Anton Emmanuel on why IgG testing for intolerances is not a useful diagnostic tool

Dr Anton Emmanuel is a Senior Lecturer in Gastroenterology at UCL. He has also studied the use of IgG testing kits – specifically, Yorktest testing kits. His research has been referred to (very likely inappropriately) by Yorktest in defence of their products. He is also one of the experts listed as backing Food Intolerance Awareness – which refers people to Yorktest for IgG tests.

When Radio 4’s Case Notes investigated food intolerance, Emmanuel was interviewed re IgG testing. We were surprised to hear him offering a rather (in our opinion, appropriately) negative assessment of the diagnostic value of such tests for identifying food intolerances.

Emmanuel is introduced by the presenter as not being very impressed with testing kits, and describes this process of testing as “not nearly as specific as one would like it to be”. For Emmanuel, the fact that wheat, yeast etc. come up often on these tests probably reflects “as much as anything else, our exposure to these things in our diet” rather than a specific intolerance/allergy.

Emmanuel is not impressed with these tests due to, among other issues:

• No external standard as to levels which show intolerance: the tests rely on internal standards which aren’t as robust as one might like.
• The effects in the patients Emmanuel has seen using these tests have largely been unimpressive, period. Even where patients did appear to benefit, results have not been great in the longer term.
• A slightly leaky gut may lead to an IgG response to various proteins. It is erroneous to tie this response to specific proteins.

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.

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 Responds to Radio 4 Programme and Misses the Point: Part 2a

Back in January we wrote to Professor Patrick Holford of Teesside University, Head of Science and Education at Biocare and CEO of Food for the Brain: we asked some questions about the survey to help us perform a robust review. We waited for three weeks but did not receive any responses and, thus hampered, continued to review the survey and uncovered about as grisly a work of ineptitude with statistics as has ever come our way.

The FFTB Child Survey literature review was irrelevant and incompetent. But the number-crunching and display of summary data were breathtakingly, unbelievably bad. Office-neighbours-should-have-been-pounding-on-the-wall-and-calling-the-statistics-authorities-and-reporting-a-hazard-to-health bad. The-guilty-parties-should-be-having-their-keyboard-privileges-revoked bad.

BBC put Holford’s science to the test. It fails.

The second part of the BBC Radio 4 show The Rise of the Lifestyle Nutritionists (listen again here, later tonight) starts by noting that “Everybody wants to be healthy, but how do you know who to trust?” Ben Goldacre then spends a considerable amount of time speaking to a number of eminent professors, in order to demonstrate that one cannot trust Holford’s science: Holford’s science fails in numerous ways.

The interviewees are extremely critical about the quality of Holford’s work, and Holford has predictably claimed that the programme was unfair. However, this programme is actually an accurate and balanced assessment of Holford’s work. If Holford finds such assessments harsh, we would argue that he should look to improve the quality of his own work and offer a meaningful response to some of the criticisms raised, along with correcting his numerous errors. His current (non)responses to the serious questions raised are woefully inadequate.

Holford tries to respond to questions raised by BBC documentary. He fails.

Having just posted about Professor Patrick Holford of Teesside University’s curious relationship with the mainstream media, we were fascinated to see Patrick Holford responding to the Radio 4 programme: The Rise of the Lifestyle Nutritionists. From what he writes, it sounds like he does feature in Part 2 of the series. I haven’t heard Part 2 yet – it’s scheduled to be broadcast on March 31 at 8pm – but it’s already clear that Holford fails to offer an adequate response to the questions raised. His responses range from dodging the questions asked, to answering while giving a clearly incorrect answer, and so gobsmackingly wrong that they even fail to qualify as wrong. Now I’m really looking forward to the radio programme: Holford digs himself in deep enough without having heard the programme, but I’m sure that the BBC’s research skills will allow them to provide a JCB or two to join Holford in his hole.