Bad Science

nutrition academics were wary about citing it, simply because his findings seemed to be so incredibly positive. In 2002 he had resigned his university post and failed to answer questions about his papers or to produce his data when challenged by his employers. The paper that Patrick Holford is referring to was finally fully retracted in 2005. The next reference in this same paragraph of his book is to another Chandra paper. Two in a row is unfortunate.

Professor Holford follows this up with a reference to a review paper, claiming that thirty-seven out of thirty- eight studies looking at vitamin C (again) found it beneficial in treating (not preventing, as in his previous claim in the text above) the common cold. Thirty-seven out of thirty-eight sounds very compelling, but the definitive Cochrane review on the subject shows mixed evidence, and only a minor benefit at higher doses.

I hooked out the paper Professor Holford is referencing for this claim: it is a retrospective re-analysis of a review of trials, looking only at ones which were conducted before 1975. Holford’s publishers describe this edition of the Optimum Nutrition Bible as ‘COMPLETELY REVISED AND UPDATED TO INCLUDE THE LATEST CUTTING-EDGE RESEARCH’. It was published in the year in which I turned thirty, yet Holford’s big reference for his claim about vitamin C and colds in this chapter is a paper which specifically only looks at trials from before I was one year old. Since this review was carried out, I have learnt to walk and talk, gone to primary school, upper school, three universities to do three degrees, worked as a doctor for a few years, got a column in the Guardian, and written a few hundred articles, not to mention this book. From my perspective, it is no exaggeration to say that 1975 is precisely a lifetime ago. As far as I am concerned, 1975 is not within living memory. Oh, and the paper Professor Holford references doesn’t even seem to have thirty-eight trials in it, only fourteen. For a man who keeps going on about vitamin C, Professor Holford does seem to be a little unfamiliar with the contemporary literature. Perhaps if you are worried about your vitamin C intake you might want to buy some ImmuneC from the BioCare Holford range, at just ?29.95 for 240 tablets, with his face on the bottle.

We’ll go on. He cherry-picks the single most dramatically positive paper that I can find in the literature for vitamin E preventing heart attacks – a 75 per cent reduction, he claims. To give you a flavour of the references he doesn’t tell you about, I have taken the trouble to go back in time and find the most up-to-date review reference, as the literature stood in 2003: a systematic review and meta-analysis, collected and published in the Lancet, which assessed all the papers published on the subject from decades previously, and found overall that there is no evidence that vitamin E is beneficial. You may be amused to know that the single positive trial referenced by Holford is not just the smallest, but also the briefest study in this review, by a wide margin. This is Professor Holford: pitched to teach and supervise at Teesside University, moulding young minds and preparing them for the rigours of academic life.

He goes on to make a string of extraordinary claims, and none has any reference whatsoever. Children with autism won’t look you in the eye, but ‘give these kids natural vitamin A and they look straight at you’. No reference. Then he makes four specific claims for vitamin B, claiming ‘studies’ but giving no references. I promise we’re coming to a punchline. There’s some more stuff about vitamin C; this time the reference is to Chandra (yet again).

Finally, on page 104, in a triumphant sprint finish, Professor Patrick Holford says that there are now oranges with no vitamin C in them at all. It’s a popular myth among self-declared nutritionists (there is no other kind), and those who sell food-supplement pills, that our food is becoming less nutritious: in reality, many argue it may be more nutritious overall, because we eat more fresh and frozen fruit and veg, less tinned or dried stuff, and so they all get to the shops quicker, and thus with more nutrients (albeit at phenomenal cost to the environment). But Holford’s vitamin claim is somewhat more extreme than the usual fare. These oranges are not just less nutritious: ‘Yes, some supermarket oranges contain no vitamin C!’ Frightening stuff! Buy pills!

This chapter is not an isolated case. There is an entire website – Holfordwatch – devoted to examining his claims in eye-watering detail, with breathtaking clarity and obsessive referencing. There you will find many more errors repeated in Holford’s other documents, and carefully dissected with wit and slightly frightening pedantry. It is a genuine joy to behold.

