9 Professor Patrick Holford
Where do all these ideas about pills, nutritionists and fad diets come from? How are they generated, and propagated? While Gillian McKeith leads the theatrical battalions, Patrick Holford is a very different animal: he is the academic linchpin at the centre of the British nutritionism movement, and the founder of its most important educational establishment, the ‘Institute for Optimum Nutrition’. This organisation has trained most of the people who describe themselves as ‘nutrition therapists’ in the UK.*
≡ ‘Nutritionist’, ‘nutrition therapist’, ‘nutritional therapy consultant’ and the many variations on this theme are not protected terms, unlike ‘nurse’, ‘dietitian’ or ‘physiotherapist’ so anyone can use them. Just to be clear, I’ll say it again: anyone can declare themselves to be a nutritionist. After reading this book, you will know more about the appraisal of evidence than most, so in the manner of Spartacus I suggest you call yourself one too; and academics working in the field of nutrition will have to move on, because the word doesn’t belong to them any more.
Holford is, in many respects, the originator of their ideas, and the inspiration for their business practices.
Praise is heaped upon him in newspapers, where he is presented as an academic expert. His books are best-sellers, and he has written or collaborated on around forty. They have been translated into twenty languages, and have sold over a million copies worldwide, to practitioners and the public. Some of his earlier works are charmingly fey, with one featuring a Blue Peter-ish ‘dowsing kit’ to help you diagnose nutritional deficiencies. The modern ones are drenched in scientific detail, and stylistically they exemplify what you might call ‘referenciness’: they have those nice little superscript numbers in the text, and lots of academic citations at the back.
Holford markets himself vigorously as a man of science, and he has recently been awarded a visiting professorship at the University of Teesside (on which more later). At various times he’s had his own slot on daytime television, and hardly a week goes by without him appearing somewhere to talk about a recommendation, his latest ‘experiment’, or a ‘study’: one school experiment (with no control group) has been uncritically covered in two separate, dedicated programmes on Tonight with Trevor MacDonald, ITV’s peak-hour investigative slot, and that sits alongside his other appearances on This Morning, BBC Breakfast, Horizon, BBC News, GMTV, London Tonight, Sky News, CBS News in America, The Late Late Show in Ireland, and many more. According to the British media establishment, Professor Patrick Holford is one of our leading public intellectuals: not a vitamin-pill salesman working in the $50-billion food-supplement industry—a fact which is very rarely mentioned, if ever—but an inspiring academic, embodying a diligent and visionary approach to scientific evidence. Let us see what calibre of work is required for journalists to accord you this level of authority in front of the nation.
AIDS, cancer and vitamin pills
I first became fully aware of Holford in a bookshop in Wales. It was a family holiday, I had nothing to write about, and it was New Year. Like a lifesaver, here was a copy of his New Optimum Nutrition Bible, the 500,000-copy best-seller. I seized it hungrily, and looked up the big killers. First I found a section heading which explains that ‘people who take vitamin C live four times longer with cancer’. Excellent stuff.
I looked up AIDS (this is what I call ‘the AIDS test’). Here is what I found on page 208: ‘AZT, the first prescribable anti-HIV drug, is potentially harmful, and proving less effective than vitamin C Now, AIDS and cancer are very serious issues indeed. When you read a dramatic claim like Holford’s, you might assume it’s based on some kind of study, perhaps where people with AIDS were given vitamin C. There’s a little superscript ‘23’, referring you to a paper by someone called Jariwalla. With bated breath I grabbed a copy of this paper online.
The first thing I noticed was that this paper does not mention ‘AZT’. It does not compare AZT with vitamin C. Nor does it involve any human beings: it’s a laboratory study, looking at some cells in a dish. Some vitamin C was squirted onto these cells, and a few complicated things were measured, like ‘giant cell syncytia formation’, which changed when there was lots of vitamin C swimming around. All well and good, but this laboratory-bench finding very clearly does not support the rather dramatic assertion that ‘AZT, the first prescribable anti-HIV drug, is potentially harmful, and proving less effective than vitamin C In fact, it seems this is yet another example of that credulous extrapolation from preliminary laboratory data to clinical claim in real human beings that we have come to recognise as a hallmark of the ‘nutritionist’.
But it gets more interesting. I casually pointed all this out in a newspaper article, and Dr Raxit Jariwalla himself appeared, writing a letter to defend his research paper against the accusation that it was ‘bad science’. This, to me, raised a fascinating question, and one which is at the core of this issue of ‘referenci-ness’. Jariwalla’s paper was a perfectly good one, and I have never said otherwise. It measured some complicated changes at a basic biological level in some cells in a dish on a lab bench, when they had lots of vitamin C squirted onto them. The methods and results were impeccably well described by Dr Jariwalla. I have no reason to doubt his clear description of what he did.
