More on this book
Community
Kindle Notes & Highlights
‘AZT, the first prescribable anti-HIV drug, is potentially harmful, and proving less effective than vitamin C.’
I am only interested in Professor Holford because he teaches the nutritionists who treat the nation, and because he has been given a professorship at Teesside University, with plans for him to teach students and supervise research. If Professor Patrick Holford is a man of science, and an academic, then we should treat him as one, with a scrupulously straight bat.
But there is a gold-standard systematic review from Cochrane which brings together the evidence from all twenty-nine different trials on this subject, covering 11,000 participants in total, and concluded that there is no evidence that vitamin C prevents colds.
There is an entire website—Holfordwatch—devoted to examining his claims in eye-watering detail, with breathtaking clarity and obsessive referencing. There you will find many more errors repeated in Holford’s other documents, and carefully dissected with wit and slightly frightening pedantry. It is a genuine joy to behold.
Last summer I bought one and took it to Camp Dorkbot, an annual festival for dorks held—in a joke taken too far—at a scout camp outside Dorking.
If, in casual conversation with nutritionists, I question the standards of the ION, this accreditation is frequently raised, so we might look at it very briefly. Luton, previously the Luton College of Higher Education, now the University of Bedfordshire, was the subject of a special inspection by the Quality Assurance Agency for Higher Education in 2005. The QAA is there to ‘safeguard the academic standards and quality of higher education in the UK’.
Interestingly, Matthias Rath’s colleague and employee, a South African barrister named Anthony Brink, takes the credit for introducing Thabo Mbeki to many of these ideas. Brink stumbled on the ‘AIDS dissident’ material in the mid-1990s, and after much surfing and reading, became convinced that it must be right.
This is a continent that has been brutally exploited by the developed world, first by empire, and then by globalised capital. Conspiracy theories about AIDS and Western medicine are not entirely absurd in this context.
In 2005, exasperated by government inaction, a group of 199 leading medical practitioners in South Africa signed an open letter to the health authorities of the Western Cape, pleading for action on the Rath Foundation.
out of its $550 billion global annual revenue, the pharmaceutical industry spends twice as much on promotion and admin as it does on research and development.
The founder of TAC is a man called Zackie Achmat, and he is the closest thing I have to a hero.
even when he was personally implored to save himself by Nelson Mandela, a public supporter of anti-retroviral medication and Achmat’s work.
Rath’s former employee Anthony Brink filed a formal complaint against Zackie Achmat, the head of the TAC. Bizarrely, he filed this complaint with the International Criminal Court at The Hague, accusing Achmat of genocide for successfully campaigning to get access to HIV drugs for the people of South Africa.
From the state of current knowledge, around 13 per cent of all treatments have good evidence, and a further 21 per cent are likely to be beneficial. This sounds low, but it seems the more common treatments tend to have a better evidence base. 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.
depending on speciality, that between 50 and 80 per cent of all medical activity is ‘evidence-based’.
Drug companies thankfully don’t advertise direct to the public in the UK—in America you can find them advertising anxiety pills for your dog—so we are pulling apart the tricks they play on doctors, an audience which is in a slightly better position to call their bluff.
In the UK, the pharmaceutical industry has become the third most profitable activity after finance and—a surprise if you live here—tourism.
And yet, of the biggest US companies’ $200 billion sales, they spend only 14 per cent on R&D, compared to 31 per cent on marketing and administration.
unnoticed side-effects, ideally reporting them using the Yellow Card system (patients can use this too; in fact, please do. It’s at http://yellowcard.mhra.gov.uk).
There are conditions which affect a small number of people, like Creutzfeldt-Jakob disease and Wilson disease, but more chilling are the diseases which are neglected because they are only found in the developing world, like Chagas disease (which threatens a quarter of Latin America) and trypanosomiasis (300,000 cases a year, but in Africa). The Global Forum for Health Research estimates that only 10 per cent of the world’s health burden receives 90 per cent of total biomedical research funding.
You might think no such thing could ever happen. If you follow the references in the back, you will find studies where patients were given really rather high doses of old-fashioned antipsychotic medication (which made the new-generation drugs look as if they were better in terms of side-effects), and studies with doses of SSRI antidepressants which some might consider unusual, to name just a couple of examples.
Of course, another trick you could pull with side-effects is simply not to ask about them; or rather—since you have to be sneaky in this field—you could be careful about how you ask.
And here is a good trick: instead of a real-world outcome, like death or pain, you could always use a ‘surrogate outcome’, which is easier to attain. If your drug is supposed to reduce cholesterol and so prevent cardiac deaths, for example, don’t measure cardiac deaths, measure reduced cholesterol instead. That’s much easier to achieve than a reduction in cardiac deaths, and the trial will be cheaper and quicker to do, so your result will be cheaper and more positive. Result!
This is exactly what the drug companies did with the data on SSRI antidepressants: they hid the data suggesting they might be dangerous, and they buried the data showing them to perform no better than placebo.
When I explain this abuse of research to friends from outside medicine and academia, they are rightly amazed. ‘How can this be possible?’ they say. Well, firstly, much bad research comes down to incompetence. Many of the methodological errors described above can come about by wishful thinking, as much as mendacity. But is it possible to prove foul play?
