What say the Nutritionistas?

In which we ponder why the “Nutritional Therapy Community” has been silent on the Goldacre-Rath libel case.

There is no doubt that Ben Goldacre and The Guardian have won a great victory for rationality and truth in their legal battle with Matthias Rath. Both should feel very proud for standing up to be counted. The fact that they defended Rath’s lawsuit under UK libel laws (notoriously friendly to plaintiffs) makes it all the more impressive. Given the potentially serious financial downside of losing a suit like this, newspapers often prefer to take the complained-of material down and settle out of court. It is to The Guardian’s great credit that they did not do this. As a regular reader for 40 years (honest) I feel the paper has justified the loyalty we leftie liberal sceptics feel towards it.

Hopefully, the judgement will see the release of a lot of new material about Dr. Rath, and particularly about his campaign to promote his vitamin concoctions to HIV-positive people in Southern Africa. The next instalment appeared in The Guardian on Monday. This second piece emphasised again the terrible human tragedy of the AIDS crisis in Southern Africa. A whole motley crew of quacks have appeared to exploit the vulnerability of those who are poor and HIV positive. Encouraged and aided by the ignorance and ideology-driven blindness of the South African government, these chancers (who come in both local and international varieties) have been able to generate a thriving trade, at a terrible cost in wasted lives.

What other things can we take from the judgement?

One point that has been made by several bloggers is that the silence from other “nutritional therapists”- including ones with high media profiles who have been known to use lines somewhat reminiscent of Rath’s – has been total. Now why is that?

Rath, of course, has been something of an Alternative Medicine rock star, touring the world giving three-hour speeches to packed halls. This is a touch surprising, since even a cursory reading of some of the vast mass of material on Rath’s myriad websites (e.g. here) reveals a lot of deeply weird stuff. I would be tempted to generate an extended post on “Matthias Rath in his own words” were it not for the fact that several such are already out there in the blogosphere. Anyway, to save time, The Guardian summarises several of Rath’s more oft-repeated accusations as follows:

“Rath could not have been clearer in his message in a campaign waged on the internet, in speeches across the world and in adverts in the New York Times: [anti-retroviral drugs] were a form of genocide against Africans, produced by drug companies responsible for the second world war, apartheid and the US invasion of Iraq.”

This in addition to Rath’s core message for the last fifteen years, namely that all cardiovascular disease is actually a vitamin deficiency (lack of vitamin C), and that people are deliberately kept in ignorance of this so that the “Pharma Conspiracy” can sell us their expensive drugs.

These accusations are not hard to find on Rath’s websites. And if that was not enough, there is his campaign to publish “Open Letters” as paid adverts in major newspapers – a selection of these can be found here.

Given the bizarre, not to mention barking mad, nature of much of this stuff, you would think many of the CAM and nutritional medicine folk – at least at the less way-out end of the “natural health” spectrum – might have sensed ”something of the night” about the charismatic Dr Matthias. However, they mostly seem to have viewed him as a hero, most probably for his “refusal to be intimidated” by conventional medicine and “Evil Pharma”.

(Translation: his ready recourse to M’Learned Friends in the case of any criticism, and the flamboyant way he has pumped out his message about how the PharmaCos conspire with governments and conventional medicine to “promote disease”).

It would seem, then, that to many in CAM Rath has been a sort of “six hundred pound gorilla”, prepared to fight the good fight for their side. A strong thread runs through many forms of CAM, increasingly so the wackier the therapy, that the practitioners and advocates are truth-seekers being “persecuted” by the force of reaction (conventional medicine and science, and/or the “Big Pharma Conspiracy”). This leads to such ludicrous things as “Health Freedom” campaigns, which largely amount to demands for the “human right” to get quack therapies paid for by public fund. Rath’s message chimes strongly with this strand of belief, and his celebrity and charisma lets people of this mindset see him as a hero, rather than a person whose weird beliefs and statements might lead you to wonder if he is losing the plot.

Of course, this highlights a key difference between CAM and the mainstream.

In the mainstream, if you are found engaging in wholly unethical practices (and/or repeatedly lying to your patients if you are a physician), you can expect to be investigated, exposed, disciplined, and potentially thrown out of “the business” for good.

If your scientific or medical evidence is found to be faked, bogus, or exaggerated, ditto.