But the flaw comes in the interpretation. If Holford had said: ‘Dr Raxit Jariwalla found that if you squirt vitamin C onto cells in a dish on a lab bench it seems to change the activity of some of their components,’ and referenced the Jariwalla paper, that would have been fine. He didn’t. He wrote: ‘AZT, the first prescribable anti-HIV drug, is potentially harmful, and proving less effective than vitamin C The scientific research is one thing. What you claim it shows—your interpretation—is entirely separate. Holford’s was preposterous over-extrapolation.
I would have thought this was the point at which many people might have said: ‘Yes, in retrospect, that was perhaps a little foolishly phrased.’ But Professor Holford took a different tack. He has claimed that I had quoted him out of context (I did not: you can view the full page from his book online). He has claimed that he has corrected his book (you can read about this in a note at the back of the book you are holding). He has thrown around repeated accusations that I have only criticised him on this point because I am a paw a of big pharmaceutical corporations (I am not; in fact, bizarrely, I am one of their most vicious critics). Crucially, he suggested that I had focused on a trivial, isolated error.
A vaguely systematic review
The joy of a book is that you have plenty of space to play with. I have here my copy of The New Optimum Nutrition Bible. It’s ‘the book you have to read if you care about your health’, according to the Sunday Times quote on the front cover. ‘Invaluable’, said the Independent on Sunday, and so on. I have decided to check every single reference, like a crazed stalker, and I will now dedicate the entire second half of this book to producing an annotated edition of Holford’s weighty tome.
Only kidding.
There are 558 pages oi plausible technical jargon in Holford’s book, with complicated advice on what foods to eat, and which kinds of pills you should buy (in the ‘resources’ section it turns out that his own range of pills are ‘the best’). For our sanity I have restricted our examination to one key section: the chapter where he explains why you should take supplements. Before we begin, we must be very clear: I am only interested in Professor Holford because he teaches the nutritionists who treat the nation, and because he has been given a professorship at Teesside University, with plans for him to teach students and supervise research. If Professor Patrick Holford is a man of science, and an academic, then we should treat him as one, with a scrupulously straight bat.
So, turning to Chapter 12, page 97 (I’m working from the ‘completely revised and updated’ 2004 edition, reprinted in 2007, if you’d like to follow the working at home), we can begin. You’ll see that Holford is explaining the need to eat pills. This might be an apposite moment to mention that Professor Patrick Holford currently has his own range of best-selling pills, at least twenty different varieties, all featuring a photograph of his smiling face on the label. This range is available through the pill company BioCare, and his previous range, which you will see in older books, was sold by Higher Nature.*
≡ Oh, and he works for the pill company BioCare as their Head of Education and Science (I may have mentioned that the company is 30 per cent owned by pharmaceuticals company Elder). In fact, in many respects he has spent his whole life selling pills. His first job on leaving York with a 2:2 in psychology in the 1970s was as a vitamin-pill salesman for the pill company Higher Nature. He sold his most recent pill-selling company, Health Products for Life, for half a million pounds in 2007 to BioCare, and he now works for that company.
My whole purpose in writing this book is to teach good science by examining the bad, so you will be pleased to hear that the very first claim Holford makes, in the very first paragraph of his key chapter, is a perfect example of a phenomenon we have already encountered: ‘cherry-picking’, or selecting the data that suits your case. He says there is a trial which shows that vitamin C will reduce the incidence of colds. But there is a gold-standard systematic review from Cochrane which brings together the evidence from all twenty-nine different trials on this subject, covering 11,000 participants in total, and concluded that there is no evidence that vitamin C prevents colds. Professor Holford doesn’t give a reference for his single, unusual trial which contradicts the entire body of research meticulously summarised by Cochrane, but it doesn’t matter: whatever it is, because it conflicts with the meta-analysis, we can be clear that it is cherry-picked.
Holford does give a reference, immediately afterwards, for a study where blood tests showed that seven out of ten subjects were deficient in vitamin B. There is an authoritative-looking superscript number in the text. Turning to the back of the book, we find that his reference for this study is a cassette you used to be able to buy from his own Institute for Optimum Nutrition (it’s called The Myth of the Balanced Diet). We then have a twenty-five-year-old report from the Bateman Catering Organisation (who?), apparently with the wrong date; a paper on vitamin B12; some ‘experiment’ without a control reported in a 1987 ION pamphlet so obscure it’s not even in the British Library (which has everything). Then there is a bland statement referenced to an article in the Institute for Optimum Nutrition’s Optimum Nutrition Magazine, and an uncontroversial claim supported by a valid paper—the children of mothers who have taken folic acid during pregnancy have fewer birth defects, a well-established fact reflected in Department of Health guidelines—because there has to be a grain of common-sense truth in the spiel somewhere. Getting back to the action, we are told about a study on ninety schoolchildren who get 10 per cent higher IQ scores after taking a high-dose multivitamin pill, sadly without a reference, before a true gem: one paragraph with four references.
