The Quackometer

Andy Burman, Chief Executive of the British Dietetic Association, appears to have resigned his post from the Complementary and Natural Healthcare Council (Ofquack).

This news follows my recent criticism on this site of the BDA for not doing enough to educate the public about the difference between pseudoscientific Nutritional Therapists (as to be 'regulated' by Ofquack) and professionally trained and regulated dietitians (as currently represented by the BDA). This came in the wake of the news that a brain damaged woman had been given £810,000 by the insurers of self-styled nutritionist Barbara Nash. I commented that the situation was being made worse by the emergence of the ill-conceived, government sponsored and Prince Charles driven, CNHC. Ofquack will not protect the public from the practices and commercial motives of Nutritional Therapists and will do nothing to improve the public understanding of nutritional science - indeed, it will substantially undermine it.

It was therefore something of a shock to read a comment left on my blog that said that Andy Burman, Chief Executive of the BDA, was on the board of directors of the newly emerging Ofquack. The commenter said, "Instead the management of the BDA is actively undermining their own members." My simple response was that the BDA was therefore doomed.

It would appear that I have poked a sharp stick into a dyke of sleeping dogs and unleashed a hornet's nest of discontented angry bear dietitians. What became clear, by further comments on my web site, was that many grass roots dietitians were livid about the situation. A selection of some of the comments follows:

I wonder how much time Dieticians spend disabusing the general public of some wacky notion they have picked up from non evidenced based nutritional practitioners?

Might as well all raise a white flag to McKeith, Holford et al and face the fact that evidence based nutrition is a dead duck.

Is the chief exec of the BDA further providing legitimacy to the very nutritional therapists that are a danger to the public and in doing so professionally humiliating his own members?
Yes.
Should dieticians now be demanding a change of direction and chief exec at the BDA or just abandoning the pointless organisation?
Yes.

I am a proud HPC registered Dietitian and up till recently I was also a proud member(albeit diminishing) of the BDA. However on discovering that my very own Chief Exec Andy Burman is, a member of the Complementary and Natural Healthcare Council's Federal Regulatory Council I am truly mad and embarrassed.

It looks like a storm was brewing. Indeed, Andy Burman appeared to feel it necessary to leave his own comment on my blog. In that comment, Mr Burman defended his role at Ofquack and the need for the organisation itself. Also, on his biography on the Ofquack website, he says,

Andy is committed to voluntary self regulation within complementary healthcare and honoured to be part of this new development.

This defense did not appease his critics. Further comments ensued.

I'm sorry - I find the response from the Chief Exec of the BDA beyond belief. How can you possibly maintain standards for stuff that doesn't work? All you will do is provide legitimacy to those practitioners who do not maintain the high standard of your own members (who, by the way - must be absolutely livid that you are choosing to tacitly support quack therapists by providing legitimacy to them via regulation).

Ladies and Gentlemen It's time to reclaim the place that is rightfully ours and maybe look at who we choose to represent us -because let's face it in any other business our PR agency would have been well and truly fired by now!

I'm also very concerned at the news about Andy Burman. Maybe we should be reviewing his position as CEO of the BDA.

I think Andy has made his position untenable - the membership is mad as hell. Those of us who work in the private sector have all dealt with clients that have seen these therapists - some of the rubbish they sprout is quite unbelievable. The new council I think is a sham - and the NTs themselves do not want any more reg because they will end up halfing their income from all the supplements they sell [The BANT code of 'ethics' explicitly allows Nutritional Therapists to take commissions on supplements they sell. - LCN]

The final comment today from an anonymous dietitician reads,

I understand that Andy Burman has resigned from OfQuack. Good news for dietitians.

Although, I have not has direct confirmation of this yet, it is backed up by the disappearance of his biography on the Ofquack web site (compare the current version with Google's cache). This was the very least that should have happened. It is obvious that some people believe that the involvement with Ofquack has undermined his role as Chief Executive at the BDA.

Ofquack was founded as a result of a monumental governmental mistake. The House of Lords, in 2000, recommended the government look into the proper regulation of alternative medicine. It was concerned that the public was not sufficiently protected from the alternative medicine trade and recommended that ways were sought to ensure practitioners were well trained, safe and effective in what they did. In an act of blazing naivity, the government saw fit to hand over this responsibility to Prince Charles and his bizarre organization, the Foundation for Integrated Health. The task defining what regulation should look like was handed over to the very people that cause the problem with their loony beliefs.

The result was predictable. FIH took to the task with gusto, forming important looking committees and consultations. The only thing dropped from the Lord's recommendations was the question of efficacy. Ofquack are only interested in showing that boxes can be ticked regarding training. It does not matter one iota that the practices of those they seek to regulate do not work.

Indeed, this was against the very wishes of the House of Lords. In their summary they said,

Many CAM therapies are based on theories about their modes of action that are not congruent with current scientific knowledge. That is not to say that new scientific knowledge may not emerge in the future. Nevertheless as a Select Committee on Science and Technology we must make it clear from the outset that while we accept that some CAM therapies, notably osteopathy, chiropractic and herbal medicine, have established efficacy in the treatment of a limited range of ailments, we remain sceptical about the modes of action of most of the others. We therefore emphasise that in recommending the regulation of training in CAM we specifically exclude training in the asserted modes of action of many CAM therapies. We do so because regulation could lead to a misleading public perception of improved status; such regulation is in fact an attempt to safeguard the public. (My emphasis)

It looks like our vestigial feudal wing of government can duly show wisdom and insight when required, even in the face of their overlord, Prince Charles. Magna Carta rocks.

Despite Prince Charles FIH’s stated commitment to evidence based alternative medicine being ‘integrated’ with real medicine they avoid the evidence base like the plague. They embrace nonsense healing rituals like homeopathy and reflexology without appearing embarrassed about the utter lack of credibility for these techniques. Just check out their site. Can you spot any alternative medicine that Prince Charles says to avoid because of its lack of a credible scientific evidence base? I can see no reason why the claims of nutritional therapists will not be treated in exactly the same manner. As long as they can claim to hold some sort of training they well get the Ofquack seal of approval. The content of that training will not be important.

