January 29

The Blackburn Award I

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George L. Blackburn, M.D.
This is going to be a two-part post. Today’s post will be the history. Tomorrow’s post will be the outrage.
Last year I initiated the Reckless Award named for Dr. John Reckless, the British physician who suggested that statins should be put in the drinking water. The award goes to the person who makes the most outrageous recommendations for statin drug use. Now comes the second such award, the Blackburn Award given to the person who makes the most feckless, stupid, dogmatic nutritional statement imaginable. The award is named after Harvard associate professor George L. Blackburn, M.D. Dr. Blackburn is the Chief of the Nutritional/Metabolism Laboratory, and Director of the Center for the Study of Nutrition Medicine, which are affiliated with the Beth Israel Deaconess Medical Center in Boston, Massachusetts.
Benjamin Franklin said that “we are all born ignorant, but one must work hard to remain stupid.” George Blackburn has not just worked hard to remain stupid, he’s made it his life’s labor. Before I get to Dr. Blackburn’s latest outrage, I need to make a disclosure. I’ve had personal experience with him that probably colors my judgment a little, but tomorrow I’ll post his latest so readers can make the call themselves. But first, the personal history.
In the early to mid 1980s I was working as a family physician. I had gained a bunch of weight and stumbled into the low-carb diet by trial and error. I had started many of my own patients on my version of the low-carb diet (which later morphed into the Protein Power diet) and was in the process of moving from a general medical practice to one more specialized in the treatment of obesity and related disorders. In about 1986 or so the physician-supervised, protein-sparing, modified fasting (PSMF) programs were becoming popular. Two companies – Optifast and Medifast – were the largest promoters of these programs: the Optifast program was generally conducted through hospitals and the Medifast program through individual doctors’ offices. I sent off for the materials on Medifast looking to see if I could make it a part of my obesity-treatment practice.
When I got the materials and read through them I was struck by a couple of things. First, all the documentation for the benefits of the PSMF were the same medical papers I had found substantiating the effects I was seeing in my own patients on low-carb diets. And second, the makers of Medifast were using the PSMF to get patients down to goal weight, then switching them to standard low-fat, high-carb, reduced calorie diets for maintenance. At the time these fasting programs were much in the news, and one of the complaints was that although subjects lost weight rapidly on the PSMF part of the program, they just as rapidly regained it once they went on maintenance. To my way of thinking, it didn’t take a rocket scientist to see why.
I decided to start using the Medifast program in my clinic to help patients rapidly lose weight, but I used my own low-carb program once they reached goal weight and started maintenance. I cranked along for a couple of years using this protocol with great success.
All of the information provided me by Medifast was soaked and cloaked in the idea that the PSMF was fraught with danger and consequently required a lot of hands-on physician supervision to ensure that patients stayed out of trouble. Me experience was that it was anything but dangerous. By the time I had supervised a couple of thousand patients on the program I realized that it was really pretty safe. And I realized that it could be made even safer if one whole-food protein meal were added to the regimen. I began putting my own patients on four shakes per day and a meat and green vegetable meal instead of the five shakes and nothing else. My patients did fine on this regimen and had zero problems. It dawned on me that such a regimen could be made available to the public at large who couldn’t afford a medically-supervised program that cost a couple of thousand dollars that insurance didn’t cover.
I wrote up my idea in a proposal form, sent it to a number of publishers, and ended up with a book contract with Warner Books to write the book Thin So Fast.
As I was nearing the end of writing the first draft of the manuscript William Vitale, M.D., the founder and owner of Medifast, somehow got wind of the fact that I was writing a book on the PSMF. He came to Little Rock, and he and his very lovely wife took MD and me to dinner. He alluded to the book I was writing and said that he would love to write the foreword to it. I assumed he knew what the book was about, so I didn’t really elaborate. We had a wonderful dinner and parted the best of friends.
