Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
nutribollocks
We are all interested in the relationship between our health and what we eat. What a pity that so little is known about it.
The problem, of course, is that it almost impossible to do randomised experiments, and quite impossible in most cases to make the experiments blind. Without randomisation there is no way to be sure about causality, and causality is all that matters. All you can do is measure “associations” and that sort of information is simply unreliable.
For example, if you simply observe that people who eat a lot of dark green vegetables are healthier than those who don’t, there is no reliable way to tell whether their health is caused by eating the vegetables. It is just as likely that, for example, rich people are healthier because the are rich, not because they eat more vegetables. The answer, though usually not known, is the only thing that matters for offering advice. The crucial problem is that, in the latter case, it will do no good at all to bully a poor person to eat more vegetables: their health will not improve because their bad health was caused by poverty, not by lack of vegetables.
It is precisely this difficulty that results in the constantly conflicting advice that we are given about diet. I can’t think of any single thing that does more harm to real science than the fact that one week we are told that red wine is bad and the next week we are told that red wine is good. No doubt both statements were based on a naive observational studies, the significance of which is vastly exaggerated by its authors (and often by their university’s media department too).
The first job of a scientist is to be able to say “I don’t know”. Under pressure from the government’s audit culture, and the HR apparatchiks who embrace it so eagerly, all that is forgotten only too easily. he lack of certain answers about diet leaves a vacuum into which not only naive scientists are sucked, but also it is a gift for hucksters who are eager to sell you expensive ‘supplements’, whether or not you need them. As always, it is a case of caveat emptor.
The questions are important to us all, so when sciencepunk pointed out to me a chance to check my own diet, I went for it. I try to keep pretty close to the current guidelines. Unreliable though they may be, they are the best we’ve got. So I went to the Nutriprofile site, and filled in the questionnaire, quite honestly (apart from saying I was 37 -I wish).
I eat plenty of fruit and oily fish every week so I though I’d do quite well. No such luck. I ended up being told I was deficient in iron and selenium, and at “risk of deficiency” in vitamin B5 (pantothenic acid), folate, vitamins D, E, K, magnesium, copper and potassium.
Uhuh, I must really be ill and I’d never realised it.
At the bottom of this analysis of all my deficiencies comes the sales pitch, “your personalised supplement recommendations”.”Strongly recommended” for me is Gold Standard A-Z Multivitamins (just click on the “buy now” button). I’m also “recommended” to buy Omega 3 1000mg capsules.
And then I’m invited to consider a whole list of other supplements
“The following products have been given a 1 star rating. This usually means they have been recommended to meet a specific issue raised by your NutriProfile. You should consider these supplements where you feel they could help if the issue is particularly important to you”
Here is the list.
- Selenium + A,C,E,
- Echinacea (“may help you maintain a healthy immune system”).
- OptiFive (antioxidant supplement)
- Co-enzyme Q10 (“may help you maintain energy levels” -look out for a forthcoming post on this scam)
- Memo Plus (“may help you maintain brain health and cognitive function”),
- Panax Ginseng (“may help you to maintain energy levels”
- Psyllium Husks
- Magnesium
- Vitamin D
- Ginkgo Biloba
- Probiotic
As always, there are lots of fantasies about “strengthening the immune system”. And the great antioxidant myth is exploited to the full.
Puzzled by this result, I got my wife to do the questionnaire, and also a particularly healthy and diet conscious colleague.
My wife was recommended to buy Omega 3 1000mg, Osteo Plus Bone health supplement (despite telling them that she already took calcium) and 50 Plus Multivitamins (“may help you address any deficiency in essential vitamins and minerals and may also help you maintain a healthy immune system and maintain energy levels. “). And then it may not.
My spectacularly healthy and diet conscious colleague got a strongly recommended (maximum 5 stars like me) for Gold Standard A-Z Multivitamins and for Omega 3 1000mg, as well as “recommended” for plant sterols, garlic and Opti-Omega 3.
Either I’m a lot unhealthier than I thought, or Nutriprofile is a sales scam.
You decide.
Is there anyone at all who does NOT need supplements?
By this stage I was getting suspicious so I sent the link to a professional dietitian, Catherine Collins of St George’s Hospital London. Unlike the people running the site, she has no financial interest in selling you pills. I asked her to fill in the questionnaire as a hypothetical person who had an ideal diet, based on current nutritional knowledge . Surely such a paragon of dietetic virtue would not need to buy pills too?
Don’t you believe it. At least she didn’t get any 5 star “strongly recommended”, but she did get “Recommended for you” Opti-Omega 3 (3.5 stars) and Gold Standard A-Z Multivitamins (3 stars). Plus, of course the whole list of “you may like to consider”, same as everyone seems to get.
So I asked Collins how it came about that everyone seems to end up being recommended to buy pills after going through all the questions. Here is what she said.
“Apparently my ratio of omega3:6 is unbalanced. not if you ate the amount of oily fish i’d put in, and used ‘vegetable’ oil which is mono-rich rapeseed. I think they’ve used the sunflower analysis to generate this distortion.
I disagree with absolute amounts of omega-3 per day. The amount I recorded meant I would easily exceed a daily intake of 500 mg of the important omega-3 fats, EPA and DHA
Low Vitamin B6 and folate – totally incorrect recommendation based on my entries
Potassium – the survey indicated concern that diet provided 200mg per day less potassium than recommended. This was incorrect, the flaw I assume being due to inability of the questionnaire to handle portion sizes. Should I have been worried even if this had been accurate? Of course not. Potassium is widespread across food groups, the most concentrated being fruit and vegetables. It is an essential nutrient, but its requirements are relative to sodium (‘salt’) intake.
Their omega-3 fat recommendation is double the FSA/ SACN suggestion of 450mg/d – they actually quote this in their supporting information but then say ‘experts say we need double’ [their experts are below]. This is highly misleading. We need a combination of omega-3 fats in our diet for health – not only the ‘fishy’ EPA and DHA, but also the readily available ALA, found in vegetable (rapeseed) oil
Omega 3:6 ratio -completely wrong based on the foods entered. Demonstrates a major flaws in the assumptions made about type and amount of foods in the diet.
