UPDATED: Observer plugs fish oil for concentration, ADHD and depression

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.

Dore and some interesting wikipedia edits

Looking at the Wikipedia page for Dore, we were interested to note that IP address 82.70.115.233 was associated with a number of edits to this page. Some of these changes – such as a 31/12/09 edit – seem to make the Wikipedia page more positive about the Dore treatment. Whois information links this IP to a Dave Harris. By a pure coincidence, I’m sure, a Dave Harris happens to be Dore’s Senior Systems Engineer.

I do like wikipedia.

Dore: nothing in it?

The ten23 campaign looked at homoeopathic pills: there’s no active ingredient in them, once diluted beyond a certain level.  This post is going to look at the Dore treatment for dyslexia, dyspraxia and ADHD: and suggest that there’s no good evidence it works and (aside from the placebo effect) there may be nothing in it.

Following an ASA ruling that claims made in Dore’s advertising were misleading, we were involved in putting out a press release: to publicise this ruling.  My mobile number was on there, and I was surprised to get a call about the release from Phil Hall Associates: Dore’s PR agency.  I subsequently spoke with them about Dore on the phone – which they asked me to keep off the record – and, at the agency’s suggestion, e-mailed them some questions about Dore.  These questions and their responses are below; I will then look at what questions they have failed to answer, and why this suggests that there may be nothing in Dore.

I asked Phil Hall Associates the following questions about Dore:

– I’d be interested in details of how Dore might have responded more strongly to the ASA. If there is good evidence that Dore can treat dyslexia, aspergers, ADHD and dyspraxia, I’d be very interested in seeing this.
– I’m pleased to hear that the new management and ownership seek to improve practice. Could you specify which practices are being revised? And can you let me know who the new owners are?
– The Balsall Common study has been removed from the ‘research’ part of the Dore website. Could you summarise why this has been removed – how does Dore currently feel about this research?
– In terms of the new research, can I see what there currently is? And can you let me know who is conducting any ongoing research – are independent researchers involved?
– Does Dore keep records re the completion rate of the programme and on what percentage of those who complete achieve a successful outcome? If so, can I see the figures? Also, how does Dore assess ‘success’ on the programme?
– Do Dore and PHA feel that there is currently enough evidence to justify promoting the programme as a treatment for dyslexia, ADHD, dyspraxia and Aspergers Syndrome? If so, what evidence do you see as justifying this?
– I gather that Dore may be moving away from ‘miracle cure’ rhetoric. What is Dore’s position on Wynford’s book still selling with that title? And do you feel that current claims (around, for example, addressing the root causes of learning difficulties) are justified?
– Was and is Roy Rutherford’s Autism Treatment and Prevention Centre linked to Dore? And is Dr Rutherford still involved with Dore?
– What evidence would it take to convince Dore and PHA that the Dore programme is not an effective treatment for some of the conditions it is advertised for? And what course of action would be taken in such circumstances?

PHA’s response is below

Firstly, thank you very much for your email in which you raised a number of issues. As you may be aware the Dore Programme has been under new ownership since January 2009 and, as such, has a totally different management team to previous administrations. We are fully committed to communicating with people in an open and honest way as we genuinely believe that the Programme could have a huge impact on the lives of people suffering with learning difficulties.

Over the past ten years (since the Programme was first established) we have consistently received feedback from our clients to indicate that the Programme has helped thousands of children and adults and, for many, this has had a transformational impact on their capacity to learn and function in everyday life.

Although we fully accept ours to be an innovative approach, we continue to be reassured by what our clients tell us and by the ongoing involvement of a number of recognised experts and higher educational establishments. Their academic and clinical input will ensure that the science underlying these observed benefits can be more easily understood and further developed.

However, we also recognise that a start-up organisation can sometimes get absorbed in its passion to bring about change and to survive. As such, there have been lessons learned and the new management team genuinely understands why some people will be wary of the Programme. We want to address these concerns as, ultimately, our goal is to help people (especially children) to overcome the impact of learning difficulties early on in their lives before the more debilitating psychological and social consequences take hold. To achieve this we actively want to promote an environment in which individuals and organisations work together rather than against each other.

