“…a lot of clinical studies are actually not well done, a lot interpretations are not accurate, a lot of people are not doing things properly.”
Dr. Christopher Labos is a cardiologist, a course lecturer in the Department of Epidemiology, Biostatistics and Occupational Health at McGill University and an affiliate member of the Department of Global and Public Health.
Chris is a columnist with the Montreal Gazette and Medscape, featured on the Sunday Morning House Call on CJAD radio, and has a regular TV segment with CTV Montreal and CBC Morning Live. He blogs and produces a video series called “On Second Thought” for Medscape. He is an associate with the McGill Office of Science and Society and hosts the award-winning podcast “The Body of Evidence.” He is the author of “Does Coffee Cause Cancer?” a story about food epidemiology and why food headlines are usually wrong. He realizes that half of his research findings will be disproved in five years: he just doesn’t know which half. Occasionally, he finds time to practice as a cardiologist so he can buy groceries. To date no one has offered him his own primetime TV show.
“I think I was lucky enough to have two very interesting deficits growing up, a stutter and nearsightedness, that combined together turned me into a pretty good public speaker, which then turned me into a science communicator.”
Welcome to MedicsVoice.com where we talk to the key opinion leaders in health and medicine around the world. Today I’m talking to Doctor Christopher Labos, who’s based in Canada. Chris is a podcaster, media guru, even a cardiologist. And has written a book called “Does Coffee Cause Cancer?” But, first, tell us about your background how you got into all of this.
Chris Labos: I’m a cardiologist by training. I did my clinical training in cardiology and then I did a master’s degree in epidemiology. And the original motivation was I wanted to be better at research and to understand the mechanics of research because, like many residents in clinical medicine, I was told you should practice but also teach and also do research. But nobody actually teaches you how to do research. So I thought, I’m going to go and do a master’s degree in epidemiology to learn the statistical techniques that you need to design a study properly and to learn all the pitfalls. It was in doing epidemiology, during my first year, where I started to realize, wow! a lot of clinical studies are actually not well done, a lot interpretations are not accurate, a lot of people are not doing things properly. You learn the basic things about epidemiology, about confounding, about selection bias, about absolute versus relative risk. And at that time, I was sitting in class with my friend Mark, and I’d seen this story come up on the news about strawberries preventing heart disease in women. I looked at it and thought they’ve made a classic mistake. They’ve taken such a very small benefit but reported the relative risk and made it seem as if strawberries were going to cure heart disease in women. And I said, I should do something about this. Another friend of mine suggested that I should write a letter to the editor. So I wrote a letter to the Montreal Gazette. “Dear editor, I saw this study….” and I explained my reasoning and why it was flawed. I talked about absolute versus relative risk. And they got back to me and said, this is very interesting, can you cut out 2000 words and then we’ll publish it in the newspaper. I sent it in and they said, this is pretty good and asked can I do more of these? And I said, sure. So I started sending in letters to the editor, and then that eventually turned into a regular column, which is still going with the Montreal Gazette. And, because of that, every time I published something, I’d be invited to come on the radio and on the TV. And it grew from there. When Covid hit, all of a sudden they needed medical people who could explain statistics, who could analyze data, because this stuff was coming out in real time. So, I would spend a lot of my time during the early days of Covid, just reading what was happening and trying to put it into context, to explain absolute risk reduction to people, and explaining how sensitivity and specificity worked with the tests. And, it just ballooned from there. Everything eventually led to something else.
“These media interviews, that’s essentially what they are, they’re small speeches in three minute increments in response to a question. Once you get into the habit of how media works, It starts to roll. “
Awarded the 2025 McGill President’s Prize for Outstanding Emerging Researchers – Public Engagement Through Media.
DMacA: You’re a fantastic communicator but you clearly didn’t pick this up as you went along. Tell us about tell us about school. Were you a communicator? Were you a leader?