Water recommendations. Totally inaccurate information based on the myth expounded by the health food industry and its workers that caffeine is a diuretic. This been extensively researched and proven to be not true ( Grandjeans excellent work). The only way in which a caffeinated beverage is ‘diuretic’ to someone who takes caffeinated drinks regularly is in the volume of drink consumed.
She concludes
“”This appears an elaborate pill-pushing exercise. Superficially reassuring in promoting the recognised FSA (Food Standards Agency] line – but then giving undue – and unjustifiable – support to the anecdotal ‘experts recommend’ to create what will be a powerful sell”
The comment about water intake stems from this bit of Collins’ Nutriprofile:
“Caffeinated drinks, fizzy drinks and alcohol do not count because, whilst they contain water, they are mild diuretics, ie. they boost urine output and therefore should only form a small part of your total fluid intake.”
This myth (aka nutribollocks) is quite contrary to what the real research (going back to 1928) says, Check “Laying the caffeine myth to rest” for the real story..
I’m told that Healthspan are now sending out the paper questionnaire in newspapers. Presumably this is to ensure that the poor, the elderly etc and others who that aren’t computer literate don’t miss their buying opportunity. How considerate of them.
Nutriprofile’s expert team
Who is the expert team behind Nutriprofile? Here they are.
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What do the real experts say about supplements?
The story you get is quite different when you ask somebody who is not trying to sell you something
The Food Standards Agency says
“Most people should be able to get all the nutrients they need by eating a varied and balanced diet. But if you choose to take supplements, it’s important to know that taking too much or taking them for too long can cause harmful effects.”
Harvard Men’s Health Watch says
“Harvard Men’s Health Watch suggests that the average man give up the multivitamin, at least until scientists solve the puzzle of folic acid and cancer.”
“If you eat a balanced diet that includes food from all the major groups, there should be no need to take vitamin supplements. The food you eat will provide you with all the vitamins and minerals you need. “
I guess we should not be surprised at the direct contradiction between this advice and that of the Nutriprofile questionnaire. After all, Nutriprofile was developed by a company, Healthspan, that is devoted to selling “supplements” with all the dubious claims and customer testimonials associated with the alternative health industry.
But this is what always happens when big business controls science.
Postscript
Oddly enough, Ann Walker’s experience seems to be much the same as ours. In an interview on the Healthspan site we read this.
Q: Which nutritional supplements do you choose to take?
A: I regularly take a multivitamin, vitamins C and E, fish oil, and a calcium and magnesium combination. I also take vitamin D during the winter and some herbs as and when they are needed.
Even if I have improved my diet, each time I complete the NutriProfile questionnaire my requirement for a multivitamin, calcium and magnesium, and a fish oil supplement are always thrown up.
Didn’t it occur to her to wonder why?
The sales pitch was followed up on 27 March the email arrived from Healthspan “Healthspan are offering you £5 to spend towards your recommended supplements”. One can’t say whether this offer goes to people who were not recommended supplements, because so far no such person has been found.
This is the third post based on a recent trip to North America (here are the first and second)
One aspect of the endarkenment, the Wal-Mart model of a university, is very much the same in the US as in the UK. At one US university, an excellent scientist offered the theory that an alien spacecraft had scattered spores across the land which developed into HR staff who appeared at first sight to be human, and who colonised academia.
The penetration of quackademics into US universities is a bit different from in the UK.
In the UK, the plague is restricted to sixteen or so ex-polytechnic universities which, to their great shame, actually offer Bachelor of Science degress in subjects like homeopathy. There are bits of quackery in good teaching hospitals (such as laying-on-of-hands at UCLH), but not very much.
In the USA and Canada, this sort of “vocational” training does not occur much in universities, but in separate colleges. The situation is worse there though, insofar as these colleges have been allowed to award titles like ‘doctor of naturopathic medicine (ND)’, for work that in no respect compares with what the rest of the world has to do to earn a doctorate. This prostitution of academic titles has not happened to anything like the same extent in the UK. How our own quacks would love it if they were allowed to call themselves ‘doctor’ and sport the initials ND (so easily mistaken for MD at first sight).
It is on the clinical side where the situation is far worse than in the UK. Almost every university hospital, including Harvard, Yale and Stanford, has departments devoted to fairy-tale medicine.
Quacks use a number of euphemisms to make themselves sound more respectable. First they became ‘alternative medicine’, then ‘complementary medicine’. Now the most-used euphemism is ‘integrative medicine’, which is favoured by most US universities (as well as by the Prince of Wales). Raymond Tallis pointed out that this seems to mean integration of treatments that don’t work with treatments that do work.
An official roll of shame for North American universities can be seen here (35 in USA and 4 in Canada). 
A bigger collection of 44 universities has been posted by the incomparable Orac at the The Academic Woo Aggregator. He’s had good support in the USA from DrRW (R.W. Donnell), see particularly his articles on How did pseudoscience get admitted to medical school? and What is happening to our medical schools? Abraham Flexner is turning over in his grave.
All these outfits have two things in common. They all claim to be scientific and evidence-based, and none has produced any real evidence that any of their treatments work.
Here are a few examples of what’s going on.
Yale University School of Medicine
The usual theme is expressed thus.
“Through open-minded exploration and rigorous scientific inquiry, we aim to improve awareness and access to the best in evidence-based, comprehensive medical care available worldwide, with the goal of optimizing health and healing for patients”
The driving force behind the woo seems to be a fourth year medical student, Rachel Friedman, so I wrote to her to ask what useful alternative treatments had been established by research at Yale. But she could not identify any. All I got was this.
“My best advice would be to do some medline searching of metaanalyses” there’s been enough research into some of these modalities to provide for a metaanalysis.”
