Patrick Holford: “conventional medicine, doesn’t have a very good track record”

Patrick Holford on ITV Lunchtime 16 April 2008
Former Visiting Professor Patrick Holford is Head of Science and Education at Biocare so, presumably, they believe that he enhances their reputation and scientific credibility. Holford regularly presents himself as a fearless advocate for scientific accuracy and rigour and the bringer of unpleasant truths. Despite an abundance of evidence to the contrary, he is so convinced of his own competence that Holford regularly accuses others of inaccuracy and questions the integrity of leading researchers such as Professor Carolyn Summerbell (we should point out that Holford was in error, not Summerbell). Holford usually does all this under the guise of a plucky underdog and gadfly to medicine so it’s not surpising that he has recently claimed that “conventional medicine, doesn’t have a very good track record”.

Patrick Holford makes this extraordinary claim because he recommends that readers should purchase some of his subscription services and his Health and Action Plan. He recommends that you should:

  • purchase the upcoming new YorkTest product, the GL Check[a] (price unknown at present)
  • take the 100% Health Check for a free snapshot of your health profile
  • purchase the 100% Health Profile (normally £24.99 but £19.99 to subscribers) to obtain a comprehensive set of results (from the questionnaire), “a detailed report and a precise action plan to follow”
  • purchase the monthly subscription to 100% Health and Action Plan for “ongoing support to help keep you motivated and inspired” with a recipe book to meet individual needs, access to specific special reports[b] and email reminders. Available for £14.99 per month or £9.99 for members.

Holford not only wants you to purchase these products because it is money in his pocket, with an additional revenue stream from any supplements that you purchase from him but because that is his mission. Holford has created his own arbitrary health assessment criteria and scoring system.[c] His explanations might provide an excellent example of what Dr Ben Goldacre complains of as unnecessary complication that intimidates people into believing that they need the advice of experts in order to know what to eat. The same experts, we should remember, who in the same newsletter, (wrongly) inform the reader that ‘chicken drumsticks and thighs are leaner and have a lower glycaemic load than chicken breast’.

My aim is to help you achieve a total health score of over 85%…You’ll…receive ongoing personalised information to help you put all your health advice into practice. For example, if you are vegetarian, have poor glycation and oxidation scores, you’ll receive recipes appropriate just for you…[100%health newsletter, Jan 2009, No. 49, pg. 1.]

HolfordWatch has to confess to being a little stumped by this. We can understand how it might be possible to estimate glycation by interpreting a haemoglobin A1c blood test (possibly the YorkTest product that isn’t yet available) but from a questionnaire? It’s not too clear what is meant by oxidation unless this involves a comprehensive cholesterol analysis with a detailed lipid profile. It’s entirely possible that a thorough health profile might involve some costly blood tests although it is plausible that some helpful health entrepreneur might manage to recommend his favourite laboratory for such tests.

Why does Patrick Holford feel that you need to spend money on some as yet unspecified tests and a health questionnaire that has never been validated? What might happen if you ignore his advice?

The alternative, that’s conventional medicine, doesn’t have a very good track record. According to research by the British Medical Journal into some 2,500 medical treatments, only 13% are rated as beneficial. Other research suggests there are an estimated 30,000 deaths associated with prescribed drugs every year in the UK, which is 1 in 20 of all deaths (annual deaths overall is about 600,000). What’s more, our risk of dying prematurely from an heart attack or stroke, or developing diabetes, breast or prostate cancer is about one in two.

It’s not rocket science to see that you are much better off investing in staying informed about the real causes of health and disease, and doing what you need to stay fighting fit rather than drifting towards preventable diseases. [100%health newsletter, Jan 2009, No. 49, pp 1-2.]

Frightening stuff. Hands up if you are surprised by the absence of references for these startling statistics or any framework for interpreting them. When you make an informed guess as to the references, you may well consider that, “It’s a bit more complicated than that, Patrick Holford, however, it is fair to say that you are somewhat distorting the facts”.

HolfordWatch is going to take a punt that these figures for medical treatments are from BMJ’s Clinical Evidence. What does Clinical Evidence actually state?

Of around 2500 treatments covered 13% are rated as beneficial, 23% likely to be beneficial, 8% as trade off between benefits and harms, 6% unlikely to be beneficial, 4% likely to be ineffective or harmful, and 46%, the largest proportion, as unknown effectiveness (see figure 1).

