Former Visiting Professor Patrick Holford is still, unaccountably, Head of Science and Education at Biocare although Biocare prides itself on the appropriate credentials of its scientific staff. We offer an illustrative example of the validity of Holford’s claim to understand evidence appropriately or interpret it for others: we shall focus on “Vaccinations: what every parent needs to know” in 100%health Newsletter, No. 46, July 2008, pp. 5-8.[a]
Holford has been advertising updates on his vaccination advice for some time. We mentioned this in June and said that we weren’t expecting much that was evidence-based or accurate but even we are surprised that he is attempting to pass off this latest dreck as serious research that is meant to clarify vaccination issues for parents. Yet again, Holford makes mistakes when citing the references (JKN’d), demonstrates that he has read news stories rather than the paper or even the abstract of the paper concerned, omits pertinent facts and makes implausible recommendations to his audience of confused and concerned parents in the guise of being an honest broker.[b]
The Holford opus is so packed with canards that this will be another multi-part examination. However, the upside is that this is a concentrated version of many of Holford’s usual practices and may serve as an examplar of what passes for adequate research for him, even in an area as vital to public and individual health as vaccination where the consequences of misinformation may be life-threatening or contribute to serious illness or disability.
Holford’s Vaccinations: what every parent needs to know
Holford provides unproven ideas and innuendo to his readers rather than a good overview of the scientific evidence on any topic. Shoddy information has contaminated the discussion of vaccines yet Holford’s opening sentence is:
Controversy continues over vaccinations and whether the benefits outweigh the risks.
That is a remarkably ahistorical and western perspective. It is a manufactroversy rather than a genuine controversy: the overwhelming scientific consensus is that most of the media storms such as those concerning MMR have been based on poor science that has been exposed as being based on vaccine-litigation driven research and riddled with basic errors.[c],[d]
Two sentences later, Holford instructs the reader:
Consider the case of Hannah Polings [sic] whose parents finally won a compensation case in March 2008 for the vaccine damage they believe caused their daughter’s autism. Before being vaccinated, Hannah was interactive, playful and communicative. Soon after receiving five jabs-containing nine different vaccines including MMR-at 19 months of age, she developed vaccine-induced varicella and was then diagnosed with encephalopathy (a brain disease causing delays in neurological and psychological development).
Holford correctly cites the Offit paper as a reference but, unaccountably, omits to mention that Hannah Poling has an underlying mitochondrial disorder that is relevant to her condition. Offit discusses the mitochondrial disorder at some length and argues that the case of Hannah Poling was distinguished from other cases that form part of the Autism Omnibus as the pre-existing condition makes it so different. Offit gives an accurate characterisation of the government position and argues that the difficulty lies in agreeing a definition of autism.
Julie Gerberding, director of the Centers for Disease Control and Prevention, responded to [the Polings’] claims that vaccines had caused their daughter’s autism. “Let me be very clear that the government has made absolutely no statement . . . indicating that vaccines are a cause of autism”…Because autism is a clinical diagnosis, children are labeled as autistic on the basis of a collection of clinical features. Hannah Poling clearly had difficulties with language, speech, and communication. But those features of her condition considered autistic were part of a global encephalopathy caused by a mitochondrial enzyme deficit. Rett’s syndrome, tuberous sclerosis, fragile X syndrome, and Down’s syndrome in children can also have autistic features. Indeed, features reminiscent of autism are evident in all children with profound impairments in cognition; but these similarities are superficial, and their causal mechanisms and genetic influences are different from those of classic autism…
So, it may look as if Holford is not entirely forthcoming about the actual significance of the Poling case although HolfordWatch has previously discussed the flaws in Holford’s thinking on this matter. This may or may not cast new light on a reader’s interpretation of Holford’s claim:
Parents increasingly tell me that they are unable to get clear unbiased guidance from their health practitioners on the risks associated with vaccinations.
HolfordWatch would argue that one source of biased guidance and partial interpretation of the scientific evidence is Holford.
After this introduction, Holford segues into a discussion of Mercury and Aluminium and we shall discuss that in a later post in this new serial. However, one of the most disturbing items in the article is the section on “Supporting your child’s immune system” that seems to flirt with germ theory dissent and over-states the value of vitamin A for a well-nourished population of children. Every sensible person would support the call for breastfeeding but it is unusual rather than the norm for it to be continued for Holford’s recommended year in the UK and Holford is placing too much reliance on its protective benefits.
Earlier this year, Holford gave an interview in which he argued that a message from his latest book is that you are unlikely to become ill when you have optimum nutrition and declared:
When you are optimally nourished you simply don’t need any medicine.
