Bad Science

forefront of their minds. They will change too.

This is not to rubbish the role of diet in health – I bend over backwards to find some good in these studies – but it does reflect one of the most important issues, which is that you might not start with goji berries, or vitamin pills, or magic enzyme powders, and in fact you might not even start with an individual changing their diet. Piecemeal individual life changes – which go against the grain of your own life and your environment – are hard to make, and even harder to maintain. It’s important to see the individual – and the dramatic claims of all lifestyle nutritionists, for that matter – in a wider social context.

Reasonable benefits have been shown in intervention studies – like the North Karelia Project in Finland – where the public health gang have moved themselves in lock, stock and barrel to set about changing everything about an entire community’s behaviour, liaising with businesses to change the food in shops, modifying whole lifestyles, employing community educators and advocates, improving healthcare provision, and more, producing some benefits, if you accept that the methodology used justifies a causal inference. (It’s tricky to engineer a control group for this kind of study, so you have to make pragmatic decisions about study design, but read it online and decide for yourself: I’d call it a ‘large and promising case study’.)

There are fairly good grounds to believe that many of these lifestyle issues are, in fact, better addressed at the societal level. One of the most significant ‘lifestyle’ causes of death and disease, after all, is social class. To take a concrete example, I rent a flat in London’s Kentish Town on my modest junior medic’s salary (don’t believe what you read in the papers about doctors’ wages). This is largely a white, working-class area, and the adult male life expectancy is about seventy years. Two miles away, in Hampstead, where the millionaire entrepreneur Dr Gillian McKeith PhD owns a large property, surrounded by other wealthy middle-class people, male life expectancy is almost eighty years. I know this because I have the Annual Public Health Report for Camden open on my kitchen table right now.

The reason for this phenomenal disparity in life expectancy – the difference between a lengthy and rich retirement, and a very truncated one indeed – is not that the people in Hampstead are careful to eat goji berries and a handful of Brazil nuts every day, thus ensuring they’re not deficient in selenium, as per nutritionists’ advice. That’s a fantasy, and in some respects one of the most destructive features of the whole nutritionist project, graphically exemplified by McKeith: it’s a distraction from the real causes of ill health, but also – do stop me if I’m pushing this too far – in some respects, a manifesto of right-wing individualism. You are what you eat, and people die young because they deserve it. They choose death, through ignorance and laziness, but you choose life, fresh fish, olive oil, and that’s why you’re healthy. You’re going to see eighty. You deserve it. Not like them.

Back in the real world, genuine public health interventions to address the social and lifestyle causes of disease are far less lucrative, and far less of a spectacle, than anything a Gillian McKeith – or, more importantly, a television commissioning editor – would ever dream of dipping into. What prime-time TV series looks at food deserts created by giant supermarket chains, the very companies with which these stellar media nutritionists so often have their lucrative commercial contracts? Who puts the issue of social inequality driving health inequality onto our screens? Where’s the human interest in prohibiting the promotion of bad foods, facilitating access to healthier foods by means of taxation, or maintaining a clear labelling system?

Where is the spectacle in ‘enabling environments’ that naturally promote exercise, or urban planning that prioritises cyclists, pedestrians and public transport over the car? Or in reducing the ever-increasing inequality between senior executive and shop-floor pay? When did you ever hear about elegant ideas like ‘walking school buses’, or were stories about their benefits crowded out by the latest urgent front-page food fad news?

I don’t expect Dr Gillian McKeith, or anyone in the media, to address a single one of these issues, and neither do you: because if we are honest with ourselves we understand that these programmes are only partly about food, and much more about salacious and prurient voyeurism, tears, viewing figures and vaudeville.

