/ Health

Had dodgy advice from a nutritional therapist? We have!

Have you ever visited a nutritional therapist? In this month’s Which? magazine we investigated the profession and found some worrying practices, such as therapists advising against going to your GP.

One therapist advised our researcher, who was posing as a cancer sufferer, against having conventional treatment (a lumpectomy and radiotherapy), saying that she should try for three to six months to rid herself of the cancer through diet (by cutting out sugar).

Nutritional therapy can be big business; therapists charge up to £80 for a consultation and often prescribe expensive supplements on top. So we wanted to investigate whether it was worth the money.

How our investigation worked

We asked five undercover researchers to each visit three therapists. Each researcher was provided with a scenario.

One researcher (in her early 30s) had been trying to conceive unsuccessfully for over a year. Two (in their 50s) had been suffering from severe tiredness for the past three months. And two women (in their 40s) had recently been diagnosed with DCIS (Ductal Carcinoma in Situ), the most common type of non-invasive breast cancer.

A panel of experts (a dietitian, a GP and a Professor of Pharmacology) then assessed recordings of the visits and any other information the therapists provided to the researchers, including prescriptions for supplements.

Are nutritional therapists worth the money?

Our expert panel concluded that visiting a nutritional therapist wasn’t worth the money – and in some cases could have actually endangered the health of the researcher. Six of the fifteen consultations were rated as ‘dangerous fails’.

This could have been down to a number of reasons:

  • The advice given by the therapist could have potentially harmed the researcher.
  • Therapists were diagnosing conditions without relevant testing (even though their Code of Practice says they shouldn’t diagnose).
  • Researchers were advised not to visit their GPs about the problem, recommending unproven testing such as hair mineral analysis, and the case above, advising against cancer treatment.

Of the remaining visits, eight were rated as ‘fails’ and only one was graded as a ‘borderline pass’. Our experts were disappointed by the advice given by therapists and concerned at their poor knowledge of the body and how it works.

The experts were also worried by some therapists using non-evidence-based testing to diagnose symptoms. These tests included iridology (studying the patterns, colour and other characteristics of the iris), hair mineral analysis and a researcher being given several liquids to hold in his mouth before being told he had a chromium deficiency.

Are the recommendations right?

Twelve of the therapists prescribed supplements to the researchers, costing up to £70 a month. Researchers were told not to buy them from Boots or other high street chemists as they weren’t ‘pure enough’ and you were effectively ‘flushing your money down the loo’. Instead, they were asked to buy them from the retailers recommended by the therapist.

Of course, there is benefit in following healthy dietary advice, but most of what was provided by the nutritional therapists is freely available on websites such as the NHS site.

Plus, most of the therapists in our investigation recommended quite restrictive diets that excluded several foods (predominantly dairy and wheat) and taking expensive supplements.

If you do have a medical condition that you are concerned about, your first port of call should be your GP. If necessary they can then refer you to a dietitian. We have contacted the British Association of Applied Nutrition and Nutritional Therapy (BANT) with our findings and concerns.

People who have visited nutritional therapists emailed us to say that they found the diets recommended to them difficult to maintain over a long time and eventually gave up.

Have you visited a nutritional therapist? What was your experience like – do any of these findings ring true or did you have a more positive experience?

Comments
Guest
Ellie says:
22 February 2012

I think I have changed my stance a bit since participating in this blog. It has made me feel that Statutary regulation of Nutritional Therapists may well be a good thing, and probably sooner, rather than later in order to protect the well qualified NT’s who are practising responsibly.

Guest

Just called back to say that CNHC now has a descriptor for nutritional therapy:

http://www.cnhc.org.uk/assets/Nutritional-Therapy-4-009.pdf

Guest

Ellie, I think you are absolutely right, the whole alternative field seems fair game for accusations of all sorts and to be able to feel confident in the qualifications and professionalism of a Therapist is vital. Both the Therapist and the Patient would benefit especially if the Regulating Body could also monitor and gather evidence of good practice and benefits to patients.
I believe the lack of credible/indisputable evidence of efficacy is the main reason why detractors can do so much damage to the reputation of soundly based Therapies delivered by dedicated and well trained Practitioners. Sadly jumping through some ‘orthodox hoops’ might make the work of delivering these valuable Therapies more successful and effective. The biggest question is who will foot the bill?

Guest
Alan Henness says:
22 February 2012

Liz said:

“the whole alternative field seems fair game for accusations of all sorts and to be able to feel confident in the qualifications and professionalism of a Therapist is vital. Both the Therapist and the Patient would benefit especially if the Regulating Body could also monitor and gather evidence of good practice and benefits to patients.”

Cart and horse here. First show that a therapy has a worthwhile, repeatable, beneficial effect; find out the parameters relating to conditions, use, dosage, training of practitioners, etc, etc, etc then you can start thinking about what regulation might be appropriate to protect the public. You can’t regulate nonsense – you have to first show that it’s non nonsense.

“I believe the lack of credible/indisputable evidence of efficacy is the main reason why detractors can do so much damage to the reputation of soundly based Therapies”

I can’t disagree with the first bit – it’s just how you can come to the conclusion that they are soundly based that I have problems with.

“delivered by dedicated and well trained Practitioners.”

I have little doubt that most providers of alternative therapies are dedicated and well trained (in whatever they are trained to do), but being dedicated and well-trained in nonsense still leaves them practising nonsense.

“Sadly jumping through some ‘orthodox hoops’ might make the work of delivering these valuable Therapies more successful and effective.”

Providing robust evidence isn’t jumping through ‘orthodox hoops’: it’s about providing a good level of assurance that the public are not going to be harmed and that there is a good chance they will be helped.

“The biggest question is who will foot the bill?”

Not me! Do you agree the onus is firmly on those who want their treatment to become accepted to come up with the money?