Andy Burman, in my opinion, is making the same mistake that everyone in the sorry tale of Ofquack is making - that the way to protect the public is to regulate the trades of alternative medicine in the same manner that you might regulate real medicine. The flaw with this idea is that you cannot regulate nonsense. Professor David Colquhoun has demonstrated the central weakness of Ofquack in the THES and on his own blog (1) (2). Is a homeopath a safer practitioner because they have successfully completed the modules that teach them that illness is caused by imbalances in the Vital Force and that a medicine's effectiveness increases with more dilution? Does a Nutritional Therapist, after completing professional development courses in Hair Mineral Analysis or Allergy Testing offer a better service to their punters or allow them to fleece the public better with fraudulent pill selling techniques?

We do not provide astrologers and psychics with state money to set up their own self-regulatory bodies. Instead we allow existing mechanisms to ensure the worst of their practices are curbed by using the Advertising Standards Authority and Trading Standards to warn and prosecute where necessary. And it does not matter if a quack genuinely believes that reflexology foot massages can help you with constipation (or whatever). Many people genuinely believe pyramid selling schemes can get you rich. We do not offer accreditation and state regulation to the owners of pyramid schemes - no, we educate the public about their dangers and prosecute those who profit.

If we believe the public should have some protection from quacks, the answer is two-fold: public education and prosecution. Not accreditation and meaningless self-regulation that only serves to aggrandise. And in anycase, Ofquack is a dead duck and is doomed to whither, mainly because the quacks do not want to be regulated by any sort of outside body and self-regulation cannot compell them to become registered. In short, a monumental folly.

The BDA could and should be offering more public education. Every time there is some self-appointed and under-educated nutritionist on the day time television couches, the BDA should be ensuring the producers know what unstable ground they are on. In Germany, they fire TV nutritionists who spout nonsense and self-servingly promote their own quack products. We should be doing the same here. The BDA should be ensuring that the public see dietitians as the first port of call for dietary advice - not the last, after the nutritionists nuts have filled peoples' heads with dietary nonsense. And the BDA should be assisting the authorities where necessary to enforce existing advertising and trading standards legislation. The legislation is not perfect, but is a damn good start.

Can Andy Burman do an about turn and work with his colleagues at the BDA to this end? Let's hope so.

Labels: Natural Healthcare Council, nutritionist, ofquack, Prince Charles

 

Barbara Nash is a nutritionist based near Oxford. Dawn Page was overweight and sought the advice of Nash. It is alleged she was put on a 'detox diet' which included drinking lots of water and consuming no salt. If true, the result was very predictable.

Mrs Page suffered 'uncontrolled vomiting and a fit' and was rushed to intensive care. The Oxford Mail now reports she has brain damage. Her husband sued Dawn Nash and her insurers have paid out £810,000 in a settlement for compensation.

It is worth noting that Nash's barrister said she was a.

"privately trained nutritionist", and emphasised she continued to deny she was in any way to blame for what happened.

Barbara Nash appears not just to offer detox diets but also sells on her web site kitchen smoothie makers, blenders and juicers that cost more than a thousand pounds.

Anyone can call themselves a nutritionist. Only Dietitians are guaranteed by their training and professional memberships to be fully competent in what they do. Sadly, the proliferation of under trained and badly trained nutritionists is growing unchecked. Universities are in on the act taking money from students to train them as 'nutritional therapists'. Such degrees, from the likes of the University of Westminster School of Magic, are a disgrace. Privately owned colleges appear to offer legitimate diplomas, but their standard of training is unchecked.

But the TV and the Sunday supplements are full of the stupid and dangerous advice about detox and vitamin pills and superfoods and allergy tests. It is quack nutritionists, rather than medical dietitians, who own the media and the attention of the public. It is a handy commercial partnership of supermarkets, quacks, health shops and pharmacies selling pills and tonics and books and over prepared foods.

And the government is not helping. Their new Prince Charles sponsored body Ofquack intends to regulate nutritional therapists. It will give them a veneer of professionalism without protecting the public one little bit. Ofquack refuses to regulate the practice of their members (what they believe and do) and only certify that they have been trained by other quacks and carry insurance.

Personally, I think the British Dietetic Association cannot escape some blame here for the growing rise of nutriquacks. This is the proper organisation that regulates real dietitians. They should be as mad as hell that their turf has been invaded by anti-science know-nothings. I am sure their members have to deal with the catastrophic results of patients who have been misinformed by nutritionists everyday. Where is the noise they ought to be making? Why are they not telling the public and government that something is terribly wrong here with they way we view food and the self-appointed gurus who profit from our confusion?

Until this is sorted out, I expect we will be seeing an ever increasing number of stories just like this.

Labels: barbara nash, detox, Natural Healthcare Council, nutritionist, ofquack, the law

 

Maybe we are witnessing the death throes of the MMR controversy. The arguments that autism is caused by the triple-jab have been shown to be without merit and only the foaming go on about mercury in vaccines anymore (MMR never had any mercury in it). Andrew Wakefield is scrabbling with his last gasp of PR before his GMC disciplinary meeting. Undoubtley, the die-hard campaigners will see a cover up and conspiracy, but there is evidence now that other autism cuplrits are being sought.

Enter the electrosensivity lobby. I have stated my worry before that the organisations that supposedly support people who claim to be electrosensitive are doing their supporters a disservice by not being open minded to the causes of the problem. Ignoring science, or being selective about it, will open a multi-dimensional portal into an evil world of quackery. We have seen innocent Independent journalists already succumbing to fraudsters and quacks. Next up, is electrosensitivity regular Sarah Dacre.

Sarah has found meaning in her illnesses by blaming electromagnetic radiation. She was told that radio waves are the cause of her suffering by an 'expert' in flower esscences. She has been ably supported in that conclusion by Rod Read of electrosensitivity.org.uk. Rod goes a bit potty if you suggest that Sarah's illness has to do with anything other than radio waves. The delusions are re-inforced.

And now Sarah is reporting on Rod Read's pages that a new 'Pilot Treatment' has been found for her illness.

Dr George Carlo and Tamara Mariea are preparing to conduct a one month pilot ES/EHS treatment for 3/4 EHS in late October/November 2007. The Internal Balance clinic is located in Franklin, Tennessee.

The treatment protocol working on the degree of membrane sensitivity syndrome exhibited by each individual, is being written up currently and will be circulated to any interested participants. The costs will include accommodation, travel and clinicians and tests.

Dr George Carlo is well known in this field. He is prominent in supporting organisations that push the idea that mobile phones and Wi-Fi cause ill health. See him with some MPs here.

