Tara Parker-Pope and Jonny Bowden

Expert PR people will tell you that the best form of advertising is that which looks like editorial rather than advertising. It is comparatively cheap and in ‘advertising value equivalents’, it is invaluable to the pundit whose work is thereby promoted because it enhances not only their pundit brand equity (‘Pundit Z – as featured in The New York Times‘ etc.) but can lead to increased book sales and sales of related products. It seems that people trust editorial more than advertising because the perception is that the material overcame close scrutiny to make it into the main part of the paper/broadcast, rather than purchasing advertising space.^[1]

Tara Parker-Pope recently posted one of those ever popular lists: The 11 Best Foods You Aren’t Eating. As soon as HolfordWatch saw the title, we suspected that we were about to read a list from a nutritionist rather than a Registered Dietitian, and this was confirmed by:

• the poor quality evidence given in support of list items
• the inclusion of cinnamon for ‘blood sugar and cholesterol control’, and turmeric for its “anti-cancer properties”.

We don’t like to appear curmudgeonly and the list was mostly fruit and vegetables so perhaps this was only worth a “Tsk” before passing on to better-researched items.

But, the list was given the imprimatur of authority because it had been drawn from an article by Dr Jonny Bowden and itself drawn from one of his books. In a very short article, Parker-Pope gave Dr Jonny Bowden this form of address 3 times. However, it is unlikely that this would happen in the UK because Bowden has a PhD in Nutrition (pdf) from Clayton College of Natural Health^[2] – the self-same place that awarded a PhD to Gillian McKeith, the one that the ASA was going to recommend that she should not use in some contexts because it is misleading. McKeith pre-empted the ASA ruling by voluntarily agreeing not to use it to promote her products.

Dr Bowden has the same alma mater for his PhD as Gillian McKeith, and, eerily, he is a CNS Diplomate of the American College of Nutrition (searchable database is down at present) – the institution from which Gillian McKeith mistakenly claimed accreditation. Gillian McKeith actually has an accreditation from the same institute as that which lent its lustre to Hettie (formerly, the feline companion of Dr Ben Goldacre). Bowden’s CV also lists a qualification that we hadn’t heard of previously: National Institute of Nutrition Education at American Health Sciences University: Degree: Certified Nutritionist (C.N.) We tried to look up more information but the American Health Sciences University seems to be in abeyance – even on the Wayback archive.^[3] [See footnote for an update which reveals that this is not currently a degree but certification so it looks as if Bowden made an error when he listed it as such.]

15 times in the comments, Parker-Pope or Jonny Bowden respond to comments and refer to him as Dr Bowden. Comment 376, somebody asks if Bowden is a Registered Dietitian and Parker-Pope responds by quoting parts of his CV:

Dr. Bowden has a Master’s Degree in psychology and counseling and a PhD in nutrition, and has earned six national certifications in personal training and exercise. He is board certified by the American College of Nutrition. He is adjunct faculty at Clayton College for Natural Health.

One of those “six national certifications” is in metabolic typing and it has some unusual certification outcomes from an academic viewpoint..^[4] In comments 405 and 443, commenters raised the issue of Clayton College of Natural Health (both link to Quackwatch on the CCNH) but Parker-Pope still hasn’t addressed the issue although she has responded to other commenters. (Interestingly, in comment 501, she drops the Dr when she advises someone on where she might purchase Bowden’s books.)

As far as HolfordWatch is concerned, people can promote lists of foods that they consider to be A Good Thing, Unduly Neglected, Ripe for Revival etc. to their heart’s content. We only demur if said list is presented with the imprimatur and respectability of someone with the title of Dr, when, in the UK, that title is awarded on the basis of a qualification that does not cut the mustard with our own Advertising Standards Authority and has been deprecated by several sources.

HolfordWatch also has a difference of opinion concerning the implicit clinical claims made for the state of the evidence about turmeric and cinnamon.

This is all very disappointing. HolfordWatch expected better from a paper of record like the New York Times. To add insult to injury, Parker-Pope has not clarified Bowden’s status for her readers despite commenters bringing it to her attention. Furthermore, she has gone on to post an item about a study that is so unexciting and lacking in novelty while also failing to make a substantial contribution to the scientific literature that it is difficult to understand why she is highlighting it: Lying About Your Vegetables. Regular readers might not be surprised to learn that this paper was published by Nutrition Journal: Effects of social approval bias on self-reported fruit and vegetable consumption: A randomized controlled trial.

