Appendix 11 – Jerome Burne’s Attempts To Get A Response To Goldacre Published

FIRST ATTEMPT

Ben Goldacre’s shock and awe assault on Gillian McKeith
http://www.guardian.co.uk/food/Story/0,,2011095,00.html was a
good example of kicking someone when they are not just down but
are, rolled up and incinerated. But it leads me to wonder whether I
would like to have Ben Goldacre as my doctor. He has, after all
described himself as a “hard working NHS doctor” in a recent shorter
version of this assault in the BMJ. So if I were to move house I suppose
it’s possible I might find he was my nearest GP – actually what
do you when wearing your white coat, Ben? Since he is the embodiment
of scientific rectitude, merciless with anyone promoting any
treatment not backed up by double-blind etc controlled trials, and
since he never seems to lay into drug treatments, I have to assume that
he regards the drug model as firmly based in sciencSo at first consultation
an obvious topic would be heart disease. As a male over 55, I
should be on cholesterol lowering statins for the rest of my life,
according to current guidelines. But is it that simple? As someone who
believes statins have been massively over-hyped, I would point him to
a very interesting paper in the Lancet entitled “Are lipid-lowering
guidelines evidence-based?” http://www.ncbi.nlm.nih.gov/entrez/
query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uid
s=17240267&query_hl=8&itool=pubmed_docsum. Among other
useful bits of information it tells me that for men who haven’t had a
heart attack, 50 of you have to take statins five years for one to benefit.
Statistical magic, at which the drug companies excel, allows both
that to be true and the claim that statins lower heart attack risk by
around 25%. Which one do you imagine is used in the drug promotional
literature? Then I’d throw in another reference from the BMJ
entitled “Should we lower cholesterol as much as possible?”
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=R
etrieve&dopt=AbstractPlus&list_uids=16740566&query_hl=10&ito
ol=pubmed_docsum, which answers by describing a few other examples
of statistical magic, such as the fact that in at least two of the big
recent statin trials the researchers deliberately excluded any patients
who had suffered any adverse side effects in pre-trial tests and then
claimed that the number of side-effects reported was low.

So already the nice clear division between fraudulent untested
nutrition and scientifically based drug treatments is emerging as in the
US were given to people on an off-label basis. What not so simple as
Goldacre’s rhetoric regularly makes it out to be. But it gets worse.
Last summer a very fascinating paper appeared in another top journal
– the Archives of Internal Medicine entitled: “Off-label prescribing
among office-based physicians” http://www.ncbi.nlm.nih.gov/entrez/
query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uid
s=16682577&q.

The authors had looked at the prescribing habits of a representative
3,700 doctors around the country and found that on average, 21
per cent of the 160 most commonly prescribed drugs this means is that
they were not licensed for that condition – all the evidence base that
Goldacre lays such store by was not there.

Of course there is a good clinical case for off-label prescribing.
Doctors should be allowed to use their experience and judgment to
prescribe unlicensed drugs where other treatments have failed or
where there is a reasonable case for it. But the really shocking part of
the study – conducted at Stanford University – was that for nearly
three-quarters of the off-label uses there was ‘little or no scientific
support’.

Do UK doctors, like Dr Goldacre, do it? Well we don’t know precise
details because no records are kept but we do know that HRT was
prescribed for years to protect women’s hearts without any evidence
base (then it turned out it actually raised heart risk), and that UK doctors
prescribed antidepressant SSRIs to 60,000 children a year until
evidence was finally wrested from the drug companies which showed
that all the brands save one were not only not effective on children but
also doubled their risk of suicide. Somehow the division between silly
unscientific non-evidence based McKeith and her ilk and proper doctors
is becoming even more blurred.

And it gets worse. About 200,000 elderly patients with dementia
are prescribed very heavyweight tranquilisers called antipsychotics
that cause them to have muscle twitches, drool, such as shuffling gait,
extreme tiredness and a worsening of memory and concentration.
Given these severe effects you’d expect there to be a strong scientifically
based case for using them. Not at all. They are not licensed for
these patients, specific warnings have been given that they raise the
risk of stroke and a recent in the New England Journal of Medicine
found they were no better than a placebo http://www.
ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dop
t=AbstractPlus&list_uids=17035647&query_hl=19&itool=pubmed_
docsum.

I would not like Ben Goldacre as my doctor because he must
either be dreadfully naïve or wilfully blind. If he is concerned about
deliberate distortion of the scientific method, as anyone concerned
with medicine should be, then the big beasts in this jungle are the drug
companies. His weekly shooting of tiddlers in a barrel is little short of
shameful.

Jerome Burne is a science and medical journalist and co-author
of “Food is Better Medicine Than Drugs” (Piatkus October 2006).
SECOND ATTEMPT

Response to “A Menace to Science”
From Jerome Burne

Dr. Goldacre certainly does a thorough job of skewering the unfortunate
Gillian McKeith but that’s no grounds for claiming her failings
condemn clinical nutrition in general.