Dr. George Carlo, Ph.D, M.S., J.D, is a public health scientist, epidemiologist, lawyer, and the founder of the Science and Public Policy Institute.

A scientist and a lawyer! An interesting combination when litigation starts. You may remember him when he got angry at Ben 'Andrew' Goldacre's comments on the electrosensitivity lobby.

Anyway. Tamara Mariea CCN, CERCA (picture above) is new to us. Her web site shows she is working with Dr Carlo on a (as yet unpublished) paper on links between electromagnetic radiation and autism. Her ideas are as follows:

Although Mariea believes that autism is a complicated condition that must have several factors at play for a child to fall to this diagnosis, she does believe that the three largest factors at play are:

• Genetically determined detoxification capacity,
• Early insult to immune system via contaminated vaccines and
• Being born with high levels of toxic burden and into a technologically advanced society riddled with ever increasing levels of radiation.

These are the key areas for research regarding the cause and etiology of autism spectrum disorders. Perhaps the genetic mutations that are being discovered in autism research are created through the DNA damage from radiation emitting devices used by families and in the households of ever member of our global society.

So there you have it. MMR is not enough anymore. You have to have some 'vaccine damage' plus DNA damage from mobiles and Wi-Fi, and a poor ability to 'detoxify'.

Tamara is a nutritionist. That is what her certifcates say, proudly displayed on the web. Athought, the certifying body of her certificates (Clinical Nutrition Certification Board (CNCB))has been described as 'questionable' and 'promoters of highly dubious practices' by QuackWatch.

She also has the letters CERCA after her name. This stands for 'Certified Electromagnetic Radiation Safety Advisor'. A quick search reveals that in order to gain these prestigious letters after your name you have to answer 45 multiple guess questions set by Dr George Carlo, and get 80% right. I hope George, her collaborator, was not too harsh on her.

So, Sarah Dacre is going over to Tennessee for some detox of toxic heavy metals, nutritional advice no doubt, and other 'therapeutic interventions to detoxify these trapped toxins from the body'.

The Internal Balance, Inc. studio is outfitted with state-of-the-art equipment that opens and detoxifies the body, or pulls the toxins that are negatively affecting people’s health, out of their bodies. Often when children see the studio for the first time they think it looks like a place where astronauts might hang out.

And I thought astronauts hang out in bars like the rest of us. Or at least those without restraining orders.

For Sarah though, she has a problem. Travelling all that way, surrounded by airport Wi-Fi, passenger mobile phones and aircraft electronics could be very debilitating. Luckily, George and Tamara have thought of that one. They say,

The 8 hour journey and airport routine is a challenge but Dr Carlo/ Ms Mariea are to consult NASA for their best recommendations.

The little black duck is speechless. But I too must consult NASA next time I have some tricky travel plans.

.

Labels: electromagnetic quackery, MMR, nutritionist

 

In this story, a supplement industry spokesperson resorts to Creationist 'Science' for their evidence to support the 'crucial' nature of supplement pills, shows how we should eat like Inuits, without the messy business of catching fish (or dying young), and has a pop at one of the UK's most respected academics when he dares to point out some herbal gobbledegook.

A quackometer refrain is that where you find people saying that you cannot get the nutrients you need through diet, you will find a supplement pill pusher. And a new pill pusher has come to light this week: Dr Ann Walker, spokesperson for the Health Supplements Information Service (HSIS), a body set up to be an,

educational programme to present facts about health supplementation in a simple, a straightforward way. We aim to empower consumers with knowledge about nutrients and their crucial role for a healthy living.

Crucial, eh? Given that the HSIS is made up of many large and small business that try to flog nutripills to us, then we might expect strong marketing language. Why take those disgusting little pills if they were not crucial?

So what evidence are we given for the 'crucial' nature of supplements? How does the science stack up and should we rely on such evidence? Let's see what Dr Walker has to say on the subject.

But first a bit of background: Dr Ann Walker looks like a busy person. As well as work with the HSIS, she runs a herbalist training school with her husband, has her own herbalist private practice open twice a week, and still finds time to supervise studies in Human Nutrition in the Hugh Sinclair Unit of Human Nutrition at The University of Reading.

However, the one of Britain's most eminent scientists, Professor David Colquhoun FRS, has pointed out that Dr Walker's association with the University counts as about one tenth of a full time job. He also commented that she signs herself as a Senior Lecturer at Reading when trying to comment on the negative effects of supplements without declaring her interests as a spokesperson for the industry. The straw on the camel's back was exposing her herbalist web site as touting 'gobbledygook' when it suggests that Red Clover is a 'blood cleanser'. The term has no scientific meaning. All this resulted in Dr Walker's husband complaining to the Provost of University College London about Professor Colquhoun and his web site. The complaint alleged defamation and breach of copyright. Ann and her husband had not complained to Professor Colquhoun directly and had not answered his request for them to explain what a 'blood cleanser' was and why this was not gobbledygook.

Threatening legal action and complaining to the University without addressing David directly is a bit unsporting. Why would you do this if your views on herbal treatments stood up to examination? A simple email to David, pointing out his errors, would surely suffice? The fact that this has not happened rings alarm bells. And so, I felt it worthwhile looking at some of the other claims that Dr Ann Walker makes to see if they too support the popping of supplement pills.

Dr Walker writes articles for the Healthspan web site, which claims to be the 'largest home shopping supplier of vitamins and supplements in the UK. Tax free prices. Free P&P (UK)'. Her articles for the site are linked to various supplements and give reasons why purchasing such products are 'crucial'. I am going to pick on the first article in her list and see if it contains good reasons to buy a supplement or two.

The article is entitled 'Did cavemen get arthritis?' and is an attempt to explain why we should be buying Omega-3 and Vitamin D pills. It starts off,

We often hear that the ideal diet to prevent all chronic diseases, including arthritis, is the Stone-Age Diet, which was believed to be based on the meat of hunted animals and the leaves, roots, seeds and fruits of gathered wild plants. Did the ancient Stone-Age diet really combine the best features of what we now call healthy eating? In this article, the links between evolution, nutrition, dietary change and arthritis are explored in relation to archaeological evidence.

It is not clear where we can hear that diet can prevent all chronic diseases. This sort of claim is typical of nutritional therapists and is highly controversial, mainly because there is little evidence for it.

