A new Cochrane review of the evidence on antioxidant supplements and mortality [PDF] has found that taking anti-oxidant supplements caused
significantly increased mortality by vitamin A…beta-carotene…and vitamin E…but no significant detrimental effect of vitamin C…Low-bias risk trials on selenium found no significant effect on mortality…The current evidence does not support the use of antioxidant supplements in the general population or in patients with certain diseases.
Holford was speaking about the review on Radio 4 and 5 Live this morning - the Head of Science and Education and the supplement company Biocare was defending the role of antioxidant supplements. Did we mention that Biocare sells a range of supplement pills with a charming picture of Holford’s face on them.
We have already looked in more detail at Holford’s specific claims, and you’ll also find a nice discussion of this review and some responses to it on the Quackometer. We’ll post more on this at a later date. First, though, there was a lot of good discussion on these radio shows that it’s worth looking at here.
On Radio 4’s Today programme (listen again here - about 2hr35min in) the dietitian Catherine Collins makes clear that - regarding these antioxidant supplements - the evidence that they are ineffective and/or harmful as been “added to over the years”. The Cochrane review is definitive: “at best they do you no good, at worst they may actually increase your risk of death”.
On the programme alongside Collins, Holford is left to scrabble around complaining about the studies which have been excluded (more on that later in this post, and in our previous post) and complain about “political bias”. Collins provides a neat summary of Holford’s quibbling, though:
I think Patrick has [given] an absolutely perfect example of why one should be wary of nutritional therapists. He’s playing about with numbers, dropping in names…
Even better was the discussion on Victoria Derbyshire’s Radio 5 show (download the podcast here). Firstly, Professor Holford of Teesside University discussed the Cochrane review with Prof Gluud (one of the paper’s authors). Holford complained bitterly that the review excluded poor quality trials with a high risk of bias; Gluud quickly and concisely explained that - in good quality research - it is important to focus on trials with “proper methodology”.
When Holford complained - again - about “political bias”, the issue of who pays him came up. Holford claims that his wages are mainly paid by publishers, although he’s “a consultant for a supplement company [and Biocare] pay me a small amount”. Holford characterised this payment from Biocare in the accepted SI unit for industry interests: “less than about a fifth of a drug rep’s salary”.
Holford acknowledges that he’s not as independent as the Prof Gluud, but we do feel that he has rather underplayed the amount he gets from the supplement industry. Somehow, Holford neglected to mention that he has been paid over £200,000 by Biocare (for his supplement selling Health Products for Life company) and has another £200,00 coming in July. Drug reps may be relatively well paid, but 6 figure plus salaries are - I would imagine - really rather rare.
Holford then got the opportunity to discuss nutrition with Catherine Collins again. Collins argued that consumers should avoid high dose supplements - and view them as something to avoid taking to excess, instead of like “nutritional smarties”.
Most worryingly, Collins discusses a case with a patient at the Brain Bio Centre (which was founded by Holford, and had him as director until 2007). This patient was prescribed a toxic level of vitamins and herbs for her condition. As Collins highlighted, although the Brain Bio Centre quickly retracted that advice once this was highlighted by medical professionals, there was no effective regulator with which she could raise her concerns.
It seems, then, that Teesside have conferred a visiting professorship onto a consultant for the supplement industry - who is, by his own admission, less independent than Professors such as Gluud. Despite his own research being exceptionally flawed, Prof Holford also feels able to complain about political bias and flawed methodology in research done by qualified, skilled and experienced scientists such as Gluud. Unfortunately, Prof Holford lacks the ability to do so particularly well - betraying, for example, difficulties in understanding what constitutes proper methodology in his criticisms of Gluud et al.
This does make one wonder - yet again - whether Teesside believes that Holford’s work has achieved a professorial standard. And, if they do hold this belief - why?
23 responses so far ↓
selective7 // April 16, 2008 at 4:27 pm
Victoria Darbyshire did a pretty good job I thought - picked up relevant points and gave enough time to the debate. However it seems like a shame that a conversation between Patrick Holford and Prof. Gluud would probably characterised as ‘balanced’.
Prof. Gluud did a decent job of speaking in plain language, despite dropping in a few terms / concepts like ‘post hoc’. However Holford seemed extremely successful at muddying the water.