Clinical nutrition is not a mixture of delusion and hope; it’s based
on many of the same biochemical pathways drugs use. Courses take
three years vs. the 10 hours or so training in it doctors get.
Practitioners are just as keen on science and evidence as Dr Goldacre.
Specific diets, studies show, can reduce the risk of heart disease and
diabetes more effectively and safely than the drugs on offer. Evidence
supports the use of specific nutrients such as chromium and cinnamon
to improve type 2 diabetics’ blood sugar levels.

Goldacre’s claim that supplementing with antioxidants not just
useless but harmful is based on a misreading of two studies. The summary
of one said that smokers given beta carotene were at a raised risk
of cancer. However, the details showed that the increase risk was not
significant and that those who stopped smoking during the trial had a
lowered risk by the same amount (see: www.foodismedicine.
co.uk/content.asp?id_Content=1695).

Equally misleading is the study that found heart patients did worse
on vitamin E. Nutritionist know that for vitamin E to work, you need
healthy levels of the enzyme CoQ10. They also know that that cholesterol-
lowering statin drugs also lower CoQ10 and all the patients in
the study were on statins. (Details at the link above.)

So why is Goldacre so rabid in his opposition? McKeith isn’t just
vain woman with poor grip on biochemistry she’s: “a menace to the
public understanding of science”. That’s obviously not true. Any more
than a gynaecologist who damages dozens of women with botched
operations is a threat to surgery.
But it provides a clue to Dr Goldacre’s real agenda. As scientific
medicine’s self-appointed enforcer he gives a right good kicking to
anyone making health claims without proper evidence. Good for him
you may say. However enforcers work for the powerful – criminal,
party-political or religious. The beneficiaries of the doctors’ weekly
drubbings are not “public understanding” but the drug companies.

One of the great strengths of the scientific method is that it is
impartial. But Dr Goldacre is very partial about who he works over.
We never see any of the drug companies being taken round the back
for fudging their statistics as they did with the anti-inflammatory drug
Vioxx that doubled the risk of heart attacks, or keeping inconvenient
findings out of sight as they did with the anti-depressant SSRIs that
doubled the risk of suicide in children. Those were serious cases of
menacing public science but did we see the burly doctor dishing out a
good hiding? We did not.

Clinical nutritionists don’t have growing client lists because the
public is stupid and don’t know what’s good for them. They’re popular
because people often feel better when they follow their recommendations
without suffering the unpleasant and sometimes deadly
side-effects of drugs. And that’s bad for business, so call for the
enforcer.

Of course I could be wrong, so here’s a challenge. Antipsychotic
drugs are not licensed for dementia patients. They raise their risk of
stroke, have horrible side-effects and are no better than a placebo, yet
200,000 elderly people are prescribed them every year. Kneecap those
responsible and I’ll give up taking vitamin C for life.

Declaration of interests: I’m the co-author with Patrick Holford of
“Food is better medicine than drugs” (Piatkus).

THIRD TIME LUCKY, BUT IN THE BMJ AND NOT THE GUARDIAN

Dr Goldacre’s article must be applauded for identifying a number of
the social factors leading to ill-health – inequality, food deserts created
by supermarkets, a failure to implement taxes for bad food and the
lack of an “enabling environment” to promote exercise. All things certainly
worth trying to improve.

However it does seem bit unfair to blame “media nutritionists” for
failing to tackle them, just as it would be unfair to blame “hard working
NHS GP’s for not campaigning for a local cycle track as part of
their daily round.

More seriously in damning the “media nutritionists” actions, he
fails to ask the two most basic questions about any form of treatment
– Does it work and is it safe? There are certainly hundreds of thousands
of people who would tell him that following dietary changes
recommended in books or TV programs benefited them enormously.
Not a randomised trial of course but surely worth considering.
Furthermore even their sternest critics have failed to make a serious
case that “media nutritionists” kill or maim people.

Unlike prescription drugs which, puzzlingly, are never the target
of Goldacres’ tirades. This is puzzling because the essence of his
assault on all non-drug medicine is that it is unscientific. Look at the
charges he levels at “media nutritionists” – they: “wear a cloak of scientific
authority”, “make up evidence when it is missing”, “cherry
pick the literature”, “only quote favourable studies.”

Is he really unable to see that every one of these is regularly done
on a far larger scale and with far more damaging effects by the pharmaceutical
companies? The concealing of evidence of problems with
SSRIs, the marketing and distorting of evidence over Vioxx, the failure
to issue warnings over anti-psychotic drugs – to mention just three
– not only did harm to innumerable patients but also seriously and
deeply “tarnished and undermined the meaningful research work of
genuine academics.

A major reason why the social factors he is concerned about are
regularly pushed to the margins in health policy is because there are
heavily marketed drugs that claim to deal with some of damage those
factors cause. The reason why large scale trials are rarely done to back
up the nutritionists’ claims is because 90% of such trials in this country
are run by drug companies.

If Dr Goldacre is genuinely concerned about ill health and bad science,
he could far more usefully focus his obvious critical abilities on
junk science practised by the drug companies. But then perhaps he
prefers to remain a “branch of the entertainment industry” poking fun
at people who for the most part can’t fight back.

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