July 13, 2009

A Tale of Two WorkForces in the Same Workplace: Different Rules for Dietitians and Nutritionists in the NHS?

Last week the newspapers covered the story of Katie Peck who is both a degree-credentialled nutritionist and a Registered Dietitian. What is particularly interesting about this story is not the nature of some of her advice but that had she been recruited to work as a nutritionist, rather than RD, in her role at an NHS Diabetes Clinic, then there would not have been a hearing involving the Health Professions Council (HPC) and it is plausible that there would be no mechanism to allow scrutiny of the evidence-base for her advice to patients (the hearing has been adjourned until December, Mrs Peck denies any wrong-doing).

So, if you were to dispense some advice that your colleagues claim to lack an appropriate evidence base as an RD, then you might be asked to account for your actions before the HPC. However, if you dispense the same advice as a nutritionist (and, let’s imagine a scenario where this is a BANT rather than Nutrition Therapy Council nutritionist), then the route for challenging the advice is unclear at best. Keep reading →

July 7, 2009

Jerome Burne and Bio-Identical Hormone Replacement Therapy: Part 3

Jerome Burne and Bio-Identical Hormone Replacement Therapy: Parts 1 and 2 covered some difficulties with Kent Holtorf’s review article, Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy?, relating to a potential conflict of interest (despite a statement to the contrary) and the completeness and quality of the review. For this final examination of Jerome Burne’s Should middle-aged women be taking natural HRT?, we focus on a paper for which we had to guess the identity: Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. (Again, This Really Is Not Good Enough or TRINGE.) Keep reading →

July 7, 2009

Jerome Burne and Bio-Identical Hormone Replacement Therapy: Part 2

Jerome Burne is co-author of Food Is Better Medicine Than Drugs (FIBMTD) with Former Visiting Professor Patrick Holford. FIBMTD has a chapter on Balancing Hormones in the Menopause -The HRT scandal vs natural control: there is a brief discussion of “Natural progesterone – a safer way with hormones”.

Progesterone is given in amounts equivalent to that normally produced by a woman who is ovulating (between 20 and 40 mg a day) and, unlike oestrogen or synthetic progestins, it has no known cancer risk – in fact…quite the opposite. [pg. 167, the reference for this bold assertion is a self-help book, not a journal paper or similar, if you were curious. And, no, no specific page reference or indication that this is a study/trial, in vitro, in vivo or animal.]

Mid-May we noticed that Burne had left a long comment, recommending his own research, on a post about The Alternative that Isn’t: Bioidentical Hormones at Science-Based Pharmacy. Gazing into our crystal ball, we anticipated that a Burne special on the topic must be in progress and so were not surprised to read today’s Should middle-aged women be taking natural HRT? in the Daily Mail. The shorthand version of the remainder of this post is:

No. Not if you are relying upon the Holftorf review to provide a comprehensive overview of the relevant evidence on efficacy and safety.

Keep reading →

July 7, 2009

Science: So What Is Recruiting a Dialogue Manager

From the Science: So What Campaign. Initially part-time (with hours to be agreed), this is a job opportunity for someone with experience of science writing and a strong interest in social media and science communication. Keep reading →

July 7, 2009

Jerome Burne and Bio-Identical Hormone Replacement Therapy: Part 1

After L’Affaire Economist, (parts 1, 2, 3) HolfordWatch really wanted to be able to commend Jerome Burne for something. We have noticed that although his last few articles in the Daily Mail haven’t actually carried links to the research upon which he relies, he has provided enough detail to allow the careful reader to identify the papers. It would, of course, be good if we did not have to resort to a treasure hunt to identify the primary sources but that is probably a confluence of out-moded thinking by both journalists and newspaper.