The first is to a study by the great Dr R.K. Chandra, a disgraced researcher whose papers have been discredited and retracted, who has been the subject of major articles on research fraud, including one by Dr Richard Smith in the British Medical Journal called ‘Investigating the previous studies of a fraudulent author’. There is an entire three-part investigative documentary series on his worrying career made by Canada’s CBC (you can watch it online), and at the conclusion of it he was, to all intents and purposes, in hiding in India. He has 120 different bank accounts in various tax havens, and he did, of course, patent his own multivitamin mixture, which he sells as an ‘evidence-based’ nutrition supplement for the elderly. The ‘evidence’ is largely derived from his own clinical trials.
In the name of scrupulous fairness, I am happy to clarify that much of this has come out since the first edition of Holford’s book; but there had been serious questions about Chandra’s research for some time, and nutrition academics were wary about citing it, simply because his findings seemed to be so incredibly positive. In 2002 he had resigned his university post and failed to answer questions about his papers or to produce his data when challenged by his employers. The paper that Patrick Holford is referring to was finally fully retracted in 2005. The next reference in this same paragraph of his book is to another Chandra paper. Two in a row is unfortunate.
Professor Holford follows this up with a reference to a review paper, claiming that thirty-seven out of thirty-eight studies looking at vitamin C (again) found it beneficial in treating (not preventing, as in his previous claim in the text above) the common cold. Thirty-seven out of thirty-eight sounds very compelling, but the definitive Cochrane review on the subject shows mixed evidence, and only a minor benefit at higher doses.
I hooked out the paper Professor Holford is referencing for this claim: it is a retrospective re-analysis of a review of trials, his key chapter, is a perfect example of a phenomenon we have already encountered: ‘cherry-picking’, or selecting the data that suits your case. He says there is a trial which shows that vitamin C will reduce the incidence of colds. But there is a gold-standard systematic review from Cochrane which brings together the evidence from all twenty-nine different trials on this subject, covering 11,000 participants in total, and concluded that there is no evidence that vitamin C prevents colds. Professor Holford doesn’t give a reference for his single, unusual trial which contradicts the entire body of research meticulously summarised by Cochrane, but it doesn’t matter: whatever it is, because it conflicts with the meta-analysis, we can be clear that it is cherry-picked.
Holford does give a reference, immediately afterwards, for a study where blood tests showed that seven out of ten subjects were deficient in vitamin B. There is an authoritative-looking superscript number in the text. Turning to the back of the book, we find that his reference for this study is a cassette you used to be able to buy from his own Institute for Optimum Nutrition (it’s called The Myth of the Balanced Diet). We then have a twenty-five-year-old report from the Bateman Catering Organisation (who?), apparently with the wrong date; a paper on vitamin B12; some ‘experiment’ without a control reported in a 1987 ION pamphlet so obscure it’s not even in the British Library (which has everything). Then there is a bland statement referenced to an article in the Institute for Optimum Nutrition’s Optimum Nutrition Magazine, and an uncontroversial claim supported by a valid paper—the children of mothers who have taken folic acid during pregnancy have fewer birth defects, a well-established fact reflected in Department of Health guidelines—because there has to be a grain of common-sense truth in the spiel somewhere. Getting back to the action, we are told about a study on ninety schoolchildren who get 10 per cent higher IQ scores after taking a high-dose multivitamin pill, sadly without a reference, before a true gem: one paragraph with four references.
The first is to a study by the great Dr R.K. Chandra, a disgraced researcher whose papers have been discredited and retracted, who has been the subject of major articles on research fraud, including one by Dr Richard Smith in the British Medical Journal called ‘Investigating the previous studies of a fraudulent author’. There is an entire three-part investigative documentary series on his worrying career made by Canada’s CBC (you can watch it online), and at the conclusion of it he was, to all intents and purposes, in hiding in India. He has 120 different bank accounts in various tax havens, and he did, of course, patent his own multivitamin mixture, which he sells as an ‘evidence-based’ nutrition supplement for the elderly. The ‘evidence’ is largely derived from his own clinical trials.
In the name of scrupulous fairness, I am happy to clarify that much of this has come out since the first edition of Holford’s book; but there had been serious questions about Chandra’s research for some time, and nutrition academics were wary about citing it, simply because his findings seemed to be so incredibly positive. In 2002 he had resigned his university post and failed to answer questions about his papers or to produce his data when challenged by his employers. The paper that Patrick Holford is referring to was finally fully retracted in 2005. The next reference in this same paragraph of his book is to another Chandra paper. Two in a row is unfortunate.
