I'm in a transition to a WONDERFUL new life. I LOVE you all my Facebook friends. You helped me get here. Life is to be enjoyed, not endured. You help me see that. I havn't gotten on Facebook as much as usual lately and it's because of this. I'll catch up with you all soon. Things are GREAT for me.
On Monday I heard that my systematic review of the Paleolithic diet for the metabolic syndrome has been accepted by the American Journal of Clinical Nutrition, the TOP nutrition journal in the world. The paleo diet was the most searched diet-related term on Google for 2013 and 2014. Politicians are on it. Celebrities are on it. But it's never been evaluated in a systematic review and meta-analysis of the evidence, done according to the highest standards. We included only RCTs and assessed them critically using the GRADE approach with a transparent assessment for the downgrading of the evidence for each outcome (e.g., blood pressure, waist circumference, bodyweight, cholesterol etc.) . Esther van Zuuren checked EVERYTHING. Dual extraction, dual search assessments, dual everything. She's a leading GRADE expert internationally. 'Aries come off as harsh and insensitive sometimes but that is only because they believe in honesty and telling things how they are.' I love that directness. We needed that toughness and critical gaze when it's a topic this controversial. It's been a team effort. I learned what teamwork is by working on this. Esther and her husband Hanno are on vacation in Spain and made their final checks from there, making some helpful catches that I missed. Fine tooth comb review. Taking their vacation days to work. Prioritizing me and the paleo review.
This is the most significant evidence-based assessment of the effects of the paleo diet to date. The paleo diet involves the elimination of processed food and grains and dairy and eating more like our Paleolithic ancestors did. I applied my 18 years of working in Cochrane/systematic reviews/EBM to a transparent and objective assessment of the data. In Cochrane reviews, you're supposed to do everything dually. In this review that was STRICTLY applied. Esther doesn't accept anything from me but my best, and she shouldn't. She checked every detail. Her and her husband Hanno are Professors and doctors at Leiden University, one of the top universities in the world. When I was a kid my parents would talk about Professor as if it's such a vaunted profession. Someone who's an authority, who does research for the benefit of everyone, who teach and mentor, who speak the truth and lead society. These are PROFESSORS. It was a team effort and I learned a lifetime in the past year. I led the review and they gave me their full support. Esther worked on it with me on Christmas Eve and Christmas Day, and after I was done on Christmas Eve I went to a small and elegant gathering at Henry Johnson's Field House. I felt a real sense of accomplishment and I had a fun night with the creme de la creme of Baltimore, though John Waters went out of town for the holidays so didn't show this year.
My philosophical thoughts about the paleo diet are that it's a return to a more natural way of eating. It makes sense. Anthropological research shows that there was little chronic disease in 'primitive' populations that ate a paleo-style diet. When these primitive populations are introduced to the Western foods of civilization, their health declines. I've always been fascinated by the work of Weston A Price and his studies of 'primitive' populations, the few that remained around the world when he did his research in the 30's, that hadn't been introduced to foods of civilization. They had perfect teeth and there were specific foods they sought out to improve their health, including high quality butter and cod liver oil. But when they were introduced to foods of Western civilization, their health declined. It is persuasive research and I cited Weston A. Price's book "Nutrition and Physical Degeneration" in our reference list. There's a lot of research related to the evidence from a broader perspective (i.e., evolutionary theory, physiology, records from 'primitive' populations, outcome measures in metabolic syndrome, endocrinology of effects of different nutrients eg, grain, dairy). It is a lot to master for preparing the systematic review and meta-analysis. Fortunately I didn't have to. Hanno answered my questions about the outcome measures and contributed large parts to the Background and Discussion. Otherwise I would have had to learn all about these fields of research to write about it knowledgably. Working as a team where each player contributes their own expertise and there are no egos and everyone works hard makes 'work' a joy.
