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	<title>Comments on: The fraud of intention-to-treat analysis</title>
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	<link>http://www.proteinpower.com/drmike/bogus-studies/the-fraud-of-intention-to-treat-analysis/</link>
	<description>A critical look at nutritional science and anything else that strikes my fancy.</description>
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		<title>By: Bad Science</title>
		<link>http://www.proteinpower.com/drmike/bogus-studies/the-fraud-of-intention-to-treat-analysis/#comment-241973</link>
		<dc:creator>Bad Science</dc:creator>
		<pubDate>Fri, 11 Dec 2009 15:11:48 +0000</pubDate>
		<guid isPermaLink="false">http://www.proteinpower.com/drmike/?p=1740#comment-241973</guid>
		<description>[...] Goldacre mentions it only in passing, Michael Eades, M.D., demolishes it in his article on &#8220;The fraud of intention-to-treat analysis.&#8221;  Cherry-picking the data is even more statistical stupidity that Dr. Goldacre discusses. [...]</description>
		<content:encoded><![CDATA[<p>[...] Goldacre mentions it only in passing, Michael Eades, M.D., demolishes it in his article on &#8220;The fraud of intention-to-treat analysis.&#8221;  Cherry-picking the data is even more statistical stupidity that Dr. Goldacre discusses. [...]</p>
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		<title>By: Billy Thompson</title>
		<link>http://www.proteinpower.com/drmike/bogus-studies/the-fraud-of-intention-to-treat-analysis/#comment-235247</link>
		<dc:creator>Billy Thompson</dc:creator>
		<pubDate>Tue, 22 Sep 2009 19:32:49 +0000</pubDate>
		<guid isPermaLink="false">http://www.proteinpower.com/drmike/?p=1740#comment-235247</guid>
		<description>First one must determine WHY the subjects withdrew from the study.  Your assumption was that one diet was more difficult to follow than the other.  This may be true, or maybe there was another reason.  In clinical drug trials, side effects and tolerance are two factors which impact compliance greatly and as suggested earlier those factors should be assessed early on.  Next, I&#039;m not convinced that an ITT was appropriate for the diet study to begin with.  Most ITT studies are clinical drug based studies where compliance is not necessarily based upon the subject/patients self motivation.  Any study which includes &#039;psycological&#039; factors is very limited in terms of ITT.  ITT studies are quite suited for &#039;objective&#039; treatments such as dose response studies but not so for more &#039;subjective&#039; studies.  Let&#039;s not throw the baby out with the bath water but rather let&#039;s use the tool in an appropriate manner.  Rather than bashing let&#039;s educate researchers on the appropriate way to use the tool.

&lt;em&gt;I&#039;m all for that.  If it truly is a valuable tool.  I&#039;m just not yet convinced that it is.&lt;/em&gt;</description>
		<content:encoded><![CDATA[<p>First one must determine WHY the subjects withdrew from the study.  Your assumption was that one diet was more difficult to follow than the other.  This may be true, or maybe there was another reason.  In clinical drug trials, side effects and tolerance are two factors which impact compliance greatly and as suggested earlier those factors should be assessed early on.  Next, I&#8217;m not convinced that an ITT was appropriate for the diet study to begin with.  Most ITT studies are clinical drug based studies where compliance is not necessarily based upon the subject/patients self motivation.  Any study which includes &#8216;psycological&#8217; factors is very limited in terms of ITT.  ITT studies are quite suited for &#8216;objective&#8217; treatments such as dose response studies but not so for more &#8217;subjective&#8217; studies.  Let&#8217;s not throw the baby out with the bath water but rather let&#8217;s use the tool in an appropriate manner.  Rather than bashing let&#8217;s educate researchers on the appropriate way to use the tool.</p>
<p><em>I&#8217;m all for that.  If it truly is a valuable tool.  I&#8217;m just not yet convinced that it is.</em></p>
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		<title>By: Lyn P</title>
		<link>http://www.proteinpower.com/drmike/bogus-studies/the-fraud-of-intention-to-treat-analysis/#comment-201498</link>
		<dc:creator>Lyn P</dc:creator>
		<pubDate>Thu, 08 Jan 2009 03:31:22 +0000</pubDate>
		<guid isPermaLink="false">http://www.proteinpower.com/drmike/?p=1740#comment-201498</guid>
		<description>Thanks for the ITT explanation!  Like so many, I read medical abstracts (ahh, this strange hobby I&#039;ve developed since my health starting going &#039;south&#039;) and often find the &#039;conclusions&#039; at seeming odds with what little methodology is described -- now it will likely make sense...that is, if anyone can say that interpreting results a la ITT makes any sense at all *G*.  Thanks for the heads up on this bizarre &#039;reasoning.&#039;