So she was unable to produce nothing (and anyway. metanalyses, useful though they may be, are not research).. A glance at the Yale publications page shows why.
The Scripps Institute
Scripps Center for Integrative Medicine says
“In use at Scripps since 1993, Healing Touch is an energy-based, non-invasive treatment that restores and balances energy to help decrease pain and relieve associated anxiety.
Healing Touch is performed by registered nurses who recognize, manipulate and balance the electromagnetic fields surrounding the human body, thereby promoting healing and the well-being of body, mind and spirit.”
“Balances energy”?
“manipulate and balance the electromagnetic fields surrounding the human body”?
This is just meaningless baloney. And it come from the Scripps Institute.
The Oregon Health & Science University
OHSU is an excellent and well-respected research university where I have many friends. It was a pleasure to meet them recently.
But it also has a big department of “Complementary and alternative medicine” and an “Integrated medicine service”. There are some good bits of advice mixed up with a whole range of crazy stuff. Take their page on homeopathy.
“This therapy treats ailments with very small amounts of the same substance that causes the patient’s symptoms.”
WRONG. In most cases it is zero amount. To brush this fact under the carpet is simply dishonest (and perhaps a sign of guilt). Then comes this (my emphasis)..
Explanations for why homeopathy works range from the idea that homeopathic medicine stimulates the body’s own natural defenses to the idea that homeopathic medicine retains a “memory” of the original substance.
However, there is no factual explanation for why homeopathy works and more research is needed.”
WRONG. This statement carries (twice) the expicit message that homeopathy does work, quite contrary to a mountain of good evidence that it is merely a placebo. The statement is deceptive and dishonest. And it comes with the OHSU logo.
The University of Arizona
” Heal medicine”, “Transform the world?” Modest uh?
The University of Arizona Program in Integrative Medicine is certainly not modest in its claims, but its publications page shows that it doesn’t even attempt to find out if its “therapies” actually work.
Here is an example. They are advertising their Nutrition and Health conference
heavily.
There’s nothing wrong with good nutrition of course, but the ‘alternative’ approach is instantly revealed by the heavy reliance on the great antioxidant myth.
And look at the sponsors. The logo at the top is for Pistachio Health, a company that promotes pistachio nuts: “Delicious and good-for-you, pistachios are nature’s super heart-healthy snack. Nutrient dense, full of fiber and antioxidants, pistachios give you more bang per calories than any other nut.”.
The other advertisement is ‘POM Wonderful’, a company that sells and promotes pomegranate juice, “POM is the only pomegranate juice you can trust for real pomegranate health benefits”
No doubt pistachio nuts and pomegranate juice are perfectly good foods. But the health claims made for them are just marketing and have very little basis in fact.
Now let’s look at the speakers. Take, for example, Dr David Heber, MD., PhD. He is director of the UCLA Center for Human Nutrition at the University of California, Los Angeles, a professor of Medicine and Public Health, and the founding Chief of the Division of Clinical Nutrition in the Department of Medicine. He is the author of several books including “What Color is Your Diet” and the “L.A. Shape Diet.” With the possible exception of the books, you can’t sound like a more respectable and impartial source of advice than that.
But hang on. Dr Heber is to be seen in a video on the Pistachio Health web site doing what amounts to a commercial for pistachio nuts.
OK let’s take a look at one of Dr Heber’s papers. Here’s one about, guess what, pomegranate juice. “Pomegranate Juice Ellagitannin Metabolites Are Present in Human Plasma and Some Persist in Urine for Up to 48 Hours”. The work was “Supported by the Stewart and Lynda Resnick Revocable Trust and from the NIH/NCI grant P50AT00151”. So no problems there. Well not until you check POM Wonderful in Wikipedia, where you find out that Stewart and Lynda Resnick just happen to be founders of POM.
Of course none of these interesting facts proves that there is anything wrong with the work. But they certainly do show that the alternative nutrition business is at least as much hand-in-glove with big business as any other form of medicine. And we know the problems that that has caused.
So, if you want impartial advice on nutrition, sign up for the 6th Annual Nutrition and Health meeting. For “MD, DO, ND & other doctors”, it will cost you only $845 to register .
The meeting is being run by The University of Arizona College of Medicine and Columbia University’s College of Physicians and Surgeons.
The University of Arizona is, incidentally, also the home of the famous (or perhaps infamous) Gary Schwartz (see also, here). He “photographs” non-existent “energy fields” and claims to be able to communicate with the dead, and he is director of its Human Energy Systems Laboratory at the University of Arizona. He is also head of the inappropriately-named Veritas Research Program and “Centre for Frontier Medicine in Biofield Science”. All of these activities make homeopathy look sane, but he is nevertheless part of an otherwise respectable university. In fact he is He is Gary E. Schwartz, Ph.D. is professor of psychology, medicine, neurology, psychiatry and surgery at the University of Arizona. Even more incredibly, this gets NIH funding.
Columbia University, along with Cornell, also has its own “Complementary, alternative, and integrative medicine“, defined as “the use of treatments, such as homeopathic medicine, ayurveda, botanical dietary supplements”. And their “Integrative Therapies Program for Children” is intimately tied up with a company called Origins, which is more a cosmetics company, Origins” (with all the mendacity that implies). They say
“Origins understands the importance of addressing wellness through an integrative approach,” says Daria Myers, President of Origins Natural Resources. “With our recent Dr. Andrew Weil collaboration, Origins demonstrated its support for the integrative wellness concept. Now, with the introduction of the new Nourishing oil for body and massage, we hope to bring not only a moment of comfort but also a healthy future to children enduring the fight of their life.”
Andrew Weil is, of course, the promoter of the Arizona meeting.
The corruption of Universities by this sort of activity is truly amazing.
| “the report is more hypothesis-generating for future research than a rigorous scientific study. Find us some money and we will do a proper job. You can quote me for that.” Professor David Smith (Oxford). Scientific adviser for Food for the Brain. |
For a quick synopsis, look at Holfordmyths.org.
