance, according to the article) to the present (although the likes of Steinberg seems to prefer to quarantine the term from the rest of his prose with inverted commas). The title is a valid term, still in use by both sides of the question. As it has been mentioned in the literature for at least the last 30 years (as per www.PubMed.gov) it has an historical validity also. Bezapt 17:49, 16 April 2007 (UTC)
Moore, Thomas J., Heart Failure (Random House, 1989) describes how the 2.5-day NIH conference made its pronouncement at the end of the second day and, before concluding for the day the panel announced that a printed national cholesterol plan would be available at 8:30 the next morning, with a press conference three hours later to announce the plan to the general public, such readiness suggesting a pre-orchestrated outcome to the conference. Despite inviting known opponents, the announcement would appear to have been pre-planned, regardless of the matters raised during the conference. Yes it is an historical anecdote, (and verifiable from responsible sources both for and against), but does it deserve so much prominence as being a powerful factor in the debate, while discussion of some 18 medical trials is omitted? The addition of the 1978 survey is opinion - from relevent professionals, to be sure - but opinion nonetheless. What trial evidence did they base their overwhelmingly positive opinion on, especially during a time when "a fair amount of questioning" was going on? Regarding the lipid hypothesis opponents using websites and popular literature to get their point across, why shouldn't they? The NIH conference panel was keen to announce their national cholesterol plan to a wider audience too -the last half-day of the conference appears to have been occupied significantly by promotional matters. The THINCS members do also publish in the scientific literature, and you can find various items listed at www.thincs.org/public.htm listed in PubMed as well (I checked a few). Bezapt 17:49, 16 April 2007 (UTC)
Parsing the above: you say, "the construction of the article places an odd prominence on reports of academic "consensus", rather than the results of the medical trials." Yes, this is exactly what we're enjoined to do by WP:OR - see here - where secondary sources (e.g. NIH consensus conference) are preferred to having us list primary sources (trials) and provide our own interpretation of what they mean. Bottom line: the NIH's interpretation of the data is more "reliable" than yours or mine, so far as Wikipedia is concerned. Also, it's not "odd" to give prominence to academic consensus - it's actually mandated by WP:WEIGHT. Impugning the motives of the NIH and citing an apparently out-of-print book does not override those considerations. MastCell Talk 18:08, 16 April 2007 (UTC)
You appear to have missed my point, MastCell. I have been writing for Wikipedia for a while now and am quite aware of the WP:No original research rule. My point is that primary and secondary sources exist which can explain the article's statement "During the 70s and 80s, a fair number of researchers and practitioners were questioning the lipid hypothesis". However these primary and secondary sources have been omitted for a large number of years - the article's chronology has a big hole in it from 1953 until a 1978 survey confidently supporting the hypothesis even though the article notes it was a time of doubt. Readers are left to wonder about the inconsistency. This selective choice of verifiable, Reliable sources, while omitting others which are equally verifiable and reliable, distorts the article, i.e. displays the effect of a point of view. It appears that the justification for the omission of opposing sources is seen as justifiable in the name of WP:Weight. While not giving the arguments of the hypothesis opponents WP:Undue_weight#Undue_weight (to reflect that there are more lipid hypothesis proponents than opponents), there needs to be a little more balance to the article. If points supporting the hypothesis are included, then at least some points opposing it should also be included, not just a few mentions that there are some opponents. Erasing opposing voices was what the Ministry of Truth was about... what a coincidence that the NIH conference occurred in 1984! Regarding the motives of the NIH, these were speculated upon by the source quoted above, which is freely available for purchase if you wish to pick up a copy at amazon.com. Virchow's book from 1856 has been out