&lt;em&gt;You should never take what the abstract of a medical paper says to be a summary of what the actual body of the paper shows.  You might be interested in reading a post I wrote a few years ago called &lt;a href=&quot;http://www.proteinpower.com/drmike/uncategorized/baboon-business/&quot; rel=&quot;nofollow&quot;&gt;Baboon Business&lt;/a&gt; about the art if dissecting medical studies.&lt;/em&gt;</description>
		<content:encoded><![CDATA[<p>Thanks for the ITT explanation!  Like so many, I read medical abstracts (ahh, this strange hobby I&#8217;ve developed since my health starting going &#8217;south&#8217;) and often find the &#8216;conclusions&#8217; at seeming odds with what little methodology is described &#8212; now it will likely make sense&#8230;that is, if anyone can say that interpreting results a la ITT makes any sense at all *G*.  Thanks for the heads up on this bizarre &#8216;reasoning.&#8217;</p>
<p><em>You should never take what the abstract of a medical paper says to be a summary of what the actual body of the paper shows.  You might be interested in reading a post I wrote a few years ago called <a href="http://www.proteinpower.com/drmike/uncategorized/baboon-business/" rel="nofollow">Baboon Business</a> about the art if dissecting medical studies.</em></p>
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		<title>By: jonny bowden</title>
		<link>http://www.proteinpower.com/drmike/bogus-studies/the-fraud-of-intention-to-treat-analysis/#comment-186974</link>
		<dc:creator>jonny bowden</dc:creator>
		<pubDate>Fri, 31 Oct 2008 20:28:04 +0000</pubDate>
		<guid isPermaLink="false">http://www.proteinpower.com/drmike/?p=1740#comment-186974</guid>
		<description>Mike

Even using the unusually high standards for quality we&#039;ve come to expect from your blogs, this one is a standout. 


Jonny Bowden, PhD, CNS

&lt;em&gt;Hey Jonny--

Thanks for the compliment.  Realizing this goes on sure makes a difference when you&#039;re trying to analyze medical papers.

Best--

M&lt;/em&gt;</description>
		<content:encoded><![CDATA[<p>Mike</p>
<p>Even using the unusually high standards for quality we&#8217;ve come to expect from your blogs, this one is a standout. </p>
<p>Jonny Bowden, PhD, CNS</p>
<p><em>Hey Jonny&#8211;</p>
<p>Thanks for the compliment.  Realizing this goes on sure makes a difference when you&#8217;re trying to analyze medical papers.</p>
<p>Best&#8211;</p>
<p>M</em></p>
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		<title>By: Robert</title>
		<link>http://www.proteinpower.com/drmike/bogus-studies/the-fraud-of-intention-to-treat-analysis/#comment-185013</link>
		<dc:creator>Robert</dc:creator>
		<pubDate>Sat, 25 Oct 2008 20:40:33 +0000</pubDate>
		<guid isPermaLink="false">http://www.proteinpower.com/drmike/?p=1740#comment-185013</guid>
		<description>Hey Doc, 
Off subject but I know you are interested in the Laws of Thermodynamics. Here&#039;s an article from Scientific American on it, not sure how accurate it may be but looked interesting. www.sciam.com/article.cfm?id=how-nature-breaks-the-second-law

&lt;em&gt;I read it on the plane a few days ago.  It was pretty interesting, but didn&#039;t apply much to diet.&lt;/em&gt;</description>
		<content:encoded><![CDATA[<p>Hey Doc,<br />
Off subject but I know you are interested in the Laws of Thermodynamics. Here&#8217;s an article from Scientific American on it, not sure how accurate it may be but looked interesting. <a href="http://www.sciam.com/article.cfm?id=how-nature-breaks-the-second-law" rel="nofollow">http://www.sciam.com/article.cfm?id=how-nature-breaks-the-second-law</a></p>
<p><em>I read it on the plane a few days ago.  It was pretty interesting, but didn&#8217;t apply much to diet.</em></p>
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		<title>By: low-carber</title>
		<link>http://www.proteinpower.com/drmike/bogus-studies/the-fraud-of-intention-to-treat-analysis/#comment-184636</link>
		<dc:creator>low-carber</dc:creator>
		<pubDate>Fri, 24 Oct 2008 19:22:13 +0000</pubDate>
		<guid isPermaLink="false">http://www.proteinpower.com/drmike/?p=1740#comment-184636</guid>
		<description>So walking burns 400 calories an hour. While stationary-bike 500 per hour

Hi Dr. Eades:, i found out that stationary-bicycling or regular bicycling burns a lot more calories than walking.  But some people claim that walking burns more than bicycling, because when you ride a bicycle or stationary bicycle you are sitting down, and walking is standing up.  I really don&#039;t understand why then most exercise calorie calculators state that bicycling burns more than walking.