It is generally acknowledged that measles is so contagious that every child with measles infects 15 others (pdf) so even well-nourished, healthy children will catch the infection. We should mention that the measles vaccine is one of the few that Holford supports albeit he argues against use of the MMR. Nonetheless, he then goes on to argue for the prophylactic value of a good diet and vitamin A. In the context of Holford’s earlier extravagant claims for diet and homeopathic remedies[f] it is disconcerting to read:
One of the best ways to support your child’s immune system, and help them avoid catching diseases in the first place, is by giving them a nutrient-packed diet…
Ensuring an optimum intake of nutrients can actually help to reduce risk of disease. For example, studies indicate that children infected with measles have lower levels of vitamin A. Consequently, eating a diet high in vitamin A, rich in fish, and its precursor beta-carotene, rich in green, leafy vegetables and yellow-orange coloured fruits and vegetables, may reduce the risk of your child developing measles or its complications. I also recommend supplementing a daily chewable multivitamin and mineral plus essential fats.
All things being equal, and in the absence of contra-indications, one of the best ways to support children’s immune systems and help them avoid potentially dangerous or disabling diseases is through the vaccination programme.
Although it may be correct that some “children infected with measles have lower levels of vitamin A”, in the absence of a reference, this omits the information that:
- low levels of plasma retinol are common during acute infections such as measles so it does not automatically follow that vitamin A status was poor before the infection
- this is primarily the case in developing countries where malnutrition is common rather than countries where children are typically well-nourished.
Asaria and MacMahon report that vitamin A deficiency is linked to measles complications, however, they mention that this is rare in developed countries although common in developing countries (Table 2). And, we should emphasise that vitamin A has been studied more as a means of preventing measles’ complications and mortality in malnourished children with known vitamin A deficiencies than as a prophylactic or means of preventing infection. E.g., the Cochrane Review of Vitamin A for treating measles in children. reported that for the trials that they assessed, although there was:
no overall significant reduction in mortality with vitamin A therapy for children with measles there was evidence that two doses were associated with a reduced risk of mortality and pneumonia-specific mortality in children under the age of two years.
HolfordWatch accepts the findings that supplementation with high-dose vitamin A (4–6-mo intervals) and low-dose vitamin A (weekly) has reduced all-cause mortality in at-risk populations. However, it is unlikely that well-nourished children in developed countries are to be classed as at “at-risk” so they are less likely to benefit from vitamin A supplementation in such cases. We should be absolutely clear that we support standard dietary recommendations however a Cochrane Review has flagged some unexpected findings for vitamin A supplementation for preventing lower respiratory tract infections (LRTI) in young children. who are otherwise well nourished. The reviewers assessed trials in countries where there is known vitamin A deficiency or malnutrition. They discovered that is possible that vitamin A may reduce the incidence of acute LRTI with children with poor nutritional status or weight, but increase it in children of normal nutitional status and weight. This is an example of unintended consequences that make it premature to assume that there are no consequences to providing supplements to children who don’t otherwise need them.
It is interesting to note that in the (then) absence of research on the impact of long-term supplementation, Eysenck and Schoenthaler make the seemingly plausible argument that:
the optimal strength [of supplementation] for one child will differ from that of another, depending on the degree of deficiency. Perhaps the requirements of the more seriously deficient children should decide this issue, there being little chance of oversupply have a negative effect on the nondeficient children within the limits described. [pg. 371]
That was a reasonable assessment given the available knowledge at that time. However, recent research with adults indicates that we may need further research and observational data about the impact of long-term supplementation:
The data presented in the article…suggest that …single supplement use produces worsened cholesterol indicators (p. 38) and worsened health outcomes for diabetes, coronary heart disease, heart attacks, angina, strokes and arthritis (pp. 40-1), when compared to no supplement usage at all.
It is attractive to assume that there are probably no adverse effects from administering a multi-supplement (the supplement that was used for most of the studies included in the literature review). However, in the light of recent observational reports involving adults (above, plus the Bjelakovic et al meta-analysis that reported increased mortality risks and the Cochrane systematic review of antioxidants and mortality), the long-term impact is an open question for the present and mandates a better understanding of possible confounds and the identification of sub-groups who may benefit disproportionately or be harmed disproportionately. We would reiterate that these studies involved adults rather than children so the reported outcomes may not be generalisable; nonetheless, they do suggest that we can not be sanguine that there are no adverse outcomes from a supplemented “oversupply”.
To sum up, Holford:
- omitted the relevant detail that Hannah Poling has a relevant mitochondrial disorder and that her experience should not be generalised to that of other children
- made sensible recommendations for a well-balanced diet but suggested that such a diet will prevent a child from developing preventable childhood illnesses or complications from them
- over-stated the benefits of vitamin A for disease prophylaxis or modification of complications in well-nourished children.
