Big Pharma And Pill Peddlers

September 23rd, 2006 by Ben Goldacre in bad science, equazen, fish oil | 50 Comments »

Ben Goldacre
Saturday September 23, 2006
The Guardian

So where were we? Oh yes. Durham Council is running a highly dubious “trial” of a food supplement that is methodologically crippled, and largely incapable of giving meaningful data, but in the process Durham Council staff are appearing all over the papers and television in news stories to promote a pill called Eye Q made by Equazen, suggesting it is effective at improving concentration and learning in normal children, an assertion that is not supported by published trial data, as we have discussed (although it might be if Durham simply did their trials properly). Meanwhile Equazen say they have 20 unpublished trials which all show a benefit for their omega-3 product, but I would have to sign a non-disclosure agreement to read them. Not very collegiate, especially when this important issue of nutrition and behaviour has been all over the papers, thanks to their efforts.

What would happen if you were a pill-peddling food supplement company, and you simply made claims that omega-3 would improve childrens’ concentration and learning, openly, in your adverts, or on your label? Well. A major competitor for Equazen – St Ivel – didn’t have Madeleine Portwood, Dave Ford, and other employees of Durham Council to appear in the media and make claims about their omega-3 product. Nor did they have the chance to put their publicity details at the bottom of Durham Council’s official press releases promoting their product.

So St Ivel made an almost identical claim for their product openly in an advert, and somebody successfully complained about them to the Advertising Standards Authority. Guess who complained? “The complainants challenged whether more Omega 3, and therefore St. Ivel ‘Advance’, enhanced children’s concentration and learning.” This is exactly the claim that Equazen’s friends in the media, and their friends in Durham Council, and indeed Equazen, make safely in “news” stories and press releases, away from the regulators. And yet it was Equazen who complained to the ASA about St Ivel. Press your advantage, I say.

So who are the multi-millionaires behind Equazen? One director is an ex-BBC foreign correspondent with a very large address book full of media contacts. The other is Cathra Kelliher, daughter of David Horrobin, the 1980s pill multi-millionaire, whose own food supplements empire – also built on “essential fatty acids” – was worth £550 million at its peak. That’s the nutritionism industry: a noble contrast to big pharmaceutical companies, as people like to believe. Or perhaps not.

In 1984, staff at Horrobin’s US distributors were found guilty in court of misbranding their food supplement as a drug; they were circumventing FDA regulations which prevented them making unfounded claims for their supplement pills in advertising, by engineering media coverage that treated the product as if it had proven medical benefits. In the court case, paperwork was exposed from Horrobin, Equazen pére, in which he explicitly said things like: “Obviously you could not advertise [evening primrose oil] for these purposes but equally obviously there are ways of getting the information across…” Company memos described elaborate promotional schemes: planting articles on their research in the media, deploying researchers to make claims on their behalf, using radio phone-ins (this was the 1970s), and the like.

Horrobin’s products were always in the news, and it was difficult to get hold of that research data too. In 1989 he published a famous meta-analysis of trials on evening primrose oil in eczema in a dermatology journal, finding that evening primrose oil, his lead product, was effective. His meta-analysis included the two oldest studies, excluded the one large published trial available (which was negative), but included seven small positive studies sponsored by his own company (these were still unavailable at the last review I could find, in 2003).

In 1990, two academics had their review of the data binned by the journal after Horrobin’s lawyers got involved. In 1995 the Department of Health commissioned a meta-analysis from a renowned epidemiologist. This included 10 unpublished studies held by the company which was marketing evening primrose oil. The ensuing scene was only fully described by Professor Hywel Williams a decade later (full quotes and references at badscience.net). The company erupted over a leak, and the Department of Health forced all authors and referees to sign written statements to reassure the company. They were not allowed to publish their report. Alternative therapy, the peoples’ medicine! It has since been shown that evening primrose oil is not effective in eczema, and it has lost its medicines license.

I’m not saying that Equazen are doing anything illegal, or breaking any regulation, but there is a theme here. Undisclosed research data, and advocacy by proxy in the media, are in fact well trodden paths for the pharmaceutical industry, and the food supplement industry, it seems, are no different. In an environment where it is difficult to make claims for food supplements explicitly in adverts, companies will inevitably be even more imaginative about how to get their message across: but personally, I think I’d rather see it in the adverts than on the news pages.


References:

The saga of trying to get research data from Horrobin and company is told in various places, including this article from the British Medical Journal:

bmj.bmjjournals.com/cgi/content/full/bmj;327/7428/1358

I should say I think a lot of what Horrobin did was interesting and useful, I am very open to the idea that nutritional interventions can be beneficial, and he was a sharp cookie. It’s just about the data. Some relevant bits from the BMJ article, for non-subscribers to that august journal (it’s actually jolly readable), are here:

“Yet many questions surrounding the story of evening primrose oil for eczema remain unanswered: how was this drug licensed in the first place and why have so few data been available in the public domain for open scientific debate?