Dr Walker continues,

The earliest known case of human arthritis was found in a cave at La Chapelle-aux-Saints, France in 1908. It was the bent-over frame of a Neanderthal Old Man, who lived 60,000 years ago. His ape-like spine was responsible for the myth that the Neanderthals were one of the missing links in human evolution. But subsequent finds suggest that they were regular humans who just looked a little different from us and that their skeletal deformities were due to diet.

The specifics of the dietary problems are explained as follows:

During the Ice Age, Neanderthals lived in dark caves and probably suffered from vitamin D deficiency due to a lack of sunlight. Hence, if their diet was low in fish, they not only missed out on its rich vitamin D content, but also on its omega 3 fatty acids, with consequent risk of the development of soft, deformed bones and arthritic joints.

The first word that springs out here is 'myth'. Now, the question of whether Neanderthals are our evolutionary ancestors, or our cousins, or even hybrids, has been the subject of much debate and research, But to call it a 'myth' is a bit odd. The next bit is even stranger. Dr Walker claims that subsequent finds now prove that Neanderthals were just plain old humans, maybe a little odd looking, but with dietary problems. Specifically, a lack of Vitamin D would have caused rickets and deformed their bones.

These sorts of arguments about Neanderthals are quite common on the web. However, you will not find them on science web sites but on web sites displaying the rantings of creationists and so-called Intelligent Design advocates. These arguments are important to the creationists. The existence of Neanderthal bones, along with fossils from other homo species, are excellent evidence that archaic forms of humans existed, quite distinct from ourselves, and that evolution can explain their development from earlier, more ape-like ancestors. This is bad news for creationists who like to pretend that no such 'missing links' exist. And so the dissemblers on such sites paint these bones as those of diseased normal humans. A good example of the type of argument can be found on the All About Creation web site. The phrasing and style of argument displayed here is remarkably similar to Dr Walker's site.

The idea that Neanderthals were deformed and diseased ordinary humans has a long heritage, going as far back as the 19th Century German Anatomist Rudolf Virchow, who examined the skeleton of a Neanderthal and pronounced it a victim of rickets and a good bludgeoning around the head. By the beginning of the 20th Century, such ideas had been proved to be nonsense and now they are only to be found on christian literalist web sites (and the odd vitamin sales site).

We now have a much better view of what the Neanderthals were. Far from being backward, diseased and brutish, our cousins were in fact highly successful colonisers of Europe and the Near East. They thrived for hundreds of thousands of years and their remains have been associated with complex hunting and tool making, control of fire and cultural artifcats. Whereas the later arriving sapiens adapted to the harsher environments of Europe though technology, Neanderthals survived through physical adaptions. Their bodies were not diseased but strong and stocky in order to conserve heat and hunt effectively. Their bodies show no signs of rickets. Rather than having the grossly weakened and twisted bones of a rickets victim, their bones are 50% stronger than ours and show none of the usual symptoms of the disease. Why they finally died out, and our own ancestors survived, is still being hotly debated as more evidence comes to light. However, it might be worth noting that the natural assumption that modern humans were far superior in their adaptions for the modern world may yet turn out to be hubris. Neandethals may yet turn out to have a longer dominion over their world than we do.

To further the idea that we will become more Neanderthal like if we don't take our Vitamin D and Omega-3 pills, Dr Walker goes on to more theories about fish oil in the diet of earlier humans. She says that intakes of "vitamins, minerals and phyto-chemicals, such as flavonoids, would have been much higher than today" and this may have made possible brain growth. It is not clear why she believes this.

But, in support of at least part of this, she cites the work of Professor Michael Crawford who published a theory in a 1989 book that early humans would have had to eat large quantities of seafood in order to get enough omega-3 for brain growth. This idea has been incorporated into what is known as the aquatic ape theory, an interesting but controversial idea that early human evolution must have gone through a phase where our ancestors lived in water. The theory is supposed to explain various odd human features such as our ability to hold our breath and swim and our nakedness. The aquatic ape theory has not gained acceptance as so many of the features the theory tries to explain can be explained in other ways. In similar ways, the fish-eating ape theory of Michael Crawford has been argued to be unlikely. John Langdon recently published a paper in the British Journal of Nutrition that reviewed the literature to see what support there may be for the theory and found that there was probably no need for an extreme fishy diet.

Dr Walker goes on,

There seems to be little doubt that many current health problems result from a mismatch between our genetically determined nutritional requirements and our modern diet. According to numerous studies, the Stone-Age diet, high in fruit, vegetables and fish, is still the best for modern humans to reduce their risk of
chronic diseases

So, far Dr Walker has given us little to convince us of the idea that chronic problems such as arthritis are due to our deviation from a stone age diet. Indeed, the leap to the 'crucialness' of taking supplement pills is even more absent. Why not just advise people to have a diet high in the food stuffs our ancestors ate?

Finally, Dr Walker says,

Interestingly, glucosamine and chondroitin (now widely used as supplements to reduce the symptoms of arthritis) are both sourced from marine life. The health benefits of seafood may explain why Greenland Inuits have one of the lowest rates of arthritis in the world.

This article is getting far too long now to look into the glucosamine and chondroitin claim, so I am happy to pass over to Coracle on Science and Progress to see what weight this bears. However, Dr Walker tries to convince us that Inuits have low levels of arthritis and this may be caused by a high fish diet. However, others think that such disparities, if they truly exist, may well have genetic components. It is also worth noting that Canadian Inuits have a life expectancy 10-15 years lower than the average Canadian. Whilst there are many factors that will play a role in this, it has been noted that the Inuit diet must have one the lowest intakes of fresh fruit and vegetables in the world.

The whole hypothesis that our caveman ancestors had superb diets that we can only emulate by buying supplements from Dr Walker's sponsors must be ridiculous. Today's western consumer has access to year round fresh fruit and vegetables, a constant and predictable supply of grains, meat, fish, dairy products and jaffa cakes, and almost never goes through periods of shortages or restrictions. Diets do go wrong, with people eating too much, or eating in an unbalanced way. But, supplements are not the answer, in most cases. Daft tabloid dietary advice, nonsense from media nutritionists, fads and scare stories all confuse people into believing organisations like Dr Walker's marketing firm. Articles, like this Neanderthal one, are not helping.