Dr. Vitale called a few times and dropped me a note or two asking about the book’s progress. When I was finally finished and had the manuscript turned into the publisher, I had my editor send Dr. Vitale a copy to read before he wrote the foreword. When he realized that the book wasn’t a history of the PSMF, but was a do-it-yourself manual for people to go on without physician supervision, he went ballistic.
He called me and had the company’s lawyer on the phone with him. He told me that under no circumstances should this book ever be published. He said that I would be responsible for the deaths of thousands of people. He begged me not to publish. It was all in his economic interest, of course, but he couched his plea in terms of patient safety. I refused and told him that his best bet was to write the foreword so that his company’s name would be out there. I told him that it was simply a matter of time before someone wrote such a book, and that if it weren’t me, it would be someone else. And soon. He said not just No, but Hell No to the idea of writing the foreword, and we ended the call unpleasantly.
A few days later I got an emergency call from my editor. She told me that Medifast’s lawyers had written a letter to Warner Books’ legal department pointing out that if Warner persisted in the publication of my book they would end up having the blood of thousands on their hands. The legal department wanted me to respond. Which I did. The decision was made to continue with publication.
Shortly, the folks at Warner got another letter of warning. This one came from Harvard professor Dr. George Blackburn. It was one of the most inarticulate letters I had ever seen. The letter echoed the one from Vitale’s attorneys, and stated in no uncertain terms that Warner was treading on dangerous ground with the publication of this book. Blackburn detailed all the dangers associated with the PSMF, and said that such a program absolutely required physician supervision. A book such as mine, so he said, would give people a blueprint for their own destruction.
Once again I had to write a rebuttal, and once again Warner decided to go through with the publication. The book Thin So Fast was on the shelves in December, 1988.
It’s difficult to believe now what with the plethora of ready to drink protein shake products available, but when I wrote this book there were no such products. The only ones available were the Medifast and Optifast shakes. I had to instruct readers on how to make their own protein powders out of non-fat powdered milk and a number of other products available at the time. Before my book and the ready-made protein shake products it inspired, the only way people could really do a PSMF was by using the Medifast and Optifast programs, which were out of reach cost-wise to the majority of people. Also, as an historical note, this book was the first mention anywhere of the idea of net effective carbs, although I didn’t call them that at the time. And it was the first to lay out for the layman the idea that the metabolic syndrome existed and that insulin resistance and too much insulin could be the cause of heart disease, high blood pressure, obesity and diabetes. I proposed some mechanisms that since have turned out to be pretty much correct.
Had the Blackburn letter been merely an effort by a friend to help out another friend (Blackburn and Vitale were buddies) it wouldn’t have gotten under my skin so much. But later events proved just what a snake Blackburn really is.
Thin So Fast came out in December 1988, and in September 1989 MD and I attended a NAASO conference in Bethesda, MD. In going through the book of abstracts for the various presentation, I noticed one by George Blackburn. He was giving a presentation on how he had developed a program on which patients went on a self-monitored (NOT physician-monitored) PSMF program that he ran out of Harvard. His presentation pointed out that the program was safe and that the patients made it through without problem. (And although he didn’t mention it, somewhere along the way he became affiliated with Slim Fast and even appeared in a video news release prepared by that company. Not only that, he has consulted for Novartis, the company that makes Optifast.)
So, Dr. Blackburn, who in late 1988 condemns me and my book as being potentially lethal to readers who might follow the PSMF on their own, comes out with his own similar program within a year. Which is why he’s not at the top of my list of friends, and which is why I might have a little bit of an axe to grind. But at least I’ve disclosed it.
Interestingly, now Medifast is sold as a self-monitored PSMF. You can order their meal replacements and go on it without physician supervision. And, the good folks at Medifast have published their own book showing how to use their supplements. And in a bizarre twist of fate, Medifast is recommended for use with Protein Power and other low-carb programs.
Today you get my personal history with Dr. Blackburn, tomorrow I’ll post on what he’s done (most recently) to have the Blackburn Award named after him.


