I have made a promise I was going to stay out of this but really it is hard. For me, the thing that is most disturbing (among an avalanche of disturbing things) is how you go from this reaction of joy and triumph in April of 2025

This is brilliant and my favourite post of the week. And you might not see the chronological anatomy of a sinking narrative with such surgical precision as this. It's just perfect. - "We retracted our paper. All good". I laughed so hard I have developed a six pack.

I think the story is... that the story kept changing. Thankfully, @drgarymcgowan took some screenshots. And I personally think that when a research group prioritises the release of a slick documentary and the establishment of a lucrative brand over basic quality control, the integrity of the data will always become a secondary concern. I don’t think they were ever interested in quality control @StevenQuartz. They didn’t even bother with a preprint. The decision to bypass a preprint, especially when launching a massive public relations and documentary campaign to me is telling. In modern clinical research, preprints should serve as a crucial public sandbox for early peer scrutiny. If an anomaly exists in a dataset, posting a preprint allows the community to inspect the preliminary data, catch the oddities, and raise red flags before a paper receives formal journal publication. Wouldn't you want that before releasing a slick and expensive documentary about this study? By skipping the preprint stage and rushing straight to publication to align with a film premiere schedule, a safety net might have been deliberately removed. The timeline prioritised maximum media impact on "launch day" over scientific vetting. And the media vehicle was already rolling, the documentary had even been premiered before the publishing of the study. Maybe, when a film, a brand and a narrative are locked to a public release schedule, the scientific timeline gets crushed by commercial deadlines? Feldman has acknowledged surprise at the NCPV numbers prior to publication. And then simultaneously attempted to downplay the discrepancy post publication. This is fundamentally backwards. The excellent post by @ChrisVMDHealth with regards to publishing day peacocking is worth a read. We witnessed a masterclass in conflict of interest and performative science. The NCPV figures returned by Cleerly were biologically startling. Anybody in the know, knew that. Seeing an average NCPV progression rate almost four times higher than expected in normal cohorts should have triggered an immediate pause by the authors. It didn’t. They went full steam ahead, hoping nobody would notice the anomalies. And now hoping you only notice the Cleerly anomalies… to deflect you from noticing the manuscript anomalies in both the retracted manuscript and it’s equally anomalous and mischievous preprint. If any of the authors mention “Cleerly”, this is simply “deflection” tactics. And now we do have a preprint. Because in all truth, that’s all it can ever be. And nine months later that preprint still hasn’t been amended, peer reviewed and published. And if I was a top journal, I’d be inclined to avoid it, knowing that peer review is not what it should be. And @JACCJournals is a good example as peer review obviously failed massively here. That the documentary's scientific backbone is based on a mischievous stranded preprint is startling to me. If you haven’t watched the @JohnSloughII and @TheCalvinWest YouTubes, I recommend you do. They are fascinating and damning of both manuscripts. And it could even be that John Slough's "letter of concerns" to the editor is the real reason for the retraction. Only that @JACCJournals could never admit to that. Formal journals rarely send out press releases or emails thanking independent sleuths for doing the editorial board's job for them. Institutional pride dictates a cleaner, more bureaucratic exit strategy, like framing the retraction around the "author requests" or "post publication re evaluations" to preserve whatever dignity the peer review apparatus has left. We'll probably never know the truth. And, I think that post retraction preprint functions as an exercise in damage control rather than transparent science. It created an illusion of scientific legitimacy for lay audiences for the documentary who do not or cannot distinguish between an unvetted preprint and a peer reviewed journal publication. Even worse, Feldman is now trying to outsource accountability for that retracted paper. Well, you can’t. You cannot outsource accountability for your work, your study. You can outsource the work, but you cannot outsource “accountability”. Most good journals require authors to sign a statement declaring they had full access to all study data and take full responsibility for its integrity. This is in line with the ICMJE accountability. And the university where I reside, we teach students that as authors, they are fully accountable for all aspects of the work. Including the third party data transfers, work and tasks. And that is because a lot of today's science requires third parties. Science has grown far too complex for any single research group to build every tool from scratch. Attempting to outsource scientific accountability to a third party vendor is not merely a weak defence, it is a fundamental violation of the core tenets of academic authorship. I find that shameful from Feldman, and this is how I know he is not a bonafide investigator. Attempting to claim all the glory of a "groundbreaking" public relations blitz on launch day, only to turn around and blame the software vendor when independent analysts dismantle the paper, is the ultimate display of intellectual dishonesty. And let's not forget that peacocking by Feldman and the authors on launch day. And never forget the final frames of the video by Feldman on that day in his favourite blue shirt as it funnels traffic directly to a proprietary film website. The documentary should be titled "The Cholesterol Code Con". piped.video/watch?v=HJJGHQDE…