Zbys Fedorowicz is the fourth author on the paleo review. He's my loyal, independent, and FEARLESS mentor who's taught me to go after all opportunities that come my way. Critical and straightforward. #Sagittarius have a sharp tongue. They will say the words you don't want to hear and don't talk to them if you can't take the truth. Also #Sagittarius are instantly annoyed by people who don't give straight answers. Zbys, or the famous Prof Z as we sometimes call him, is going into dissemination overdrive for getting word out about paleo. He established Cochrane Bahrain in 2005 and it covers the Middle-East region. He served for six years as the Center Director representative on the Cochrane Steering Group. His Bahrain Center has produced the second most systematic reviews of anyone in the world. It's because of Zbys and his mentoring of junior colleagues. He's helped paved the way for me to be a big success and he's done the same for others before me and concurrently with me. He's doing everything he can to get the word out about the review. He's taught me about tweeting and using social media for getting the word out about our publications and more. He's also helping us put together a group of the leading lights internationally to evaluate the paleo diet in an international trial. The results of this trial could change the way the world eats. Zbys does NOT think small. Sagittarius don't like someone telling them what to do, or how to do it. They are the Universe's free-thinkers.
The most exciting news is that I'm starting a new job, at DynaMed. As a medical writer and methodologist. A way to apply my 18 years of systematic review expertise to getting accurate and unbiased information to doctors at the point of care. This is a huge opportunity. Doctors need accurate information. Evidence-based medicine is the evaluation of the studies and doctors basing their treatment on the evidence from the studies. DynaMed is getting that evidence to doctors. Brian Alper and his team at DynaMed critically assess the evidence for all of medicine. It is updated daily. It never stops. Efficiency and accurateness is required. They noticed a discrepancy between what all the top sources were reporting about the stroke drug alteplase when given more than three hours after stroke versus what the data showed. The data showed a clear risk of harm and an unclear benefit. The top sources (e.g., Cochrane reviews, Lancet meta-analyses, AHA guidelines) suggested the benefit outweighed the harm. We wrote an Analysis article for BMJ about this that I was senior author on. My role was data checking and manuscript adjustment. It was some complex statistics. We had to consult with one of my mentors, Doug Altman, to make sure we were doing everything right. Doug is the teacher of statistics to the world. He's the one who's made it clear for me, since I started in Epidemiology in 1995. He makes it as simple as it can be, but no simpler. He was the recipient of this year's BMJ Lifetime Achievement Award. You can't describe the accomplishments of a guy like this in one sentence. There are links to projects of some of my mentors on my website if anyone wants to read more (http://www.ericwmanheimer.com/links.html). The issue is being taken seriously by the UK government. It's going to be addressed by UK Parliament House of Commons Health Committee after the medicine regulator's review is completed. The alteplase issue was covered a couple weeks ago by BBC radio (http://www.bbc.co.uk/programmes/b05xxkr0). Here's a snippet from the conclusion of the program (starting at 34:22 point):
"...But this program has learned that the Chief Medical Officer for England, Professor Dame Sally Davies, has asked the Academy of Medical Sciences to conduct an independent investigation into how society should judge the safety and efficacy of drugs. Citing recent arguments over the cholesterol lowering drugs statins and the antiviral treatment tamiflu, she concludes "There seems to be a view that doctors overmedicate so it is difficult to trust them. And that clinical scientists are all beset by conflicts of interest from industry funding and are therefore untrustworthy too. This cannot be in the interests of patients and the public's health for this debate to continue as it is." The Academy has confirmed to this program that its deliberations, starting tomorrow, will also cover the use of alteplase in stroke..."
This paper is an example of how a point of care tool like DynaMed can provide additional checks so that medicine based on the evidence gets to doctors. Brian Alper founded DynaMed more than 20 years ago while he was a medical student with the ultimate objective to "make accessing EBM easier in moment-to-moment clinical decision -- so easy that it becomes an expectation in clinical practice." Now DynaMed's a global company and it's made EBM achievable in real time. It is an expectation in clinical practice (https://www.ebsco.com/blog/article/dynamed-plus-release-will-establish-a-disruptive-innovation). I have a new life ahead joining the army -- the mighty (albeit small) EBM army at DynaMed. My start date is July 27 and I am so excited about moving to Ipswich and starting my GREAT new life. Before that I am excited about dinners and lunches and parties planned by my friends before I leave Baltimore.