Professor Holford follows this up with a reference to a review paper, claiming that thirty-seven out of thirty-eight studies looking at vitamin C (again) found it beneficial in treating (not preventing, as in his previous claim in the text above) the common cold. Thirty-seven out of thirty-eight sounds very compelling, but the definitive Cochrane review on the subject shows mixed evidence, and only a minor benefit at higher doses.
I hooked out the paper Professor Holford is referencing for this claim: it is a retrospective re-analysis of a review of trials, his key chapter, is a perfect example of a phenomenon we have already encountered: ‘cherry-picking’, or selecting the data that suits your case. He says there is a trial which shows that vitamin C will reduce the incidence of colds. But there is a gold-standard systematic review from Cochrane which brings together the evidence from all twenty-nine different trials on this subject, covering 11,000 participants in total, and concluded that there is no evidence that vitamin C prevents colds. Professor Holford doesn’t give a reference for his single, unusual trial which contradicts the entire body of research meticulously summarised by Cochrane, but it doesn’t matter: whatever it is, because it conflicts with the meta-analysis, we can be clear that it is cherry-picked.
Holford does give a reference, immediately afterwards, for a study where blood tests showed that seven out of ten subjects were deficient in vitamin B. There is an authoritative-looking superscript number in the text. Turning to the back of the book, we find that his reference for this study is a cassette you used to be able to buy from his own Institute for Optimum Nutrition (it’s called The Myth of the Balanced Diet). We then have a twenty-five-year-old report from the Bateman Catering Organisation (who?), apparently with the wrong date; a paper on vitamin B12; some ‘experiment’ without a control reported in a 1987 ION pamphlet so obscure it’s not even in the British Library (which has everything). Then there is a bland statement referenced to an article in the Institute for Optimum Nutrition’s Optimum Nutrition Magazine, and an uncontroversial claim supported by a valid paper—the children of mothers who have taken folic acid during pregnancy have fewer birth defects, a well-established fact reflected in Department of Health guidelines—because there has to be a grain of common-sense truth in the spiel somewhere. Getting back to the action, we are told about a study on ninety schoolchildren who get 10 per cent higher IQ scores after taking a high-dose multivitamin pill, sadly without a reference, before a true gem: one paragraph with four references.
The first is to a study by the great Dr R.K. Chandra, a disgraced researcher whose papers have been discredited and retracted, who has been the subject of major articles on research fraud, including one by Dr Richard Smith in the British Medical Journal called ‘Investigating the previous studies of a fraudulent author’. There is an entire three-part investigative documentary series on his worrying career made by Canada’s CBC (you can watch it online), and at the conclusion of it he was, to all intents and purposes, in hiding in India. He has 120 different bank accounts in various tax havens, and he did, of course, patent his own multivitamin mixture, which he sells as an ‘evidence-based’ nutrition supplement for the elderly. The ‘evidence’ is largely derived from his own clinical trials.
In the name of scrupulous fairness, I am happy to clarify that much of this has come out since the first edition of Holford’s book; but there had been serious questions about Chandra’s research for some time, and nutrition academics were wary about citing it, simply because his findings seemed to be so incredibly positive. In 2002 he had resigned his university post and failed to answer questions about his papers or to produce his data when challenged by his employers. The paper that Patrick Holford is referring to was finally fully retracted in 2005. The next reference in this same paragraph of his book is to another Chandra paper. Two in a row is unfortunate.
Professor Holford follows this up with a reference to a review paper, claiming that thirty-seven out of thirty-eight studies looking at vitamin C (again) found it beneficial in treating (not preventing, as in his previous claim in the text above) the common cold. Thirty-seven out of thirty-eight sounds very compelling, but the definitive Cochrane review on the subject shows mixed evidence, and only a minor benefit at higher doses.
I hooked out the paper Professor Holford is referencing for this claim: it is a retrospective re-analysis of a review of trials, looking only at ones which were conducted before 1975. Holford’s publishers describe this edition of the Optimum Nutrition Bible as ‘COMPLETELY REVISED AND UPDATED TO INCLUDE THE LATEST CUTTING-EDGE RESEARCH’. It was published in the year in which I turned thirty, yet Holford’s big reference for his claim about vitamin C and colds in this chapter is a paper which specifically only looks at trials from before I was one year old. Since this review was carried out, I have learnt to walk and talk, gone to primary school, upper school, three universities to do three degrees, worked as a doctor for a few years, got a column in the Guardian, and written a few hundred articles, not to mention this book. From my perspective, it is no exaggeration to say that 1975 is precisely a lifetime ago. As far as I am concerned, 1975 is not within living memory. Oh, and the paper Professor Holford references doesn’t even seem to have thirty-eight trials in it, only fourteen. For a man who keeps going on about vitamin C, Professor Holford does seem to be a little unfamiliar with the contemporary literature. Perhaps if you are worried about your vitamin C intake you might want to buy some ImmuneC from the BioCare Holford range, at just ￡29.95 for 240 tablets, with his face on the bottle.*
≡ It’s important to remember the difference between preventing colds, where the Cochrane review found no evidence of any benefit, and treating them, where Cochrane shows minor benefit at very high doses. There are, as you might imagine, cases of Holford eliding the two, and more recently, in a newsletter to his paying customers, he mangled the data in a way that might well startle the original authors. He took the modest 13.6 per cent reduction in cold duration for children taking high-dost- vitamin C and claimed: ‘This equates to up to a month less ‘cold’ days per year for the average child.’ For this claim to be true, the average child would be having more than two hundred days of cold symptoms a year. According to the review, children who had the highest number of colds might actually expect a reduction of four days per year. I could go on with the litany of errors in his mailouts, but there is a line between making a point and driving the reader away.