Ironically, Dr Walker might be nearer the truth of advocating a Neanderthal lifestyle when she is promoting her herbal remedies. Human beings have a long tradition of using plants in therapeutic ways and this undoubtedly goes back into our prehistory. As our ancestors evolved, so their brains got better at fathoming causal relationships in the world. Tools and technology are the consequence of brains that can accurately model cause and effect relationships. To those emerging human minds, the instinct to find causal reasons for disease and to take action to cure must have been strong. After all, humans can influence and manipulate so much of their world, why not their bodies and their illnesses? It is interesting to speculate how humans' love of quackery comes from those primitive instincts and how our minds still seek patterns and explanations in illness. Is herbalism deeply rooted in our evolutionary past?

Did Neanderthals use herbs to heal? Tantalisingly, there is some evidence from a grave in Iraq. Maybe, our relationship with plants is even deeper than the Neanderthals. Last Christmas, I had the pleasure of meeting a researcher who was off to Borneo to study how Orang-Utans maybe self-medicated with various plants. She was going to be collecting Orang pooh for six months and studying it, and was obviously destined to become the Gillian McKeith of the Orang-Utan world. But with an accredited PhD. And even more matted ginger hair.

But to fall for the alluring idea of the 'wisdom of the ancients' and their 'natural' healing powers would be missing what was going on here. Maybe, some plants had a therapeutic effect. Maybe, the action of a social group using plants gave a strong placebo response in the ill. As we find today, many illnesses would be fought off by an immune response or be self-limiting in some other way. The act of healing rituals cemented social bonds and the plants used formed part of the groups' defining cultures. There is evidence that Neanderthals cared for their sick and elderly, however, the value of using plants in healing was probably more cultural and social than pharmaceutical.

We scientific humans, however, have developed skills that allow us to work out which plants really have beneficial effect, and we have technologies that allow us to refine the chemicals that cause the effect, how to minimize risks and side-effects and how to standardise doses. It's called modern, scientific medicine. Dr Walker's herbalism has more in common with our ancestors shamanic rituals than with what goes on in hospitals. If there is good evidence for the beneficial effect of a herb then it ceases to be herbalism and becomes part of the tools of real medicine. This does happen, of course. The majority of drugs now used have their origins in plants and other natural substances.

However, Dr Walker appears to be more rooted in our Neanderthal past using mystical and non-scientific explanations for herbal remedies. Professor Colquhoun was quite right to point out that using terms like 'blood cleanser' is just gobbledegook. Fortunately, I have just heard that his web site will be re-instated on the UCL servers and that the university consider the meat of the complaint groundless. So much for legalistic threats. Can we get back to the science now please?

So, why did Neanderthals not get arthritis? Was it fish oil? Is this the answer?

Perhaps, it had something to do with the probable life expectancy of a Neanderthal being just 20 years.


-

Labels: diets, nutritionist, pseudoscience, vitamins

 

Patrick Holford has built up a very impressive and comprehensive empire; networks of web sites, charities, a college, educational trusts and of course, books, TV shows, supplements sales, and licensing deals. It is a very impressive achievement and it would be hard to argue that Patrick, and his philosophies, did not pretty much dominate the UK nutritionist scene. Some nutritionists might outsell him in book sales, but none have created such influence. Patrick has had his set-backs over the past 30 years, but now, mention ‘nutritional therapy’ in the UK and you will soon come across the name of Patrick Holford. The energy and drive required make this happen over the years is indeed remarkable.

It is a far reaching network. Even the bodies that set themselves up to govern the profession of 'nutritional therapist' are indebted to him. A list of the people involved with the British Association of Nutritional Therapists (BANT) will reveal many names whose qualifications are given as DipION, from the London college that Patrick set up many years ago. Patrick, himself, was awarded an honoury Fellowship of BANT. (One has to hypothetically wonder what would happen if one had cause to complain to BANT about something you felt was not right about Patrick. )

There are other celebrity media nutritionists out there too, but again, most stand in the shadow of Patrick. Columnist Dr John Briffa has attended training courses at the Institute of Optimum Nutrition (ION), and now gives lectures there; the Food Doctor, Ian Marber MBant Dip ION (not a real doctor) gained his qualification at ION; and so did the Channel 4 Diet Doctors, Vicki Edgson Dip ION (not a real doctor) and Dr Wendy Denning (this time, a real doctor). Perhaps, the only major name missing is 'Dr' Gillian McKeith.

The feat of building this nutritionist world is even more remarkable when one remembers that Patrick does not have a degree in nutrition, or indeed any statutorily recognised qualification in such matters. Patrick comes from a psychology background, but at some point, according to his own biography, he became interested in the nutritional impact on mental health. He then says that he studied the ideas of Linus Pauling and became fascinated with Pauling's ideas on 'molecular nutrition'.

Now, Pauling has a unique and outstanding position in science in that he is the only person ever to receive two unshared Nobel prizes. One is for quantum chemistry and the other, the Peace prize, was awarded for campaigning against atmospheric nuclear testing. Towards the latter part of Pauling’s career, he became convinced that Vitamin C was a miraculous substance that could transform our health. Out of these ideas came the concept of Orthomolecular Medicine and Orthomolecular Therapy. The core of this idea is that you can treat disease with large quantities of nutrients, far beyond that which you would find in the best of diets. Supplementation with gram level quantities of vitamins is what is required to achieve this health boost. Somehow, these large doses are seen as 'optimum' for the human body. Patrick calls this the medicine of tomorrow. It has been the medicine of tomorrow for quite a while now.

When one criticises the concepts of Orthomolecular Therapy, one is almost immediately reminded of Pauling’s god like status in science by its advocates. Who am I to question a double-Nobel laureate? However, it is equally as easy to be told that Pauling's nutritional convictions should be a warning to us all not to take scientific authority as proof of a proposition. More than that, Pauling shows us that when an accomplished scientist talks about areas outside of the domain in which they have excelled, we should be just as suspicious of the claims made as of claims made by anyone else. Nobel Prizes do not infer omnipotence and infallibility.

Despite the allure of believing that mega-vitamin doses can help alleviate all sorts of health problems, the scientific research to back this up has been rather weak, an idea regularly now explored on HolfordWatch. This is not just because, as Patrick would claim, that vitamins are unpatentable and so of no interest to ‘Big Pharma’, rather that when the research is done, the results are invariably disappointing. This is a big shame. It was such a good idea.