One interesting thing about the BMJ paper on alteplase is that the biggest international newspapers didn't cover it, for the most part. My acupuncture systematic reviews got covered by newspapers around the world and this was more important. We weren't sure why. The issue is being addressed by the UK policy makers and that's what's important. But even without a lot of mainstream news outlet coverage, we were ranked as one of the top 100 BMJ articles out of 21K+ articles published by BMJ (in my mind the most influential and important journal in the world). The reason for that was all the tweeting. Social media is where it's at. Our tweets are going to go through the roof for the paleo review. Loren Cordain, the founder of the paleo movement provided me with resources and references for the systematic review. Since I told him it's been accepted, he's favorited several of my tweets and retweeted me to his 26K followers. I asked him yesterday if he'd get the word out, and by his Twitter response the answer is clearly 'yes'.
Loren's the founder of paleo. He changed the way the world eats, maybe more than anyone. He's written best-selling books about paleo for the public and writes scientific articles about it for leading journals. His 2005 AJCN article 'Origins and evolution of the Western diet: health implications for the 21st century' has 1000+ citations. It's an interesting case, because it's someone who's a Professor and does research and gets widely read and discussed among academics but he's also gotten his research into the real world by moving his ideas from the ivory towers to the Public. I got a wonderful e-mail from him this morning where he wrote the following:
"Congratulations upon this absolute "coup de force" in the scientific literature. Your AJCN paper will resonate throughout the years and will move the academic community towards a new norm regarding how Paleo diets are objectively viewed. I wonder how the naysayers at U.S. News and World Reports will rank Paleo in their annual review of popular diets. They have typically rated the DASH number one, year in and year out, and Paleo dead last. Since you have compiled your paper at least one additional RCT of Paleo has been published...
Your group has done a superb job with the writeup for this paper and I can’t wait to see the final published paper. My website (www.thepaleodiet.com ) receives more than a million hits per month, so I will be sure to get the word out on one of our blogs when the paper is published. It would be great publicity if you can get the word out at TED. That would certainly clear up the negative TED publicity created by an anthropologist from Harvard who blasted the scientific validity of contemporary Paleo Diets almost a year or so ago.
I know almost nothing about social media, so I have my marketing person, Julia, at my website do all the tweets, ect. You can thank Julia for the re-tweets. I know that once we post your study at my website, it will help to get the word out of your study to both the scientific and lay communities.
Again Eric, congratulations to you and your team for this brilliant paper."
Staffan Lindeberg another founding father of the paleo movement who's done seminal research on traditional dietary patterns at Lund University also e-mailed me and wrote:
"My sincere congratulations to this great achievement. For prevention and for evidence based nutrition. It is certainly not easy to get something like this into AJCN, especially not in a situation when there is a paucity of longer term trials."
There's more I want to say both about the exciting developments in my life and also about the beauty I see in all of you. I had an earlier version of this post that talked more about how I value these friendships with one example from each. It was hard to limit you each to a sentence. But I decided to make this about me instead. You already know about yourself after all ;). And it's all positive and good news about me.
Maybe I'll write more about my research or thoughts about life in general in the future. I was thinking about starting a blog. I talked about it with my life coach Scott Howard and Rain Rvs encouraged me to. Prof Edzard Ernst invited me to be a Guest Editor for his blog or write articles for his journal, so I can give my thoughts on CAM through there and I'll have an automatic built-in audience of his followers and readers. That's the way to do it. I have to say a few words about Prof Ernst. He was the senior author on my first major acupuncture systematic review, my 2005 Annals of Internal Medicine systematic review of acupuncture for low back pain. He's sometimes portrayed as being difficult but I didn't find that at all. He was a joy to work with. He only helped. He later wrote a positive commentary on my 2007 Annals of Internal Medicine review of acupuncture for osteoarthritis. Having my work positively evaluated by the world's first and foremost Professor of complementary medicine made me think I must know what I'm doing. I remember where I was now when I first read it. We had discussions about methodology around my 2008 acupuncture for IVF review in BMJ. We don't agree on everything, but he is not afraid to speak out against fraud or injustice, and that's something I respect. He writes best sellers for the Public and is featured all the time in leading UK newspapers. He has a column in the Guardian. He's someone who's not confined to the ivory tower talking only to other academics. He gets his work and his message out to the Public. He's faced a lot of opposition by speaking the truth. His latest book 'A Scientist in Wonderland: A Memoir of Searching for Truth and Finding Trouble' talks about how he was forced out of his university post as the world's leading Professor of complementary medicine after he was critical of a report commissioned by the Prince of Wales. They can't keep it stocked in the bookstores and it's getting rave reviews. In a tweet I retweeted today, Ben Goldacre the author of Bad Pharma wrote the following about it
"Do read @EdzardErnst memoir. A chilling & frank description of how sadly, u need to be brave to speak up for science."