Another masterclass in reductionist, low carb tinted biochemistry. It’s the classic online nutrition trope we expect to see from such luminaries as Bikman, Baker and many others. That is take a kernel of technical truth, strip away all physiological context, and package it up neatly to sell a book. They may not be essential, but they most certainly are optimal. Saturated fatty acids by the way are also not essential, but Bikman forgot to conveniently mention that. The vilification of carbohydrates is of course to sell the low carb brand and protocol. But what is really sad is that they monetise the solution via the vilification. They have manufactured a universal metabolic villain, striped away the systems level nuance, sold the fear, and then handily monetise the salvation. Which is ironic, because in my line of work, it is in fact lipids and fatty acids that are often the true villains. Most aberrations of glucose metabolism I see in practice are actually aberrations of lipid and fatty acid kinetics and metabolism beforehand. I have been prescribing therapeutic ketogenic diets now for over forty years, and I find it profoundly disheartening to see worthy tool, used by such online predators. These people are often not on the front line where it matters. Their credentials are used to inform sometimes gullible people. And that is even sadder, exploiting the vulnerable. And they can operate with complete immunity.

Constructing an absurd strawman to mock sports science only highlights a fundamental lack of understanding. Conflating intra workout substrate oxidation in high output athletes with sitting on a bench eating a fried pastry is precisely why educated folks find it impossible to take @BiggestComeback commentary and many of the low carb community seriously. This bad faith caricature is exactly why serious professionals tune them out. And why is it that when these guys mention "high carb" they compulsively resort to a donut? Which can be as much as forty-five percent of the calories from fat? And this is precisely why the image is such a blatantly absurd strawman, because no runner or cyclist finishes a session and reaches for an iced, sprinkled pastry to hit their refueling targets. High fat actively delays gastric emptying, ruining the very rate of glucose absorption an athlete requires. And the great thing about exercise, you begin to view nutrition through the lens of recovery, performance, and cellular efficiency rather than mindless gratification. That intrinsic discipline is precisely why caricatures like Chris' donut post are so fundamentally disconnected from reality. The truth is, by substituting proper fueling options with a deep fried pastry, Chris isn't engaging with actual sports nutrition or real world athlete behaviour. It is pure theatrical caricature designed to score quick points with an already dumb audience that already wants to believe high carbohydrate diets are inherently foolish. The real fool here is Chris S. Cornell.