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  1. That’s hilarious! My guess is, either Blackburn was working on a book already, or most probably hurried to cash in when he saw he couldn’t stop you. Talk about hypocrisy! I guess giving the “blueprint to destruction” out to people is only wrong when he isn’t the one making money on it.

  2. Hi Dr Eades,
    This is a very likely candidate:
    http://www.pbn.com/stories/29231.html
    “….On the patient side, the panel found that 99 percent of those who are eligible for weight-loss surgery never receive it, and said the need to accommodate the growing number of severely obese patients will require wide-ranging changes in new and existing health care facilities.
    ” “We have an older, heavier population, and a rapidly-evolving surgical specialty,” said Dr. George L. Blackburn, of Beth Israel Deaconess Medical Center, chairman of the expert panel. “With up to one in 10 U.S. adults a potential candidate for weight-loss surgery, the need to protect the safety and well-being of patients who undergo these procedures is more critical than ever.” ”
    Unless he has done something even more stupid! Weight-loss surgery for 10% of the population is, after all, spectacularly stupid.
    The Internet is a wonderful thing.
    All the Best,
    Michael Richards

  3. @Mike Richards:
    Weightloss surgery for 10% of a population where 30% are likely obese? Considering that few of those people are going to make lifetime commitments to LC diets, why not? Bariatric surgery for 10%, Alli for the next 10%.
    I think a quick discussion of hard commitment vs. soft commitment is in order. If you adopt protein power, this is a soft commitment. You can quit any time and go back to your less healthful way of eating. If you get a gastric bypass, this is hard commitment. To go back, you have to overeat for a long time to reexpand your stomach or you have to have surgery to undo it. If you take Alli, it’s a firm commitment to a low fat diet. Eat fat, mess pants. Eat fat regularly, blow out your gallbladder. Hard commitments are liable to make things that are hard to do stick. No one, not even Dr. Mike himself, will suggest that weight loss is easy. Even with TSF/PP it takes time. For a lot of people, it takes a lot of sorting through the junk that got them the weight in the first place. Stress. Emotional eating. Self Image. Etc.
    None of this is to say that PP(LP)/TSF are ineffective or suboptimal. What it is saying is that a large majority of these large people need a commitment to lose the weight that is firmer than a soft commitment.
    The brilliance of Alli is that people go in thinking it’s a magic bullet. They come out with a hard commitment.

  4. Hi Mike,
    I had a similar experience in another field. A turned a chapter of my dissertation on Ezra Pound into an article, since publish or perish was the rule. The article treated Pound’s editing of Ernest Fenollosa’s “Chinese Written Character as a Medium for Poetry.” I was arguing that Pound had misconstrued Fenollosa in fundamental ways and that Fenollosa’s essay was important enough to have a reach beyond Pound Studies.
    I submitted the article to a journal dedicated to Pound studies and got a very nice letter from the editor, praising the article, but suggesting a different venue since I was trying to reach an audience beyond Pound scholars. I thought his comment was appropriate, and I sent the article to the PMLA, the journal of the Modern Language Association. The PMLA sent my article to this same person for peer review and then sent the comments to me.
    In these comments, the editor who praised my work to my face trashed the article in the most scathing terms and suggested that I be barred from the pantheon of Pound scholarship.
    He sounds like a student of Blackburn.
    Chuck Berezin

  5. I think the initial panic of people going it on their own when it came to doing the PSMF diet probably stemed from the days of the liquid protein diets. Anybody remember those bottles of cherry-flavored liquid protein that briefly lined the shelves of the drugstore until people started dying while using it? I think that’s the biggest reason why Opti-fast and Medi-fast were done under medical supervision when they were developed. I was curious about Opti-fast at the time bacause I worked with a lady who was on it. The big selling point was that it would be safe, because unlike the old liquid protein diet, it was done under medical supervision. Anyway, I’m sure the spector they were trying to raise when you were publishing your book was the one of people dying like they had on the old liquid diet.
    And yeah, how nice that after you pave the way for a self-administered PSMF diet despite all the obstacles strewn in your path by Dr. Blackburn and his ilk, he comes out with his own similar program within a year.

