We are all interested in the relationship between our health and what we eat. What a pity that so little is known about it.
The problem, of course, is that it almost impossible to do randomised experiments, and quite impossible in most cases to make the experiments blind. Without randomisation there is no way to be sure about causality, and causality is all that matters. All you can do is measure “associations” and that sort of information is simply unreliable.
For example, if you simply observe that people who eat a lot of dark green vegetables are healthier than those who don’t, there is no reliable way to tell whether their health is caused by eating the vegetables. It is just as likely that, for example, rich people are healthier because the are rich, not because they eat more vegetables. The answer, though usually not known, is the only thing that matters for offering advice. The crucial problem is that, in the latter case, it will do no good at all to bully a poor person to eat more vegetables: their health will not improve because their bad health was caused by poverty, not by lack of vegetables.
It is precisely this difficulty that results in the constantly conflicting advice that we are given about diet. I can’t think of any single thing that does more harm to real science than the fact that one week we are told that red wine is bad and the next week we are told that red wine is good. No doubt both statements were based on a naive observational studies, the significance of which is vastly exaggerated by its authors (and often by their university’s media department too).
The first job of a scientist is to be able to say “I don’t know”. Under pressure from the government’s audit culture, and the HR apparatchiks who embrace it so eagerly, all that is forgotten only too easily. he lack of certain answers about diet leaves a vacuum into which not only naive scientists are sucked, but also it is a gift for hucksters who are eager to sell you expensive ‘supplements’, whether or not you need them. As always, it is a case of caveat emptor.
The questions are important to us all, so when sciencepunk pointed out to me a chance to check my own diet, I went for it. I try to keep pretty close to the current guidelines. Unreliable though they may be, they are the best we’ve got. So I went to the Nutriprofile site, and filled in the questionnaire, quite honestly (apart from saying I was 37 -I wish).
I eat plenty of fruit and oily fish every week so I though I’d do quite well. No such luck. I ended up being told I was deficient in iron and selenium, and at “risk of deficiency” in vitamin B5 (pantothenic acid), folate, vitamins D, E, K, magnesium, copper and potassium.
Uhuh, I must really be ill and I’d never realised it.
At the bottom of this analysis of all my deficiencies comes the sales pitch, “your personalised supplement recommendations”.”Strongly recommended” for me is Gold Standard A-Z Multivitamins (just click on the “buy now” button). I’m also “recommended” to buy Omega 3 1000mg capsules.
And then I’m invited to consider a whole list of other supplements
“The following products have been given a 1 star rating. This usually means they have been recommended to meet a specific issue raised by your NutriProfile. You should consider these supplements where you feel they could help if the issue is particularly important to you”
Here is the list.
- Selenium + A,C,E,
- Echinacea (“may help you maintain a healthy immune system”).
- OptiFive (antioxidant supplement)
- Co-enzyme Q10 (“may help you maintain energy levels” -look out for a forthcoming post on this scam)
- Memo Plus (“may help you maintain brain health and cognitive function”),
- Panax Ginseng (“may help you to maintain energy levels”
- Psyllium Husks
- Vitamin D
- Ginkgo Biloba
As always, there are lots of fantasies about “strengthening the immune system”. And the great antioxidant myth is exploited to the full.
Puzzled by this result, I got my wife to do the questionnaire, and also a particularly healthy and diet conscious colleague.
My wife was recommended to buy Omega 3 1000mg, Osteo Plus Bone health supplement (despite telling them that she already took calcium) and 50 Plus Multivitamins (“may help you address any deficiency in essential vitamins and minerals and may also help you maintain a healthy immune system and maintain energy levels. “). And then it may not.
My spectacularly healthy and diet conscious colleague got a strongly recommended (maximum 5 stars like me) for Gold Standard A-Z Multivitamins and for Omega 3 1000mg, as well as “recommended” for plant sterols, garlic and Opti-Omega 3.
Either I’m a lot unhealthier than I thought, or Nutriprofile is a sales scam.
Is there anyone at all who does NOT need supplements?
By this stage I was getting suspicious so I sent the link to a professional dietitian, Catherine Collins of St George’s Hospital London. Unlike the people running the site, she has no financial interest in selling you pills. I asked her to fill in the questionnaire as a hypothetical person who had an ideal diet, based on current nutritional knowledge . Surely such a paragon of dietetic virtue would not need to buy pills too?
Don’t you believe it. At least she didn’t get any 5 star “strongly recommended”, but she did get “Recommended for you” Opti-Omega 3 (3.5 stars) and Gold Standard A-Z Multivitamins (3 stars). Plus, of course the whole list of “you may like to consider”, same as everyone seems to get.
So I asked Collins how it came about that everyone seems to end up being recommended to buy pills after going through all the questions. Here is what she said.
“Apparently my ratio of omega3:6 is unbalanced. not if you ate the amount of oily fish i’d put in, and used ‘vegetable’ oil which is mono-rich rapeseed. I think they’ve used the sunflower analysis to generate this distortion.
I disagree with absolute amounts of omega-3 per day. The amount I recorded meant I would easily exceed a daily intake of 500 mg of the important omega-3 fats, EPA and DHA
Low Vitamin B6 and folate – totally incorrect recommendation based on my entries
Potassium – the survey indicated concern that diet provided 200mg per day less potassium than recommended. This was incorrect, the flaw I assume being due to inability of the questionnaire to handle portion sizes. Should I have been worried even if this had been accurate? Of course not. Potassium is widespread across food groups, the most concentrated being fruit and vegetables. It is an essential nutrient, but its requirements are relative to sodium (‘salt’) intake.
Their omega-3 fat recommendation is double the FSA/ SACN suggestion of 450mg/d – they actually quote this in their supporting information but then say ‘experts say we need double’ [their experts are below]. This is highly misleading. We need a combination of omega-3 fats in our diet for health – not only the ‘fishy’ EPA and DHA, but also the readily available ALA, found in vegetable (rapeseed) oil
Omega 3:6 ratio -completely wrong based on the foods entered. Demonstrates a major flaws in the assumptions made about type and amount of foods in the diet.
Water recommendations. Totally inaccurate information based on the myth expounded by the health food industry and its workers that caffeine is a diuretic. This been extensively researched and proven to be not true ( Grandjeans excellent work). The only way in which a caffeinated beverage is ‘diuretic’ to someone who takes caffeinated drinks regularly is in the volume of drink consumed.