We’ll go on. He cherry-picks the single most dramatically positive paper that I can find in the literature for vitamin E preventing heart attacks—a 75 per cent reduction, he claims. To give you a flavour of the references he doesn’t tell you about, I have taken the trouble to go back in time and find the most up-to-date review reference, as the literature stood in 2003: a systematic review and meta-analysis, collected and published in the Lancet, which assessed all the papers published on the subject from decades previously, and found overall that there is no evidence that vitamin E is beneficial. You may be amused to know that the single positive trial referenced by Holford is not just the smallest, but also the briefest study in this review, by a wide margin. This is Professor Holford: pitched to teach and supervise at Teesside University, moulding young minds and preparing them for the rigours of academic life.
He goes on to make a string of extraordinary claims, and none has any reference whatsoever. Children with autism won’t look you in the eye, but ‘give these kids natural vitamin A and they look straight at you’. No reference. Then he makes four specific claims for vitamin B, claiming ‘studies’ but giving no references. I promise we’re coming to a punchline. There’s some more stuff about vitamin C; this time the reference is to Chandra (yet again).
Finally, on page 104, in a triumphant sprint finish, Professor Patrick Holford says that there are now oranges with no vitamin C in them at all. It’s a popular myth among self-declared nutritionists (there is no other kind), and those who sell food-supplement pills, that our food is becoming less nutritious: in reality, many argue it may be more nutritious overall, because we eat more fresh and frozen fruit and veg, less tinned or dried stuff, and so they all get to the shops quicker, and thus with more nutrients (albeit at phenomenal cost to the environment). But Holford’s vitamin claim is somewhat more extreme than the usual fare. These oranges are not just less nutritious: ‘Yes, some supermarket oranges contain no vitamin C!’* Frightening stuff! Buy pills!
≡ I would like to invite Professor Holford to send me a supermarket orange that has no vitamin C in it, via the publisher’s address.
This chapter is not an isolated case. There is an entire website—Holfordwatch—devoted to examining his claims in eye-watering detail, with breathtaking clarity and obsessive referencing. There you will find many more errors repeated in Holford’s other documents, and carefully dissected with wit and slightly frightening pedantry. It is a genuine joy to behold.
Professor?
A couple of interesting things arise from this realisation. Firstly, and importantly, since I am always keen to engage with people’s ideas: how might you conduct a discussion with someone like Patrick Holford? He is constantly accusing others of ‘not keeping up’ with the literature. Anyone who doubts the value of his pills is a ‘flat-earther’, or a pawn of the pharmaceutical industry. He would pull out research claims and references. What would you do, given that you can’t possibly read them on the spot? Being scrupulously polite, and yet firm, the only sensible answer, surely, would be to say: ‘I’m not entirely sure I can accept your precis or your interpretation of that data without checking it myself.’ This may not go down too well.
But the second point is more important. Holford has been appointed—as I might have mentioned briefly—a professor at Teesside. He brandishes this fact proudly in his press releases, as you would expect. And according to Teesside documents—there’s a large set, obtained under the Freedom of Information Act, available online—the clear plan at his appointment was for Professor Holford to supervise research, and to teach university courses.
It is not a surprise to me that there are entrepreneurs and gurus—individuals—selling their pills and their ideas on the open market. In some strange sense I respect and admire their tenacity. But it strikes me that universities have a very different set of responsibilities, and in the field of nutrition there is a particular danger. Homeopathy degrees, at least, are transparent. The universities where it is taught are secretive and sheepish about their courses (perhaps because when the exam papers leak, it turns out that they’re asking questions about ‘miasma’—in 2008) but at least these degrees in alternative therapies are what they say on the tin.