“Unanswered questions”

“In 1989 Horrobin et al published a meta-analysis in the British Journal of Dermatology of the two earliest studies plus another seven small (14-47 participants) company sponsored studies of evening primrose oil (Epogam, Scotia Pharmaceuticals) for atopic dermatitis.8 They found that atopic dermatitis improvement scores for evening primrose oil were significantly better than placebo, with effects on itch being “particularly striking.” Apart from the fact that the seven company trials included in that study have never since appeared in the public domain, the other concern about that meta-analysis was its exclusion of the one other independent and relatively large study (123 participants) by Bamford et al.9 The company authors of the meta-analysis suggested that active versus placebo treatments became mixed up in the Bamford study, based on an analysis done by the company of fatty acid levels in blood samples taken from study participants.8 After this meta-analysis was published, others thought it odd that Bamford et al never published a response to the company’s serious criticisms of their study.10 In fact Bamford immediately wrote a lengthy and clear explanation of the steps that were in place to avoid such purported contamination, but he was refused an opportunity to defend his study with a published response because the journal decided that Bamford’s response did not add anything to the understanding on the use of evening primrose oil as a supplemental treatment for atopic eczema (J Bamford, written communication 12 Nov 2003). In desperation, Bamford tried to publish his response in other dermatology journals, but without success, so his defence of his original paper (a copy of which is now sitting on my desk) has to this day remained unpublished.

“A year later, two British dermatologists wrote a detailed review article on evening primrose oil and atopic dermatitis. Out of courtesy, they showed a copy of the peer reviewed article to the manufacturers, who intimated their intent to pursue the matter legally further if the authors did not withdraw or modify the article substantially. (J Marsden, written communication, 27 November 2003). The article (now sitting on my desk) was never published despite getting to proof stage.

“More significantly, in 1995 the Department of Health commissioned me and a colleague to conduct an individual patient meta-analysis of 20 studies of oral evening primrose oil supplementation for treatment of atopic dermatitis, which included 10 unpublished studies held by the company (Li Wan Po A, Williams HC. A systematic overview of clinical trials of Epogam in atopic eczema. Department of Health, 1995). Although it was our view that the report produced a relatively clear conclusion, we were never allowed to share the report in the public domain for reasons that are still unclear to me, even though it was funded by public money. Shortly after we submitted our report to the Department of Health, Searle, the company then responsible for marketing evening primrose oil, expressed concern that the contents of the report had been leaked, and the authors and referees were required to sign a written statement to the company (through the Department of Health) to indicate that this was not the case.

“Too little data in the public domain”

“The Health Technology Assessment systematic review published in 2000 provided an opportunity for the company to hand over its unpublished studies for inclusion in that report.5 Although Searle wrote back to tell us that they would be “compiling the data,” no data have been forthcoming to date. We can only hope that it will be compiled in time for the current Cochrane review on GLA supplementation for atopic dermatitis.11 Finally, in the autumn of 2002 the Medicines Control Agency withdrew the marketing authorisations for evening primrose oil following a “review of all the relevant information, including new studies,” although which information and new studies is unclear from the very limited information available on the agency’s website.12

“In fairness to the innovators of evening primrose oil for atopic dermatitis, they evaluated their product more than many other products used in dermatology. Nobody would have been happier than myself if evening primrose oil had produced a clinically worthwhile benefit for eczema sufferers. But the history of its development has been marred by lack of data in the public domain. As we bid goodnight to the evening primrose oil story, perhaps we can awaken to a world where all clinical trial data, derived from people who are good enough to volunteer for such studies, reach the light of day, where they can be openly debated in the public domain.”

(Hywel C Williams, professor of dermatoepidemiology, Nottingham)


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50 Responses



  1. Bob O'H said,

    September 23, 2006 at 8:16 am

    Oh, the irony. I went to the Equazen website, and found myself here:
    www.equazen.com/default.aspx?pid=238
    A nifty animation explaining how double-blind trials should be carried out. Including an explanation that the trial needs to be peer reviewed.

    Bob

  2. crichmond said,

    September 23, 2006 at 9:38 am

    1. What if some Durham parentsveto their child taking medication except as part of a properly-deisnged randomised controlled trial?

    2. One of the problems with fish oil capsules is that they return again and again as disagreeable fishy burps. Might this will lead to some non-compliance?

    3. What do Durham teachers think about being expected to hand out unproven medication in these circumstances? Are they going to do it? Will there be sanctons against teachers who demur?

  3. Andrew Clegg said,

    September 23, 2006 at 11:23 am

    Not all fish oil capsules give you the fishy burps.I’ve taken them for a while — family history of arthritis + potentially joint-straining exercise = possible cost-effective harm reduction for little risk. I changed brands a while ago and the burps went away.