Overall, studies funded by a pharmaceutical company were found to be four times more likely to give results that were favourable to the company than independent studies.
‘Publication bias’ is a very interesting and very human phenomenon. For a number of reasons, positive trials are more likely to get published than negative ones. It’s easy enough to understand, if you put yourself in the shoes of the researcher. Firstly, when you get a negative result, it feels as if it’s all been a bit of a waste of time. It’s easy to convince yourself that you found nothing, when in fact you discovered a very useful piece of information: that the thing you were testing doesn’t work
Publication bias is common, and in some fields it is more rife than in others. In 1995, only 1 per cent of all articles published in alternative medicine journals gave a negative result. The most recent figure is 5 per cent negative.
A group of academics published a paper in the New England Journal of Medicine at the beginning of 2008 which listed all the trials on SSRIs which had ever been formally registered with the FDA, and examined the same trials in the academic literature.
In 2000, a US company filed a claim against both the lead investigators and their universities in an attempt to block publication of a study on an HIV vaccine that found the product was no better than placebo. The investigators felt they had to put patients before the product. The company felt otherwise. The results were published in JAMA that year.
Patients are so much more easily led than doctors by drug company advertising that the budget for direct-to-consumer advertising in America has risen twice as fast as the budget for addressing doctors directly.
This is why drug companies are keen to sponsor patient groups, or to exploit the media for their campaigns, as has been seen recently in the news stories singing the praises of the breast cancer drug Herceptin, or Alzheimer’s drugs of borderline efficacy. These advocacy groups demand vociferously in the media that the companies’ drugs be funded by the NHS. I know people associated with these patient advocacy groups—academics—who have spoken out and tried to change their stance, without success: because in the case of the British Alzheimer’s campaign in particular, it struck many people that
...more
awful?
We need to make some sense of all this, and appreciate just how deep into our culture the misunderstandings and misrepresentations of science go.
My basic hypothesis is this: the people who run the media are humanities graduates with little understanding of science, who wear their ignorance as a badge of honour.
On this template, science is portrayed as groundless, incomprehensible, didactic truth statements from scientists, who themselves are socially powerful, arbitrary, unelected authority figures.
Science stories generally fall into one of three categories: the wacky stories, the ‘breakthrough’ stories, and the ‘scare’ stories. Each undermines and distorts science in its own idiosyncratic way. We’ll do them in order.
These stories are invariably written up by science correspondents, and hotly followed—to universal approbation—by comment pieces from humanities graduates on how bonkers and irrelevant scientists are, because from the bunker-like mentality of my ‘parody’ hypothesis, that is the appeal of these stories: they play on the public’s view of science as irrelevant, peripheral boffinry.
‘Dr Cliff Arnall of Cardiff University’. In reality he’s a private entrepreneur running confidence-building and stress-management courses, who has done a bit of part-time instructing at Cardiff University. The university’s press office, however, are keen to put him in their monthly media-monitoring success reports. This is how low we have sunk.
They are promotional activity masquerading as news. They play—rather cynically—on the fact that most news editors wouldn’t know a science story if it danced naked in front of them.
Research conducted at Cardiff University in 2007 showed that 80 per cent of all broadsheet news stories were ‘wholly, mainly or partially constructed from second-hand material, provided by news agencies and by the public relations industry’. It strikes me that you can read press releases on the internet, without paying for them in newsagents.
would—you will often find that the worst science stories are written by consumer correspondents, or news generalists—and if I can borrow a concept from evolutionary theory myself, the selection pressure on employees in national newspapers is for journalists who compliantly and swiftly write up commercial puff nonsense as ‘science news’.
Before 1935 doctors were basically useless. We had morphine for pain relief—a drug with superficial charm, at least—and we could do operations fairly cleanly, although with huge doses of anaesthetics, because we hadn’t yet sorted out well-targeted muscle-relaxant drugs. Then suddenly, between about 1935 and 1975, science poured out an almost constant stream of miracle cures.
I would go further, and argue that science itself works very badly as a news story: it is by its very nature a subject for the ‘features’ section, because it does not generally move ahead by sudden, epoch-making breakthroughs. It moves ahead by gradually emergent themes and theories, supported by a raft of evidence from a number of different disciplines on a number of different explanatory levels. Yet the media remain obsessed with ‘new breakthroughs’.
Compare the two sentences ‘Research has shown that black children in America tend to perform less well in IQ tests than white children’ and ‘Research has shown that black people are less intelligent than white people.’ The first tells you about what the research found: it is the evidence. The second tells you the hypothesis, somebody’s interpretation of the evidence: somebody who, you will agree, doesn’t know much about the relationship between IQ tests and intelligence.
It also reinforces the humanities graduate journalists’ parody of science, for which we now have all the ingredients: science is about groundless, changeable, didactic truth statements from arbitrary unelected authority figures.
diversion.
We have already looked at regression to the mean in our section on homeopathy: it is the phenomenon whereby, when things are at their extremes, they are likely to settle back down to the middle, or ‘regress to the mean’.
Simple regression is confused with causation, and this is perhaps quite natural for animals like humans, whose success in the world depends on our being able to spot causal relationships rapidly and intuitively: we are inherently oversensitive to them.
1. We see patterns where there is only random noise. 2. We see causal relationships where there are none.
