Download Lectures on Biostatistics (1971).
Corrected and searchable version of Google books edition

Download review of Lectures on Biostatistics (THES, 1973).

Latest Tweets

Bad journalism

Jump to follow-up

The press releases (STOP PRESS)

Uhuh, here we go again.

All over the media we see headlines like “Honey ‘beats cough medicine’ “.
Take for example, the Daily Telegraph, where Ben Farmer writes “Honey is better at treating children’s coughs than an ingredient used in many over-the-counter medicines, according to new research”.

That is NOT what the research found This is what the research paper itself says (DM refers to the standard ‘cough suppressant’ dextromethorphan, which is already known to be ineffective).

“honey was significantly superior to no treatment for cough frequency’

DM was not better than no treatment for any outcome.

Comparison of honey with DM revealed no significant differences.”

See it? No detectable difference between honey and standard cough medicine.

Everyone in the media misinterpreted what the paper said, but at least one blogger is already on to it, with Today’s “duh” study is a honey”.

At first sight, the results seem contradictory, No difference between honey and DM, No difference between DM and ‘no treatment’. So how can honey be better than ‘no treatment’?

The study was by Ian M. Paul, MD, MSc; Jessica Beiler, MPH; Amyee McMonagle, RN; Michele L. Shaffer, PhD; Laura Duda, MD; Cheston M. Berlin Jr, MD, published in Archives of Pediatrics & Adolescent Medicine 2007, 161, 1140 – 1146.

What was done

The design of this trial was pretty good apart from one thing Three things were compared (a) buckwheat honey, (b) a standard ‘cough suppressant’, dextromethorphan in a honey-flavoured syrup that was designed to be similar to the honey (DM for short), and (c) no treatment whatsoever.

The median age of the children who completed the study was 5.2 years (range, 2.2 – 16.9 years). They all had coughs attributed to upper respiratory tract infection. Thirty-five patients received honey, 33 received DM, and 37 received no treatment.The good thing is that the treatments were allocated randomly to the children, and that the person doing the assessment didn’t know which treatment each child had received. The children didn’t know whether they were getting honey or DM either, but they DID know when they got ‘no treatment’. The trial was carried out over two days. On day one nobody got a treatment, but they filled in a survey that asked, for example, “How frequent was your child’s coughing last night”. The parent had to tick one of seven boxes, from ‘not at all’ (score zero) to ‘extremely’ (score 6). They were then given the treatment allocated to them in a brown paper bag, so the person who gave it didn’t know which it was. The patients then went home and on the next day the same survey was completed by the same parent, over the telephone.

What happened?

First look at the raw data. Here is Figure 2 from the original paper.The charts show the results for 5 different measures of the severity of cough, and the last chart (F) shows the aggregate score for all the criteria.

The first thing to notice is that there are no error bars on these charts. In my area, at least, no journal would accept a chart like this with no indication of scatter. There is a snag, though. Each patient acts as his/her own control, and that would not be reflected properly if errors bars were calculated for the numbers plotted in Fig. 2. It would therefore have been better to have a chart in which the difference in score between day 1 and day 2 was calculated from each patient, and the size of these differences plotted, with a standard deviation of the mean to indicate the amount of scatter in the observations. I have asked Dr Paul to send me a version that indicates the scatter of the numbers in this way (but I don’t think it will come).

The second thing to notice is that there is there is quite a big difference between the score on the first day (pale columns) and on the second day (dark columns), even in the no treatment group .

Thirdly, the pale columns are all much the same. On the first day the average score was about 4 (“a lot”) though on the second day, even with no treatment, the score fell quite a lot, to something between 2 (“a little”) and 3 (“somewhat”). This is a bit baffling because no treatment was given on either day. Presumably it results from the different settings in which the survey was given, or because the kids were getting better anyway.

Fourthly, insofar as the pale columns (baseline values) are all much the same, the thing you need to concentrate on is the difference, on each chart, between the height of the dark bars, for honey, DM and no treatment. These differences are pretty small, but on all the charts, the honey score is slightly smaller than the DM score, and the DM score is slightly smaller than the ‘no treatment’ score. What are we to make of that?

Here beginneth the statistical lesson.

Because the differences are small, and the scatter is quite big, we have to ask whether the differences are just random fluctuations rather than a result of any real difference between the treatments. That means we need statistics. Here is how the statistical argument works. Put roughly, we ask “how probable is it that the observations could arise by chance”. More precisely, the question is this. If there were no difference between the treatments, what is the probability that we would observe by chance a difference as big as, or bigger than, that seen in the experiment? (You need the subjunctive mood to explain statistics -pity it’s vanishing.)

Above each chart in the Figure we see P < 0.001. This means that there is less than a one in 1000 chance of the results arising by chance. More precisely, if all three treatments (honey, DM and no treatment) were actually identical, it is very unlikely that we’d see these results. The reasonable conclusion is, therefore, that all three treatments are not identical. The problem with this argument is that it tells you nothing about where the differences lie, so it is of no help whatsoever to a patient who is trying to decide what to do about a cough. The other problem is that it includes the ‘no treatment’ group, which was not blind. Both the children and parents were well aware that no treatment was given.

The most helpful comparison is really the properly-blinded comparison between honey and DM. And when this was looked at the result was no significant differences. In other words the small differences between the heights of the dark columns for honey and DM could perfectly well have arisen by chance if honey and DM were identical in their properties.
There isn’t any reason at all to think that honey is better than the standard (but ineffective) cough medicine.