If your science is found to be genuinely done but incorrect, you can expect to see people picking holes in your arguments, discussing your mistakes and why and how you made them, how to avoid similar errors in future, what better ways to do things are there, and what we can learn from it all.

In contrast, in far too many alternative medicine communities, none of the above happens.

So what might we expect from the “nutritional therapy” community in the wake of the court case, and the Guardian’s reporting of Rath’s activities?

In particular, what should they be saying about Rath’s attempts to use the libel laws to suppress scrutiny of what he does?

If they had any genuine ability to self-regulate – and this, remember, is something that nutritionists and other CAM practitioners are repeatedly telling the Government they are ready and keen to do – they should surely be speaking out about what a bad example Rath has set.

They should be admitting how what has been happening in South Africa bears out almost everything the sceptics and bad science watchers have said about the worst excesses of unlicensed nutritionists and nutrition companies.

They should be setting out how they would devise codes of practise for nutritional supplement manufacturers and nutritional therapists that would try and prevent these kind of abuses.

They should be insisting on open debate, on the scientific facts, and condemning the use of defamation law as a gagging tactic in matters of science and medicine, real or “alternative”.

Instead, what we have is silence.

A whole lot of silence.

Let’s hope the nutritional therapists in particular are using this silence to take a long, hard, look at themselves.

But somehow, I am not optimistic.

[BPSDB]

28 Responses to “What say the Nutritionistas?”

  1. gimpy Says:

    Yes, the silence is damning. However, the ANH have broken the silence and issued a statement that flat out ignores Goldacre’s accusations against Rath and seems to portray Rath as an innocent victim of malign intent. Deeply odd.

    They should be admitting how what has been happening in South Africa bears out almost everything the sceptics and bad science watchers have said about the worst excesses of unlicensed nutritionists and nutrition companies.

    It’s not just nutritionists. It is a scary fact that the vast bulk of CAM seems to think that they offer a better alternative to conventional medicine when it comes to life threatening disease, whether that be AIDS, cancer or malaria. I have documented some examples of homeopaths indulging in deeply unethical trials and projects in Africa where they advocate the use of homeopathy for very serious illnesses.
    I think we have to face the seriousness of this situation head on, the practice of CAM and its credibility within society has led a large number of practitioners and patients believing that it is a credible alternative to conventional medicine. While they may be prevented from actively carrying out deeply unethical trials to show this here in the developed world they have absolutely no compunction in taking their beliefs to less educated and regulated parts of the world where they are free to indulge in their fantasies of healing and pretences of ethical trials.

  2. wilsontown Says:

    I think Patrick Holford is probably wise to keep quiet, given his comment that “”AZT, the first prescribable anti-HIV drug, is potentially harmful and proving less effective than vitamin C”. Although he does insist that statement doesn’t equate to saying “vitamin C is more effective in treating AIDS than the anti-retroviral drug AZT”. I’m not sure, logically, how that works. He does insist that people shouldn’t “throw away their anti-retrovirals in favour of vitamin pills”, though; it would nice if he could repeat that statement.

  3. Sceric Says:

    Well, do you ever get any other options than silence or load grunting noises, when you talk to a “true” believer about how they made fools of themselves??
    On the other hand, isn’t Rath from Germany? and what is in the food here, that we create these big numbers of completely selfrightous, ignorant fools?? and wouldn’t that be a questions for a Nutritionista?? Does Sauerkraut make you loud and obnoxious (well, if you accompany it with a lot of poorly diluted brewers yeast), or is it the vitamins in the Kraut??

  4. Madsadgirl Says:

    It is the fact that these people can never show any scientific evidence to back up their claims that should show any half-way intelligent person that they are nothing more than quacks. But, of course, they get so-called celebrities on board with their crackpot ideas and ‘new-age thinking’ and believe that this gives them the right to tell the rest of the world that their thinking and science is wrong. It is a shame that there is no punishment that can be meted out to these quacks and their crackpot followers that would identify them to the right-thinking and intelligent members of the human race.

  5. draust Says:

    Gimpy: Agreed. Of course, we have seen this kind of exploitative behaviour in the developing world before, notably from proselytising religions. But at least they only (usually) claim to be “medicine for the soul”.

