JDC reports that he “always thought that Dr John Briffa was like a more grown-up version of Patrick Holford” - and until recently I had rather agreed with him. However, Briffa has now taken up some worrying positions on vaccines and autism. Along with Dr Crippen, “I am worried about Dr John Briffa.”
I have just come across some of Briffa’s claims about food sensitivity testing - they are almost Holfordesque. Writing in the Guardian about Irritable Bowel syndrome, Briffa argues that:
Those with IBS can…benefit from identification of problem foods. Several methods of testing exist, such as kinesiology (muscle testing) and dowsing. I believe all such methods have some validity, though those who are more comfortable taking a more ’scientific’ approach may have their blood tested for IgG antibodies to specific foods. One study published last year in the journal Gut found that elimination of foods identified by this form of testing was beneficial for IBS sufferers.
Now, Patrick Holford has written positively about health dowsing and Applied Kinesiology (AK), but this was quite a while ago. Briffa’s Guardian article was from 2005. As we’re going to find out below, Briffa gets things badly wrong on food sensitivity testing and on recommendations for dealing with (potential) sensitivities.
Applied Kinesiology
John Garrow has shown that AK is not an effective way to diagnose allergy. AK testing thus lacks a plausible mechanism of action, and - in a blinded trial - has failed to do better than one would expect if the practitioners were guessing. Professor Chris Corrigan was thus moved to describe AK - in his testimony to the House of Lords Science and Technology Committee - as
all completely bizarre and, I am afraid, utter nonsense. There is no scientific evidence or mechanistic base to suggest that these tests could be remotely effective.
Putting it politely, this is not a valid way to diagnose food sensitivities.
Dowsing
Quite simply, there is no plausible mechanism through which dowsing might work as a test for food sensitivity, and we have no good evidence that it does work. I cannot see any reason why a competent professional would recommend dowsing for anything other than entertainment.
IgG testing
When recommending IgG testing as a more ’scientific’ approach to diagnosing food sensitivities, Briffa does point to an article in Gut. Unfortunately, its results indicate that an IgG-guided elimination diet is less effective than a ‘conventional’ elimination diet when you interpret the results using a straightforward Numbers Need to Treat analysis. This is not an effective way to diagnose allergy, intolerance or sensitivity. The House of Lords Science and Technology Committee’s 2007 Report on allergy [PDF, 8.40] have therefore cautioned against the recommendation of IgG testing:
We urge general practitioners, pharmacists and charities not to endorse the use of these products until conclusive proof of their efficacy has been established.
Unfortunate clinical recommendations
This dubious account of food sensitivity testing leads Briffa to make some unfortunate recommendations. Firstly, inaccurate food sensitivity testing can be harmful: both leading patients to avoid foods which they are quite able to eat (false positives) and failing to diagnose genuine allergies and intolerances (false negatives). Secondly, Briffa then suggests a rather haphazard approach to an elimination diet:
there is usually no reason why individuals should not make changes to their diet without testing. I advise trying a diet devoid of wheat (pasta, bread, biscuits, pastries, breakfast cereals) and cows’ milk (another common offender) for a week or two. Better tolerated grains include rice and oats (oat-based muesli, porridge, oatcakes), and rice and oat milks are good swaps for dairy milk, too.
While an elimination diet can be a useful way of diagnosing allergies and intolerances, one would be advised to take a more systematic approach (preferably under medical and/or dietetic supervision). As argued in Allergy: The Unmet Need [PDF, p 53) appropriate advice and supervision is important when a patient is cutting out certain food groups. It is also not entirely clear how Briffa has selected which foods are to be eliminated: for example, while lactose intolerance is relatively common, some milk products (such as some cheeses) contain negligible quantities of lactose.
We should also emphasise that cutting out whole foodgroups from your diet can be harmful, if you fail to adequately substitute alternatives. While eliminating these for 1-2 weeks - as Briffa suggests - is pretty safe in most circumstances, we would have more concerns in the longer term. It is unclear whether Briffa anticipates any kind of challenge protocol being used - for patients to test whether a food which they have eliminated causes problems when reintroduced - or simply expects IBS-sufferers to continue with the exclusion of wheat and cows milk if this exclusion coincides with an improvement in symptoms.
Both milk and wheat are significant sources of calories for many children and adults in the UK. Milk is a significant source of calcium, and some wheat-based products (such as certain fortified breakfast cereals) are a significant source of fibre for many people. Also, fortified wheat-based breakfast cereals and breads can be a useful source of a number of vitamins and minerals. One should therefore not exclude these food groups from the diet without finding suitable alternatives. There are particular concerns with children: Allergy observes [PDF, p11] that “it is harmful to put a child on an extensive exclusion diet that has no scientific basis, because of the risk of nutritional compromise and poor growth.”
This is all rather worrying. Briffa manages to recommend three inappropriate approaches to testing for food sensitivity, and then suggest an haphazard approach to an elimination diet. His clinical recommendations are also unfortunate - failing to take into account the potential harm caused by eliminating whole food groups if this course of action is continued for some time and without appropriate advice and supervision.