Here is the link of the calories-burned calculator for each sport activity:

http://www.healthstatus.com/calculate/cbc</description>
		<content:encoded><![CDATA[<p>So walking burns 400 calories an hour. While stationary-bike 500 per hour</p>
<p>Hi Dr. Eades:, i found out that stationary-bicycling or regular bicycling burns a lot more calories than walking.  But some people claim that walking burns more than bicycling, because when you ride a bicycle or stationary bicycle you are sitting down, and walking is standing up.  I really don&#8217;t understand why then most exercise calorie calculators state that bicycling burns more than walking.</p>
<p>Here is the link of the calories-burned calculator for each sport activity:</p>
<p><a href="http://www.healthstatus.com/calculate/cbc" rel="nofollow">http://www.healthstatus.com/calculate/cbc</a></p>
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		<title>By: low-carber</title>
		<link>http://www.proteinpower.com/drmike/bogus-studies/the-fraud-of-intention-to-treat-analysis/#comment-184563</link>
		<dc:creator>low-carber</dc:creator>
		<pubDate>Fri, 24 Oct 2008 16:17:43 +0000</pubDate>
		<guid isPermaLink="false">http://www.proteinpower.com/drmike/?p=1740#comment-184563</guid>
		<description>Hello Dr. Eades: I have a question: are carbohydrates really necessary? I mean is it possible to eat a diet real low in carbohydrates like 10 to 20 grams a day? or should do we need more carbohydrates than 20 grams a day? like 40 to 50 grams a day?  I mean can we get our glucose and energies straight from the protein and fat we eat?  Because some people state that a diet real low in carbohydrates leads to sluggishness and tiredness.  

Thanks, and i would like your comments on this

low-carber

&lt;em&gt;We don&#039;t need any carbohydrates for life.  There are no carbohydrate deficiency diseases.  The same can&#039;t be said for fat or protein.&lt;/em&gt;</description>
		<content:encoded><![CDATA[<p>Hello Dr. Eades: I have a question: are carbohydrates really necessary? I mean is it possible to eat a diet real low in carbohydrates like 10 to 20 grams a day? or should do we need more carbohydrates than 20 grams a day? like 40 to 50 grams a day?  I mean can we get our glucose and energies straight from the protein and fat we eat?  Because some people state that a diet real low in carbohydrates leads to sluggishness and tiredness.  </p>
<p>Thanks, and i would like your comments on this</p>
<p>low-carber</p>
<p><em>We don&#8217;t need any carbohydrates for life.  There are no carbohydrate deficiency diseases.  The same can&#8217;t be said for fat or protein.</em></p>
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		<title>By: Michael Norman</title>
		<link>http://www.proteinpower.com/drmike/bogus-studies/the-fraud-of-intention-to-treat-analysis/#comment-184337</link>
		<dc:creator>Michael Norman</dc:creator>
		<pubDate>Fri, 24 Oct 2008 06:39:26 +0000</pubDate>
		<guid isPermaLink="false">http://www.proteinpower.com/drmike/?p=1740#comment-184337</guid>
		<description>Hi Michael,

I&#039;m sure you&#039;re busy on your new big thing... if you have 2 minutes would you be so kind as to fill in my understanding on these two things please:

1. When one has depleted glycogen stores (such as when on a low-carb diet for an extended period)... what happens if you suddenly ingest a big quantity of carbs? Does excess blood glucose go first to glycogen? Or is it possible to gain fat (shift in the equilibrium of fat into and out of cells) even with depleted glycogen.

2. What happens to excess dietary protein? It obviously does not necessarily get stored as muscle mass as otherwise ingesting high amounts of dietary protein would lead to muscle gain without resistance training. And I presume every after resistance training, there is a maximum amount of protein used in protein syntehis... some used for gluconeogensis if blood glucose levels are getting low and glycogen are low... where does the surplus go? Do it get converted to FAs and glycerol? 

I&#039;ve looked for these answers everywhere and can&#039;t find a good overview of glycogen storage that covers this aspect. Would you be able to point me in the right direction please?

Many thanks Michael. I really appreciate it,

Michael

&lt;em&gt;The intake of excess carbs in your first example (those beyond the amount used for energy productiob) would go first to glycogen, then to fat. And probably would do some of both simultaneously.

