A correspondent has been nice enough to send me a copy of Holford’s latest 100% Health newsletter. There are some moving words about off-label prescribing: Holford writes that “In the US, one in every five prescriptions is ‘off label’, meaning a drug is given to treat a condition other than the one it was originally licensed for. Of these, 75% lack any scientific basis for their prescription.”
Clearly, this is a concern: medicine is not evidence-based enough. While some off-label prescribing may be necessary (for example, because drugs are very rarely tested on children and therefore are generally not licensed for use on children, this practice would be hard to avoid in paediatrics), I would absolutely agree that doctors should draw on the best available evidence when determining how to treat their patients.
What’s odd, though, is that Holford himself argues that off-label use of secretin as an autism treatment is “Worth considering”. It is almost certain that secretin will never be licensed for this use. This is for a very good reason: as I’ve shown, the evidence shows that secretin is either useless for treating autism, or even performs worse than placebo. It may also be associated with adverse effects. Drugs should not be licensed for purposes for which they are either useless or worse than useless; generally, aside from the occasional disaster, they aren’t.
In the same newsletter, Holford argues that “true medicine must be people-centred not drug-centred”. I’d be quite happy to agree with that (as would, I imagine, my GP). With this in mind, though, it’s worth looking at Holford’s ‘reference’ for the efficacy of selenium: the controversial Autism Research Institute, which has also been a key force behind Defeat Autism Now! When trying to defend the safety of secretin, an article on the Institute’s website argues that “It is possible that the problems described above [when secretin was administered] may not be caused by secretin but instead by the panic and stress experienced by a child who is held down by adults while an IV needle is inserted.” So, the off-label use of secretin for autism which Holford thinks is ‘worth considering’ can cause real distress to autistic children, while being – at best – a placebo.
Adults holding down a panicking child, while forcibly inserting an IV needle – and all so that they can administer a drug that is useless or harmful. That doesn’t sound very person-centred to me.
4 Comments
June 26, 2007 at 5:42 pm
I think that what we have here is the irregular verb theory, Jon.
In line with this theory, Patrick Holford may believe that he has impeccable moral and scientific compass that would alert him to inappropriate off-label uses. He may also believe that when others recommend off-label uses then they may have a conflict of interest or even be a pharma/industrial/medico complex shill.
It is distressing to note that there are people (signatory 5764 of the Nigel Thomas petition) who consider Holford’s writings on this or related topics to be reliable. “The evidence as explained in Mr Holford’s email is very compelling.” As you know, there are even people (signatory 4805) who claim that family decisions on whether or not to vaccinate were based on Holford’s work. One has to assume that there are people who may be influenced by Holford’s recommendations for diet, secretin treatment etc.
July 27, 2007 at 12:42 am
[...] critiqued on Holford Watch and elsewhere). For example, both believe – contrary to the evidence – that secretin is an autism treatment worth considering (p. 5), that hair mineral analysis is worthwhile (p. 2), and that IgG blood tests are valuable (p. [...]
February 16, 2009 at 2:15 pm
[...] research literature, and so forth. He recommends, ironically, considering a number of drugs – from secretin to kava kava – although we are not convinced that Holford has adequately assessed the evidence of [...]
May 25, 2010 at 3:08 pm
is there anything i can use as a natural medicine to calm my daughters tantrums that can last up to 2 hours. She is diagnosed autistic, she is high functioning.