The nutritionists’ project is more interesting: this work takes the form of science—the language, the pills and the referenci-ness—making claims that superficially mirror the assertions made by academics in the field of nutrition, where there is much real science to be done. Occasionally there may be some good evidence for their assertions (although I can’t imagine the point of taking health advice from someone who is only occasionally correct). But in reality the work of ‘nutritionists’ is often, as we have seen, rooted in New Age alternative therapy, and while reiki quantum energy healing is fairly clear about where it’s coming from, nutritionists have adopted the cloak of scientific authority so plausibly, with a smattering of common-sense lifestyle advice and a few references, that most people have barely spotted the discipline for what it is. On very close questioning, some nutritionists will acknowledge that theirs is a ‘complementary or alternative therapy’, but the House of Lords inquiry into alternative medicines, for example, didn’t even list it as one.
This proximity to real academic scientific work summons up sufficient paradoxes that it is reasonable to wonder what might happen in Teesside when Professor Holford begins to help shape young minds. In one room, we can only imagine, a full-time academic will teach that you should look at the totality of evidence rather than cherry-pick, that you cannot over-extrapolate from preliminary lab data, that referencing should be accurate, and should reflect the content of the paper you are citing, and everything else that an academic department might teach about science and health. In another room, will there be Patrick Holford, exhibiting the scholarship we have already witnessed?
We can have one very direct insight into this clash from a recent Holford mailout. Periodically, inevitably, a large academic study will be published which finds no evidence of benefit from one of Patrick Holford’s favoured pills. Often he will issue a confused and angry rebuttal, and these critiques are highly influential behind the scenes: snippets of them frequently appear in newspaper articles, and traces of their flawed logic emerge in discussions with nutritionists.
In one, for example, he attacked a meta-analysis of randomised controlled trials of antioxidants as being biased, because it excluded two trials he said were positive. In fact they were not trials, they were simply observational surveys, and so could never have been included. On the occasion we are interested in, Patrick Holford was angry about a meta-analysis on omega-3 fats (such as fish oils), co-authored by Professor Carolyn Summerbell: she holds the full-time academic chair in Nutrition at Teesside University, where she is also Assistant Dean of Research, with a long-standing track record of published academic research in the field of nutrition.
In this case, Holford seems quite simply not to understand the main results statistics in the paper’s results blobbogram, which showed no benefit for the fish oils.*
≡ There is a more detailed explanation of his misunderstanding online, but for nerds, it seems he is amazed that several studies with a non-significant trend towards showing a benefit for fish-oil pills do not collectively add up to show a statistically significant benefit. This is in fact, as you know, rather commonplace. There are several other interesting criticisms to be made of the omega-3 research paper, as there always are of any research paper, but sadly this, from Holford, is not one of them.
Furious at what he thought he had found, Professor Holford then went on to accuse the authors of being pawns of the pharmaceutical industry (you may be spotting a pattern). ‘What I find particularly deceptive is that this obvious skew is not even discussed in the research paper,’ he says. ‘It really makes me question the integrity of the authors and the journal.’ He is talking here, remember, about the Professor of Nutrition at Teesside University and Assistant Dean of Research. Things then deteriorate further. ‘Let’s explore that for a minute with a ‘conspiracy theory’ hat on. Last week pharmaceutical drug sales topped $600 billion. The number one best seller was Lipitor, a statin drug for lowering cholesterol. It brought in $12.9 billion…’
Let us be clear: there is no doubt that there are serious problems with the pharmaceutical industry—I should know, I teach both medical students and doctors on the subject, I write about it regularly in national newspapers, and I am about to walk you through their evils in the next chapter—but the answer to this problem is not bad scholarship, nor is it another substitute set of pills from a related industry. Enough.
How did Holford come to be appointed?
David Colquhoun is Emeritus Professor in Pharmacology at UCL, and runs a magnificently shouty science blog at dcscience.net. Concerned, he obtained the ‘case’ for Professor Holford’s appointment using the Freedom of Information Act, and posted it online. There are some interesting finds. Firstly, Teesside accepts that this is an unusual case. It goes on to explain that Holford is director of the Food for the Brain Foundation, which will be donating funds for a PhD bursary, and that he could help in a university autism clinic.
I am not going to dwell on Holford’s CV—because I want to stay focused on the science—but the one sent to Teesside makes a good starting point for a brief biography. It says that he was at York studying experimental psychology from 1973 to 1976, before studying in America under two researchers in mental health and nutrition (Carl Pfeiffer and Abram Hoffer), and then returning to the UK in 1980 to treat ‘mental health patients with nutritional medicine’. In fact 1975 was the first year that York ran a degree in psychology. Ho! ford actually attended from 1976 to 1979, and after getting a .2:2 degree he began his first job, working as a salesman for the supplement-pill company Higher Nature. So he was treating patients in 1980, one year out of this undergraduate degree. Not a problem. I’m just trying to get this clear in my mind.