Evidence-base for benefit of medical interventions expressed in pie-chart
So, yes, “only 13% are rated as beneficial” but that doesn’t actually mean that the remainder are actively harmful as one might reasonably conclude from yoking that figure together with the dire figures from an unattributed anecdote[d] that Holford has used on many occasions. It is possible that Holford has repeated the anecdote so often that it has taken on a degree of authority for him but it still doesn’t make it either accurate or relevant. Where is this fabulous track record that Holford is implying for the nutritional interventions that he is recommending? Let us not forget that Patrick Holford attempted to dismiss the Cochrane Review of antioxidants which covered approx. 230,000 participants in favour of his own anecdote with n=2.

Dr Ben Goldacre provides a context for interpreting such figures in Bad Science .

Another way of measuring is to look at how much medical activity is evidence-based, taking consecutive patients, in a hospital outpatients clinic for example, looking at their diagnosis, what treatment they were given, and then looking at whether that treatment decision was based on evidence. These real-world studies give a more meaningful figure: lots were done in the 1990s, and it turns out, depending on speciality, that between 50 and 80 per cent of all clinical activity is ‘evidence-based’. [Bad Science , pg 182.]

We’ll repeat those last figures: “between 50 and 80 per cent of all clinical activity is ‘evidence-based'”. That sounds rather different to Holford’s summary of the evidence. Andrew Booth has compiled a classic review and resource guide of these “real-world studies” for people who would like to look through the detail. Drs Harriet Hall, Steve Novella and Peter Lipson have all commented on the distortion of figures around the evidence-base for medical treatments and the estimation of iatrogenic harm. Holford v. Goldacre, Booth, Hall, Novella and Lipton. In whom do you repose your trust?

We have no idea where Holford obtained the numbers relating to premature death, diabetes and cancer, but it is sufficient to say that he has been spectacularly wrong about similar numbers on previous occasions. Plus, it is rather a truism, but more men die with prostate cancer than from prostate cancer, so, the relevance of the incidence of prostate cancer rather depends on whether it is progressive or not. Dr Dave Gorski points out that The early detection of cancer and improved survival: [Is more] complicated than most people think.

Sadly, as HolfordWatch has documented on many, many occasions, Holford is not an adequate participant in discussions about research. He is not even an reliable intermediary for disseminating research findings or understanding them appropriately. He should certainly not be accepted at his own valuation as an expert or even competent commentator.

People send us extracts from Holford’s 100%health subscription newsletters and Special Reports because they believe that they prove that Holford is a gifted researcher and that we fail to give him due credit for his scientific rigour. They expect us to read these snippets and collapse sobbing as we are overcome with remorse at our unfounded criticisms of one of the UK’s leading thinkers and scientists.

As for “staying informed” and Holford helping readers…Time and time again, Holford’s scholarship is demonstrated to be shoddy and inaccurate. As Professor Tom Sanders remarked, nutritional therapists tend to “feed on the detritus that comes out from the scientific community” – but it doesn’t mean that they assimilate it correctly.[e]

Notes

[a] GL Check, without further information, this test may be as unevidenced and arbitrary as some of the other offerings in the YorkTest portfolio.
[b] We have previously commented on just how out-of-date and inaccurate some of these Special Reports are and the fact that they seem to be very poor value for money.
[c] Holford has a track record for establishing his own levels when current ones don’t dovetail into his supplement recommendations. Holford’s recommendations for homocysteine levels are substantially lower than those of people who have some actual research or clinical background in the topic: he does not give a satisfactory explanation for this although it is serendipitous that by establishing a very low baseline, it may well happen that more people need to take supplements to achieve his recommended levels.
[d] This anecdote turns up on many occasions and is worthy of its own place in that fine journal, Things I heard in the pub.

I met a man who processes drugs statistics for many NHS hospitals and he estimates the number of deaths associated with adverse drug reactions in the UK to be around 30,000 per year. That’s one in twenty deaths! [100%health newsletter, Nov. 2007, No. 42, pg. 1.]

[e] Yet again, we refer interested readers to an overview of the Justin Kruger and David Dunning paper that discusses how difficulties in understanding one’s own incompetence can lead to inflated self-assessments.

What’s even more amazing is that when they then shared the performance of other participants with the people who performed poorly (hoping that they would then adjust their self-perception downward) people who scored poorly failed to adjust their self-perception of their performance. In other words, they are completely unaware of their own [in]competence, and can’t detect competence in others.

It really it a very helpful paper that explains many otherwise inexplicable actions. (Holford Myths offers an excellent discussion as to why pundit brand equity ensures that Holford still receives so much positive attention in the mainstream media.)

A Photon in the Darkness likewise offers a helpful discussion of this paper: The Arrogance of Ignorance.