In retrospect, there is no real surprise to this lack of success. Just because a mineral or chemical acts as an essential part of a diet at low concentrations, does not mean that it will take on therapeutic qualities at very high doses. It may just as well take on toxic qualities. Many vitamins and minerals are now well known to give nasty side-effects and even cause cancer at doses higher than the recommended allowances. This is because 'naturalness' and a continual low-level presence in the body does not guarantee tolerance at excessive 'unnatural' levels. Each mineral or vitamin has to be taken on its own merit, along with every other possible chemical, in the chance of becoming the next wonder drug or treatment. There is no magic in minerals, no panacea in Vitamin C, no matter how bewitching the idea.

Orthomolecular medicine has not died with Pauling. But, first it is right to note that Linus had every right to dream up fanciful new ideas. The creativity of science depends on wild hunches, dreams, flashes of insight and sometimes what is even seen as madness. But just because an idea is persuasive, alluring or even unconventional, does not mean that it is right. Science must discard those ideas that fail experimental tests, no matter how much we would wish them to be true. Starting out as a promising idea, orthomolecular medicine must now join the others in the 'good ideas that failed' cupboard, including the flat earth idea, n-rays and cold fusion.

It is maybe the simple attractiveness of orthomolecular medicine that has meant it has survived beyond its natural lifetime. One can see the core of the syllabus of ION coming from the ideas of Pauling and his followers. Those that call themselves orthomolecular therapists follow the patterns of providing health questionnaires, hair mineral analysis, optimum target levels, and then prescribing many vitamin and mineral supplements, sometimes way beyond RDA levels, as well as large dietary changes. But, the science behind this methodology is heavily disputed. For example, I have written about the problems of Hair Mineral Analysis previously, a subject Patrick studied at postgraduate level, but failed to complete.

Patrick is the UK representative of the International Society for Orthomolecular Medicine. The Institute of Optimum Nutrition and its philosophy may be seen, at least in part, as a re-branding of these ideas for a British audience. But by clinging to these ideas, Patrick has cut the nutritionist industry he has created off from mainstream dietary thought. There is now a chasm between scientific nutritional studies, as typified by the work carried out largely by Registered Dieticians, and the work carried out by ‘alternative medicine’ nutritionists, as typified by your ION educated therapists. This is a conscious act; Patrick and BANT make it quite clear that Nutritional Therapy is a ‘complementary and alternative medicine’, and so is more aligned with homeopathy, reiki, magnet therapy and angel healing than science. By clinging to alluring ideas in the face of contrary evidence, nutritionist science has become more like a pseudoscience and their health claims and practice, quackery.

The whole concept of 'optimum nutrition' appears to be rather intellectually and philosophically lacking. We are all rather special apes. We have evolved from common ancestors with chimps, and our furry cousins appear to have quite broad diets of mostly plants, supplemented with occasional meat, not unlike what dieticians tell us we ought to be eating. But homo has taken this basic food pattern and exploited it to its full potential. Various waves of our ancestors spread out from Africa, through forests, grasslands, deserts, coasts, mountains and frozen wastelands. Our diets changed as our ancestors moved, with the diet changing must faster than our bodies evolved. The success of humans appears to be in some major part due the fact that we can cope with huge changes in dietary inputs and still maybe live to 40 or 50 years or so without medical intervention. We exist on a broad nutritional plateau of possibilities, not a supplement sustained 'optimum'. Many species must exist within narrow nutritional windows; we, most obviously, do not. It would appear highly improbable that our current generation should suddenly be susceptible to small variations away from the nutritionists' 'optimum'. Of course, we can stray off that plateau into the McDiet lowlands - but Patrick is preaching to many of us most firmly rooted on top of it.

The whole concept of '100% health for life' appears to deny how we can choose our level of health (to some extent) and that anything less than 100% is 'bad'. A rugby player ends up battered at the end of the season, but willingly enters the next season for the life-enhancing benefits that the game brings. Parents may accept the inevitability of exhaustion of looking after a newborn, and many accept stressful jobs for the rewards that it may bring later in life. We trade health for other things we value. But more importantly, our bodies go through natural cycles of renewal and regeneration and our rhythms of health are a natural part of our lives. And when we do succumb to a virus, it is not because of some moral shortcoming in not keeping ourselves on that pinnacle of nutritional perfection, but rather because our immune systems have not encountered this particular cold virus before, and our body's evolved defence mechanisms are kicking in. '100% health' promises and ideal that is not meaningful, possible or even desirable for many of us.

As you might then expect, Nutritional Therapists have a strong streak of anti-science in their creed; the rejection of ‘the other lot’, the dieticians who are more cautious in their interpretation of data and a huge distrust of mainstream medicine, their drugs and practitioners. As with almost all people who call themselves complementary therapists, there is the inevitable tendency to disparage those they say they complement. Nutritionists also do tend to embrace the much quackier side of medicine, with many practitioners also offering highly dubious techniques from reflexology, homeopathy to naturopathy.

Moreover, I would contend that Nutritional Therapy is more than just another alternative medicine. In order to understand it, it is worth looking at its cult-like qualities as well. Whereas an alternative medicine like homeopathy is diffuse and widespread in its allegiances, Nutritional Therapy still very much has its recent founders and living gurus. With its god-like revealer, Pauling, and his messenger in Britain, Patrick, its special college, somewhat outside of the main education establishments, its rather closed synod, BANT, and not forgetting its holy scriptures, the New Optimum Nutrition Bible. Optimum Nutrition has more in common with scientology than science. And I mean this in more than just in a metaphorical way.

As the prophet of nutritional healing, Patrick is reaching out to the people of Britain, bringing them a message of hope that society's ills can be cured by dietary changes and vitamin pills. The evils of the drug industry, the misery of disease and the side-effects of Big Pharma's drugs can be side-stepped by just eating better and popping pills. He calls the children to come to him through the Food for the Brain programme, and then offers to rid them of the evils of ADHD and underachievement, by banning their loaves and feeding them fish transubstantiated into thousands of miraculous supplements.

The Food for the Brain charity is on a messianic message to liberate the sub-optimally nourished children of Britain and to transform their brains into supplement-popping nutritionist consumers. Although Patrick talks quite rightly about the need for good diet, supplements are very much there at the front of their schools projects, being promoted and dished out for free, getting you hooked. The Orthomolecular programme is influencing thoughts here. My message is not one of impropriety as people can buy supplements anywhere, but when Patrick has so comprehensively covered the nutritionist space in the UK, and if the schools programme is successful, then many more fish oil pills will be popped, books will be bought, hair analyses performed and nutritionists consulted. That web of business will invariably fall back into the walled garden of BANT practitioners and so naturally help Patrick's disciples.

