Dear Vice-Chancellor Terence Kealey,
Your comment piece in The Times triggered some tristesse: The limitations of peer review. If Eddie ‘The Eagle’ Edwards had been capable of making leaps on a similar scale to yours then Britain’s medal haul in the Winter Olympics would be a cause for celebration rather than derision.
It would take a lot of time and space to discuss all of the distortions and errors so we shall just address some of the ones about the recent Cochrane Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases (review) by Bjelakovic et al. We would find it too distressing to deal with the declaration, “The authors dismissed the omission with hypothetical statistics, yet the paper passed peer review”,[a] so we have opted for calm thoughts. And a fervent wish that your article does not encapsulate something worrying about the general understanding of randomised controlled trials, systematic reviews and meta-analyses among senior staff in british universities.[b]
We have already addressed several (by now, familiar) criticisms in previous posts so we shall just highlight your chestnut-stuffed canard of natural v. synthetic vitamins.
Moreover, the patients were not taking natural vitamins but artificial ones, and the reports all differed in terms of dose, combination of vitamins and duration (weeks or years).
Oddly enough, the widespread belief in the virtue of supplements is mostly grounded in Orthomolecular Medicine. Yet, the blanket criticism of synthetic vitamins is something that Linus Pauling would have disputed; as would present-day heroes of Orthomolecular Medicine such as Dr Andrew Saul. According to Pauling in Vitamin C and the Common Cold:
There is only one vitamin C. It is the substance L-ascorbic acid, which is also called ascorbic acid…So-called synthetic ascorbic acid is natural ascorbic acid, identical with the vitamin C in oranges and other foods. [Vitamin C products that are derived from rose hip extracts or similar have] no advantage whatever…In fact, there is a disadvantage that you would waste your money if you bought them, rather than the ordinary ascorbic acid. [pg. 89]
On pg. 90, Pauling advises the reader that at the then current prices, vitamin C should cost around $5-7.50/kg. He warned readers not to buy ascorbic acid if it cost more than $20 per kilogram.
The dealer also misleads his customers by suggesting that ordinary ascorbic acid is different from ‘all-natural vitamin C, from organically grown rosehips imported from Northern Europe.’ The words ‘organically grown’ are essentially meaningless — just part of the jargon used by health-food promoters in making their excess profits, often from elderly people with low incomes. [pg. 91]
Pauling continues in this vein and on pg. 95 he suggests that appropriate supplementation with cheap (generic) multivitamin supplements should only cost a few dollars a year. Interestingly, on pages 96-7 Pauling discusses ‘bioflavinoids’ (both he and Saul use this term) and declares that they are likely to have little or no role in the prevention of the common cold and therefore “need not be included in the regimen”.
Dr Saul makes several similar points in: What’s the difference between natural and synthetic vitamins?
Most vitamin products, even those sold in health food stores or by distributors, contain synthetic vitamin powders. There are only a few manufacturers of vitamin powders, and they are almost always large pharmaceutical companies. Generally,
a) Laboratory-made vitamins are far cheaper than whole food concentrates;
b) Synthetic vitamins USUALLY work quite well,
c) High potency can be achieved with a nice, small tablet size
…
Drs. Linus Pauling, Ewan Cameron, Robert Cathcart and others have established that very high doses of factory-made ascorbic acid vitamin C work just fine against viral and bacterial illness.
Saul even recounts an anecdote about Szent-Gyorgyi and some lab animals that surreptiously ate his dinner of stuffed pepper (rich in bioflavinoids) and subsequently absorbed more vitamin C. Saul concludes we should obtain phyto-nutrients from food and not shoe-horn them into supplemental vitamins which should be cheap.
I (in agreement with Linus Pauling) recommend that people buy the cheapest vitamin C they can find, and take a lot of it…
I recommend that people take cheap C, AND eat right. Foods are a lousy source of vitamin C but an excellent source of bioflavinoids. Vitamin C tablets are a lousy source of bioflavinoids, but a good source of C. Good match.
