Archive for the ‘Nutri-nonsense’ Category

Satire is dead. Have a burger.

November 12, 2010

One of my satirical and musical heroes, the great Tom Lehrer, was famously quoted as saying that political satire died the day Henry Kissinger was awarded the Nobel Peace Prize.

I am having something of a similar moment today.

This time last week I was reading in the British Medical Journal that 17% – around a sixth – of the colossal US spend on healthcare was accounted for by diseases resulting from obesity. [Original report here – pay to read full version]

Obesity is also, of course, a major source of health problems, and health expenditure, in the UK.

And you do not have to watch Jamie Oliver’s TV shows to understand that changes in our diet, and the inexorable rise of high-calorie convenience foods, play a role in this.

But Fear Not – our new Government Has A Plan.

It must, indeed, be a cunning and subtle one.

For how else to explain that the people who are going to be “helping” with the Govt’s new anti-obesity public health strategy are apparently to be McDonald’s, KFC, PepsiCo, Kellogg’s, Unilever, Mars and Diageo.

I am delighted that these major retail concerns, who sell such excellent, nutritious, refreshing and health-giving food and beverage products, are to put their undoubted expertise to use in making as much money selling us processed food as they possibly can helping us eat a healthier diet.

Alternatively, you might consider the following words:

“fox” “chicken coop” “in charge of”

Keeping it unreal

January 3, 2009

A correction: Matthias Rath vs. Ben Goldacre and the Guardian

In September 2008 the Badscience Blogosphere, in common with media outlets, reported that controversial vitamin entrepreneur Dr Matthias Rath had dropped a legal action for defamation against writer Ben Goldacre and the Guardian, a major debacle for Rath.

We now realise that this impression, conveyed in headlines like:

”Fall of the doctor who said his vitamins would cure AIDS”

(The Guardian, Sept 12th 2008)

”The Matthias Rath case exposes the difference between science and its imitators”

(The Times, Sept 20th 2008)

”One small additional reason to despise Matthias Rath – he sues over good honest journalism”

(Holfordwatch, 12th Sept 2008)

”Matthias Rath drops his million pound legal case against me and the Guardian”

(Badscience.net 12th Sept 2008)

”The Gripes of Rath”

(DC’s Improbable Science, Sept 13th 2008)

(and many others, see also here (Gimpy), here (the Quackometer) and here (jdc 325))

- was wholly misleading.

These articles conveyed the erroneous impression that Dr Rath and his organisation had, in effect, lost the court case. We had inferred this from the reports that Dr Rath had abandoned the legal action, in which he had been seeking judgement and damages against Goldacre and the Guardian, and been ordered to pay the newspaper’s legal costs.

However, this state of affairs was, we are now forced to admit, only true in one particular frame of reality. This particular reality is commonly described as “reality”, but we must now learn to call it instead the “False Pharma-Reality” – because it is clearly a corrupt product of the “Pharma-Geschäft mit der Wirklichkeit”, which translates from the original German as ”the Pharma business with reality”, or “the Pharma trade in reality”.

In fact, as reported in the parallel reality on the website of the Dr Rath Foundation, the court case was a tremendous and epochal victory for Dr Rath. This can be seen from the triumphant coverage here and here:

“In a historic case at the High Court in London, the British newspaper The Guardian was sued for maintaining the fraudulent claims that ARV drugs are life saving and life prolonging. Dr. Matthias Rath, who initiated this litigation, together with his colleagues, gave the newspaper and its team of ARV promoting experts the opportunity to defend their false claims under oath. They could not. The details of this historic litigation are documented here.

The year 2008 marks a watershed for the multi-billion dollar ARV business: it has been exposed as a hoax in sworn court testimonies. By publishing this historic exchange of scientific arguments conducted under oath – and details of the capitulation of the ARV promoters in the face of the scientific facts – insurance companies, governments and above all millions of patients now have a legal base from which to hold responsible the drug companies involved in such unscrupulous and criminal behavior.”

This 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 vindication for Dr Rath, and not a defeat.

