Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
Our undercover investigation finds evidence of nutritional therapists giving out advice that could seriously harm patients’ health
That’s the title of an article in February’s Which? magazine. (That’s similar to Consumer Reports in the USA).
“When Which? sent researchers to investigate the quality of advice from nutritional therapists, some was so bad that patients’ health was put at risk. One nutritional therapist advised against surgery and radiotherapy to treat cancer, while another ‘diagnosed’ a problem with adrenal glands without any blood-test results. Some also used unproven testing, such as iridology or mineral testing, to identify problems or diagnose conditions.”
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This sort of sting operation may seem a bit mean but there is no option. It’s the only way to discover what’s actually happening and it is very much in the public interest to know about that. "Our panel of medical experts rated six of our 15 consultations as ‘dangerous fails’ – potentially endangering the health of our researchers – with a further eight rated as ‘fails’. Only one consultation of the 15 was deemed a borderline pass by our experts.” |
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"We sent five undercover researchers to visit three nutritional therapists each. Every researcher was equipped with a specific health-related scenario: Helen (46) and Sarah (40), recently diagnosed with Ductal Carcinoma In Situ (DCIS), the most common type of non-invasive breast cancer; Mark (56) and Linda (52), suffering with serious fatigue for the past three months; and Emily (31), trying unsuccessfully to conceive for more than a year."
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Sarah, posing as a patient diagnosed with DCIS, visited a nutritional therapist who advised her to delay treatment recommended by her oncologist (a lumpectomy and a course of radiotherapy). The therapist suggested that Sarah follow a no-sugar diet for three to six months and told her, ‘cancer lives off sugar; if you feed it sugar it’s going to thrive. If we starve the cancer of sugar then you have a better opportunity of the cancer going away’. When Sarah asked whether the cancer could progress during this time the therapist said it was a ‘gamble’. Dr Margaret McCartney, from our panel of experts, says: ‘If cancer treatment were as simplistic as cutting out sugar, surely we would have discovered a cure. This advice is highly irresponsible.’ Our experts rated this consultation as a ‘dangerous fail’." The Patients’ Guide to magic medicine defined “Nutritional therapy: self-styled ‘nutritionists’ making untrue claims about diet in order to sell you unnecessary supplements”. That turned out to be pretty accurate. They are part of the alternative medicine fringe. The Universities Admission Service (UCAS) no longer lists any BSc/MSc degrees in "Nutritional Therapy" or "Nutritional medicine". Westminster University closed its BSc Nutritional Therapy during last year. We still don’t know the fate of the notorious (or should I say hilarious) course run at the Northern College of Acupuncture and validated (after a fashion) by the late University of Wales, but it isn’t listed for entry in 2012. [We do now: see follow-up‘] But there are a large number of university courses called "Nutrition". How many of them teach properly, and how many of them teach the nonsense that prevails in "nutritional therapy", I don’t know. The term ‘nutrition’ has turned into a dangerous minefield. It can mean almost anything, because the term is undefined. Anyone can, and does, describe themselves as a nutritionist. At one extreme you have slick pills salesman like ‘not-a-Dr’ Gillian McKeith and Patrick Holford. At the other extreme you have a fascinating and respectable subject for study. The one thing that you need to get clear is that if you want advice about nutrition, go to a dietitian not a "nutritionist". Dietitians are the properly qualified people who work in the NHS, and who are (mostly) free of crackpot ideas. |
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I suppose that one should not be surprised at the poor, and sometimes dangerous, advice that was given by nutritional therapists. Their training contains much nonsense so it isn’t surprising that they did so badly. Some of it has been revealed here. See, for example,
Another worthless validation: the University of Wales and nutritional therapy
Nutritional Fairy Tales from Thames Valley University
College of Natural Nutrition: bizarre teaching revealed
Nutriprofile: useful aid or sales scam?
Response to a threatening letter from Mr Holford
Food for the Brain: Child Survey. A proper job?
Teaching bad science to children: OfQual and Edexcel are to blame
The last BSc (Hons) Homeopathy closes! But look at what they still teach at Westminster University.
The level of knowledge of both physiology and chemistry shown my some of the therapists was shocking. One recommended avoiding margarine, because it’s “two chemical bonds away from pure plastic”. Another said that Flora margarine contains lots of trans fat, which has not been true for a long time.
One graduate ot the late Thames Valley University course said “”advantage of the wholemeal or the wholegrain … is that they contain more fibre and the fibre stops the sugars being absorbed quite as quickly”. Not so. Brown and white bread have much the same glycaemic index (60 – 70).
Quack diagnosis
One alarming fact was that several therapists offered methods of diagnosis for allergy and for deficiencies that have been known for many years not to work. There isn’t anything controversial about iridology, hair mineral analysis, taste tests. kinesiology. or the Vega test. They are pure quackery.