Excess dietary protein can be converted to sugar (if the body needs it due to low-carb intake) and can be used as a source for other nitrogen-containing body substances (of the three macronutreints only protein contains nitrogen).  Any excess is deaminated ( a process whereby the NH3 is removed), leaving a carbon skeleton that can then be treated just like a fat or carbohydrate and burned for energy.&lt;/em&gt;</description>
		<content:encoded><![CDATA[<p>Hi Michael,</p>
<p>I&#8217;m sure you&#8217;re busy on your new big thing&#8230; if you have 2 minutes would you be so kind as to fill in my understanding on these two things please:</p>
<p>1. When one has depleted glycogen stores (such as when on a low-carb diet for an extended period)&#8230; what happens if you suddenly ingest a big quantity of carbs? Does excess blood glucose go first to glycogen? Or is it possible to gain fat (shift in the equilibrium of fat into and out of cells) even with depleted glycogen.</p>
<p>2. What happens to excess dietary protein? It obviously does not necessarily get stored as muscle mass as otherwise ingesting high amounts of dietary protein would lead to muscle gain without resistance training. And I presume every after resistance training, there is a maximum amount of protein used in protein syntehis&#8230; some used for gluconeogensis if blood glucose levels are getting low and glycogen are low&#8230; where does the surplus go? Do it get converted to FAs and glycerol? </p>
<p>I&#8217;ve looked for these answers everywhere and can&#8217;t find a good overview of glycogen storage that covers this aspect. Would you be able to point me in the right direction please?</p>
<p>Many thanks Michael. I really appreciate it,</p>
<p>Michael</p>
<p><em>The intake of excess carbs in your first example (those beyond the amount used for energy productiob) would go first to glycogen, then to fat. And probably would do some of both simultaneously.</p>
<p>Excess dietary protein can be converted to sugar (if the body needs it due to low-carb intake) and can be used as a source for other nitrogen-containing body substances (of the three macronutreints only protein contains nitrogen).  Any excess is deaminated ( a process whereby the NH3 is removed), leaving a carbon skeleton that can then be treated just like a fat or carbohydrate and burned for energy.</em></p>
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		<title>By: Venkat</title>
		<link>http://www.proteinpower.com/drmike/bogus-studies/the-fraud-of-intention-to-treat-analysis/#comment-184042</link>
		<dc:creator>Venkat</dc:creator>
		<pubDate>Thu, 23 Oct 2008 19:03:05 +0000</pubDate>
		<guid isPermaLink="false">http://www.proteinpower.com/drmike/?p=1740#comment-184042</guid>
		<description>Thanks a ton for bringing us another excellent post. You have a very good knack of explaining technical jargon in a way that non-medicos can easily understand. 

Esp the protein power life plan book and these blog posts - wonderful and excellent.

I cannot believe a process like this will be used to mess up the results. Simply put - remove ITT and provide 2 answers as you have suggested.

Thanks once again for your service.

&lt;em&gt;I&#039;m glad you&#039;ve enjoyed the information.&lt;/em&gt;</description>
		<content:encoded><![CDATA[<p>Thanks a ton for bringing us another excellent post. You have a very good knack of explaining technical jargon in a way that non-medicos can easily understand. </p>
<p>Esp the protein power life plan book and these blog posts &#8211; wonderful and excellent.</p>
<p>I cannot believe a process like this will be used to mess up the results. Simply put &#8211; remove ITT and provide 2 answers as you have suggested.</p>
<p>Thanks once again for your service.</p>
<p><em>I&#8217;m glad you&#8217;ve enjoyed the information.</em></p>
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		<title>By: Olga</title>
		<link>http://www.proteinpower.com/drmike/bogus-studies/the-fraud-of-intention-to-treat-analysis/#comment-183845</link>
		<dc:creator>Olga</dc:creator>
		<pubDate>Thu, 23 Oct 2008 11:57:21 +0000</pubDate>
		<guid isPermaLink="false">http://www.proteinpower.com/drmike/?p=1740#comment-183845</guid>
		<description>Hi Dr. Eades:

I was wondering if you read the paper posted in Medscape this week entitled 
&quot;Low-Carb/High-Fat or High-Carb/Low-Fat Diet Improves Weight Loss, Mood&quot; in which they found that a low carb diet was superior to a low fat diet in terms of weight loss, but that the low fat diet was associated with a greater improvement in speed of cognitive processing.  I find this interesting, because my ability to focus greatly improved on a low carb diet as compared to high carb.  Thanks for the post.

Olga

&lt;em&gt;Haven&#039;t read it yet.  I saw the Medscape piece, but haven&#039;t had a chance to look at the actual study.  I find it hard to believe, however, just as you do.&lt;/em&gt;</description>
		<content:encoded><![CDATA[<p>Hi Dr. Eades:</p>
<p>I was wondering if you read the paper posted in Medscape this week entitled<br />
&#8220;Low-Carb/High-Fat or High-Carb/Low-Fat Diet Improves Weight Loss, Mood&#8221; in which they found that a low carb diet was superior to a low fat diet in terms of weight loss, but that the low fat diet was associated with a greater improvement in speed of cognitive processing.  I find this interesting, because my ability to focus greatly improved on a low carb diet as compared to high carb.  Thanks for the post.</p>
<p>Olga</p>
<p><em>Haven&#8217;t read it yet.  I saw the Medscape piece, but haven&#8217;t had a chance to look at the actual study.  I find it hard to believe, however, just as you do.</em></p>
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