Prof Ernst is someone I respect for his principles and his prodigious output (1000+ scientific articles) and several popular books. He retweets me regularly to his 10K+ followers, including influential policy-makers and scholars. He's making me a star ;). He's a friend and colleague of Professor Emeritus Barker Bausell, a mentor and the previous research director at the UMD Center for Integrative Medicine. I'm going to have dinner with Barker before I move and I can't wait to give him Edzard's new book as a gift (I wanted to treat him for dinner but Barker insisted he'll pay). On Tuesday I'm going to meet Jeanette Ezzo PhD for coffee, another research scholar extraordinaire in CAM. She coordinated the activities of the Cochrane Cochrane CAM Field before me, and was one of my key collaborators even after she left, continuing to work with me on my systematic reviews and research on a voluntary basis. She wants the Public to have accurate information about health and if she doesn't do it, no one will. A treasure I will miss when I leave Baltimore even though we only see each other a few times a year. Despite us both being in Baltimore, we still work together mostly electronically.
With all these beautiful people in my life, and my special Facebook friends, some of the coolest people on the planet, I will succeed. I have to thank Esther about Facebook too. I had an account but I didn't use it or meet anyone through it. I learned by watching her how Facebook is done. How valuable a tool it can be for learning and growing in all areas. She's the reason I got on Facebook, initially being inspired by her postings, so if it weren't for her I never would have met any of you. She's also the reason I started yoga. She sometimes said in e-mails she just finished yoga and felt good. She regularly works 12-16 hour days. She must get the energy somewhere. I thought why not try it. Now I go to yoga class most days. Sir Iain Chalmers, the founder of the Cochrane Cochrane and last year's recipient of the BMJ Lifetime Achievement Award and someone who's secured his place in the history of medicine for his accomplishments e-mailed me recently to get my thoughts about the future direction of CAM/herbal medicine research, policy and practice. I responded with my input and suggestions, and Iain started his response to me with 'You're a star, Eric.' Iain's a tough critic who speaks the truth. He advised me on my PhD thesis. He helped me see the truth. He's one of the most influential and respected epidemiologists alive today and he's as active as ever. Getting that from him makes me believe it myself.
When Janice Manger told me I'd have great days ahead, I didn't see how it could get even better, but it has and my research is coming to fruition with influential publications and I have my dream job lined up. But it's not all about research. There needs to be balance. Over the years sometimes a weekend of pure fun and relaxation was needed and I came back to my papers refreshed and better than ever. My BFFs Elias and Gil in NYC always gave me that. Just pure fun and relaxation with them. I went up there this past weekend and the picture below is from the Pier Dance. Thank you Rayan Garcia for messaging it to me yesterday. We both look like we are having fun, and we were. Supporting freedom of expression to be who I am authentically and naturally is important to me and the same goes for science. One thing that sets the mentors I describe above apart is that they speak for the truth and they speak out against oppression and they do their research and teaching to help the Public. That's what it's all about.
Thank you all for your LOVE and LIGHT. You've helped me soar to the highest heights. The sky's the limit. <3 <3 <3. You're all MAGIC. Love and hugs to my 'soul group'. I'll be your Facebook follower and friend for years to come.