    I feel that showing that they can develop enough “collective self-awareness and self-criticism ” to identify charlatans, crooks and nutters, and bonkers beliefs, is a key issue for ALL the alternative therapies if they want to be taken in any way seriously. Until they can do this, all talk of routinely bringing “lay practitioners” of CAM into the medical mainstream is utterly premature. Indeed, cases like Rath’s also ought to be highlighted to all the mainstream people in medical schools who have embraced alternative therapies. The point is that many of the people they are getting to come and talk to their students probably share at least some of Rath’s crazier beliefs.

    Wilsontown: The silence from cher Patrique is indeed deafening. He has apparently gone to great lengths in the S African media over the last year or two to stress that he has no connection to Rath, but the similarity of some of the statements (like the ones you mentioned) might make you wonder if there is really that much difference in what he and Rath believe.

    Eric – Of course Herr Dr med. Rath should be a big fan of Sauerkraut, since pickled cabbage is rich in his (and Linus Pauling’s) favourite chemical Vitamin C.

    My German friend likes to tell me that if only the 15th and 16th century sailors had routinely taken several barrels of Sauerkraut on board their ships, they would have avoided dying of scurvy. I am actually amazed that there is not already a “Dr Rath Brand” Sauerkraut on the market.

    MadSadGirl: Agreed about the celeb endorsements. Indeed, the celeb endorsement alone is almost enough to identify a load of alternative nonsense, with a few rare exceptions.

    David Colquhoun always makes the point that there already is legislation to tackle people like Rath and their claims in the UK, notably relating to Trades Descriptions and Advertising Standards, provided there is the will to enforce it. In fact, Rath has previously fallen foul of these rules in the UK a few years ago, as Sarah Boseley’s Guardian article last Saturday mentions. It is less clear what can be done if most of the loonier claims are made via multiple websites.

  6. She-Liger Says:

    Sauerkraut contains vitamins, indeed. However, “Sauerkraut make you loud and obnoxious” not because of vitamins. There is mustard oil there, which contains different compounds of sulfur, and also other compounds of sulfur. All these compounds make you to “bloat out” :)
    Nevertheless, both cabbage and Sauerkraut are useful thing if one “knows a sense of proportion”.
    By the way, the concentration of vitamin C in Sauerkraut is higher than in natural cabbage. Probably lacto-bacteria produce it additionally, when fresh cabbage “is turning into” Sauerkraut. Besides there is other vitamins there – group of B, vitamin PP, and vitamin U (“anti-ulcerative factor”). Besides of that – I don’t know how it is in Britain – however in Russia the pickle of Sauerkraut is used as an excellent ancient folk remedy against “morning-after feeling” :)

  7. She-Liger Says:

    And as for the silence of nutritionists…

    Maybe is it ” the hush before the storm”, eh?

  8. gimpy Says:

    The point is that many of the people they are getting to come and talk to their students probably share at least some of Rath’s crazier beliefs.

    How much of a leap of faith does it require to go from the belief that a megadose of vitamin C can cure a virus such as the common cold to one that it can cure a virus such as HIV? Little more than a hairsbreadth shimmy sideways if one maintains a consistent alt-logic.

    I know we are all having a go at Rath because his actions and arguments result in unnecessary death but there is no difference between his arguments and those of media friendly CAM therapists who argue for the use of vitamin capsules against colds.

    To be blunt, we cannot allow CAM into medicine. At all. We need a version of the National Secular Society to campaign against any use of CAM by government agencies and we need very strict regulation to forbid any medical claim.

  9. Teek Says:

    draust – clinically assessed, nice post. the silence is deafening, not least because nutritionists are so apt at self-aggrandising when it comes to pimping themselves to the meeja over flaky, quacky and downright criminal claims of how X cures/prevents Y.

    it has to be said that no matter how much we rationalists commemorate Rath vs. Guardian/Goldacre as a landmark ruling, no matter how many blogs and articles cover the shocking truth of Rath’s irresponsible practices, no matter indeed how much noise we make, believers will go on believing and supplements will keep on selling. sad but true, I even doubt that the AIDS denialists in SA will be all that damaged by Rath’s public dressing-down.