The direct comparison between DM and ‘no treatment’ also shows no significant difference. Yet there are signs of a real difference between ‘no treatment’ and honey, though only for the cough frequency, not the other four measures. The aggregate measure (F in the figure) gave P = 0.04 for the comparison, so the authors are running a risk of 1 in 25 of being wrong in claiming a real effect. Although some people seem to regard a value of P = 0.05 as indicating a real effect, the fact that you’ll make a fool of yourself 1 time in 20 by claiming a real effect when none exists has never seemed to me to be good enough odds to stake one’s reputation on.

The ‘no treatment’ group certainly has some interest, but the fact that it was not blind means that the fact that honey was marginally better than ‘no treatment’ could perfectly well mean that taking honey has a better placebo effect that doing nothing at all. It provides no evidence at all that honey has any genuine therapeutic effect. If it had, one would then have to find out if the therapeutic effect was specific to buckwheat honey, or whether any old honey would do. It could be argued that even if the effect were real rather than placebo, the size of the effect is too small to make all that effort worthwhile.

A couple more things

It is already well known, from several good studies, that DM is useless, no better than placebo. This inconvenient fact has not yet reached many places that it should have (not even mentioned on wikipedia for example), but the American Academy of Pediatrics says

“Numerous prescription and nonprescription medications are currently available for suppression of cough, a common symptom in children. Because adverse effects and overdosage associated with the administration of cough and cold preparations in children have been reported, education of patients and parents about the lack of proven antitussive effects and the potential risks of these products is needed.”

The discussion in the paper by Paul et al, seems surprisingly upbeat about honey, in the light of their own findings. I’m surprised that they use the term ‘demulcent’ which I had thought to have died out, like the word ‘tonic’, on the grounds that it had no defined meaning

It is because meaningless terms and useless medicines die out eventually that medicine makes progress. The problem with alternative medicine is that nothing dies out: on the contrary they keep adding myths.

And finally

Always look at the end of the paper. On this one we see that the study was paid for by the National Honey Board. Dr Paul assures me that the funding source had no say in the design or analysis, which is as it should be.

Financial Disclosure: Dr Paul has been a consultant to the Consumer Healthcare Products Association and McNeil Consumer Healthcare.

Funding/Support: This work was supported by an unrestricted research grant from the National Honey Board, an industry-funded agency of the US Department of Agriculture.

So what is the practical outcome?

My conclusion from all this is simple. If you have got a cough, tough luck. There isn’t really anything available, conventional or alternative, that does much good. You’ll just have to wait for it to get better. But if you want to take something that tastes nice, why not honey? It almost certainly won’t do any good but it tastes good and it’s safer than the standard cough medicine.

The sponsor’s interpretation

It seems that the sponsor of the work is happy with the misinterpretation.

Charlotte Jordan a project manager of research at the National Honey Board, believes the finding confirms what your grandmother told you.

“This is a really exciting finding,” she said. “For a long time it’s been folklore medicine to use honey when you have a cough or a cold, but it’s exciting to have a scientific study to back that up.”

Just one problem, That is NOT what the paper says.

How did all this mis-reporting happen?

One reason is misleading press releases. Universities and Academic journals now engage in shameless PR, spin and hype. They prostitute good science.

Download press releases from Penn State, JAMA and Press Association [pdf file]

Here is the highly misleading bit of hype that came from the Press Office of the Pennsylvania State University. The headline is “Honey a better option for childhood cough than OTCs” (OTC means over-the-counter medicines that contain DM). That contradicts directly the paper which says “Comparison of honey with DM revealed no significant differences”.

Likewise the statement in the Penn State release “Honey did a better job reducing the severity, frequency and bothersome nature of nighttime cough from upper respiratory infection than DM or no treatment” is equally incompatible with “Comparison of honey with DM revealed no significant differences”. Its only possible justification is from the 3 way comparison by analysis of variance and that does not tell us what we need to know.

To make matters worse, the media office is not to blame this time. Ms Manlove told me tonight that the press release had been approved by Dr Paul himself.

Contact: Megan W. Manlove

Penn State

Honey a better option for childhood cough than OTCs

A new study by a Penn State College of Medicine research team found that honey may offer parents an effective and safe alternative than over the counter children’s cough medicines.
The study found that a small dose of buckwheat honey given before bedtime provided better relief of nighttime cough and sleep difficulty in children than no treatment or dextromethorphan (DM), a cough suppressant found in many over-the-counter cold medications.

Honey did a better job reducing the severity, frequency and bothersome nature of nighttime cough from upper respiratory infection than DM or no treatment. Honey also showed a positive effect on the sleep quality of both the coughing child and the child’s parents. DM was not significantly better at alleviating symptoms than no treatment.
. . .

All that Candice Yakel, of the Office for Research Protections at Penn State had ro say in the matter was

“Our investigators stand by the conclusions of the study as reported in the Archives of Pediatric and Adolescent Medicine and as characterized in our press release of December 3, 2007.”

And here is the equally misleading bit of hype issued by the Journal of the American Medical Association (Ms Manlove tells me that this was also approved bt Dr Paul).

JAMA and Archives Journals

Study suggests honey may help relieve children’s cough, improve sleep during colds

A single dose of buckwheat honey before bedtime provided the greatest relief from cough and sleep difficulty compared with no treatment and an over-the-counter cough medicine in children with upper respiratory tract infections, according to a report in the December issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

The Press Association release was equally bad, and probably the one used by many of the reporters as a basis for stories in the media. The opening statement is totally wrong.