We are delighted to have the chance to print this correction, and apologise unreservedly to our readers for having led them to believe that there was any such thing as reality.

———————————————————————————-

Following publication of the above correction, the organisation “Concerned Citizens for Reality Freedom” has asked us to print the following article in our recurring “Comment is Free (of reality)” feature, where people involved with an issue the BadScience Blogosphere has covered respond to the coverage.


We demand universal freedom of reality – a basic human right

“We are delighted to hear that the true story of how Dr Rath won a magnificent victory for truth by spending a great deal of money on lawyers’ fees has now been told. It is typical of the lies and deceptions of the bought-and-paid-for front men of the Illuminati New World Order Icarus-Sect Lizard Overlords global Pharma-Cartel that they are promulgating the discredited idea that an account of what actually happened can ever constitute any kind of meaningful “truth”.

All concerned citizens must be eternally vigilant against those who will try to claim that “reality” is truly “reality”, rather than “Pharma-Reality”. They should be especially sceptical of the claims of blinkered scientists, doctors and other “experts” in the pay of the global Pharma-Cartel, who will try to insist that this “reality” represents some kind of privileged empirical reality, as attested to by verifiable scientific data. As a mark potential cash-cow useful idiot concerned citizen, you should not believe them, but should instead stand up for your human right to a reality of your choice, as Dr Rath has so successfully done.

Our unreality is under threat! Get involved! Join us in the global campaign for ”Reality Freedom”. Our two key slogans, which we expect to be available soon on a range of badges, T-shirts, mugs and bumper stickers, are:

“Reality – no thanks!”

(from the original German: Wirklichkeit – Nein Danke!)

and:

“Keeping it unreal”

Come and fight alongside us – for a personal reality of your own choosing.“


[bpsdb]

——————————————————————————————-

Useful links:

UK press gazette – brief interim coverage of earlier stages of the case from March 08. The story concerns an “evidentiary” legal decision relating to the case that can be found in full here (NB – PDF).

Brief video in which Rath gives his own account of the libel case he brought against the British Medical Journal a couple of years ago. Interestingly, his view of what the case was about does not seem to match the BMJ’s published apology. A comment on this intriguing discrepancy can be found here.

Extended video clip from the Guardian detailing Rath’s activities in South Africa. Anyone who is unclear about the nature of the Herr Dr’s “engagement” should watch this.

Guardian page with links to all their coverage of Rath and the court case.

The Tragic Human Cost of Political Idiocy and AIDS Pseudoscience

December 13, 2008

In which Dr Aust ruminates somewhat unoriginally on the desperate consequences of delusional thinking about medicine… when the deluded are the people running the country.

Somewhat submerged under the media storm over the Bombay terrorist attacks, last month saw the publication of a sobering estimate of the true human cost of the Mbeki government’s decade of incomprehensible HIV denialism in South Africa. The Guardian covered the story here.

The basic history is no doubt well known to most readers in the Badscience blogosphere; as the millenium dawned, South Africa faced an unprecendented AIDS crisis, with 10% of the population infected with HIV. However, seemingly enchanted by the claims of maverick scientists like Peter Duesberg, President Thabo Mbeki and his government decided to pursue a policy based on the view that HIV was not the cause of AIDS. They therefore failed to implement programmes of treatment with antiretroviral drugs – the drugs that had transformed the prognosis of HIV-positive patients in other parts of the world in the late 90s.

They continued with this policy as yet more scientific evidence accumulated that HIV was the cause of AIDS.

They continued as HIV-positive people in many other countries had their death sentences stayed by antiretroviral therapy.

They continued even when the cost of the antiretroviral drugs tumbled, and when global schemes were set up to fund the treatment programmes.

They continued even though studies showed antiretroviral treatment was cost effective in South Africa.

And they continued even when South Africa’s poorer regional neighbours, like Botswana and Namibia, managed to implement treatment programmes.

The authors of the recent estimate summarise some of the timeline in a handy diagram:

hiv-timeline

To see the original,  go to the paper, click the “Full text” link, then “Fig. 1″, and finally click the figure itself to get an enlarged version – or, when you reach the full version of the paper, click “View full-size inline images”.