Although the contribution by the dietician served both to balance the debate (i.e. 2 real scientists to 1 pretend one) and to reinforce the point that Holford was causing confusion, it may have been rather too late for many listeners.
I had previously had the impression that Holford may be ignorant. This interview served to show that he is calculating and deliberate in his attempts to confuse the public.
dvnutrix // April 16, 2008 at 4:44 pm
Yes - for people who heard only part of the discussion or tuned out because Holford made it inappropriately technical, it may well have seemed like a “One says, the other says”.
If you can’t make an informed comment - carp, but make it seem like there is something amiss and that you have the inside scoop. It wouldn’t be such a common tactic if it weren’t so effective.
Anthony // April 16, 2008 at 4:59 pm
Why was the man given airtime? In the case of Radio 4 it seemed to be the old formula. Put two people with opposing”scientific” views, no matter how wacky, in the same room to create news. Obviously nothing has been learned from the MMR vaccine debacle.
Surely not being able to interpret a Forest plot should be a bar from appearing on national radio to discuss a Cochrane review?
dvnutrix // April 16, 2008 at 5:37 pm
And failing to understand that there is more to assessing the risk bias of a study’s outcome than deciding just that you like or dislike something…And that this is a well-specified, publicly-available protocol that you can follow for yourself.
Sadly - there seem to be few criteria that would ever diminish Holford’s pundit brand equity.
Andy Lewis // April 16, 2008 at 6:51 pm
My opinion of PH changed too on this interview. It was a skillfully crafted obfuscation. His criticisms were so shallow that they stood in contrast with the intelligence he was showing when trying to interpret the results that people ought to be taking even more supplements to counter the ‘bad’ ones.
Claire // April 16, 2008 at 7:59 pm
OT really but reportedly the Southampton study is having repercussions for the supplements industry:
http://www.foodnavigator.com/news/ng.asp?n=84699&c=PiqxtCzIYGPlW%2BwZkGYEYw%3D%3D
Martin // April 16, 2008 at 8:09 pm
Go Victoria! I was most impressed with the part that went:
VD - “So you’re less independent than Professor Gluud”.
PH - “Yes, in this case I am.”
VD - “Right. Let’s go to the travel.”
Claire // April 16, 2008 at 9:21 pm
“Holford complained bitterly that the review excluded poor quality trials with a high risk of bias; Gluud quickly and concisely explained that - in good quality research - it is important to focus on trials with “proper methodology”…”
Some more supplement industry types in need of enlightenment about meta-analysis methodology here:
“John Hathcock, Ph.D., senior vice president, scientific and international affairs, CRN, was quick to draw attention to the exclusion criteria employed by the researchers.
“With nearly 750 studies to choose from, it’s interesting that they chose to include only 67 studies - less than nine percent of the total clinical trials on antioxidants that are available,” said Dr. Hancock. “Moreover, the possible 750 clinical trials do not even account for other sources of evidence, such as observational studies, which were not considered by the authors at all. It is their exclusions, not the inclusions, where the fault lies.”
http://www.foodnavigator.com/news/ng.asp?n=84681&c=PiqxtCzIYGN2FgUXO7jpsw%3D%3D
draust // April 16, 2008 at 11:10 pm
Yep. Plausible (unless you can tell he’s talking bollocks). Handsome in a kind of ageing-Richard Gere way. Glowing with sun-bed tan health and star-quality (obviously a testament to his own products). Caring (or at least giving a good impersonation of it)…
…Patrick is the Andrew Wakefield of supplement peddlers.
No wonder he has been supporting Dr W.
Do you think there is any chance we could send Patrick to Texas too?
Dietitian in the North // April 16, 2008 at 11:57 pm
I loved the bit where mr Holford produced his newspaper trial evidence of 2 readers (somewhere in the five live programme) each on different things and the one taking his preferred regimen felt better -I think it was in a national newspaper so thats OK then-who needs statistical significance and Cochrane reviews with quality trials like this …?!?
Also PH allowed himself to be called Professor whilst speaking about nutrition -which implies that his professorship is in the field of nutrition - no law against it but surprised that Teeside allow it given that they do have a real one …
Wulfstan // April 17, 2008 at 1:06 am
Dietitian in the North, a while back a teacher designed his own version of Brain Gym exercises.
