Patrick Holford Advises You to Remove Mercury Fillings and Undergo Chelation But Is Still Silent About Andrew Wakefield?

Former Visiting Professor Patrick Holford never fails to disappoint. The other day, I had noted that although he cleaves to his over-hyped enthusiasm for chromium supplements, the hyperbolic claims about cinnamon although still excessive were comparatively more nuanced than previous occasions – still wrong, but some useful nuance. I had hoped that this was the first green shoots of an improved approach to evidence.

However, Holford is now back to his usual form. He ignores the opportunity to update his advice for the ‘treatment’ of autism following the public revelations about the fraud and deliberate manipulation that irreperably taint Dr Andrew Wakefield and his research. He clutches instead for the topical subject of mercury fillings on Tonight with Trevor McDonald because it allows him to shill for his Alzheimer’s Prevention Plan. Patrick Holford displays no sense of taste or decorum – presumably he takes special supplements that confer the protection of a brass neck on him.

Seriously, What Do They Teach at the Institute for Optimum Nutrition Judging by the IONistas in the Public Eye?

What do they teach people at the Institute for Optimum Nutrition? When the founder of one’s alma mater is Former Visiting Professor Patrick Holford this might, occasionally, give one pause as to exactly what is taught to the aspiring cohorts of students of nutritionism. Patrick Holford set up the Institute of Optimum Nutrition as a limited company, back when he was in such a state of despair as to the disparity between his own auto-didact expertise and that of people who had actually studied the topic for several decades and researched it in rigorous detail, that he felt that he had no option but to set up his own institute of learning to spread his own special take on nutritionism throughout the tranche of gullible like-minded, well-heeled seekers after knowledge.

Ben Goldacre’s Rise of the Lifestyle Nutritionists on Radio 4 Won a Norwich Union Medical Journalism Award

HolfordWatch enjoyed Dr Ben Goldacre and Rami Tzabar’s 2-parter on The Rise of the Lifestyle Nutritionists on Radio 4 (see update for MP3 links). We thought that it was an interesting exploration of the scientific rhetoric that is intended to lend respectability to nutritionism, and its adherents. Visiting Professor Patrick Holford was included as a notable example of a self-styled nutritionists who distorts research and reduces it to what was characterised as ‘a low and somewhat tabloid-y level of discourse’ with a hefty dose of promotion for supplements. We’ve just learned that it won the Norwich Union Healthcare Medical Journalism Award for National Radio, 2008.

You & Yours on Barbara Nash and the risks of nutritional therapy Updated (again)

Radio 4’s You & Yours today discussed the issues arising from the alleged injury of a client of nutritional therapist Barbara Nash, when Nash put the client onto a ‘detox diet’.

The programme (here and you can listen again here, while it’s still available) includes an interview with registered dietitian Catherine Collins, and the BANT Chair Emma Stiles: extraordinarily, Stiles apparently acknowledges that nutritional therapists do not practise evidence-based medicine. However, the segment began with Mr Page telling the sad story of how this diet – including lots of water and low sodium – progressed. Dawn Page consulted a nutritional therapist because she wanted to lose some weight, but she ended up in intensive care and still suffers from cognitive problems (this case was settled out of court for £810,000; Nash continues to deny responsibility for the injuries to Mrs Page, and due to the settlement there has not been a court finding on this case).

Tara Parker-Pope suggests consulting a nutritionist if “on a renal diet in advanced stages of CKD”

Reading the comments on a dubious New York Times blog post offering a list of 11 foods to eat, we were very concerned to see Tara Parker-Pope’s response to one comment.  The comment states that “Your list of 11 foods is fine except for anyone on a renal diet in advanced stages of CKD [Chronic Kidney Disease].”  Tara Parker-Pope replies by advising that “obviously people with specific dietary concerns need to discuss the issue with their doctor or nutritionist.”

Unfortunately, as we have explained on many occasions, ‘nutritionist’ is not usually a protected title.  While there are no doubt a number of well-qualified, university-level-credentialled and capable individuals practising as nutritionists, in most states absolutely anyone is able to call themselves a nutritionist.  As Ben Goldacre’s dead cat Hettie demonstrated, you don’t even need to be alive or human in order to be a credentialled nutritionist.