Guest
Maria says:
22 February 2012

Liz said,

“I believe the lack of credible/indisputable evidence of efficacy is the main reason why detractors can do so much damage to the reputation of soundly based Therapies delivered by dedicated and well trained Practitioners.”

The lack of credible evidence is one of the mains reasons, the fact that they are not “soundly based” is the other. The lack of scientific plausibility coupled with the lack of evidence for efficacy is the reason why any further research into a “therapy” like homeopathy is a waste of time.

Guest
Maria says:
22 February 2012

Sorry, I cross-posted with Alan. Didn’t mean to pile on.

Guest

Barney, your reply to Alan………………..

“Alan, it would indeed be wonderful to compare just how many people have been helped by non-orthodox medicine with those helped by conventional methods, just as it would be marvelous to know for sure just how many people are injured and killed by both approaches”.

Now let’s see, Modern Medicine has been around for about 150 years or so, give or take a decade, whereas Alternative Therapies have been around for thousands of years, such as TCM about 2500 years; Ayurvedic Medicine about 5000 years and so on.

Now if we use a bit of logic/reasoning (popular here BTW) and some here say that I am devoid of, then these Alternatives would have vanished into the night as being ineffective hocus-pocus, but here they are today being used by thousands if not millions.
This of course presupposes that all these millions of people are mindless gullible morons, who have been duped, and had their money extracted from their wallets under false pretences.
Does anyone seriously believe that these therapies, which have stood the test of time, are worthless and ineffective, and kill on a scale akin to the holocaust?
Logic dear friends. Logic.

Guest
Stuart says:
23 February 2012

“whereas Alternative Therapies have been around for thousands of years, such as TCM about 2500 years; Ayurvedic Medicine about 5000 years and so on.”

An thinly veiled appeal to tradition.

“then these Alternatives would have vanished into the night as being ineffective hocus-pocus, but here they are today being used by thousands if not millions.”

An appeal to popularity which says nothing about how effective something is. Smoking has been around since 5000BC, and we only discovered relatively recently that its harmful. Smoking is still very popular today.

“This of course presupposes that all these millions of people are mindless gullible morons, who have been duped, and had their money extracted from their wallets under false pretences”

Strawman. No it doesn’t. It supposes that human beings are capable of wrongly attributing cause and effect, and are succeptible to conformation bias, placebo effect etc. No-one has accused anyone of fraud, although its telling you feel the need to defend it against this accusation.

“Does anyone seriously believe that these therapies, which have stood the test of time, are worthless and ineffective, and kill on a scale akin to the holocaust?”

Are you close minded to that possibility? How can you regulate alt med if you cannot at least consider its potential for harm. No-one mentioned the holocaust, or any scale.

Guest
Stuart says:
23 February 2012

You haven’t answered alans question.

How many people have been helped by drugs and conventional medicine, lets include any intervention which saved a life, improved quality of life, relieved pain etc.

How many? Simple question. Then we can discuss those harmed by it and look at risk/benefit.

Guest
Barney says:
23 February 2012

Come on Stuart, you cannot simply dismiss with an airy wave thousands of years of human experience and learning, to which chrisb was referring, as “a thinly veiled appeal to tradition”. This experience is a form of scientific evidence: observational, experiential, a process of development over long periods of time. It may not be randomised, controlled, clinical trials, but it’s still a genuine form of scientific evidence. If you’re going to base your position on what you term ‘science’ and ‘critical reasoning’, jettisoning huge portions of the data simply won’t do. And if you’re going to wait for the clinical trials evidence of every aspect of traditions like TCM and Ayurveda, you’ll be here until Doomsday.

As I mentioned in my previous post, it’s difficult if not impossible to obtain figures for morbidity and mortality caused by non-orthodox methods, purely since they are overwhelmingly practised outside the big institutions that collect those data. On the other hand, providing figures for how many people have been helped by orthodox medicine – or non-orthodox, for that matter – is far from a “simple question”! If it was such an easy matter, don’t you think someone would have done it by now? You’re asking for the numbers of people who visit their GPs, receive medicine and get better as a result of the medicine and not regression to the mean; for the numbers of people who go to hospital, receive treatment and get better as a result; for the numbers of people who take an aspirin for a headache, who take an antacid after a big meal, who take Alka-Seltzer after a night out, etc. etc. etc. I’m pretty sure those data aren’t available, anywhere, but I’m open to being proven wrong. Ditto for the numbers of people helped by non-orthodox approaches.

All we can do at this stage is get an idea of the relative harm caused by orthodox and non-orthodox medicine. Yesterday, I provided robust data, taken from government institutions, meta-analyses and major peer-reviewed scientific papers, that orthodox medicine is likely the third-leading cause of death in the USA – a country using pretty much the same medical orthodoxy as the UK. As a comparison, data from the American Association of Poison Control Centers revealed 6 deaths from vitamins/minerals, herbs and homeopathy combined in 2010. I fully admit that these data are incomplete, and I fully admit that many alternative therapies are not included in the dataset. But I think it gives us a fair idea of the comparative safety of the two approaches. Do you have any data that indicates any different, please?

Guest
Stuart says:
23 February 2012

“Come on Stuart, you cannot simply dismiss with an airy wave thousands of years of human experience and learning, to which chrisb was referring, as “a thinly veiled appeal to tradition”.”

It an appeal to traditon which has no bearing on whether it works or not. Plenty have things have a long history and tradition. That doesnt validate them. People have been wrongt many many times.

“This experience is a form of scientific evidence: observational, experiential, a process of development over long periods of time. It may not be randomised, controlled, clinical trials, but it’s still a genuine form of scientific evidence.”

Agree. Would you also agree that its a form of evidence which we know can be subject to bias? Would you also agree that anecdotes are not a rational way of making decisions, since there is anecdotal evidence that everything works at some time? How do you propose dealing with that?