  6. Max,
    I’m sorry, but I don’t subscribe to the theory that the general public are lazy idiots. You will find (check out Sandy Swarzc’s blog http://junkfoodscience.blogspot.com/ for the details) that far from everyone being lazier and not trying, the studies are time and again coming up with the finding that people are exercising a lot more than before and that they’re really trying to lose weight — but with ineffective advice. I’m afraid I don’t have the time to come up with the relevant posts (am posting this from work, naughty boy that I am), and leave that exercise for the reader.
    Here in New South Wales, the finding has been that children are far more active than before, in spite of TV, games consoles and My Space. Such is the case with my own children who spend hours playing Assassin’s Creed and whatever else is the latest (I can’t keep up). But my youngest also does gymnastics (or “tricking” as they call it), Rugby League, BMX tricks and trampoline. My eldest does Shore Patrol at a local beach (“Wiggles Bay” for those of you who have young children), races boats with his friends, BMX stuff, skate boarding, etc. He recently completed his Bronze Medallion, for which he had to learn first aid and prove he could swim 200 m in 5 minutes or less.
    Even your humble correspondent swims 2 km a week (two sessions) and often runs along the local beaches like Mona Vale and Palm Beach (runs of 5 km or more). Lots of locals also do it. And I know all my neighbours and they’re not slobs. Yes, I know that we live in a beautiful part of the world. (See http://www.pittwater.nsw.gov.au/ for a view of Palm Beach)
    Where you make the mistake, I feel, is that you are confusing motivation with credibility of source of information. For most people doctors are credible sources of information and when they say that that stomach’s got to be stapled, then, by jingo the patient believes them and undergoes the procedure. If a doc says that Alii is the go, then people go for it.
    What makes this whole Blackburn incident so distressing is that someone so “credible” is advocating something so dangerous.
    Trust me, people are not pathetic. They are real. A snobby, snooty attitude is demeaning to the holder and not to the people being held in contempt.
    Michael Richards

  7. @Mike Richards:
    I didn’t say it was about move more, eat less. I said nothing of the sort. I said that dieting is a soft commitment. People make make it firm, but you can always quit the diet, stop the exercise, etc, without relative pain.
    I said that Bariatric surgery and Alli (no idea what label they sell it under in NSW, if it’s even sold there) are hard commitments. They make it very costly to quit, in psychic or real cost, time, and health consequences.
    There is nothing about people being “lazy idiots.” Or anything of the sort. You have misconstrued me, twisted my meaning (without actually talking to anything I said), and in effect, built argument, not rebuttal.
    I would refer you to your parting shot. I believe you are living in a glass house AND throwing stones.

  8. Max,
    Whatever. The point was this: people are not contemptible. They do try. Your tone was not exactly respectful to all those people struggling to lose weight.
    BTW, I DO live in a glass house with a nice view, thank you very much. That view is currently obscured by much-needed rain.
    Michael Richards

  9. Max,
    Seems like Alli is pretty much OPPOSITE of the correct tool for weight loss, at least if you actually believe that PP is based on sound science. Why would you put obese individuals on a drug that prevents them from eating a scientifically sound weight loss diet?