“”This appears an elaborate pill-pushing exercise. Superficially reassuring in promoting the recognised FSA (Food Standards Agency] line – but then giving undue – and unjustifiable – support to the anecdotal ‘experts recommend’ to create what will be a powerful sell”
The comment about water intake stems from this bit of Collins’ Nutriprofile:
“Caffeinated drinks, fizzy drinks and alcohol do not count because, whilst they contain water, they are mild diuretics, ie. they boost urine output and therefore should only form a small part of your total fluid intake.”
This myth (aka nutribollocks) is quite contrary to what the real research (going back to 1928) says, Check “Laying the caffeine myth to rest” for the real story..
I’m told that Healthspan are now sending out the paper questionnaire in newspapers. Presumably this is to ensure that the poor, the elderly etc and others who that aren’t computer literate don’t miss their buying opportunity. How considerate of them.
Nutriprofile’s expert team
Who is the expert team behind Nutriprofile? Here they are.
What do the real experts say about supplements?
The story you get is quite different when you ask somebody who is not trying to sell you something
“Most people should be able to get all the nutrients they need by eating a varied and balanced diet. But if you choose to take supplements, it’s important to know that taking too much or taking them for too long can cause harmful effects.”
“Harvard Men’s Health Watch suggests that the average man give up the multivitamin, at least until scientists solve the puzzle of folic acid and cancer.”
“If you eat a balancedthat includes food from all the major groups, there should be no need to take vitamin supplements. The food you eat will provide you with all the vitamins and minerals you need. “
I guess we should not be surprised at the direct contradiction between this advice and that of the Nutriprofile questionnaire. After all, Nutriprofile was developed by a company, Healthspan, that is devoted to selling “supplements” with all the dubious claims and customer testimonials associated with the alternative health industry.
But this is what always happens when big business controls science.
Oddly enough, Ann Walker’s experience seems to be much the same as ours. In an interview on the Healthspan site we read this.
Q: Which nutritional supplements do you choose to take?
A: I regularly take a multivitamin, vitamins C and E, fish oil, and a calcium and magnesium combination. I also take vitamin D during the winter and some herbs as and when they are needed.
Even if I have improved my diet, each time I complete the NutriProfile questionnaire my requirement for a multivitamin, calcium and magnesium, and a fish oil supplement are always thrown up.
Didn’t it occur to her to wonder why?
The sales pitch was followed up on 27 March the email arrived from Healthspan “Healthspan are offering you £5 to spend towards your recommended supplements”. One can’t say whether this offer goes to people who were not recommended supplements, because so far no such person has been found.
This afternoon I went to the Coliseum to see a revival of Jonathan Miller’s 1986 production of the Mikado. It was beautifully staged. The well-known patter song of Ko-Ko, the Lord High Executioner of Japan, begged for a version that deals with anti-science (original here). The serious post will come later. Meanwhile here’s some late night rhyming.
As some day it may happen that a victim must be found,
I’ve got a little list — I’ve got a little list
Of society offenders who might well be underground,
And who never would be missed — who never would be missed!
There’s the pestilential bureaucrats who want to send you on a course —
The HR folks who treat you not as human but as mere resource
Skills specialists who think that education just means training
And all ex-scientists who used to work, but now are only feigning
They’d none of ’em be missed — they’d none of ’em be missed!
He’s got ’em on the list — he’s got ’em on the list;
And they’ll none of ’em be missed — they’ll none of ’em be missed.
And that deluded nuisance, whom no one understands
The homeopathist – I’ve got her on the list!
All Reiki folks, pill hucksters and layers on of hands
They’d none of ’em be missed — they’d none of ’em be missed.
And herbalists and Princes who like to talk to trees
Those phony nutritionists who’ll treat you for large fees
And that singular anomaly, the acupuncturist —
I don’t think they’d be missed — I’m sure they’d not be missed!
You may put ’em on the list — you may put ’em on the list;
And they’ll none of ’em be missed — they’ll none of ’em be missed!
There’s the vision statement writer, and others of that sort
And the crystal therapist — I’ve got him on the list!
And the people who think long words are a substitute for thought
They never would be missed — they never would be missed!
Then those whose knight starvation makes them crave the honours list
So all below must suffer in case their chance is missed
And those who think that science can be judged by its citations
And so kill creativity by funding only applications
But it really doesn’t matter whom you put upon the list,
For they’d none of ’em be missed — they’d none of ’em be missed!
You may put ’em on the list — you may put ’em on the list;
And they’ll none of ’em be missed — they’ll none of ’em be missed!
I replaced two lines after my pedantic sister pointed out their imperfect rhyme and scansion. Personally I’m with Charles Babbage.
Here is letter that Babbage is said to have written to Tennyson after reading “The vision of sin”.
In your otherwise beautiful poem there is a verse that reads:
“Every moment dies a man
Every moment one is born”
It must be manifest that, were this true, the population of the world would be at a standstill. In truth the rate of birth is slightly in excess of that of death. I would suggest that in the next edition of your poem you have it read:
“Every moment dies a man
Every moment 1 1/16 is born”
Strictly speaking this is not correct. The actual figure is a decimal so long that I cannot get it in the line, but I believe that 1 1/16 will be sufficiently accurate for poetry.
I am etc,
(The Mathematical Gazette, 1927, p270)
One of the effects of this affair has been the posting of some critical examinations of some of the writings of Dr Ann Walker. I make no comment. The links are here.
This item appeared originally on the old IMPROBABLE SCIENCE page
The reversal of UCL’s request to remove this page from UCL’s server was, in large part, the result of the power of the blogosphere. Here are some of the things that did the trick.
He gives links to the close examination of the work of Dr Ann Walker that that is now appearing.
“UCL have just issued a smashing statement on Prof Colquhoun’s de-excommunication.” Comment from badscience.
This episode seems to have sparked a close inspection of some of the claims made by Ann Walker. Here are some examples.
“In one piece, Walker promotes the idea that neanderthals were not a distinct kind of human, but degenerate and malnourished versions of ordinary humans: buy pills or regress to a sub-human state, seems to be Walker’s message. Yikes.”
“Ann Walker festival: “There is no convincing evidence that Ginkgo biloba is efficacious for dementia and cognitive impairment” ” Holfordwatch takes a cool look at more claims by Ann Walker.
“Red Clover comments leave a bitter aftertaste” Click here
“The War Against Gobbledygook” Comment from Astrophysicists.
