Food for the Brain seem very pleased about an embarrassingly poor quality interview with Holford in National Health Executive (PDF): a journal targeted at senior health managers. Food for the Brain have sent out an e-mail to their mailing list to proudly plug this piece. However, the questions are frankly rather odd, and Holford is allowed:
- to bask in the glory of a Associate Parliamentary Forum report on diet, mental health and behaviour (despite the fact that the report failed to mention his work or that of Food for the Brain)
- to cast aspersions on the nutritional knowledge of qualified health professionals
- to accuse healthcare professionals of being biased against nutrition due to the role of pharmaceutical industry funding although Holford himself works for a company part-owned by Elder Pharmaceuticals, and accepted £464,000 from Neutrahealth.
It also looks like the NHE takes pay-to-print articles which might or might not explain the appearance of an article that reads like an extended advertorial for Food for the Brain and Holford.
The interview starts by paying considerable attention to the recent Parliamentary Food and Health Forum inquiry on diet, mental health and behaviour. Holford is asked whether “the report will help the nutritional approach to good health become more mainstream”. However, although Holford did make a submission to the Inquiry (a discussion of some jaw-droppingly poor-quality research conducted by Food for the Brain: the charity which has Holford as CEO), the Forum did not mention or reference any of this research in the body of the report which resulted from this Inquiry. Neither Holford nor Food for the Brain are even mentioned in this Report, except to acknowledge that they submitted evidence. Some people might find this embarrassing: it does appear that the Forum did not see Holford’s research as particularly noteworthy. However, Holford remains happy to use this report when plugging his own work (the same type of poor-quality research that the Forum did not even consider worth mentioning in their report). In a rather Grouchian way, it seems that Holford may rather admire clubs that would not accept him as an appropriate member.
In probably the weirdest interview question I’ve seen for a while, Holford’s interviewer poses this puzzler:
Some of the attacks on you and other high profile nutritionists by mainstream health practitioners are extraordinarily hostile. Do you think this is going to be lessened by the parliamentary report and by other projects that you have taken on with schools in south London or is that resistance still there?
Where to start?
“Extraordinarily hostile” relative to whom? Holford’s own letters to people who disagree with him or displease him? Extracts from the lamentable Martin Walker book from which Patrick Holford has quoted vast swathes on his own website? Holford’s astonishing letters of complaint to newspapers that carry articles that displease him? Holford’s own assertions about the integrity of journals such as the BMJ and researchers such as Professor Summerbell?
The quality of Patrick Holford’s research does not withstand even cursory, far less close, scrutiny. When Prof Tom Sanders – an academic expert on nutrition – analysed some of Holford’s work he was highly critical, not because of some imagined professional jealousy but because of the poor quality of Holford’s research.
Ben Goldacre dedicated Chapter 9; pp 161-80 of Bad Science to a scrutiny of the core chapter of the core text of british nutritionism, Holford’s Optimum Nutrition Bible. Suffice it to say that Holford’s research is demonstrably of a poor quality and of a disappointing standard.
People challenge Holford, not because of some kind of professional competition, but because he gets the facts about health and nutrition badly wrong – sometimes in potentially harmful ways or ways that undermine the public understanding of science.
The Food for the Brain Survey 2007 was such poor quality that Professor David Smith, a member of Food for the Brain’s own Scientific Advisory Board admitted that it hadn’t been a ‘proper job’. There really can not be a stronger indication that the people who conducted this research and wrote up the report demonstrated serious flaws in their understanding of research methodology and analysis of results.
As Mark Etherton points out in the comments, this was not actually a “parliamentary report” in terms of the usual understanding of parliamentary report. The Associate Parliamentary Food and Health Forum is not a body set up by Parliament on the lines of the Commons Health Committee or the Lords Science and Technology Committee but just a Special Interest Group which is not quite the same thing. As Mark Etherton points out, the reports carry no special weight or imprimatur of respectability.