Patrick Holford and Drew Fobbester are joint researchers and authors of the Food for the Brain Child Survey , September 2007 (pdf). Holfordwatch has made a very thorough study of this report, in eight parts (so far). They conclude
“HolfordWatch can not share the optimism for these claimed benefits and finds that there is insufficient data to support them in a robust manner.”
There are many detailed questions, but the basic problem with the report is very simple. The fact that is (a) self-selected and (b) not randomised make it just another naive observational study. The stunningly obvious confounder in this case is, as so often, the socio-economic background of the kids. That was not even assessed, never mind any attempt being made to allow for it.
This isn’t just pedantry because what matters is causality. It is worth very little to know that eating vegetables is correlated with high SAT score if the correlation is a result of having well-off parents. If that were the reason, then forcing kids with poor parents to eat vegetables would make no difference to their SAT score because their parents would still be poor. The only conclusion of the study seems to be that we should eat more fruit and vegetables, something that we are already lectured about in every waking moment.
Many questions about the report have not yet been answered by its authors. But the report has a panel of scientific advisors, some of whom at least seem to be very respectable (though not ‘orthomolecular medicine‘, which is a cult founded on the batty late-life beliefs of the once great Linus Pauling that Vitamin C is a magic bullet).
Furthermore they are thanked thus
As it happens, David Smith is an old friend, so I wrote to him, and also to Philip Cowen, with some detailed questions. I didn’t get detailed answers, but the responses were none the less interesting. Cowen said
“I did see the report and quite agree with your conclusions that it an observational study and therefore not informative about causality.”
“The advice about diet seems reasonable although, as you point out, probably somewhat redundant.”
But still more interesting, David Smith told me (my emphasis)
“the survey was the largest of its kind and was done on minimal funding; hence several matters could not be dealt with and so the report is more hypothesis-generating for future research than a rigorous scientific study. Find us some money and we will do a proper job. You can quote me for that, if you wish.”
I’d grateful to David for his permission to quote this comment, It seems that Holford’s top scientific advisor agrees that it is not a rigorous study, and even agrees that the “proper job” is still to be done.
But it does seem a shame that that was not made clear in the report itself.
Today is World AIDS Day, and the Society of Homeopaths is holding a meeting to “discuss the evidence” concerning the idea that you can treat AIDS with sugar pills. Needless to say, there is no evidence to discuss, but that doesn’t put them off for a moment.
Not content with killing people with malaria, some homeopaths are now into killing people with AIDS, by treating them with their funny water. That is a serious allegation, but how else can one interpret the treatment of people with serious diseases with sugar pills?
It isn’t only pharmacologists who believe that. Even the better-educated homeopaths would take a position not much different from mine. Of course they word it a bit more diplomatically than me, in a vain attempt to disguise the obvious fact that there is
now all out internecine warfare between medically-qualified homeopaths (in the Faculty of Homeopathy), and the far greater number of non-medical homeopaths (in the Society of Homeopaths, among other splinter groups).
For the malaria scandal, click here and here, and follow the links. Recall that Peter Fisher (of the Faculty of Homepaths) said of that scandal
“I’m very angry about it because people are going to get malaria – there is absolutely no reason to think that homeopathy works to prevent malaria and you won’t find that in any textbook or journal of homeopathy so people will get malaria, people may even die of malaria if they follow this advice.”
The two warring branches of homeopathy have fallen out over immunisation too.
The medical side, the Faculty of Homeopathy, recently issued a statement about AIDS.
| Statement from the Faculty of Homeopathy on HIV/AIDS 27-11-2007, 9:57 am In the light of current knowledge, homeopathic treatment of patients with HIV/AIDS should not replace, but may usefully sit alongside, conventional anti-retroviral treatment. However, the Faculty regrets that for many people in developing countries like Africa, antiretroviral drugs may not be available. . . . The Faculty of Homeopathy does not support the approach of and claims made by Peter Chappell for the use of “PC” remedies. |
Incidentally, one can’t help wondering if it is a coincidence that the Amma Resonance Healing Foundation (ARHF) has almost the same initials as AHRF, the totally respectable African HIV Research Forum. It was presumably in an attempt to gain respectability that the press release from the Society of Homeopaths, signed by Jayne Thomas, had a single link at the bottom to the National AIDS Trust (NAT). Or at least it did until the ever alert quackometer blogger told NAT about it, whereupon they were told by NAT to remove it. NAT is a serious organisation that has no truck with sugar pills.
Today Programme. The Society of Homeopaths’ conference was featured on the Today programme this morning, Hear the interview here [mp3 file, 1.6 Mb]Jayne Thomas spoke for the Society of Homeopaths. She is Vice Chair of the Society of Homeopaths, Chair of the Professional Standards Committee and Professional Conduct Director. When challenged about how they fail ever to find fault with a member, however grossly that member breaches the society’s own code of ethics, she denied everything (see links in the follow up for more on that)Jayne Thomas also said, of today’s conference
“today will afford a critical examination of those opportunities we may have to provide relief to patients”
The interviewer, Edward Stourton, said
“The ambition of the meeting sounds relatively modest. They’re just going to discuss the evidence and presumably if it doesn’t stack up to much we’ll hear that.”
I just hope that Today will have a follow-up to see what the “critical examination” will yield. Perhaps a statement from the Society of Homeopaths that there is no evidence and that it “doesn’t stack up to much”?
Somehow I doubt it. But watch this space.
Follow up
Letting off steam posted the results of a complaint against a member of the Society of Homeopaths, Sue Young. Young persistently makes claims to cure specific, serious diseases, in clear contravention of the SoH’s (utterly ineffective) code of ethics. Needless to say, the complaint got nowhere. Just read the account here if you were inclined to give a moment’s credence to Jayne Thomas’s remarks about self-regulation on the Today programme yesterday.