We do, however, acknowledge that there are some examinations of the variance of ability as a function of ability. It may be true that we all misjudge our ability and task difficulty but some of us seem to be more rigorous in scrutinising the evidence to guard against this and are open to correcting any errors.

BPSDB

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23 Comments

Filed under Ben Goldacre, blood sugar, patrick holford, yorktest

23 responses to “Patrick Holford: “conventional medicine, doesn’t have a very good track record”

  1. There is an interesting section on the Cochrane website on this subject:
    http://www.cochrane.org/docs/faq.htm#q20

    As lots of people die in the care of the NHS are ex-Professor Holford and his chums saying we should avoid hospitals?

  2. The Andrew Booth summary goes into quite some detail on that incident and it is strongly suggested that there was a certain amount of good humour in that exchange and the low estimates were meant quasi-seriously (I think) and that (probably) the:

    figures came from a two week survey in 1963 of 19 general practitioners “representing almost every partnership and practice in a northern (British) industrial town”. All recorded the “intent” of each prescription written. Those for proprietary drugs with “specific” benefit were 9.3%. Another 22.8% were considered to be of “probable” benefit, 27.2% of “possible” benefit, 28.2% were “hopeful”, and 8.9% were regarded as a placebo; 3.6% were “not stated”.

    And, yes, it is extraordinary how many people die in the care of the NHS in the UK. In fact, there must be an extraordinary number of people who are registered voters who die every year. :-)

  3. Mojo

    “Other research suggests there are an estimated 30,000 deaths associated with prescribed drugs every year in the UK”

    “Associated with”. Well, yes, I expect that many people who die are ill in some way, and people who are ill often get drugs prescribed to them…

  4. In Archie Cochrane’s autobiography “One Man’s Medicine” he describes an incident where some one at a medical conference tells him that gentlemen do not clinical trials.

    Mr ‘Olford you is a gentleman and a scholar, sir.

  5. Seriously, Lee? I hadn’t heard that – I really must dig it out because that is superb.

    Mojo, there is a good chance that the 30,000 ‘research’ is courtesy of the bloke in a pub, on the back of an envelope however, yes, it is extraordinary how people who have had a cardiac arrest might find that they have received an extraordinary array of drugs – similarly for septicaemia.

    I would like to see the grounds for “associated with” plus a rough categorisation of the illnesses and fragility of those involved. In fact, I’d like some proper references – I can’t believe that this standard is acceptable to the people who are paying good money to subscribe to this service.

  6. Wulfstan

    Reading Dave Gorski’s piece on cancer diagnosis and survival, it is initially alarming to learn that:

    Thyroid cancer is fairly uncommon (although certainly not rare) among cancers, with a prevalence of around 0.1% for clinically apparent cancer in adults between ages 50 and 70. Finnish investigators performed an autopsy study in which they sliced the thyroids at 2.5 mm intervals and found at least one papillary thyroid cancer in 36% of Finnish adults. Doing some calculations, they estimated that, if they were to decrease the width of the “slices,” at a certain point they could “find” papillary cancer in nearly 100% of people between 50-70.

    But then, it really does make you think that it is inevitable that mutations will happen as we age but that the overwhelming majority of them must not be progressive. So – ability to diagnose such will make medicine look worse if you don’t allow for this.

    At the risk of starting a Life of Brian line-swap meet, “What’s modern medicine ever done for us?” apart from safer surgery, decreasing the likelihood of dying of tetanus, safer childbirth…but apart from that.

  7. After lecturing in Germany on the value of randomised controlled trials in cariovascular medicine, and after a rather violent discussion, I was taken aside by the chairman, who said, “Dr Cochrane, you don’t seem to understand. Controlled trials are done by the pharmaceutical industry. Gentlemen don’t do them.” (One Man’s Medicine, p.257)

  8. Wulfstan

    Lee – if I had a hat on my head I would doff it to you. A very good spot and one that I must try to remember. How very ‘Trade’ v. the Gentry. Or Gentlemen and Players, if I remember the old-fashioned cricket terminology correctly.

    How very easy and restful it is to be a gentleman and a scholar (in that narrow sense) and for no expenditure of energy or finances.

  9. Of course there are a number of similarities between the lives of Archie Cochrane and Patrick Holford:
    (1) Archie Cochrane spent several years as a professor of epidemiology at Cardiff medical school. Patrick spent several months as a visiting professor somewhere or another
    (2) Cochrane fought with the good guys in the Spanish Civil War. Patrick is fighting his own civil war with the medical establishment and is on the side of righteous.
    (3) Cochrane’s life inspired the Cochrane Collaboration whereas Holford’s inspired the Institute for Optimum Nutrition.