“UCL Makes good” Comment from the University of Minnesota
University Diaries. A US Professor of English reproduced Ben Goldacre’s first
“Science bloggers unite” Comment from a Yale neurologist.
“The Guardian: a quackbuster . . . “ Comment from MIT (and it’s on the MIT server).
“UCL change tack: Colquhoun is back” The Sceptical Preacher speaks
Freedom of speech and litigious herbalists
Announcement 13 June 2007. UCL restores
DC’s IMPROBABLE SCIENCE page.
After taking legal advice, the provost and I have agreed a joint statememt.
Read it on the UCL web site.
“ . . . the Provost and Professor Colquhoun have taken advice from
a senior defamation Queen’s Counsel, and we are pleased to announce that Professor Colquhoun’s website – with some modifications effected by him on counsel’s advice – will shortly be restored to UCL’s servers.”
I am grateful to UCL for its legal support, and I’m very grateful too for the enormous support I’ve had from many people, especially since Ben Goldacre mentioned the site move. Now all I need is a bit of help to get it into a more convenient format. The page will stay at its present address until there is time to sort things out. For some of the fallout from these events, click here. The name of the page has been changed from quack.html to improbable.html on the advice of lawyers, but the old addresses still work.
Announcement 30 May 2007.
My item about claims made for alleged benefits of the red clover and other herbs has resulted in complaints being made to the provost of UCL (Malcolm Grant), and to Chair of Council (Lord Woolf). The complaints have come from Alan Lakin, husband of Ann Walker. I have received no complaints from them myself.
In the six or years that I have been running this attempt to improve public understanding of science, I am aware of only two serious complaints being made, and as far as I know, this is the first to reach the level of the provost. This one resulted in a request to remove of this page from the UCL server, but that is now reversed.
This is a follow-up of the poat on BBC2 and the Open University on Alternative Medicine.
Following the article by Simon Singh in the Guardian (25 March 2006), two letters appeared on April 1, 2006. The first, from Prof. Edzard Ernst, confirmed that he felt the BBC had ignored and misrepresented his advice.
In its response to our criticism of the Alternative Medicine series, the BBC says “it is extremely unusual that Professor Ernst should make these comments so long after the series was aired” (Report, March 25). I made my criticism in writing two months before the programme was broadcast. The reason why I reiterated them when I did was simply because Simon Singh interviewed me in my capacity as adviser to the BBC. Extremely unusual? Long after? I don’t think so.
Prof Edzard Ernst
Peninsula Medical School, Exeter
The second letter defended the BBC. It was unequivocal in its support of the entire series of programmes, and its appearence surprised me. In the light of all that has been written, one might have hoped that the BBC would listen and learn from its mistakes. The letter has ten signatories.
We are all scientists involved as consultants or contributors to the BBC2 series, Alternative Medicine. We do not in any way recognise the experience of working on the series as described in your article (Was this proof of acupuncture’s power … or a sensationalised TV stunt?, Science, March 25), nor do we share the views of those scientists you have quoted in it. In all its dealings with us, the BBC asked for advice and input where needed, took on board our feedback and incorporated our comments into the final edit of the programme as transmitted, where appropriate. Far from feeling dissatisfied with the final outcome, we feel the series seemed well balanced and informative, doing full justice to the subject matter it addressed.
Dr Jack Tinker
Prof Brian Berman
Prof Liz Williamson
Dr Andrew Vickers
Dr James Warner
Dr Mike Cummings
Prof Gary Green
Dr Carl Albrecht
Dr Jen Cleland
Professor Irving Kirsch
But all is not what it seems. Contrary to appearances, this letter was actually written by the BBC who also compiled the signatories (it seems to have been the responsibility of Kim Creed, of BBC Factual Publicity).
- One of the signatories. Dr James Warner, had never seen the letter until after it was published, and tells me that “[I] substantially do not agree with the sentiments expressed therein. Indeed, we had to resist attempts by the programme makers to sensationalise our work”.
The Guardian has published a correction.
- Six other signatories tell me that their approval was limited to the way their own contribution was treated, and was not intended as approval of the whole series. One commented ” I’ve obviously been naïve, and I am very fed up with this whole thing”. Another says ” I suppose I (foolishly by the sounds of things) extrapolated from my own programme and experience, without considering the wider implications of the concluding sentence”.
- Only one of the eight signatories whom I’ve asked has actually seen all three programmes, as they were transmitted. This makes it rather odd that they should appear to endorse so unequivocally the whole series.
- One of the signatories, Carl Albrecht, gives his address as “University of Johannesburg”, but oddly the BBC forgot to mention that Dr Albrecht is co-owner (at least until very recently) of the South African Company, Phyto Nova, that makes, promotes and sells the untested herb, Sutherlandia, for treatment of AIDS (see, for example, here).
He is, therefore, highly biassed. He is also exceedingly controversial. One of his strongest critics has been Stuart Thomson, Director of the Gaia Research Institute,
hardly an organisation that is biassed against “natural medicines”. Albrecht is indeed a very curious choice of advisor for a programme about science.
- Three of the signatories (Berman, Cummings and Albrecht) are heavily committed to CAM, and so unlikely to be critical of anything that favours it, even apart from financial interests in the outcome. Brian Berman even has is own an entry in Quackwatch. So several of the signatories are pretty much committed in advance. Asking them if they endorse the programmes is about as informative as asking a group of priests if the endorse god.
- It gets worse. This morning, 6th April, I heard from Andrew Vickers, of the Memorial Sloan-Kettering Cancer Center, New York. This is what he says.
“I didn’t sign this letter ”
“I was shown the text of the letter but didn’t fully agree with it and told them so. I said something along the lines that the series didn’t do ‘full justice to the subject matter’ (how could it possibly?) but that what they did was fair and reasonable within the constraints set by the medium. You are also right to point out that my comments only go so far as the acupuncture episodes (which I saw) rather than the other two shows (which I did not). No doubt had I been shown a final version for signature I would have also pointed this out.”
The BBC brought us superb programmes like Life on Earth and Planet Earth. They bring us superb news (I’m listening to the incomparable John Humphrys on the Today Programme right now). They have suffered unjustly at the hands of spin-meisters like Alastair Campbell and the execrable Hutton Report (If the Hutton Report had been an undergraduate essay, it would have scored alpha-plus for collection of evidence and gamma-minus for ability to connect evidence to conclusions).