CL: Let me tell you story. When I was young, I had a very bad stutter. Very bad to the point that I couldn’t speak on the phone. I used to write out what I wanted to say. If I ever had to call my father at work, I would have to write it out on a piece of paper because I just couldn’t get the words out. A lot of kids have speech impediments like that and most eventually grow out of it. I did, but one of the things I realized was that it was very hard for me to have a one to one conversation with somebody, if I had to look somebody in the eyes and talk to them, that was always more difficult. Whereas, if I had to give a talk in front of the class that was easier for me. And the second physical defect I had is that I’m pretty nearsighted. I wear glasses all the time. I was very nearsighted when I was young but I’m a lot better now because I had laser treatment when I was in my 20s and that reduced it quite a bit. But, at the time, I was so nearsighted I found that I could get up in front of a crowd, take my glasses off, and all of a sudden everything in front of me was a blur. I was really good at giving public presentations because It was like I was talking to an empty room. And, when you’re young and people keep telling you you’re good at something, you start to believe it. And so I became a fairly practiced public speaker. These media interviews, that’s essentially what they are, they’re small speeches in three minute increments in response to a question. Once you get into the habit of how media works, It starts to roll. In radio, you’ve got a 15 minute block and you have to break for commercials. You keep an eye on a clock, you get used to the rhythm. It is, to a certain degree, practice and you get better at it as you go. I can now write articles, 650 words, without even checking the word count because I sort of know. So, yes, I think I was lucky enough to have two very interesting deficits growing up, a stutter and nearsightedness, that combined together turned me into a pretty good public speaker, which then turned me into a science communicator.
DMacA: You went to what seems to have been a very liberal school, an English speaking school in the French speaking area, tell me about school and that opportunity.
CL: I was pretty lucky. I went to public school, and public school means something a little bit different in North America, public school is where the poor people go. We were not rich growing up. It was a very good public school; we had uniforms, there was a lot of discipline. So it was like a private school, it just didn’t cost any money. We had a lot of very good teachers and I did a lot of public speaking there. And then, when I went on to higher education at university, I did a lot of debates and took part in the model United Nations, which sounds dorky, but was actually a lot of fun. I learned a lot about international politics and international relations. For people who had never done model United Nations, let me explain a little more. Basically a bunch of people come together and everybody represents a country so you debate issues as if you were that country. It’s a little bit of role playing and it’s fun, but it’s very much a public speaking type exercise. It was about putting you in a context where you have to debate and argue a position and convince other people that you are right. As I was from a science background, I did all of this stuff for fun, which is not typical of people who have a science background. My dabbling in the liberal arts meant that, when it became time to do the extracurricular stuff in medicine, I was pretty good at giving presentations. I was very good about writing up my results, presenting stuff to people, as in the medical journal club where you present a journal article. And because of my background in epidemiology, and because I was interested in it, I wasn’t just reciting the article, I would give people the background, I would look at the caveats and people told me like they enjoyed it because it was a much more interesting presentation. Even when I give proper scientific presentations, I’m always a little bit worried because my presentations are always a little bit kooky, a little bit off the wall. I also put in funny titles. I try to inject humour and people come up and say, I wasn’t expecting grand rounds to be funny. I’m always a little bit shocked – why don’t other people do this? And I think it’s just because I got so used to doing non-medical stuff that I try to make stuff funny, I try to make stuff interesting for people, because science doesn’t have to be dry and boring. It can be fun.
DMacA: You said that you didn’t want science to be dull and boring, but then you picked the ultimate conservative career after medical school, cardiology. And, if you were to ask someone to pick the most boring subject within medicine, they would likely pick epidemiology. But this doesn’t really fit with your personality. Did you get any pushback or limitations to your ability to do things?
CL: I have a sort of a running joke. Whenever I have to explain something and I say we’re going to explain it with maths…You’re right, a lot of people say we don’t care about the maths! It’s a sort of throwaway joke in the book where a couple of times some of the characters are able to say, “no maths”. And that became a very useful literary technique for me to jump over some of the statistics for the general audience. But it is challenging because I speak to my friends and they say- just tell me if the p value is less than 0.05. That’s all they care about. It’s very painful to hear people say that but I understand where they’re coming from. So the trick becomes, whether you’re talking to the public or to your colleagues, to explain why it’s important to do a study a certain way. I am a little bit shocked sometimes when colleagues who don’t have a statistical background ask me to run stats for them. Sometimes you don’t have the funding to be a statistician so I tell my friends to call me, that I’ll run the stats, it’s not going to be that hard, it’ll take me a day. So, I’ll send them the results and they ask, what do these mean? What’s the odds ratio, the confidence interval, and here’s the p value, but what does it mean? It’s not enough to just know the statistics, it’s not enough to just know the math, you have to be able to explain it to people, otherwise it doesn’t matter. You have to put stuff into context. And so there hasn’t really been that much pushback for me because I think people realize how important it is, not just to have a statistician who can give you a statistical output, which is often unintelligible, but to have somebody that can identify what is actually important. If you’ve ever seen raw output from some of these statistical software packages, they’re not the easiest things to read. So the fact that I have a little bit of a foot in both worlds helps, and it’s fun.