Among the things the Mbeki government failed to do was implement programmes to treat HIV-positive pregnant women. An untreated HIV-positive woman has around a 25% chance of passing HIV on to her child during childbirth. With antiretroviral therapy, that transmission risk can be reduced to around 10% in developing world settings with vaginal delivery, or even to only a few per cent in some recent studies (for a medical review of some recent trials see here, or the Cochrane summary here). This is not enough on its own, sadly, as breast feeding can also pass on the virus – but it is a start. Around half to two-thirds of children who acquire HIV from their mothers in the developing world do so during delivery.


Estimating the true cost in lives

The stories that appeared last month centred round a new analysis, by a group of workers from the Harvard School of Public Health, that estimated how many lives the Mbeki regime’s failure had cost. They did this by assuming that South Africa could have achieved something approaching the kind of treatment coverage and results that proved possible in neighbouring Botswana and Namibia, countries with similar social and infrastructure “contexts”.

The authors estimate – and they make clear that their estimates are “conservative”, so likely to be on the low side – that each year from 2000 to 2005, about 7000 HIV-positive babies were born in South Africa who could have been born virus-free had their mothers been treated.

They also estimate that around a third of a million people in all died unnecessarily over these five years. People who might have lived had they got timely treatment with antiretroviral medication.

The terrible effects of this death toll, of course, go beyond the lives of those lost. In the Introduction of their paper, the authors note that:

Approximately 1.2 million children [in South Africa] younger than 17 years have lost one or both parents due to the [HIV/AIDS] epidemic”.

So what caused the Mbeki Government’s disastrousfailure? The authors of the study discuss one salient issue, that of the cost of the antiretroviral drugs, and conclude that this cannot account for the South African government’s actions. They could have afforded the programme, as their poorer neighbours ultimately did. The cost of the drugs has dropped dramatically over the last decade, largely due to pressure on the pharmaceutical companies from activists and campaigners – the real heroes of the hour – as well as from governments, NGOs and charities. So cost alone was unlikely to have been the decisive issue.

The South African government also chose to convince itself that the scientific consensus that HIV caused AIDS was uncertain.

One vehicle for this was Mbeki’s notorious Presidential Advisory Panel on AIDS in 2000. The Panel included Peter Duesberg and a bunch of other “HIV sceptics”, like Harvey Bialy and David Rasnick (the latter now seems to have fetched up working for the Dr Rath Health Foundation in South Africa).

As the British Medical Journal noted at the time:

“At least half of the Presidential Advisory Panel on AIDS, as the group is now known, are scientists and doctors who have disputed the orthodox views on AIDS. Many of these do not believe HIV causes AIDS.”

Unsurprisingly, the Panel rapidly split into two distinct groups; those who believed HIV was the cause of AIDS, and recommended rapid institution of retroviral treatment programmes along with public health measures; and those, like Duesberg, who denounced the HIV hypothesis and recommended (largely) public health measures alone. The Panel’s report, which can still be found online in full here (warning! – 1 MB PDF), makes bizarre reading; it is really two reports in one.

What appears nowhere in the report is any hint that the HIV sceptics, who were well represented and even in a majority on the Panel, were representative of a tiny – if vocal – minority of the scientists and doctors studying AIDS worldwide.

In a recent editorial, entitled “The Cost of Silence?” Nature suggests that the mainstream scientists and doctors might have done better to have refused to serve on the Mbeki Advisory Panel at all. Their participation, Nature says, led to the appearance in the Panel’s deliberations that there was a real scientific issue to be argued. The Panel’s report, in turn, presented this “dichotomy of views” – when really there was a massive preponderance of evidence, and expert views, on one side, and a lot of evidence-free fringe theorizing on the other. This appearance of an undecided issue gave the Mbeki government the fig-leaf it needed to state that the issue was still contested, and to stall on antiretroviral therapy programmes. While Nature does not state outright that it thinks the South African government had already made up its mind when it set up the Panel, the implication is clear.