“If you’re going to base your position on what you term ‘science’ and ‘critical reasoning’, jettisoning huge portions of the data simply won’t do. And if you’re going to wait for the clinical trials evidence of every aspect of traditions like TCM and Ayurveda, you’ll be here until Doomsday”

Science is about using the best quality data we have, not all of it. High quality evidence is more rational and less subject to bias, and so its logical to give that greater weighting in decision making.
We know blood letting was anecdotally a good idea. When good quality evidence emerged it was harmful, did we simply ignore that? Of course not. We went with the stronger less biased evidence. The only reason for using less rigourous evidence is special pleading because it shows that your modality works . Luckily we don’t need to wait until doomsday. many of the alt med practices have been subject to controlled clinical studies which have either shown no effect or inconclusive results.

Guest

What do you mean by ‘Logic’.

Guest
Maria says:
23 February 2012

“What do you mean by ‘Logic’.”

Prime Minister raises a good question. chrisb, You are misusing the term ‘logic’ What you are offering here is not ‘logic’ (which is a system for determining the validity of arguments) but circular reasoning, which is a formal logical fallacy. Your argument boils down to this:

If it didn’t work, people wouldn’t use it, therefore it must work.

You supplement this with a number of other fallacious arguments. Stuart has pointed these out and offered rational counter arguments that counter the fallacy and which, unfortunatley, have been ignored by Barney who simply repeats the same fallacy, to which Stuart has had to respond again.

To stop going round in circles, let’s take a more critical look at your Appeal to Tradition (i.e. argument that a practice or a belief is justifiable simply because it has a long and established history).

You said, “these Alternatives would have vanished into the night as being ineffective hocus-pocus,”

I note you specify Modern Medicine as starting in the 19th century, which is fair enough but it’s actually irrelevant. Historical records indicate that people have always practised some kind of ‘medicine’ in the hope that it will have specific beneficial effects.

Historical records also tell us that much of what was used as medicine was, at best, useless superstition which had no beneficial effect and, at worst, was actively harmful. We now know that people didn’t necessarily abandon useless or harmful practices quickly. Some continued for thousands of years.

Why do you think people continued to use leeches and bleeding over centuries? Do you think it is because they worked, that they saved lives? Do you think the Big Pharma was forcing them on people?

No. People used harmful practices for the same reason they used harmless practises: because (a) they didn’t know what else to do and (b) they believed they could be effective. This raises the question of how people could possibly believe that practices like leeching and bleeding ever worked?

The answer is that some people recovered in spite of these practices, not because of them, and human beings erroneously (as we now know) saw a causal connection between the administered practice and the recovery. Exactly as they do today. This has nothing to do with what kind of treatment is being offered and whether it is ‘orthodox’ or ‘alternative’. It is to do with the flawed way human beings think: Sore throat better? Must have been the antibiotics/homeopathic remedy.

(Of course, when people died after whatever useless or barbaric practice was inflicted on them this was explained by the illness being too serious or advanced for treatment, coupled with speculation about God’s purpose.)

These are the same reasons why people use treatments of any sort today. The thalidomide tragedy is, in this way, no different from the tragedies of children like Cameron Ayres and Gloria Thomas. Notably, the first tragedy was caused by faith in modern medicine and the others were caused rejection of modern medicine.There is a point here being about proportioning one’s belief to the evidence.

Your ‘evidence’ that some therapies have lasted for thousand years and so people must have benefitted from them is undermined by the fact that some therapies, also lasted for thousands of years, even though they were worse than useless. People who are sick and who die whether in spite of or because of the treatment they were given, don’t leave testimonies.

I hope you can see the problem with your appeal to tradition now.

(If we were on another forum, I would also challenge your premise that TCM is 5,000 years old but here is not the place.)

Guest
Barney says:
23 February 2012

People might have been wrong “many, many times”, but we’re talking systems of healthcare that have survived for, literally, thousands of years. We’re not talking the odd, isolated anecdote, but the combined wisdom of civilisations! The traditions have grown, diversified and developed in that time – and continue to do so. As I pointed out earlier in this thread, the danger of an over-reliance on RCTs is that we end up in a “tyranny” where all human experience is dismissed as an anecdote – which you sail perilously close to doing here.

I also find it remarkable that anyone can consider that Western, orthodox, pharmaceutical-led medicine is the only way forward for healthcare, and that the rest of the world has nothing to offer at all. Especially when this supposedly most evidence-led of disciplines is killing and maiming people every day.

Since bloodletting has reared its ugly head once again, it’s worth noting a) that it was only practised by orthodox physicians, like other quackery such as mercury (=quicksilver or ‘quackselber’ in German – ironic that a term originally used to describe orthodox physicians has been highjacked by them and their followers to denigrate the competition), and b) its use wasn’t discontinued because of evidence from clinical trials. Good old observation and clinical experience were enough for doctors to finally give it the heave-ho. Funnily enough, the age of EBM is seeing something of a resurgence in bloodletting, AKA therapeutic phlebotomy (tongue slightly in cheek): http://www.ncbi.nlm.nih.gov/pubmed/8261683, http://www.ncbi.nlm.nih.gov/pubmed/1642354. Anyway, comparing a subtle, complex, interlocking system of medicine like Ayurveda or TCM to a single intervention like bloodletting – as I note Maria has just done – is like comparing apples and oranges. Or rather, a single mouldy apple with an entire orange grove.