This randomised control trial attempts to be both an observation study and an RCT: it is a very odd design. One would normally wonder what the reviewers were doing in letting this through but Nutrition is a pay-to-publish journal and although it styles itself as peer-review, it isn’t in the usual meaning of that phrase.^[5] We find ourselves in some agreement with the criticisms of Nutrition and its peer-review policy in comment 78:

Some pay to publish journals are excellent but this is not one of them. [Nutrition] is also fast becoming the preferred publication venue for supplement companies…
This is an a faint echo of what is typically understood to be peer-review. Posting an online response to a paper means that it is not listed in PubMed – publishing a response that would be listed probably involves paying to publish your response (US$1900).

Readers expect better from a US paper of record. Not only that, but, as Goldacre highlighted recently, the NYT was the subject of the fascinating Phillips et al study: Importance of the lay press in the transmission of medical knowledge to the scientific community. Goldacre wrote:

Phillips et al showed, in a seminal paper from the New England Journal of Medicine in 1991, that if a study was covered by The New York Times, it was significantly more likely to be cited by other academic papers. Was coverage in the NYT just a surrogate marker for the importance of the research? History provided the researchers with a control: for 3 months, large parts of the NYT went on strike, and while the journalists did produce an “edition of record”, this was never published. They wrote stories about academic research, using the same criteria of importance as ever: the research they wrote about, in articles which never saw the light of day, saw no increase in citations.

People read newspapers. Despite everything we think we know, their contents seep in, we believe them to be true, and we act upon them.

So, whether somebody is seeking to increase their pundit brand equity or to raise the profile of an academic paper, it is significant if something is cited in the NYT.^[6] One thing is clear, with all due respect to the well-credentialled shade of the long-dead Hettie, the NYT needs to pay more care and attention to selecting its sources for nutrition information if it is going to claim more authority for them than “X thinks eating this list of fruit and vegetables is A Good Thing“.

Update: In comment 636 RD Catherine Collins has commented on the value of a Mediterranean Diet and admonished the NYT.

It is rather sad the prestigious NYTimes should have to descend to the musings of self-styled nutritionists to support this weak article. I’m sure my American Registered Dietitian colleagues would concur with my opinions. Lets have more Michael Pollan, and less pseudoscientific nutrition. Your readers deserve better.

Although Parker-Pope has not yet put an addendum on her post that acknowledges the comments about Bowden’s PhD and other qualifications, she has stopped referring to him as Dr Bowden in the comments. However, this is not good enough and it would be better if she were to update her post.
Update 2: TPP continue to disappoint. She refers to him as Dr Bowden when discussing his qualifications in comment 672 and doesn’t elaborate on the PhD.
I would hope that the US Registered Dietitians and their associations will contact the NYT to express their displeasure about this item.
Update 3 July 3: Well, the embarrassment continues. We have added further information about the AHSU in footnote [3]. TPP continues to fail to answer reasonable questions about Bowden’s PhD and is now affecting not to understand english in spots. TPP apparently doesn’t understand the use of the word ‘topic’ and she is now concentrating on a defence of Bowden’s certification by the American College of Nutrition. TPP is ignoring a perfectly clear set of questions in comment 700; and some pertinent observations in #733.
In perhaps one of the oddest comments that I’ve seen, TPP writes:

It doesn’t matter to me if somebody’s degree is from Harvard or a local community college. What I’m interested in is the science and evidence that backs their claims.

Which would be commendable if the evidence that she provided for cinnamon and turmeric were not so poor and unrepresentative of the state of the scientific literature on this point.