  10. Wulfstan Says:

    This is odd – i just commented on a HolfordWatch post that I wondered when those ANH favourite sons and daughters aka Cliff Richards and the Motley Crue of supplement-popping celebrities would offer their wisdom on this issue. If the celebrities were so fast to condemn Cochrane reviews it seems odd that they have nothing to say on this issue.

    How much of a leap of faith does it require to go from the belief that a megadose of vitamin C can cure a virus such as the common cold to one that it can cure a virus such as HIV?

    Difficulty with this is that so many of these people seem to be germ-theory denialists which makes their vitamin-obsession more sensible to them – they don’t believe in HIV as such so they are happy to enthuse about supplements.

  11. Dr* T Says:

    As an aside, I’m glad Lehmann’s didn’t collapse before it did or HBOS get collared by Lloyds earlier, or this excellent story may not have been so prominent. Weird in a way how events happen.

    I would have thought that there was some PR capital to made out of nutritionistas being first to distance themselves from Rath and promote ‘sensible advice’.

  12. She-Liger Says:

    http://dinoquest-3.blogspot.com/2008/09/deafening-silence.html

  13. jdc325 Says:

    Nice post Dr Aust. I particularly liked your ‘four shoulds of nutritionism’ – and would recommend that anyone who is interested in writing to a member of the nutritionista community about Rath consider using them in their communication.

  14. UPDATED: An open invitation to the ‘alternative’ medicine community: comment on Matthias Rath’s tactics « Holford Watch: Patrick Holford, nutritionism and bad science Says:

    [...] 3: Dr Aust has also posted to ask about the silence of most of those in ‘alternative’ medicine, and especial…. Dr Aust hopes they will speak out, but for the moment Instead, what we have is silence…A [...]

  15. pv Says:

    Wulfsatn wrote:

    Difficulty with this is that so many of these people seem to be germ-theory denialists which makes their vitamin-obsession more sensible to them – they don’t believe in HIV as such so they are happy to enthuse about supplements.

    Maybe it’s not that they deny anything so much as not understand anything about it. One of the defining characteristics I think of your average quack (the man or woman who has taken a 3 month course to do “alternative”, non-invasive brain surgery, for example, or reiki, nutribollox therapy or homeofantasy) is how little understanding they have of anything scientific. I don’t believe most of them even think about it, or the fact that they are in effect exploitative parasites.
    The Raths and Holfords of this world aren’t your average quacks. I suspect as far as their own health is concerned they don’t deny the germ theory of disease. But they have profitable pill pushing businesses and an agenda to support their budding empires. However, they are also among the gods of the sCAM practitioners, so what can their followers say? They’ll wait for it to die down a bit then pretend it never happened. Just like any other religion. Ask any devout Christian about the Inquisition and the historical obsession with torture as a tool for doing “God’s work” and see how far you get, and how long they stick to the subject.

  16. Ray Girvan Says:

    One reaction I did notice: there was a minor spot of Wikidrama following the Rath news that left one of the chief vitamin-therapy apologists there whining about “tag-teaming”* on being unable to make the article downplay Rath’s new-found reputation.

    * The latest whinge vehicle for Wikipedia CAM artists when there’s a consensus against them.

  17. Wulfstan Says:

    The Raths and Holfords of this world aren’t your average quacks. I suspect as far as their own health is concerned they don’t deny the germ theory of disease.

    With Holford’s recent collaborations with Dr Halvorsen, both of them do seem to be very close to saying that children with a good diet and ‘healthy’ immune system don’t need vaccinations. Holford also said people need to take supplements to make them optimally healthy and impervious to disease.

    Overall, who knows. It’s difficult to get a handle on how much more than “a healthy diet and supplements are good for you” the average Holfordista buys into.

  18. Claire Says:

    “Does Sauerkraut make you loud and obnoxious …(well, if you accompany it with a lot of poorly diluted brewers yeast)” [Seric]

    From a couple of years spent studying in Germany (rather long ago), I recall the consequences of this dietary combination tended to be of the “silent but deadly” flatulent variety .

  19. draust Says:

    Yes… Sauerkraut and wheat beer (which is splendidly yeasty), aka Weissbier or Weizen, can be a dangerous combination under the wrong circumstances…

    More response to come over the w/end, blogging remotely from conference in Belgium at the moment and wrestling with unfamiliar keyboard and (wheat and normal) beer-induced morning-after thick head. Don’t tell Mrs Dr Aust.