There is no ‘special pleading’ in asking for all forms of scientific evidence to be considered. I think someone posted this before, but it contains some interesting arguments: http://www.orthomolecular.org/resources/omns/v07n15.shtml. As I’ve said before, I agree with Dr Sackett when he says that clinical and RCT evidence must be considered. There are flaws with the EBM model as a whole and with RCTs in particular, not least that they are incredibly difficult to organise and expensive to perform – so most forms of non-orthodox medicine don’t have the resources to fund them. Hence lots of poor-quality trials and inconclusive results. Plus a small army of people dedicated to picking holes in even the decent ones. It is an easy matter to rig RCTs anyway, as a critical look at most of the large negative studies into vitamins shows: for example, some have studied a high daily dose of a synthetic vitamin form that isn’t found in nature, and lo and behold, negative results ensue [http://www.bmj.com/content/341/bmj.c5702.long]. Such poor science then gets plastered all over the media and yet more people think that all vitamins are bad for you.

What we need is to look again at how we assess treatments, so that important, non-RCT evidence isn’t excluded. I don’t know how we do that, before you ask. I am not proposing that we ditch the RCT entirely, only that we don’t assume it’s the one and only way to truth. At present, even the best, most instinctively brilliant practitioners of whatever stripe are in danger of being prevented from exercising any kind of art or discernment in their clinical decision-making: if it ain’t in an RCT, it doesn’t work, you can’t do it. It’s a short step from that to robotic, mindless, tick-box medicine. Is that what you want?

Incidentally, you’ve completely avoided addressing the main issue of my post, which was about the relative safety of orthodox versus non-orthodox methods.

Guest
Stuart says:
23 February 2012

“People might have been wrong “many, many times”, but we’re talking systems of healthcare that have survived for, literally, thousands of years. We’re not talking the odd, isolated anecdote, but the combined wisdom of civilisations!”

Repeating the same fallacy over and over again does not make it true. Maris’ examplanation above is far more elequant than I could manage ^

“The traditions have grown, diversified and developed in that time – and continue to do so.”

I disagree, many are belief based systems based on concepts long since shown to be wrong. Many haven’t evolved or diversified especially in the light of new evidence that they were wrong (meridans, Chi energy, law of simliars, succussion).

“As I pointed out earlier in this thread, the danger of an over-reliance on RCTs is that we end up in a “tyranny” where all human experience is dismissed as an anecdote – which you sail perilously close to doing here.”

I acknowledged that human experience is one form of evidence, and that RCT are not the only form of testing that can help to eliminate bias. All I am asking is that bias is removed as far as is practicable, and decision making uses the best evidence of benefit and harm available. Do you disagree with that aim? If so, you sail dangerously close to having virtually no standard of rigour.
I’ll ask again – bearing in mind there are anecdotes which tell us everything is effective, how should we make decisions with such conflicting evidence? How do we ensure that we hear all anecdotes/observations (not just the positive ones which reinforce the belief) and reach a balanced conclusion? Do you believe that these are better evidence when we have controlled trials clinical trials which show us no such effects when bias is controlled?

“I also find it remarkable that anyone can consider that Western, orthodox, pharmaceutical-led medicine is the only way forward for healthcare, and that the rest of the world has nothing to offer at all.”

Strawman. No-one said that, I don’t care where healthcare comes from if it is effective and we have a reasonable understanding of the risks involved.

“Especially when this supposedly most evidence-led of disciplines is killing and maiming people every day.”

The failings of conventional medicine has no bearing on whether alt med works as you are well aware. You havent yet defined the benefits.

“Since bloodletting has reared its ugly head once again, it’s worth noting a) that it was only practised by orthodox physicians,”

……..who changed their approach when their ‘beliefs’ in that intervention were shown to be wrong.

“…….. and b) its use wasn’t discontinued because of evidence from clinical trials.”

Nobody said it was. However, once robust irrefutable evidence was provided that blood circulated within the body, the concept that new blood was made and old blood destroyed was found to be wrong. The concepts on which blood letting were based were shown to be without basis. Had someone suggested this without strong evidence do you think they would have abandoned their traditional and long believed system of medicine, or continued?

“Anyway, comparing a subtle, complex, interlocking system of medicine like Ayurveda or TCM to a single intervention like bloodletting – as I note Maria has just done – is like comparing apples and oranges.”

Why?

“There is no ‘special pleading’ in asking for all forms of scientific evidence to be considered.”

You suggested that we should consider less rigourous forms of evidence, but didn’t first address why this would be beneficial. Special pleading.

“There are flaws with the EBM model as a whole and with RCTs in particular, not least that they are incredibly difficult to organise and expensive to perform – so most forms of non-orthodox medicine don’t have the resources to fund them. Hence lots of poor-quality trials and inconclusive results.”

Yes things could be improved.

The poor quality of studies I have seen have been nothing to do with lack of funding, but through poor experimental design to eliminate bias and a lack of critical review.

“What we need is to look again at how we assess treatments, so that important, non-RCT evidence isn’t excluded.”

But we should be cautious about using poor quality information or that susceptible to bias, and use high quality information where available.

“It’s a short step from that to robotic, mindless, tick-box medicine. Is that what you want?”

No, never said I did.

“Incidentally, you’ve completely avoided addressing the main issue of my post, which was about the relative safety of orthodox versus non-orthodox methods.”

Sorry, Chrisb derailed it! The numbers of people killed by orthodox and alternative medicine can only be considered in the context of the benefits. You cannot simply look at the figures you have given and conclude that one is ‘safer’ and therefore better. There is no point in a safe ineffective treatment is there? Also as I have pointed out all interventions carry some degree of risk, there is no such thing as 100% safe treatment.

Guest
Maria says:
23 February 2012

Barney

As Stuart has noted, you persist in your fallacious argument and “simply dismiss with an airy wave” the flaw that has been pointed out without actually responding to it.

You said:

“Since bloodletting has reared its ugly head once again, it’s worth noting a) that it was only practised by orthodox physicians,”

This is a red herring. A thousand years ago, there was no ‘mainstream’ versus ‘alternative’ medicine. There was just medicine and most of it was useless and a lot of it was harmful. And yet it continued to be used.

“its use wasn’t discontinued because of evidence from clinical trials. Good old observation and clinical experience were enough for doctors to finally give it the heave-ho.”