Quackometer has some relevant comments. In particular he points out the disgraceful and inconsistent attempts of the Society of Homeopaths to pretend that their members had nothing to do with the malaria scam.
Gimpy blog makes related points
Badscience this week is on the ball, as always, with “AIDS Quackery International Tour”
This advertisement has to be one of the sneakiest bits of spin that I’ve seen in a while. It appeared in today’s Guardian. And a lot more people will see it than will look at the homeopathic nonsense on the Boots ‘education’ site.
What on earth does it mean? One interpretation could be this. We can’t make false claims for Vitamin(s) B in print, but your Boots Pharmacy Team will be happy to do so in private. OK gang, let’s find out. Get out there and ask them. I’ll be happy to post the answers you get (one of those little mp3 recorders is useful).
The Boots web site isn’t much better. Their Vitality Overview says
“The following vitamins and supplements are important for vitality..
B Vitamins
Ginkgo biloba
Ginseng
Iron
Magnesium
Vitamin C”
Needless to say “vitality” isn’t defined and there is the slightest reason to think that any of these things help the “energy level” of any person on a normal diet.
Sting number 1
I went into a large branch of Boots and asked to speak to a pharmacist. This what ensued (BP= Boots Pharmacist).
DC. My eye was caught by your advertisement. I’m pretty healthy for my age but I do get very tired sometimes and it says “ask your Boots pharmacy team, so what can you recommend?”
BP. “Well basically it helps release energy from your cells so you’ll feel more energetic if you have enough vitamin B in your, eh, blood system”
DC. “Ah, I see, I’ll feel more energetic?”
BP. “yes you’ll feel more energetic because it releases the energy from the cells ”
DC. “which vitamin B does that?”
BP. “It’s a complex. it has all the vitamins in it.”
DC. “So which one is it that makes you feel more energetic?”
BP. “Vitamin B”
DC. “All of them? ”
BP. “All of them. It’s mainly vitamin B12”
DC. “Vitamin B12. That makes you feel more energetic?”
BP. “Yes. B12 and B6.”
DC. “hmm B12 and B6. I wasn’t aware of that before so I’m a bit puzzled. I mean, vitamin B12. I thought that was for pernicious anaemia.”
At this point I think the pharmacist was getting a bit suspicious about all my questions (and spotted the recorder) and began to back off.
BP. “Not necessarily. You know its got [pause], basically what its [pause], if you have enough in your diet there’s no need to take an extra vitamin B.” . . .”This is really for people who are on the go and are, you know, unable to get fresh meals.”
Then the senior pharmacist (SP) was called and I repeated the question.
DC. “Will it give me extra energy? It says I should ask my Boots Pharmacy team about that.”
SP. “It may do, yes. It depends on your own body’s individual reaction to it.” . . . “To be honest I’m not the best person to ask about clinical data on it. If you have more detailed questions I can send them to head office”
At this point. I gave up. The first pharmacist ended up with reasonable advice, but only after she’d obviously become suspicious about all my questions (and spotted the recorder). The senior pharmacist just fudged it when asked a direct question. Initially, the ‘expert advice’ was pure gobbledygook. What does one make of it? The fact that I got the right answer in the end, one could argue, makes the first part worse rather than better. She knew the right answer, but didn’t give it straight away. Instead she talked a lot of nonsense in which two quite different meanings of the word ‘energy’ were confused in a way that is only too familiar in the supplement huckster business. I’m not impressed.
Sting number 2
An email enquiry to Boots customer service asked whether Vitamin B really helped ‘vitality’. It elicited this hilarious non-response (original spelling retained).
| Dear Mrs M*** Thank you for contacting us regarding an advertisement you have seen in relation to the benifits to vitamin C. Unfortunately as I am not medically trained I would be unable to provide you with advice on this particular product. I would however, advise that you contact our pharmacy team at your local store via the telephone directly. You’ll find that they will be more than happy to help you further. |
Aha, so the Pharmacy Team are medically-trained?
Here is an interchange of letters from this week’s BMJ. George Lewith says more money should be spent by the government on research on alternative medicine. Well, only if it is spent properly, and that is not what has happened in the past. (Letters here, if you have a subscription.)
In all probability money spent in this way would be money down the drain, just as it has proved to be in the USA. As pointed out by Wallace I. Sampson, M.D., NCCAM has spent almost a billion dollars on research into alternative medicine, and
“. . it has not proved effectiveness for any “alternative” method. It has added evidence of ineffectiveness of some methods that we knew did not work before NCCAM was formed.”
It is a bottomless pit, and there are more promising ways to spend the money.