As Dr Crippen might put it, this is wibble - damaging wibble.
51 responses so far ↓
pv // June 9, 2008 at 12:42 am
Can I just add what a brilliant piece Dr Crippen has written about Briffa.
popey // June 9, 2008 at 8:35 am
Does anyone know anything about Dr Nigel Plummer on the ailment website?
openmind // June 9, 2008 at 8:47 am
Oddly enough, he’s not very keen to comment on the efficacy or otherwsie of AK:
http://www.drbriffa.com/blog/2008/06/06/health-professionals-ignore-their-patients-at-their-and-their-patients-peril/#comment-94321
(Comment 60)
dvnutrix // June 9, 2008 at 9:17 am
Dr Nigel Plummer owns Cultech. He advises Biocare (pdf), like Former Visiting Professor Patrick Holford. Like the usual suspects, he lectures at CNELM (pdf), the ION, the Uni. of Westminster and similar.
Interestingly, on the Alimént website, you learn that supplementscompared.com praises their products. I reproduce a press release about supplementscompared.com.
Interesting overlap between some of the people who advise a company that distributes supplements (Aliment) and the advisory panel of a service that assesses the quality of supplements. However, it seems that all the proceeds go to charity so that must be OK.
Claire // June 9, 2008 at 9:42 am
“It’s an excellent way of sparking new interest in health supplements. …”
kerching!
And,regarding the point about DIY exclusion diets, I would echo your point about appropriate advice and supervision (and diagnosis!), especially in allergic children. There is a small possibility that reintroduction/accidental exposure to an excluded food might cause a significant reaction (I know personally a case where this happened). In this scenario, self-testing and self-treatment are not advised.
Claire // June 9, 2008 at 10:24 am
just spotted this - not an exclusion diet in the sense discussed here but a miserable outcome for this child:
http://www.dailyrecord.co.uk/news/scottish-news/2008/06/09/shock-as-vegan-diet-girl-12-diagnosed-with-rickets-86908-20600599/
draust // June 9, 2008 at 10:49 am
Nice job on Dr Plummer.
I do find it hilarious that this same small group of ranking Nutritionistas fill all the “expert” slots, lecture on each others’ courses, puff one another’s books and columns, assess themselves etc etc.
The similarity with the “Look! a web of corrupt Pharma-Illuminati!” line that serial conspiracy loons like Martin J Walker and the JABS crew now gabble out endlessly re. the “Bad Science Lobby” is instructive.
Of course, winning a small Prize that is given by a charity but funded by the External Relations budget of a PharmaCo might seem rather different to being a direct and major financial beneficiary of a company or product that you are plugging. But not to the Alt.Reality loons.
Wulfstan // June 9, 2008 at 11:20 am
If you will indulge us by reading one more remark from Holford’s account of why he did not participate in the Radio 4 programme:
We strongly suggest that Holford should have a chat with Jerome Burne, his co-author on Food Is Better Medicine Than Drugs. You see, one of those Science Writer awards, one of the ones that is “funded by the big pharmaceuticals”, it turns out that Burne wanted one. In 2005 (oddly, at the time when Burne was collaborating with Holford) both Burne and Goldacre were shortlisted for the award and Goldacre won.
—————
Above extract quoted from Ben Goldacre Usually Gets The Science Wrong: Patrick Holford Speaks From His Own Reality.
Was that the sort of Alt Reality (tm respected) that you had in mind?
Wulfstan // June 9, 2008 at 11:34 am
And I like the summary of who owns what and advises where in a comment on Dr Crippen’s post.
Anjana Ahuga was writing about autism quackery but the figures of speech seem on the money:
wilsontown // June 9, 2008 at 11:39 am
Dowsing? DOWSING!?
Good grief.
jonhw // June 9, 2008 at 12:41 pm
Grief, indeed.
popey // June 9, 2008 at 7:55 pm
Thank you for the info on Nigel Plummer.
The reason i asked was because as i looked at the ailment website, i noticed that i had seen this guy lecture a couple of years ago in the U.S
He was talking about IL1 IL6 TNF and their relationship with atherosclorosis. He seem to make alot of sense and did not once mention any supplement companies.
In your opinion, do you beleive Dr Plummer should not be lecturing on such a subject? I am genuinly interested in what you think.
dvnutrix // June 9, 2008 at 9:08 pm
Dr Plummer has a lot of relevant industrial experience with formulating products. He is obviously successful with his OmegaWise range of products and I gather that he has a range of nutraceuticals that he supplies to health practitioners in the US .
In general, people with a lot of industrial experience are exposed to a broad range of research interests and can speak well and informatively on a number of topics. The need for specialisation will vary with a particular audience. E.g., is it a one-off education lecture, at a fairly basic level for a general audience or a very technical, specialist event/seminar for a very specific, very knowledgeable audience.