    (In the interests of not sounding like a woo, I’m not going to plug the brand in question unless anyone really wants to know.)

    Andrew.

  4. Michael Harman said,

    September 23, 2006 at 3:08 pm

    Could the Freedom of Information Act be of any use? Probably difficult to use against Equazen directly, but it could perhaps be used against Durham Council.

  5. Kess said,

    September 23, 2006 at 3:44 pm

    I find this situation so frustrating. Are there no ambitious local journalists in the Durham area willing to publicise and expose this farce?

  6. Ben Goldacre said,

    September 23, 2006 at 3:51 pm

    i’m sure if i dressed it up and said “i am doctor goldacre, i am science and i criticise this study” then they could say “scientists today were highly critical of a study in durham schools..”

    but simply telling the actual story, of the problems with the “study”, the hawthorne effect, the placebo effect, the fact that there is no control, the nondisclosure of data, and all the other key aspects, i suspect, they could not do. there is no template for it. i would love to be proved wrong but i just dont believe they could do it. that to me is almost as interesting as the story itself, natch.

  7. glutam9 said,

    September 23, 2006 at 6:16 pm

    someone could Freedom of Information Durham Council for everything related to Equazin, most public bodies are wise to this and i doubt you’d find much incriminating. Although in itself that might be interesting

    Q. Under the freedom of information act i request details of all the data used used in the development of the policy.

    A. We dont have any…..

    As Equazen are a private company ( i presume) its no use.

  8. Peter Robins said,

    September 23, 2006 at 8:10 pm

    On the question of the local press doing something about it…

    As it happens, Barry Nelson of the Northern Echo, which is the regional morning paper in Co Durham, does appear to have made some follow-up calls for this story, before the first Bad Science piece on the question. He got the responses you would expect — the study would “really struggle to come up with some hard evidence” and was “not good science”.

    The quotes ended up halfway down the resulting piece, with the reasoning behind them cut. The headline was “Daily fish oil capsules ‘will make a difference to lives of teenagers'” and the opening paragraph read “EDUCATION bosses have insisted that giving daily fish oil capsules to up to 5,000 teenagers will really make a difference, despite criticism by some experts.”

    None of this is necessarily Barry Nelson’s fault. His editors may have decided not to spoil a nice positive story. They are also likely to be much more cautious about getting sued than the Guardian is.

    Still, I would have thought he could get something out of the ASA connection in your column this week, if he wanted to.

  9. Peter Robins said,

    September 23, 2006 at 8:16 pm

    On second thoughts, ‘with the reasoning behind them cut’ is a bit harsh — he does have the fact there’s no placebo mentioned high up, although he doesn’t spell out its significance for the value of the study.

  10. Robert Carnegie said,

    September 24, 2006 at 2:49 am

    Could we FOIA the secret government report on evening primrose oil?

    Media being a muddy battlefield, how about getting up a story that the omega 3 capsules (1) are against some students’ religious dietary rules or (2) are a choking hazard? In fact, surely somewhere in the world a child must have died who was in a household where someone was taking an omega 3 supplement, and others fallen ill. A version of (1), we are told, was significant in the Indian Mutiny of 1857-8, the casualties of which were terrible.

  11. David Mingay said,

    September 24, 2006 at 4:38 am

    Dr Madelaine Portwood is described by Barry Nelson (and probably by herself) as “senior educational psychologist with Durham County Council and a world authority on food supplementation”. If this is the case, one might expect to run a search for her name in PsycINFO, the database of all the psychological research ever published, and come up with a figure, out of the 654 articles published on fatty acids/Omega 3/etc, or indeed the 10 zillion articles published on anything, greater than zero.

  12. gadgeezer said,

    September 24, 2006 at 11:33 am

    There is some concern on the message-boards for families with Von Willebrand’s disease (a clotting disorder that is relatively common, estimated 1% of population) that Omega 3 may be contraindicated. The families are particularly worried because VWB may not be severe enough to trigger a diagnosis until there is a trauma etc.

    There is a review that indicates that Omega 3 may not be a significant problem for people with VWB but enough people are sufficiently apprehensive about the implications of dosing these children that their concerns should be addressed.

  13. monkeychicken said,

    September 24, 2006 at 9:04 pm

    New Scientist talks about the benefits of omega-3 for depression and schitzophrenia (sp?)…

    www.newscientist.com/channel/health/mg19125701.300-the-good-the-fad-and-the-unhealthy.html

    nothing about increasing “brain power” of children though….