“Professor David Colquhoun, from our panel of experts, said: ‘Sadly, nutritional therapy is plagued by “diagnostic tests” that are little more than quackery; they are tools to aid sales, rather than tools to diagnose deficiencies. Iridology and hair analysis simply don’t work.”
Unnecessary treatments
One therapist advised a researcher to have an optimum nutritional evaluation test, costing £312, and a cellular nutrition profile, costing £156. Apparently, these would allow the therapist to give a
more targeted service by establishing what vitamin and mineral deficiencies he had.
Our experts were not convinced by these tests and certainly didn’t think they were worth the money; any necessary testing
could be done by a GP for free.
In 12 of the 15 consultations, researchers were prescribed a huge range of supplements, costing up to £70 per month. It was not revealed whether or not the prescriber made money from this, but usually you were asked to give the prescriber’s name "to get a discount". So it’s a fair guess that they got kickbacks.
British Association for Applied Nutrition & Nutritional Therapy (BANT)
Despite the low standards of advice, 13 out of the 14 therapists who were visited were registered with BANT, the British Association for Applied Nutrition & Nutritional Therapy. This is what passes for a professional association for nutritional therapists, though like all such bodies in alternative medicine, it is entirely ineffective as a regulator. Rather it serves to protect whatever untrue claims they make. BANT’s code of practice says that its members won’t diagnose, but in fact many of the therapists diagnosed conditions and created treatment plans. You can be confident that BANT will do nothing to stop this bad practice.
You can find out a lot about BANT from these sources:
British Association for Nutritional Therapy – when an organisation looks like a regulator, quacks like a regulator, but isn’t a regulator
Why it is easy to get the incorrect impression that BANT is a regulator
Nutritional Therapists Fail to Join Ofquack
BANT: A Profile
Matthias Rath drops his million pound legal case against me and the Guardian.
Only 3 of the 14 therapists were registered with the Complementary and Natural Healthcare Council (the CNHC, more commonly know as Ofquack). They are meant to be the official regulator, launched with a good chunk of taxpayers’ money, but registration is voluntary and not many have volunteered. As a requlator, Ofquack is a bad joke.
Conclusion
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"Dr Margaret McCartney says: ‘This investigation appears to show that high street nutritional therapists are a waste of money. If you have symptoms please see your GP, not someone who can’t diagnose accurately.’ If you’re looking for tailored dietary advice, visit a registered dietitian.
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There is a discussion of this topic on the Which? magazine site.
Follow-up
The excellent Quackometer has posted simultaneously on the great nutritional therapy scam.
16 January 2012 The British Dietetic Association issued a press release that describes very clearly the many differences between a real dietitian and a "nutritional therapist". Download Leading UK Nutrition Association Urges Awareness Between Dietitians and Nutritionists (pdf).
16 January 2012 BANT issued a press release. Download Are Nutritional Therapists Gambling with Your Health?. It answers none of the serious questions raised by the Which? investigation. BANT moans that that Which? “did not provide all the promised transcripts/questionnaires in a timely fashion”. In fact they got them before Christmas and were given until January 15th to respond.
16 January 2012. BBC Radio 4 programme, You and Yours, had an item with Jenny Driscoll from Which? magazine and BANT chairperson, Catherine Honeywell. She did, inter alia, admit that some of the behaviour of the therapists were irresponsible. It remains to be seen if they do anything about it. don’t hold your breath. Hear it on BBC iPlayer.
16 January 2012. There was pretty god coverage of the story, even in the Daily Mail.
17 January 2012 Another question answered. I just learned that the ludicrous course in Nutritional Therapy, previously validated by the University of Wales (and a contributor to its downfall), is now being validated by, yes, you guessed, Middlesex University. Professor Driscoll seems determined to lead his univerity to the bottom of the academic heap. His new partnership with the Northern college of Acupuncture is just one of a long list of validations that almost rivals that of the late University of Wales. The course has, of course, an enthusiastic testimonial, from a student. It starts
I work full time as a team leader for a pension company but I am also a kinesiologist and work in my spare time doing kinesiology, reiki and Indian head massage.
Evidently she’s a believer in the barmiest and totally disproved forms of magic medicine. And Middlesex University will give her a Master of Science degree. I have to say I find it worrying that she’s a team leader for a pension company. Does she also believe in the value of worthless derivatives. I wonder?
17 January 2012 The discussion is going on at the Which? web site. A Chris James cast doubt on the reaults because ot the small sample size, and asked for confidence limits, so I gave them.
