The vote to take the UK out of the EU has chilled me to the bone. Social well-being is inextricably linked to health and a careless decision taken by a majority of around 52% of voters has just messed up our economic system on which our well-being as citizens and patients depends.
Scotland, Northern Ireland, central London and Gibraltar have unequivocally voted to stay in the EU. There are 1.3 million Brits who study, work or have retired to the EU, and many of these people were not able to vote in the referendum. If they had, the margin of success for Brexit would have been lessened considerably.
The people who voted to stay tended to be younger, have degrees, have jobs, and be wealthier. Those who wanted to leave tended to be older, be on benefits and perhaps feel that they will be more sheltered from the effects of their choice.
Economists, business leaders, bankers, most MPs, and the British Medical Association which represents the majority of UK doctors, all want to stay in the EU. Reasoned discussion has been going on for months in such papers as the Guardian and the Times. Pictures of the Union Jack, the Queen, and rants about immigration and the millions that could be diverted to the NHS have been on the front pages of the tabloids for months. On the very morning of the result, Mr Farage, leader of the UKIP party, admitted that the slogans on the buses and billboards about money going to the NHS from the EU were lies. “Nothing to do with me”, he said.
Meanwhile the UK has lost David Cameron as Prime Minister. He has been an emotionally stable, sensible, well informed, inclusive, solution seeking head of the government. Very far from Maggie Thatcher or Tony Blair in performance or nature, he has felt the need to step down, despite demonstrating an integrity that Farage and the likes do not appear to emulate.
So, what has the EU done for us? Quite a lot as far as I can see. Most of it beneficial.
We have a decimal currency, much easier than the old 12 unit system. We get cheap good quality food, particularly fruit, vegetables, wine, ham, olive oil, nuts and cheese. Many of these items feature heavily in a low carbohydrate Mediteranean style diet which is so important in keeping well if you have diabetes.
For doctors, the European Working Time Directive, which limits junior hospital doctors working hours to 48 hours a week was a God send. I used to work 120-145 hours a week as a junior doctor. It was described as “training” but it was slave labour. I was paid one third of my basic rate for the extra hundred or so hours I was on evenings and weekends. On Christmas day 1983 I earned 50 pence per hour and that was before tax. Older doctors and consultants didn’t care. They did nothing about it. If we did it and survived, you can too was the mentality. It took the EU to get doctors out of that mess and without the working directive it could easily revert back.
There is a workforce crisis in UK medicine as it is. Worsening of terms and conditions for doctors will lead even more of them to jack it in and head for Australia.
What of our working population generally? The EU have brought in laws to give reasonable hours, breaks, holidays and contracts to workers. Without the EU there will be more likelihood for zero hour contracts to become the norm, if you can even get a job.
When it comes to selling a house, the main thing that estate agents say are important are location, location, location. When it comes to the well -being of a countries citizens the important things are economy, economy, economy.
Like it or lump it, we are all part of a global economy now. The EU is not responsible for all the bad things that are happening that affect the economy. The immigration crisis is due to an undeclared third world war which is due to Islamic separatists destroying these people’s homes, countries and own economies.
A government can’t hand out money to sick people, the unemployed, the NHS or anyone else unless they have money raised from taxation. They can’t get this unless people have jobs. If the economists are right, and there is no reason to believe that they will not be, there will be fewer jobs, worse terms and conditions, less money able to be raised from tax and therefore less money for pensions, benefits and health care.
Leaving the EU is not a vote for prosperity.
What can we do about it?
To really improve things we need to get a review of the referendum decision. If it can’t happen for the whole of the UK, the best option in my view, then perhaps it can be achieved in Scotland. This would mean a difficult choice for Scots. Do we stay with England and Wales? Do we stay with Europe?
When people look across at Southern Ireland it would appear that they have not done very well in terms of economic prosperity by staying in the EU. On the other hand do we revert back to the dark ages with the working classes being over worked and underpaid with a deficient social care system but with an elite few at the top as could happen for England and Wales?