How ironic it is, then, to see the BBC behaving in this case like spin artists. Deny everything, and, if necessary, falsify the evidence.
|The programmes are presented by Kathy Sykes, who is professor of the public understanding of science at Bristol University. She has done some excellent work in that area, for example, in the Rough Science TV series.|
The first programme: acupuncture
The first programme, on acupuncture, was shown on 24th January, 2006. The programme did not start
in a very promising way. Just lots of testimonials from happy patients, the staple diet of all snake oil salesmen.
They are watchable, of course, but don’t do anything at all to promote public understanding of what constitutes evidence.
There is, of course, little doubt that sticking needles into your body can produce physiological responses. Two things remain uncertain.
- Just how useful are these responses in helping particular conditions?
- Is there anything at all in the mumbo jumbo of meridians and chi?.
With a big flourish we were shown “a 21-year-old Shanghai factory worker undergoing open-heart surgery with only the needles to control her pain”. It turns out that this was a sham. The patient was doped on opiates and local anaesthetics. The needles were merely cosmetic. Why were we not told?
The apparently contradictory trials suggested that, at least the alleged principles of acupuncture are nonsense. The programme concentrated on a trial by Berman (Ann Intern Med. 2004,
141, 901-10 ) which used ‘sham acupuncture’, with ‘stage dagger needles’, on osteoarthritis of the knees. In this sort of trial there is no actual penetration, and the sham needles are placed on the places dictated by the mumbo jumbo. This procedure was justly criticised by a subsequent letters in the same journal (Ann
Intern Med 2005, 142, 871).
Another large study was ignored by the TV programme altogether. This was by Linde et al. (Journal of the American Medical Association. 2005 293(17):2118-25). This study concluded
“Acupuncture was no more effective than sham acupuncture in reducing migraine headaches although both interventions were more effective than a waiting list control.”
As pointed out above, this study is, in many ways, much more interesting than Berman’s, because the control group did not have ‘sham acupuncture’. Needles were really inserted, but they were inserted in points that have nothing to do with the mumbo jumbo of meridians. The fact that the controls were much the same as the treated group suggests that, whatever effect the needles produce, it doesn’t matter much where they are inserted. The only obvious interpretation of this is that the ‘principles’ on which acupuncture is based are so much nonsense (and, therefore, it is not a subject that can possibly be taught in a university).
This crucial point was ignored by the TV programme. A big fuss was made of a functional magnetic resonance experiment, staged for TV, that showed that the effects on brain ‘activation’ are different for superficial needling and for real needling. There is nothing in the least surprising in the observation that have a needle pushed into you affects the brain, but it really does not help at all in answering the important questions. Incidentally that experiment had already been done anyway.
In summary, the first programme, failed to give a fair assessment of current knowledge about acupuncture, and failed to consider the important questions of what sort of controls are appropriate, and whether talk of meridians means anything whatsoever. Sadly, I can’t agree with the boast that “It’s the deepest investigation into the efficacy of alternative medicine ever attempted on TV”. Let’s hope the second programme is a bit more critical.
The second programme: healing
The second programme (31st January, 2006). I liked this programme much better than the first, even if it left the crucial questions unresolved.
|The programme started with a healing meeting by the notorious Benny Hinn. The meeting had all the mass hysteria of a Nuremburg rally, though no mention was made of the fact that this (very rich) man’s financial malpractice had been revealed by a CBC TV programme.|
On the right is his receipt for £3347 for two nights at the Lanesborough hotel in London (that did not include $1700 he gave in tips).
The lovely Ghanaian lady who cleans my office and lab every morning gives gives money to this mega-rich man because “he needs it to preach the gospel”.
The National Institutes of Health provided $1.8 m of US taxpayers’ money for this project which seems not to do real research at all. After seeing a demonstration of the “Gas Discharge Visualization”, GDV, or Kirlian camera, given by a very gullible Dr Melinda Connor, Sykes comments that this ‘research’ “is not so much trying to find the evidence for ‘healing energy’, but is rather working on the basis that there is one”
Kathy Sykes did, though show a pretty healthy degree of scepticism about the people who pretend to photograph “auras” and other imaginary “force fields”. She visited the “Center for Frontier Medicine in Biofield Science” at the University of Arizona.
In other words, the ‘research’ is a con. Once again (see above) we see money given by well-intentioned governments diverted form the purpose for which it was given. For more first class boloney on ‘imaging’, see for example, Biofield Sciences in Exeter (UK) and ‘electro-crystal therapy’. The list is endless.
Kathy Sykes went on to show several interesting experiments on placebo effects. For example sham healers (played by actors) do at least as well as ‘real’ healers. And sham knee surgery may be as effective as real surgery, though the programme failed to mention the obvious possibility that this could mean nothing more than that real knee surgery is itself pretty ineffective. As so often in this series, the producers failed to talk to the right people.
She concludes “healing does not work beyond placebo”.
So I’m right with her, though it would have been better if there had been a more critical mention of the fact that not all placebo effects are real. Many probably depend on the natural fluctuations in the intensity of the patient’s condition. Anything can ‘cure a cold’, because you recover from a cold in a few days anyway,
Sykes concludes, speaking of the placebo effect, “I want to see that power properly harnessed -we’d be mad not to”. But that, disappointingly, was the end of the programme. That point is where the problems begin. How do you harness the placebo effect? How do you justify lying to the patient in order to maximize the effect? How do you train the ‘healers’? Are they themselves to believe the same lies, or are they to be trained in the art of deception? As pointed out in a recent review of the neurobiology of placebos (Colloca and Benedetti, 2005)
“For example, the assertion that placebos, fake therapies, fresh water and sugar pills could positively affect the brain biochemistry in the appropriate psychosocial context might lead to a dangerous justification for deception, lying and quackery”.
These are the central dilemmas of sCAM, as listed at the top of this page. The programme did nothing to solve them, or even to draw attention to them.
The link with Open University Course K221
The blurb on this programme on the Open University/BBC site concludes
“So, could the power of the mind explain the benefits people experience from healers? And have healers tapped into this power somehow? The conclusion throws new light on all healing processes, and has a surprising and inspirational message for every practitioner and patient.”
But what is to be done about this “inspiration”? Nothing is said about that. The TV programme was immediately followed by voice-over that advertised an Open University pamphlet, which is publicity for their course K221. That course, judging from what is posted on the web, is run by true believers who are a lot less sceptical than Sykes. She says that she did the voice-over but has not yet been shown the contents of the course.