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| George T Lewith, Reader in Complementary Medicine, University of Southampton Primary Medical Care, Aldermoor Health Centre, Southampton SO16 5ST Send response to journal: Re: Valuing Research |
I remain unclear about John Garrow and David Colquhoun’s position with respect to “funding CAM”. Are they suggesting that there should be no funding for CAM research or are they suggesting this embargo should apply to the provision of CAM services within the NHS? If the former, how do they justify this position with respect to the many UK taxpayers who use CAM each year and for whom the government has some obligation to provide information? Competing interests: None declared |
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| John S. Garrow, vice-chairman HealthWatch The Dial House, Rickmansworth, WD3 7DQ Send response to journal: Re: Taxpayer funding of CAM research |
Dr Lewith wants clarification of my view about public funding of CAM research. It has changed over the last 7 years. In 2000 the House of Lords Select Committee (HLSC)advised the Department of Health to fund research on acupuncture, chiropractic, herbal medicine, homeopathy and osteopathy to see if these therapies were safe, more effective than placebo and good value for money, At the time I supported this decision. However in 2003 it was disclosed that £1.3m had funded 8 research projects, at the Universities of Leeds, Southampton, Bristol, Brunel, Sheffield and York, but none of these were directly testing the safety, efficacy or value-for- money of the main CAM therapies.[1] I noted that these Universities did not have as good a record of research into the efficacy of CAM as Exeter, which had applied but failed to get funding. It was also noticable that the panel awarding the grants tended to work at the funded Universities. CAM research is not so impoverished as Dr Lewith implies. The onus is now upon the researchers who received £1.3m from the taxpayer, and more from the Foundation for Integrated Health, to tell us what answers they have found to HLSC’s very pertinent questions. Only in the light of these answers can we judge if they deserve further public funding. If initially the Government had an “obligation” to fund CAM research I think the £1.3m discharged it, and now there is an obligation on CAM practitioners to show that they have not misappropriated these funds. [1]Garrow JS et al. UK government funds CAM research. FACT 8:397-402, 2003 Competing interests: None declared |
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| David Colquhoun, Prof of Pharmacology UCL Send response to journal: Re: Funding for alternative medicine research |
I agree entirely with John Garrow’s response. A corollary of his analysis is that, if there is to be any more funding for research in alternative medicine, it is essential that the allocation of the money should not be in the hands of alternative medicine people. The reason for that is that past experience has shown that they will give the money to projects that don’t answer the real questions. If no applications are received that address the proper questions with rigorous experimental design then the money should be clawed back and spent on something that has a better chance of being a real advance. I am perpetually amazed by the reluctance of advocates of alternative medicine to subject their claims to proper tests. The only interpretation that I can see of this failure is that they themselves believe, deep down, that the tests would be failed. I hope that isn’t the explanation though, because if they were convinced that the tests would fail, it would mean that we are dealing with fraud, not just delusion. Competing interests: None declared |
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A new judgment today from the Advertising Standards Authority .
A direct mailing for books by Patrick Holford, a nutritionist, contained a booklet entitled “100%health”. Headline text stated “You don’t swallow junk food. Why swallow junk health advice?” Text in a letter from the “Editor of 100%health”, Patrick Holford, on an inner page of the booklet stated
“I would like you and your family to stay healthy, free of pain and the need for drugs. But if I told you the truth in this letter, I would break the law … I’d love to tell you how powerful nutrition is, both for your mind and body. But I can’t. Why? Because advertising law prohibits me saying anything that claims to ‘treat, prevent or cure’ any condition! Even if there’s undisputed proof that nutrient ‘x’ cures condition ‘y’ I’m not allowed to tell you here. By law, I can tell you in my newsletters, but I can’t in this publication … So, excuse me if you have to read between the lines …”.
The ASA upheld a complaint against this passage
” the ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness), 50.1 (Health & beauty products and therapies – General) and 50.20 (Health & beauty products and therapies – Vitamins, minerals and other food supplements). “
Text on a separate page stated “Don’t waste your money on vitamins Myth: ‘If you eat a balanced diet you get all the vitamins and minerals you need.’ WRONG!”. The ASA upheld a complaint against this passage too.
the ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness) and 50.21 (Health & beauty products and therapies – Vitamins, minerals and other food supplements).
The code for “truthfulness” reads thus
7.1 No marketing communication should mislead, or be likely to mislead, by inaccuracy, ambiguity, exaggeration, omission or otherwise.
What a pity that Mr Holford has been judged not to live up to this criterion.
This was not a first offence either. In 2003 four complaints to the ASA about Holford were all upheld, as pointed out in the comment by Shinga, below.
Read more at badscience.net
And at quackometer
Steven Novella, MD, an academic neurologist at Yale University, runs The Skeptics Guide to the Universe: Your Escape to Reality
He is author of Weird Science , a monthly column featured in the New Haven Advocate. He is the co-founder and President of the New England Skeptical Society, Associate Editor of the Scientific Review of Alternative Medicine , and a contributing editor of Quackwatch , a consumer advocacy website dealing with all types of health fraud.
At 5 am on 12 September he phoned to record a podcast. You can here the whole thing here. It includes various items of skeptical news and an interview with James Randi too.
Steve Novella quizzed me about the circumstances surrounding the request to move my web site from UCL’s server, and we discussed the incursion of endarkenment values into universities and politics. My bit is here.
It sounds as though Tennessee pharmacist, Larry Rawdon, is in trouble. According to a report in the Tennessean (11 Sept, 2007)
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Then, in authentic Tennessee style,
“Rawdon calls his approach to health care “Health God’s Way.” It’s a form of naturopathy” using natural remedies such as foods, herbs and minerals to treat illness. Naturopathy is legal in some states, but not in Tennessee.
“It’s not me healing people, it’s God,” Rawdon said.
“God sent Joshua into the Promised Land and told him not to destroy the fruit trees because in them is a man’s life that he can eat and live,” he said. “So the life force that is in the fruits and vegetables, it’s what our cells need for the healing process.” ”
. . . .
The Board of Medical Examiners found Rawdon guilty of treating patients without a medical license in addition to practising naturopathy.
Now “Dr” (of pharmacy) Rawdon seems to work for Wellness America (no mention there of the fine). Their mission statement is
| Our Mission is to gather, educate, and empower individuals to take control of their health and wealth by applying biblical principles to their everyday life. To promote prevention of illness, wellness from sickness, fitness for the body, freedom from debt, and health for the whole man BODY – SOUL – SPIRIT. |
You couldn’t make it up.
Very interesting uh? Someone fined a million dollars for pretending to be able to cure serious diseases by nutrition and supplements. I wonder if that could ever happen here?
I have received today (11 September 2007) a rather threatening letter from Patrick Holford. He says
“I am writing to you directly to complain about both your article in The Guardian of 15 August, in which you falsely claim that my advocacy that Vitamin C is better than conventional drugs to treat AIDS is “truly scary”, and in respect of the equally false claims you have posted on your website, DC Improbable Science, particularly in relation to Dr John Marks.”
He ends, more threateningly,
“I nonetheless believe it appropriate that you withdraw the allegations you have made and apologise for making these unwarranted and defamatory allegations. Provided that we can agree the wording of an apology and the removal of the false claims, I am prepared to leave it there. However, I fully reserve my right to take this matter further should my complaint not be resolved to my satisfaction.”
