Bad Science

foundation degrees (p.12, para 45 onwards). It states outright that in the view of the auditing team, the expectations of the code of practice for the assurance of academic quality and standards in higher education, specifically with regard to accrediting foundation degrees, were simply not met. As they go – and I try not to read this kind of document too often – this report is pretty full-on. If you look it up online, I particularly recommend paragraphs 45 to 52.

At the very moment that this book was going to press, it transpired that Professor Holford has resigned from his post as visiting professor, citing reorganisation in the university. I have time to add just one sentence, and it is this: It will not stop. He is now looking for academic credibility elsewhere. The reality is that this vast industry of nutritionism – and more importantly than anything, this fascinating brand of scholarship – is now penetrating, uncriticised, unnoticed, to the heart of our academic system, because of our desperation to find easy answers to big problems like obesity, our collective need for quick fixes, the willingness of universities to work with industry figures across the board, the admirable desire to give students what they want, and the phenomenal mainstream credibility that these pseudo-academic figures have attained, in a world that has apparently forgotten the importance of critically appraising all scientific claims.

There are other reasons why these ideas have gone unexamined. One is workload. Patrick Holford, for example, will occasionally respond on an issue of evidence, but often, it seems to me, by producing an even greater cloud of sciencey material: enough to shoo off many critics, perhaps, and certainly reassuring for the followers, but anybody daring to question must be ready to address a potentially exponential mass of content, both from Holford, and also from his extensive array of paid staff. It’s extremely good fun.

There is also the PCC complaint against me (not upheld, and not even forwarded to the paper for comment), the lengthy legal letters, his claims that the Guardian has corrected articles critical of him (which it most certainly has not), and so on. He writes long letters, sent to huge numbers of people, accusing me and others critical of his work of some rather astonishing things. These claims appear in mailouts to the customers of his pill shop, in letters to health charities I’ve never heard of, in emails to academics, and in vast web pages: endless thousands of words, mostly revolving around his repeated and rather incongruous claim that I am somehow in the pocket of big pharma. I am not, but I note with some delight that – as I may have mentioned – Patrick, who sold his own pill retail outfit for half a million pounds last year, now works for BioCare, which is 30 per cent owned by a pharmaceutical company.

I am therefore speaking directly to you now, Professor Patrick Holford. If we disagree on any point of scientific evidence, instead of this stuff about the pharmaceutical industry being out to get you, or a complaint, or a legal letter, instead of airily claiming that queries should be taken up with the scientist whose valid work you are – as I think I have shown – overinterpreting, instead of responding on a different question than the one which was posed, or any other form of theatrics, I would welcome professorial clarification, simply and clearly.

These are not complicated matters. Either it is acceptable to cherry-pick evidence on, say, vitamin E, or it is not. Either it is reasonable to extrapolate from lab data about cells in a dish to a clinical claim about people with AIDS, or it is not. Either an orange contains vitamin C, or it does not. And so on. Where you have made errors, perhaps you could simply acknowledge that, and correct them. I will always happily do so myself, and indeed have done so many times, on many issues, and felt no great loss of face.

I welcome other people challenging my ideas: it helps me to refine them.

‘Nutritionist’, ‘nutrition therapist’, ‘nutritional therapy consultant’ and the many variations on this theme are not protected terms, unlike ‘nurse’, ‘dietitian’ or ‘physiotherapist’, so anyone can use them. Just to be clear, I’ll say it again: anyone can declare themselves to be a nutritionist. After reading this book, you will know more about the appraisal of evidence than most, so in the manner of Spartacus I suggest you call yourself one too; and academics working in the field of nutrition will have to move on, because the word doesn’t belong to them any more.

Oh, and he works for the pill company BioCare as their Head of Education and Science (I may have mentioned that the company is 30 per cent owned by pharmaceuticals company Elder). In fact, in many respects he has spent his whole life selling pills. His first job on leaving York with a 2:2 in psychology in the 1970s was as a vitamin-pill salesman for the pill company Higher Nature. He sold his most recent pill-selling company, Health Products for Life, for half a million pounds in 2007 to BioCare, and he now works for that company.

It’s important to remember the difference between preventing colds, where the Cochrane review found no evidence of any benefit, and treating them, where Cochrane shows minor benefit at very high doses. There are, as you might imagine, cases of Holford eliding the two, and more recently, in a newsletter to his paying customers, he mangled the data in a way that might well startle the original authors. He took the modest 13.6 per cent reduction in cold duration for children taking high-dose vitamin C and claimed: ‘This equates to up to a month less “cold” days per year for the average child.’ For this claim to be true, the average child would be having more than two hundred days of cold symptoms a year. According to the review, children who had the highest number of colds might actually expect a reduction of four days per year. I could go on with the litany of errors in his mailouts, but there is a line between making a point and driving the reader away.

I would like to invite Professor Holford to send me a supermarket orange that has no vitamin C in it, via the publisher’s address.

There is a more detailed explanation of his misunderstanding online, but for nerds, it seems he is amazed that several studies with a non-significant trend towards showing a benefit for fish-oil pills do not collectively add up to show a statistically significant benefit. This is in fact, as you know, rather commonplace. There are several other interesting criticisms to be made of the fish-oil research paper, as there always are of any research paper, but sadly this, from Holford, is not one of them.

I contacted qlinkworld. co. uk to discuss my findings. They kindly contacted the inventor, who informed me that they have always been clear that the QLink does not use electronics components ‘in a conventional electronic way’. Apparently the energy pattern reprogramming work is done by some finely powdered crystal embedded in the resin. I think that means it’s a New Age crystal pendant, in which case they could just say so.

Is Mainstream Medicine Evil?

So that was the alternative therapy industry. Its practitioners’ claims are made directly to the public, so they have greater cultural currency; and while they use the same tricks of the trade as the pharmaceutical industry – as we have seen along the way – their strategies and errors are more transparent, so they make for a neat teaching tool. Now, once again, we should raise our game.

For this chapter you will also have to rise above your own narcissism. We will not be talking about the fact that your GP is sometimes rushed, or that your consultant was rude to you. We will not be talking about the fact that nobody could work out what was wrong with your knee, and we will not even be discussing the time that someone misdiagnosed your grandfather’s cancer, and he suffered unnecessarily for months before a painful, bloody, undeserved and undignified death at the end of a productive and loving life.

Terrible things happen in medicine, when it goes right as well as when it goes wrong. Everybody agrees that we should work to minimise the errors, everybody agrees that doctors are sometimes terrible; if the subject fascinates you, then I encourage you to buy one of the libraries’ worth of books on clinical governance. Doctors can be awful, and mistakes can be murderous, but the philosophy driving evidence-based medicine is not. How well does it work?

One thing you could measure is how much medical practice is evidence-based. This is not easy. From the state of current knowledge, around 13 per cent of all treatments have good evidence, and a further 21 per cent are likely to be beneficial. This sounds low, but it seems the more common treatments tend to have a better evidence base. Another way of measuring is to look at how much medical activity is evidence-based, taking consecutive patients, in a hospital outpatients clinic for example, looking at their diagnosis, what treatment they were given, and then looking at whether that treatment decision was based on evidence. These real-world studies give a more meaningful figure: lots were done in the 1990s, and it turns out, depending on speciality, that between 50 and 80 per cent of all medical activity is ‘evidence-based’. It’s still not great, and if you have any ideas on how to improve that, do please write about it.