1 HEALTH Honey Embargoed to 2100 Monday December 3


By John von Radowitz, PA Science Correspondent

Natural honey is a better remedy for children’s coughs than expensive over-the-counter medicines, researchers said today.
A dose of buckwheat honey before bedtime easily outperformed a cough suppressant widely used in commercial treatments, a US study found.

. . .


There is a review of over-the-counter cough medicines in the BMJ (2002) [free full text]. It concludes “Recommendation of over the counter cough medicines to patients is not justified by current evidence”.

Jump straight to the stings.

This advertisement has to be one of the sneakiest bits of spin that I’ve seen in a while. It appeared in today’s Guardian. And a lot more people will see it than will look at the homeopathic nonsense on the Boots ‘education’ site.

What on earth does it mean? One interpretation could be this. We can’t make false claims for Vitamin(s) B in print, but your Boots Pharmacy Team will be happy to do so in private. OK gang, let’s find out. Get out there and ask them. I’ll be happy to post the answers you get (one of those little mp3 recorders is useful).

Boots advert Guardian 21 Nov 07

The Boots web site isn’t much better. Their Vitality Overview says

“The following vitamins and supplements are important for vitality..
B Vitamins
Ginkgo biloba
Vitamin C”

Needless to say “vitality” isn’t defined and there is the slightest reason to think that any of these things help the “energy level” of any person on a normal diet.

Sting number 1

I went into a large branch of Boots and asked to speak to a pharmacist. This what ensued (BP= Boots Pharmacist).

DC. My eye was caught by your advertisement. I’m pretty healthy for my age but I do get very tired sometimes and it says “ask your Boots pharmacy team, so what can you recommend?”

BP. “Well basically it helps release energy from your cells so you’ll feel more energetic if you have enough vitamin B in your, eh, blood system”

DC. “Ah, I see, I’ll feel more energetic?”

BP. “yes you’ll feel more energetic because it releases the energy from the cells ”

DC. “which vitamin B does that?”

BP. “It’s a complex. it has all the vitamins in it.”

DC. “So which one is it that makes you feel more energetic?”

BP. “Vitamin B”

DC. “All of them? ”

BP. “All of them. It’s mainly vitamin B12”

DC. “Vitamin B12. That makes you feel more energetic?”

BP. “Yes. B12 and B6.”

DC. “hmm B12 and B6. I wasn’t aware of that before so I’m a bit puzzled. I mean, vitamin B12. I thought that was for pernicious anaemia.”

At this point I think the pharmacist was getting a bit suspicious about all my questions (and spotted the recorder) and began to back off.

BP. “Not necessarily. You know its got [pause], basically what its [pause], if you have enough in your diet there’s no need to take an extra vitamin B.” . . .”This is really for people who are on the go and are, you know, unable to get fresh meals.”

Then the senior pharmacist (SP) was called and I repeated the question.

DC. “Will it give me extra energy? It says I should ask my Boots Pharmacy team about that.”

SP. “It may do, yes. It depends on your own body’s individual reaction to it.” . . . “To be honest I’m not the best person to ask about clinical data on it. If you have more detailed questions I can send them to head office”

At this point. I gave up. The first pharmacist ended up with reasonable advice, but only after she’d obviously become suspicious about all my questions (and spotted the recorder). The senior pharmacist just fudged it when asked a direct question. Initially, the ‘expert advice’ was pure gobbledygook. What does one make of it? The fact that I got the right answer in the end, one could argue, makes the first part worse rather than better. She knew the right answer, but didn’t give it straight away. Instead she talked a lot of nonsense in which two quite different meanings of the word ‘energy’ were confused in a way that is only too familiar in the supplement huckster business. I’m not impressed.

Sting number 2

An email enquiry to Boots customer service asked whether Vitamin B really helped ‘vitality’. It elicited this hilarious non-response (original spelling retained).

Dear Mrs M***

Thank you for contacting us regarding an advertisement you have seen in relation to the benifits to vitamin C.

Unfortunately as I am not medically trained I would be unable to provide you with advice on this particular product. I would however, advise that you contact our pharmacy team at your local store via the telephone directly. You’ll find that they will be more than happy to help you further.

Aha, so the Pharmacy Team are medically-trained?

The British Medical Journal ran an article on “doctor bloggers” last week.

BMJ header

Photo ©Mark Thomas

The BMJ put the article behind a paywall, but you can download a reprint here.

Oops, no you can’t. The BMJ have dictated that their piece on bloggers should not be available to bloggers. If you want a copy, email me. The question of availability is more interesting than the article itself anyway. It is by a journalist, Rebecca Coombes. Contrary to what you might think from reading it, I have never met her. She asked for opinions by email, so I spent a while writing something out, which she cut and pasted into an article (and I spent another hour with their photographer, Mark Thomas, who took a lot of pictures). But I can’t use either the article or the photos freely. I don’t even get paid. The commercial journals, as always, do pretty well out of exploiting academics.

The picture at the top should have been Ben Goldacre, whose badscience.net is now number two in the world. That picture prompted the child of a friend to ask if I was doing an impression of a velocirapter, I guess that is one better that gimpyblog’s perception of me as being a dead ringer for some computer game thug.

So here is another one (possibly no less scary).

Photo ©Mark Thomas

By way of compensation, here is a picture of Goldacre.


Science writer award 2005

Goldacre said

“. . . blogs are popular because they are more honest than other media. It is hard to get away with misrepresenting stuff when the original source is but a click away.  I see it as a way of making conversation public. What is good about it is you get unmediated expertise.”

“In the press it’s hard to know what is true. But with blogs people can link directly to the original source: this never happens in a newspaper.”

