I was surprised to see the usually excellent Guardian Science tweeting that “Fish oil helps schoolchildren to concentrate”. This linked to Denis Campbell’s Observer article, reporting that
Fish oil helps schoolchildren to concentrate
US academics discover high doses of omega-3 fish oil combat hyperactivity and attention deficit disorder
Children can learn better at school by taking omega-3 fish oil supplements which boost their concentration, scientists say.
Boys aged eight to 11 who were given doses once or twice a day of docosahexaenoic acid, an essential fatty acid known as DHA, showed big improvements in their performance during tasks involving attention.
Dr Robert McNamara, of the University of Cincinnati, who led the team of American researchers, said their findings could help pupils to study more effectively and potentially help to tackle both attention deficit hyperactivity disorder (ADHD) and depression.
Unfortunately, the Observer’s claims about fish oil are not evidence-based. Continue reading
We were fascinated to come across a Madeleine Portwood presentation on the Food for the Brain site [PDF]: discussing “Essential Fats, School Performance and Behaviour”. One quote stands out, repeated on two slides alongside pictures of very sweet-looking children:
this is not about chemistry. This is about children.
At a first glance, this sounds very compelling: after all, who could argue with the fact that educational psychology in our schools needs to be about children? However, the dichotomy invoked by Portwood here is extremely problematic. A brief discussion of the Cochrane Collaboration will help to make clear why.
The Cochrane logo features a prominent diagram. The diagram
shows the results of a systematic review of RCTs of a short, inexpensive course of a corticosteroid given to women about to give birth too early. The first of these RCTs was reported in 1972. The diagram summarises the evidence that would have been revealed had the available RCTs been reviewed systematically a decade later it indicates strongly that corticosteroids reduce the risk of babies dying from the complications of immaturity. By 1991, seven more trials had been reported, and the picture had become still stronger. This treatment reduces the odds of the babies of these women dying from the complications of immaturity by 30 to 50 per cent.
Because no systematic review of these trials had been published until 1989, most obstetricians had not realised that the treatment was so effective. As a result, tens of thousands of premature babies have probably suffered and died unnecessarily (and needed more expensive treatment than was necessary). This is just one of many examples of the human costs resulting from failure to perform systematic, up-to-date reviews of RCTs of health care.
Research is about both chemistry and children. Because of suboptimal evaluation of the research into how particular chemicals worked in particular situations, a number of babies will have died who might otherwise have been saved.
It is because we care about children – and because children are important – that we need to insist that research conducted in children and on childhood conditions meets the highest possible standards. Continue reading
In response to a FOIA request, Durham has told us about another significant flaw in their fish oil (non)trial: the ‘treatment’ arm was students with more than 80% reported compliance with supplementation with Equazen fish oil pills; the ‘control groups was selected from any students with less than 80% reported compliance. This means that – while a student with 80% reported compliance could have counted as an example of the success of this ‘treatment’ – a student with 79% reported compliance could have been compared to them as part of the ‘control group’.
I am really not sure what to say Continue reading
Filed under Equazen, fish
Looking over the Durham fish oil (non)trial again, I noticed something I had missed: they have previously claimed to be looking at three quite different things in order to determine whether the pills are effective. They started out (back in 2006) with a press release where they promised to measure efficacy by comparing students’ actual GCSE results to their predicted results. Not terribly promising methodologically, but at least Durham were explicit about what was going to be measured. Except that, in their response to a 2008 FOIA request, Durham stated that
All that was being sought was the number of children taking up the offer of capsules and a comparison of GCSE results from the previous year
To me, that sounds rather different. Then, to make matters worse (as we have already noted) Durham eventually chose to measure how fish oil takers compared with ‘matched pairs’ from the same year group. Again, this is a different test of whether the pills work. Those of you wondering why Durham are taking so long to release these results might also be interested to know that the 2006 press release promised that
the first test of the supplement’s effectiveness will be when they sit their ‘mock’ exams this December.
It is good practice to decide what you are measuring – and how you are going to judge the efficacy of a treatment – before starting a trial: otherwise, it can be tempting to change what is measured in order to generate the ‘right’ result. While I cannot know why Durham have discussed plans to measure the ‘success’ of fish oil in this (non)trial in three ways since 2006, this gives yet another reason why it is imperative that Durham release their data ASAP: so that the claims in their press releases can be scrutinised.
Rather than Durham playing third time lucky with tests of efficacy, could this be a case for Einstein creature?
In the course of a truly dire article on Patrick Holford – ‘Eat Your Medicine’ – the Irish Times states that “Holford has been a vegetarian for 30 years”. This seems a peculiar claim: the Independent has previously referred to Holford eating fish, and the Health Products for Life web shop states that Holford takes fish oil pills.
Honestly, I wouldn’t generally care what Holford ate or what pills he takes: if he wants to eat fish, he has every right to do so; he is also quite entitled to take fish oil pills, although I would imagine that the fish is tastier. But Holford makes a big play of his own lifestyle when selling his ideas and his products:
people are motivated to follow my advice because I explain the logic of it and I embody it
Which makes it peculiar for Holford to be described as a vegetarian – and a vegetarian for 30 years, no less – at the same time as discussing eating fish and taking fish oil pills. If fans of ‘alternative’ nutrition are going to base their lifestyle on one other person who happens to be healthy (a pretty daft move in itself – I’m sure we all have anecdotes of people who lived long, healthy lives while smoking and drinking heavily, avoiding exercise, etc.) surely Holford could at least publicise a consistent account of his lifestyle? Continue reading
In their continued efforts to provide a textbook example of why science by press release is a very bad thing, Durham Council’s press releases about their fish oil (non)trial even manage to muddy the water as to which Essential Fatty Acids (EFAs) were in the capsules that Durham gave to their schoolchildren. Their latest press release on the issue refers to the “Omega-3 tablets” the children were taking. However, back in 2006 Durham’s press release implied that Equazen’s Eye Q capsules (not tablets) were being used: it quoted Equazen’s Managing Director saying that
the eye q formula can really help enhance achievement in the classroom
Eye Q does not just contain omega 3 fats: it also contains “Omega-6 Gamma Linolenic Acid (GLA) from evening primrose oil and its metabolite Arachidonic Acid (AA)”. However, as well as Durham’s latest press release, recent coverage by the BBC referred to “fish oil” and Omega-3 supplements. The Northern Chronicle also referred to “fish oil capsules”. Ironically, it took an otherwise pretty poor article in the Daily Mail to point out that evening primrose oil was also given to the children.
It might seem like I’m being pedantic, but Equazen clearly view Evening Primrose Oil as significant, claiming that this “also plays a structural role, assisting in normal nerve function, especially learning and memory.” If we’re going to have ‘pill solves complex social problem‘ stories, people could at least be clear as to what is in the pills. Continue reading
If I didn’t know better, I might suspect that Durham’s fish oil
trial initiative has been designed as an example of the dangers of releasing scientific results via the mainstream media. I have been looking over the Durham figures, and the situation is so bad that there is even some confusion as to how many students were eligible to start on the trial and how many took the pills. Continue reading