You’re the one who attended his lecture (was it a postgrad event for nutritionists or people involved in the clinical management of atherosclerosis?), so you’re in a much better position to have an opinion about the coverage of the topic, meeting the audience’s needs etc. Was it an educational event or a conference?
According to this bio, he is a world expert in:
*The role of fatty acids in infant cognitive development, inflammatory disease, depression, psychiatric disorders, and age-related mental processes
*The influence of the human gastrointestinal and genitourinary tract microflora on disease and health, including antibiotic-associated effects, IBS, IBD, allergy and autoimmune disease (Dr. Plummer developed and manufactured the very first human-use commercial probiotic derived from indigenous lactic acid bacteria)
*The evaluation and potential for plant-derived antimicrobials .
Ultimately, if you came away from his lecture with good resources, insights, fresh understanding and information that you didn’t have before about that topic, and you have been able to apply what you learned - then, IMO, that is a good lecture.
popey // June 10, 2008 at 11:14 am
it was for people who are involved in clinical management of atherosclerosis although the lecture was based on nutritional practices.
His theory was suggesting that the atheroslerotic process is an inflammatory one created by increased levels of plasma lipoproteins building up and eventually being oxidised in the intima. The unrecognised LDL particles activate macrophages to produce the cytokines plus stimulate endothelium cells to do the same.
The cytokines stimulate the endothiluim cells to produce adhesion molecules which trap more LDL molecules, which leads to further build up and further oxidation.
The monocytes that drop from circulation and become macrophages, engulf the oxidised LDL and become foam cells.
I am noticing in practice that patients that develop atherosclorosis usually have long term inflammatory conditions all involving these cytokines, be it asthma, fibromyalgia, RA, IBS, IBD etc.
It is now strange to see this guy only out for profit, he really didnt come across that way.
dvnutrix // June 10, 2008 at 12:50 pm
I am interested in what might be characterised (crudely) as systemic inflammation and its association with several chronic illnesses that are themselves associated with co-moribidities that have an inflammatory component.
It has also been fascinating to watch the conventional wisdom change. It certainly used to be a widely-held truism that, e.g., people with asthma rarely developed rheumatoid arthritis and were supposed not to develop various other illnesses. However, in the last few years, as asthma diagnosis has detected more cases and more people are being managed for asthma (prompting the call for the abolition of asthma as a single disease entity and discussed here) it seems as if asthma is typically associated with co-morbidities once people hit their 40s and 50s. The usual confounding variables here are whether people tend to be overweight through lack of exercise which they haven’t engaged in because of their asthma. And, there is the speculation about adipose tissue effectively operating as another endocrine system and manufacturing its own pro-inflammatory substances. However, the argument holds that some researchers are looking at chronic diseases as manifestations of underlying systemic inflammation.
As a matter of interest, were there recommendations other than the standard (where applicable): smoking cessation; watch your weight; be active; monitor blood pressure; monitor blood sugar for signs of IGT or diabetes; monitor for dysregulated lipids; monitor for elevated inflammatory markers? Did you receive some useful resource pointers for further information? Or was it part of a lecture (series) asking you to monitor particular risk factors as part of a data-gathering exercise or awareness programme? (Ignore if this is too intrusive.)
I really have no idea at all as to Dr Plummer’s motivations etc. However, I am interested in the inter-connections of who supports which supplements, sits on advisory panels for independent review bodies, set up by someone who manufactures and distributes supplements etc. Partially for the reasons given in Nick Gene’s stories that we cite in Grand Rounds. And partly because, in the UK, if you mention that you don’t think that there is an evidence base to support the use of some supplements, then as night follows day, you tend to be called a Pharma Shill and accused of some very odd conflicts of interest.
Gimpy // June 10, 2008 at 3:44 pm
Popey
I wonder if you can provide any references to support this contention. I recognise you are repeating the opinions of a third party but hope that party provided scientific evidence.
LDLs are recognised by LDL receptors and not adhesion molecules. Now there is some evidence that LDL levels can affect levels of adhesion molecule expression in some cell types but there is no evidence for a direct physical interaction between LDL and adhesion molecules. Rather it is likely to be a signalling event mediated by the binding of LDL to the LDL receptor. LDL receptors have been described as the swiss army knife of the cell as they can bind to a staggeringly large range of molecules and thus function in a bewildering array of signalling pathways. Teasing apart these interactions is a very difficult job and while there are legions of biochemists and molecular biologists doing just that it is far from clear how LDL levels affect atherosclerosis. I wonder if Dr Plummer is guilty of simplistic explanations for complex events to boost the commercial profile of his company?
popey // June 10, 2008 at 8:53 pm
His protocols were generally based on down regulating the three main cytokines in all tissues along with NFkappa B and peroxinitrite. He also discussed antioxiandant/oxidant equlibrium, so possibly a sales pitch for his antioxidant supplements.
At the time i remember thinking how well referenced his lecture was, but will have to dig out my notes if i can find them and have a second look.