I enjoyed the Substack article of Norwitz by Nicola Guess a few months back, and this new one by @drgarymcgowan is equally worthy of reading. So Norwitz went straight from graduation into the content studio, bypassing the entirety of postgraduate clinical training. Which was actually the real lesson. Those eighty hour working weeks, the brutal night shifts, real time clinical pressure and iatrogenic accountability for actual patients. Professors, textbooks, scientific literature, they were all important. But nothing was as important as being in the field, learning to be a clinician. I spent twelve years at various universities, three different disciplines. But it is the twelve months of my internship that taught me the most. This is where the clinical craft was forged. This is what tempered that raw scientific knowledge into actual clinical wisdom. That single year of internship imparted something no lecture hall, no textbook could ever replicate. What we see here from Norwitz is simply a shortcut in credential arbitrage, the acquiring of academic titles to unlock immediate public trust. But skipping the clinical grind that tests and tempers that knowledge doesn’t make you a real doctor. It probably makes you a grifter, a science commodifier instead. And you can spot them a mile off, because they participate in the fallacy of mechanistic reductionism. This is why non practising doctors fall so hard for biohacking panaceas. and hospital scrubs are for people working in hospitals. Norwitz has never worn them in a hospital. Maybe he did in some soft ball clerkships? They exist for a precise, mundane purpose. Because they are cheap, easily sterilised garments designed to be splashed with blood, bile, shit and other bodily fluids on a hectic ward. Which makes these thumbnails particularly entertaining as why would you need hospital scrubs for a carpeted home studio beneath softbox lights? It is the ultimate performative contradiction. Let's call it what it is - grifting. The wearing of the uniform of a frontline worker to sell Substack prescriptions and peptide discount codes to an unsuspecting audience is simply a visual signal required to subconsciously trick the viewer into believing they are receiving advice from a battle tested physician. One video is titled “Why I Quit Being A Doctor”, which is laughable as Norwitz never was a real doctor. That relationship is doctor - patient, not creator - consumer. If I were Norwitz’s parents, I would be slightly embarrassed. Because we don't become clinicians to "influence" or for "money". It is because of the quiet privilege of using hard earned clinical judgement to help the human being sitting right in front of you. Stay curious, folks.

My humble synopsis of #TheCholesterolCode In reality, the film uses a Trojan horse to smuggle in unverified, potentially dangerous scientific extrapolations. The scientific backbone of the documentary is based on an incredibly flimsy preprint that has yet to pass peer review or be published. The John Slough audits of both the original KETO-CTA study and the preprint are pretty damning. And the many inquisitions and critiques we see here on X about the authors and the study are equally damning. The title of the documentary is evidence of intent. This film is about making stratospheric ApoB irrelevant first and foremost, which it has to be for the brand to continue to sell. They could have called the documentary “The Keto Feel-Good Movie” if it was mostly about the "stories of pure turmoil turned hopeful" and "spreading awareness of a therapeutic strategy that may be helpful for some”. They didn’t. Instead they captured the viewer’s empathy with genuine human stories of metabolic turnaround, and then casually smuggled in a freight train of unvetted, dogmatic lipid theology. The convincing of the audience that decades of lipidology are merely a tragic misunderstanding. I'd recommend this documentary to everybody in a heartbeat if it was solely a keto feel-good movie. The power of appropriate therapeutic diets. I have been prescribing them for over forty years now. And by the way, you can get equally great results with specific high carbohydrate diets too. I mostly resolve insulin resistance, obesity and many other metabolic disorders with them these days. I watched the documentary twice, but I'm against recommending something that many of my clients relied on get repackaged into something that has to pretend risk doesn't exist to keep it selling it. And forty years in the game, I find it quite sad that therapeutic dietary interventions should need a side order of risk denial to be validated. Because that's not how interventions work. I've noticed that wellness culture and the online nutrition tribes, can only acknowledge a trade off as a total ideological defeat. It is a sad day when scientific validation is replaced by crowdfunding, social media campaigns, and slick documentaries, and the public is coaxed into treating cinematic persuasion as clinical proof. @ApoDudz

Yes, this isn't the win it's presented as by Feldman. But I guess the low carb audience will simply not go through the finer details as well as @zz_2141 did to understand that. Comparing their healthy, symptom free group to the less unwell half of a chest pain clinic and not to healthy people is disingenuous to say the least. But these guys are the kings of the "sleight of hand". The comparison group also started with three times more existing plaque, so similar growth isn't the win it's presented as. And when you plot the study's own actual data (not the tidied up chart), the real range of results reaches right up to, and by one measuring method, past the rapid progression zone the slide implies it avoids. Worth being sceptical of anything this reassuring.