of print for considerably longer and is probably harder to get hold of, not to mention being written in an older style of German and printed in that gothic font they used to use - yet it is quoted as a source. Surely you are not implying that if a book is out of print it is unreliable? Further criticism of the NIH conference's National Cholesterol campaign was published in reliable sources after its release, appearing in The Lancet 1:633-634 (1984) & 1:1087-1089 (1985) & 1:503 (1987), JAMA 256:2779-2780 (1986) and Mayo Clinic Proceedings 63:88-90 (1988), so while there might have been consensus amongst the NIH conference panel of 14 members, consensus was certainly not achieved in the medical community of the time. When I have some more time I will make an attempt at providing some balance while trying not to upset the dominant position held by the hypothesis proponents. Bezapt 15:38, 18 April 2007 (UTC)
Basically, the entire article is a POV fork - it's as if the article on AIDS was entitled "HIV/AIDS hypothesis". If you re-read the AfD discussion, the article was kept on grounds of tameeria's excellent rewrite and provided that it covers the "lipid hypothesis" as a historical dispute now considered settled (with the exception of a small but vocal fringe). I don't see how citing letters to the editor from 20 years ago suggests that the lipid hypothesis is currently controversial in the scientific community, and as you probably know, letters to the editor are not peer-reviewed and are generally selected to foment discussion - therefore, they should not be taken as evidence of a weight of scientific opinion. The difference between Virchow's monograph (which is cited for its historical importance) and Thomas Moore's book is obvious, and the fact that Moore's book is out of print suggests that perhaps its impact has not been particularly profound - although of course this is indirect evidence. Finally, please leave the Orwell analogies at home, as they tend to undercut one's credibility in the same manner as a reference to Nazi Germany. MastCell Talk 16:09, 18 April 2007 (UTC)
Sorry, your analogy is not quite congruent. There exists a main cholesterol article, and this one is merely supplementary to the main subject, providing information about a term with a valid historical existence for at least 50 years if not more, as well as being in use still by some and, as tameeria notes, being employed in other contexts too. Consider the student using Wikipedia to help with research, or a school project. They may have seen "lipid hypothesis" in some publication and wish to investigate it further. Surely they have a right to expect Wikipedia will have some sort of article or section explaining said term?
Your confusion regarding submissions from approximately 20 years ago has resulted from your overlooking the fact that I was discussing the NIH conference, which occurred 20 years ago, and not the present. The differences between Virchow's and Moore's publications include: one is relatively much harder to obtain than the other; even if both were obtained, one is less accessible and liable to have a profound impact on those unfamiliar with antique scientific German; one proposed the lipid hypothesis and the other includes an eyewitness account of a conference related to the subject (which, as Ravnskov notes in The Cholesterol Myths (2000), p.295, n.1, "(Moore's) views have been violently criticised by the diet-heart proponents. However, no one has questioned his description of the conference.") Sorry if my Orwellian reference offended, I must have touched a nerve.. Bezapt 18:29, 18 April 2007 (UTC)
This is a POV fork because the history of the "lipid hypothesis", as well as the fact that a small fringe of dissenters exists, should both be covered under cholesterol, atherosclerosis, and/or coronary heart disease. Creating an article using a (now)-partisan title to expand on the views of that small fringe of dissenters smacks of POV-pushing and violates WP:WEIGHT. But those are my 2 cents. No, the Orwell thing hasn't touched a nerve. I've heard the same before from editors who are convinced that Wikipedia is a soapbox upon which one can expound uncritically on fringe views and challenge scientific "dogma" - but a reliance on conspiracism is generally not an effective persuasive tool here, I've found. MastCell Talk 19:26, 18 April 2007 (UTC)