Irish Association of Nutritional Therapy: Giving the Facts About the Cochrane Review of Antioxidant Supplements

You may remember that Miriam Barry of the Irish Association of Nutritional Therapy (IANT) offers a Response to the recent media coverage regarding antioxidants. She opens her response with these words:

As nutritional therapists we feel compelled to give the public the facts of this case. Please click here to inform yourself of the facts regarding this study.

The Rise of the Lifestyle Nutritionists: “food has become a modern obsession”

In the first part of this two-parter, Ben Goldacre does an excellent job of reminding us that of how “food has become a modern obsession”. We’re taken through the colourful history of nutritionism in the US – and, in a sense, this is a rather sad story. If you missed it the first time round, you can listen again here.

In the early days of nutritionism, medicine wasn’t able to do that much – so there was a certain rationale for focusing on lifestyle change or, even, using a relatively harmless snake oil (although not all nostrums were harmless, it had not been that long since many prescription medications contained remarkably toxic or addictive substances). If the choice appeared to be palliation or heroic surgery, it is understandable that people were interested in the promise of elixirs and potions from alternative health practitioners. While early nutritionists (Kellogg, McFadden etc.) may have had an unhealthy obsession with pumping various fluids into the behinds of their patients – in Kellogg’s case, an eye-watering 15 gallons in a matter of seconds – and spouted nonsense about the insanity-inducing properties of mustard and so forth, a lot of the advice was basically sensible

The Rise of the Lifestyle Nutritionists: Ben Goldacre on nutritionists and nutritionism

Ben Goldacre‘s presenting an interesting-looking 2 part programme on BBC Radio 4 – starting at 8pm on Monday March 24. The first part analyses the history of lifestyle nutritionists – everything from the quack cure-all Hadacol to the (mis)appropriation of bona fide nutritional research in order to sell various pills and potions. Sounds well worth a listen – and, tantalisingly, the second part of the programme is going to discuss nutritionists and nutritionism in the present day.

There’s a (rather minimalist) programme website available – where I presume you’ll be able to listen again to the programme if you miss it first time round. After all, it is the bank holiday – and I guess that fermented and distilled whole foods may have a real lure on Monday…

Is Holfordism Harmless? Part 2

A recurrent theme among the anonymous commenters is that we need to develop compassion and an open mind when we discuss Patrick Holford and his work. I’m unclear as to whether either of these ought to encompass the acceptance of information that is mis-leading or wrong. More recently, a (named) commenter wrote to tell us how impressed she is by Holford:

I certainly don’t agree with everything alternative medicine has to offer, but some of it does work, so please don’t criticise too much!

Nutritionists (as opposed to dieticians) want to help people towards optimum health – who doesn’t want to feel good? Some of us can’t seem to get the balance right ourselves and, since doctors and buying heavily marketed products often doesn’t help (docs, like dietitians, tend to want to cure rather than prevent), we want to ask someone who knows more than us.

Why is it not appropriate to criticise someone when they are wrong? Or do you think that confusing premature mortality figures of 250,000 for cardiovascular disease when the actual figure should have been 60,000 is neither here nor there? What did you think of the WiFi avoidance advice that would turn your domestic wiring into an aerial? Is it acceptable to extol the virtues of a prophylactic pendant that works by faith and magic rather than science? What about Holford’s fauxrious claim that Watchdog had misrepresented the strength of the research literature for food intolerance tests when he was mistaken?

Holford has removed his fauxrious claims about the Watchdog programme but it still exists on the websites of his supporters. In response to some of Jon’s concerns, he has amended some dietary claims and recommendations on his Food for the Brain website and has now reported that he will ask Health Products for Life to amend advice about folic acid supplements. Holford’s testimonial about the QLink also seems to have disappeared.

Holford Watch hasn’t begun to scratch the surface of what is amiss with some of Holford’s claims or his sometimes inappropriate characterisation of the scientific literature. It is difficult to estimate whether these flaws are minor or might have greater significance: it is also difficult to assess how widespread they are among (say) nutritionists who have trained at ION or any nutritional therapist that one might consult. Catherine Collins gave a robust response to the commenter’s misconceptions about the work and scope of practice of registered dietitians. I would dispute the commenter’s implication that a nutritionist will, by default, always know more than ‘us’.