DC said

“I think they [blogs] have really had some success in spreading public understanding of science and even in influencing public affairs (firstly with the merger [of Imperial and UCL] and more recently with withdrawal of NHS funding for homoeopathy).  My own research is on the stochastic properties of single ion channels.  I love it, but it is specialist and of zero interest to the public. So it’s fun to talk about things that do interest the public. It’s also fun to be able to influence politicians and vice chancellors, though that is rather harder.”

Back pain is a big problem, and Ben Goldacre has already written about the new study

The German Acupuncture Trials (GERAC) for chronic low back pain
Randomized. Multicenter, Blinded, Parallel-Group Trial wth 3 groups.

Sadly, the Journal of the American Medical Association have told me to remove the link to the original paper, so if you want to know more about it, email me. There is something rather irresponsible in the way journals promote papers to the media, but then deny the public the right to see the original work.

There has been a real orgy of bad science reporting about this interesting paper The main conclusion is that both sham acupuncture and ‘real’ acupuncture have essentially the same effectiveness in reducing back pain. Both the real and the sham treatment came out better than the group given ‘conventional therapy’ (a combination of drugs, physical therapy, and exercise).

Perhaps it isn’t surprising that many of the headlines in the press were misleading. So was the press release for the journal, which had the title “Acupuncture Treatment May Be More Effective Than Conventional Therapy In Treating Lower Back Pain, German Study Finds “. The bad journalism can be blamed in part by the self-promotion of journals, as so often.

My first take on what this means is

  • a theatrical treatment can have a strong placebo effect, or any old prick produces a long lasting physiological effect
  • acupuncture is a sham.

For an excellent account of the placebo effect, go to Goldacre.

This is the latest in a series of trials that shows essentially no difference between real and sham acupuncture. Here are examples.

This may not matter very much for patients, but it is enormously important in principle. It is enormously important for education, qualifications and for regulation. If, as seems to be the case, real acupuncture and sham are much the same, that means that all the ancient Chinese wisdom on which the acupuncture is allegedly based is just so much bunk. A typical statement of these was reproduced in the Dilemmas of Alternative Medicine.

. . . its advocates try to ‘explain’ the effects, along these lines.

  • “There are 14 major avenues of energy flowing through the body. These are known as meridians”.
  • The energy that moves through the meridians is called Qi.
  • Think of Qi as “The Force”. It is the energy that makes a clear distinction between life and death.
  • Acupuncture needles are gently placed through the skin along various key points along the meridians. This helps rebalance the Qi so the body systems work harmoniously.

I suppose, to the uneducated, the language sounds a bit like that of physics. But it is not. The words have no discernable meaning whatsoever. They are pure gobbledygook. Can any serious university be expected to teach such nonsense as though the words meant something?

I’ll declare an interest. I get intermittent back pain too.

The picture is an X-ray of my spinal cord, You can see two lumbar vertebrae bolted together from the front and back with huge titanium woodscrews. The vertebrae had become disconnected in what the surgeon called the worst spondylolisthesis he’d seen.

One thing that I do know is that my back pain is enormously variable from day to day, for no obvious reason, That alone makes it almost impossible to tell whether any treatment helps.

Here is the advice from a review in the BMJ by Koes et al.

“The evidence that non-steroidal anti-inflammatory drugs relieve pain better than placebo is strong. Advice to stay active speeds up recovery and reduces chronic disability. Muscle relaxants relieve pain more than placebo, strong evidence also shows, but side effects such as drowsiness may occur. Conversely, strong evidence shows that bed rest and specific back exercises (strengthening, flexibility, stretching, flexion, and extension exercises) are not effective. These interventions mentioned were equally as effective as a variety of placebo, sham, or as no treatment at all. Moderate evidence shows that spinal manipulation, behavioural treatment, and multidisciplinary treatment (for subacute low back pain) are effective for pain relief. Finally, no evidence shows that other interventions (for example, lumbar supports, traction, massage, or acupuncture) are effective for acute low back pain”

The main advice seems to be “avoid rest”. This is me avoiding
rest by walking across the Alps a few years ago.

The Times. The best so far seems to be from Nigel Hawkes in the Times “Sticking needles in a bad back “eases pain better than drugs”

“Acupuncture works better than conventional treatments in reducing lower back pain, according to researchers in Germany. But so does fake acupuncture, where the needles are inserted shallowly and in the wrong places.”

The BBC. The BBC report (anonymous) posted on 26th September misssed the point altogether, but a day later it is much better (could that have anything to do with the complaint that I made about it?).

The title changed overnight from “Acupuncture ‘best for back pain’.” to “Needles ‘are best for back pain’ Acupuncture – real or sham – is more effective at treating back pain than conventional
therapies, research suggests.”

“their findings suggest that the body may react positively to any thin needle prick – or that acupuncture may simply trigger a placebo effect.”

The Independent. On the other hand, The Independent makes a hash of it. “Acupuncture is best way to treat back pain, study finds” By Jeremy Laurance, Health Editor.
It starts “The ancient Chinese practice of acupuncture works better than anything modern medicine has devised for the treatment of back pain, scientists have concluded.”. That is precisely what they didn’t show. On the contrary they showed than any old pricking does as well as the ancient Chinese practice.

The Telegraph. Nic Fleming in the Telegraph missed the point too ” Acupuncture ‘best therapy for back pain’ By Nic Fleming, Science Correspondent. “Acupuncture can provide significantly more relief from lower back pain than conventional therapies, scientists say.”.