Straw man. I asked “Why do you think people continued to use leeches and bleeding over centuries?” To put it another way, why did it take a thousand years of “good old observation and clinical experience” before it was finally given the heave-ho.

That is the key to understanding why your fallacious argument is fallacious.

“I also find it remarkable that anyone can consider that Western, orthodox, pharmaceutical-led medicine is the only way forward for healthcare, and that the rest of the world has nothing to offer at all.”

Straw man. Nobody has argued this. The arguments have been entirely about what constitutes good evidence. I think the non-quacks contributing here would agree that evidence-based medicine is the only way forward for healthcare and this is not to say that “the rest of the world has nothing to offer at all” – another straw man. I’m sure nobody would deny that there are complementary therapies that have a place as, well, complementary therapies.

“As I’ve said before, I agree with Dr Sackett when he says that clinical and RCT evidence must be considered. There are flaws with the EBM model as a whole and with RCTs in particular, not least that they are incredibly difficult to organise and expensive to perform – so most forms of non-orthodox medicine don’t have the resources to fund them.”

That is a misrepresentation of what Sackett says. You imply Sackett gives RCT and clinical evidence equal status. In fact, he says,

“Because the randomised trial, and especially the systematic review of several randomised trials, is so much more likely to inform us and so much less likely to mislead us, it has become the “gold standard” for judging whether a treatment does more good than harm.”

Nor does he say there are flaws in the RCT and, anyway, what you are describing is not a flaw in the methodology but a practical problem that limits their use. Sackett acknowledges there are limitations. He goes on to say,

“However, some questions about therapy do not require randomised trials (successful interventions for otherwise fatal conditions) or cannot wait for the trials to be conducted. And if no randomised trial has been carried out for our patient’s predicament, we must follow the trail to the NEXT BEST external evidence and work from there.” (My emphasis)

In a nutshell,

“Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”

Please note this is not an argument to treat thousands of years of anecdotes as if they were scientific evidence because they aren’t.

Guest
Barney says:
23 February 2012

And with respect to both Maria and yourself, repeatedly calling my point of view a fallacy doesn’t make it so, either 🙂

For me, the main benefits of raising the importance of clinical and observational experience are to maintain medicine as an art rather than an algorithm, and so that the experiences of the healer (of whatever stripe) can be taken into account. The failings of modern, orthodox healthcare – or rather, sickness management – are absolutely relevant to this argument. If modern medicine is so evidence-based, and if EBM is the be-all and end-all of unbiased analysis, how come so many people are killed and injured by it? That doesn’t sound like “The best evidence of benefit and harm available” to me! The EBM model is clearly missing something if only a fraction of its vaunted treatments are of known effectiveness [http://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisations.html].

Something is also going wrong if systems of medicine that have served people well, and which continue to serve people well today, have no place in the EBM system. Non-orthodox medicine has far more to offer people suffering with the chronic conditions of the modern age than modern, orthodox medicine.

The comparison of bloodletting with Ayurveda is specious, because one is a single treatment and the other goes beyond a system of medicine and encompasses an entire way of living! You can’t do an RCT on a philosophy, and the scientific evidence that exists doesn’t refute the effectiveness of Ayurveda. Same with Chinese medicine. Every day, thousands of people gain clinical benefit from these techniques, with measurable, repeatable results. Both of them may be based on concepts you don’t care to understand, but they consist of many different techniques – including herbs, breathing techniques, acupuncture, massage, oils, scents, dietary advice and more – that can be adapted to the needs of each individual patient. This is why those systems have survived for so long: because they work and because they are almost infinitely adaptable. Bloodletting is bloodletting is bloodletting, and survived so long because physicians probably felt better doing something than nothing.

I have never said that Sackett put RCTs and other evidence on the same level. What I did say was that he warned that, “Without clinical expertise, practice risks becoming tyrannised by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient.” He was worried that clinical evidence was being ignored as EBM developed – which has happened a lot more since he wrote those words in 1996, and which you seem perfectly happy with.

Speaking of which, going back to bloodletting for a second, aren’t red blood cells are made in the bone marrow and broken down in the spleen?

Guest
Maria says:
23 February 2012

Barney said,

“And with respect to both Maria and yourself, repeatedly calling my point of view a fallacy doesn’t make it so, either”

Indeed it doesn’t. But I have just “called” your point of view a fallacy, I have demonstrated why it is so but as you have refused to engage with that argument and have ducked the very simple and straightforward question I have asked, I’m afraid I can’t be bothered to read the rest of your comment.

Guest
Barney says:
24 February 2012

If you had actually read my comment, you’d see that I addressed the question you asked quite clearly. It says a lot about the standard of this debate that a refusal even to engage with an argument is given 7 thumbs up.

Guest
Stuart says:
24 February 2012

I share Maria frustration that despite pointing out the difficulties and assumptions made when relying on anecdotal evidence and tradition you still fail to address the major logical flaw at the very heart of your argument.

There seems little point engaging with you in rational debate on that basis.

Guest
Stuart says:
24 February 2012

“Speaking of which, going back to bloodletting for a second, aren’t red blood cells are made in the bone marrow and broken down in the spleen”

I have no idea, I was talking about blood, not cells. The assumption around the time of blood letting was that blood was created at one point in the body and then flowed to another point where it was destroyed and new blood was continuously ‘made’ to replace it. The idea of letting was to purgue out the bad blood in the system to enable new blood to be generated to take its place.

Of course, once it was shown that blood flowed continuously pumped around by the heart the traditional wisdoms of the time seemed a very very bad idea.

Guest

As interesting as this debate is (it’s almost a debate about debating!) it’s veering slightly off the main topic at hand. Your comments are also getting a bit heated – so I just want to remind you of my final warning below.

Can we draw a line under this thread? Thanks.