Including the term in another article is certainly an option, but if you continue to feel so strongly about the title, what about us renaming this article "Cholesterol controversy", with "lipid hypothesis" pointing to it via redirect link? Then it would, for example, parallel the arrangement of the "Evolution" article which has a "Theory of evolution" redirect and also separate subsidiary artcles Creation-evolution controversy, and Objections to evolution. This precedent would appear to be a way forward. Thanks for the advice re conspiracy theories, but I am relying on the authors I have quoted (with the exception of Colpo, who provides extensive citations) rather than a single lighthearted literary reference (suggested to me by Moore's viewpoint and the date); while not holding to the mainstream view, they are medically qualified. They are not hippies, or sensation-seeking journalists, but the professional peers of the proponents. Bezapt 15:55, 20 April 2007 (UTC)

I can see that the PubMed sources appear to be inconsistent and lacking in original data. Part of this may be because "lipid hypothesis" as a search term preferentially pulls up reviews from the two opposing sides in the argument. As a matter of fact, all the articles after the 1996 introduction of the Diabetes Atherosclerosis Intervention Study that the PubMed search brings up are review articles (and one interview). (The non-review of 1999 is regarding the lipid hypothesis of osteoporosis, and the 2007 paper deals with the lipid hypothesis of cold tolerance. Both are thus off-topic in this context.) Of course, they will place different weights and emphases on consensus and interpretation of results, thus the apparent inconsistency. Going backwards, the first articles with actual data date from 1987 (Effects of fenofibrate on plasma lipoproteins in hypercholesterolemia and combined hyperlipidemia) and 1986 (In vivo effect of a high-cholesterol diet on the endothelial integrity of rat aorta). Why is that and where is the data that has been generated since then? It appears to me that all primary sources containing data on the topic published since the late 80s consistently avoided using the term "lipid hypothesis" and it has since then only been used by those who argue about it. - tameeria 20:52, 16 April 2007 (UTC)

Why do articles with data not use the term lipid hypothesis these days? A very good question indeed. I did find a few articles referring to the 2006 Women's Health Initiative trial, but they slipped by my search as they apparently do not refer to "that" hypothesis by name. Perhaps the term is now too politically incorrect in mainstream medical circles but, since I do not move in them, this is pure speculation of course.
  • Howard BV, et al., "Low-fat dietary pattern and risk of cardiovascular disease: the Women's Health Initiative Randomized Controlled Dietary Modification Trial.", 1: JAMA 2006 Feb 8;295(6):655-66. PMID: 16467234. "CONCLUSIONS: Over a mean of 8.1 years, a dietary intervention that reduced total fat intake and increased intakes of vegetables, fruits, and grains did not significantly reduce the risk of CHD, stroke, or CVD in postmenopausal women and achieved only modest effects on CVD risk factors, suggesting that more focused diet and lifestyle interventions may be needed to improve risk factors and reduce CVD risk."
There are number of other articles cross referenced to that one in PubMed, but one item alleges that debate has been stirred again in the mainstream:
  • Twombly R, "Negative Women's Health Initiative findings stir consternation, debate among researchers", J Natl Cancer Inst 2006 Apr 19;98(8):508-10. PMID: 16622115.
Perhaps those other uses of the term "lipid hypothesis" that you spotted should be added to the article in an additional section. Bezapt 18:29, 18 April 2007 (UTC)
Interesting citation. Hopefully you have the whole article available to look at, particularly the last paragraph of the Results section and the entire Comment section. The Howard study's main conclusion was that reducing total fat intake had no discernible effect. However, the "lipid hypothesis" specifically identifies saturated fat (and more recently, trans-fat) as the bad actor in atherogenesis. So when Howard et al. looked at this, what did they find? A trend toward reduction in heart disease risk in those with the lowest intake of saturated fat and trans-fat, along with a decrease in LDL-cholesterol in those with the lowest saturated fat intake. Even though these were not pre-specified objectives of the study, the p values were pretty good - 0.05 for saturated fat and 0.10 for trans-fat.
