Which? magazine, a consumer comparison and review publication has just published a study on the dangers posed by nutritional therapists. A difficult leap from its traditional role of testing washing machines and vacuum cleaners – nevertheless the headline scoop “Are Nutritional Therapists Gambling With Your Health?” shows a robustness of tone and a certainty not often seen in scientific papers. So just how well was this supposed ‘scientific study’ designed and executed?

Which’s usual techniques involve comparing a variety of solutions, to whatever problem interests them, and determining the best option on offer. The validity and legitimacy of the product is on the whole, taken as a given. We need to wash our clothes, we need to vacuum up dust, we need a TV set and so on. This form of review journalism, whilst not easy, is inherently simple in purpose and straightforward in execution.

Should Which? ever decide to ask “Are Washing Machines Really Necessary At All”, then a completely different style of study is clearly required, engaging broadly different contributors across related fields. Stuffing a review panel with individuals with a track record of hostility to personal hygiene would introduce an unwelcome bias into the conclusions. Lastly, if the study excluded all representation by those being studied – if the washing machine manufacturers and retailers were denied any input in evaluating the results, then those same results would show a clear review bias.

Nevertheless this is how the Which? study has been structured.

In this particular case, whilst there was no nutritional therapist representative on the review panel, Which? attempts to cover itself by the simple expedient of ‘deeming’ that the panel are experts in the field of nutritional therapy and therefore qualified to sit in judgment on nutritional therapists. This expert panel consists of three individuals with a long history of collaboration with each other, and a well established antipathy to Nutritional Medicine including owning websites whose sole purpose appears to be the disparagement of all nutritional therapists and related academic qualifications up to and including MSc degrees. This clearly indicates a bias of authority.

Nevertheless this is how the Which? study has been structured.

Part of their conclusion states that GP’s and dietitians should be consulted for any medical condition. No evidence is offered for this assertion, whilst both a Dietitian and a GP are represented on the review panel. There is a clear conflict of interest bias.

Nevertheless this is how the Which? study has been structured.

One supposed aim of the study was to measure the quality of advice on offer by nutritional therapists. The questions were designed specifically to tempt the subjects into indiscretion and error, which clearly implies the covert real aim of this project was to ‘expose’ supposed charlatans much in the way the late and unlamented News Of The World might have approached the question. Secretly recording advice given in good faith in response to questions partly designed by those with a conflict of interest is good tabloid journalism, but extremely bad science. This is a fine example of measurement bias.

Nevertheless this is how the Which? study has been structured.

Which? studied a sample of 15 nutritional therapists out of a total population of over 2,400. In order for any valid results to be considered representative of all nutritional therapists (with a reasonable degree of certainty) then rigorous scientific methodologies exist covering sample size and selection methods, and much else besides. In summary, for such a study to claim any representative value at all, a sample size of around 100 would be the bare minimum required. A sample size of 15 is not even ‘bad science’ – it’s no science at all.

Nevertheless this is how the Which? study has been structured.

Which? offers no insight into how the sample was selected – it should of course be completely random but in the absence of confirmation doubts must remain. Certainly if it transpires the nutritional therapists were individually selected by the review panel, the entire basis of the study is undermined. This is known as selection bias.

So what did the ‘study’ really measure?

As pseudo-science, it quite clearly measures nothing at all. However, it certainly does illustrate that an unknown percentage of nutritional therapists may be incompetent, and that BANT may be ineffective in policing it’s members’ competencies. But are there more useless nutritional therapists than there are useless dietitians? Or useless GP’s? And who is the most dangerous? The study carefully avoids these important questions.

I‘m disappointed to note that dietitians, who claim to place reliance on evidence-based science, should contribute to such bad science in a non-peer reviewed article in a consumer magazine traditionally more concerned with vacuum cleaners. I certainly hope that the damage to their professional reputations is only temporary.

I await a well-designed comparison study in the more honorable tradition of Which? magazine. But next time please – be careful how you choose your ‘experts’.

Note:

For more information on sources of bias, please refer to:

http://www.umdnj.edu/idsweb/shared/biases.htm

 

 

 

 

I absolutely loved this article in CAM magazine on “blinkered” scientists and was laughing out loud as I read it. It was written by my good friend and colleague Dr. Natasha Campbell-McBride in her own direct conversational style and deserves all the attention it can get.

We live in an age of evidence based medicine.

What does it mean? It means that we medics can not make one little step to the right, to the left, forward or backwards until we have a stackful of double blind placebo controlled studies to justify that step. The truth may be staring us in the face, our clinical knowledge and instincts may be telling us what to do, but we have to resist all that and say the famous phrase “There is no evidence!”. No evidence until Her Majesty Science will provide us with that evidence. Let us have a look at her majesty and how much we can rely on her evidence.

It is amongst scientists that I met the most cynical people, who do not believe anything. They have got a good reason for that. They are the insiders who know very well all the hundreds of different pitfalls in scientific studies. They also know all the hundreds of political knots our modern science is tied in. Science is an expensive business.