Gimpy // June 10, 2008 at 10:24 pm
popey could you clarify what you mean by “the three main cytokines”, also are you sure you mean down regulating these in all tissues. It seems to me that this would severely impair the inflammatory response after tissue damage or infection that could have detrimental effects on health. Likewise NFkappaB which, as I’m sure you know, is a transcription factor that affects gene expression in many different tissues and in many different processes. Isn’t this an unrefined sledgehammer approach where you hammer down gene expression in all tissues rather than specific targeting of a specific pathway in a specific cell type?
I’m sure if his lectures were so well referenced you will have no problem in supplying supporting detail.
draust // June 10, 2008 at 10:27 pm
NFkappaB and peroxynitrite definitely sounds like an antioxidant pitch.
The problem is the following “antioxidant paradox”:
- lots of lines of evidence implicate oxidative mechanisms in bad things all over the body, in multiple systems.
BUT:
- supplementation with “anti-oxidants” pills has NEVER been shown to have clear-cut benefits. No matter what antioxidant has been tried, and no matter for what problem.
This is true even in the “best-case” scenarios where the role of “oxidative stress” in the underlying pathophysiology is surest.
The good news, though, is that there are things people can do to damp “oxidant stress” or if they are worried about “generalised subclinical inflammatory this and that”.
These are: eat more fruit and veg, don’t over-eat , take regular exercise, lose some weight, start a hobby, don’t get wound up…
…sounds rather familiar, what?
Not keying obsessively on one’s lack of antioxidants, or pro-inflammatory cytokines, is probably a good idea too. Although if everyone did this, the supplement sellers’ profits would start looking less healthy.
dvnutrix // June 10, 2008 at 11:46 pm
Without knowing any of the details, and this may not apply to Plummer, one of the major issues with Patrick Holford is that people are readily impressed by the number of references he supplies.
Again, this may not apply to Plummer in any way, but when you start checking Holford’s references, the story falls apart. The references are either remarkably obscure (a no longer available cassette of a lecture delivered in the 80s, or a report written by a Catering Organisation in the 80s or books that even the British Library doesn’t have) or, when you look at them, they don’t support the claims being made. Or, too frequently, although Holford describes the work in such a way as to imply that the research was conducted with humans, the research has been done with animals or cell lines.
If you can find your notes, it would be very helpful to know more about Plummer’s references and recommendations (e.g., the protocols).
dvnutrix // June 11, 2008 at 1:43 am
Gimpy - I like Orac’s classic line about boosting the immune system when discussing Airborne.
As ever, if there are upsides, there are probably downsides. Boost an immune system and notionally you may be pushing towards auto-immune diseases. Downplay appropriate inflammatory responses and there goes the neighbourhood with ’simple’ illnesses.
Dr Aust - it is all true but why is it that visions of codger-dom come to mind whenever you say that, “Remarkably - yes, it is all true. Don’t smoke. Alcohol in moderation ditto food. Eat your fruit and veg, not neglecting your greens. If you don’t like formal exercise and don’t own a dog, behave as if you have a dog and go for a walk at least twice a day. Cultivate your family and friends. Have some past-times that you practice regularly and enjoy”.
Wulfstan // June 11, 2008 at 2:07 am
I saw snippets of two episodes in series 12 of ER and both of them stuck with me because they gave explanations that made them sound very exciting, plausible, simple or dramatic (in various permutations). One of them starred James Wood and he gave a thrilling lecture about ATP (season 12:13 but can’t find the YouTube for this part of Body and Soul). The other involved a surgeon (Dubenko) who was grilling the residents about free radicals during a code and later started writing out some processes on the nearest lightbox and then the wall. Part of his explanation soundbites were: “The difference between a physician and a witch doctor is an appreciation of the science beneath the disease” (8:30-8:35); and “Free radicals are the link to so many disease processes in the human body - ischaemia, cancer, ageing - they form after tissue is deprived of oxygen. Why are they bad?…What happens when a radical encounters the mitochondria of a healthy cell, Lockhart?…Everything that we do in ER, every intervention, ultimately operates at a molecular level. I don’t understand how any of you expects to affect the complex machinery of the human body if you don’t understand the basics.” (2:00-2:25).
Simple explanations for complex events that worked well in a TV drama. Probably riddled with so many inaccuracies that it made people who know something weep. Even I wondered why ageing could be so blithely referred to as a disease. The sort of material that would probably be flayed if anyone ever analysed it like Scott Morrison does for House at Polite Dissent.
popey // June 11, 2008 at 6:42 am
Gimpy, i believe he was suggesting that reducing IL1 IL6 TNF NFKB peroxinitrite only if these molecules are elevated. I totally agree that you would never want to do this otherwise and i assume plummer is fully aware of this. From what i can remember he was looking at dealing with factors that raise these levels. poor adrenal function, digestive issues, low antioxidant status ie glutatione P and SOD levels, RA allergy asthma.
Sorry, the 3 main cytokines were the ones i originally mentioned (not the 3 main one whatsoever, very badly worded)
Much of his lecture was concerning diet, life style, stress maagement.