Overall, it seems the pillars of orthomolecular medicine support the value and cost-effectiveness of synthetic vitamins. They argue that for some of them, even if people absorb less (not an established fact in every case but see Natural versus synthetic vitamins), then this is an argument for advising a larger dose of an affordable substance to supplement a wholesome diet. In a way, this seems rather more tasteful and appropriate than arguing for the merits of ‘natural’ supplements that are presumably derived from vast quantities of whole foods and food crops at a time when there are food riots in an increasing number of countries and some apprehension about food shortages. There are many irrationalities that we all accept, but somehow, processing yet more of the world’s food resources to create (effectively) food concentrate vitamin and mineral supplements for the already well-nourished, those without clinical deficiencies or without especial needs, would seem particularly obscene.
Notes
[a] The full horror of this section:
The vitamin paper was not an original study, but simply an overview of 67 previously published reports in which someone died while taking supplements. But the study ignored 405 other reports in which nobody died, so one possible explanation for the results is that the authors omitted inconvenient data. The authors dismissed the omission with hypothetical statistics, yet the paper passed peer review.
[b] After all your hard work slogging through a nearly 200 page report, we are loth to suggest something more but we are troubled by some apparent misunderstandings. Effectively, the systematic review process is geared towards evaluating whether or not a particular study was a ‘fair test’. One of the best explanations of ‘fair tests’ is Evans, Thornton and Chalmers’ Testing Treatments (available for free download). We strongly recommend this generalist and entertaining book to interested parties as it explains all the ins-and-outs of what makes a fair test and the fair way in which to interpret the results.
References
Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD007176. DOI: 10.1002/14651858.CD007176.
Pauling, L. (1970) Vitamin C and the Common Cold, San Francisco: W. H. Freeman and Company.
Related Reading
Dr G of Wandering Primate offers a good discussion of Natural versus synthetic vitamins.
We have dealt with some of the content of the more common puzzling ‘criticisms’ of the Cochrane Review 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
Irish Association of Nutritional Therapy: Giving the Facts About the Cochrane Review of Antioxidant Supplements
12 responses so far ↓
jonhw // April 29, 2008 at 1:48 am
From the end of the article: “Terence Kealey is Vice-Chancellor of the University of Buckingham”. I wonder what staff and students at Buckingham would make of their Vice Chancellor’s arguments?
draust // April 29, 2008 at 11:50 am
All rather bizarre.
Terence Kealey was once a respectable enough biochemist, although we are talking more than 20 yrs back. He was best known around the scientific community for his taste for the ideology of “unfettered free markets” - think Mrs Thatcher and then much, much, further - which is really how he ended up being Top Banana of Britain’s only wholly private (and hence big fee-charging) University.
Kealey main theme has always been that there should be little or no state research funding of science. In his view all research should be paid for by private companies, or private foundations, as he argued only they had a clear view of whether it was worth the money to do it and that this would “enhanced creativity and performance” in science.
Needless to say this view did not win him many friends around science and medicine, and he has always been generally regarded as an ideologue loony. He did used to have the ear of parts of the Tory party back in the early 90s, though they never did anything to implement his ideas that widely. I think they found him (and Buckingham) useful as a way of pushing “business thinking” on the (then) reluctant Universities. Sort of “well, if you chaps don’t embrace the idea of students as customers, the whole system may have to go private…. look at what Terence Kealey has done at Buckingham…”
One wonders if Terence K has popped up again as a consequence of there now being a realistic prospect, for the first time in more than a decade, of the Tories forming the next Govt.
On the specific issue of anti-oxidants, I suspect Terence K is generally sympathetic to the idea that the private companies supply a consumer demand for vitamin pills and should be allowed to carry on doing their own research, which the consumers are free to believe or not - caveat emptor . In his thinking about how research should be funded, “vested interests” are inevitable and indeed necessary (see above). So he is also probably objecting to the idea that the Cochrane group are “more independent” because they are funded by Govt research grants rather than private money .
dvnutrix // April 29, 2008 at 1:15 pm
Dr Aust, what an illuminating interview. I do wonder how he would distinguish the Cochrane evaluation of various bio-med interventions from the Tobacco wars.
Why would independent foundations be interested in exploring whether or not antioxidant supplements are valuable for the general population? Where is the money in non-sales of supplements, or the non-sales of diet books because your dietary message boils down to Pollan’s maxim? Eat food. Not too much. Mostly plants.
In the interview, it is remarkable how many times he veered towards sounding neo-Holmesian.
