In this video, we step back from discussing the multitude of statistical errors and reporting problems of the KETO-CTA studies and look at the whole saga. And we discuss a recent comparison of the KETO-CTA plaque data to the PARADIGM study. The whole story was not presented in that comparison.But, taking a step back, what are my thoughts from following this whole saga? I cannot but come to the conclusion that these researchers are extremely biased and are willing to spin the result of their studies in ways that make it appear more favorable, "reassuring", and fit the story they already believe. We clearly saw this in their promotion of the 2025 JACC paper, Plaque Begets Plaque, ApoB Does Not. In the words of Norwitz, "This reflects a level of progression that is expected with aging", and that “LDL and ApoB were pretty much irrelevant in determining or predicting whether or not plaque would progress”. And Feldman: “Many are focusing specifically on the change in % NCPV only, particularly given it is our preregistered endpoint.” Later in the same thread, Feldman added: “There was no correlation with LDL-C or ApoB — arguably the most relevant of all.”And Soto-Mota: “Are LMHRs progressing faster than others? No! They behave like other ↓CVDrisk groups” and “these first prospective data should be reassuring for LMHR patients and their physicians”. Reassuring?? This is exactly the framing or spin I am talking about.They promoted their questionable, preliminary and exploratory finding of no relationship between LDL/ApoB and plaque progression and downplayed or ignored the actual amount of plaque and plaque progression. It's as if they were implicitly saying: don't focus on the primary outcome of our study, because it's very concerning, focus instead on our fragile and weak exploratory statistical analysis.Now, everyone has some bias of course. But this, to me, was misleading and irresponsible. And whatever you believe about the Cleerly situation, that happened later, and has no bearing on how they promoted this study at that time. It is my view that they so fully believe their proposed theory that every study, data point, or result they get is analyzed within that framework. This allows them to ignore, downplay and explain away anything that isn’t “reassuring” to them. They don’t even appear to consider the alternative explanation, except perhaps in a few passing ‘strategic disclaimers’. The same pattern extends beyond their own studies to how they interpret and present other evidence, especially in The Cholesterol Code documentary and in comparisons such as PARADIGM versus KETO-CTA.I didn’t start from this position. I just wanted to analyze the study’s methods and data. But from following this whole saga, this is where I’ve ended up. So I caution anyone evaluating analyses from these authors that there may be much more to the story than the conclusions they present. Important caveats may be downplayed, relevant information may be left out or reframed to sound more reassuring, consequential statistical issues may be ignored or misunderstood, and any uncertainty may be interpreted asymmetrically through a pre-existing framework of belief.For these reasons, studies and analyses from these authors warrant especially strong scrutiny of the underlying data, methods, analytical choices, and what is and is not being presented.