  20. Sceric Says:

    No, I’m not gonna tell, smile…I will test the Vitamin C, yeast combination next weekend extensivly at the Oktoberfest .
    DrAust: While you are in Belgium you could wave a hand into easterly direction and I try to spot a sceptic waving…hmmm, as likely as a spotting an ingredient atom in a C30 dilution…
    Claire: for the more experimental people…try “onion pie” (Zwiebelkuchen) with “new wine” (neuer Wein – the wine has not been filtered, so the yeast is still in it)…even more deadly then with beer…
    I’m wondering where Rath did get his medical degree…I need to look that up…

  21. draust Says:

    The information about his degree usually appears on the Herr Dr med.’s German websites, Eric (not surprising since in Germany it is an offence to claim a degree you do not have), but not so much on the English language ones. According to the German sites (e.g. here) Rath “studied medicine in Münster and Hamburg” and then “worked as a Dr and researcher at the Hamburg (Eppendorf) University Hospital and the Berlin Heart Centre”.

    Münster and Hamburg are both long-established and irreproachably respectable German medical schools, so this seems a perfectly conventional medical education. And one can find scientific papers coming from the University at Hamburg which confirm Rath worked there, possibly in the “Institut für Pathologie”. I don’t remember seeing any papers on PubMed which listed his address as “Berlin Heart Centre”.

    The Hamburg papers were published over the years from 1989-91 – this is consistent with Rath’s website bio which states that Pauling “invited Rath to join his (Pauling’s) institute in 1989″. So it seems that Rath graduated in 1985 (this information appears on another of his websites) and then worked for 4 to 5 years as either a junior doctor or (more likely) a junior researcher, before moving to the Pauling Institute in about 1990.

    (The Guardian gave some more background in Sarah Boseley’s long article last week – see here).

    I don’t know if anyone has tried tracing Rath’s scientific or medical colleagues from the Hamburg days to see if they can shed light on his “conversion” from conventional doctor and researcher to Pharma-conspiracy-warrior and Vitamin Messiah. I would have thought some enterprising German investigative reporter might have tried at some stage, but I don’t know of anything written on this subject. Vielleicht sollte jemand durch die Deutsche Internetseiten suchen…

  22. Sceric Says:

    draust:

    do I sense a proposal there, smile…in between taking my turns sitting the Little Sceptic, I’ll have a look into it, perhaps also the German sceptics (GWUP) have some info …and thanks for the input

  23. Sceric Says:

    Well, what I did find is this link to the German National Library (Deutsche National Bibliothek, DNB), which states only the one article from 1989 that you already mentioned (his dissertation) [see links in later comment – Dr Aust]. All the other publications listed are of a date after his fall from reality…on the funny side is the latest addon…where he seems to have been mentioned or quoted or has written something himself on heredity for a publication about pythons (unfortunately not the Monty version).

    Besides that, there is a lot about him sueing somebody or getting sued by someone…and the rather sad story about the boy “Dominik” (Dominik Feld), a cancer patient whose parents unfortunately skipped the conventional treatment on advise from Rath and used his crap…well you can guess what happened (in case you haven’t heard about it, go here [in German]. In English I was only able to find an apology – legally advised- by the British Medical Journal.

    There is not much about Rath’s time before he went “vitamin C”…but, then there is this short news clip from SA:


    “Gajana said that when Matthias Rath called himself ‘Dr Rath’, this was a reference to a Ph.D. doctorate he had obtained and his position as a researcher, not a medical doctor.”.

    ..why, I wonder, is he then always quoted as a “Dr. med.”??

    The homepages of both his prior job placement do not mention his name…I’m going to send them an e-mail and see if I get an answer..

    ScEric

  24. draust Says:

    Thanks Eric. I have tidied up your HTML a bit.

    I think what Rath means in the quote about “Dr med” is that in Germany you are only really allowed to only call yourself “Doktor” if you complete some kind of doctoral thesis. If you simply complete the compulsory parts of medical school and pass the state (Land) medical licencing exam you are an “Artzt” (physician) (and can work as a doctor) but you are not officially a “Herr/Frau Doktor”. People like this are supposed to list their qualification formally as “State Med Exam (Bayern)” or similar.