I will find the notes today and show yo the refs to see what you think
popey // June 11, 2008 at 6:48 am
Gimpey, you seem a little angry, im not sure why. Im not disputing what you are saying and value Holfordwatch opinion. I said i will post the refs when i have time to dig them out.
Wulfstan // June 11, 2008 at 2:36 pm
I pass no comment on this set of Bad Science awards (nothing to do with Ben Goldacre). Apparently, Victor Herbert, M.D., J.D. and Tracy Stopler Kasdan, M.S., R.D. wrote:
These Bad Science award people say:
Over-stated but it is one of those things that feels as if it has a kernel of something useful at its core. However, you could probably make the same broadstroke judgment about anyone who is dedicated to an idea.
draust // June 11, 2008 at 2:54 pm
Being a die-hard fan, I remember both episodes of ER very well, Wulfstan.
I remember finding the Dubenko free radicals exposition particularly funny, since a surgeon would never, ever, say these sorts of things to the junior doctors. On the whole, it is the basic scientists that believe the Dubenko line (”we need to know and understand the underlying molecular events”) , while clinicians view this sort of “waaaay down there underlying molecule stuff” stuff as fairly irrelevant to clinical medicine, and pass this view on to their juniors.
This take is actually understandable, in the sense that it is clinical trials that ultimately tell doctors what works on people, not whether the underlying basic science can provide a mechanistic explanation. The science is most useful in complex cases when there is little or no clinical “evidence base” to help. In those settings reasoning from underlying basic science principles gives you a starting point.
In the antioxidant context, many antioxidants were tested in clinical trials for all sorts of disease states, and shown to be ineffective, while science types like me were still struggling to work out the intricacies of the test-tube-ery on “what do oxidants and anti-oxidants do to cells?”
The Nutri-bollocks gang have, of course, exploited this by keying on (i) that the doctors aren’t interested in tons of confusing biochemistry; and (ii) that cells-in-a-dish studies and human trials often don’t give the same answer. The Nutritionista crew have used these two things to sell supplements “around” the barrier posed by their ineffectiveness in controlled trials.
UKdietitian // June 11, 2008 at 4:23 pm
dvnutrix says:
“Dr. Plummer developed and manufactured the very first human-use commercial probiotic derived from indigenous lactic acid bacteria”
think that attribute in th 20th century goes to Metchnikoff - or if you want to define ‘manufacture’ on a commercial basis then Dr Minoru Shirota takes the prize for Yakult
dvnutrix // June 11, 2008 at 5:31 pm
Professor UKdietitian - always a pleasure even if it is for a mild rebuke.
dvnutrix quoted the bio which said…
However, I should have made that plainer. What can I say? I was over-awed by the number of areas in which one person can claim world expertise. Particularly when other slackers can devote an entire career to one tiny, specific area of any one of those topics - nowhere near being able to claim expertise in several complete areas.
I can only hope that people like
PaulMark* Levine are abashed (albeit that is vitamin C). What have the Romans and people like Levine ever done for us, eh? Comparatively speaking…Edited *see jdc325 comment. [blush]
jdc325 // June 11, 2008 at 6:17 pm
“I can only hope that people like Paul Levine are abashed (albeit that is vitamin C).”
Re Paul Levine and Vit C: isn’t P Levine into epidemiology and cancer rather than vitamin C? Pretty sure it’s Mark Levine who is well known for his work on vit C research.
dvnutrix // June 11, 2008 at 6:20 pm
You are right, jdc325 - mixed them up because I’m working on a post (that involves both although I will reference neither) about antioxidants.
I was also thinking about Dr Aust’s words of wisdom on Experts.
Anti-oxidants and Supplementation: Not As Straightforward As It Is Made Out To Be « Holford Watch: Patrick Holford, nutritionism and bad science // June 11, 2008 at 7:20 pm
[...] and Dr Aust have commented about anti-oxidant supplementation and its putative benefits on Dr John Briffa on testing for food sensitivity: applied kinesiology, dowsing and IgG tests. There is a dearth of clinical evidence to support the use of supplements in a well-nourished, [...]
dvnutrix // June 12, 2008 at 12:56 pm
Fascinating topic and sadly one that I can’t get into in any detail.
It was not at the cellular level (of course) but one of the reasons that pinks disease took so long to identify was that people were prepared to hand wave the underlying causative principles and didn’t examine the arguments of those who proposed causes (including that of Warkany, the paediatrician and teratologist who did recognise it for what it was).