    I guess will never know about that one unless Equazen release their data

  14. Dr Aust said,

    September 24, 2006 at 9:11 pm

    To inject a note of surrealism (sorry, blame Sunday night and the large glass of wine):

    Remember the discussion on one of the earlier threads about whether linseed oil was as good a source of polyunsaturated fatty acids (PUFAs) as oliy fish…

    We have just painted our garden gates with linseed oil and , blimey, if they weren’t absolutely triple-covered with snails and slugs the next morning.

    The effect wore off after a couple of days. Volatile component? Is linseed oil the slug equivalent of Chanel?

    What I’m worried about is that I will now have super-intelligent snails and slugs lurking in the garden plotting world domination (or at least working out the fastest way to Mrs Dr Aust’s tomato plants).

    Come ot think of it, I know a couple of snail neurobiologists so perhaps I should contact Equazen and see if they would like to fund a ground-breaking study of snail intelligence. After all, if it works on slugs, why not schoolchildren (or should that be the other way round?)

  15. MJ Simpson said,

    September 25, 2006 at 9:40 am

    I don’t know whether this is relevant or useful, but the Anaphylaxis Campaign (www.anaphylaxis.org.uk) is “advising fish-allergic people to avoid products containing Omega-3 if the oil has been derived from fish.”

    If the fish oil capsules confer an educational advantage but are not suitable for people who suffer from anaphylaxis, doesn’t the Council break the Disability Discrimination Act by supplying them?

  16. Wonko said,

    September 25, 2006 at 11:46 am

    I heard a piece on Radio 4 some months ago where someone from an arthritis charity said that people with arthritis should avoid using Omega 3 as it could trigger/exacerbate inflamation.

    I am also fairly sure that serveral suicides and people killed in road accidents died after taking fish oils.

    Is there not some Melanie Phillips type out there who could pick this up and run with it?

  17. Delster said,

    September 25, 2006 at 1:41 pm

    the whole issue of getting information on these trials that Equazen say they have carried out is a bit of a problem…. but to exercise some logic for a moment

    Assume for a moment that they have done these trials, that the trials have been done properly and that the results are all they say they are.

    Given this assumption any scientist or organisation, after patenting drug/process/etc, would be publishing these trials in any and every publication that would give them the column inches to do so until they made a veritable pest of themselves.

    Assume then that the trials have been done but they have not been carried out in a rigorous fashion and would therefore be torn to shreds in any peer reviewed publication.

    Given this assumption… well, we’d probably end up with a large scale “study” being done in such a slipshod manner that the data could be interpreted in just about any way you wanted too.

    hang on a second…

  18. latsot said,

    September 25, 2006 at 2:51 pm

    Thanks Ben. I always appreciate your hard work but as a potential parent and a taxpayer in County Durham, this is close to home, depressing and all the better for being publically aired.

  19. pv said,

    September 26, 2006 at 9:30 pm

    Frankly all County Durham tax payers (parents and non-parents) should be making a big noise about this because they clearly don’t have intelligent, competent people working on their behalf.

  20. raygirvan said,

    September 26, 2006 at 9:42 pm

    The North East seems to attract this kind of official endorsement of woo. Other examples are the Shieldfield scandal, and the North East Chamber of Commerce awarding an export award last year to Platinum Detox, a brand of rusty-water-is-toxins footbath.

  21. j said,

    September 27, 2006 at 1:17 pm

    btw, You and Yours (radio4, 12pm) are apparently discussing this tommorrow (thurs).

  22. Smidsy said,

    September 27, 2006 at 5:59 pm

    If I was a parent in Durham and the Council wanted my child to take part in this “study ” I would expect it to be approved by the local research ethics committee and for there to be a proper study protocol. I would insist on my informed consent being given in writing before my child took anything. If something goes wrong (severe allergic reaction etc) Durham council could find itself in deep shit legally.

    Has anyone asked the council if written informed consent will be obtained and if they have a copy of the protocol available?

  23. Barnacle Bill said,

    September 27, 2006 at 7:28 pm

    Hang on – if teachers can’t even give a pupil an asprin without incurring the wrath of the courts, then how on earth can they feed them stuff which has not been scientifically tested for the claimed effects?

  24. Dr Aust said,

    September 28, 2006 at 11:23 am

    “Hang on – if teachers can’t even give a pupil an asprin without incurring the wrath of the courts, then how on earth can they feed them stuff which has not been scientifically tested for the claimed effects?”

    Now there’s a question.

    Ans – aspirin is “a medicine”. Fish oil is “a dietary supplement”.

    This is going back to the problem of supplements, namely that they only have to meet basic standards of “safety OK-ness” compared to medicines, even Over-The-Counter (TOC) ones.

    [There is also the Catch-22 that something that has a real but beneficial effect at sensible doses (like aspirin or paracetamol) is more likely to have adverse effects at daft doses (e.g. if you neck the whole bottle)- because the stuff actually does something.