Chris James
It is easy enough to calculate limits yourself -you don’t even need to be able to do the maths -there are web calculators that do it for you, e.g. http://www.causascientia.org/math_stat/ProportionCI.html
14/15 = 93% failed. 95% confidence limits for this are 69.8% to 98.4%
6/15 = 40% gave dangerous advice 95% confidence limits 19.7% to 64.6%
So despite the small sample size we can say that it’s likely that at least 70% (and possibly 98%) of nutritional therapists fail.
And it is likely that at least 20% (and possibly 65%) of nutritional therapists give dangerous advice.
These results give real cause for concern, despite the small sample size.
For statistical enthusiasts, these limits are Bayesian with a uniform prior. Very much the same result is given by the standard analysis which is explained in section 7.7 of Lectures on Biostatistics [download pdf 10.5 Mb]
18 January 2012. BANT has, at last, produced an “updated response”. The good thing is that it starts by saying
” . . it is completely outside the BANT Code of Practice to advise a client to withhold any treatment for cancer for any period of time in order to follow a nutritional approach. Were a client to be advised in such a way we would expect to receive a complaint against the practitioner.”
I hope that this will happen. This statement, the only admission of guilt in BANT’s response, is rather spoiled by a later suggestion that no such recommendation was made. It looked very clear to both Which? magazine and to the three members of the expert panel.
The rest of the response admits no fault of any sort.
I’m sorry to say that the response by BANT shows very clearly what is wrong in nutritional therapy. Any organisation which can see nothing wrong in the advice given in 14 of the 15 consultations is, I’d argue, a threat to the health of the nation. Rather than saying we’ll try to improve, they just deny everything.
The response seems to show that the professional organisation for nutritional therapists is not part of the solution. Rather it is part of the problem.
16 Responses to Which? magazine: “…high street nutritional therapists are a waste of money”
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May I recommend the Association for Nutrition for accredited nutritional scientists with proper understanding of biochemistry and physiology. They are working very hard to bring some credibility to the profession of nutrition.
These high-street nutritionists constitute, it seems to me, a “perfect storm”: almost everyone is scared of serious illness; everyone eats. It’s the perfect nexus for the quack and the charlatan. Add into the mixture the often confusing and conflicting advice from properly qualified practitioners and it’s a health disaster waiting to happen. During my one and only pregnancy (admittedly more than 40 years ago) I was advised to eat Marmite by one GP and told by another that the one food I should avoid was – Marmite. But that’s an anecdote.
The point is, what to do about this particularly pernicious form of quackery? Criminalising the practitioners is certainly worth considering, but reflecting on the reluctance of the authorities to prosecute under the 1939 Cancer Act, it’s probably a waste of time.
Educating the public has to be the way to proceed, and Which? has surely made a great start, especially since its audience is exactly the main target of this sort of dangerous rubbish – the so-called middle classes.
A minor point: in their press release (ie the one that doesn’t answer the serious questions), BANT state they represent ‘2400+ Nutritional Therapy practitioners’. However, their ‘Practitioner search’ facility on their website only returns 1,805 results. Whither the 595+?
After some reflection, maybe it is best to statutorily regulate nutritionists as a distinct worker from the dietician.
This would be under strict conditions though. Firstly, a nutritionist would not be allowed to perform any sort of diagnostic test. They would not be able to diagnose any deficiency or illness and they would not be allowed to treat any illness. They would be limited to helping people with healthy eating advice.
The problem with this is that I doubt anyone could survive as a business by just saying ‘eat your greens’. And the nutritionists have far bigger ambitions and fantasies than this. It would essentially criminalise the vast majority of them – but maybe that is not a bad thing.
I understand what you say about controlling them via statutory regulation, but I’m not yet convinced – I know they might be regulated by the HPC rather than a useless GCC-type of ‘regulator’, but I can see the public being misled even more by the claims that they were statutorily regulated, and therefore safe and authoritative. It would all depend on how stringent they were regulated and how active the regulator was in curbing their behaviour.
As you say however, it’s not clear that any quack nutritionist would survive in such a regulatory regime.
Of course, being ‘regulated’ by the CNHC is an utter waste of time as has been amply demonstrated.
As for the question of legislation/regulation, I have these thoughts: I think we need to start with the premise that these people are offering advice and treatments without proper, relevant professional qualifications (usually) or good evidence for efficacy. Both their advice and their treatments are useless, misleading, downright harmful – or all of the above. Many of them are already arguably contravening at least one act of parliament with no one in authority chasing them.
I do believe that the principle effect of regulating them would be to allow them to claim that they are “regulated” practitioners with a consequent increase in credibility with the uninformed public.
One is tempted to recall the effect of legislation on psychic practitioners, who are required to make it known that their activities are “for entertainment purposes only”. This has had little to no effect on protecting their gullible targets. Public exposure of good evidence for “faking it”, however, has. Even if only temporary.
What we really need as I have said elsewhere is for existing laws actually to be applied.
I note from listening to the Radio 4 broadcast that the damning report will be handed over to the government.