This may be literally true but overlooks the fact that it doesn’t matter how much you jargonise something, there are times when a basic knowledge of science leads someone to say, “You’re claiming to have built a perpetual motion machine” or “You’re claiming that chlorophyll oxygenates my blood when it really can’t do that”.
Beyond that, I wonder how free-marketeers reconcile the fact that we don’t live in an unfettered free market (try taking a job in the US or Australia for a few months and stand back in amazement at the paperwork) with promoting the idea that we should introduce elements that suggest that we do.
I can’t express the next bit of what I wanted to say, so I shall think some more.
Claire // April 29, 2008 at 2:51 pm
Ah yes, Dr Aust, the Thatcher era worship of ‘business leaders’…(groan)
who, according to the IoD magazine, are increasingly opting for cosmetic procedures - http://www.director.co.uk/MAGAZINE/2008/5%20May/plastic_surgery_61_10.html
They must be getting ready for prime time.
Wulfstan // April 29, 2008 at 5:57 pm
Garfield for economic guru and Vice-Chancellor of somewhere.
Dr Aust // April 29, 2008 at 5:59 pm
I agree, but I think there’s more too it than that, Claire. There is definitely a premium on appearing youthful and telegenic - think Tony Blair, or Sarkozy - but in these executive roles it also relates, I think, to the idea that one of the “selectors ” for making it to the top is being “super-charged”, i.e. having the physical energy and endurance to work twice as hard as everyone else.
My experience of academia has been that it is rarely the most intellectually gifted scientists that make it to the very top these days, and far more the gifted enough but noticeably most driven / indefatigable.
I can believe CEOs want to be viewed as simultaneously “tremendously experienced” (safe pair of hands) “…but young for his/her age” (exudes youth, health and vigour, good hair and teeth etc etc).
In the Alt Health setting, how much of Patrick H’s pitch is based on his own matinee idol housewives’ heartthrob schtick and “glow of health”? Quite a bit, I’d say.
Actually, I’d love to see some “rejuvenating supplement”-peddling AltMed guru getting papparazzi-ed sneaking out of a cosmetic surgery clinic. That really would be something to dream of.
LeeT // April 29, 2008 at 7:55 pm
Thanks for the background informtion Dr Aust, further proof of what a bunch of right-wing reactionaries Holford and his friends are.
I read an article somewhere on the internet recently which said Count Dracula was supporting him. Funny old world ehhh?
dvnutrix // April 29, 2008 at 8:09 pm
Goldacre on TAPL. Some of this is very Ayn Rand.
draust // April 29, 2008 at 9:06 pm
Talking of TAPL, have you heard the one about her appearing in one of the mens’ mags of the sub-Esquire type variety, clad in a skintight rubber catsuit and wielding a whip?
Is there anything the woman won’t do for publicity?
LeeT // April 29, 2008 at 9:11 pm
Certainly, I think Mr Holford’s education policy is rather strange - raise educational standards through fish pills.
It would be interesting to ask Rona Tutt of Food for the Brain if she could confirm whether Mr Holford has had his own child(ren) educated in the state sector.
Claire // April 29, 2008 at 10:07 pm
Very true, Dr Aust. I was indulging slightly in the ‘o tempora, o mores’! I can’t make up my mind if the suggestion in that article (that age and experience might become more valued in times of credit crunch) is on the money or wishful thinking - hopefully the former but maybe hard times will make it even more incumbent on individuals to conform to ideals of how ‘a winner’ should look. Having some business experience, the anecdote about the female US directors rings true: refusing to dye one’s greying hair seems to be viewed as highly eccentric.
re TAPL, I’m afraid any sympathy I’ve managed to dredge up for people who feel pressurized to look good evaporates. So, I will very uncharitably observe that I was surprised to read in a newspaper report recently that she is only 48. I would not have thought that from the accompanying picture.
ross // May 8, 2008 at 1:17 am
Wow…I am reading this for the third time and still trying to understand it because I don’t have a medical background. I got here via Google looking for more about a recent claim I heard on TV from someone saying multivitamins and supplements have very little or no health benefit. I spend a fair bit on vitamins and supplements and want to find out more about that Claim. I am gald I found your blog though and will read on and have bookmarked it.
Regards,
Ross.
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