No. The story was unanimously ignored by the British news media, despite their preoccupation with both antisocial behaviour and miracle cures, for one simple reason: the research was not about a pill. It was about a cheap, practical parenting programme.
At the same time, for over five years now, newspapers and television stations have tried to persuade us, with ‘science’, that fish-oil pills have been proven to improve children’s school performance, IQ, behaviour, attention, and more. In fact, nothing could be further from the truth. We are about to learn some very interesting lessons about the media, about how not to conduct a trial, and about our collective desire for medicalised, sciencey-sounding explanations for everyday problems. Do fish-oil pills work? Do they make your child cleverer and better-behaved? The simple answer is, at the moment, nobody could possibly know. Despite everything you have been told, a trial has never been done in mainstream children.
The newspapers would have you believe otherwise. I first became aware of ‘the Durham trials’ when I saw on the news that a trial of fish-oil capsules was being planned in 5,000 children. It’s an astonishing testament to the news values of the British media that this piece of research remains, I am quite prepared to suggest, probably the single most well-reported clinical trial of the past few years. It was on Channel 4 and ITV, and in every national newspaper, sometimes repeatedly. Impressive results were confidently predicted.
This rang alarm bells for two reasons. Firstly, I knew the results of the previous trials of fish-oil capsules in children – I’ll describe them in due course – and they weren’t very exciting. But more than that, as a basic rule, I would say this: whenever somebody tells you that their trial is going to be positive before they’ve even started it, then you know you’re onto an interesting story.
Here is what they were planning to do in their ‘trial’: recruit 5,000 children in their GCSE year, give them all six fish-oil capsules a day, then compare how they did in their exams with how the council had estimated they should do without the capsules. There was no ‘control’ group to compare against (like the Aqua Detox bath with no feet in it, or the ear candle on the picnic table, or a group of children taking placebo capsules without fish oil in them). Nothing.
By now you might not need me to tell you that this is a preposterous and above all wasteful way to go about doing a study on a pill that is supposed to improve school performance, with ?1 million worth of generously donated capsules and 5,000 children at your disposal. But humour an old man, and let me flesh out your hunches, because if we cover the theoretical issues properly first, then the ‘researchers’ at Durham become even more amusingly absurd.
Why you have a placebo group
If you divide a group of kids in half, and give a placebo capsule to one group, and the real capsule to the other group, you can then compare how well each group does, and see whether it was the ingredients in the pill that made the difference to their performance, or just the fact of taking a pill, and being in a study. Why is this important? Because you have to remember that whatever you do to children, in a trial of a pill to improve their performance, their performance will improve.
Firstly, children’s skills improve over time anyway: they grow up, time passes, and they get better at stuff. You might think you’re clever, sitting there with no nappy on, reading this book, but things haven’t always been that way, as your mother could tell you.
Secondly, the children – and their parents – know that they are being given these tablets to improve their performance, so they will be subject to a placebo effect. I have already harped on about this at phenomenal length, because I think the real scientific story of the connections between body and mind are infinitely more interesting than anything concocted by the miracle-cure community, but here it is enough to remind you that the placebo effect is very powerful: consciously or unconsciously, the children will expect themselves to improve, and so will their parents and their teachers. Children are exquisitely sensitive to our expectations of them, and anyone who doubts that fact should have their parenting permit revoked.
Thirdly, children will do better just from being in a special group that is being studied, observed and closely attended to, since it seems that the simple fact of
I will give you the simplified ‘myth’ version of the findings, as a rare compromise between pedantry and simplicity. When the researchers increased light levels, they found that performance improved. But when they reduced the light levels, performance improved then, too. In fact, they found that no matter what they did, productivity increased anyway. This finding was very important: when you tell workers they are part of a special study to see what might improve productivity, and then you do something … they improve their productivity. This is a kind of placebo effect, because the placebo is not about the mechanics of a sugar pill, it is about the cultural meaning of an intervention, which includes, amongst other things, your expectations, and the expectations of the people tending to you and measuring you.
Beyond all this technical stuff, we also have to place the GCSE results – the outcome which was being measured in this ‘trial’ – in their proper context. Durham has a very bad exam record, so its council will be battling hard in every way it possibly can to improve school performance, with all manner of different initiatives and special efforts, and extra funding, running simultaneously with the fish-oil ‘trials’.
We should also remember that bizarre English ritual whereby GCSE results get better every year, yet anyone who suggests that the exams are getting easier is criticised for undermining the achievement of the successful candidates. In fact, taking the long view, this easing is obvious: there are forty-year-old O-level papers which are harder than the current A-level syllabus; and there are present-day university finals papers in maths that are easier than old A-level papers.
To recap: GCSE results will get better anyway; Durham will be desperately trying to improve its GCSE results through other methods anyway; and any kids taking pills will improve their GCSE results anyway, because of the placebo effect and the Hawthorne effect.
This could all be avoided by splitting the group in half and giving a placebo to one group, separating out what is a specific effect of the fish-oil pills, and what is a general effect of all the other stuff we’ve described above. That would give you very useful information.
Is it ever acceptable to do the kind of trial that was being carried out in Durham? Yes. You can do something called an ‘open trial’, without a placebo group, and this is an accepted kind of research. In fact, there is an important lesson about science here: you can do a less rigorous experiment, for practical reasons, as long as you are clear about what you are doing when you present your study, so other people can make their own minds up about how they interpret your findings.
But there is an important caveat. If you do this kind of ‘compromise’ study, without a placebo group, ‘open label’, but in the hope of getting the most accurate possible picture of the treatment’s benefits, then you do it as carefully as you can, while being fully aware that your results might be distorted by expectation, by the placebo effect, by the Hawthorne effect, and so on. You might sign up your kids calmly and cautiously, saying in a casual, offhand fashion that you’re doing a small informal study on some tablets, you don’t say what you expect to find, you hand them out without fanfare, and you calmly measure the results at the end.
What they did in Durham was the polar opposite. There were camera crews, soundmen and lighting men flooding the classrooms. Children were interviewed for radio, for television, for the newspapers; so were their parents; so were their teachers: so were Madeleine Portwood, the educational psychologist who was performing the trial, and Dave Ford, Head of Education, talking – bizarrely – about how they confidently expected positive results. They did literally everything which, in my view, would guarantee them a false positive result, and ruin any chance of their study giving meaningful and useful new information. How often does this happen? In the world of nutritionism, sadly, it seems to be standard research protocol.
We should also remember that these fish-oil ‘trials’ were measuring some highly volatile outcomes. Performance at school in a test, and ‘behaviour’ (a word with a large semantic footprint, if ever I saw one) are huge, variable, amorphous things. More than most outcomes, they will change from moment to moment, with different circumstances, frames of mind, and expectations. Behaviour is not like a blood haemoglobin level, or even height, and nor is intelligence.