Reading the Advisory Panel report, one can perhaps catch glimpses of why the “HIV is not the cause” case might chime with the thinking of some populist politicians. Since they had decided HIV was not the agent causing the AIDS epidemic, the “HIV sceptics” could instead call for progress on a long list of the kinds of things dear to politicians’ hearts:

———————————————————————————————–

The recommendations listed below were proposed as necessary and sufficient to combat all the risk factors that are the real cause of AIDS:

1. Improving sanitation and public health measures to decrease water-borne diseases.

2. Strengthening health infrastructure.

3. Reduction of poverty and improving general nutrition and implementing nutritional education and supplements for the general population.

4. Improving screening for and treatment of sexually transmitted diseases.

5. Promoting sex education based on the premise that many sexually transmitted diseases and pregnancies could be avoided.

6. Implementing public education campaigns to destigmatise AIDS and reduce public hysteria surrounding the disease.

9. Treating infections vigorously and timeously (sic – possibly meaning “in a timely fashion”).

10. Increased support for and promotion of research into the development of drugs against AIDS, its cofactors and risk factors.

12. Implementing aggressive programmes to empower women and change the power relations between men and women.

13. Reducing the vulnerability of communities by improving access to health care.

14. Improving literacy.

[Presidential AIDS Advisory Panel Report: March 2001: pp 86-87].

—————————————————————————————–

Now, none of these is a bad thing – far from it. Who could argue with any of it? All good stuff, and the “HIV causes AIDS” group on the panel said many of the same things in their recommendations.

But – and it is a very, VERY big “But”- these laudable measure were, sadly, just not what was needed as a first priority in the face of an unprecedented epidemic of a deadly but slow-acting viral disease. Or, at least, they were not enough, and never would be. They would do some good – but not nearly as much good as if they had been combined with an immediate and vigorous campaign of treatment with antiretroviral drugs.

There is also another side to the catastrophe, as noted by many commentators, including Bad Science’s own Ben Goldacre, and also the Harvard authors:

The South African government, through the Health Minister Manto Tshabalala-Msimang, …continued… to divert attention from ARV drugs to non-tested alternative remedies, such as lemon juice, beetroot, and garlic, sometimes even promoted as better alternatives and not supplements for AIDS treatment

Tshabalala-Msimang scores high on the infamy scales for me because she is, almost unbelievably, a medical doctor who trained in obstetrics and gynecology and later in public health. I am truly dumbstruck that a person with her professional background could have participated in such an orgy of delusion. Though if some of the stuff that newspapers in South Africa have printed about her is true (see e.g. here and here) it is pretty scary that she was a Minister in the first place.

Anyway, the quackery was doubtless not just Tshablala-Msimang’s idea; the promotion of alternative therapies was prominent in the recommendations of the HIV denier half of the Advisory Panel. The keen-eyed reader will have noted the omission of several numbered points from the list above. The missing ones are as follows:

———————————————————————————————–

7. Investigating the use of immune-boosting medications, such as interferons, growth factors, B-complex vitamins and herbs (such as ginseng, Chinese cucumber, curcumin, aloe vera, garlic and echinacea).

8. Encouraging the detoxification of the body through several inexpensive interventions, such as massage therapy, music therapy, yoga, spiritual care, homeopathy, Indian ayurvedic medicine, light therapy and many other methods.

11. Encouraging the involvement of complementary medical and health practitioners, including indigenous healers, in research and clinical fields.

(Italics mine)

——————————————————————————————–

Following the embracing of this menu of delusion by the Mbeki government, Tshablala-Msmang enthusiastically promoted it – no doubt applauded by plausible nitwits, sorry, “Nutritionists”,  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 last eight years or so.

It does not take a genius to surmise that they would have seen a large market, full of often poorly-educated people, where their seductive nutritional remedies (“no nasty toxic drug side effects!”) would appear almost officially sanctioned.