  10. @Kim: Even Dr. Mike will not say that reducing calories through the elimination of dietary fat won’t work for weight loss. Why? Because it will. The problems with that type of diet are more in the adherence and the secondary problems that come from it. Alli is a firm commitment. It clears up any adherence problems people have. They don’t enter it as a firm commitment, they enter it looking for a magic bullet. what they get is a magic bullet to firm commitment to calorie restriction through dietary fat reduction.
    I do not think this is optimal, but how many times have you read this story… “Back in 2003, I lost XX lbs of weight on a low carb diet. I felt great, life was great. Then X changed. I slipped. Now I am back, having realized the error of my ways, and I have regained all XX lbs I lost, and got YY pounds in interest.” Clearly, the problem with changing your diet isn’t in the diet itself. It’s in the lifetime commitment phase. Alli/low fat might not be the BEST solution, from a dietary standpoint, but it should be effective as a weight loss tool, and should see low rates in recidivism, thus addressing the “lifetime commitment” phase.
    @Michael Richards: Internet tone is as much in the eye of the reader as in the fingers of the author. My suggestions about hard commitments may seem condescending to you. Your comments to me may seem condescending. That speaks as much about us as readers as it does about us as authors. My point is this: a lot of people find it very difficult to make firm, lifetime commitments to dietary changes that would be good for them. And by a lot, the numbers are on my side. 95% of people who lose significant weight gain it back (sourcing in Taubes, Good Calories, Bad Calories). Many people also seek a quick and easy solution. At least in the States. And in Italy as well. Huge market for weight loss supplements, diet books, hollywood miracle diets, tummy tucks and other cosmetic weight loss surgeries, etc. Billions with a B. So, clearly, I’m not out of line, in my experience, suggesting that people want it gone faster. So, you and I both know this is flawed thinking. Weight loss/health improvement is a time intensive activity. So, if you know fact a: people want it badly, fact b: people want it quickly, and fact c: most people will be disappointed, largely due to long term commitment issues, the clear consultant solution is that you have to do something about the commitment aspect.
    The consultant solution might strike you as condescending. I can’t help that. I can offer you the non-apology of “I’m sorry you feel that way.” I would look at it more as a little cold, but solutions oriented.
    All statements in support of bariatric surgery and Alli do not supersede low carb living as the optimal healthful diet. My statements do not even preclude people from eating low carb. The point is that, for people who aren’t gonna get the “religion” or the science or the culinary challenge, or whatever it is that makes long term low carb adherents stay adherent, bar surgery and Alli might provide the hard commitment they would need to control their weights and move on down the actuarial table. In a package that presents as a quick fix at first, but winds up as a hard commitment. If that’s a poor view of people, fine. I’ll take the Oscar for lines like, “I see nothing worth liking in these people.” It’s not true, but if that’s how you feel, there are worse things.

  11. Dear Doc, I wonder if the same Journal “Obesity” has also published studies promoting low carb for weight loss? Perhaps they are just trying to be “journalistically balanced”. No excuses for the Blackburn guy, however.
    They haven’t published any low-carb papers yet. This is the first issue.

  12. Interestingly, the same Dr. Blackburn is credited as being the original developer of the PSMF in the 1970’s. In fact, a search of PubMed shows that he published articles on it dating back to 1973.
    At the time, I believe it was physician monitored. Apparently, sometime before the encounter with Dr. Eades 15 years later, it became a self-monitored program.
    The real question is this: why did a formerly strong proponent of a successful low-carb approach change his nutritional views in the interceding 35 years?
    He indeed was one of the early pioneers of the PSMF. Why he went south on the whole idea, I haven’t a clue. Maybe because he got caught up in the herd mentality of academia.

  13. ok ok so will someone spell it out for me in layman’s terms — are these medically supervised liquid diets safe for the general public…..
    I think so if the person following such has no health problems except for obesity and uses a modified version including one protein meal per day and at least 1000 kcal or so per day of intake.

  14. This seems to be a bash on ideas, who said what first..get over it. Medical research appears on many levels, science and technology will serve to convince the network of practioners in ongoing practice..change is progress. Live and learn. If your experience was of constructive criticism all the better. We cannot stop developement of science and medicine because of disagreements, the high road would be to enter in the discussion, compliment the criticism. Now who deserves one of your rewards. Oh yes, you wrote a book. Don’t you have better ideas to stroke your ego?
    This is just research and development 101.
    It’s not a bash at all on ideas. Go back and reread the post.

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