One of the on-going arguments seems to be that homeopathy etc. will continue to be eligible for clinical trials because people claim results, despite the lack of plausibility for any underlying biological mechanism. But, LCN put up a good argument about that and SBM writes about it regularly.
draust // June 12, 2008 at 11:11 pm
Yes, I like the science-based medicine “prior probability” take on trials for Alt Therapy. It is far too easy for folk like John Briffa to employ a kind of catch-all get-out by saying (I’m paraphrasing slightly):
“Oh but applied kinesiology for diagnosing food intolerance hasn’t been tested systematically, so you can’t say it’s rubbish”
(Apply to Alt daftness of your choice)
I wouldn’t say trials of such things weren’t needed - Edzard Ernst does a great job rounding up the trials and showing how think the evidence for almost any Alt modality is - but for inherently utterly biologically implausible things, the evidence to rule them out does not have to be as strong (at least for me) as for things that have some claim to plausibility. The obvious contrast is the (oft-confused) homeopathy and herbal.
Re. the Dubenko thing, as a basic scientist I obviously believe in looking for mechanism. It is just that sometimes you have mechanisms in both directions, and the one that biologically “ought” to win doesn’t. Beta blockers in heart failure (which the physiology really says should be a terrible idea) is an example. And another one (which I have some personal acquaintance with) is the antioxidant one. I used to do antioxidant research in the context of chronic pancreatitis, and there is still reasonable evidence that oxidative stress is part of the (poorly understood) pathophysiology. But antioxidants were tried extensively and did bugger all for the chronic panc patients. This obviously tended to mean that most of the pancreatic physicians and surgeons couldn’t see why we were bothering to keep on with the research… and from where they stood you could see what they meant.
draust // June 12, 2008 at 11:12 pm
Oops - meant “how thin the evidence…”
jonhw // June 13, 2008 at 12:06 am
The interesting thing is that even when these approaches are tested (for example, Garrow’s blinded test of Applied Kinesiology which showed it to work about as well as guessing) this is still not seen as convincing if it gives the ‘wrong’ result.
draust // June 13, 2008 at 1:39 am
Quite, Jon.
I specifically picked applied kinesiology as an example since it is in the post title and John Briffa commented on it recently on his blog along the “no evidence either way” line… but he didn’t mention Garrow - quelle surprise.
The dishonesty argument is also relevant. If applied kinesiology does “reveal” anything, it seems highly likely it has to do with psychology, and expectations, and the practitioner’s ability to pick up on them - a bit like various kinds of cold reading - and nothing to do with real physiological effects .
One suspects that the more intelligent practitioners - certainly any of them with medical degrees - must know this, but conceal it to keep the hocus-pocus intact and the mystique potent. “Smoke and mirrors”, as the phrase is.
dvnutrix // June 13, 2008 at 10:42 am
Couldn’t agree more. Failing any demonstration of plausible mechanism, a complete lack of replicable bench results, no decent animal studies etc. then there is absolutely no justification for spending more money on homeopathy trials. Some of the herbals are a completely different matter.
Re: beta-blockers, it is wrong of me but I am fascinated by ideas that have a firm logical underpinning but for some reason, in the real world and the human body, the outcomes are different. One of my favourites is giving a blood transfusion after cardiac surgery which seemed to be commonsense. However, clinical testing discredited the practice and revealed that it was linked with a higher risk of ischaemic events, leading to higher rates of kidney impairment, strokes, and heart attacks.
Re: the anti-oxidants and chronic pancreatitis, I’m about to raise one of the current topics we’ve been researching for a while. Holford and other ‘visionaries’ are wibbling on about the brave new world of nutrigenomics (as if Berthelot’s notion of food pharmacies had not anticipated them a century and more ago, but, obviously not with the genetics component).
Do you have any expectation that genetic profiling will identify groups of people who do benefit from particular interventions? Or, is shovelling anti-oxidants into someone going to be far too broad an intervention if you are not sure what you might be up-regulating or down-regulating?
dvnutrix // June 13, 2008 at 11:01 am
I’ve seen teachers use it - not in a Brain Gym way. They use it (and pendulum swinging) to demostrate ideomotor movement (for the latter) and how a set of beliefs about something can change muscle tone etc. without you being aware of it. The AK in that case is good fun. The children are asked to think of a food they like and one they dislike (just think, it isn’t present) and note the difference in muscle tone as they think of each one. They try several more like-dislike combinations and then they are asked to consider whether the attitude that they have about something can affect their experience of it. This usually creates quite a strong argument as the children discuss perception - the difference in taste receptors- how context can change experience and perception etc.
Somewhere (no idea where), I have a copy of Ian Rowland’s cold reading book and it is a very interesting read. I must excavate it from wherever it is.
Dr Aust // June 13, 2008 at 10:11 pm
No specific expertise, but on the whole I suspect the latter, unless you can find people with a very specific major “genetic antioxidant defence defect”. And any such would presumably be rare as it would hardly be a genetic plus..!
On the whole I am rather cynical about “nutrigenomics “… as indeed I am about “toxicogenomics” and “pharmacogenomics” - they all have possibilities, clearly, and there is certainly a lot of money and drive behind it all, but the hype is tremendous. Of course, if I worked on polymorphisms in GST, or CYPs, or some other detoxifying enzyme, or even on antioxidant enzymes, I would no doubt be talking up the “genetic profiling” ideas too.