There is an excellent comparison of the newspaper reports at “Journalists are shit, study finds

A new judgment today from the Advertising Standards Authority .

A direct mailing for books by Patrick Holford, a nutritionist, contained a booklet entitled “100%health”. Headline text stated “You don’t swallow junk food. Why swallow junk health advice?” Text in a letter from the “Editor of 100%health”, Patrick Holford, on an inner page of the booklet stated

“I would like you and your family to stay healthy, free of pain and the need for drugs. But if I told you the truth in this letter, I would break the law … I’d love to tell you how powerful nutrition is, both for your mind and body. But I can’t. Why? Because advertising law prohibits me saying anything that claims to ‘treat, prevent or cure’ any condition! Even if there’s undisputed proof that nutrient ‘x’ cures condition ‘y’ I’m not allowed to tell you here. By law, I can tell you in my newsletters, but I can’t in this publication … So, excuse me if you have to read between the lines …”.

The ASA upheld a complaint against this passage

” the ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness), 50.1 (Health & beauty products and therapies – General) and 50.20 (Health & beauty products and therapies – Vitamins, minerals and other food supplements). “

Text on a separate page stated “Don’t waste your money on vitamins Myth: ‘If you eat a balanced diet you get all the vitamins and minerals you need.’ WRONG!”. The ASA upheld a complaint against this passage too.

the ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness) and 50.21 (Health & beauty products and therapies – Vitamins, minerals and other food supplements).

The code for “truthfulness” reads thus

7.1 No marketing communication should mislead, or be likely to mislead, by inaccuracy, ambiguity, exaggeration, omission or otherwise.

What a pity that Mr Holford has been judged not to live up to this criterion.

This was not a first offence either. In 2003 four complaints to the ASA about Holford were all upheld, as pointed out in the comment by Shinga, below.

Read more at badscience.net

And at quackometer

Steven Novella, MD, an academic neurologist at Yale University, runs The Skeptics Guide to the Universe: Your Escape to Reality

He is author of Weird Science , a monthly column featured in the New Haven Advocate. He is the co-founder and President of the New England Skeptical Society, Associate Editor of the Scientific Review of Alternative Medicine , and a contributing editor of Quackwatch , a consumer advocacy website dealing with all types of health fraud.

At 5 am on 12 September he phoned to record a podcast. You can here the whole thing here. It includes various items of skeptical news and an interview with James Randi too.

Steve Novella quizzed me about the circumstances surrounding the request to move my web site from UCL’s server, and we discussed the incursion of endarkenment values into universities and politics. My bit is here.

I have received today (11 September 2007) a rather threatening letter from Patrick Holford. He says

“I am writing to you directly to complain about both your article in The Guardian of 15 August, in which you falsely claim that my advocacy that Vitamin C is better than conventional drugs to treat AIDS is “truly scary”, and in respect of the equally false claims you have posted on your website, DC Improbable Science, particularly in relation to Dr John Marks.”

He ends, more threateningly,

“I nonetheless believe it appropriate that you withdraw the allegations you have made and apologise for making these unwarranted and defamatory allegations. Provided that we can agree the wording of an apology and the removal of the false claims, I am prepared to leave it there. However, I fully reserve my right to take this matter further should my complaint not be resolved to my satisfaction.”

Here are responses to these two allegations.
(Some follow ups on this post have been added below)

Vitamin C and AIDS

What does Holford actually say about HIV/AIDS? On page 208 of his New Optimum Nutrition Bible (2003) we read (see Google books)

“Yet for the last 100 years, medicine has focused on drugs designed to destroy the invader -antibiotics, anti-viral agents, chemotherapy. By their very nature, these drugs are poison to the body. AZT, the first prescribable anti-HIV drug, is potentially harmful and proving less effective than vitamin C (23)”

This sounds to me like a pretty clear statement that AZT is “less effective than Vitamin C”. The interested reader may skip forward to page 544 to see what reference 23 actually says. The reference that they will find is this

You can read this paper here. If you get that far, you might well be surprised to find that it is not a study of people with HIV/AIDS, but merely shows that vitamin C can, under lab conditions, inhibit HIV in cells in a dish. You might be even more surprised that the paper does not compare vitamin C and AZT. In fact AZT is not mentioned at all (except for a brief reference in the discussion).It is true, that on his web site, as opposed to his book, Holford expands on this theme a bit. For example here he says. of reference 23,

“Ref 23. These in vitro studies on human T-cells shows that vitamin C suppresses the HIV virus in both chronically and latently infected cells, while AZT has no significant effect. It is a tragedy that this simple, non-toxic treatment hasn’t been further tested. ”

Harakeh S, Jariwalla RJ.Ascorbate effect on cytokine stimulation of HIV production. Nutrition. 1995 Sep-Oct;11(5 Suppl):684-7.

But the reference given here (which does use AZT) is not reference 23 (which does not test AZT at all). Holford himself acknowleges that his book cites the wrong reference in his book.

Holford also forgets to mention (or perhaps didn’t notice) that the concentrations of Vitamin C that are used in these in vitro studies are something like 10 times greater than can be achieved in man even with very high oral doses,

More recently he has backed off a bit. For example, here he says

“There is no doubt that anti-retroviral drugs save lives. So too may high dose vitamin C, but we just won’t know until the definitive research trial is done.”

Why, one wonders, has Holford not done studies in man himself? His name does not appear in the research literature at all (search Pubmed for ‘Holford PJ’ yourself). And Holford is not a poor man.

It still seems to me that anyone reading his New Optimum Nutrition Bible (2003) will be misled into thinking that Vitamin C is better than AZT for curing HIV/AIDS in man.