We shall look at Holford’s other canards in later posts; these include the poisonous toxins gambit and the some vaccines aren’t necessary unless you live in an area of social deprivation gambit. However, readers may be relieved to learn that there is no sign of Holford’s previous advice that parents might consider homeopathic immunisations for diseases such as meningitis.[f]
 Offit PA. Vaccines and autism revisited–the Hannah Poling case. N Engl J Med. 2008 May 15;358(20):2089-91.
 Harnden A, Shakespeare J. 10-minute consultation: MMR immunisation. BMJ. 2001 Jul 7;323(7303):32. http://bmj.bmjjournals.com/cgi/reprint/323/7303/32.pdf
 Asaria P, MacMahon E. Measles in the United Kingdom: can we eradicate it by 2010? BMJ. 2006 Oct 28;333(7574):890-5.
 Huiming Y, Chaomin W, Meng M. Vitamin A for treating measles in children. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD001479. DOI: 10.1002/14651858.CD001479.pub3. (pdf for those with access) PubMed
 Beaton GH, Martorell R, Aronson KJ, Edmonston B, McCabe G, Ross AC, Harvey B. Effectiveness of vitamin A supplementation in the control of young child morbidity and mortality in developing countries. Geneva: World Health Organization, 1993. (ACC/SCN State-of-the-Art Series policy discussion paper no. 13.)
 Chen H, Zhuo Q, Yuan W, Wang J, Wu T. Vitamin A for preventing acute lower respiratory tract infections in children up to seven years of age. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD006090 (pdf for those with access)
 Eysenck HJ and Schoenthaler SJ. Raising IQ level by vitamin and mineral supplementation. In: Sternberg RJ and Grigorenko EL, (Eds), Intelligence heredity and environment, Cambridge University Press, Cambridge (1997), pp. 363–392.
 Block G, Jensen CD, Norkus EP, Dalvi TB, Wong LG, McManus JF, Hudes ML. Usage patterns, health, and nutritional status of long-term multiple dietary supplement users: a cross-sectional study. Nutr J. 2007 Oct 24;6:30.
 Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA. 2007 Feb 28;297(8):842-57
 Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. (pdf for those with access) Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD007176. DOI:10.1002/14651858.CD007176.
[a] Holford thanks Melody Mackeown of Natural Nutrition for “all her excellent research”. Now, this farrago of nonsense is published under Holford’s own name so he must assume the bulk of responsibility but it doesn’t look as if Mackeown was able to stop him from repeating the same
googling research errors that he has made so frequently in the past. What passes for adequate research at the Institute for Optimum Nutrition from which she gained her DipION?
[b] Holford creates confusion, mistrust and uncertainty. He then concludes with this recommendation:
Only you can decide in the face of conflicting and often confusing information when, and if, to vaccinate your children. My advice is don’t be bullied. Ask your health practitioner for clear answers to your questions, and if you’re not satisfied, ask to see an immunologist. [pg.8. My emphasis.]
Is there any reason to think that an immunologist would provide different answers to those from your GP unless there are already contraindications that a GP knows about and is already taking into account? There is probably a long lead-time for a non-urgent referral on this matter and in the interim that might disrupt a child’s vaccination schedule. Such recommendations are disingenuous and seem to be made only to create discord and distrust rather than discourse.
[c] Holford has studiously avoided any mention of the Autism Omnibus revelations about the errors in Wakefield’s work and how this removed his theoretical foundation for the idea that MMR is linked to findings of measles virus in the gut or contributes to autism. See, e.g., Patrick Holford and Andrew Wakefield’s Discredited Findings Part 1 and Patrick Holford and Andrew Wakefield’s Discredited Findings Part 2. This lack of any willingness to review new information is remarkable in one who so frequently upbraids academics, researchers and doctors for failing to keep up-to-date.
[d] We commend Holford that he forbears from repeating most of the conspiracy theories he mongered in his March 2008 email: The Truth About Vaccine Damage.
[e] A surprising number of nutritionists seem to partially or completely discount germ theory. They argue that it is possible to take such a level of supplementation to the diet that the resulting immune system is impervious to bacteria and viruses that are involved in the aetiology of infectious disease.
[f] Holford Special Report on Alternatives to Vaccination.
It is highly likely, although not yet proven, that a good all-round intake of immune-boosting vitamins, minerals, amino acids and essential fats can turn a potentially life-threatening virus into a mild and temporary illness…
Although less well researched, you may wish to investigate homoeopathic immunisations. In one study 18,000 children were successfully protected against meningitis with a homoeopathic remedy, without a single side-effect.
There were, of course, no references for either of these claims.