    If it does bugger all (see e.g. homeopathy) it won’t have any adverse effects and can thus be declared “safe” “gentle” “In harmony with your body” etc]

    The aim of companies like Equazen is to PROMOTE their products as if they were medicines (maximum sales “buzz”), while SELLING them under the flag of “dietary supplements” (minimal regulation, no proof of effect needed).

    And so it goes on…

  25. ceec said,

    September 28, 2006 at 12:47 pm

    #22 Smidsy:
    “Has anyone asked the council if written informed consent will be obtained and if they have a copy of the protocol available?”

    I wrote to the council and asked that. Received a reply saying parents would be given “full and transparent information on the project” but not what that info would be. Although I have asked for specific details of research ethics approval (twice), e.g. what committee approved it, what consent procedures are, what systems in place for monitoring side effects etc. No such details have been forthcoming so far.

  26. jdc325 said,

    September 28, 2006 at 1:52 pm

    #24 Dr Aust – re your statement about dietary supplements and no proof of effect:
    I wrote something similar to the following on an older thread somewhere else, but here goes…
    You are absolutely correct at time of ‘going to press’. However, keep an eye on the new EC Regulation to be introduced following Common Position No 3/2006 (adopted by the council on 8 Dec 2005). Once in place, this regulation will ensure that all health and nutrition claims on food (including ALL dietary supplements) are substantiated by “generally accepted scientific evidence”. I believe that EFSA are going to be conducting the reviews – should be very stringent by all accounts. The claims on fish oil and concentration are likely to disappear altogether. This does not mean that fish and the oils thereof have no benefit, simply that people are exceeding the bounds of what the science on fish oils allows for. JHCI (joint health claims initiative) approved claims re Omega 3 PUFA and heart health and there is good evidence that Omega 3 (specifically forms of EPA) benefit those with mental health issues such as depression, possibly due to an actual clinical deficiency of n3 fatty acids or simply a ‘less than desirable’ intake thereof. Depression in children is estimated at 2% and in teenagers at 5% – I would guess (very unscientifically) that EPA / fish oil would benefit the 2-5% of young children/teenagers that suffer from depression – as for the other 95-97% of “normal” kids/teenagers, there’s no evidence I’m aware of that would justify a claim on maintaining concentration etc… Supplements SUPPLEMENT the diet, they do not cure all ills or act as magic bullets. There is great ignorance from both sides on this issue, as people simply state their own prejudices and attempt to bully others into accepting these as fact – I mean anti-nutritionists AND nutritionists here. People should pull their heads out of their own arses and start reviewing the evidence (or lack of) objectively and dispassionately (some chance!!).

    Regards.

  27. Delster said,

    September 28, 2006 at 2:02 pm

    jdc325,

    It’s a little hard to pull head out of anywhere and review the evidence when the company in question is witholding it.

    The two main thrusts of the comments on here is the lack of scientific method in the “trial” and the fact that the Eye-Q people have not released their reasearch.

    Another matter is the way it’s been done in terms of media publicity and lack of hard facts such as Ethics review etc

  28. jdc325 said,

    September 28, 2006 at 2:39 pm

    I take your point re lack of scientific method in the non-trial being carried out under the misnomer of “trial” and the (HIGHLY suspicious) secretive behaviour, but my remarks also relate to the general extreme negativity towards nutritional interventions and were also prompted in part by Ben G’s constant badmouthing of nutritionists both on this website and in the (normally fair and balanced) Bad Science column itself – even if 90% of nutritionists were shysters this would not mean that ALL nutritionists were fair game or should be treated as a homogenous group with no independent thoughts or theories. I am not a nutritionist myself, but am considering taking up this or a similar career as I believe that (if one conducts oneself properly) this COULD be a noble profession and one in which it would be possible to help a great many people (if using ‘good’ science that can be validated). Please feel free to ridicule my views on nutritionists, as I value lively debate. I will, however, attempt to moderate my language (just in case anyone is offended by mention of arses and heads being pulled out etc). Cheers, JDC

  29. Dr Aust said,

    September 28, 2006 at 2:59 pm

    Hi jdc.

    Perfectly happy to agree that giving out SENSIBLE nutritional advice is a good thing. This is partly why Jamie the Chirpy Cockney Chef gets a relatively good press from blog posters here, since he is conducting a high-profile campaign attempting to re-introduce sensible fresh food-sourcing / cooking / eating attitudes, mercifully without overblown pseudo-scientific claims. And I have no problem with dietitians, basic nutritional advice from GP surgeries, “eat more veg”, “eat less processed food” etc etc And I think British schools should be teaching kids “basic nutrition” along with what used to be called “Domestic Science” (how to choose and cook good food rather than sh*t).

    So I have no problem with people dispensing sensible, evidence-based dietary advice. The UK and US populations seem in dire need of it..

    HOWEVER…..