Admittedly, the role of AIDS deniers, of alternative medicine idiots, and of vitamin pushers like Rath and Holford, are minor compared to the overwhelming responsibility of Mbeki, his Health Minister, and the rest of the President’s deluded inner cabal. But there is an obvious element of “toxic enabling” at work.Which suggests:

—————————————————————————————-

A BadScience Formula:

Self-deluding scientifically illiterate politicians

+ vocal “skeptics of the scientific orthodoxy”

+ “traditional healing practices” enthusiasts

+ vitamin salesmen and Nutritionistas

+ endless ill-informed media reportage, especially of the previous three groups

= possibly catastrophic consequences

———————————————————————————–

Anyway, I would like to think that the next time dear old Patrick Holford says something mind-bogglingly dim like:

“[The retroviral drug] AZT is… proving less effective than vitamin C” [ in treating HIV]

- or the next time that Matthias Rath claims that modern medicine is a Pharma conspiracy to keep people sick – that someone will be there to remind them of just where their preferred nostrums and delusions can lead.

You might, for instance, like to ask Patrick:

“So can Vitamin C prevent mother-to-child transmission of HIV, the way that anti-retrovirals do?”

I would love to know what his answer would be.

Getting back to the paper, the authors’ conclusion is chilling:

“Access to appropriate public health practice is often determined by a small number of political leaders. In the case of South Africa, many lives were lost because of a failure to accept the use of available [antiretrovirals] to prevent and treat HIV/Aids in a timely manner.”

One can only hope that political leaders elsewhere have proper scientific and medical advisers. And that they can keep their minds free of the soothing claptrap peddled by the fans of Alternative Reality.

Although looking at the way that politicians in the UK these days persist in regarding CAM as purely an issue of consumer choice, with no health implications… sometimes I am not so confident

—————————————————————————————

Notes:

This post is not very original, and obviously owes a lot to Ben Goldacre’s coverage of the issue. Talking of which, word in the bookosphere has it that the revised edition of Ben’s Bad Science book, due out next Spring, will have an extra chapter devoted to Herr Dr Med Matthias Rath, in which the learned Herr Doktor’s South African activities can presumably be expected to feature prominently.

Another good guide to the history of the South African HIV denialism catastrophe is the Skeptical Inquirer article by South African economics Professor Nicoli Natrass.

Finally, a longer and more scholarly article written earlier this year by Prof Nattrass for the journal African Affairs, can be found here. It includes an earlier estimate of the human cost of Mbeki’s policies, broadly similar to the Harvard study’s conclusions. This article also has a section (pp 169-171) dealing with Rath and other peddlers of “nutritional solutions”, and their relationships with Tshabalala-Msimang.

[BPSDB]


The First Nutritionista’s Song

November 19, 2008

In which Dr Aust gets all Gilbert and Sullivan on celebrity Nutritionistas and their airs

Dr Aust is into rhyming at the moment.

This is in part because the Aust-mobile (a twelve-year old tin box on wheels with the absolute minimum of features) finally gave up the ghost a few weeks back. The clutch started making strange groaning noises, and was diagnosed as terminal, and the gearbox is apparently also on its last legs. As result I have been travelling to work and back each day on our wonderful (note: irony) local public transport system, after a gap of nearly a decade. I now get 40 minutes* each way, daily, to read a book (too much paper-folding to read a broadsheet, the Metro is too brain-numbing to count as a newspaper, can’t face working), or to do some thinking.

(*median value: the range so far is 30-55)

Anyway, one of the more relaxing ways I have found to pass these journeys is to try and think up lyrics to comic (more specifically, parody) songs.

But who to write them about?

Well, recently I was thinking it had been a while since I wrote anything about our friends the Nutritionistas. And then I saw this amusing – if rather depressing – piece about an Old Friend of the BadScience Blogosphere who is something of a National Nutritionista celeb.

The final piece of the jigsaw fell into place when my father, while visiting last weekend, told me that he was once in the chorus for a student production of Gilbert and Sullivan’s H.M.S. Pinafore.