Things get even stranger, however, when you look at Holford’s answer to a subsequent question about why healthcare professionals criticise him:
It’s partly to do with training. If a doctor trained ten years ago they will have had between six and twelve hours on nutrition. And probably none of those hours were to do with mental health and nutrition.
Firstly, I would query how many hours of education on mental health and nutrition Holford received during his BSc Psychology at York (his only accredited degree-level qualification). Holford stresses that he is an auto-didact. He would – I am sure – have looked at nutrition in more depth when he was studying for an MPhil at Surrey; however, given that he failed to complete the MPhil, I am not sure that this really counts. It is unclear why Holford believes that GPs and other doctors should be less able than he is to pick up information about nutrition from reading various sources (some of which they may read with greater understanding than Holford exhibits when he writes them up).
Secondly, while many or most doctors have a better understanding of nutrition than Holford implies (and I would suspect that most people who listened to their grandmothers get fewer things wrong about nutrition than Holford does) it is bizarre that neither Holford nor the interviewer mentions dietitians: these healthcare professionals have a degree in food science or dietetics and a postgraduate-level training, and some prominent criticisms of Holford have come from dietitians. Holford may not agree with these dietitians, but for him to imply that they lack an adequate training in nutrition is rather odd. I wonder if the British Dietetic Association will be contacting National Health Executive, to correct this omission?
I am not sure if Holford is being deliberately ironic when he argues that
What is more insidious is that the pharmaceutical approach to health funds a lot of education and a lot of continued education…When you have a multi-million pound market with a very evolved structure of marketeers and educators influencing conventional medical practice, then to start to suggest that a supplement might be an alternative or an adjunctive treatment is really quite controversial. In other words, money talks.
Certainly, money talks, and the pharmaceutical industry does a lot of unpleasant things (this is part of the reason why we do not accept donations from the pharmaceutical industry).
On the issue of just who accepts funding from specialist sources or people with a vested interest, we refer interested readers to pg viii of Holford’s Improve Your Digestion 1999: there, you may read about “Lamberts’ Library at the Institute of Optimum Nutrition”. Lamberts is a company that manufactures supplements. Allegedly, Patrick Holford’s mentor, Linus Pauling, accepted funding from a pharmaceutical company to fund his research.
Additionally, it was revealed that Hoffman-La Roche, a company that at the time produced most of the world’s vitamin C supplements, extensively funded Pauling’s Institute.
Holford currently markets a range of Biocare pills that happen to coincide remarkably well with his nutritional recommendations and which carry a picture of Holford’s face on the bottles. He sold his Health Products for Life company to Biocare (whom he currently works for as Head of Science and Education) for £464,000; Biocare are owned by Neutrahealth who, as we may have mentioned, are 30% owned by Elder Pharmaceuticals. When Holford founded the Institute for Optimum Nutrition – which has educated an impressive proportion of UK ‘alternative’ nutritionists, albeit not very impressively – it started out a private company, ran into difficulties and dropped off the radar for some time before reinventing itself as a charity with not-for-profit remits. Food for the Brain 2008 conference is ‘in partnership with’ Biocare (I may have mentioned Elder Pharmaceuticals’ 30% ownership of Biocare/Neutrahealth) and also ’supported by’ Equazen (owned by the pharmaceutical company Galenica).
These factors might have made some of us cautious about attacking the role of pharmaceutical industry money in distorting the education of healthcare professionals – or, at least, others would have acknowledged their own commercial involvement with the pharmaceutical industry and pill sales before ranting about pharmaceutical industry influence. However, both Holford and his interviewer are apparently untroubled by this.
To top things off, the interview ends with Holford asserting (unchallenged) an outright falsehood:
There are no side effects that we know from taking fish oil supplements.