Notes

[1] Advertising equivalents are a frequent topic for discussion. Proving the value of public relations gives a good overview of the current state of this discussion: Advertising Value Equivalents Revisited.
[2] The PhD must be quite a recent acquisition because as recently as 2005, Jonny Bowden was listing MA CNS as his qualifications: see the cover of Living the Low Carb Life. HolfordWatch’s first sighting is the cover of a CD in 2006. As for the PhD itself, the Clayton College of Natural Health states its accreditation as follows:

Clayton College is accredited by the American Association of Drugless Practitioners and the American Naturopathic Medical Accreditation Board . The International Iridology Practitioners Association accredits CCNH’s Iridology Certificate program. These private associations offer professional accreditation in the field of naturopathy and other areas of natural health. As such, they are designed to meet the needs of non-traditional education and are not recognized by the United States Department of Education…Clayton College is licensed by the Alabama Department of Postsecondary Education. [Emphasis added.]

There is some cause for concern here. Some people are attempting to use the visibility and media status of people like Jonny Bowden to amend the Wiki entry about CCNH which currently quotes the QuackWatch view. It would be ironic if somebody were to gain pundit brand equity through non-standard qualifications and that pundit equity was then used to validate the ‘respectability’ of the course and give it standing in the mainstream.
The CCNH was formerly known as the American Holistic College of Nutrition: it was known by this name when Gillian McKeith acquired her PhD from this institution.
[3] This degree from National Institute of Nutrition Education at American Health Sciences University is also mentioned at Quackwatch. AHSU is discussed at Quackwatch.

American Health Science University offers a Certified Nutritionist (CN) credential to students who complete its six-course “distance learning program” and take an examination. Although accredited, it is closely aligned with the health-food industry and should not be regarded as trustworthy. Its president, James R. Johnston, does not appear to have a accredited doctoral degree.

The CNS from the American College of Nutrition requires “requires an advanced degree, professional experience, and a passing score on the CBNS certifying examination”. The exam is described thus:

Examinees for certification as Certified Nutrition Specialists will be allowed four hours to complete the examination. The examination questions will be drawn from a bank of questions submitted by examination committee. The examination will consist of 200 questions, all in single-answer, multiple choice format, and will cover the broad spectrum of basic and applied nutritional science. Themes such as nutritional science, nutrition assessment, treatment outcomes, epidemiology, and integration of these areas are threaded throughout examination. An adjusted score of 65% is required to pass the examination.

However, it is remarkably unfortunate to have ‘qualifications’ from CCNH and ASHU on the same C.V. as it detracts from a more bona fide qualification such as the ACN board certification.
Update July 3: We managed to contact the AHSU. AHSU state that they offer a certification,
and not a degree so we have to assume that Bowden made a mistake when he listed it as a degree on his CV (pdf). ASHU states that this qualification is suitable for candidates with no science background, and can be completed in 2-3hrs/week over 15-20 months. They report that they’ve had candidates complete the course in eight months. The certifications costs about $3100 in course fees.
[4] You can read all about Bowden’s Certificate in Advanced Metabolic Typing and Analysis. Successful certification allows:

access to the online questionnaire. This questionnaire is a thorough and accurate computerized test, based on over 25 years of clinical experience analyzed at Healthexcel, Inc. The Advanced Program identifies Metabolic Types (autonomic, oxidative, endocrine), proper diet plans, Candida Albicans Overgrowth propensity, and life-style considerations.

One of the outcomes from certification is “40% commission for supplement orders from your clients through Ultra Life”. Oddly enough, the outcome of going through this online questionnaire is a programme of recommended supplements – ones that you can purchase from your nutritionist who is entitled to a 40% commission for any client orders placed through them. Depending on how many clients you persuade to purchase the designated supplements, the course price of $445 for the online version or $795 for the workshop version may represent good value and open up a good ROI.
[5] From Nutrition Journal‘s Peer Review Policies:

Each manuscript submitted to Nutrition Journal will be assigned to one or two external reviewers for peer-review, which is normally completed in 2 to 8 weeks. In deciding whether to accept or reject a manuscript, a reviewer asks him/herself whether the scientific community is better served by publishing or not publishing the manuscript. In the absence of compelling reasons to reject, Nutrition Journal advises that reviewers recommend acceptance, as ultimately the quality of an article will be judged by the scientific community after its publication. [Emphasis added.]

[6] It would be invaluable if somebody were able to design a study that assessed the impact of (say) the NYT’s blogs. Would the impact be diminished because it is a blog rather than the paper? Do more people find the papers because they are actively linked from blogs (although, the NYT is notable for its policy of linking to papers that it discusses in health and science articles)?