Dr McKeith puts a cabbie straight

Here is my favourite Dr McKeith story, and it comes from her own book, Living Food for Health. She is in a cab, and the driver, Harry, has spotted her. He tries to spark up a friendly conversation by suggesting that fish contains more omega oils than flax. Dr McKeith disputes this: ‘Flax seeds contain far greater levels of the healthy oils (omega-3 and omega-6) in a properly balanced and assimilable form.’ When Harry disagrees, she replies: ‘What do you mean, you disagree? Have you spent years conducting clinical research, working with patients, lecturing, teaching, studying the omega oils in flax, obtaining worldwide data, compiling one of the largest private health libraries on the planet, and writing extensively on the topic? Are you a scientist, a biochemist, a botanist, or have you spent a lifetime studying food and biochemistry as I have done? Where is your scientific authority?’ Harry responds that his wife is a doctor, a gynaecologist. ‘Is she a food specialist or nutritional biochemist as well?’ demands Dr McKeith. ‘Um, ah, well, no, but she is a doctor.’

I am not a food specialist, nor am I a nutritional biochemist. In fact, as you know, I claim no special expertise whatsoever: I hope I can read and critically appraise medical academic literature – something common to all recent medical graduates – and I apply this pedestrian skill to the millionaire businesspeople who drive our culture’s understanding of science.

Flax seeds contain large amounts of fibre (along with oestrogenic compounds), so they’re not very ‘assimilable’, as Dr McKeith asserts, unless you crush them, in which case they taste foul. They’re sold as a laxative in doses of 15g, and you will need a lot of the stuff, partly because there’s also a problem with the form of omega oils in them: flax contains a short-chain plant form, and these must be converted in your body to the long-chain animal forms which may be beneficial (called DHA and EPA). When you account for the poor conversion in the body, then flax seeds and fish contain roughly the same amounts of omega oil.

We must also remember that we live not in a laboratory, but in the real world. It’s very easy to eat 100g of mackerel – if this were a completely different kind of book I’d be giving you my kedgeree recipe right now – whereas I would suggest that it’s slightly trickier to get a tablespoon of flax seed into you. Parsley, similarly, is a rich source of vitamin C, but you’re not going to eat an orange-sized lump of the stuff. As for Dr McKeith’s further claim that flax is ‘properly balanced’, I don’t know if she means spiritually or biologically, but fish is much higher in omega-3, which most people would say is better.

More importantly, why is everyone talking about omega-3? On to the next chapter.

Interestingly, Macfadden’s food product range was complemented by a more unusual invention of his own. The ‘Peniscope’ was a popular suction device designed to enlarge the male organ which is still used by many today, in a modestly updated form. Since this may be your only opportunity to learn about the data on penis enlargement, it’s worth mentioning that there is, in fact, some evidence that stretching devices can increase penis size. Gillian McKeith’s ‘Wild Pink’ and ‘Horny Goat Weed’ sex supplement pills, however, sold for ‘maintaining erections, orgasmic pleasure, ejaculation … lubrication, satisfaction, and arousal’, could claim no such evidence for efficacy (and in 2007, after much complaining, these seedy and rather old-fashioned products were declared illegal by the Medicines and Healthcare Products Regulatory Agency, or MHRA). I mention this only because, rather charmingly, it means that Macfadden’s Peniscope may have a better evidence base for its claims than either his own food products or McKeith’s Horny Goat penis pills.

‘Pill Solves Complex Social Problem’

Medicalisation – or ‘Will fish-oil pills make my child a genius?’

In 2007 the British Medical Journal published a large, well-conducted, randomised controlled trial, performed at lots of different locations, run by publicly funded scientists, and with a strikingly positive result: it showed that one treatment could significantly improve children’s antisocial behaviour. The treatment was entirely safe, and the study was even accompanied by a very compelling cost-effectiveness analysis.

Did this story get reported as front-page news in the Daily Mail, the natural home of miracle cures (and sinister hidden scares)? Was it followed up on the health pages, with an accompanying photo feature, describing one child’s miraculous recovery, and an interview with an attractive relieved mum with whom we could all identify?