  10. Wulfstan

    Cochrane fought with the good guys in the Spanish Civil War. Patrick is fighting his own civil war with the medical establishment and is on the side of righteous.

    Excellent. Up until now, I also failed to notice the similarities between Holford and Orwell ((Spanish) Civil War and fiction).

    Cochrane inspired people to collaborate on review of evidence-based medicine. Holford has obviously inspired people to comment on the stupidities of nutritionism.

  11. Pingback: Patrick Holford Is Selling Gluten-Free Rice - Eh? « Holford Watch: Patrick Holford, nutritionism and bad science

  12. The light-hearted exchange between Archie Cochrane and Kerr White referred to above made me wonder what would have happened if Professor Archie Cochrane had attended one of ex-professor Holford’s seminars?

    Patrick: Oh course, conventional medicine does not have a good track record. Of the interventions I promote 143% of them are known to be successful ….
    Archie: You’re a damned liar Holford. You know perfectly well that I have done a series of randomised controlled trials and only 2.4367% of the things you do have any benefit to man or beast.
    Patrick: Ahhh, I see as usual Professor Cochrane is so far behind. He has forgotten to mention how his professorship in Cardiff is funded by the pharmaceutical industry.

  13. Ah, Lee. You may be entertained by the latest missive from Food for the Brain:

    I am pleased to let you know that we are on the brink of starting our long-awaited nutrition and schizophrenia project. We’ve identified the researchers, research supervisors and collaborative university and hope to start in the next couple of months.
    The design we favour is not a randomised placebo-controlled trial (RCT) but a comparison of the relative effectiveness of a systems-based approach, as used by the Brain Bio Centre, on a group of people with schizophrenia, compared to a group receiving conventional treatment. Last year, in a keynote speech at the Royal College of Physicians, Professor Sir Michael Rawlings, head of NICE (the National Institute of Clinical Excellence), laid out his reasons for why the kind of research we intend to do has real merit and why RCTs have been placed on an undeserved pedestal.

    So, yes, Cochrane would have neglected to mention his pharma connections (Holford’s association with Biocare et al is irrelevant). And, within the next 3 years, without a doubt, we shall all acknowledge the superiority of whatever this is instead of an RCT and finally have caught up with Holford.

  14. “As for “staying informed” and Holford helping readers…Time and time again, Holford’s scholarship is demonstrated to be shoddy and inaccurate.”
    Yes. When I read about Holford’s newsletters, I’m reminded of Mark Twain. If you don’t read newspapers you are uninformed. If you do, then you are misinformed.

  15. jdc, how odd I saw that Twain recently and meant to make a note of it so thanks for the reminder. I’m wondering about adopting it as a maxim, maybe painting it on a banner, stencilling it on a bike frame.

  16. “Ah, Lee. You may be entertained by the latest missive from Food for the Brain”

    I plucked up the courage to open and read that email earlier today. It caused me to shake, swear and attempt to throw the PC monitor out of the window and on to the street outside.

    Fortunately, no Holford fans were passing by otherwise an ION ambulance may have rushed me to the Brain Bio for immediate treatment ..

  17. Or – they might have chucked you a nice pack of seeds with added magnesium – we hear that it is very calming.

    If anybody knows which university has agreed to sponsor this research, please don’t keep it to yourself.

  18. Ohhh noooo, I missed that. Normally, the words “collaborative” and “university” are quite inoffensive, but place them together in a sentence with soon-to-be-professor-again Holfrd and and the consequences are too fearsome to contemplate …

  19. Wm Thacker

    I think I add my voice to those who think that this shouldn’t be allowed. I didn’t think that CAM practitioners were allowed to derogate (medical) doctors in the absence of good quality evidence.

    If he is so personally wealthy on the back of all this salesmanship, why doesn’t he set up a research foundation and do some of this properly? All those students going through that institute and no worthwhile research? In 30 years?

  20. ewan

    even if you grant the point that there are bad things about conventional medicine (Ben Goldacre has a chapter with a title like “Is Pharma Evil?” isn’t it possible that in an advantages, disadvantages assessment, the positive side of conventional medicine wins out?

    there are lots of people in my family who talk about preferring natural medicine and refusing to take pills. but they are happy to try and have medical effects on the body by taking pills where there is no guarantee that they contain the substances, vitamin,s minerals that they claim, in the quantities they claim.

    if you ask me, other forms of medicine had a clear run for a very long time. conventional medicine may not have perfect track record but it is still in its infancy and working hard to improve itself.

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