Professor?

A couple of interesting things arise from this realisation. Firstly, and importantly, since I am always keen to engage with people’s ideas: how might you conduct a discussion with someone like Patrick Holford? He is constantly accusing others of ‘not keeping up’ with the literature. Anyone who doubts the value of his pills is a ‘flat-earther’, or a pawn of the pharmaceutical industry. He would pull out research claims and references. What would you do, given that you can’t possibly read them on the spot? Being scrupulously polite, and yet firm, the only sensible answer, surely, would be to say: ‘I’m not entirely sure I can accept your precis or your interpretation of that data without checking it myself.’ This may not go down too well.

But the second point is more important. Holford has been appointed – as I might have mentioned briefly – a professor at Teesside. He brandishes this fact proudly in his press releases, as you would expect. And according to Teesside documents – there’s a large set, obtained under the Freedom of Information Act, available online – the clear plan at his appointment was for Professor Holford to supervise research, and to teach university courses.

It is not a surprise to me that there are entrepreneurs and gurus – individuals – selling their pills and their ideas on the open market. In some strange sense I respect and admire their tenacity. But it strikes me that universities have a very different set of responsibilities, and in the field of nutrition there is a particular danger. Homeopathy degrees, at least, are transparent. The universities where it is taught are secretive and sheepish about their courses (perhaps because when the exam papers leak, it turns out that they’re asking questions about ‘miasma’ – in 2008) but at least these degrees in alternative therapies are what they say on the tin.

The nutritionists’ project is more interesting: this work takes the form of science – the language, the pills and the referenciness – making claims that superficially mirror the assertions made by academics in the field of nutrition, where there is much real science to be done. Occasionally there may be some good evidence for their assertions (although I can’t imagine the point of taking health advice from someone who is only occasionally correct). But in reality the work of ‘nutritionists’ is often, as we have seen, rooted in New Age alternative therapy, and while reiki quantum energy healing is fairly clear about where it’s coming from, nutritionists have adopted the cloak of scientific authority so plausibly, with a smattering of commonsense lifestyle advice and a few references, that most people have barely spotted the discipline for what it is. On very close questioning, some nutritionists will acknowledge that theirs is a ‘complementary or alternative therapy’, but the House of Lords inquiry into alternative medicines, for example, didn’t even list it as one.

This proximity to real academic scientific work summons up sufficient paradoxes that it is reasonable to wonder what might happen in Teesside when Professor Holford begins to help shape young minds. In one room, we can only imagine, a full-time academic will teach that you should look at the totality of evidence rather than cherry-pick, that you cannot overextrapolate from preliminary lab data, that referencing should be accurate, and should reflect the content of the paper you are citing, and everything else that an academic department might teach about science and health. In another room, will there be Patrick Holford, exhibiting the scholarship we have already witnessed?

We can have one very direct insight into this clash from a recent Holford mailout. Periodically, inevitably, a large academic study will be published which finds no evidence of benefit from one of Patrick Holford’s favoured pills. Often he will issue a confused and angry rebuttal, and these critiques are highly influential behind the scenes: snippets of them frequently appear in newspaper articles, and traces of their flawed logic emerge in discussions with nutritionists.

In one, for example, he attacked a meta-analysis of randomised controlled trials of antioxidants as being biased, because it excluded two trials he said were positive. In fact they were not trials, they were simply observational surveys, and so could never have been included. On the occasion we are interested in, Patrick Holford was angry about a meta-analysis on omega-3 fish-oil pills, co-authored by Professor Carolyn Summerbell: she holds the full-time academic chair in Nutrition at Teesside University, where she is also Assistant Dean of Research, with a long-standing track record of published academic research in the field of nutrition.

In this case, Holford seems quite simply not to understand the main results statistics in the paper’s results blobbogram, which showed no benefit for the fish oils. Furious at what he thought he had found, Professor Holford then went on to accuse the authors of being pawns of the pharmaceutical industry (you may be spotting a pattern).