    One of the things Ben repeatedly highlights, quite correctly, is that “nutrition-ism” is overwhelmingly dominated by hucksters whose interest is in selling, and their pseudo-“nutrition therapist” buddies who constantly reinforce evidence-free “magic bullet” ideas: “if you want to combat anti-oxidants eat more gurgleberries, natures super-fruit!” or “eat more Ox-de-radical(TM)”.

    The example of Equazen essentially shows that even the most apparently scientifically serious/respectable bits of the supplement industry are full of dishonesty / misselling / PR balls / weasel-ing.

    And in other cases, even if the actual advice on what to eat is sensible, it is justified in scientifically ludicrous misleading ways (see e.g. “Dr” McTeeth) which reinforce the punters’ misconceptions and leave people pray to the next “super-supplement” con-man.

    Anyway, it’s no wonder we’re cynical.

    To end on a positive note, I would suggest that if you want to pursue a career in nutrition you should have a look at the British Dietetic Association’s leaflet:

    www.bda.uk.com/Downloads/whynottrain.pdf

    It’s not a quick training but it is science and evidence-based and leads to a job doing something good and useful.

  30. Barnacle Bill said,

    September 28, 2006 at 3:47 pm

    I think Ben mentioned somewhere that You and Yours was going to do a piece on this story today. List used the “listen again” facility and nary a mention.

  31. j said,

    September 28, 2006 at 5:32 pm

    I mentioned it – sorry, looks like they didn’t run it. I swear they mentioned it yesterday – unless I was hallucinating due to lack of fish oil ;) – but yeah, it wasn’t on today.

  32. ceec said,

    September 28, 2006 at 10:58 pm

    or maybe the oil made them too slippery to actually make any kind of case and they er… slid off the programme

  33. Ben Goldacre said,

    September 29, 2006 at 12:45 am

    yup. slippery fish oil characters, fishy trials, rotten.. er… fishy boroughs, er, fatty acid fat cats, these and other permutations i have studiously avoided. and yet here you are. sigh.

  34. jdc325 said,

    September 29, 2006 at 10:36 am

    Re #29 from Dr Aust:
    1. Thank you for the link and your final sentence.
    2. Quick question – although some believe we are overly keen on legislating for everything these days, would you (personally) be in favour of some kind of law/directive regarding (a) Disclosure of (financial and personal) interests (b) Disclosure of academic credentials?
    3. If by ‘hucksters’ you mean the likes of ‘celebrity poo doctor’ G McTeith, then I am in total agreement – I used to watch YAWYE on C4, but found it to be seriously bad for my blood pressure as attested by my red/purple face by the time each episode finished. (see also 2(b) with regards “Dr” McTeeth.
    4. I would humbly suggest that one reason scientists are cynical about nutritionists is because of “Daily Mail Syndrome” – unless something is proclaimed as a miracle cure, it is unlikely to gain media attention and therefore only those making claims they (probably) can’t back up will get coverage. Other reasons include the fact that ANYONE can use (misuse?) the term nutritionist, as it is not a protected term.
    5. Re. “Even the most apparently scientific/serious bits of the supplements industry” – having viewed the Equazen website (the [misleading] fish counter being particularly amusing), I would struggle to describe Equazen as serious or respectable.
    6. To sum up – I guess I am a fan of nutrition, but not nutritionists. I’m sure that Hippocrates couldn’t have imagined the consequences of his dictum(s) on food and medicine – but maybe he is to blame! Change Hippocratic oath to hypocritical oath and you could have a code for the McTeiths.

  35. Ken Zetie said,

    September 29, 2006 at 1:41 pm

    My wife just received the following email from BUPA (Apologies for the length but it would be unfair to edit someone else’s statements):

    “ALL ABOUT OMEGA-3
    —————————

    Research has shown that omega-3 fatty acids have properties that promote healthy brain development and decrease inflammation in the body. In addition, studies have shown a link between omega-3 fatty acids and good heart health.

    Increasing omega-3 fatty acids in your diet on a regular basis may:

    __Decrease risk of sudden cardiac death __Lower triglyceride levels __Decrease growth of plaque on artery walls __Prevent irregular heartbeat __Prevent excessive blood clots from forming __Lower blood pressure

    To read more about omega-3 foods and why they’re good for you click the link below or copy & paste into your browser:

    www.bupa-php.co.uk/redirect.asp?p=ar&c=104&v=113810&ck=bupawell&cp=bupawell

    The bit about ‘promote healthy brain development’ isn’t repeated in the second list of benefits which ‘may’ happen. I guess if you take Omega-3 you ‘may’ win the lottery too…

