≡ Oh, and he works for the pill company BioCare as their Head of Education and Science (I may have mentioned that the company is 30 per cent owned by pharmaceuticals company Elder). In fact, in many respects he has spent his whole life selling pills. His first job on leaving York with a 2:2 in psychology in the 1970s was as a vitamin-pill salesman for the pill company Higher Nature. He sold his most recent pill-selling company, Health Products for Life, for half a million pounds in 2007 to BioCare, and he now works for that company.
My whole purpose in writing this book is to teach good science by examining the bad, so you will be pleased to hear that the very first claim Holford makes, in the very first paragraph of his key chapter, is a perfect example of a phenomenon we have already encountered: ‘cherry-picking’, or selecting the data that suits your case. He says there is a trial which shows that vitamin C will reduce the incidence of colds. But there is a gold-standard systematic review from Cochrane which brings together the evidence from all twenty-nine different trials on this subject, covering 11,000 participants in total, and concluded that there is no evidence that vitamin C prevents colds. Professor Holford doesn’t give a reference for his single, unusual trial which contradicts the entire body of research meticulously summarised by Cochrane, but it doesn’t matter: whatever it is, because it conflicts with the meta-analysis, we can be clear that it is cherry-picked.
Holford does give a reference, immediately afterwards, for a study where blood tests showed that seven out of ten subjects were deficient in vitamin B. There is an authoritative-looking superscript number in the text. Turning to the back of the book, we find that his reference for this study is a cassette you used to be able to buy from his own Institute for Optimum Nutrition (it’s called The Myth of the Balanced Diet). We then have a twenty-five-year-old report from the Bateman Catering Organisation (who?), apparently with the wrong date; a paper on vitamin B12; some ‘experiment’ without a control reported in a 1987 ION pamphlet so obscure it’s not even in the British Library (which has everything). Then there is a bland statement referenced to an article in the Institute for Optimum Nutrition’s Optimum Nutrition Magazine, and an uncontroversial claim supported by a valid paper—the children of mothers who have taken folic acid during pregnancy have fewer birth defects, a well-established fact reflected in Department of Health guidelines—because there has to be a grain of common-sense truth in the spiel somewhere. Getting back to the action, we are told about a study on ninety schoolchildren who get 10 per cent higher IQ scores after taking a high-dose multivitamin pill, sadly without a reference, before a true gem: one paragraph with four references.
The first is to a study by the great Dr R.K. Chandra, a disgraced researcher whose papers have been discredited and retracted, who has been the subject of major articles on research fraud, including one by Dr Richard Smith in the British Medical Journal called ‘Investigating the previous studies of a fraudulent author’. There is an entire three-part investigative documentary series on his worrying career made by Canada’s CBC (you can watch it online), and at the conclusion of it he was, to all intents and purposes, in hiding in India. He has 120 different bank accounts in various tax havens, and he did, of course, patent his own multivitamin mixture, which he sells as an ‘evidence-based’ nutrition supplement for the elderly. The ‘evidence’ is largely derived from his own clinical trials.
In the name of scrupulous fairness, I am happy to clarify that much of this has come out since the first edition of Holford’s book; but there had been serious questions about Chandra’s research for some time, and nutrition academics were wary about citing it, simply because his findings seemed to be so incredibly positive. In 2002 he had resigned his university post and failed to answer questions about his papers or to produce his data when challenged by his employers. The paper that Patrick Holford is referring to was finally fully retracted in 2005. The next reference in this same paragraph of his book is to another Chandra paper. Two in a row is unfortunate.
Professor Holford follows this up with a reference to a review paper, claiming that thirty-seven out of thirty-eight studies looking at vitamin C (again) found it beneficial in treating (not preventing, as in his previous claim in the text above) the common cold. Thirty-seven out of thirty-eight sounds very compelling, but the definitive Cochrane review on the subject shows mixed evidence, and only a minor benefit at higher doses.