Large number of studies are funded by companies or organisations which expect the scientist to come up with particular results, suiting their agenda. There are many ways in designing and conducting a scientific study, which would ensure a particular result. At the end of any study, when all the data is collected, this data has to be statistically analysed. People, who are familiar with statistics, will tell you that there are many statistical methods to analyse the same data. Depending on which method you choose, you may arrive at very different results.

Large commercial companies, who conduct research to back their products, usually have an army of statisticians employed to do just that. When the study is completed, the public at large is given a conclusion from that study, made by whatever party is interested to popularise that conclusion. The public at large has no chance to look at the study in detail, to see the numbers and to interpret them for themselves. Of course there are many properly conducted studies, but how do we know which one is which? Majority of people have no training, time or ability to analyse them for themselves. So, they are fed the “scientific evidence”, based on studies, which often are politically manipulated, statistically twisted or simply incorrectly conducted.

There is no other science so thoroughly confused and confusing than nutritional science. Incidentally, it is amongst nutritional scientists that I met a lot of very unhealthy people. They are the people who tell us what we should and should not eat, so they should be healthy themselves, shouldn’t they?…..

Majority of nutritional scientific studies are funded by food industry. Is it a surprise then that all the brightly packaged foods offered to us by food industry are fully backed by nutritional science? Foods with virtually no nutritional value, full of E-numbers, flavour enhances, colorants, preservatives, chemically altered proteins, chemically altered fats and carbohydrates, pumped with sugar and salt. Never in the human civilisation there have been such drastic changes in the way we eat, as in the last 50-60 years.

Apart from the food industry, who else do we have to thank for this change? The humble nutritional science of course, which provided us with huge amount of confusion and misinformation about foods. Their “scientific evidence” made us abandon the natural foods, which we used to eat for thousands of years, and replace them with nicely packaged chemical concoctions, which we call “food” nowadays. There is no doubt that this dramatic changes in the way we eat are largely responsible for the epidemics in obesity, diabetes, heart disease, cancer and many other health problems, which plague the human race today.

For every bunch of nutritional studies telling you that a particular food or nutrient is harmful for you one can find an equal amount of studies telling you how good it is for you. I would certainly never rush to make any conclusions based on one study. But unfortunately that is exactly what happens.

I will never forget a presentation made by the head clinical nutritionist of one of the top kidney hospitals in the country. After an hour of listening to all the scientific evidence, available on the subject, the audience was completely confused what should be the right nutritional management of patients with kidney failure. It was obvious that the nutritionist, charged with helping these patients, was thoroughly confused as well. The audience went home feeling very sorry for the patients of that kidney hospital.

It is particularly amusing to see scientists proclaiming what we should or should not eat based on studying one particular small aspect of human biology. A lot of worried parents once contacted me to say that a scientist in a seminar told them that olive oil is bad for their autistic children. This Earth shattering advice was based on a study of one particular chemical reaction in the body where one of the ingredients of olive oil apparently may be interfering with that particular chemical reaction. Well, a human body does not equal to that one chemical reaction, it has got trillions of chemical reactions going on at the same time, interacting with each other, changing in response to what the body is doing at the time and many other factors.

Olive oil is not made of one ingredient either. It has got hundreds of different ingredients and as a whole it is a time proven health-giving food, used by people for thousands of years. But of course that scientist has spent years of studying that one chemical reaction, so naturally that is the most important single thing in the whole of human body, as far as this scientist is concerned. If you spend long enough digging a hole in the ground, then your whole world becomes that hole.

In our modern world it is very easy to become a victim of “scientific evidence”. Of course, those scientists have laboratories, expensive and sophisticated equipment, so they should know! I meet patient after patient confused and bewildered by all the conflicting bits of information they get from different scientific sources. As a result they finish up at a complete loss of what exactly they should eat and what they should not.

People are absolutely right to try and learn as much as possible. The more you know the more you are capable to help yourself or your child. However, there are number of things which are important to realise before looking at the scientific evidence.

• Scientific evidence is often full of conflicting information, negating each other and unless you have thoroughly ploughed through every study on the subject, do not attempt to make any conclusions.
• Science is tightly bound by political and commercial constraints, so never take any single study on its face value.
• An amazingly large percent of studies are conducted or interpreted incorrectly.
• Science can only present you with what it has studied. It can not tell you anything about things, which it didn’t get round to study yet. As a result that little bit of knowledge may give us a completely wrong view of the whole problem. A little knowledge is more dangerous than no knowledge at all.
• Scientific evidence can only be used in context with proper clinical assessment of the patient and must never be taken as a gospel on its face value.

Scientific evidence is like a large jigsaw puzzle, where each study is a small piece. Because not all aspects of the problem have been studied yet, an unknown number of pieces of this puzzle are missing. On top of that many pieces, which are available, may be false and misleading. God save anybody who tries to manage their health based on this puzzle!

So, what are we to do?