For those not familiar with HMS Pinafore, Wikipedia notes that one of its underlying themes is

“pok[ing]…fun at… the rise of unqualified people to positions of authority”

G and S were rather good at puncturing pomposity and sending up those with inflated ideas of their eminence and importance. The particular scene that swam into my mind’s eye on this occasion was this one from Act One of H.M.S. Pinafore.

I have attempted a Nutritionist re-write.

Scene: A conference held in the Institute of Optimistic Nutrition.

An audience of worried looking people sit in anticipation. Many are clutching books with a picture of a bronzed and healthy-looking smiling man with short greying hair on the cover.

Enter THE CHORUS stage right. They are dressed as journalists, and carry notebooks, laptops and Blackberrys. Some are Lifestyle journalists, recognisable by their GoreTex bicycle clothing (men) or unfeasibly large handbags (women)

A second chorus of younger people (THE GRADUATES) files on stage left. They are wearing white coats and smart trousers and carrying clipboards and glossy brochures. Their leader is a glamorous blonde (the NUTRITIONAL THERAPIST).

Finally, THE NUTRITIONIST enters, smiling and waving, to applause from the CHORUS OF GRADUATES. He is clad in jeans and a collar-less denim shirt, and looks about 35.

[Note: If the production budget stretches to this, he may be accompanied by a MINOR CELEBRITY, for instance an actress, model, has-been singer or serial footballer dater, The MINOR CELEBRITY does not speak or sing, but should look at THE NUTRITIONIST adoringly].


Music: “Now give three cheers” (sometimes known as “I am the monarch of the sea”)

NUTRIONIST (N): I am the Great Nutritionist

On that my revenues quite insist

To whom packed lecture halls pay tribute

NUTRITIONAL THERAPIST (NT): And so do the graduates of his Institute!

ALL: And so do the graduates of his Institute!

The Graduates of his Institute!

N: I know what’s best for you and me

Vitamins A, B, C, D and E

My supplements are just as good as eating fruit

NT: And so say the graduates of his Institute!

ALL: And so say the graduates of his Institute!

The Graduates of his Institute!

N: When sceptics try to catch me out

To claim the rules of evidence I flout

I’ll just deny I made the statement in dispute

NT: Supported by the graduates of his Institute!

ALL: Supported by the graduates of his Institute!

And also by his clients who think it must be a science Institute!

(music changes to tune of Gilbert and Sullivan’s “First Lord’s Song”, sometimes known as “When I was a lad”)

The Nutritionist’s Song


N: When I was a lad I took a degree

In experimental psychology

In a library book I found the odd conceit

That schizophrenia is caused by what we eat

ALL: That schizophrenia is caused by what we eat!

N: I seized on this idea so avidly

That I now am a Nutritional Authority

ALL: He seized on this idea so avidly

That he now is a Nutritional Authority!

——————————————————–


(NB Repeats similarly for each following verse)

———————————————————


Finding that my skill was at the writing game

I churned out books and got a shot at fame

I found that people crave Eternal Youth

And pseudoscience makes my Snake Oil sound like truth

I flannelled away so semi-plausibly

That I now am a Nutritional Authority

—————————————————-

My Richard Gere looks and healthy glow

Won me a slot on a breakfast TV show

I plugged antioxidants and vitamin pills

Whilst denouncing the Poisons of the Pharma Shills

I smiled so winningly handsomely

That I now am a Nutritional Authority

——————————————————

To improve education I took a new route

By setting up my very own Institute

And no-one could have been more surprised than me

When it then awarded me a very special degree!

I burnished my CV so meticulously

That I now am a Nutritional Authority

——————————————————

Now I lecture round the country giving more hard sell

To my target audience of the worried well

I listen to their piteous laments

And then I plug my own-brand range of supplements

I’ve played this game so successfully

That I now am a Nutritional Authority

————————————————–


So nutritionists all whoever you may be

If you wish to rise to the top of the tree

The Golden rule is to smile – insist it’s “common sense”

And at all costs have no truck with evidence

Stick to this rule – and charge eye-watering fees

And you too may be Nutritional Authorities

[BPSDB]



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