Here are responses to these two allegations.
(Some follow ups on this post have been added below)
Vitamin C and AIDS
What does Holford actually say about HIV/AIDS? On page 208 of his New Optimum Nutrition Bible (2003) we read (see Google books)
| “Yet for the last 100 years, medicine has focused on drugs designed to destroy the invader -antibiotics, anti-viral agents, chemotherapy. By their very nature, these drugs are poison to the body. AZT, the first prescribable anti-HIV drug, is potentially harmful and proving less effective than vitamin C (23)” |
You can read this paper here. If you get that far, you might well be surprised to find that it is not a study of people with HIV/AIDS, but merely shows that vitamin C can, under lab conditions, inhibit HIV in cells in a dish. You might be even more surprised that the paper does not compare vitamin C and AZT. In fact AZT is not mentioned at all (except for a brief reference in the discussion).It is true, that on his web site, as opposed to his book, Holford expands on this theme a bit. For example here he says. of reference 23,
“Ref 23. These in vitro studies on human T-cells shows that vitamin C suppresses the HIV virus in both chronically and latently infected cells, while AZT has no significant effect. It is a tragedy that this simple, non-toxic treatment hasn’t been further tested. ”
Harakeh S, Jariwalla RJ.Ascorbate effect on cytokine stimulation of HIV production. Nutrition. 1995 Sep-Oct;11(5 Suppl):684-7.
But the reference given here (which does use AZT) is not reference 23 (which does not test AZT at all). Holford himself acknowleges that his book cites the wrong reference in his book.
Holford also forgets to mention (or perhaps didn’t notice) that the concentrations of Vitamin C that are used in these in vitro studies are something like 10 times greater than can be achieved in man even with very high oral doses,
More recently he has backed off a bit. For example, here he says
“There is no doubt that anti-retroviral drugs save lives. So too may high dose vitamin C, but we just won’t know until the definitive research trial is done.”
Why, one wonders, has Holford not done studies in man himself? His name does not appear in the research literature at all (search Pubmed for ‘Holford PJ’ yourself). And Holford is not a poor man.
It still seems to me that anyone reading his New Optimum Nutrition Bible (2003) will be misled into thinking that Vitamin C is better than AZT for curing HIV/AIDS in man.
You can read more interesting stuff on this question at Holfordwatch.
What did Dr Marks actually say?
I’m accused of malicious behaviour, because I posted a letter from Dr Marks which set out his present views All I did was ask Dr Marks about what happened, and, with his encouragement, published his
answer. I also suggested to Dr Marks that he should write to Holford to ask for the basis on which Marks was quoted. When Marks received no reply, we decided to go ahead anyway.
I am, therefore, very grateful to Mr Holford for sending me a letter, dated 16 September 1997, that was sent to him by Dr Marks. The whole letter can be downloaded here.
It seems that in the ten years since that letter was written, Dr Marks has changed his mind a bit about Holford. but the main interest attached to the letter is the selective quotations that have been made from it.
In his 1997 letter to Holford, Marks says “On the basis of this I am entirely happy for you to quote as much or as little of the following comments as you wish. If you change the order of phrases or omit portions of sentences I am confident that you will not alter the general sense”.
Judge for yourself whether the general sense has been changed in this case.
Dr Marks said (in 1997)
“There have been dramatic changes over the past decade in our views about that area of health care which comes under the general term “alternative medicine” and Patrick Holford, author of this book has been right at the forefront of many of these changes, particularly those associated with our revised appreciation of human nutrition. I commend this book to you on the basis that it is well researched and written with a substantial backing ofreferences from reliable and peer reviewed scientific and medical journals.
I do not accept all his conclusions and I suspect that his other readers will not agree with all that he says. On the other hand there is considerable food for thought in each chapter and adequate arguments on which you will be able to make up your own mind about the ideas which he puts forward. The road to bad medicine and bad health is built on the foundation of dogma and it is very refreshing to have, in a single readable volume, much of this dogma subjected to fresh examination.”
Compare this with the quotation attributed to Dr Marks in the CV which was submitted by Holford to the University of Teesside.
“There have been dramatic changes over the past decade in our views about healthcare and Patrick Holford has been right at the forefront of many of these changes, particularly with our revised appreciation of nutrition. The road to bad medicine and bad health is built on the foundation of dogma. It is refreshing to have this dogma subjected to fresh examination.”
So what happened to the bit where Marks refers to the work as “Alternative Medicine”.
And what happened to the bit where Marks says “I do not accept all his conclusions and I suspect that his other readers will not agree with all that he says.”
They seem to have vanished without trace.
I rest my case.
Some comments that followed this post
At Holfordwatch “Patrick Holford Refers to Someone Else as Inaccurate”.
And at Quackometer ” Patrick Holford – No Comment”
Curiouser and curiouser. Not only have we the curious case of Dr Marks, but Holford’s CV on his web site, and as submitted to the University of Tesside, has alway said that his degree from the University of York in experimental psychology was taken in 1973 – 1976. But an enquiry to the registrar of the University of York, elicited this response.
| Dear Professor Colquhoun Your enquiry about a claim to hold a degree from the University of York has been passed to me. I can confirm that a BSc in Psychology was awarded to a P J Holford in 1979, as published in the Yorkshire Evening Press on 7 July 1979. Sue Hardman Academic Registrar University of York |
Read much more about all these inconsistencies at Holfordwatch and at Quackometer.
Update 17th September 2007
Another email today from the Registrar reveals that Mr Holford got a 2.2 degree.
One of the effects of this affair has been the posting of some critical examinations of some of the writings of Dr Ann Walker. I make no comment. The links are here.
This item appeared originally on the old IMPROBABLE SCIENCE page
The reversal of UCL’s request to remove this page from UCL’s server was, in large part, the result of the power of the blogosphere. Here are some of the things that did the trick.