Guest

Maria said,
“The lack of credible evidence is one of the mains reasons, the fact that they are not “soundly based” is the other. The lack of scientific plausibility coupled with the lack of evidence for efficacy is the reason why any further research into a “therapy” like homeopathy is a waste of time”.

Let’s try and look at this in a rational manner: the only plausible evidence that a therapy works, and works effectively, is the test of time and the testimony of patients who have used those therapies. Thousands upon thousands of them.
Like me, and others like me.

The question for science should be: WHY do they work, and the mechanisms for their efficacy.

This reminds me of the quote from a surgeon after an operation which states: the operation was a complete success……………………but the patient died.

Guest
Alan Henness says:
22 February 2012

Ditto.

Guest
Stuart says:
23 February 2012

“Let’s try and look at this in a rational manner: the only plausible evidence that a therapy works, and works effectively, is the test of time and the testimony of patients who have used those therapies. Thousands upon thousands of them. Like me, and others like me.”

We’ve had this discussion before. If you believe that anecdotes/experience are the only suitable evidence are you happy for these to be used for assessing the effectiveness of drugs and alt med?

“The question for science should be: WHY do they work, and the mechanisms for their efficacy.”

Another discussion we had previously. Lets assume you are right and these things work. Why is the mechanism important at all?

Guest

What a hornet’s nest I have stirred!
Thank you ‘chrisb’ for your voice of reason!
I am retiring from the fray, will spend my time more effectively elsewhere.
Maybe reason will prevail one day, in the mean time I shall continue to benefit from the Therapies I trust. I hope that eventually they will win the respect they deserve so they can help more people thrive.

Guest
Ellie says:
24 February 2012

I think we are in danger of taking the ‘science of logic’ too far. I doubt that we would have survived as a human race long enough to be contributing to this forum – if all we relied on was logic.

We have survived because our ancesters were intelligent, creative, inventive and adaptable and shared their knowledge and expertise with their fellow human beings.

Guest

Wavechange, you said………………………
“Those who sell expensive supplements would have us believe that they are better but a lot of it is advertising. Advertising is not always as honest as it should be and there are plenty of people ready to swallow both the hype and the expensive pills”.

Now we’ve had this out before, but you are still repeating the same old mantra.
Supplements are not expensive, in fact they are quite inexpensive in comparison to pharmaceutical drugs, which can compete for the same market. I can get a high quality supply of Magnesium Ascorbate (Vitamin C) that lasts me for 3 months at just over £21.50, and a high quality supply of Vitamin D3 for £12.50 which lasts for about the same time period.
To compare: I spend in excess of £80.00 per week on fuel for my car, £200.00 per week on my household shopping and so on and so on and so on.

This is not rocket science, as supplement manufacturers are forced to advertise (as with any other product for sale) to enable people to ascertain their efficacy and usefulness, unlike prescription drugs, which require little to no advertising (except in the USA) because they are already have a very substantial market (the entire population of the free World and beyond) via Medical Doctors who prescribe and approve them.
I suggest you read this thoroughly about supp-le-menting your diet.
http://www.chlorellafactor.com/
Touche.

Guest
Stuart says:
23 February 2012

“Now we’ve had this out before, but you are still repeating the same old mantra.
Supplements are not expensive, in fact they are quite inexpensive in comparison to pharmaceutical drugs, which can compete for the same market.”

They are also cheap compared to buying say, a Ferrari. But we are not comparing supplements to drugs or sports cars. We are comparing them to not taking anything which is the alternative.

“To compare: I spend in excess of £80.00 per week on fuel for my car, £200.00 per week on my household shopping and so on and so on and so on”

…..likewise fuel and shopping. Rather a pointless comparision.

“This is not rocket science, as supplement manufacturers are forced to advertise (as with any other product for sale) to enable people to ascertain their efficacy and usefulness”

You might want to think whether the supplement manufacturers are therefore in the right position to give an impartial view on how effective and useful they are, bearing in mind they sell them?

Guest

Thanks for the link to the book about Chlorella and Spirulina. The claims are impressive, especially the one about killing tumours. From what is stated, this seems to offer the answer to so many medical problems.

For goodness sake. I know that there are some gullible people in this world, but I think they would be more likely to trust a snake oil salesman. 🙂

Actually, Chlorella and Spirulina may become extremely important if conventional agriculture cannot produce sufficient food to sustain the rising population. I first read about Chlorella in the 1960s, in a book that I was given as a school prize.

Guest

As Stuart points out, price is relative. Anyone surviving on a state pension could not afford these prices. I could afford them, but taking chemicals I am unlikely to benefit from is as pointless as buying dishwasher tablets when I don’t have a dishwasher.

Oh, and it is magnesium ascorbate, not Magnesium Ascorbate.

Guest
ExR&D says:
22 February 2012

Wavechange said:

“The Eatwell plate is simply an acknowledgement that most of us will eat some junk food and not a recommendation that we do.”

Beneath the eatwell plate on the NHS Choices website it says:

“The eatwell plate shows the different types of food we need to eat – and in what proportions – to have a well balanced and healthy diet.”

One segment of the plate is devoted to foods and drinks high in fat and/or sugar. It clearly shows foods and drinks that are not needed in a healthy balanced diet: sweets, cakes, biscuits, chocolate, crisps and cola.

This information on the NHS Choices website comes from the Department of Health (DH) advised by one of their committees: the Scientific Advisory Committee on Nutrition.

On the DH website it says:

“The eatwell plate is a policy tool that defines the Government’s recommendations on healthy diets. It makes healthy eating easier to understand by giving a visual representation of the types and proportions of foods needed for a healthy and well balanced diet.”