I hooked out the paper Professor Holford is referencing for this claim: it is a retrospective re-analysis of a review of trials, his key chapter, is a perfect example of a phenomenon we have already encountered: ‘cherry-picking’, or selecting the data that suits your case. He says there is a trial which shows that vitamin C will reduce the incidence of colds. But there is a gold-standard systematic review from Cochrane which brings together the evidence from all twenty-nine different trials on this subject, covering 11,000 participants in total, and concluded that there is no evidence that vitamin C prevents colds. Professor Holford doesn’t give a reference for his single, unusual trial which contradicts the entire body of research meticulously summarised by Cochrane, but it doesn’t matter: whatever it is, because it conflicts with the meta-analysis, we can be clear that it is cherry-picked.
Holford does give a reference, immediately afterwards, for a study where blood tests showed that seven out of ten subjects were deficient in vitamin B. There is an authoritative-looking superscript number in the text. Turning to the back of the book, we find that his reference for this study is a cassette you used to be able to buy from his own Institute for Optimum Nutrition (it’s called The Myth of the Balanced Diet). We then have a twenty-five-year-old report from the Bateman Catering Organisation (who?), apparently with the wrong date; a paper on vitamin B12; some ‘experiment’ without a control reported in a 1987 ION pamphlet so obscure it’s not even in the British Library (which has everything). Then there is a bland statement referenced to an article in the Institute for Optimum Nutrition’s Optimum Nutrition Magazine, and an uncontroversial claim supported by a valid paper—the children of mothers who have taken folic acid during pregnancy have fewer birth defects, a well-established fact reflected in Department of Health guidelines—because there has to be a grain of common-sense truth in the spiel somewhere. Getting back to the action, we are told about a study on ninety schoolchildren who get 10 per cent higher IQ scores after taking a high-dose multivitamin pill, sadly without a reference, before a true gem: one paragraph with four references.
The first is to a study by the great Dr R.K. Chandra, a disgraced researcher whose papers have been discredited and retracted, who has been the subject of major articles on research fraud, including one by Dr Richard Smith in the British Medical Journal called ‘Investigating the previous studies of a fraudulent author’. There is an entire three-part investigative documentary series on his worrying career made by Canada’s CBC (you can watch it online), and at the conclusion of it he was, to all intents and purposes, in hiding in India. He has 120 different bank accounts in various tax havens, and he did, of course, patent his own multivitamin mixture, which he sells as an ‘evidence-based’ nutrition supplement for the elderly. The ‘evidence’ is largely derived from his own clinical trials.
In the name of scrupulous fairness, I am happy to clarify that much of this has come out since the first edition of Holford’s book; but there had been serious questions about Chandra’s research for some time, and nutrition academics were wary about citing it, simply because his findings seemed to be so incredibly positive. In 2002 he had resigned his university post and failed to answer questions about his papers or to produce his data when challenged by his employers. The paper that Patrick Holford is referring to was finally fully retracted in 2005. The next reference in this same paragraph of his book is to another Chandra paper. Two in a row is unfortunate.
Professor Holford follows this up with a reference to a review paper, claiming that thirty-seven out of thirty-eight studies looking at vitamin C (again) found it beneficial in tr
eating (not preventing, as in his previous claim in the text above) the common cold. Thirty-seven out of thirty-eight sounds very compelling, but the definitive Cochrane review on the subject shows mixed evidence, and only a minor benefit at higher doses.
I hooked out the paper Professor Holford is referencing for this claim: it is a retrospective re-analysis of a review of trials, his key chapter, is a perfect example of a phenomenon we have already encountered: ‘cherry-picking’, or selecting the data that suits your case. He says there is a trial which shows that vitamin C will reduce the incidence of colds. But there is a gold-standard systematic review from Cochrane which brings together the evidence from all twenty-nine different trials on this subject, covering 11,000 participants in total, and concluded that there is no evidence that vitamin C prevents colds. Professor Holford doesn’t give a reference for his single, unusual trial which contradicts the entire body of research meticulously summarised by Cochrane, but it doesn’t matter: whatever it is, because it conflicts with the meta-analysis, we can be clear that it is cherry-picked.