“Moved to tears by the beauty of blogs”. Goldacre wraps up the affair in the Guardian, and on badscience.net (“Stifling Debate – When Bloggers Attack”).
He gives links to the close examination of the work of Dr Ann Walker that that is now appearing.
“UCL have just issued a smashing statement on Prof Colquhoun’s de-excommunication.” Comment from badscience.
This episode seems to have sparked a close inspection of some of the claims made by Ann Walker. Here are some examples.
“Dr Ann Walker and Her Neanderthal Theories”. An analysis of Walker’s theory about the Neanderthal diet, on the quackometer blog. Goldacre comments
“In one piece, Walker promotes the idea that neanderthals were not a distinct kind of human, but degenerate and malnourished versions of ordinary humans: buy pills or regress to a sub-human state, seems to be Walker’s message. Yikes.”
“Ann Walker festival: “There is no convincing evidence that Ginkgo biloba is efficacious for dementia and cognitive impairment” ” Holfordwatch takes a cool look at more claims by Ann Walker.
“Red Clover comments leave a bitter aftertaste” Click here
“The War Against Gobbledygook” Comment from Astrophysicists.
“UCL Makes good” Comment from the University of Minnesota
University Diaries. A US Professor of English reproduced Ben Goldacre’s first
article.
“Science bloggers unite” Comment from a Yale neurologist.
“The Guardian: a quackbuster . . . “ Comment from MIT (and it’s on the MIT server).
“UCL change tack: Colquhoun is back” The Sceptical Preacher speaks
Freedom of speech and litigious herbalists
Announcement 13 June 2007. UCL restores
DC’s IMPROBABLE SCIENCE page.
After taking legal advice, the provost and I have agreed a joint statememt.
Read it on the UCL web site.
“ . . . the Provost and Professor Colquhoun have taken advice from
a senior defamation Queen’s Counsel, and we are pleased to announce that Professor Colquhoun’s website – with some modifications effected by him on counsel’s advice – will shortly be restored to UCL’s servers.”
I am grateful to UCL for its legal support, and I’m very grateful too for the enormous support I’ve had from many people, especially since Ben Goldacre mentioned the site move. Now all I need is a bit of help to get it into a more convenient format. The page will stay at its present address until there is time to sort things out. For some of the fallout from these events, click here. The name of the page has been changed from quack.html to improbable.html on the advice of lawyers, but the old addresses still work.
Announcement 30 May 2007.
My item about claims made for alleged benefits of the red clover and other herbs has resulted in complaints being made to the provost of UCL (Malcolm Grant), and to Chair of Council (Lord Woolf). The complaints have come from Alan Lakin, husband of Ann Walker. I have received no complaints from them myself.
In the six or years that I have been running this attempt to improve public understanding of science, I am aware of only two serious complaints being made, and as far as I know, this is the first to reach the level of the provost. This one resulted in a request to remove of this page from the UCL server, but that is now reversed.
One year from our first letter to NHS Trusts, we sent another. Listen to the interview by John Humphrys on the Radio 4 Today Programme, with Raymond Tallis and Peter Fisher. :And hear Fisher suggest that he works for UCL (not true). You can also download a summary of the current evidence in the form of an example commissioning document which accompanied our letter.
May 23, 2007. A year ago, our letter to NHS Trusts urged them to stop paying for “unproven and disproved treatments”. A year on, we sent a second letter. Read it here.
On May 23 2007, John Humphrys introduced coverage of this on the Radio 4 Today Programme with the words
“Doctors who think homeopathy is a waste of time and money seem to be winning the argument”
To listen to his interview with Raymond Tallis and Peter Fisher click here. In the interview, Peter Fisher not only misrepresented the evidence, as usual, but also he said
“We are integrating it [homeopathy] within NHS services in University College London which is one of the leading, you know, biomedical centres in the country.”
Hang on a moment! I’m glad that Fisher thinks that UCL is a “leading biomedical centre”, but he does not work for UCL (which is a university), but for the UCLH Trust, which is an NHS Trust. This shameless attempt to use the reputation of a quite different institution to bolster his case smacks of desperation (not to mention mendacity).
After Fisher’s emphasis on “integration”, Tallis commented
“The use of the word integrate is interesting. I mean I suppose you can regard combining medicines that don’t work with medicines that do work as a kind of integrative approach . . “;
The evidence
Our second letter to NHS Trusts said “If you have not already reviewed your own trust’s provision, you might find it useful to consider, in conjunction with your Director of Public Health, the paper that we have enclosed which, while not a full review of the scientific position, has been used by other trusts to promote evidence based commissioning.”. This letter has a summary of the evidence,
Good reports in the newspapers include
“Hard-up NHS trusts cut back on unproven homoeopathy treatment”: Mark Henderson in The Times
“Doctors renew drive to ban NHS homeopathy”: James Randerson, in the Guardian
[This post has been transferred from my old IMPROBABLE SCIENCE page]
Follow-up
Homeopaths have been harping on about our alleged misuse of the NHS logo, ever since this second letter was sent. It is often said that the letter was sent under the NHS letterhead. As so often, they don’t bother to check. There was no NHS logo on the letter. The only place the logo occurred was on the sample template fo commissioners that was sent with the letter. That template has always been available for download from this post. It is very obviously intended to be a template, with sections that are to be completed by commissioners highlighted. There is no way it could be taken to be representing itself as a letter from the NHS. This is how it starts.
A new paper, with a very large sample, almost 300 000 men, shows an association between taking large doses of multivitamin supplements and death from prostate cancer. But this, like most observations on diet, was not a randomised study. The paper itself discusses the interpretation carefully. The reports in the newspapers did not.
Read more on the original IMPROBABLE SCIENCE page
A particularly powerful plea to forget homeopathy from Michael Baum, based on his experience as a cancer surgeon.
Read more on the original IMPROBABLE SCIENCE page