DH goes on to say:

“The eatwell plate is based on the five food groups:

• Bread, rice, potatoes, pasta and other starchy foods
• Fruit and vegetables
• Milk and dairy foods
• Meat, fish, eggs, beans and other non-dairy sources of protein
• Foods and drinks high in fat and/or sugar

The eatwell plate encourages the choice of different foods from the first four groups every day, to help ensure the population obtains a wide range of nutrients needed to remain healthy. Choosing a variety of foods from within each group will add to the range of nutrients consumed.”

And then DH says:

“Foods in the fifth group – foods and drinks high in fat and/or sugar are not essential to a healthy diet.”

So on the NHS choices website via the eatwell plate DH are saying foods and drinks high in fat and/or sugar are an essential part of a healthy balanced diet. They also say this on their own website. But further down on their own website they then say foods and drinks high in fat and/or sugar are not essential!

Don’t worry, I shall be writing to DH to bring these discrepancies to their attention, as well as introducing them to the Harvard healthy eating plate.

Guest

Sorry for giving my interpretation rather than checking the information.

I believe that my suggestion is practical. There can be few who manage to completely avoid foods that are high in sugar and/or salt, and for most people a bit of unhealthy food will do no harm. We need everyone to eat a good diet but not cranks who are obsessed with what every mouthful contains. You can try and deprive children of sweets, etc. but that is a recipe for encouraging them to eat junk whenever their parents are not looking.

Hopefully the NHS will reprimand their graphic designer and introduce consistency.

Guest
Maria says:
23 February 2012

wavechange said,

“There can be few who manage to completely avoid foods that are high in sugar and/or salt, and for most people a bit of unhealthy food will do no harm.”

Ian Marber Dip ION aka the ‘Food Doctor’ incorporates this reality into his healthy eating guidelines with his “80:20” principle, which is that if you follow his healthy eating principles sound, I am not qualified to say but they seem pretty close to mainstream nutritional advice.

Guest
Maria says:
23 February 2012

OK, that ended up as gibberish, I’ll try again.

wavechange said,

“There can be few who manage to completely avoid foods that are high in sugar and/or salt, and for most people a bit of unhealthy food will do no harm.”

Ian Marber Dip ION aka the ‘Food Doctor’ incorporates this reality into his healthy eating guidelines with his “80:20″ principle, which is that if you follow his healthy eating principles 80% of the time, you can break them the rest of the time. Whether the rest of his principles are sound, I am not qualified to say but they seem pretty close to mainstream nutritional advice.

Guest
Stuart says:
23 February 2012

Yes, because as we discussed previously its highly unlikely that people would eradicate these thing entirely from their diet. People like sweet high fat things, that isnt harmful in a balanced diet.

Simply question then ExR&D whats for health:-

Everyone adopts eatwell (including a proportion of high fat/sweet things)
People ignore eatwell entirely because they are being denied food types they enjoy.

Its about gradual change. This assumption that any amount of fat/sugar is wrong and I think by doing this you actually give an unacheivable target for someones diet.

This only serves to reinforce the Which? findings that people were recommended restrictive diets by NTs lacking in some food groups.

Food can be enjoyable. Its not a punishment.

Guest

Stuart said………………….
“Another discussion we had previously. Lets assume you are right and these things work. Why is the mechanism important at all”?

Well for one thing, it would get you and others like you “off our backs” as the science in proving those mechanisms would silence the critique of those therapies.
It seems that you are unable to fathom what is really quite obvious.

Guest
Stuart says:
23 February 2012

It isn’t obvious, thats why I am asking you to explain.

If something has a scientific validated mechanism for action, then shouldn’t that by definition also lend itself to providing strong evidence of its efficacy Without relying on anecdotal evidence?

Guest

Stuart,
Strong evidence of its efficacy is sometimes not enough:-Drug trial victim’s ‘hell’ months

(http://news.bbc.co.uk/1/hi/health/5121824.stm

Guest
Stuart says:
23 February 2012

“Strong evidence of its efficacy is sometimes not enough:-Drug trial victim’s ‘hell’ months”

Thats why they test the safety of drugs and have procedures for reporting adverse effects.

Safety and efficacy are both key components of an effective treatment. Its pointless to have a safe but ineffective treatment isnt it?

All medical interventions carry some degree of risk. Its whether the benefits outweight the costs.

By safety, I of course mean that the side effects are reasonable in relation to the benefits they offer, not that it is 100% safe. Thats a bar so high nothing would ever pass.

Guest

Hello everyone, particularly Alan, Chrisb, Selina and Stuart, we have once again had to delete a number of comments as they were what can only be described as personal attacks on other commenters.

This is completely against our commenting guidelines as we’ve said many times before. Comments should about the topic at hand, in this case nutritional therapists, and not other commenters. Tackle a commenter’s arguments not the commenter themselves.

This thread has so often stepped away from our commenting guidelines that we may have no other choice than to close this Conversation for good. I’m sure that’s not what you would like to see happen.

So, we will treat this as your final warning, otherwise that will be the action we will be forced to take. We are planning a new nutritional therapists Conversation and we hope that you will treat each other with respect there. Thanks, Patrick.

Guest
Stuart says:
23 February 2012

Patrick, sorry if some of the comments have stepped over the mark. I think some of us feel very passionate about this subject, especially when we feel that people may read comments and see them as an endorsement of dangerous, or unproven treatments. The intention is only to provide information in response to mis-information and sometimes that means asking people to support whath they say.

Bearing in mind the subject of many of the comments on here, particularly those endorsing cancer treatment with diet and Vit C, I am amazed Which? has allowed this thread to continue as long as it has.

Perhaps its time to leave this thread and participate on the new one on the basis you describe above.

Guest

Mis-information is one thing that has compelled me to participate in many discussions and this topic in particular. But the T&Cs state “Any content you add to the website will:
-be factually accurate and/or be your genuinely held belief or opinion that is based on facts;

What annoys you, Stuart, (and me) are legitimate comments. It would be difficult to run this site on any other basis.