The third programme: herbalism
Oooh dear. The third programme was, in my view, by far the worst. Hardly a single critical voice was heard. Despite the odd word of reservation, the programme left the impression of being an advertisement for the herbal medicine industry. Did the BBC not think of asking a pharmacologist? In my view, this programme was a disservice to human knowledge. Let’s look at some of the details.
The programme once again starts with dramatic testimonials from satisfied customers. No hint is given to the viewer of the total unreliability of such testimonials. References, in awed voice, are mad to “a vast body of ancient knowledge that herbalists draw on”. No mention of the superb track record that ‘ancient knowledge’ has for turning out to being dead wrong. It was 11 minutes into the programme before the question of evidence was even mentioned and then we had a herbalist wandering through a field. At 13 minutes, the herbalist, Simon Mills, was interviewed -he rattled on about dampness. marshy conditions. “There
are herbs for heating and drying”. Sheer gobbledygook. And still no discussion of evidence.
Sutherlandia At 18 minutes “To get another view I’m going to a country where herbs are claimed to have dramatic effects”. Off to Africa to spend a good 10 minutes on Sutherlandia, a totally unverified treatment for AIDS. Why spend all this time (and licence-payers money) to end up with the conclusion that clinical trials have
not been done yet, and we have no real idea whether it works or not? A search of Pubmed for Sutherlandia and AIDS produces a mere five papers. Mills et al. Nutrition Journal 2005, 4:19 write as follows.
“Despite the popularity of their use and the support of Ministries of Health and NGOs in some African countries, no clinical trials of efficacy exist, and low-level evidence of harm identifies the potential for drug interactions with antiretroviral drugs.”
(and one of the authors on that paper is from the Canadian College of Naturopathic Medicine: hardly likely to have a bias against herbs). The comments made in the programme about AIDS were irresponsible and potentially dangerous: they could kill people..
It took until almost half way through the programme, before we got round to the question of whether any of these claims are true. Very impressive to learn that the Nazis pushed herbal medicine, but totally uninformative (or does it mean that herbalism appeals to nutters?). We are shown the German herbal bible, but again it is pointed out that it contains no evidence about their efficacy. So no further forward yet. Then we are introduced to chromatography: very pretty, but still no evidence about whether herbs help people.
At 9.34 pm we are last get round to some evidence. Or do we? Not yet, just another personal testimonial about the the wonders of St John’s Wort. St John’s Wort (Hypericum) is an interesting case, because there is at least some evidence that it works, though certainly not enough for it to be described as a “superherb”, as Sykes did. Of course depression (like knee surgery -above) makes a pretty good case for herbalists, because conventional antidepressants are so very unsatisfactory themselves. It doesn’t take much to do better than Seroxat (Paxil, paroxetine). At 9.38 pm we get the first actual numbers. And very selective numbers they are
too. The view presented in the programme was desperately over-optimistic about the wondrous effects of St John’s wort. Consider the recent review by Linde et al. (2005 Brit J. Psychiatry, 186, 99-107) (read
it yourself –download pdf file). The conclusion was as follows.
“Current evidence regarding Hypericum extracts inconsistent and confusing. In patients who meet criteria for major depression, several recent placebo-controlled trials suggest that Hypericum has minimal beneficial effects while other trials suggest that Hypericum and standard antidepressants have similar beneficial effects. ”
And another trial, again not mentioned in the programme, was published in Journal of the American Medical Association, 2002, 287, 1807 – 1814) [download the pdf file]. This paper was interesting because it compared placebo, St John’s Wort and sertraline (Zoloft), a drug of the same class as Seroxat). All three were indistinguishable (on the two primary outcome measures). So St John’s Wort was as good as Zoloft, but only because Zoloft was no better than placebo either. The paper concluded thus.
“This study fails to support the efficacy the efficacy of H. perforatum [St John’s Wort] in moderately severe major depression. The result may be due to low assay sensitivity of the trial, but the complete absence of trends suggestive of efficacy for H. perforatum is noteworthy.”
Why were we not told about trials like these?
At 9.43 pm, almost three quarters of the way through the programme, we are eventually told that ginseng, echinacea and evening primrose oil do not work. What took so long?
9.46 pm. Off to South Africa to look at research in Johannesburg on Sutherlandia by Carl Albrecht (more of him below). Some impressive stuff about flavonoids but no results. Flavonoids can’t be absorbed, but, aha, it contains saponins too. Perhaps they allow the flavonoids into cells. Well perhaps.
But this is not information, it is idle speculation.
At 9.51, we get back to brain imaging, this time at Imperial College. Professor Sykes seems to be excessively impressed by brain imaging. We are then treated to more idle speculation about how ginko might help in Alzheimer’s disease. Dr Warner is running a clinical trial to find out whether ginko really helps. But there were no results yet. In that case why not wait until there is a result, before telling us all about it?
We are told that herbs now “have to go through rigorous quality standards”. It was NOT made clear that the standards don’t include anything about the herb actually doing anything useful. The standards may give some protection against your being poisoned. They do nothing at all to guarantee you’ll be helped.
“What’s really impressed me is the way that different ingredients from particular herb can combine together and have really powerful effects on us humans. So I believe that herbs are going to play a key role in medicines of the future”
“What started as an ancient wisdom may just might provide new medicines that will help us all live longer, fuller lives”
These statements are quite outrageous! The first statement has no basis whatsoever. It is sheer idle speculation. It could be true, but there is no reason to believe it is.
The second statement is content-free. Yes, it “may just” do that. On the other hand it may not.
The web site for the third programme. (7th February, 2006, 2100-2200) concludes thus.
“So, what’s their secret? Working with fellow scientists, Kathy discovers that plants contain much more than a single – or even two or three – active ingredients. They are enormously complex
Chemical cocktails that have medicinal properties modern pharmaceuticals simply can’t reproduce.”
Just one snag (apart from the misleading implication the Sykes was doing pharmacological experiments), There is not the slightest reason, thus far, to think there is any advantage in using an “enormously complex chemical cocktail”.
Stop press: on Saw palmetto (one of the “superherbs” of the TV series)
The New England Journal of Medicine, for February 9th 2006 (354, 557 – 566), reports a clinical trial of “Saw Palmetto for Benign Prostatic Hyperplasia”. This is what they say.