“The fundamental business model of medical journals has a problem and people criticize them on the basis that it’s no longer necessary in the age of the internet. And that’s true.”
DMacA: We’ve talked mostly about the science communication, and people might that might forget that you’re actually a proper researcher and have published academic research in quality peer reviewed journal journals. Because you straddle both modes of communication, I’m interested in your thoughts on the future of medical journals
CL: Good question. Here’s the thing, the internet exists. A medical librarian once had a great quote about the business model of medical journals. Just think about that for a second. We produce the research, we give it to them for free, and then they sell it back to us. There is no other industry in which that would make sense. The fundamental business model of medical journals has a problem and people criticize them on the basis that it’s no longer necessary in the age of the internet. And that’s true. If you go back 50 years or 100 years, there was a value in medical journals. Somebody needed to collect the evidence, somebody needed to edit it, somebody needed to disseminate it. But now everybody’s putting their research online. I don’t know if you still read paper medical journals, I certainly don’t, I get the email table of contents, I read them online. So, eventually I think they’re going to transition to be fully online. Paper journals will eventually go away. There may be hard copies in official medical libraries just for record keeping purposes. But paper journals are probably going to transition out very quickly over the next few years. It’s going to be very problematic because subscriptions for medical journals are very expensive. If you, as an independent person, wanted to go out and buy an online subscription to the New England Journal of Medicine, that’s expensive. But then you also have JAMA, Lancet, BMJ and it starts to become a lot. We don’t think about it now because if you’re affiliated with a university or a medical group, you probably have a group license and you think it’s free, but it’s not. Your library and your university are spending a lot of money on this.
And, when you live in the developed world, you’re probably okay. But think about people who are living in the developing world, they often don’t have access to these journals behind a paywall. There is going to be a real problem. There has been an interesting shift, especially in the US, so that if you have NIH funding or government funding of any kind, you have to make your article open access. Its just part of the funding model now and you have to build that into your budget. So, more and more we’re moving towards putting research into open access and then you get to a point where, if we’re doing that anyway, why do we still have the middleman? It’s like, why are we still using travel agents to book our flights? Why don’t we just book it directly online? Medical journals still offer an important function in terms of editing and statistical editing and all that but a lot of universities could do that in-house anyway. I’m not really sure about the future of medical publishing because its no longer really as relevant in a digital age. If they can adapt in some way to be more interesting, like putting out videos and podcasts and all that, then maybe they’ll stay relevant. But I think we’re in a very important junction point where it could go either way. At some point they may become obsolete, or they may pivot and become a completely different thing but I think the idea of putting out a magazine as a written source of research is probably no longer as necessary as it once was.
DMacA: Before we get to your book, I’m going to put you on the spot. You’ve spoken about medical journals in the third person. So lets make you the editor of a medical journal. What are you going to do?
CL: Good question. First I would look for the money tree because I think one of the things that we have to do, if you gave me an unlimited source of money, is to start paying people. I would get professional reviewers and have a core full time staff. Right now, most reviewers are volunteers and people do it out of the goodness of their heart. But it takes a lot of time, and more often than not, you may not have specific expertise in statistics. A lot of journals now have a statistical reviewer, a dedicated statistical reviewer but we need to professionalize. If medical journals are going to continue, you have to professionalize the system, which means you have to have a permanent full time staff that are reviewing all the articles that come in so that you can judge them properly. And medical journals have to start being the guarantor of the data. They have to start asking researchers- give us your raw data so that we can double check it. What happens now, more often than not, if somebody raises a concern about a paper- this data doesn’t make sense, the p value distribution isn’t plausible, I think something kind of screwy happened with the data- the medical journal will say we can’t investigate the raw data because we don’t have it but we see no evidence of fraud. The article will stay up and a lot of papers that probably should be retracted, don’t get retracted because there’s no mechanism for investigating the veracity of the data.
The second big change I would make, and that would make them very relevant in this age, is to be the guarantors of the data- to have the data in deposit so you can come in and reanalyze the data to provide a double check. Sometimes you get these crazy stories asking, was this really a randomized controlled trial. The journals have no way to know that unless they go the author and request every single patient enrolment form. You can’t fake that sort of thing. You can but it would be incredibly tedious to do that. So I’d want medical journals to be much more robust and proactive in ensuring that the data is accurate, which is, I think, a big problem and will be going forward. All that would require a lot of money which is not floating around right now.