    Sigh

    Ken

  36. jdc325 said,

    September 29, 2006 at 2:55 pm

    #35 Ken Zetie:
    I read that Omega 3 Fatty Acids may decrease incidence of one type of stroke (ischaemic), although by the same token they may increase incidence of another type of stroke (haemorhhagic). The increased incidence of the second type of stroke fits with the evidence of decreased incidence of the first type of stroke due to the “blood-thinning” properties of Omega 3 fatty acids – therefore Omega 3 will help decrease your risk of stroke ONLY if you already know which type of stroke you are more likely to suffer. Re brain development – the specific omega 3 fatty acid (can I just call them n-3 PUFAs?) that is involved is DHA and generally a store of this type of fat is built up prior to birth and in early infancy – as I understand it, the foetus/neonate receives DHA from the mother across the placenta and, following birth, through breast milk. It would therefore seem inappropriate to me to claim any benefit on brain development for {example} children aged 3 and upwards, as appears on most n3 PUFA labels and as seems to be implied by BUPA. With regards inflammation – anti-inflammatory series three prostaglandins (such as PGE3) are formed from eicosapentaenoic acid, but I would imagine one could argue (or even test the theory) that these are formed by the body on an as-required basis in response to ‘excessive’ levels of series two prostaglandins which are formed as metabolites of arachidonic acid, the omega 6 PUFA.

    *This links in with the use of Evening Primrose Oil that has been criticised by many as having no basis. The alleged basis is that the body may require higher levels of n6-PUFA as found in EPO to form series 1/ series 2 prostaglandins. As the intake of n6 PUFAs already far exceeds that of n3 PUFAs, I would be astonished if increased intake of n6 PUFAs benefitted health in any way. High levels of n6 PUFAs have been ‘associated’ with conditions that are exacerbated by inflammation – cancer, arthritis etc… Increasing ones intake of n6 PUFAs by taking EPO supplements would seem to me to be unwise. Fish such as sardines contain a mixture of mono- and poly- unsaturated fatty acids and as such would presumably provide the body with whichever fatty acids were required. Natural versus man-made: I know what my money is on. We’re back therefore to general, basic (and very un-sexy) messages about eating sensible, balanced diets. I think the posts on this page have made my mind up. I’m changing sides – screw the nutritionists and vive le common sense.

  37. Dr Aust said,

    September 29, 2006 at 3:37 pm

    Good for you jdc

    A rather general theme that has emerged in many pieces of nutrition-related medical research is that eating a range of foods rich in things that are generally good for you (aka “a healthy balanced diet with plenty of fresh produce”) has health benefits, while chomping SUPPLEMENTS containing the “magic things that ought to protect you from X Y or Z” is ineffective.

    As a consequence I have rarely (if ever) never met a doctor or scientist who is a believer in paying Boots for dietary supplements. Most favour fresh fruit and veg and sardines.

    Note that as well as being better supported by the evidence this option is probably cheaper , and certainly a great deal more enjoyable.

  38. Ben Goldacre said,

    September 29, 2006 at 3:52 pm

    jdc: does that mean youre giving up the day job at the pill peddlers? ; )

  39. Delster said,

    September 29, 2006 at 5:40 pm

    yep…. sardines grilled with lemon juice and butter beats a pill anyday!

  40. stever said,

    September 29, 2006 at 6:37 pm

    mmmm sardines

  41. Hate that poo-lady said,

    September 30, 2006 at 11:50 am

    jdc – i agree w Dr Aust, look into training as a dietitian – i’m one and i’ve found the training and experience in the NHS invaluable – our role is to translate nutritional science into practical and acceptable advice to people of all walks of life.

    My job working with children overlaps with aspects of counselling, social work, education, management, strategic planning, resource development, marketting, speech therapy, psychology, etc etc. I see children at home who are terminally ill and need to be tube-fed, children with special needs in schools, and all range of nutritional problems in clinics – from allergies, malnutrition, obesity, liver and kidney diseases and various rare metabolic. I’ve also been involved in research and innovative nutritional treatments. Outside the NHS there are lots of opportunites to work in industry, with supermarkets or weight-management firms, food manufacturers, media, sports or malnutrition overseas, to name a few.

    Being a dietitian is not for everyone though, and hopefully the title nutritionist will be a protected by law like dietitian is. Legitimate nutritionists have a recognised degree in nutrition and can do much of the work i described above that dietitians do out of the NHS – particularly public health policy planning and research. Nutritionists also work for the NHS often alongside dietitians and sometimes giving advice – but on non-clinical stuff – for example on weight management, weaning babies, healthy eating. The nutrition society lists legitimate nutrition degree courses.

    I’d be wary of any courses in nutritional therapy if you want to be viewed with any credibility.

    Sorry to go on, but i love my job, and really value the legitimate nutritionists i work with!!