You can read more interesting stuff on this question at Holfordwatch.

What did Dr Marks actually say?

I’m accused of malicious behaviour, because I posted a letter from Dr Marks which set out his present views All I did was ask Dr Marks about what happened, and, with his encouragement, published his
answer. I also suggested to Dr Marks that he should write to Holford to ask for the basis on which Marks was quoted. When Marks received no reply, we decided to go ahead anyway.

I am, therefore, very grateful to Mr Holford for sending me a letter, dated 16 September 1997, that was sent to him by Dr Marks. The whole letter can be downloaded here.

It seems that in the ten years since that letter was written, Dr Marks has changed his mind a bit about Holford. but the main interest attached to the letter is the selective quotations that have been made from it.

In his 1997 letter to Holford, Marks says “On the basis of this I am entirely happy for you to quote as much or as little of the following comments as you wish. If you change the order of phrases or omit portions of sentences I am confident that you will not alter the general sense”.

Judge for yourself whether the general sense has been changed in this case.

Dr Marks said (in 1997)

“There have been dramatic changes over the past decade in our views about that area of health care which comes under the general term “alternative medicine” and Patrick Holford, author of this book has been right at the forefront of many of these changes, particularly those associated with our revised appreciation of human nutrition. I commend this book to you on the basis that it is well researched and written with a substantial backing ofreferences from reliable and peer reviewed scientific and medical journals.

I do not accept all his conclusions and I suspect that his other readers will not agree with all that he says. On the other hand there is considerable food for thought in each chapter and adequate arguments on which you will be able to make up your own mind about the ideas which he puts forward. The road to bad medicine and bad health is built on the foundation of dogma and it is very refreshing to have, in a single readable volume, much of this dogma subjected to fresh examination.”

Compare this with the quotation attributed to Dr Marks in the CV which was submitted by Holford to the University of Teesside.

“There have been dramatic changes over the past decade in our views about healthcare and Patrick Holford has been right at the forefront of many of these changes, particularly with our revised appreciation of nutrition. The road to bad medicine and bad health is built on the foundation of dogma. It is refreshing to have this dogma subjected to fresh examination.”

So what happened to the bit where Marks refers to the work as “Alternative Medicine”.

And what happened to the bit where Marks says “I do not accept all his conclusions and I suspect that his other readers will not agree with all that he says.”

They seem to have vanished without trace.

I rest my case.

Some comments that followed this post

At Holfordwatch “Patrick Holford Refers to Someone Else as Inaccurate”.

And at Quackometer ” Patrick Holford – No Comment”

Curiouser and curiouser. Not only have we the curious case of Dr Marks, but Holford’s CV on his web site, and as submitted to the University of Tesside, has alway said that his degree from the University of York in experimental psychology was taken in 1973 – 1976. But an enquiry to the registrar of the University of York, elicited this response.

Dear Professor Colquhoun
Your enquiry about a claim to hold a degree from the University of York has been passed to me.

I can confirm that a BSc in Psychology was awarded to a P J Holford in 1979, as published in the Yorkshire Evening Press on 7 July 1979.

Sue Hardman

Academic Registrar

University of York

It does seem odd to make an error of three years in the dates of your own degree.

Read much more about all these inconsistencies at Holfordwatch and at Quackometer.

Update 17th September 2007

Another email today from the Registrar reveals that Mr Holford got a 2.2 degree.

A recent post, Homeopathic “cures” for malaria: a wicked scam, revealed two more cases of claims to cure malaria with homeopathic funny water.

One was the claim of Kate Birch, the vice president of the North American Society of Homeopaths, that “Homeopathy is more effective that any western medication”
for treatment of malaria.

This is so dangerous that some action was needed.

The other was a claim by a UK company that claims for Demal 200 (which contains nothing but 15% alcohol)

“Demal 200 is highly effective in treating all types of Malaria even the strains that have developed a resistance to chemical based drugs”

But on checking the web site in 28 Aug, 18 days after the original post, guess what? Demal 200 has vanished. I wonder who told them to do that? The advert was still in the Google cache, and you can download it here, as it appeared on 10th August. Don’t worry though, 20 seconds with Google shows that there are plenty of other people willing to sell this expensive hooch. For example ‘Blueturtle Remedial Sciences’. They give a lot of email addresses to which you can write for further information.

I made a lot of complaints about these wickedly dangerous claims. So far, the result is close to zero.

The Society of Homeopaths, both UK and USA, refuse point blank to give any opinion about the ability of homeopaths to cure malaria.

The Society of Homeopaths is also making its contribution to deaths in Africa by its utterly delusional attitude to AIDS.

They do nothing to stop their many members who do make such claims from killing people. As regulatory organisations, they are just a sick joke.

The Advertising Standards Authority and the Trading Standards people disclaim any responsibility, as does the Center for Disease Control (USA). The FDA and the MHRA have yet to reply, but they did very little after the revelation that homeopaths claimed to be able to prevent malaria.

Nobody seems willing to do anything at all.

But is characteristic of quasi-religious organisations that they split in to warring sects. The Faculty of Homeopaths (UK), in stark contrast to the Society of Homeopaths,

” . . . does not promote the use of homeopathy for the prevention of malaria.

It also supports steps to inform the public of the dangers of malaria and the need to follow government guidance. Last year the Faculty worked with the Health Protection Agency (HPA) on a statement for the HPA website: http://www.hpa.org.uk/infections/topics_az/malaria/homeopathic_statement_260705.htm

All that can be said for the malaria scandal is that it has revealed that the curious world of homeopathy is in in chaos when it comes to serious diseases. And it shows very starkly how utterly meaningless self-regulation of homeopathy is, and how government agencies disclaim responsibility

There is lots more about this wickedness on the web: try The Gentle Art of Homeopathic Killing.