“Saw palmetto is used by over 2 million men in the United States for the treatment of benign prostatic hyperplasia and is commonly recommended as an alternative to drugs approved by the Food and Drug Administration.”
“In this double-blind trial, we randomly assigned 225 men over the age of 49 years who had moderate-to-severe symptoms of benign prostatic hyperplasia to one year of treatment with saw palmetto extract (160 mg twice a day) or placebo.”
“Conclusions. In this study, saw palmetto did not improve symptoms or objective measures of benign prostatic hyperplasia.”
I hope that the BBC, the Open University and Prof Sykes now appreciate the folly of judging treatments before the results are in.
Postscript. Some reviews of the TV programmes
There has been some lively discussion of the BBC2 series on a forum of the James Randi Educational Foundation, on the BBC2/Open University site, on Ben Goldacres’s Badscience site, and at ebm-first.com.
- The Times TV critic was unenthusiastic.
“So having started out as a sceptic, Sykes ended the programme chirruping, like a born-again Christian, about how herbs contain complex combinations of chemicals that scientists cannot yet reproduce&”;
Simon Singh writes in the Daily Telegraph (14 Feb., 2006): "Did we really witness the ‘amazing power’ of acupuncture?
“A BBC series on unorthodox therapies was devoid of scepticism and rigour, says Simon Singh.”
“Although the second programme was indeed a rational look at the placebo effect, the other two episodes were little more than rose-tinted adverts for the alternative medicine industry.”
“For example, the scene showing a patient punctured with needles and undergoing open heart surgery left viewers with the strong impression that acupuncture was providing immense pain relief. In fact, in addition to acupuncture, the patient had a combination of three very powerful sedatives (midazolam, droperidol, fentanyl) and large volumes of local anaesthetic injected into the tissues on the front of the chest.
With such a cocktail of chemicals, the acupuncture needles were apparently cosmetic. In short, this memorable bit of telly was emotionally powerful, but scientifically meaningless in building a case for acupuncture. ”
“This TV series pretended to be scientific and had the chance to set the record straight, but instead it chickened out of confronting the widespread failure of alternative medicine. ”
- Advertisers cash in. Sadly, but predictably, the programme on herbalism has
already been exploited by vendors of unproven treatments. While it is true that the programme did not actually assert that this herb cured AIDS, it certainly left the impression that it was good stuff. Here is an example: “As seen on BBC2”
“In South Africa, BBC 2 TV presenter, Professor Kathy Sykes learnt of the herb Sutherlandia, which is being touted as a new weapon in the fight against HIV and ”
“It is with thanks to programmes such as Alternative Medicine shown on BBC 2 on Tuesday 7th February, and the work carried out by Professor Kathy Sykes that medicinal herbs can receive the acknowledgement they truly deserve, and this knowledge be passed on to the general public.”
“Bioharmony Sutherlandia is available from Revital Ltd in 60 x 300mg tablets for £19.99rrp. ”
- A groundbreaking experiment … or a sensationalised TV stunt?
Simon Singh, in The Guardian (25 March 2006) followed through with some more details on the BBC2 series. It’s not only pharmacologists who were unhappy about it. So were several of the people who advised the BBC and/or appeared on the programme.
“But this week scientists involved in the series have complained that elements of the programmes were misleading, the production team was uninformed, and scientists were used as “marionettes” ”
At the end of the first programme a “hugely ambitious” imaging experiment was shown with an enormous flourish. The outcome was, roughly speaking, that pushing needles into yourself produces a signal in the brain. Good heavens! Who’d have thought it? Even George Lewith, normally an apologist for CAM, was critical.
“The interpretation of the science in this particular programme was not good and was inappropriately sensationalised by the production team. I think all of us on the experiment felt like that.”
“The experiment was not groundbreaking, its results were sensationalised and there was insufficient time to analyse the data properly and so draw any sound conclusions. It was oversold and over-interpreted. We were encouraged to over-interpret, and proper scientific qualifications that might suggest alternative interpretations of the data appear to have been edited out of the programme.”
Edzard Ernst, professor of complementary medicine at Exeter University, and the main consultant for the series says:
“The BBC decided to do disturbingly simple storylines with disturbingly happy endings. But none of these stories is as simple as they presented, nor do they have such happy endings. Even when the evidence was outright negative, they somehow bent over backwards to create another happy ending.
“I feel that they abused me in a way. It was as if they had instructions from higher up that this had to be a happy story about complementary medicine without any complexity, and they used me to give a veneer of respectability.”
The BBC, thus far, remain unapologetic
“We take these allegations very seriously and we strongly refute them.We used two scientific consultants for the series, Prof Ernst and Dr Jack Tinker, dean emeritus of the Royal Society of Medicine, both of whom signed off the programme scripts.”
This is the same Jack Tinker who, as Chairman of the Ethics Committee of the Dr Foster organisation, also approved their “COMPLEMENTARY therapists Guide 2004”, and the utterly uncritical complementary practioner directory. The ‘Dr Foster’ organisation is a commercial business that supplies "management information", "market research services", "marketing services" and "information for the public". Let’s hope their services in conventional health care are a bit more critical than their evaluation of CAM. Their “Guide to [CAM] therapies” repeats all the usual pseudo-scientific gobbledygook in a totally uncritical way.
Singh’s article ended with some quotations from this site, concerning Sutherlandia and AIDS, with the remark made above, highlighted: "Comments about Aids were irresponsible and potentially dangerous".
- Science accuses BBC of medical quackery
Lois Rogers, in the Sunday Times for 26th March, reports on the same topic.
“Ernst yesterday released the contents of a letter that he has written to Martin Wilson, the series producer, criticising him for promoting “US-style anti-science”.
He said he felt “abused” by the programme makers: “It was as if they had instructions from higher up that this had to be a happy story about complementary medicine without any complexity, and they used me to give a veneer of respectability.” “
“This is no longer a fringe game played by new age people,” said Colquhoun. “It is beginning to erode intellectual standards at real universities.”
Later a letter appeared in defence of the programmes. Investigation showed that this letter had actually been written by the BBC and not all of the ‘signatories’ had seen it.This is dealt with in a separate post, Alternative Medicine series: dirty tricks at the BBC?
This item appeared originally on my old Religion and Education page. It has been moved here because of the discussion that followed my review in the BMJ of Unscientific America and the discussion that followed, on this blog and on P.Z. Myers Pharyngula blog.