The other big caveat is the “adaptability” you describe. One of the things that comes clearly out of even the crudest array experiments is what vast numbers of genes change their expression when you perturb cells or tissues. And this message also comes out (at the organism level) from gene knockout studies. I have lost count of the seminars I have sat through where the person say “errm… we knocked out A.N. Other gene… and to our surprise the mice were fine”. Nature is rather amazingly adaptable, which explains why we are all here.
PS Agree about it not being new as an idea. Benecol, whether you believe it or no, is targetted at those with slightly dodgy lipid levels. Such folk may well have a decent element of familial genetics to their lipid profile… ergo: genetically-tailored functional food.
Of course, it is a pretty safe bet that long before gene profiling and tailored drugs/foods/supplements are a widespread reality, we are going to have loads of folk trying to sell us things they say are “tailored XYZ”. I won’t place a bet on whether it will be the PharmaCos, the Consumer ProductCos like Unilever, or the nutri-pill gang first. They all have a pretty obvious financial motive.
Claire // June 14, 2008 at 2:10 pm
The functional food Cos are already pushing the nutrigenomics idea e.g. here from the FoodNavigator site (my favourite source of reports about nutritionally-enhanced junk food!):
http://www.foodnavigator.com/news/ng.asp?id=79205-chr-hansen-nutrigenomics-r-d
“…Chr Hansen regards nutrigenomics as technology to underlie the food industry’s future away from one-size-fits-all nutrition, and has placed exploration of this area high-up on its R&D agenda…”
Claire // June 14, 2008 at 2:16 pm
and another report from the same site, ‘Obesity report lends weight to nutrigenomics’ includes this on testing:
“…Nutrigenetic testing is already commercially available, with tests costing around $250.
Those offered by Sciona and Genelex test for around 20 genes and people’s lifestyle and dietary habits. However, attempts to introduce them into mainstream shops were not easy. In 2002 The Body Shop UK withdrew a range of tests from Sciona from its shelves, which was available as a trial basis. The tests were mired by criticism that they were “unregulated” and “misleading.”
In the UK these types of tests are now only available through private clinics…”
The representative of the European Nutrigenomics gives a fairly cautious opinion:
“…Indeed, the study of personalized nutrition is in its infancy, and according to the the European Nutrigenomics Organisation (NuGO) it could be upto 20 years before nutrigenomics will be able to underpin public health care advice.
Dr Siân Astley from NuGo said: “It is true that nutrigenomics may have a role in both managing and treating obesity as well as its prevention.
“The problem is there are more than 600 genes currently associated with obesity. These genes interact with one another and with our environment including diet and lifestyle to impact an individual’s risk of becoming obese. But, obesity is a highly complex disease and includes not only biochemical but also physiological and social issues.”
She added that nutrigenomics is not the magic bullet but has “potential to underpin more-targeted more-specific public healthcare advice and perhaps in the future, when we have a better understanding of which if any genes are most important, may be individualised advice via nutrigenetics and genetic testing.”…”
but my guess is that this is not the approach adopted by the private clinics in the UK which sell these tests.
http://www.foodnavigator.com/news/ng.asp?id=80683-nutrigenomics-nutrigenetics-obesity
draust // June 15, 2008 at 12:24 pm
Only a matter of time, methinks, before all the Nutritionistas start pushing these worthless “personal nutrigenomic profiling” tests - at a hefty mark-up, of course.
Can anyone find us a private nutritionista clinic website in the UK already touting such useless junk?
dvnutrix // June 16, 2008 at 10:11 am
As recommended in Former Visiting Professor Holford’s last newsletter to his paying customers: Genetic Health’s Gene Nutrition.
I can’t tell you how perplexed and disappointed I am that everyone’s favourite PCR pin-up, Prof Stephen Bustin, is one of the SAB for that place.
Claire // June 16, 2008 at 1:44 pm
“I can’t tell you how perplexed and disappointed I am that everyone’s favourite PCR pin-up, Prof Stephen Bustin, is one of the SAB for that place.” [DVN]
I imagine that it’s entirely possible that Prof. Bustin’s advice to Genetic Health about this kind of testing is critical and fastidiously objective, reflecting current levels of knowledge. But somebody happening on such a site is more likely, I think, to view his membership of their SAB as suggestive of endorsement, and that is a problem.
Wulfstan // June 16, 2008 at 2:15 pm
Gene Watch UK asked the Medicines and Healthcare Regulatory Agency (MHRA) to investigate the genetic tests being marketed by the UK company Genetic Health (pdf) via its Harley Street clinic in London.
I would think it was entirely above suspicion if I saw that Bustin was involved with it in an advisory capacity.
But, I would have been impressed by the involvement of Profs. Smith and Cowen with FFTB before reading about it here. What are SAB’s for if they are not a guarantee of intellectual and business rigour and ethics? Or, should there be a disclaimer: “Our SAB’s involvement is related only to the science and is not a comment on the efficacy or real-world relevance of the tests that we offer as a business. Nor should it be assumed that their expertise underpins any claims that we make for the diagnostic value of our tests. Nor the nutritional or other pharmacological recommendations that we makes as part of our analysis”.