It might help if the moderators or users could flag comments as off-topic, to keep us on track. Of course, I would have more flagged comments than most, and this is a good example. 🙂

Guest
Maria says:
23 February 2012

As the only reason anyone is posting here is because it is still open and, as I said a couple of pages back, it has become cyclical and repetitive, I don’t see any reason not to close it.

It’s obviously outlived its purpose and isn’t going anywhere except round in circles (or down the pan).

Guest
Selina Import says:
23 February 2012

Patrick, I am sorry. You are quite right. It is easy to get drawn in.

Guest

Just called in to read the recent messages. I do like Stuart’s comment that “Food can be enjoyable. Its not a punishment.”

Guest
Ellie says:
23 February 2012

My view is that you cannot use the same kind of evidence for Nutritional therapy as for orthodox medicine. That does not mean that is should not be evidence informed, using as wide a base as research as possible.

At the end of the day it is still a complementary therapy and as such doesn’t advocate the replacement of modern orthodox medicine, however, if it helps to the extent that it reduces the need for medical interventions and pharmaceuticals, – then thats a positive result for all concerned!

As an example – the aim of the Human Genome Project was to chart all the genes in the human body in order to discover their relation to health. Hundeds of scientists from all over the world worked on this amazing project. Many scientists believed that gene therapy would be the health breakthrough of the future, and that in the long term faulty genes might simply be replaced by healthy ones (and thIs may still be achievable – to a degree)

You could say that this was an extremely logical approach using convergent thinking i.e. one problem, one solution.

Has it proved to be the case? No……………..what has been discovered is that a cascade of molecular interactions are involved in the transcription of many genes and that genes interact uniquely with the envornment.

What are the main environmental factors? Well surely the food we eat and nutrition has to be near the top of the list? Manipulated in the right way and it can potentially have a huge impact on our genetic make-up and especially on chronic ill health.

Other detrimental environmental factors include toxins in the environment and chronic stress – (which is rife in our society, as we live life at such a fast pace). All kinds of complimentary therapies have a positive effect on reducing stress, meditation, reflexology, massage etc. We do not need to produce robust evidence (as in double-blind controlled trials which are used for pharmaceuticals, – which would be impossible to do anyway).

If someone feels less stressed, then they are less stressed, and surely thats all the evidence that is required if the therapy is non-interventional?

Guest
Ellie says:
23 February 2012

Just as an add on….

Dr Andrew McCulloch (Chief executive for the Mental Health Foundation) has stated that:

“the economic costs of unmanaged stress are huge (and increasing) – 11 million lost working days per year, – at the last count”

Guest
Selina Import says:
23 February 2012

Yes Barney. We did evolve and learn to survive through communicating with each other long before science and any organised kind of medicine turned up. To deny anecdotes seems to me to deny the very essence of what it is to be human.

Guest

Stuart commented………………
“You might want to think whether the supplement manufacturers are therefore in the right position to give an impartial view on how effective and useful they are, bearing in mind they sell them”?

First of all many, though not all Nutraceuticals, ARE in direct competition to Pharmaceuticals, and why current proposals within the EU are trying to restrict their usage to RDI’s or less, rather than allow them to be available at a therapeutic dosage. Big Pharma anticipated this well in advance, and have effectively lobbied to that effect, ensuring a monopoly for them in the future. (source MEP).
The comparison I made between both Nutraceuticals and Pharmaceuticals as to cost, is therefore entirely relevant to their usage and sale. Not forgetting that the latter are far far more expensive than the former.

In addition, supplement manufacturers usually cite references of many scientific nutritional studies which support the information about their products, and which forms the basis on why they can be purchased and targeted at specific disease-states; but even health-claims re’ Nutraceuticals are now under threat, even though there is a wealth of Scientific information that provides factual scientific health benefits from the same.

This is especially so in the United States where the FDA and FTC state that it is LEGAL for DRUG Companies to advertise known harmful DRUGS, drugs that have been documented to kill and maim patients, as “SAFE and EFFECTIVE” for the prevention and treatment of disease.
The FDA’s legal definition of a drug, is anything that “diagnoses, cures, mitigates, treats, or prevents a disease”. So next time you eat an orange, you are actually eating a drug, as it contains Vitamin C which prevents and cures scurvy.

Guest

Please let greegrocers know that they are drug dealers.

Food for thought?

Guest
Stuart says:
24 February 2012

Chrisb, ignoring all the wild conspiracy theory you’ve dodged the central question:

Do you think that a commerial company which exists to make a profit can be trusted as a wholy impartial source of information on the efficacy of their product?

Guest
Ellie says:
23 February 2012

Out of interest here are some facts and figures taken from the Mental Health Foundation website and the Government white paper ‘Healthy Lives, Healthy People’:

‘Depression is linked with a 67% increased mortality form cardiovascular disease and a 50% increase in cancer, and a 2-fold increase in respiratory disease’

‘Individuals diagnosed with Bi-polar and Schizophrenia have a 4-fold higher risk of contracting an infectious disease’

‘Depression is linked to a higher incidence of back pain and IBS in later life’

‘11% of adult health care costs in the UK are attributable to physical symptoms caused or exacerbated by mental health problems’

and this is an interesting one:

‘Between 20% – 30% of consultations in primary care are with people who are experiencing medically unexplained symptoms and have no clear diagnosis’

Guest
Ellie says:
23 February 2012

Sorry I ran out of time to sum up – but the last statistic in particular indicates that almost a third of patients have unexplained symptoms that never recieve a diagnosis.

If nutritional therapy can help some of these clients and thus reduce their stress, anxiety and possible depression then it has to be worthwhile.

Guest
Chloe says:
23 February 2012

18 Feb 2012:The Guardian

for Wavechange

Scientist claim that giving up almost all food for one or two days a week can counteract impact of Alzheimer’s and Parkinson’s – interesting to investigate and keep an open mind!!??