With Holford displaying a desire to discount the Cochrane researchers’ decisions about methodological quality while pushing his own anecdote with n=2, is it possible he is manifesting a deficiency that might be fixed with rigorous practice of this exercise?
superburger // April 17, 2008 at 8:29 am
ha ha, PH just looked foolish.
think victoria derbeyshire saw right through his bizarre ramblings.
can’t believe PH would try and give a dull anecdote about 2 women in a newspaper lifestyle supplement as counter evidence to a massive review paper. Jesus.
s
selective7 // April 17, 2008 at 11:52 am
In case any one is interested…
At around 9:57 he says that “we spoke to the former director of the National Institutes of Health in America [who said] ‘Blenderizing these diverse trials…to come up with a seductively simple proclamation is just silly’”
This person is apparently Bernadine Healy. She was appointed as Director by the President. The NIH is a real institution “the Nation’s Medical Research Agency” and is part of the US government. She has been involved in a bit of controversy but that doesn’t seem to be relevant.
She didn’t just say this to Patrick Holford; she said it in her column here: http://health.usnews.com/usnews/health/articles/070304/12healy_2.htm
Which seems to be reported in a longer version here: http://www.gordonresearch.com/Presentations/GRI_mar07/articles/vitamins_and_good_sense.html
*sigh* more confusion… I know this site is about PH but if he keeps sending people off to find other sources, perhaps it’s worth pulling those apart as well?
The only thing I could find was this old article which suggests that she perhaps has a faulty understanding of (and a strong political perspective on)* evidence-based medicine: http://hcrenewal.blogspot.com/2006/09/bernadine-healy-takes-some-cheap-shots.html
*and possibly some relevant undeclared financial interests.
ross // April 17, 2008 at 2:06 pm
I think I am slightly in love with Catherine Collins.
Did I say that out loud?
troldman // April 17, 2008 at 2:06 pm
The reason that Holford is such a worry is that he does have a good telly/radio manner. Compare him to the clown discussing brain gym with Paxo last week….nobody would surely be taking him seriously.
Anyway, he cleary is intelligent and scheming. But what I don’t get is if he’s so clever why does he set himself up to go head to head with people who are clearly going to destroy him on air.
As an aside, I’m getting more and more in to Radio 5 and am moving away from Radio 4. I got in to it mainly through the film show with Mark Kermode on Fridays, but the same principals apply. Kermode treats the audience with respect and isn’t afraid to delve in to complex details with the listener. The same was true with Holford on Radio 5 and the details discussed exposed him as a quack.
Woobegone // April 17, 2008 at 4:35 pm
To be fair… lumping the different antioxidants together (”blenderizing” the studies) is a bit questionable. In this case it looks like it’s ok, but we shouldn’t be assuming that all antioxidants are equal, when it’s known that Vitamin C is basically non-toxic whereas selenium can be horrible (”Symptoms of selenosis include a garlic odour on the breath, gastrointestinal disorders, hair loss, sloughing of nails, fatigue, irritability and neurological damage.” - Wikipedia). Although ironically it was selenium that seemed to be most beneficial…
The reason I’m saying this is that it’s exactly the same thing that Kirsch et al. did when they lumped together venlafaxine (according to head-to-head trials, the most powerful new generation antidepressant) with nefazadone (a crap drug that no-one uses). “Evidence based blogs” were critical of Kirsch, partly for that reason, so I think it would be fair to apply the same standards in this case.
End of the day, though, it’s nit-picking because the evidence clearly shows that with the possible exception of selenium, these vitamins are either hazardous or a waste of money (if you like staying alive).
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dvnutrix // April 18, 2008 at 3:17 pm
selective7 - thanks for the link to the HCRenewal item, I didn’t know that Healy had decided to attack EBM as well.
Woobegone - the review authors did plenty of separate analyses, they didn’t just ‘blenderize’ all of the antioxidants together so to speak. However, I take your point that it is mostly not relevant.
Of course, now the celebrities are dispensing words of wisdom, we should all hush our mouths and cleanse our ears.
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