What do you think of the result of the vote? What do you think we can do to makes things less awful than what has been predicted for us all?
Dr Katharine Morrison
Feature
Diabetes Diet 
I’m delighted that The BMJ has stood by this article and decided against retraction. Two outside reviewers judged that the criticisms of the piece did not merit its retraction, and in the end, the corrections made by The BMJ do not, in my view, materially undermine any of the article’s key claims. This article therefore stands as one of the most serious ever, peer-reviewed critiques of the expert report for the US Dietary Guidelines for Americans (DGAs).
The importance of the DGAs, and therefore of this article, should not be understated (and indeed was recognized by many in the mainstream media when the article was published). The DGAs have long been considered the “gold standard,” informing the US food supply, military rations, US government feeding assistance programs such as the National School Lunch Program which are, altogether, consumed by 1 in 4 Americans each month, as well as the guidelines of professional societies and governments around the world, and eating habits generally.
Yet rates of obesity began to shoot upwards in the very year, 1980, that the DGAs were introduced, and the diabetes epidemic began soon thereafter. A critically important yet little understood issue is why the DGAs have failed, so spectacularly, to safeguard health from the very nutrition-related diseases that they were supposed to prevent.
In documenting fundamental failures in the science behind the DGAs, this article offers new insights; It establishes that a vast amount of nutrition science funded by the National Institutes of Health and other governments worldwide has, for decades, been systematically ignored or dismissed, and that therefore, that the DGAs are not based on a comprehensive reviews of the most rigorous science. Incorporating this long-ignored relevant science would likely lead to fundamentally different DGAs and could very well be an important step in infusing them with the power to better fight the nutrition-related diseases.
A fundamental question is why 170+ researchers (including all the 2015 DGA committee members, or “DGAC”), organized by the advocacy group, the Center for Science in the Public Interest (CSPI), would sign a letter asking for retraction. After all, in the weeks following publication, any person had the opportunity to submit a “Rapid Response” to the article, and both CSPI and the DGAC did so, alleging many errors. I responded to them all in my Rapid Response. This is the normal post-publication process.
Yet after all this, CSPI returned for a second round of criticisms, recycling two of the issues (CSPI points #3 and #10) that I had already addressed in my Rapid Response (and which had required no correction), adding another 9 (one of which, #4, contained no challenge of fact), and demanding that based on these alleged errors, the article be retracted. CSPI then circulated this letter widely to colleagues and asked them to sign on.
This lack of substance in the retraction effort seems to point to the reality that it was first and foremost an act of advocacy—a heavy handed attempt to silence arguments with which CSPI, a longtime supporter of the Dietary Guidelines and its allies disagree.[ footnote 1] And this applies not just to the retraction letter but to other CSPI efforts to stifle alternative viewpoints. Earlier this year, for example, I was dis-invited from the National Food Policy Conference after CSPI, together with the USDA official in charge of the Dietary Guidelines, threatened to withdraw if I were included, details of which are reported here and which a Spiked columnist called an act of “censorship.”
It’s important to note that I am not the only person disturbed by the lack of rigorous science underpinning our dietary guidelines. Numerous scientists around the world have expressed concern about the science. And indeed, this consternation is shared by no less than the US Congress, which held a hearing on Oct 7, 2015 to address its serious doubts about the DGAs. Such was this concern that last year that Congress mandated the first-ever major peer-review of the DGAs, by the National Academy of Medicine. Congress appropriated $1 million for this review, and it additionally stipulated that all members of the 2015 DGA committee recuse themselves from the process.
What is the dangerous information challenging the DGAs that cannot be heard on a conference panel nor published in a peer-reviewed journal?