The paragraphs below aim to address some of your particular concerns, however, we would be delighted to offer you the opportunity to visit our new centre in Stratford upon Avon and speak with members of the clinical and/or management team.

1. Our method has always been to treat the root cause of learning difficulties with individually designed, physical exercises designed to stimulate the cerebellum. We recognise there are different schools of thought regarding how best to treat people with dyslexia, dyspraxia and ADHD and we believe that many of these strategies have an important role to play.

2. A fundamental issue to tackle is the ‘miracle cure’ debate. The simple truth is that Dore does not market itself as a single, one size fits all solution to learning difficulties. We consider the Programme to be part of the solution and something that works best when combined with other teaching and supporting strategies. The Programme does not teach people to read or write, but is intended to help make the process of learning easier. There are many other organisations in the field of learning difficulties who continue to deliver incredibly important work and we hope that one day we will work in partnership with them as we believe our different methods can complement each other.

3. We acknowledge that, in the past, certain marketing activities have attempted to position Dore as a ‘miracle cure’. Whilst this positioning was based on the anecdotal evidence of numerous people who genuinely considered the Programme to have worked wonders for them, we fully acknowledge that from a scientific point of view no such thing as a miracle cure exists and, accordingly, no longer brand ourselves as such. We are also extremely clear with everyone we speak to that success on the Programme cannot be guaranteed and that the positive benefits depend on many factors – including significant, long-term personal commitment. We also point out that the Programme won’t necessarily be appropriate for everyone – or work for everyone – which is why the initial assessment is specifically designed for us to identify a person’s suitability (or not) and, just as importantly, to allow the individual to make their own judgement.

4. Another criticism the Dore Programme has faced has been one of commercialism. If we genuinely want to help people suffering from learning difficulties then why do we charge a fee? The simple answer to this question is that without Government funding we have no choice but to charge for the treatment as it’s the only way we can afford to deliver and further develop the Dore Programme. Anyone who has ever been to the Dore Centre in Stratford upon Avon will realise straight away that we passionately care about helping people and in no way could be described as a profiteering organisation. Having said this we are aware that some individuals do find the Dore Programme to be beyond their financial reach and, therefore, we are currently reviewing our corporate constitution to ensure that it is aligned to our primary objective of assisting those with learning difficulties as opposed to profit maximisation.

5. There is also the issue about research. Since 2001 there have been thirteen different studies examining the impact of the Dore Programme with eleven of these conducted on an independent basis and four of which having been peer reviewed. Whilst these studies have provided large amounts of valid evidence pointing to the Dore Programme’s success we do, however, acknowledge that they have also attracted some criticism. This criticism has largely focused on the lack of placebo control groups which, as has been explained in the past, was a decision made partly on ethical grounds as it was considered inappropriate to put young children through a minimum 12-month programme of placebo exercises. It is worth pointing out that we are not aware of any other organisation operating in the field of learning difficulties who has conducted placebo control group studies and we suspect that this is for similar reasons to our own.

6. The research supported by Dore in the past is important and has given us a valuable insight into the effectiveness of the Programme. There is also plenty of research around the world (and not just from Dore) supporting the view that the cerebellum is linked to a wide range of learning, cognitive, attention and communication issues. Of course, all research projects have their critics and ours are no exception. There is still much more work that needs to be done and we are committed to undertaking further research studies and we are also keen to work with other organisations to develop these. One independent research project currently being undertaken by Ohio State University in the USA is a pilot feasibility study exploring various types of treatments for ADHD and reading disorders. This study is blind and includes a placebo control group and we look forward to learning of the outcome in due course and very much hope that this will then attract further federal funding to be able to conduct a full study.

This leaves a number of unanswered questions about Dore. I forwarded some of the most significant to Phil Hall Associates, (but have not had a response). Questions are below:

– Does Dore keep records re the completion rate of the programme and on what percentage of those who complete achieve a successful outcome? If so, can I see the figures? Also, how does Dore assess ‘success’ on the programme?
– Was and is Roy Rutherford’s Autism Treatment and Prevention Centre linked to Dore? And is Dr Rutherford still involved with Dore?
– What is Dore’s position on Wynford’s book still selling with
‘miracle cure’ in the title?
– I’d be interested in details as to how – if there is good evidence that Dore can treat dyslexia, aspergers, ADHD and dyspraxia, I’d be very interested in seeing this.

