‘How the hell did Noakes paper get through peer review?’

2013-12-15 10:00

The brouhaha following the South African Medical Journal’s (SAMJ’s) publication of the Noakes paper is probably best captured by the angry Tweet of Mail & Guardian editor Nic Dawes: “How the hell did that thing get through peer review? Should be a scandal at the SAMJ.”

Others have said the journal would not have published such an anecdote-based paper if it weren’t authored by a scientist of Noakes’ standing.

The paper is based on a series of personal, self-reported case studies from 127 people who contacted Noakes with accounts of the successes they’d had with drastic weight loss, stabilising cholesterol and other positive health spin-offs by switching to a low carb/high fat (LCHF) diet.

Criticism of the paper was more about the process than the content: self-reporting by individuals is notoriously unreliable since it’s hard to eliminate personal biases in the recounting of these cases; this only reflects success stories, not the cases where the diet has failed people (where people have gained weight, their bad cholesterol has climbed or they haven’t been able to sustain the eating plan).

However, SAMJ deputy editor Dr Bridget Farham defended the decision to publish the paper, because Noakes clearly states the limitations of self-reported cases like this, and he lists peer-reviewed references which show that “these findings are congruent with what people have found in nutritional studies in the USA”.

“(The paper) was published in the Forum section of the journal,” explains Farham, which is a space that allows for ideas which provoke thinking, “one of the functions of an academic journal”.

Even though the “hierarchy of evidence” behind these self-reported cases is “questionable”, Farham points out that Noakes uses the paper as a platform to call for the very thing he is accused of not having: solid, evidence-based data from long-term clinical trials. This will give the kind of conclusions needed to redraft the problematic dietary guidelines that have dictated how we have been instructed to eat for the past three decades.

“These guidelines are being questioned globally, and he uses this article to do so.”

Meanwhile, health writer Mandi Smallhorne explains that an “occasional survey” of this nature is a valid and recognised way of presenting an emerging idea in a scientific journal. It’s a “trending” idea, where something is emerging but there hasn’t been of interest to science yet or still needs years of research to back it up.

“It’s saying ‘let’s think about this’ rather than ‘I claim this’,’ explains Smallhorne.

Noakes says he’s not making any scientific claims on the back of this paper, but merely saying it raises some questions which now need answering, and the next step is the clinical trials that will shed further light, either way.

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