Fish oil supplements are generally thought to be relatively safe, but they can have side effects: for example, fishy burps and an upset stomach are pretty common, and a high intake of fish oil can also lead to increased bleeding times. There are also some groups of people who should not take fish oil supplements without consulting appropriately-qualified medical advisors: people who have bleeding disorders, or those who already take blood-thinners come to mind. We should also add that it may depend on the source of your fish oil supplement: consumers should be mindful that it is possible to obtain excessive amounts of vitamin A from fish oil if a little too much is taken over time. (Update: according to Dr Alex Richardson, not all fish oil supplements are of comparable or adequate quality.)
The interview thus ends with an excellent example of why people criticise Holford: nutritional supplements (although inadequately regulated, and sold in all kinds of inappropriate places) are not sweeties, and can have real effects and real side effects. It is important to get things right when discussing such supplements – something which, despite the fish oil that he reportedly takes, Holford appears to be unable or unwilling to do.
In what seems to be a recurrent theme, it is hard to conjecture why anybody thought that this article was worth publishing. It reads as an advertorial for Food for the Brain and for Holford’s own view of himself: an explanation may lie in the NHE mission statement.
But promoting your company to the NHS can be difficult and frustrating. Who controls the budget? Who is involved in the final decision? Who signs off the orders? How do you get your product or service in front of the people who count?…
It is targeted at and read by chief executives and senior managers across the sector. That’s why some of the biggest companies in the market such as Fujitsu, Siemens and Boots use it to get their message across to decision-makers as well as NHS bodies such as NICE and NHS Alliance to promote their campaigns.
NHE works. Why not let it work for you?
Given Holford’s usual sensitivities to the appearance of impropriety or conflict of interest, it would be a service to the readers of National Health Executive if they were to include a small disclaimer at the footnote of articles that would let the reader know whether or not an article is pay-to-print or a spontaneous accolade or preview for an up-coming hagiography.
16 Comments
November 17, 2008 at 11:26 pm
It’s perhaps worth adding that the parliamentary report is not an official one, in the sense that the Associate Parliamentary Food and Health Forum is not a body set up by Parliament on the lines of the Commons Health Committee or the Lords Science and Technology Committee. The Forum is a presumably a group of MPs and peers interested in the subject, similar, for example, to an All-Party group on a particular country. Its report carries no official weight other than its own merits (whatever they may be) and it is not printed by tSO – formerly the Stationery Office. Nor is the Government obliged to respond to it, as it would have to to a Select Committee report.
November 17, 2008 at 11:33 pm
Good point – revised the post to make clear that this is an Associate forum.
November 18, 2008 at 12:40 am
Just to note that even the Daily Mail sees fit to mention caveats.
(There are some harsh words about the quality of some fish oil supplements in that piece.)
November 18, 2008 at 2:09 am
‘Firstly, I would query how many hours of education on mental health and nutrition Holford received during his BSc Psychology at York (his only accredited degree-level qualification).’
Came up once or twice, but since the course doesn’t cover much mental illness, and isn’t about treating people, not a lot – occasionally mentioned as a tangent or ‘alternative therapy’. To be fair, we didn’t do huge amounts on meds either – it’s just not a big part of undergrad psychology since it’s not a clinical qualification.
November 18, 2008 at 9:30 am
spectacular. how can Holford justify his criticism of Big Pharma, when, as you point out, he himself has very large interests in the companies that sell the supplements he advocates?!
as for the NHE, most medical practitioners and managers do know that many of the pieces are pushed on a pay-per-print basis and so don’t necessarily take what’s printed as gospel – not that this is an excuse to print such rubbish mind!
November 18, 2008 at 12:51 pm
Teek is that generally known about NHE? Not so much for the targeted audience but in this case, the audiences to whom Patrick Holford sent the email that promoted this interview and its Weltanschauung of hostility and the plucky underdog trying to get his message about diet out to the public.
So, if I’m irritated by the interview should I stop thinking that it will have any impact on other readers? A bona fide example of W. Phillips Davison’s third person effect.