Holford does give a reference, immediately afterwards, for a study where blood tests showed that seven out of ten subjects were deficient in vitamin B. There is an authoritative-looking superscript number in the text. Turning to the back of the book, we find that his reference for this study is a cassette you used to be able to buy from his own Institute for Optimum Nutrition (it’s called The Myth of the Balanced Diet). We then have a twenty-five-year-old report from the Bateman Catering Organisation (who?), apparently with the wrong date; a paper on vitamin B12; some ‘experiment’ without a control reported in a 1987 ION pamphlet so obscure it’s not even in the British Library (which has everything). Then there is a bland statement referenced to an article in the Institute for Optimum Nutrition’s Optimum Nutrition Magazine, and an uncontroversial claim supported by a valid paper—the children of mothers who have taken folic acid during pregnancy have fewer birth defects, a well-established fact reflected in Department of Health guidelines—because there has to be a grain of common-sense truth in the spiel somewhere. Getting back to the action, we are told about a study on ninety schoolchildren who get 10 per cent higher IQ scores after taking a high-dose multivitamin pill, sadly without a reference, before a true gem: one paragraph with four references.
The first is to a study by the great Dr R.K. Chandra, a disgraced researcher whose papers have been discredited and retracted, who has been the subject of major articles on research fraud, including one by Dr Richard Smith in the British Medical Journal called ‘Investigating the previous studies of a fraudulent author’. There is an entire three-part investigative documentary series on his worrying career made by Canada’s CBC (you can watch it online), and at the conclusion of it he was, to all intents and purposes, in hiding in India. He has 120 different bank accounts in various tax havens, and he did, of course, patent his own multivitamin mixture, which he sells as an ‘evidence-based’ nutrition supplement for the elderly. The ‘evidence’ is largely derived from his own clinical trials.
In the name of scrupulous fairness, I am happy to clarify that much of this has come out since the first edition of Holford’s book; but there had been serious questions about Chandra’s research for some time, and nutrition academics were wary about citing it, simply because his findings seemed to be so incredibly positive. In 2002 he had resigned his university post and failed to answer questions about his papers or to produce his data when challenged by his employers. The paper that Patrick Holford is referring to was finally fully retracted in 2005. The next reference in this same paragraph of his book is to another Chandra paper. Two in a row is unfortunate.
Professor Holford follows this up with a reference to a review paper, claiming that thirty-seven out of thirty-eight studies looking at vitamin C (again) found it beneficial in treating (not preventing, as in his previous claim in the text above) the common cold. Thirty-seven out of thirty-eight sounds very compelling, but the definitive Cochrane review on the subject shows mixed evidence, and only a minor benefit at higher doses.
I hooked out the paper Professor Holford is referencing for this claim: it is a retrospective re-analysis of a review of trials, looking only at ones which were conducted before 1975. Holford’s publishers describe this edition of the Optimum Nutrition Bible as ‘COMPLETELY REVISED AND UPDATED TO INCLUDE THE LATEST CUTTING-EDGE RESEARCH’. It was published in the year in which I turned thirty, yet Holford’s big reference for his claim about vitamin C and colds in this chapter is a paper which specifically only looks at trials from before I was one year old. Since this review was carried out, I have learnt to walk and talk, gone to primary school, upper school, three universities to do three degrees, worked as a doctor for a few years, got a column in the Guardian, and written a few hundred articles, not to mention this book. From my perspective, it is no exaggeration to say that 1975 is precisely a lifetime ago. As far as I am concerned, 1975 is not within living memory. Oh, and the paper Professor Holford references doesn’t even seem to have thirty-eight trials in it, only fourteen. For a man who keeps going on about vitamin C, Professor Holford does seem to be a little unfamiliar with the contemporary literature. Perhaps if you are worried about your vitamin C intake you might want to buy some ImmuneC from the BioCare Holford range, at just £29.95 for 240 tablets, with his face on the bottle.*
≡ It’s important to remember the difference between preventing colds, where the Cochrane review found no evidence of any benefit, and treating them, where Cochrane shows minor benefit at very high doses. There are, as you might imagine, cases of Holford eliding the two, and more recently, in a newsletter to his paying customers, he mangled the data in a way that might well startle the original authors. He took the modest 13.6 per cent reduction in cold duration for children taking high-dost- vitamin C and claimed: ‘This equates to up to a month less ‘cold’ days per year for the average child.’ For this claim to be true, the average child would be having more than two hundred days of cold symptoms a year. According to the review, children who had the highest number of colds might actually expect a reduction of four days per year. I could go on with the litany of errors in his mailouts, but there is a line between making a point and driving the reader away.