The authors concluded, "Collectively, these analyses, despite their inherent limitations, suggest that a diet lower in saturated and trans fat intake and higher in intakes of vegetables and fruits and polyunsaturated fat than what was achieved in this trial might show significant benefit in preventing CHD." Hence, "more focused" dietary interventions, rather than dealing with total fat intake alone. Doesn't sound like a challenge to the "lipid hypothesis" to me. MastCell Talk 19:26, 18 April 2007 (UTC)
I've tried to address some of the points raised by rewriting a bit, adding more references (e.g. Science coverage of NIH conference criticism) and verifying sources. Does this address the issues for the NPOV tag, and can it be removed? Or are there other points? - tameeria 17:35, 19 April 2007 (UTC)

Thanks for the excellent work. I think the tag could be removed, from my perspective, but the article needs to continue to be watched closely. MastCell Talk 18:21, 19 April 2007 (UTC)

Ok, I've removed the NPOV tags for now. It appears to me that the only section under dispute may be the controversy section. Therefore, I would suggest using a section tag if you think the NPOV tag removal was premature. I think though that this is not really the place for detailed discussions of experiments and their criticism. Also, the section's references include seven reviews summarizing criticism and seven reviews from proponents/neutral sources now. I think that's as much balance as we can get without tipping the scale into the other direction. Maybe criticism voiced by THINCS members could go onto the THINCS page? Or should there be an extra page with more details on the cholesterol controversy that is then linked from the summary section in this article? - tameeria 14:54, 20 April 2007 (UTC)
Jacqueline Walker MD, from THINCS, has questioned that last paragraph of the results section in a forum discussion[1]. "The study found no significant increase in CVD outcomes in the low-fat group EXCEPT, they found the hazard ratio for women in the low-fat intervention group who already had CVD to increase 1.26 (CVI 1.03-1.54) and this was significant (P=0.006). Interestingly they put this bit in at the end of a section in a sentence which completely omits to mention the direction of the 'interaction between the intervention and the [baseline] disease'). However, they did do some fancy calculations on CHD risk and found some groups where this fell where saturated fat and trans fat consumption was lowered. Now this can usually safely be ignored because 'risk' usually just means the application of a model incorporating LDL levels, triglycerides, diabetes, BP etc. However, it's not clear how this was calculated. The paper says: "Trends for changes .... were examined by evaluating CHD risk for individuals stratified by quartiles of achieved levels of key nutrients in year 1, using the rate in the comparison group as reference. Analyses were adjusted for age, baseline CHD, ... randomization group.." My question is - is this using actual CHD outcomes for the intervention individuals or not? It's not clear because then they talk about a 'CVD risk model' which includes the usual suspects (BP, cholesterol level etc.). And then they compare each quartile intervention group with the WHOLE comparison group!" Perhaps, as Howard's paper says, "more focused" dietary interventions might add clarity, rather than using data with "inherent limitations" and not in a situation "where the additional analyses are subject to residual confounding". Not really a completely confident statement, but hedged and qualified.
A pertinent posting relating more confident observations re saturated vs unsaturated fats:[2] "Half a century ago, CHD was rare in India. It was only after the West told them that their diet was 'unhealthy' and the Prudent Diet introduced them to polyunsaturated vegetable oils that CHD took off in that country. A population comparison was reported in 1967. Dr S L Malhotra, Chief Medical Officer for the Western Railway system had reason to question the Prudent Diet. (Malhotra S L. Serum lipids, dietary factors and ischemic heart disease. Am J Clin Nutr. 1967; 20: 462-75.) He reported that in Madras, in the south of India, the population was vegetarian, living mainly on rice. Although they had a relatively high-fat diet, it was mainly of peanut oil. As vegetarians, there was practically no animal fat in their diet. In effect they were living on the Prudent Diet more strictly than were the Americans. Malhotra compared these Madrassis with a population who lived in the north near Udaipur. Their religion allowed them to eat meat and their fat intake was almost entirely from animal sources and highly saturated. They cooked in ghee (clarified butter) and had what was probably the highest butterfat consumption in the world. Present-day 'wisdom' would predict that the vegetarian Madrassis would have the lower rate of heart disease but the opposite was true. Malhotra found that the Madrassis who adhered so well to the precepts of the Prudent Diet had fifteen times the death rate from heart attacks compared to the northern Indians even though those in the north ate nine times as much fat - and that fat was saturated animal fat. Twenty years later the Lancet noted an increase in heart-attack deaths amongst the northern Indians. By this time the northerners diet had also been made 'healthier' by the replacement of the traditional ghee in their diets with margarine and refined vegetable oils. ((No authors listed) Ghee, cholesterol, and heart disease. Lancet. 1987; 2 (8568):1144-5.)".