It is not the messages around eating well that is wrong. If Patrick helps kids eat their greens then great. It is the message that 'Food is better medicine than drugs' (the name of a book he has co-authored) and the implication that supplements are even better than food is the one we should be critical of. It medicalises the food we eat. It turns eating into a health obsession. It confounds nutrition with medicine, the healthy with the sick, and drugs with profit motives. It adds to the neuroses we have about food, rather than diminishing them. Rather than being taught to enjoy food and celebrate its diversity and its pleasures, we are being taught to fetishise what we put in our mouths.

So, we have two worlds in the UK. Worlds with very different views on how food and diet affects our health and how we can manipulate diet to improve our health.

The first world is typically populated by scientists and dieticians. They take an evidence-based approach to understanding food and are cautious in coming to conclusion where there is insufficient data. They work in clinical practice, in hospitals, universities and on an NHS wage. They advise on good, affordable and understandable diets, and treat patients who are sick and need careful advice on their road back to health. They concentrate on the overall diet and not on an obsession with nutrients. They are regulated under law, have transparent and meaningful governing bodies. They are accountable for their actions and can be struck off if they fail in their duties. They promote their work in science journals. They share their canteens with nurses, surgeons, medical students and doctors.

The second world is populated by lawyers, accountants and journalists that have undertaken a career change. Younger students enter independent nutrition colleges and need little scientific training to do so. If they don't get training, they add 'Dr' to their name anyway and get a contact with Channel 4. They selectively pick evidence that suits their alternative philosophies and learn to be suspicious, if not downright hostile, to science and medicine. They work in private practice and sell food supplements, questionable allergy tests and hair mineral analyses. They confuse allergy and intolerance, and fetish on vitamins and minerals, whilst advising clients to remove whole food groups from their diets. They sell their business to the worried well and poke around in their poo. They are not statutorily regulated and so lack that accountability. They promote their work in newspapers and magazines. They share their Richmond bistro with reflexologists, personal trainers, homeopaths and TV producers.

Does this divide matter? Surely, if the end result is that people eat better, then who cares how we got there? It is important to ask though if we do end up at the same point. Does Nutritional Therapy provide health benefits? Having stepped outside of the scientific mainstream then this is more difficult to answer than it should be. People like Patrick complain that as vitamins are not patentable then the incentives to do the research are not there. This rather sidesteps the moral incentives to be sure that what you preach is true. Much science is done for its own sake if it is felt to be worthwhile. What more worthwhile cause is there than easy routes to health through nutrition? The sale of food supplements in Britain is worth over £200 million annually. Some of Britain's biggest companies are involved, such as Boots. Holland and Barret is owned by one the largest pharmaceutical companies in the US. Surely 1% of these sales would provide a very good start to a research fund. This would be much less, pound for pound, than 'Big Pharma' spends on research. Patrick could be instrumental in corralling 'Big Nutripharma' into similar activities.

But I think it it gets worse. With the Nutritional Therapists emphasis on cutting out whole food groups and on cramming useless supplements, diets could indeed worsen under their advice. Patrick has been recently criticised for Food for the Brain approaches that could have damaged an autistic child. Furthermore, with Patrick's interest in mental health there is the a real risk of harm if such advice leads to sub-optimum control of the illness. Mental health problems wreck lives, destroy families and kill. There is no scope for wishful thinking not backed up by sound evidence. The very nature of mental health problems means that it can be difficult to carefully manage a therapy with a patient. Adding groundless nutritional advice into the mix, and instilling distrust of mental health professionals, cannot be good for patients.

So, could we have imagined a different history, where Patrick came back from his Paulingian epiphany and put his undeniable talents and energy into a more science-based programme on nutritional health? Would we have a more unified and positive approach to dietary information in the UK? Somehow, I doubt it. There may always be a tempting hole for someone to fill, where people will believe that a multivitamin is a shortcut to eternal health. Parallels with Holford exist in other countries. Germany has Matthias Rath who claims to have also been inspired by Pauling, who has rebranded Orthomolecular medicine as 'cellular medicine', sells loads of supplements, but, whereas Patrick tends to focus on mental health, Rath focuses on HIV and cancer for his nutrient panaceas. His advocacy of vitamin C as an AIDS cure in South Africa has met with, what can I say, severe criticism. Tens of millions of people have the HIV virus in South Africa and there is a large HIV denialist movement that extends up the highest reaches of government. There is no room for equivocation here and Patrick's own mixed messages on Vitamin C being better than AZT, could have the most serious consequences.

Modern medicine is founded on the depersonalisation of illness. It rejects the subjective and seeks dispassionate views. Its undeniable success in doubling life expectancy, eradicating diseases, transplanting organs, and showing us that smoking is bad has been achieved by what looks like treating people as numbers, data and, at times, test subjects. By an ironic twist, this apparent scientific coldness allows us to strikingly transcend the inhumanity of sickness and disease. However, the perception of indifference and distance may be the very thing that makes Patrick's message of nutritional health answers so alluring, and allows the nutritional therapy business to survive. People want to feel their health fears have personal meaning and are controllable.

The impact of Patrick's nutritional army is a confused public that hear contradictory evidence daily in the newspapers. It results in unnecessary worry, in meaningless expense, and forms a distrust of authorities that could actually offer sound advice.

We are being dis-served at our dinner table by the nutrionist dogma.

Labels: nutritionist, Patrick Holford, vitamins

 

It's been a bad week for Gillian. The anti-quackery blogging brigade have been partaking in bouts of the great British pastime of uncontrolled Schadenfreude (why did we leave it to the Germans to coin that term?) after the Advertising Standards Authority stopped Gillian McKeith as advertising herself as 'Dr Gillian'. The Guardian printed a huge article by Ben Goldacre about how she is a 'Menace to Science' and how her particular brand of nutrionism is deeply anti-science and harmful.

Is there anything else left to say on the subject? One thing that Ben and Gillian's defenders have in common is their belief that, in many ways, it is immaterial by what title she calls herself. Obviously, her use of the title offends the many hardworking PhDs who have sweated and slaved to use their title in order to try to secure upgrades at airport check-ins. But if her advice leads to people eating more sensible diets then surely 'all's well that end's well'? That would be fine. But Gillian just speaks nonsense at people. Her thoughts on chlorophyll and food colour have been well addressed as non-scientific silliness. If people take her seriously, then how do they know what is good advice and what is rubbish? Therein lies the problem.