He set up the Institute of Optimum Nutrition in 1984, and he was director until 1998: it must therefoie have been a touching and unexpected tribute for Patrick in 1995 when the Institute conferred upon him a Diploma in Nutritional Therapy. Since he started but failed to complete his Mphil in nutrition at the University of Surrey twenty years ago, this Dip.ION from his own organisation remains his only qualification in nutrition.
I could go on, but I find it unseemly, and also these are dreary details. OK, one more, but you’ll have to read the rest online:
In 1986 he started researching the effects of nutrition on intelligence, collaborating with Gwillym Roberts, a headmaster and student at ION. This culminated in a randomised controlled trial testing the effects of improved nutrition on children’s IQ—an experiment that was the subject of a Horizon documentary and published in the Lancet in 1988.
I have this Lancet paper in front of me. It does not feature Holford’s name anywhere. Not as an author, and not even as an acknowledgement.
Let’s get back to his science, post haste. Could Teesside have easily discovered that there were reasons to be concerned about Patrick Holford’s take on science, without deploying any evidence, before they appointed him as a visiting professor? Yes. Simply by reading the brochures from his own company, Health Products for Life. Among the many pills, for example, they might have found his promotion and endorsement of the QLink pendant, at just ￡69.99. The QLink is a device sold to protect you from terrifying invisible electromagnetic rays, which Holford is eager to talk about, and it cures many ills. According to Holford’s catalogue:
It needs no batteries as it is ‘powered’ by the wearer—the microchip is activated by a copper induction coil which picks up sufficient micro currents from your heart to power the pendant.
The manufacturers explain that the QLink corrects your ‘energy frequencies’. It has been covered in praise by The Times, the Daily Mail and ITV’s London Today, and it’s easy to see why: it looks a bit like a digital memory card for a camera, with eight contact pads on the circuit board on the front, a hi-tech electronic component mounted in the centre, and a copper coil around the edge.
Last summer I bought one and took it to Camp Dorkbot, an annual festival for dorks held—in a joke taken too far—at a scout camp outside Dorking. Here, in the sunshine, some of the nation’s more childish electronics geeks examined the QLink. We chucked probes at it, and tried to detect any’frequencies’ emitted, but no luck. Then we did what any dork does when presented with an interesting device: we broke it open. Drilling down, the first thing we came to was the circuit board. This, we noted with some amusement, was not in any sense connected to the copper coil, and therefore it is not powered by the coil, as claimed.
The eight copper pads did have some intriguing-looking circuit-board tracks coming out of them, but on close inspection these were connected to absolutely nothing. You might call them ‘decorative’. I should mention, in the name of accuracy, that I’m not clear if I can call something a ‘circuit board’ when there is no ‘circuit’.
Finally, there is a modern surface-mount electronic component soldered to the centre of the device, prominently on display through the clear plastic cover. It looks impressive, but whatever it is, it is connected to absolutely nothing. Close examination with a magnifying glass, and experiments with a multimeter and an oscilloscope, revealed that this component on the ‘circuit board’ was a zero-ohm resistor. This is a resistor that has no resistance: a bit of wire in a tiny box. It sounds like a useless component, but they’re actually quite useful for bridging a gap between adjacent tracks on a circuit board. (I feel I should apologise for knowing that.)
Now, such a component is not cheap. We must assume that this is an extremely high-quality surface-mount resistor, manufactured to very high tolerances, well calibrated, and sourced in small quantities. You buy them on paper tape in seven-inch reels, each reel containing about 5,000 resistors, and you could easily pay as much as ￡0.005 for such a resistor. Sorry, I was being sarcastic. Zero ohm resistors are extremely cheap. That’s the QLink pendant. No microchip. A coil connected to nothing. And a zero-ohm resistor, which costs half a penny, and is also connected to nothing.*
≡ I contacted qlinkworld.co.uk to discuss my findings. They kindly contacted the inventor, who informed me that they have always been clear that the QLink does not use electronics components ‘in a conventional electronic way’. Apparently the energy pattern reprogramming work is done by some finely powdered crystal embedded in the resin. I think that means it’s a New Age crystal pendant, in which case they could just say so.
Teesside is only part of the story. Our main reason for showing an interest in Patrick Holford is his phenomenal influence on the nutritionist community in the UK. As I have mentioned, I have a huge respect for the people I am writing about in this book, and I am happy to flatter Holford by saying that the modern phenomenon of nutritionism which pervades every aspect of the media is in large part his doing, through the graduates of his phenomenally successful Institute for Optimum Nutrition, where he still teaches. This institute has trained the majority of self-styled nutrition therapists in the UK, including Vicki Edgson from Diet Doctors on Channel Five, and Ian Marber, owner of the extensive ‘Food Doctor’ product range. It has hundreds of students.