We’ll go on. He cherry-picks the single most dramatically positive paper that I can find in the literature for vitamin E preventing heart attacks—a 75 per cent reduction, he claims. To give you a flavour of the references he doesn’t tell you about, I have taken the trouble to go back in time and find the most up-to-date review reference, as the literature stood in 2003: a systematic review and meta-analysis, collected and published in the Lancet, which assessed all the papers published on the subject from decades previously, and found overall that there is no evidence that vitamin E is beneficial. You may be amused to know that the single positive trial referenced by Holford is not just the smallest, but also the briefest study in this review, by a wide margin. This is Professor Holford: pitched to teach and supervise at Teesside University, moulding young minds and preparing them for the rigours of academic life.
He goes on to make a string of extraordinary claims, and none has any reference whatsoever. Children with autism won’t look you in the eye, but ‘give these kids natural vitamin A and they look straight at you’. No reference. Then he makes four specific claims for vitamin B, claiming ‘studies’ but giving no references. I promise we’re coming to a punchline. There’s some more stuff about vitamin C; this time the reference is to Chandra (yet again).
Finally, on page 104, in a triumphant sprint finish, Professor Patrick Holford says that there are now oranges with no vitamin C in them at all. It’s a popular myth among self-declared nutritionists (there is no other kind), and those who sell food-supplement pills, that our food is becoming less nutritious: in reality, many argue it may be more nutritious overall, because we eat more fresh and frozen fruit and veg, less tinned or dried stuff, and so they all get to the shops quicker, and thus with more nutrients (a
lbeit at phenomenal cost to the environment). But Holford’s vitamin claim is somewhat more extreme than the usual fare. These oranges are not just less nutritious: ‘Yes, some supermarket oranges contain no vitamin C!’* Frightening stuff! Buy pills!
≡ I would like to invite Professor Holford to send me a supermarket orange that has no vitamin C in it, via the publisher’s address.
This chapter is not an isolated case. There is an entire website—Holfordwatch—devoted to examining his claims in eye-watering detail, with breathtaking clarity and obsessive referencing. There you will find many more errors repeated in Holford’s other documents, and carefully dissected with wit and slightly frightening pedantry. It is a genuine joy to behold.
Professor?
A couple of interesting things arise from this realisation. Firstly, and importantly, since I am always keen to engage with people’s ideas: how might you conduct a discussion with someone like Patrick Holford? He is constantly accusing others of ‘not keeping up’ with the literature. Anyone who doubts the value of his pills is a ‘flat-earther’, or a pawn of the pharmaceutical industry. He would pull out research claims and references. What would you do, given that you can’t possibly read them on the spot? Being scrupulously polite, and yet firm, the only sensible answer, surely, would be to say: ‘I’m not entirely sure I can accept your precis or your interpretation of that data without checking it myself.’ This may not go down too well.
But the second point is more important. Holford has been appointed—as I might have mentioned briefly—a professor at Teesside. He brandishes this fact proudly in his press releases, as you would expect. And according to Teesside documents—there’s a large set, obtained under the Freedom of Information Act, available online—the clear plan at his appointment was for Professor Holford to supervise research, and to teach university courses.