Occasionally, we are accused of mocking industry claims for their supplement pills. However, we could never do that: the supplement pill industry has moved far beyond any kind of satire. Today, the Health Food Manufacturers Association (HFMA) proudly responded to a Cochrane review on antioxidants and mortality [PDF] by announcing that
Sir Cliff Richard, Gloria Hunniford…and Carole Caplin have joined health industry experts in rejecting the widely publicised antioxidant review and reassuring consumers that concerns over these supplements are unfounded…
Sir Cliff Richard said: “I’ve always freely admitted to taking food supplements. I’ve done so for years and believe that they’ve been beneficial to me personally. For those of us prone to put on weight at the drop of a chocolate digestive, it’s only logical to compensate for some of the vitamins and nutrients that we deny ourselves at mealtimes. Certainly if a time came when we were denied the freedom of choice to take our daily pills and potions, I would be seriously concerned.”
Gloria Hunniford said: “Doctors and ‘experts’ are always saying that to get the nutrients we need, all we have to do is eat a proper diet. But show me the people who do on a regular basis. Most of us eat on the run, myself included, and sometimes we have no choice but to snack on whatever food is available at the time. Under professional guidance, I have used vitamin supplements for many years to augment what I eat - and will certainly continue to do so.”
Carole Caplin added: “It must be obvious to everyone who hasn’t got a vested interest in supplements that this review is absolute rubbish, it contains fundamental flaws.
I’m not sure what I can add to that. It seems that HFMA live in a world where one can refute a detailed, careful, and rather definitive meta-analysis by wheeling out a few celebrities to share some anecdotes with us. Of course, the likes of Sir Cliff are very special people - but why would their anecdotes about these pills be more significant than the records of mortality rates among the hundreds of thousands of patients in the research analysed in the Cochrane review?
I would leave things there - but Caplin’s comment that “It must be obvious to everyone who hasn’t got a vested interest in supplements that this review is absolute rubbish, it contains fundamental flaws” is so strange that it deserves special note. The Cochrane Collaboration has a commendably strong policy on sponsorship and “sponsorship of a Cochrane review by any commercial source or sources (as defined above) is prohibited”. On the other hand, Caplin was speaking for a HFMA press release and one of HFMA’s stated goals is to “effectively to represent the interests of the specialist health product sector”: it is a body to represent industry interests.
Anthony - from the excellent blacktriangle blog - suggests that “not being able to interpret a Forest plot should be a bar from appearing on national radio to discuss a Cochrane review”. However, it seems that the supplement pill industry lives in a world where a few celebrity anecdotes can trump a gold standard meta-analysis and a press release from an industry body is quite able to complain about how one would only believe the conclusions of a Cochrane review if one had vested interests.
I seem to have developed a desk-shaped dent on my head. Can anyone suggest a suitable pill.
Update 21 April: Joanna Blythman offers us Doctors’ allergy to vitamins. Does any of the following look familiar to you?
Faced with a substantial number of studies reporting positive results for antioxidant vitamins, they first excluded more than 400 trials that had no deaths, then decided which trials they liked (those with a low risk bias) and did not like (those with a high risk bias).
According to one leading expert in this field, Dr Balz Frei, it is “a flawed analysis of flawed data, and it does little to help us understand the real health effects of antioxidants, whether beneficial or otherwise”. (For a detailed critique of the methodology of this study see www.patrickholford.com, “How antioxidant researchers cooked the books”.)
Why does Blythman find him plausible?
Peta Bee offers Vitamin pills: friends or foes? There are sensible comments both from Bridget Aisbitt and Catherine Collins. However, somewhat surprisingly, Dr Michele Sadler of the Health Food Manufacturers’ Association says:
While the authors claim to be assessing antioxidants for the prevention of mortality, she says, “they used two statistical methods that produced different results, so the evidence is far from clear-cut”.
Eh?
We have to assume that Sadler is referring to the use of both the fixed-effects and random-effects meta-analyses; something that the reviewers discuss in some detail. The reviewers provide an explanation as to why their previous JAMA paper was restricted to a random-effects model and what they felt was lost by that.
We should also send a h/t to Skeptical Chemist for the link to a good discussion of the difference between the models.
We have dealt with some of the content of the more puzzling ‘criticisms’ in these posts:
Patrick Holford and His Own Reality: Part 2, estimating risk bias in Cochrane reviews
Catherine Collins: “Patrick has [given] an absolutely perfect example of why one should be wary of nutritional therapists.”