Here are some of the results of complaints.

Society of Homeopaths (SoH) (UK)

I wrote (13 Aug) to the Society of Homeopaths (SoH) to ask about the use of the initials RSHom and RSHom (NA), and to ask about their attitude to the claims made for Demal 200.”Please could you tell me the opinion of the Society of Homeopaths about someone describing herself as RSHom behaving in this way, and also about Demal 200.”

I had a very quick reply from Paula Ross, chief executive of the SoH. She said

“There is no connection between The Society of Homeopaths (whose registered members use the designation ‘RSHom’) and the North American Society of Homeopaths (whose registered members use the designation ‘RSHom NA’).”

But she ignored the second question.

My other question was about whether SoH would like to comment on Demal 200.A company called giftofafrica says of its homeopathic malaria treatment. “Demal 200 is highly effective in treating all types of Malaria even the strains that have developed a resistance to chemical based drugs.” The company selling this is based in Wolverhampton, UK. and their claim seems to contradict directly your statement at http://www.homeopathy-soh.org/whats-new/patientinfo.aspxBest regardsDavid Colquhoun

After more than a week, and two reminders, I got no reply whatsoever.from
Paula Ross. However a correspondent sent a similar enquiry to the Society of Homeopaths, asking of Demal 200

“Would you recommend this product for use in Malaria regions or are the claims bogus?”

This was the ‘response’.

Dear ***,
Thank you for your email.May I suggest you contact one of the Homeopathic manufacturers who will be able to advise you and give you more information regarding Demal 200.For our list of Pharmacies please visit our website www.homeopathy-soh.org
Melissa Wootton
Office Administrator
The Society of Homeopaths.
11 Brookfield, Duncan Close,
Park, Northampton NN3 6WL
Website: www.homeopathy-soh.org

It is hard to imagine any more irresponsible evasiveness than this.The North American Society of Homeopaths was less reticent when I asked about their attitude to claims to be able to treat serious infectious diseases.

13 Aug 2007

Please can you clarify for me the policy of NASH regarding infectious diseases.

Recently the Society of Homeopaths (UK) issued a statement that read thus
“The Society of Homeopaths, the UK’s largest register of professional homeopaths, acknowledges that malaria is a serious and life-threatening condition and that there is currently no peer reviewed research to support the use of homeopathy as an anti-malarial treatment. ”
(see http://www.homeopathy-soh.org/whats-new/patientinfo.aspx )

I can see no such statement on the NASH web site. In fact there are some things that seem to suggest that NASH approves of homeopathic treatment of infectious diseases (not least Kate Birch’s book), despite the fact that your Standards of Practice Guidelines says

“Do not claim that you can treat any disease, condition or ailment or imply that you can do so.
Be extremely careful when speaking or writing about the treatment of particular diseases or conditions (and never offer or claim to help anybody)”

Please could you give me a clear statement of your policy concerning homeopathic treatment of malaria, AIDS, cholera, typhoid fever, yellow fever and tuberculosis.

Best regards

David Colquhoun

The reply ignored entirely the question about their own code of practice

Dear Mr. Colquhoun,

Thank you for your inquiry of 8/13/07. NASH does not have a policy on the treatment of any disease category, in accordance with the tenet that homeopathy treats the whole person based on characteristic symptoms rather than a diagnosis.

Liz Bonfig
NASH Administrator==============================

PO BOX 450039, Sunrise, FL 33345-0039, USA ~ Tel: 206-720-7000 ~ Fax:
208-248-1942 343 Carrville Road, Richmond Hill, ONT L4C 6E4, CANADA ~ Tel:
905-886-1060 ~ Fax: 905-886-1418

Again, the question was totally evaded. These people can’t be serious. But then, on 17th August I got from Ms Birch a note that suggests that there has been a bit of internal dissension within NASH. Have they censured their vice president for going too far? If so will she recant? Don’t hold your breath.

X-UCL-MailScanner-From: katebhom@hotmail.commy final statement to you is: The personal response that was solicited from me on my private e-mail does not represent the views of the North American Society of Homeopaths.

Next, here is my mail to the US Centers for Disease Control and Prevention, concerning the claims of Kate Birch, “Homeopathy is more effective that any western medication“.

It has come to my attention that a Ms Kate Birch (vice chair of the North American Society of Homeopaths), is advocating homeopathic treatment of malaria and also yellow fever, typhoid, dengue fever and cholera. She does this through her book and also in emails to potential customers.This seems to me to be very dangerous, so I have asembled some of the relevant evidence at http://dcscience.net/?p=24Please can you tell me if it is legal in the USA to claim to cure serious diseases like these with “remedies” that contain nothing but water and alcohol?

Their reply was nothing if not blunt (but not very helpful).

Dear Mr. Colquhoun,I forwarded your email to one of our staff scientists; his response was as follows:—–Original Message—–FDA regulates medicines, vaccines, and drugs. States regulate the practice of medicine.Charlatans and quacks can be reported to these regulatory agencies.However, the Constitution guarantees freedom of the press and authors can write all kinds of wacky stuff that is bad for your health.

Thank you for your inquiry.