My contribution to the debate is going to be to show just how deep her embrace of anti-science is. I don't think even Ben has described just how far she is prepared to go. She does not just embrace the language of science in a pseudoscientific way, but is also quite prepared to get into bed with a deep anti-science agri-woo in order to sell her products. Let's just look at one of her products for sale on her web site: Veggie Vitality, available in 200ml quantities for £1.79. Her description reads...

Labels: Ben Goldacre, diets, Gillian McKeith, homeopathy, nutritionist, organic quackery

 

Regular listeners to BBC Radio 4's Womans' Hour will have recently heard nutritionist Suzi Grant extolling the virtues of so-called superfoods. Quackery, I say.

Labels: Ben Goldacre, diets, mckeith, nutritionist, Quack Words, qualifications, vitamins

 

Happy new year to you all. I've been off for my Christmas break and I am now attending to my post bag and I thought I would share a few gems with the world.

First, I am always up for a challenge and so when writer Geoff Freed starts off his email "You pure miserable person", I know I am in for a treat! When Geoff adds "I bet you would not have the guts to print this" I really have no alternative!

This is really my point. Sounds like nice science about how some plants may defend themselves from fungus, but now we have a long string of what-ifs and maybes to get to the mass supplementation of the public with a pill. Whatever trials are currently being done, the results are not in and yet and in the meantime these companies are marketing products as if it is a done deal. As with my first correspondent, there are many good ideas out there and loads of laudable intentions. However, not all those ideas are good - in fact the majority end up on the dustbin of discarded science, no matter how much we wish them to be true.

As Guy correctly states, the best evidence for salvestrols as a cancer/cure prevention is largely anecdotal - a few doctors with case histories. Guy says,

It is not true that all anecdotes are nearly worthless. Some are; some are not. It depends on the source of the evidence.

Labels: dax moy, diets, nutritionist, salvestrols

 

Le Canard Noir has a hectic international life, flitting around the world in luxury, from hotel to beach, from fine restaurants to top spas. And all I have to do is occasionally blog from wherever I can get WiFi access. Such are the benefits of being a Big Pharma shill. (Keep the cheques coming in - my stocks of champagne are getting low for Christmas).

However, yesterday was a little more mundane with a 4am foggy dash to Luton for the first easyJet flight to Edinburgh. A quick meeting there, and then back in the afternoon. So, in my caffeine starved, befuddled and yawning state, I had found myself flicking through the easyJet in-flight magazine. Something I usually avoid, but I was late and had to run past the magazine shop to board the plane. I was going to do my Xmas shopping in the duty free shop, but that will have to wait now til Saturday.

Now I was not expecting investigative journalism, insightful political analysis or even peer-reviewed papers. No, I would have been happy to read about some groovy bars in ski resorts, boutique hotels in city break destinations and even flick through the vanity surgery adverts and pictures of expensive villas in Mallorca (do I really need another one?) What I was confronted with was a shed load of quackery. Astonishing amounts for one small in-flight magazine.

Let me give you some highlights...

• Top tips on avoiding a cold. Dubious vitamin C advice, superfoods (aarrrggh), and my real pet hate - drink at least 2 litres of water per day.


• A new concept of 'Wine Therapy'. Apparently wine contains lots of essential 'pure essences' and 'natural ingredients'. A new spa has opened up to exploit the curative properties of wine - the Caudalie Vinotherapie Spa near Bilbao.


• A review of the 'Bliss Energy Mask'. Some sort of facial stuff that has vitamin C and a 'shot of oxygen'. Marvelous.


• Top tips for healthy skiing, including laying off the cheese (is that possible in the Haute Savoie?)


• One of those standard 'Surviving Christmas' articles including great advice from a Boots the Chemist nutriquack and a reflexologist.


• Stress relieving tips including taking herbal supplements and Bach Flower Remedies.


• Hangover remedies from around the world - placing parsley on your head and eating marinated fish is the thing, apparently.

and my favourite,

• The amazing benefits of inhaling copious amounts of smoke in an Estonian Smoke Sauna. Don't forget to thwack yourself with birch branches too.

So, is there any harm in this? Directly, I doubt it. At worst, a lot of the advice is pretty soulless and is just missing the point of having a good ski holiday or a weekend in a spa drinking wine. Even inhaling smoke in a sauna is unlikely to be that bad and the invigorating experience of the sauna is going to be stress relieving and fun. Indirectly though, the trotting out of old canards about drinking loads of water and the thinking that vitamins in cosmetics is a good idea, just adds to the noise of uncritical and lazy health advice in the media.

For me, what this represented was just the depressing reality of the mainstream acceptance of the views of reflexologists as being valuable, the acceptance of the pseudoscience of oxygen rich facial creams being unchallenged, and the need to subvert life affirming activities, such as skiing, spas and saunas with meaningless health advice.

It is just low cost journalism for a low cost airline. I guess with everything else on these low cost airlines, we mustn't grumble.

Labels: detox, diets, journalists, nutritionist

 

A regular comment to me is to ask "why have I got it in for Nutritionists?" Surely, these are dedicated health professionals who do wonders for peoples' health by improving their diets and making sure people take the right supplements, if required. Well maybe. The problem is that so many nutritionists are not doing this and often resort to pseudoscience and quackery. This week's Quack Word blog entry will argue that the Quackometer is quite right (most of the time) in scoring highly a web page with the word 'nutritionist' in it.

So, a quick definition of 'nutritionist'. Whilst one should always take wikipedea articles with a sceptical eye, their definition of nutritionist is a good starting point:

A nutritionist is a person who advises people on dietary matters relating to health, well-being and optimal nutrition. Nutritionists should not be confused with dietitians. Dietitians are health care professionals who have received specialised formal accredited tertiary education and training, and undertake internship in hospitals, and who are required to adhere to their regulatory body's code of conduct. They are also the only non-medically-trained health-care professionals permitted to practise clinically in hospitals or health-care facilities. Many "nutritionists" appear on television, in newspapers and magazines, and write bestselling nutritional books.

Self-identified nutritionists have varying levels of education, and can be someone with little education up to someone who may have the equivalent of a master's degree in Physiology or Biology.