Since I seem to be on a roll writing about rear ends (politicians and fatty stools) I might as well go ahead and post this piece now that I’ve gotten all the results in. As near as I can figure, I’ve got about 7,000-8,000 people reading this blog daily, so given the percentage of people who are afflicted with hemorrhoids, this should be of interest to at least a couple of thousand. If you don’t have a hemorrhoid, if you don’t know anyone who has a hemorrhoid, and if you don’t think you will ever get a hemorrhoid, you can quit reading now.

When MD and I were in Dallas a month of so ago visiting our kids, I went to visit (as I usually do when in Dallas) a friend I’ve known for years (let’s call him Jack, not his real name). As we were talking he was squirming around on his couch, looking like he was in some kind of discomfort. I asked him if he was having a problem, and said no. At that point his wife, who was bringing us some coffee, said, “Tell him; he’s a doctor for God’s sake.” Jack then sheepishly told me that he had a bad hemorrhoid that was intensely painful. I asked him all the appropriate questions and diagnosed him as having a thrombosed hemorrhoid that needed treatment.

Jack said he would call is doctor and try to get in. I told him that I had fixed countless thrombosed hemorrhoids, and that if I had the tools I needed, I could fix it for him in a flash. I made a couple of calls and found out that I could get all the necessary equipment at a drugstore nearby. Off we went to gather the stuff. We returned with a latex gloves, a scalpel, a couple of syringes and needles, a bunch of gauze 4X4s for packing after the surgery, and a bottle of xylocaine (an injectible local anesthetic). I recruited Jack’s wife as my assistant, and we got him down on the bed. I had his wife spread his cheeks so that I could get to work. I immediately realized that I had made one of the cardinal errors of doctoring: I had failed to examine the patient before I made the diagnosis.

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I’ve read the paper that is the topic of today’s post from beginning to end five times. Not because it is a brilliant, enlightening paper, but because I found it so worthless I kept thinking there was something I was missing. If this paper had been published in the Journal of the American Dietetic Association or some other third tier journal I wouldn’t have thought so much about it. Were it published in a second tier journal such as Metabolism, I would have wondered a little more. But it was published in the October issue of the venerable American Journal of Clinical Nutrition, a first tier journal for sure, and, arguably, the most prestigious nutritional journal in the world.

I’ve decided to use this paper entitled “Arterial endothelial dysfunction in baboons fed a high-cholesterol, high-fat diet” to demonstrate how totally meaningless research can find its way to the best of journals thanks to a built-in bias among the “peers”? who are reviewing such research and to show how to interpret a scientific/medical article.

Critically reading a scientific paper is a piece of detective work. One has to discover motives, obfuscations, biases, and sloppy work and put it all together to get the real picture, not just the picture the author of the paper wants to be seen. Just like a good detective who assumes everyone is lying until stories are corroborated, so it is with the scientific literature. One must always corroborate, probe, compare and dig deeply because almost nothing is as it appears on the surface. As Sherlock Holmes says, “These are very deep waters.”? In the case of the study we will in due course explore, the waters are very deep indeed.

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