If Holfordism has persuaded somebody that it is inappropriate to comment on unsubstantiated claims, poor research or bad science, is it harmless?

British Association for Nutritional Therapy – when an organisation looks like a regulator, quacks like a regulator, but isn’t a regulator

11111It is important for healthcare providers to be properly regulated. An important aspect of this is the transparency of the regulatory process: for example, the GMC (which regulates Britain’s medical doctors) makes its guidelines on good practice available on its website, along with its hearings and decisions. Dieticians are regulated by the HPC, and you can view the standards they have to abide by, and details of the complaints heard by the HPC, online. Transparency is significant – it allows the public to monitor the standards to which medical doctors are held, and ensure that these are satisfactory (while also encouraging those with genuine complaints to submit them – as they can see that they will be fairly treated).

The British Association for Nutritional Therapy (BANT) claims to be “a governing, professional body regulating the activities, training and Continuing Professional Development of its practitioners“. Patrick Holford is a member, and the wikipedia page on Holford states that “Holford is a Fellow of…BANT…one of a number of bodies that aims to regulate nutritional therapists in the UK.” So, BANT looks like a regulator, and quacks like a regulator; however, BANT has told me that they are “a professional association and not a regulator”.

BANT’s disciplinary procedure completely lacks the transparency of the procedures of convincing healthcare regulators. I’ve been in contact with BANT about their complaints procedures for a good month or so now – I’ll use this post to outline what I’ve found out, and some of my objections to their procedures.

I first contacted BANT to ask about their complaints procedure in early April. I asked – reasonably enough, I thought – to see a copy of their ethics code (which they use to evaluate complaints against members). I was initially told that this is not available to members of the public – BANT is apparently concerned that people might misquote or steal their ethics code. Like you do – there’s a thriving market in nicked ethics codes down my local.

I pushed BANT to see if they would give me any details on their ethics code (I can be relatively stubborn). At the end of April, BANT relented a little and told me that “decisions are now based against the Nutritional Therapy Council Code“. I then asked whether BANT’s decisions are based solely on this code, and on May 8 BANT told me that they use “a rigorous complaints procedure, the requirements of which are given in the NTC Codes and expanded for clarity in a BANT document that is currently not available for public release”. Given that this BANT document isn’t available to the public, there’s no way of knowing whether or not it’s satisfactory, or for members of the public to determine whether a BANT member has breached it.

Of course, another thing to look at when determining how BANT regulates its members is the disciplinary proceedings that have already taken place. When I asked BANT about this, I was told that:

A total of six complaints were received in the previous year of which one was later withdrawn by the client and one was still being considered at the end of the year. Following examination of the complaints and the members responses two members were asked to write letters of apology to their clients where they had not maintained the usual high standards expected. No complaint was considered of sufficient substance or gravity to require a member to be excluded, and accordingly no further information is to be made available.

The details of these complaints and hearings (or even the names of those involved) is not publicly available, so there is no way to tell whether or not they were handled appropriately. For all I know, the complaints could have been very minor, or involving serious and dangerous professional misconduct. The hearings might have been completely fair, or could have been a total whitewash.

As I’ve said, if you’ve got such concerns about organisations like the GMC, you can read details of the hearings yourself and make your own mind up. With BANT, though, you have to take their word on this as details of their Ethics committee’s meetings and decisions are kept hidden from the public (I should note that BANT have told me that that their “Ethics committee do indeed meet in a room but there is nothing secret about the meetings and we have a lay-member on that committee.”)

I would also argue that – because of the lack of availability of information on BANT’s ethics codes etc. – the number of complaints may be artificially low. I’ve been pushing BANT for over a month for the limited amount of information in this post – many would have given up far sooner.

To summarise, then:

• BANT are not a regulatory body.
• BANT’s ethics code is kept secret from the public.
• BANT’s ethics committee meets in secret (sorry, meets in a non-secret room to which the general public does not have access, and does not publish details of its discussions)

While a ‘nutritional therapist’ being a member of an organisation like BANT might make prospective patients feel safe – lead them to assume that the therapist is properly regulated – I would therefore advise much greater caution. As BANT themselves acknowledge, they are not a regulator; I would also argue that there is no way of telling whether or not they adequately regulate their members.