Dr Aust // June 16, 2008 at 2:58 pm
The Genewatch document from the second of Wulfstan’s links is a real corker in the context of the “flogging expensive nonsense DNA tests to the worried well”.
As has been said, I guess Bustin may only be advising them on how to do PCR properly, but if I was him I might be wondering who I was holding hands with.
dvnutrix // June 17, 2008 at 6:57 am
More action in the US about dtc genetic tests.
And, consequently, your own GP etc. is probably not in a position to give you a sanity-check on any worrying information that you receive from private genetic tests. (As ever, Gene Sherpa has something of interest to say on a related issue and comments on the California ruling.)
Claire // June 17, 2008 at 9:37 am
Mayo Clinic ran this fairly neutral patient information piece on genetic testing recently:
http://www.mayoclinic.com/health/genetic-testing/FL00076/rss=1
Claire // June 18, 2008 at 1:14 pm
just came across this:
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1398-9995.2008.01705.x
‘Testing for IgG4 against foods is not recommended as a diagnostic tool: EAACI Task Force
(Allergy journal)
Abstract:
Serological tests for immunoglobulin G4 (IgG4) against foods are persistently promoted for the diagnosis of food-induced hypersensitivity. Since many patients believe that their symptoms are related to food ingestion without diagnostic confirmation of a causal relationship, tests for food-specific IgG4 represent a growing market. Testing for blood IgG4 against different foods is performed with large-scale screening for hundreds of food items by enzyme-linked immunosorbent assay-type and radioallergosorbent-type assays in young children, adolescents and adults. However, many serum samples show positive IgG4 results without corresponding clinical symptoms. These findings, combined with the lack of convincing evidence for histamine-releasing properties of IgG4 in humans, and lack of any controlled studies on the diagnostic value of IgG4 testing in food allergy, do not provide any basis for the hypothesis that food-specific IgG4 should be attributed with an effector role in food hypersensitivity. In contrast to the disputed beliefs, IgG4 against foods indicates that the organism has been repeatedly exposed to food components, recognized as foreign proteins by the immune system. Its presence should not be considered as a factor which induces hypersensitivity, but rather as an indicator for immunological tolerance, linked to the activity of regulatory T cells. In conclusion, food-specific IgG4 does not indicate (imminent) food allergy or intolerance, but rather a physiological response of the immune system after exposition to food components. Therefore, testing of IgG4 to foods is considered as irrelevant for the laboratory work-up of food allergy or intolerance and should not be performed in case of food-related complaints.
dvnutrix // June 19, 2008 at 10:08 am
We are still waiting for confirmation from the notes from Holford’s recent talk at the Allergy and Gluten Free Show. However, it looks like Holford mentioned a well-known IgG testing service on several occasions as well as selling out the test-kits at the back of the room. tbc but, there are rumours that he claimed:
*he was working in allergy clinics back in 1980
*most food allergies can be reversed and can be unlearned
*he has treated “thousands and thousands of people with allergies” .
Most pertinently for the IgG test, Holford said:
*as a clinician he finds that IgG accounts for more food reactions
*IgG doesn’t have IgE histamine reaction or Mast cell degranulation
*IgG is the “new kid on the block although there is 15 years of research now”
*”[S]ome critics have said that “Everyone has IgG reactions you just develop it to any food you eat”. That is nonsense. If your body’s healthy you do not develop IgG reactions to foods.”
Now, he was using ‘reactions’ and ‘antibodies’ quite loosely but even so, that last one is remarkable. One of the significant issues with Holford’s talks seems to be that he puts up slides of tremendously complex processes, with the technical vocabulary, and sometimes uses that vocabulary which rather loses his audience. And then he uses everyday terms so loosely that it is difficult to discern what he is trying to say. But I would hope that even he realises that the general population does produce IgG antibodies in response to eating foodstuffs.
We’ll write more on this but suspect that Holford would argue that he is discussing a non-histamine mechanism so this is irrelevant. Plus, the authors seem to hedge their bets by referring to “(imminent) food allergy or intolerance” in their conclusion.
The position paper (pdf) says:
Bearing in mind that the industry would try to confuse consumers by highlighting that this paper is about: IgG4, sometimes RAST rather than ELISA and refers to ‘imminent’ rather than the delayed reactions that nutritionistas etc. talk about, I would prefer it if the authors had issued a more unambiguous conclusion but that is neither here nor there. For those who are looking for wiggle room (or prefer to ignore such studies), the wiggle is there. And, let us recall, Holford is the man who prefers his anecdote of 2 people to a systematic review of 230,000+.
Edit to add in link to position paper.
Claire // June 19, 2008 at 11:11 am
another position statement link (pdf), this time from the Allergy Society of South Africa. Refers to ASA October 2007 YT ruling:
http://www.allergysa.org/pdfs/intolerance_tests.pdf
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