I am not on a crusade against science here. It is thanks to science we, humans, have reached such a high level of sophistication. Because we made science work for us! It is our human ideas, instincts, empirical knowledge and experience, which employed the science and used it to our advantage. Not the other way round! At the moment we have a situation, where we are afraid to think, to listen to our instincts or experience unless science allows us to. From being our employee science has become our boss. Remember, that it is our human mind that has to put all the pieces of scientific jigsaw puzzle in the right places. Without that they mean nothing.

It is human mind, which employs experience, empirical knowledge, thinking and available scientific data and thus moves progress. Throughout years there always have been doctors and other medical practitioners, whose clinical experience and knowledge led them against available at the time scientific evidence. Health practitioners who work with real people every day, dealing with their real health problems accumulate an empirical clinical knowledge of what works and what doesn’t. These people are not working with laboratory equipment detached from patients. Very often their clinical experience goes against perceived science. But more often than not science eventually confirms what this people knew through their clinical experience all along.

Unfortunately, this kind or medicine does not fit into the straight jacket of evidence based official medicine. As a result more often than not the official medicine brands it quackery and alternative. It is no secret that official western medicine is run by pharmaceutical industry, where money and profit rule the roost. The alternative medicine uses diet and natural ways of healing the patient. There is no profit in that for the pharmaceutical industry, so this rather powerful industry does not like alternative medicine.

Were does all this leave the patient? Well, millions of patients around the world have discovered that having been through every expensive test and treatment of the evidence based very scientific official medicine, they get real help from using diet and natural approaches. There is centuries old wisdom accumulated in treating disease with natural means. A lot of modern scientific knowledge has complemented and confirmed this wisdom. It is an area where science knows its place.

To conclude, we should not get intimidated by scientific evidence and never try to make any changes in our lives based just on it. Science is only one of the tools in our human toolbox. Let’s keep it in its right place!

©Dr Natasha Campbell-McBride, February 2007 All Rights Reserved

www.behealthy.org.uk

:END

Article first published in CAM Magazine, February 2007

 

The artichoke

With a tender heart
Dressed up like a warrior,
Standing at attention, it built
A small helmet
Under its scales
It remained
Unshakeable,
By its side
The crazy vegetables
Uncurled
Their tendrills and leaf-crowns,
Throbbing bulbs,
In the sub-soil
The carrot
With its red mustaches
Was sleeping,
The grapevine
Hung out to dry its branches
Through which the wine will rise,
The cabbage
Dedicated itself
To trying on skirts,
The oregano
To perfuming the world,
And the sweet
Artichoke
There in the garden,
Dressed like a warrior,
Burnished
Like a proud
Pomegrante.

And one day
Side by side
In big wicker baskets
Walking through the market
To realize their dream
The artichoke army
In formation.
Never was it so military
Like on parade.
The men
In their white shirts
Among the vegetables
Were
The Marshals
Of the artichokes
Lines in close order
Command voices,
And the bang
Of a falling box.

But
Then
Maria
Comes
With her basket
She chooses
An artichoke,
She’s not afraid of it.
She examines it, she observes it
Up against the light like it was an egg,
She buys it,
She mixes it up
In her handbag
With a pair of shoes
With a cabbage head and a
Bottle
Of vinegar
Until
She enters the kitchen
And submerges it in a pot.

Thus ends
In peace
This career
Of the armed vegetable
Which is called an artichoke,
Then
Scale by scale,
We strip off
The delicacy
And eat
The peaceful mush
Of its green heart.

(Translated from Spanish by Jodey Bateman)

ODA A LA ALCACHOFA

La alcachofa

de tierno corazón

se vistió de guerrero,

erecta, construyó

una pequeña cúpula,

se mantuvo

impermeable

bajo

sus escamas,

a su lado

los vegetales locos

se encresparon,

se hicieron

zarcillos, espadañas,

bulbos conmovedores,

en el subsuelo

durmió la zanahoria

de bigotes rojos,

la viña

resecó los sarmientos

por donde sube el vino,

la col

se dedicó

a probarse faldas,

el orégano

a perfumar el mundo,

y la dulce

alcachofa

allí en el huerto,

vestida de guerrero,

bruñida

como una granada,

orgullosa,

y un día

una con otra

en grandes cestos

de mimbre, caminó

por el mercado

a realizar su sueño:

la milicia.

En hileras

nunca fue tan marcial

como en la feria,

los hombres

entre las legumbres

con sus camisas blancas

eran

mariscales

de las alcachofas,

las filas apretadas,

las voces de comando,

y la detonación

de una caja que cae,

pero

entonces

viene

María

con su cesto,

escoge

una alcachofa,

no le teme,

la examina, la observa

contra la luz como si fuera un huevo,

la compra,

la confunde

en su bolsa

con un par de zapatos,

con un repollo y una

botella

de vinagre

hasta

que entrando a la cocina

la sumerge en la olla.

Así termina

en paz

esta carrera

del vegetal armado

que se llama alcachofa,

luego

escama por escama

desvestimos

la delicia

y comemos

la pacífica pasta

de su corazón verde.