Patrick Holford and Contriving a Controversy: the Cochrane review of antioxidant supplements
25 responses so far ↓
Woobegone // April 18, 2008 at 6:58 pm
You cut Caplin off just before she really got into her stride. Ok, so her next sentence is nothing new:
“With nearly 750 studies to choose from, why did the researchers manage to focus on just 67? That’s less than nine per cent of the total number of clinical trials on antioxidants available.”
Yawn, but then we come to a new argument!
“The research makes clear the team failed to determine the actual cause of death, so there is no proven link whatsoever between the antioxidants assessed and mortality.”
With a single sentence, Caplin explodes the myth that all-cause mortality is a meaningful outcome measure. Thousands of papers stand to be retracted - hundreds of epidemiologists slap their foreheads and wonder why they didn’t see that all along.
But this is the most interesting sentence of all:
“It is only common sense that our bodies need regular supplies of essential nutrients for growth and maintenance.”
For Caplin, as for others, the details of this review are not the issue. No matter how robust the evidence it just cannot be true because vitamins are good for you. It’s just common sense. If scientists say otherwise, so bad for them.
The best line wasn’t from Caplin though:
“Twenty-one million people in the UK use dietary supplements every day. They can’t all be wrong!” - Sue Croft, Director of Consumers for Health Choice
jonhw // April 18, 2008 at 7:06 pm
Thanks Woobegone. Yes, in terms of daft claims, our cup really does runneth over at the moment…
Wulfstan // April 18, 2008 at 9:00 pm
I for one look forward to the day when the reviewers for the Cochrane Collaboration save their time and energy and just ask assorted celebrities to read their tea-leaves or entrails when they want an important scientific or medical issue resolved.
draust // April 18, 2008 at 9:42 pm
I love the way the three Nutri-celebs are in effect attributing their state of apparent preservation to the anti-oxidants rather than the more plausible:
(i) being rich
(ii) cosmetic surgery
(iii) botox
LeeT // April 19, 2008 at 11:53 am
If Gloria and Cliff are on the move why don’t they carry some fruit, nuts and oatcakes with them? That would be cheaper, healthier and tastier than supplements.
Wulfstan // April 19, 2008 at 1:32 pm
Presumably the botox paralyses your planning skills so you can’t think ahead and bring snacks with you?
It’s almost hard to believe that this is the same Carole Caplin who was the former evangelist for Exegesis; campaigned against EU “plans to force alternative therapy peddlers to put proper ingredients labels on its products and get licences for the dangerous ones”; and fretted about the impact of computerised running shoes on the energy meridians of your feet.
jdc // April 19, 2008 at 6:18 pm
The food supplements industry is clearly intent on making a laughing stock of itself. Hilarious.
Lenora // April 20, 2008 at 1:08 am
Who the heck is Cliff Richard?
UK dietitian // April 20, 2008 at 10:33 am
A latter day, bus driving Gary Linekar but he doesn’t eat …………crisps
dvnutrix // April 20, 2008 at 2:17 pm
A National Treasure. Sir Cliff can be relied upon to rally a hacked-off Wimbledon crowd with a sing-song during another rained-off day with no fixtures - he reminds us that there are worse things than taking a day’s precious holiday to get soaking wet and see no action for your pains.
He is a man of faith in many things - including supplements. He has had a No 1 hit in every decade since his career started (I think). A modern-day Peter Pan. Or, if the supplements are working as well as he thinks, possibly Dorian Gray. Hope that has cleared up the matter.
Dr Aust // April 20, 2008 at 8:49 pm
A succinct description of Sir Cliff would be “Britain’s most celebrated celibate Christian Rock star”… or (for US readers) “the British Elvis-turned-Pat Boone”
The Quacktitioner Royal gets a drubbing // April 20, 2008 at 10:43 pm
[...] Predictably enough, the conclusions were denied by the Health Food Manufacturers’ Association (HFMA). They wheeled out several pop singers to say how wonderful their products are. Read about that pathetic defence on Holfordwatch. [...]
Lenora // April 20, 2008 at 11:31 pm
Thank you for clearing that up. He sounds like an entertainer we’d have headlining in Branson or singing “God Bless America” before the Daytona 500.