Until recently, the idea that the earth was created 6000 years ago was largely restricted to right wing religious fundamentalists in the USA. Now we have a government in the UK which seems to be happy that such “fruit-cake” nonsense should be taught at the taxpayers’ expense.
The following article, Good God Almighty, was commissioned by Punch magazine, which folded before it could be published.
It refers to the fuss that followed the discovery that a state-funded school was being run by extreme ‘young earth’ creationists. If you want to see just how extreme, look at the speech made by Steven Layfield, the head of science at Emmanuel School. The views expressed are so extreme that the speech was actually deleted from the web site of the Christian Institute as soon as the fuss blew up. Luckily, thanks to the Google cache, this did not work and you can still read it at here.
Good God Almighty!
or Jurassic Theology
[This article was commissioned by Punch, but the magazine went out of business before it was published]
OK class, settle down. Here is your quiz. Compare and contrast the following.
(1) ” . . if the Bible really is the Word of God – and the internal evidence is overwhelming – true Science will always agree with it.”
(2)Science teachers should
“Note every occasion when an evolutionary/old-earth paradigm (millions or billions of years) is explicitly mentioned or implied by a text-book, examination question or visitor and courteously point out the fallibility of the statement and, wherever possible, give the alternative (always better) Biblical explanation of the same data”.
[Steven Layfield, Head of Science at Emmanuel School Gateshead, 2000]
(3) “There are those that argue that Science and Christianity can be harmoniously reconciled . . . We cannot subscribe to this view”
[John Burn & Nigel McQuoid; ex-head, and head, of Emmanuel School Gateshead, 2002]
(4) “Then there is science. Science is a God-given activity. Scientists are 5using their God-given minds and God-given creativity to explore and utilise God-given nature. Sadly, biblical literalism brings not only the bible but Christianity itself into disrepute.”
[The Bishop of Oxford. The Rt. Revd. Richard Harries, 2002]
(5) “God created the world and everything in it.” “It is about 6000 years old”
[Kate and Simon, pupils of Emmanuel School, Gateshead, interviewed by Mike Thomson, BBC]
(5) [Jenny Tonge, MP:] “Is the Prime Minister happy to allow the teaching of creationism alongside Darwin’s theory of evolution in state schools?”
[Tony Blair]. First I am very happy.”
“Secondly, I know that the honourable lady is referring to a school in the north-east, and I think that certain reports about what it has been teaching have been somewhat exaggerated”.
The prime minister is right. Something has been exaggerated:
The idea that teachers realise that the scientific method involves not declaring the outcome in advance.
Clearly, the head of science at Emmanuel doesn’t. To proclaim, before looking, that one view (the literal interpretation of the bible) is “always better” might be expected of an itinerant preacher in the deepest bible belt, but that is the view of the man in charge of educating children at a state-funded English school.
It is a view that offends the Bishop of Oxford, and it is contrary to the views expressed by Pope John Paul II. But don’t worry, our leader is “very happy” with it. To give equal time to a simple assertion (that the earth was created 6000 years ago), and to the wealth of hard-won reasons for thinking it to be untrue, is deeply offensive to every scientist who is trying to fumble towards the best approximation to the truth that can be found. Rarely can a couple of teachers and one prime minister have managed to offend so many people, everyone from bishops to professors, at a single sweep.
Of course neither the prime minister nor anybody else knows exactly what Emmanuel School has been teaching (though the reports from the children themselves give us a good idea). The glowing report from OFSTED was actually the result of a “short inspection” which does not look at such details. The school has not been given a full inspection since 1994, before the serious zealots took control. Views such as those in the first two quotations are so obviously relevant to the quality of science teaching that you may well ask how OFSTED managed not to notice that the views of the head of science were at the very extreme edge of fundamentalism.
Consider also the following amazing coincidence. The team of inspectors who found no fault with the unusual science (biblical is always best) teaching at Emmanuel was almost the same as the team that inspected the Huntington School, York. At that school they said that there was not enough teaching of religion (in the narrow sense, as opposed to spiritual values in general). The Huntington head teacher Chris Bridge lodged a complaint against that report, and it was partially upheld by OFSTED.
Does all this mean that extreme fundamentalism has infiltrated OFSTED, or does it simply mean that the inspectors did not do their homework?
The latter is the more charitable interpretation, but the inspectors are not going to get the chance to ‘try harder next time’. Instead Her Majesty’s Chief Inspector, wrote a letter to the chairman of the governors, asking for “clarification”. Unlike most schools, the Emmanuel School does not publish the names of its governors in the school prospectus, and neither OFSTED, nor the Department of Education, knows who they are. OFSTED does give the name of the chairman as “Dr `Peter Vardy” (as does the school if you phone). It turns out that the learned Dr Vardy is one and the same person as Sir Peter Vardy, the man who gave the government two million pounds to pay for the school. Don’t worry about the “Dr” bit though –it is perfectly genuine. The University of Sunderland was generous enough to give him an honorary doctorate in business administration (after he generously gave the University £1 million). The Chief Inspector (by then changed) recieved a suitably emollient letter from Sir Peter, but did no investigation whatsoever. Ofsted gives the firm impression of having born yesterday.
It is hard to appreciate the manic fervour of Mr Layfield’s notorious speech from only two quotations. It used to be on the web site of the Christian Institute (www.Christian.org.uk), and that site is still worth a visit. Mr McQuoid is a major contributor (see quotation no 2), but other bits are well worth reading too, like the vigorous defence of beating children (don’t get me wrong –I know there are lots of sites that deal with that sort of thing, but this is different; it is holy beating).
Mr Layfield’s speech suddenly vanished from this web site shortly after Tania Brannigan (of the Guardian) told us what was going on. Luckily, though, some kind folks thought it was such an outstanding piece of work that should still be available to everyone (just go to http://www.darwinwars.com/lunatic/liars/layfield.html).
Time’s up folks. Put down your pens and now go out and vote.
This item appeared originally on my old Religion and Education page. It has been moved here because of the discussion that followed my review in the BMJ of Unscientific America and the discussion that followed, on this blog and on P.Z. Myers Pharyngula blog. Evan Harris MP and I were up against the head of fundamentist school that had been started by wealthy used-car dealer, Peter Vardy. Being rather daunted by the Oxford Union, I actually wrote down my bit. The order of speaking because Evan Harris had to rush back to the House of Commons to vote against the Iraq war. The rest is history.