    One of my German medical friends tells me that if you were applying for a hospital job and put “Dr Med” on your CV when you were really just “State med exam (Land)” this would be regarded as serious professional dishonesty.

    So – in order to call yourself “Doktor” you have to complete some research work and write a research thesis which is then examined and ratified by the University. Quite a lot of German medical students do this during their time as students by doing research work in one of the Professors’ labs in the evenings, at weekends and in the holidays (although often they do not complete the actual written thesis until some time – even several years – after finishing medical school).

    The thesis is not really equivalent to a Ph.D., though, as it is not as much work (a Ph.D. being 3-5 years full time depending on the country). The German medical thesis is more like an extended Master’s Degree Thesis in research (about equivalent to 1-2 years full-time). But anyway, if you pass the medical licencing exams and complete the research thesis then you are entitled to call yourself “Doktor Medizin” or Dr. Med. … and you can style yourself “Doktor”.

    It is of course possible that Rath may have completed a full Ph.D. later, but I doubt it – given his liking for making himself sound important and learned, I think that if he did have a real Ph.D. he would be listing his qualifications on the American websites as “M.D. Ph.D”. A lot of American medical researchers have both degrees, and it is common to list them that way.

    [An "MD" degree, as a kind of research-degree-but-shorter-duration-than-a-PhD, also occurs in the UK, and it is sometimes argued that it is "broadly equivalent" to a Ph.D,as Rath is seemingly equating them This always causes heated arguments between scientists and medics!

    In Britain a doctor's degrees when he/she graduates from medical school graduation are "MB ChB" or "MB BS" which is formally "Bachelor of Medicine and Bachelor of Surgery". It is possible later to take a "research doctorate in medical research", usually taking two years, and submit an MD Thesis - a bit like what Rath did in Germany. It is a subject of regular debate between (non-medical) scientists and medical doctors whether this MD degree is really equivalent to a Ph.D. The scientists (who take 3-4 yr Ph.D.s) typically think it isn't. The medics and surgeons (who do the 2 yrs research MD degrees) like to argue that it is. In reality, it will depend on the project and the work. There is a considerable range in what is acceptable for both degrees in terms of the quality and quantity of research].

    Anyway, to summarise, if one asks the question “does Rath have a degree based on research work and a thesis” the answer is yes, though the degree is not precisely a Ph.D.

    Finally, the reason Rath would be talking about this in South Africa is that presumably he is not licenced with the South African Medical Board and thus cannot practise as a medical doctor (physician) in South Africa. So his line is “Oh well, doctor is just a title based on my earlier training, I do not claim to be a physician” – though you might wonder if poor South Africans attending his “Dr Rath Centres” for “nutritional advice” would be clear about the difference.

    It is actually a common practise of some “medical nutritional therapists” and gurus that even when they have a medical degree they are not licenced to practise (mainstream) medicine in the country where they are working. They often say this is because it would be “too much trouble” but it is widely suspected that it is more to do with there being standards and codes of conduct, and disciplinary procedures, for people that are properly registered to practise medicine. An example of this kind of “once doctor but not doctor” in the UK is “Doctor” Nish Joshi, celebrity nutri-detox guru to various dimwitted celebrities.

  25. draust Says:

    I have now tracked down the DNB entry Eric mentioned earlier to Rath’s MD dissertation – this link should work. It confirms Rath completed the dissertation in 1989, some years after he graduated from medical school (1985). This (completing the MD dissertation a few years after graduating) is pretty common. The research is probably the same as described in one of the papers for the Hamburg era. This paper certainly looks similar by title.

  26. The Tragic Human Cost of Political Idiocy and AIDS Pseudoscience « Dr Aust’s Spleen Says:

    [...] – no doubt applauded by plausible nitwits like Patrick Holford, and by the “Pope of Vitamins”, Dr med Matthias Rath. Both Holford and Rath have spent a lot of time in, and promotional effort on, South Africa these [...]

  27. The twelve days of (alternative) Christmas « Dr Aust’s Spleen Says:

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  28. Keeping it unreal « Dr Aust’s Spleen Says:

    [...] also makes clear why no nutritionist in the UK has ever commented on the Rath vs. Goldacre case. Simply put, in the nutritionists’ particular reality the case was, as described, a triumphant [...]

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