Of course, both Dore and Phil Hall Associates are quite within their rights not to answer my questions. If they’re going to be phoning me up unexpectedly, it seems a bit of a shame if they’re not wanting to answer questions about the evidence for their treatment – but that’s entirely their call, of course. If Dore or Phil Hall Associates belatedly decide that they would like to answer my questions, I will quite happily link their response or post it on this blog.

Currently, though, there’s not any good evidence that Dore works, though – I mean, a ‘pilot study’ taking place after they’ve been selling a horribly time-consuming and expensive ‘cure’ for years… I therefore can’t help but think that there’s really nothing in Dore.

ASA: Dore advert is “misleading” and breaches rules on “truthfullness” and “substantiation”

I was delighted to see that the Advertising Standards Authority (ASA) has upheld a complaint of mine about Dore’s advertising. I complained about an advert referring to “help with Dyslexia, ADHD, Dyspraxia or Asperger’s”. The ASA has reviewed the evidence Dore submitted to support their claims, and found that:

the evidence was inadequate to support claims to treat those [Aspergers Syndrome and dyspraxia]. With regards to dyslexia and ADHD, we did not consider that the studies were sufficiently robust to support the treatment claims for those conditions, and we therefore concluded that the claim was misleading.

The ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness) and 50.1 (Health and beauty products and therapies).

I am delighted that the ASA has made such a firm ruling.

More Dore: now it’s “Dyslexia and ADHD The Miracle Cure”

In the aftermath of a recent radio discussion, Ben Goldacre reported that the “barefaced cheek of [certain] characters will never cease to amaze and delight me.” We were amazed – albeit not entirely delighted – to see a striking example of Wynford Dore’s chutzpah: the 2008 edition of his book is titled “Dyslexia and ADHD The Miracle Cure” [sic] (it was previously ‘just’ called “Dyslexia: The Miracle Cure). There was not good evidence that Dore offers a miracle for dyslexia (or any learning difficulty) – a fact that has been repeatedly, and forcibly, pointed out – but that did not stop Dore from extending the claims for his ‘miracle cure’ to cover ADHD as well. Given that Dore himself states that “dyslexia is not a “disease” and, therefore, cannot be ‘cured'”, it is surprising that the title of his book changed to include ‘ADHD’ but not to exclude the misleading reference to a ‘miracle cure’.

BPSDB

Genuinely amazing, though not in a good way.

Equazen and the ASA – Again

Visiting Professor Patrick Holford is Head of Science and Education at Biocare and has an unerring sense for his endorsements (see, e.g., the qLink with the unconnected coil and the dLan that may enhance your exposure to EMR and YorkTest, source of the IgG food intolerance tests criticised by both the House of Lords and the ASA). Holford managed to procure some useful backing for the Food for the Brain project. One of the companies is Equazen. Equazen donated essential fat supplements to school projects. With an astonishing sense of inevitability, although the ASA criticised Equazen in 2007 for being unable to substantiate some of its advertising claims, it has just issued an adjudication against more unjustified claims by Equazen, this time for indirectly implying that fish oils are a treatment for ADHD.

Ben Goldacre and Placebo (Part 2) Radio 4: Lacking In Cheese or Missing An Eye

Bad Science‘s Dr Ben Goldacre has collaborated with Radio 4 to produce a 2-part exploration of the potent, intriguing power of placebo. Both Part 1 and Part 2 discussed the history, science and theatre of this fascinating phenomenon and it has been notable that the examples spanned from Perkins Tractors, Mesmer and animal magnetism, to work that was published only this year. Placebo has such an extensive and rich history and encompasses so many issues aside from medicine such as social influence and trust that it isn’t practical to present more than a tasting menu of it in 2 half-hour programes. Nonetheless, at the risk of sounding like Brillat-Savarin, it was strangely unsatisfying that neither of the programmes addressed the issue that some researchers argue that the placebo is both over-rated and ineffective and that there is no role for it in medicine, outside the context of a clinical trial.