Oxford Union talk on ‘faith schools’ and creationism
This debate is meant to be about ‘faith schools’, but I suspect that the differences between the views of my two friends opposite are rather large. Mr Brady will, I presume, advocate schools that teach conventional religious views, and that I take to be the topic under discussion. First let’s get the issue of Mr McQuoid’s view on creation out of the way before coming to the serious matter of the debate. We have to be clear about one thing -there is a spectrum of religious views and Mr McQuoid is at the extreme fruit cake end of that spectrum. A true flat-earther.
An article by John Burn & Nigel McQuoid; (ex-head, and head, of Emmanuel School) stated:
“There are those that argue that Science and Christianity can be harmoniously reconciled . . . We cannot subscribe to this view”
This appeared on the web site of the Christian Institute, and that site is well worth a look. Apart from promoting ‘young-earth creationism’, it has two other obsessions, the evilness of homosexuality and the desirability of corporal punishment of small boys. It is truly bizarre. Well, at least Mr McQuoid’s job is not to teach science, but the head of science in his school, Steven Layfield, said in a speech published on the same web site (in 2000)
“…if the Bible really is the Word of God – and the internal evidence is overwhelming – true Science will always agree with it.”
Science teachers should… “Note every occasion when an evolutionary/old-earth paradigm (millions or billions of years) is explicitly mentioned or implied by a text-book, examination question or visitor and courteously point out the fallibility of the statement and, wherever possible, give the alternative (always better) Biblical explanation of the same data”.
He is free to express that view, but it disqualifies him from teaching science. The speech from which this is quoted, incidentally, disappeared form the web site of christian.org as soon as the row became public -one does wonder why, but don’t worry you can still ready it at the quaintly named site http://www.darwinwars.com/lunatic/liars/layfield.html However offensive it may be that such extremism is subsidised by taxpayers money, however offensive it may be that no full inspection of his school has been carried out since he came to power, and however offensive it may be that the prime minister supported his views, it is an irrelevant issue for the purposes of serious discussion. The pope does not believe that the earth was created 6000 years ago, the Anglican church does not believe that the earth was created 6000 years ago, hardly anyone but Mr. McQuoid thinks that the earth was created 6000 years ago (except in some parts of the south USA). The number of people who have that capacity to deny the obvious will never be more than handful, and to that extent we need not bother any further about them, and we can get on with the real issue of religious schools. As the Bishop of Oxford (The Rt. Revd. Richard Harries) said (2002)
“Then there is science. Science is a God-given activity. Scientists are using their God-given minds and God-given creativity to explore and utilise God-given nature. Sadly, biblical literalism brings not only the bible but Christianity itself into disrepute.”
Now to the real question…
What is wrong with allowing parents to choose a school for their child that teaches the parents’ religious belief? At first sight this sounds quite innocent, apart from the fact that it is the parents’ religious belief, not the child’s. In any case there are not many parents in the country who have religious (well Christian) beliefs. No more than 7.5 % now go to church regularly, and recently, for the first time, the proportion who profess even a nominal attachment to the church fell below half (as did the proportion of parents who have children baptised).
Why, then, are religious schools quite popular? The reason appears to be that they are selective. The rules say that selection must be on religious grounds only, but it simply does not work out like that. It is bad enough that children’s access to education should depend on their parents’ religious views (or, not infrequently, on their parents’ skill at lying about their religious views). But of course, selection of some implies exclusion of others, and, it turns out, not only because of their religion. Religious selection leads inevitably to racial selection too. In Oldham, scene of the recent race riots, the christian schools are almost exclusively white. Selection by wealth occurs too. In Accrington a C of E school has 12.5% of special needs pupils, while its neighbouring non-religious school has 69.8%; eligibility for free school meals is and 5% in the C of E school and 33% in its neighbour (on average the factor is almost 2).
How could such a disgraceful state of affairs come about? I believe that, as so often, a look at history might help, so let’s go back to see how the world looked in 1820.
Apart from 9 years I have spent all my working life at University College London.
The relevance of that will be obvious if we recall that in 1820, there were only two universities in England, Oxford and Cambridge (though 3 in Scotland). Both Oxford and Cambridge restricted entry to members of the Church of England – not only did they exclude Jews, atheists and muslims, but they also excluded many christians -catholics, protestants and dissenters. They would, no doubt, have excluded Mr McQuoid from getting higher education. It was in this context that liberals and dissenters in London founded the University of London, soon to become known as University College London, with the specific aim of admitting good students regardless of their religious beliefs, and with providing them with non-sectarian education in science as well as humanities (there was little science in Oxford and Cambridge at that time). Despite prolonged opposition from Oxford and Cambridge, UCL opened its doors in 1828.
At that time the fiercely conservative Duke of Wellington had just, albeit reluctantly, made the transition from general to prime minister. Even his government passed measures to increase the rights of catholics and dissenters, but his implacable opposition to electoral reform led to his resignation two years later, to be replaced by the Whig administration of Earl Grey.
The country was in ferment and change was rapid -in 1830 the Liverpool-Manchester railway opened and Faraday’s work on electricity was well-developed. But the electoral system was still mediaeval. The ‘rotten borough’ of Old Sarum (an iron age fort and 7 inhabitants) had two MPs while Manchester, already busy with the cotton trade, had none at all. In 1831 three attempts at electoral reform failed in parliament, but Earl Grey had told William IV “it is the spirit of the age which is triumphing and that to resist it is certain destruction”. The next year, in 1832, Lord John Russell (grandfather of Bertrand Russell) successfully got parliament to pass the (first) Reform Act and the modern age of democracy had begun.
The political ferment was paralleled by scientific ferment -people were no longer constrained by dogma and authority and new ideas came into medicine and biology too.
After another 40 years, Oxford and Cambridge caught up, when the Universities Test Act of 1870 eliminated religious criteria for university entrance. After 1870 it became quite unthinkable that a selection for higher education should be dependent on what a person believed, or did not believe in their private lives about religion.
That was 1870. Now it is 2002.. Can you imagine Oxford reintroducing religious selection of undergraduates now? Yet my friends opposite, and the government, are supporting a view of education that started to vanish in 1828 with the foundation of UCL, and finally died in 1870 with the Test Acts. They are trying to set back progress not by 10 or 20 years but by 175 years.
What next? Bring back rotten boroughs?