The major findings of this article are that:
1. The DGAC’s finding that the evidence of a “strong” link between saturated fats and heart disease was not clearly supported by the evidence cited. (Note that as of last year, the Heart and Stroke Foundation of Canada no longer limits saturated fats. Note, also, that Frank Hu, the Harvard epidemiologist in charge of the DGAC review on saturated fats, was an energetic promoter of the retraction letter against my article that critiqued his review, according to emails obtained through FOIA requests);
2. Successive DGA committees have for decades ignored or dismissed a large body of rigorous (randomized controlled trial) literature on the low-fat diet, on more than 50K subjects, collectively finding that this diet is ineffective for fighting obesity, diabetes, heart disease or any kind of cancer;
3. Although the DGAs have for decades recommended avoiding saturated fats and cholesterol to prevent heart disease, no DGA committee has ever directly reviewed the enormous body of rigorous (government-funded, randomized controlled trials) evidence, testing more than 25,000 people, on this hypothesis. Many reviews of this data have concluded that saturated fats have no effect on cardiovascular mortality;
4. The DGAC ignored a large body of scientific literature on low-carbohydrate diets (including several “long term” trials, of 2-years duration) demonstrating that these diets are safe and highly effective for combatting obesity, diabetes, and heart disease;
5. The Nutrition Evidence Library (NEL) set up by USDA to do systematic reviews of the science did not meet its own standards for its review of saturated fats in 2010;
6. Although the DGAC is supposed to consult the NEL to conduct systematic reviews of the science, the 2015 DGAC did so for only 67% of the questions that required systematic reviews;
7. For a number of key reviews, the 2015 DGAC relied on work done in part by the American Heart Association and the American College of Cardiology, which are private associations supported by industry and therefore have a potential conflict of interest;
8. The DGAs, for the first time, introduce the “vegetarian diet” as one of its three, recommended “Dietary Patterns,” yet a NEL review of this diet concluded that the evidence for this its disease-fighting powers is only “limited,” which is the lowest rank of evidence assigned for available data;
9. The DGA’s three recommended “Dietary Patterns” are supported by only limited evidence. The NEL review found only “limited” or “insufficient” evidence that the diets could combat diabetes and only “moderate” evidence that the diets can help people lose weight. The report also gave a strong rating to the evidence that its recommended diets can fight heart disease, yet here, several studies are presented, but none unambiguously supports this claim. In conclusion, the quantity of recommended diets are supported by a small quantity of rigorous evidence that only marginally supports claims that these diets can promote better health than alternatives;
10. The DGA process does not require committee members to disclose conflicts of interest and also that, for the first time, the committee chair came not from a university but from industry;
11. The 2015 DGAC conducted a number of reviews in ways that were not systematic. This allowed for the potential introduction of bias (e.g., cherry picking of the evidence).
This last claim, on the systematic nature of the DGAC reviews, is the subject of the corrections published in The BMJ this week, and refer to CSPI points #1, #2, #7, and #8 (two of which are statements in the text and two of which are in the supporting tables). I am grateful to have had the opportunity to work with The BMJ on developing this notice.
The BMJ has placed a word limit on my response. For the rest of this comment, please see: http://thebigfatsurprise.com/comment-bmj-correction-notice/
Footnote 1
CSPI has fought for decades to eliminate saturated fats from the American food supply (so much so, that throughout the late 1980s, CSPI advocated for replacing saturated fats with trans fats and succeeded in driving up consumption of trans fats to historic levels, as described in The Big Fat Surprise, pp.227-228). CSPI has also long advocated for shifting away from animal foods containing saturated fats, towards a plant-based diet based on grains and industrial vegetable oils. The researchers who joined CSPI in signing the letter are largely adherents to this view; many have participated in generating the science that has been used to support the hypothesis that fat and cholesterol cause heart disease, and it is upon this hypothesis that the Guidelines have been based.
Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I am the author of The Big Fat Surprise (Simon & Schuster, 2014), on the history, science, and politics of dietary fat recommendations. I have received modest honorariums for presenting my research findings presented in the book to a variety of groups related to the medical, restaurant, financial, meat, and dairy industries. I am also a board member of a non-profit organization, the Nutrition Coalition, dedicated to ensuring that nutrition policy is based on rigorous science.