Patrick Holford is an ex-Professor: he has resigned his Visiting Professorship at Teesside. UPDATE: Teesside’s Cactus Clinic also ceases to operate

HolfordWatch has just learned that Patrick Holford has resigned his post of Visiting Professor at Teesside; a call to Teesside confirms that the reception don’t have a record of any Professor Holford at the University. We don’t have any more details at the moment: we will post information as it arrives.

Clearly, this is good news: Holford does not produce professorial-standard work. We trust that Holford will update his CV ASAP, and that Teesside will soon put out a press release to clarify the situation.

Sun, Times and Independent articles on Dore closure

The Sun, Times and Independent have just published articles on Dore UK going into administration: it’s great to see this getting into the mainstream media. The Sun’s the Times’ articles are excellent – so we’ll look at those first. Then we’ll take a brief look at why the Independent‘s article is so poor.

Dore UK go into administration: updated 6 times

Following Dore Australia’s move into administration at the end of last week, Dore UK has now also gone into administration. A Dore staff member on Dore’s discussion forums stated that they have gone into administration, and Dore UK staff were told about the move after lunch today. Dore states that they are “closing all of the UK centres which deliver the Dore Programme with immediate effect…We are presently exploring alternative arrangements to ensure every client is cared for”: I hope that this is does prove to be the case, and that staff will get what they are owed. See UPDATE 2 below, though, for a statement from Dore’s PR firm claiming that this is ‘restructuring’ instead of ‘administration’.

Firstly, we would offer our sympathies to all those who are caught up in this. Citizen’s Advice Bureau can be an excellent source of free practical advice on your rights in this type of situation; if you’re a member of a trade union, they will also often be able to help (and should definitely be contacted if Dore have made you redundant).

Secondly, we would like to point out the differences between how the blogosphere and the mainstream media dealt with Dore. A number of blogs noted the limited evidence for Dore’s efficacy – among others, see Bad Science, Brainduck, Gimpy, Left Brain/Right Brain, Podblack, and right here on HolfordWatch – while Gimpy raised the issue of financial problems with Dore back in January. However, the mainstream media has continued the overwhelmingly positive coverage of Dore, notwithstanding any such concerns.

Perhaps most damningly, You & Yours – nominally Radio 4’s flagship consumer programme – had positive coverage about Dore on last Monday [MP3]: immediately after Dore Australia went into administration leaving staff and clients unsure what would happen to what they were owed. You & Yours did know about the problems in Australia – I phoned them myself to tell them – but as far as I can tell they haven’t chosen to cover this (or to return my call).

More broadly – as we have noted on this blog – the mainstream media seem much happier to cover ‘miracle cure’ stories than to write about criticisms of the evidence for such ‘miracles’. Even after – to my shame – I was pedantic enough to call and e-mail a number of media outlets to let them know about a new article trashing Dore’s research base, no-one chose to cover this story. There are definitely questions to be asked about the media’s role in the rise of Dore, and Dore’s often-uncritical acceptance.

We will update this post when more news becomes available (you can e-mail us at holfordwatch at googlemail dot com if you would like to pass anything on, in confidence if necessary). We very much hope that things work out well for Dore staff and clients.

UPDATE 1: Gimpy and Podlback have now both posted on this.

UPDATE 2: Apparently, this morning Phil Hall Associates denied that Dore UK was going into administration, supplying a statement to the media that:

The business is being restructured to make it more cost efficient. We will be communicating directly with our clients. Plans are being drawn up to ensure that every patient is able to complete their programme. Wynford Dore has subsidised the programme to the tune of £15 million and is unable to sustain that level of investment any longer.

UPDATE 3: Gimpy has now blogged about a statement from Wynford Dore to UK clients. Apparently, Dore clients will be contacted next week.

UPDATE 4: Ben Goldacre’s Guardian Column this weeks looks at Dore, and the way that they were able to market their ‘miracle cure’ through the media. The announcement of Dore’s move into administration – or ‘restructuring’ – came in too late for inclusion in the column.

UPDATE 5: Brainduck blogs about the history of the Dore programme, how they have handled their financial troubles, and offers some good advice for the staff and clients caught up in this.

UPDATE 6: There are now reports of problems with Dore US. We will update this blog when we have confirmation.