Drowned // April 21, 2008 at 11:12 am
Of course the people being targetted by the press release will be persuaded by a few idiot celebritites. That’s why the industry uses them. We don’t take any account of their views because we’re not supposed to - it’s called dog-whistle politics or something isn’t it? You aim your message at the people most likely to listen to you, and in this case that message is doubt, or “don’t pay any attention to the scientists, they don’t know what they’re talking about - why look, they didn’t even use all of the studies, that’s not very sciencey is it?” Of course, if your science information comes from the Daily Mail then this is the message you get, not the one that says vitamin supplements are pretty worthless. Heck, In this parallel world “Dr” Gillian McKeith still gets Daily Mail profiles and new television programmes. Any scientist that faked or misrepresented their credentials in the same way as she did would find it very hard to get work, medical doctors would get struck off and politicians would face such a hammering from the press that they might think about retiring early. And so the march of studid continues apace to the drumbeat of incredulity.
Claire // April 21, 2008 at 2:19 pm
looks like Spiderman’s been drafted in defence of supplements:
http://www.foodnavigator.com/news/ng.asp?n=84792&c=PiqxtCzIYGNtM4IHH5CsXw%3D%3D
steve // April 21, 2008 at 5:49 pm
Cliff Richard has, unbelievably, sold more records than the Beatles in the UK. surely those record buyers can’t all be wrong?
dvnutrix // April 21, 2008 at 6:10 pm
Wow - how many people bought The Birdie Song, Shadduppa Your Face, Rabbit or Viva Espana? I’m not sure we can judge nutritional soundness or gravitas by record sales or even book sales, if Holford’s Optimum Nutrition Bible has genuinely sold more than a million copies in around 10 years.
However, it is a delightful new wrinkle for the next X Factor. Hopefuls will need to sing, dance and present a 20 minute talk on antioxidants or some other topic of the day. After all, what with the need to design lingerie and formulate salad dressings and perfumes, the celebrities of the future have to be flexible and knowledgeable.
New Celebrity endorsement for antioxidants « Dr Aust’s Spleen // April 21, 2008 at 9:45 pm
[...] would never be able to sustain his punishing round-the-clock lifestyle. Count Dracula joins other celebrities, like Sir Cliff Richard, Gloria Hunniford and Carole Caplin, who have spoken out to defend [...]
steppen wolf // April 22, 2008 at 7:21 pm
I linked to your post, over at Take your vitamins…and die?
doogledoogle // April 22, 2008 at 7:40 pm
Anybody want to comment on this bit though:
“…over two thirds of the total were conducted on individuals already diagnosed with disease, resulting in a serious bias in the results. No matter how positive the effects of antioxidant vitamins on good health, they simply cannot be expected to overturn previously diagnosed, chronic illness.”
I’m not sure how this would bias the results, but it does sound a bit odd. I guess I may have to go and read the damn study.
dvnutrix // April 22, 2008 at 8:39 pm
Well, you have to do something special to end up with those figures.
So, yes, the crude third v two-thirds is true for the number of trials but not for the breakdown of the number of participants in those trials. The healthy participants make up around 71% of the total pool of participants (232,550).
For those with access to the full report, there is more detail.
So, not to underplay the seriousness/inconvenience/quality of life reducing impact of (say) cataracts, but it’s not as if all the “chronic illness” is of the sort that you would typically think of in such terms such as type I or II diabetes etc. that will have an impact on multiple bodily systems in obvious ways.
I think that some of the commentators have been mislead by people in whom they placed their trust.
doogledoogle // April 23, 2008 at 1:59 pm
@dvnutrix - Thanks for the clarification. Most of their claims are of course total BS, but this one has sort-of, maybe, perhaps, possibly, a slightly valid point - even if it’s exagerated.
Claire // April 26, 2008 at 1:35 pm
http://www.guardian.co.uk/commentisfree/2008/apr/26/medicalresearch.health & on Bad Science. Impeccable but I do wish it could be published more widely, say in women’s magazines, who tend to be among the worst offenders in uncritically promoting pseudoscience. Though maybe that’s a fond wish, as I imagine advertising supplements etc must be a considerable revenue stream.
jonhw // April 26, 2008 at 4:07 pm
Yes - thanks for the link, a nice article. More refs etc. in the version on badscience.net.
Experts: hired lackeys - & moon made of cream cheese. « Dr Aust’s Spleen // May 8, 2008 at 10:41 am
[...] Cliff is not, whatever the food supplement industry appear to think, an [...]
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