“And she responded to me with a two line email. ‘Pretty good. But I kept expecting him to ask her out at the end…” and the minute I saw that, I thought, this is a romantic comedy.”
DMacA: Well, money is not going to be a problem, because you’ve just written a bestseller! Tell us about the book. It’s different. It’s a story.
CL: Let me tell you how it started. The book is called “Does Coffee Cause Cancer?” And before you ask, I’m drinking coffee right now, so clearly it doesn’t. During Covid, I was sitting here, debunking stuff in the media- No, vitamin D doesn’t treat Covid. No, smoking isn’t protective. – Really like wacky stuff. Credible physicians believed some of this and I’m thinking, do you guys not understand selection bias. We’ve been through this so many times, like the protective effects of smoking… Really! So, I thought, wouldn’t it be great if somebody could do a handbook of epidemiology for the general public. But, the problem was that nobody was going to read that book- a handbook of epidemiology. And, to write a book about Covid was going to be problematic because by the time I wrote it, Covid was going to have changed. So, I thought, let’s make it about food. I was speaking with a friend of mine, a journalist, when I was in Ottawa for a conference, and he said- “why don’t you do it about food myths?” He gave me the idea for a title. Why don’t you call it ‘Fake Food News’ – Fake News and with the word food pencilled in. That was the idea that crystallized in my brain. I’ll make it about food and every chapter will be about an epidemiology concept.- p hacking, selection bias, information bias, confounding, absolute risk versus relative risk. But each chapter is also going to be about a food. It will be about red meat and salt, a discussion about vitamin C and the common cold etc The basic framework was to start with a headline, a popular news headline, and then explain why it was wrong, but more importantly so people would really understand how the food works. I wrote up the first chapter, which was about coffee, and it was a pretty standard science communication book- this is why coffee doesn’t cause cancer. I had secured an agent and he sent it to the publisher, and the publisher said, he wanted to talk to me about the book. He said, “it’s good but there are a lot of books like this. Is there a way that we can jazz it up?” At that time, I was doing a podcast with my friend Jonathan and we used a question and answer type format, which made it a bit more dynamic. So, I said, “maybe I could do it as a conversation between two people, like a Socratic dialogue where the characters could be stand-ins for the reader.” He thought that was kind of interesting so I wrote up a chapter where a doctor goes into a coffee shop and talks to a barista. I sent it to a friend of mine to see what she thought. And she responded to me with a two line email. ‘Pretty good. But I kept expecting him to ask her out at the end…” and the minute I saw that, I thought, this is a romantic comedy. So I reworked the entire plot as a romantic comedy. And what was going to be dry dialog between me and the audience became these fleshed out characters. When I started writing it, I was afraid to go too far into the narrative because I thought, people won’t like it, they want just the science. But as I was writing it, the characters fleshed out a lot more, and I started to wonder, how would this character respond in this situation? I often heard authors say things like- oh, the characters told me what to write- and I used think, that sounds that’s bizarre, you’re the one at the keyboard. But it’s actually true. As soon as you have the character in your head, and you understand who and what they are, they start dictating what their next words are going to be. So, you can read the book as a narrative from beginning to end, with characters, a plot and a subplot. Actually, there are two romantic subplots. But, you can read it as a science book and learn about these myths, and then you can explore the core of the book and look at the appendix, which I have annotated with all the references, so you can follow through it and learn. It’s a very different epidemiology book, and you’re either going to love it or you’re going to hate it. There are some people who won’t like the narrative and just want the science and that’s fine. But there are other people who will think, this was actually kind of fun and it’s a very quick read. You could literally read this book in a day because it has a lot of dialogue and a lot of action. It’s a very PG 13 romance. It’s by no means a Harlequin romance. It’s a very easy book, it’s a very quick book, and it’s also a really good book that you could give to younger people as their first introduction into statistics and debunking. It can be a very surface level analysis or, if you want to, you could go a lot deeper and get into the very nitty gritty of where this stuff comes from.
DMacA: Whoever thought the epidemiology could foster a love story? What a creative imagination. It’s been really fun talking to you. Thank you very much for sharing so much of your life, your career in cardiology and epidemiology, together with your communication skills. It’s just been fun. Thank you very much indeed