Would that be the government which floated the idea that giving the queen a nice new boat to play with is going to make us all so much happier?
@PhDelinquent
I agree with you.
The question of regulation is really quite tricky, simply because regulators usually turn out to be quite ineffective. There can be no better example of that than the General Chiropractic Council. That’s the highest level of statutory regulation, on par with the GMC. Yet it proved totally ineffective. When the British Chiropractic Association tried to sue Simon Singh for defamation, after he described some of their treatments as bogus, the claims made by chiropractors came under close scrutiny and were found to be wanting. Over 600 complaints were sent to the GCC but very few were acted on. Even statutory regulation is no guarantee that a practitioner won’t make false claims. The regulator, in the case of the GCC, itself supported the false claims.
The only sort of regulation that is likely to work is for the Advertising Standards people to clamp down on false health claims (a job at which they are quite good) and for the Office of Fair Trading to ensure that Trading Standards officers prosecute serious cases (a job at which they are abysmally bad).
One question Which (who the hell still reads this and the Guardian) should be asking is why members of the public actually go and visit nutritional therapists?
Could it be they are highly satisfied with what conventional medicine has offered them?
@Dangerous Conventional
Depends what one means by “highly satisfied”. Trouble is, people have been taught to believe that they should be feeling like fantastically well 20-year-olds all the time and for all their lives. This is simply unrealistic. Most people suffer from all kinds of aches, pains and general malaise from time to time. Mostly these problems resolve themselves or one learns to accept them as part of life and one learns to live with them.
When I am genuinely puzzled or concerned, I go to my GP and talk things through, and get treatment if it is appropriate. I can do this without worrying about the cost, what’s more, because I live in a country civilised enough to have an NHS. I would say I am “highly satisfied” with conventional medicine, because I am a realist. Plus, the wonderful advances in conventional medicine which I have seen in my lifetime are truly impressive to the rational mind.
By the way, though I don’t read Which?, I do try and read the Kindle editions of both the Guardian and the Telegraph every day. It’s a good way to get a genuine news and opinion balance.
I noted that you highlighted the case of the nutritionist who tried to “treat” the woman with ductal carcinoma. Now did Which check out the evidence for this advice. I tried to work out the NNT for radiotherapy in this condition. As with most conventional therapies when I looked up Cochrane I could only find a review which looked at surrogate markers. Would I be happy to recommend a therapy without primary end point data.
As you suggest PhD, it’s good to have an opinion balance.
Goodwin A, Parker S, Ghersi D, Wilcken N. Post-operative radiotherapy for ductal carcinoma in situ of the breast. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD000563. DOI: 10.1002/14651858.CD000563.pub6
@Dangerous Conventional
You are up to your usual trick of changing the subject. If you believe that it would be sensible to spend 6 months on a sugar free diet, it is up to you to produce some evidence. You also talk as though radiotherapy were the only other option.
I feel rather strongly about this because it isn’t long since my wife was found to have breast cancer at routine screening. It was at an early stage, and thanks to our wonderful NHS it was soon found that there was no spread to lymph nodes, and that it was ER-positive. She had a mastectomy and needs only to take tamoxifen now.
If she had been to a nutritional therapist who advised 6 months delay, the tumour might have grown and metastasized to a point where radiotherapy was needed.
I am eternally grateful that she had a proper oncologist and didn’t go for advice to someone like you.
After an objection was raised on the discussion at the Which? web site that the sample was too small to be meaningful, I did some calculations which I’ve added to the follow-up.
More regulation of this kind of thing can be very dangerous, especially when the existing law would cover it but for that regualtion.
Steve Novella covered this on the SGU podcast a while back about why it is a bad idea to license psychics. If you have a regulator then it becomes very hard to say that the entire field is nonsense any more, as the regualtion gives the cover of legitimacy.
Even clear criminal behaviour can suddenly become virtually unenforceable if the regulator decides they will allow that behaviour, which is what happened when regulation of wheel-clampign was introduced in England and Wales.
What also then happens is that the industry itself starts to control the code of what is acceptable and not acceptable, because it is much easier to change that code than it is to change the law. And it is the industry that has the greatest incentive to take an interest in lobbying the regulator.
After emerging from a rather big operation on my right hip, I was astonished to discover that the squabbling was still going on at the Which? magazine web site is still going strong. As of a few minutes ago it was up to 1088 comments, the most I’ve ever seen. I can’t say that I recommend ploughing through them all.
Nutritional therapists are out in force. but rather than admitting that there industry has problems, most of them deny everything and quite a lot (including their ‘professional organisation’, BANT, accuse both Which? magazine and the expert panel of lying.
The net effect of reading the comments from NTs on me, was to make me trust them rather less than I did after reading the transcripts. That is not how it should be.
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