A paper from before the results of the Women's Health Initiative trial (L.A. Corr, "The low fat/low cholesterol diet is ineffective", European Heart Journal (1997) 18, 18-22, PMID: 9049510)[3], stated "Remarkably, no primary prevention trial of sufficient size or sensitivity to examine the effect of a low total and saturated fat diet alone has ever been conducted". With the Women's Health Initiative trial, now total fat intake has' now been studied, without finding significant beneficial results from lowering total fats in the diet. The same 1997 paper referred to two other trials (Research Committee to the Medical Research Council, "Low fat diet in myocardial infarction. A controlled trial" Lancet 1965: ii: 501-4 ('the MRC Trial'); and an Australian trial by Woodhill JM et al., "Low fat, low cholesterol diet in secondary prevention of coronary disease", Adv Exp Med Biol 1978: 109: 317-30.) which were conducted to study the effect of a low saturated fat diet *alone* in patients with coronary heart disease - neither produced significant results to support the lipid hypothesis either.
While the Women's Health Initiative trial paper does not set out to "challenge" the lipid hypothesis (instead shoring it up with some qualified and results which could do with further clarification as to their derivation), it does usefully provide results that Corr stated were missing from the scientific research - low *total* fat intake does not appear to have a significant effect on heart disease prevention. To get back to the article itself, it needs more information. By careful selection of sources and omitting commentary on the conflicting for-and-against trial results conducted over the half century since 1953, a reader of the article would gain little idea about why in the 70s and 80s there was doubt about the hypothesis and also why statins are perceived as the proof of it (as statins have other effects besides stopping the formation of cholesterol, that these considerations should be discounted should be explained with appropriate citations, if the cholesterol effect alone is the reason for statins "proving" the hypothesis). While acknowlegding WP:Weight, there is certainly room for a little more balancing information in the article without overpowering the majority viewpoint. When I have a moment to attend to it, be assured I will proceed with as neutral a flavour as possible. Tameeria, I noticed the new extra sections for other use of the term - perhaps the NPOV tag about the article title can go now. Bezapt 14:27, 20 April 2007 (UTC)

What, exactly, is unbalanced about the article? The consensus view is presented as the consensus view (with references to back up its wide acceptance), and the THINCS view is presented as that of a small but vocal minority, which it is. It looks like it follows WP:WEIGHT pretty closely. I think adding a bunch of outdated primary sources from the 70's and 80's only confuses the general reader, gives undue weight to the cholesterol "skeptics" (as their ideas are much more marginal now than in the 70's/80's), and violates WP:RS and its injunction to avoid outdated primary sources and use secondary sources (e.g. NIH consensus conference, review articles) where possible. MastCell Talk 18:17, 20 April 2007 (UTC)

[edit] Palm oil and blood cholesterol controversy

It appears this section was orginally copied straight from the palm oil article. There was some confusion about "palmitic oil." (Palm oil or palmitic acid? The two are not identical, palm oil is a mix containing palmitic acid. I looked up the WHO report and it says palmitic acid, not oil.) I tried to verify the sources and rewrote the section based on PubMed references, but I couldn't find a copy of the Vessby paper and it is not on PubMed. Can anyone verify it? - tameeria 23:20, 18 April 2007 (UTC)

This section (aplm oil) feels really out of place and breaks the flow of the argument. How about simply deleting it? Uffish 13:14, 11 November 2007 (UTC)