November 18, 2008 at 1:04 pm
Jesus. Did they seriously write “extraordinarily hostile” in relation to people criticising Holford? Excuse me while I retrieve my jaw from the floor.
November 18, 2008 at 1:25 pm
jdc, yes, there are people who react badly if you disagree with them or try to stop them from putting their little brother’s wet fingers in an open socket. Allegedly, they perceive this as a personal affront or hostile attack.
To borrow from Wulfstan, that’s Holford’s Weltanschauung and that’s fine. But, at the risk of sounding as if I have a bad case of the 3rd person effect, I don’t think it is fine when that interview is presented to Holford’s mailing-list as if it is evidence of a tacit acknowledgement of that Weltanschauung .
It’s getting to be pretty depressing. In the past few weeks we’ve had:
* a misunderstanding as to the source of a Holford press release that somehow looked as if it came from NTA
*an article on nutritional approaches to treating addiction in The Economist that deviated from the usual standards and was written by Jerome Burne
*a credulous piece in NHE that may or may not have been pay-to-print that doesn’t challenge Holford in any way.
November 18, 2008 at 4:14 pm
Seems like you can write your own editorial material for NHE. Hmm…
Admin edit to fix html
Update – and crossed the correction
November 18, 2008 at 4:17 pm
Grr – corrected link!
Seems like you can write your own editorial material for NHE. Hmm…
November 19, 2008 at 12:14 am
Wow – so nothing about accuracy, appropriateness, sense of perspective or other such mundanities. Basically, pay for a number of words, write it as if somebody else is writing it about you, submit it in Word format, hand it in before the copy deadline and that’s you.
That is…whatever the appropriate word is in this context.
@Duck, given how very young York’s Psychology degree was back then, I should imagine there was even less nutrition content than there is now.
November 19, 2008 at 2:22 am
So let me get this straight: it’s really paid advertising.
How utterly surprising, then, that it should present best-selling author, wealthy supplement entrepreneur and highly paid TV Nutritionista Patrick as a “plucky underdog”, in Wulfstan’s phrase.
One can only conclude that being the underdog helps shift the product.
November 19, 2008 at 10:30 am
That editorial guide is a bit of hoot, isn’t it? Basically boils down to “don’t be too obvious about advertising your wares and we’ll happily promote you/your product”
November 19, 2008 at 11:39 am
The question is whether there are senior people in the NHS who resonate with this message about being the heroic, plucky underdog, with the message to save us all, but to whom The Powers That Be Won’t Listen. My guess is that there are.
The next question is whether they would read the article and be well-disposed to considering any applications to PCTs etc. (as per the appeal) that:
*they should introduce nutritional therapy into their addiction treatment centres
*they should accept contracts from private treatment centres that offer beds and this treatment.
Holford and Miller Masterclass: Nutritional Strategies for Breaking Addiction.
So, Patrick Holford gets money for:
*giving seminars about his book to the public
*training IONistas
*delivering masterclasses to train IONistas and allied health professionals in nutritional strategies for addiction (never mind the messy emotional stuff, family work etc. etc.)
*his book, video and supporting materials
*any sales of his recommended supplements that they prescribe
*presumably, he gets a slice of any referrals to the FFTB or Brain Bio Centre.
And all for the financial outlay of writing a book that contains no original research (qua bench research, appropriate trials in appropriate facilities) and can basically be stitched together from some Googling and linking up work by other people (Miller and Braly probably contributed their own work that hasn’t been published in one of the expected venues).
Holford has great emotional, business and financial acumen.
November 19, 2008 at 12:25 pm
I have another musical parody nearly done which pokes fun at our Nutritionista chums. Doesn’t have a verse on “stealth marketing”, though, I’m afraid.
November 19, 2008 at 11:25 pm
[...] it had been a while since I wrote anything about our friends the Nutritionistas. And then I saw this amusing – if rather depressing – piece about an Old Friend of the BadScience Blogosphere who is something of a National Nutritionista [...]