Internet Response Team National Center for Infectious Diseases Centers for Disease Control and Prevention

Demal 200 UK

This UK company makes the outrageuous claim that their 15% alcohol “”Demal 200 is highly effective in treating all types of Malaria even the strains that have developed a resistance to chemical based drugs”

A complaint about this to the Advertising Standards Authority about this mendacious
advertisement produced a quick reply which said it did not come under their remit,

They suggested trying the Trading Standards people. The Trading Standards Authority replied on 28 Aug 07 (Adrian Winter).

” . . . this is not a matter that falls under the jurisdiction of
Trading Standards. The Medicines and Heathcare

Products Regulatory Agency (MHRA) is the appropriate body in this instance.”

I’d already written to the MHRA (13 Aug 2007) thus,

A company called giftofafrica says of its homeopathic malaria treatment:

“Demal 200 is highly effective in treating all types of Malaria even the strains that have developed a resistance to chemical based drugs.”

This direct claim of effectiveness seems to me to be mind-bogglingly irresponsible.

The company selling this stuff is based in Wolverhampton, UK. It costs £31.99 (or $56.40) for 30 ml of 15% alcohol (and 200C homeopathic dilutions, .i.e., nothing)

Please can you tell me about the legal position concerning claims to be able to cure infectious diseases, and whether or not the MHRA has any responsibility in cases like this.

Best regards

David Colquhoun

The MHRA are taking their time. No response by yet. But all they did after the Newsnight programme was to issue a statement which nobody is likely to read. They have done nothing to stop these dangerous advertisements.

For once, the Advertising Standards Authority (ASA) has done a good job. Legal loopholes prevent them from doing much about fraudulent advertisements for homeopathy, but they have upheld complaints about the Body Detox Clinic in Newcastle upon Tyne.


“. . .considered that, because the substantiation supplied was anecdotal in nature, it was not robust enough to support the implication that colonic irrigation could relieve the symptoms of: diarrhoea; bloating; haemorrhoids; I.B.S.; colitis; flatulence; bad breath; body odour; headaches; fatigue; M.E.; eczema; psoriasis; dandruff; acne; joint pain; P.M.T; and water retention. Because of that, we concluded that the ad breached the Code.”

“Detoxification” is, of course a bit of meaningless mumbo jumbo that is widely used in the healhfraud industry (see, for example, here and here).

If the ASA can do this, why do they do nothing at all about the mountain of mendacious advertisements for “supplements”and  cosmetics?

Channel 4 TV, Monday 13 August, 8.00 pm in the UK

The Enemies of Reason: new age therapies cause ‘retreat from reason’

The Sunday Telegraph (5 August 2007) gave a bit of advance publicity for “The Enemies of Reason”.

Prof Dawkins says that alternative remedies constitute little more than a “money-spinning, multi-million pound industry that impoverishes our culture and throws up new age gurus who exhort us to run away from reality”.

The first episode can be seen at http://video.google.co.uk/videoplay?docid=8669488783707640763


An entire issue of the journal Homeopathy has been devoted to speculations about the memory of water.

The link to this issue is http://www.sciencedirect.com/science/journal/14754916 , but sadly you can’t read the papers without a subscription to the journal (and believe me, they aren’t worth paying much for). With luck, Ben Goldacre will be able to post the full text at badscience.net.

The first paper, The Memory of Water: a scientific heresy?, is by Peter Fisher, the editor of the journal. Peter Fisher, Homeopathic physician to the Queen, is a person whose name appears often in the original IMPROBABLE SCIENCE page, is not at unreasonable man, by the standards of homeopaths. He condemned roundly the recommendation by less-educated homeopaths of homeopathic pills for prevention of malaria. And he did agree with me that homeopathy had not got sufficient scientific basis to justify a BSc degree.

Peter Fisher’s introduction to the issue admits quite frankly that there is no strong evidence for water having memory of the sort that would be needed to explain the claims of homeopaths. There is nothing that explains the bizarre proposition that the medicine gets stronger the more you dilute it. There is nothing that explains the equally bizarre proposition that the water ‘remembers’ only the ingredient that you add, but conveniently forgets the countless other substances that it has encountered in the oceans and the bodies of the vast numbers of animals and plants through which it has passed.

Fisher is also sufficiently honest to include in his special issue a contribution “Can water possibly have a memory? A sceptical view“, written by José Teixeira (a physicist from the European Neutron scattering lab -see some of his publications).


To summarize this short overview, one can say that water is a ‘complex’ liquid with many fascinating, sometimes unique aspects. Except for some academic aspects concerning supercooled water, the structure of the liquid is well known. In particular, it is certain that:

(a) There are no water clusters in pure liquid water, but only density fluctuations.

(b) The longest life of any structure observed in liquid water is of the order of 1 ps [one millionth of a millionth of a second]

This is why any interpretation calling for ‘memory’.effects in pure water must be totally excluded.

The special issue on the memory of water takes us no further. After 200 years, there is still no good evidence.

The Independent on Sunday carried an article with the title “Electronic smog linked to respiratory disease, study shows”, by Geoffrey Lean, Environment Editor.

So wifi is bad for you after all?

As usual the reference is not given, But if you look at the original paper (download it here), guess what? It bears little resemblance to the newspaper report. Continue reading

After the fuss about the BBC Alternative Medicine series (see next item), it was good to see the excellent report on the news last night (16th July 2007) about the appearence of the notorious Andrew Wakefield to face charges of professional misconduct. They showed graphs of the increase in
the incidence of measles which has followed the fall in MMR vaccination. They reported on the many studies that have shown no link between MMR and autism. And most fascinatingly, they showed a movie of Wakefield’s speech at the Mind Institute.

Continue reading