Today, Burne gave generous amounts of detail as to one of the major sources for his claims in his article: Should middle-aged women be taking natural HRT?. HolfordWatch was poised to congratulate Burne for semi-identifying this work up until we actually read the paper that he describes as a “major review”: Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy?. Leaving aside the lack of appropriate rigour in the paper, we noticed that, despite his usual exquisite sensitivity in such matters, Burne seems to be overlooking the “review” author’s failure to declare what might appear, to others, as a substantial conflict of interest. Keep reading →

July 6, 2009

GCC ‘What Can I Expect’ leaflet

Correction: as Lothian has helpfully pointed out, the leaflet is still readily available on the GCC site [PDF]. I did spend some time looking for it previously – but clearly not effectively enough. The scratched post is towards the bottom, with the text struck through; sorry about the error. Now the leaflet is online, I can post about what I was planning to originally.

In late June, Edzard Ernst published an open letter to UK chiropractors. He asked that chiropractors should

let the British public know, through your professional organisations, which of these three possible explanations is correct: you no longer hold that chiropractic is an effective treatment for non-spinal conditions like asthma, you admit that the inclusion of treatment of non-spinal conditions in chiropractic means that it can no longer be considered an evidence-based profession, or you can provide good evidence that chiropractic can treat non-spinal conditions.

A GCC leaflet (PDF, p. 2) argues that, with chiropractic treatment

You may also see an improvement in some types of
● asthma
● headaches, including migraine; and
● infant colic

Keep reading →

July 5, 2009

Milking bees, Nelson and the BBC: arthritis, bee venom and an unfortunate BBC article

I was disappointed to see the BBC News website giving lots of space to a health product from Nelson Honey and Marketing, despite a lack of evidence of efficacy. It appears – strangely – that the BBC views the fact that Nelson has asked the Food Standards Agency (FSA) for permission to make certain claims for their product as newsworthy in itself.

The BBC reports that Nelson is

seeking EU approval to market honeybee venom to help people with arthritis ease their pain. Nelson Honey & Marketing says two teaspoons a day of its honey with added venom milked from honeybees has anti-inflammatory power to soothe joints. Keep reading →

July 3, 2009

Patrick Holford, Shark Liver Oil and Walnuts

Patrick Holford on ITV Lunchtime 16 April 2008
Former Visiting Professor Patrick Holford is Head of Science and Education at Biocare. From time to time Holford has nothing but harsh words for randomised controlled trials and the perceived iniquity of systematic reviews or meta-analyses. Unless they confirm a point of view that he already holds, of course, or that he can adapt to the self-aggrandisement of his opinions. And so it is with some delight and no obvious trace of irony that Holford welcomes the release of a systematic review and meta-analysis that evaluates the impact of incorporating walnuts into the diet and outcomes for blood lipids as a proxy for a risk factor for cardiovascular disease. Or, as Holford so pithily phrases it, Go (wal) nuts this summer – walnuts lower your cholesterol (as ever, you need to go to the home page to read the first paragraph but Holford is handily re-cycling his blog posts as email newsletters which must be value for money). Keep reading →

June 25, 2009

FSA’s Low Income Diet and Nutrition Survey: Some Snippets

The Eating within recommended dietary guidelines and on a budget project is having some difficulties. Not, oddly, on the actual shopping, cooking or budgeting fronts but the dietary analysis that I want to perform. On the upside, I have located some useful figures relating to low income diet, nutrient intake and food spend budgets. Keep reading →

June 23, 2009

Patrick Holford Claims More People Die, Prematurely, From Cardiovascular Disease Than Actually Die, Prematurely, From All Causes

Patrick Holford on ITV Lunchtime 16 April 2008
Former Visiting Professor Patrick Holford is Head of Science and Education at Biocare. Despite the imprimatur of respectability about these confidence-inspiring titles, from time to time, there are disappointing errors in the content of Holford’s health advice and sales pitches for home tests and the evidence base for supplements. These errors are all the more dispiriting when one recalls that he was corrected about some of them more than two years ago. We don’t mean differences of opinion, we mean verifiable, checkable facts. When Holford persuades people to rely upon his opinion and lend credence to it because he undertakes to do the scientific research and interpret it for them then it seems inappropriate to claim that more people died, prematurely, from a specific cause than actually died, prematurely, from all causes. Keep reading →