We’ve seen some examples of the standard of Holford’s scholarship. What happens in his Institute? Are its students, we might wonder, being tutored in the academic ways of its founder?
As an outsider, it’s hard to tell. If you visit the academic-sounding website, www.ion.ac.uk (registered before the current rules on academic .ac.uk web addresses), you won’t find a list of academics on the staff, or research programmes in progress, in the way that you would, say, for the Institute for Cognitive Neurosciences in London. Nor will you find a list of academic publications. When I rang up the press office once to get one, I was told about some magazine articles, and then when I explained what I really meant, the press officer went away, and came back, and told me that ION was ‘a research institute, so they don’t have time for academic papers and stuff’.
Slowly, more so since Holford’s departure as head (he still teaches there), the Institute of Optimum Nutrition has managed to squeeze some respectability out of its office space in south-west London. It has managed to get its diploma properly accredited, by the University of Luton, and it now counts as a ‘foundation degree’. With one more year of study, if you can find anyone to take you—that is, the University of Luton—you can convert your JON diploma into a full BSc science degree.
If, in casual conversation with nutritionists, I question the standards of the ION, this accreditation is frequently raised, so we might look at it very briefly. Luton, previously the Luton College of Higher Education, now the University of Bedfordshire, was the subject of a special inspection by the Quality Assurance Agency for Higher Education in 2005. The QAA is there to ‘safeguard the academic standards and quality of higher education in the UK’.
When the QAA’s report was published, the Daily Telegraph ran an article about Luton titled: ‘Is this the Worst University in Britain?’ The answer, I suspect, is yes. But of particular interest to us is the way the report specifically singled out the slapdash approach of the university towards validating external foundation degrees (p. 12, para 45 onwards). It states outright that in the view of the auditing team, the expectations of the code of practice for the assurance of academic quality and standards in higher education, specifically with regard to accrediting foundation degrees, were simply not met. As they go—and I by not to read this kind of document too often—this report is pretty full-on. If you look it up online, I particularly recommend paragraphs 45 to 52.
At the very moment that this book was going to press, it transpired that Professor Holford has resigned from his post as visiting professor, citing reorganisation in the university. I have time to add just one sentence, and it is this: It will not stop. He is now looking for academic credibility elsewhere. The reality is that this vast industry of nutritionism—and more importantly than anything, this fascinating brand of scholarship—is now penetrating, uncriticised, unnoticed, to the heart of our academic system, because of our desperation to find easy answers to big problems like obesity, our collective need for quick fixes, the willingness of universities to work with industry figures across the board, the admirable desire to give students what they want, and the phenomenal mainstream credibility that these pseudo-academic figures have attained, in a world that has apparently forgotten the importance of critically appraising all scientific claims.
There are other reasons why these ideas have gone unexamined. One is workload. Patrick Holford, for example, will occasionally respond on an issue of evidence, but often, it seems to me, by producing an even greater cloud of sciencey material: enough to shoo off many critics, perhaps, and certainly reassuring for the followers, but anybody daring to question must be ready to address a potentially exponential mass of content, both from Holford, and also from his extensive array of paid staff. It’s extremely good fun.
There is also the PCC complaint against me (not upheld, and not even forwarded to the paper for comment), the lengthy legal letters, his claims that the Guardian has corrected articles critical of him (which it most certainly has not), and so on. He writes long letters, sent to huge numbers of people, accusing me and others critical of his work of some rather astonishing things. These claims appear in mail-outs to the customers of his pill shop, in letters to health charities I’ve never heard of, in emails to academics, and in vast web pages: endless thousands of words, mostly revolving around his repeated and rather incongruous claim that I am somehow in the pocket of big pharma. I am not, but I note with some delight that—as I may have mentioned—Patrick, who sold his own pill retail outfit for half a million pounds last year, now works for BioCare, which is 30 per cent owned by a pharmaceutical company.
I am therefore speaking directly to you now, Professor Patrick Holford. If we disagree on any point of scientific evidence, instead of this stuff about the pharmaceutical industry being out to get you, or a complaint, or a legal letter, instead of airily claiming that queries should be taken up with the scientist whose valid work you are—as I think I have shown—overinterpreting, instead of responding on a different question than the one which was posed, or any other form of theatrics, I would welcome professorial clarification, simply and clearly.
These are not complicated matters. Either it is acceptable to cherry-pick evidence on, say, vitamin E, or it is not. Either it is reasonable to extrapolate from lab data about cells in a dish to a clinical claim about people with AIDS, or it is not. Either an orange contains vitamin C, or it does not. And so on. Where you have made errors, perhaps you could simply acknowledge that, and correct them. I will always happily do so myself, and indeed have done so many times, on many issues, and felt no great loss of face.
I welcome other people challenging my ideas: it helps me to refine them.