  42. Hate that poo-lady said,

    September 30, 2006 at 12:05 pm

    p.s. I often am asked to advise parents on taking fish oils, particularly Eye-Q, and tend to advise to aim to have the recommended 2 portions of fish a week first. However, as fish is not popular with children – particularly the omega3 rich oily fish, and so parents are keen to try these supplements whether or not there is enough evidence

    I say that if they want to try fish oil supplements, to make sure they are not too high in vitamin A, purified to remove harmful pollutants (as most brands are anyway), to check with their doctor if they have epilepsy or clotting problems and to stop them well in advanced of any planned surgery due to the possible reduced blood clotting effect.

    I then say to start them when there are not other big changes in their lifestyle, and to review whether they think they have had any effect (on their child’s behaviour/concentration/school performance) after a few months. In my experience, some parents don’t see any improvement, and some are convinced they do. Many aren’t sure and continue giving them to their children just in case.

  43. Dr Aust said,

    October 2, 2006 at 10:40 am

    Laudable, no. 42, esp. the advice re. eating oily fish first, but….

    One might think the million dollar question is whether you say, or are professionally obliged to say at any point, “there is no good scientific evidence that fish oil pills work” or “The only evidence it works is for kids with ADHD -there is no evidence it does anything for behaviourally normal children”.

    Once people start their kids on it, there is a good chance they will convince themselves it works – placebo effect at work. Cue more sales for the FishOil peddlars.

    Talking of getting kids to eat oily fish, pity the British manufacturers can’t work out a way to make decent-tasting tinned sardines. The French ones are usually much nicer and hence I would imagine easier to “sell” to children.

    I also wonder whether children’s often rather restricted tastes (i.e. not wanting to eat oliy fish) reflects the boring / flavourless sugar-loaded food they typically get given post-weaning? I have been amazed how enthusiastic our 2-yr old is about things I would never have expected, like “smelly fish” (sardines), garlic, strong pickled onions, etc. Keeping our fingers crossed that this taste range lives on into her school years..

  44. jdc325 said,

    October 2, 2006 at 1:22 pm

    #38: Don’t tempt me Ben. I need the money – although I am well aware that if I don’t try to stop the “dark lords” I work for from making unscientific claims I may well be as bad as they are. I hope my boss doesn’t walk in while I’m writing this, but here goes… Today, I have been reviewing product information pages written by the marketing department of the pill-peddling company I work for and had to delete large chunks of information as my conscience won’t allow me to let them unleash any more bad science on an unsuspecting public I’m waiting now to see what they try to sneak back in. Please don’t give anyone clues to my identity or refer to this in your newspaper column, as I can’t afford to get sacked. I’m wary of giving you examples of the bad science we use just in case anyone ever finds out what I’m telling you, but rest assured there’s plenty. (Oh, OK just the one to be going on with: Omega 3 fatty acids may help to maintain concentration levels). Are you interested in having a mole on the inside?

  45. jdc325 said,

    October 2, 2006 at 1:26 pm

    #39 – Cheers Delster, I might use that one. I tried a new sardine sandwich last week – sardines mashed with olive oil, a good squeeze of lemon juice and some sliced tomato on brown bread.

  46. Hate that poo-lady said,

    October 2, 2006 at 5:05 pm

    no.43 – yes i absolutely do say there is not enough good evidence, even for ADHD, but try not to be too disapproving as there is so little reliable evidence base to a lot of nutritional and dietetic stuff!! When i try to be disapproving i get asked to refer families on to ‘a real nutritionist like that What not to eat doctor lady’ !!!
    and it sounds like your daughter is on the right track – well done!

  47. Dr Aust said,

    October 2, 2006 at 5:22 pm

    One family theory is that daughter 1’s taste for pickles is the result of her mother combating morning sickness by developing a serious dill pickle habit. I once saw ‘er indoors devour an entire large jar of dill pickles at a single sitting – quite scary.

  48. Robert Carnegie said,

    October 4, 2006 at 2:44 pm

    #47, Mrs Aust. “Lips that touch brine shall never…” ? :-)

  49. Ben Goldacre said,

    December 6, 2006 at 10:11 am

    Equazen has just been bought by Galenica, reported twice below. Excellent to see that Adam Kelliher will now be concentrating on research!

    www.forbes.com/business/feeds/afx/2006/12/05/afx3228013.html

    ZURICH (AFX) – Galenica Holding AG said it bought UK food supplements producer Equazen Nutraceuticals, effective Dec 1, through its UK subsidiary Potter’s Ltd.

    The purchase price was not released.

    Equazen had a turnover of about 20 mln sfr in 2005 and makes a number of best-selling food supplements based on fish oil.

    The acquisition will help the Bern-based group to significantly expand its brand portfolio in the UK.

    Following the transaction, the combined Potter’s and Equazen business will rank among the UK’s 15 largest OTC/healthcare companies, Galenica said.

    www.nutraingredients.com/news/ng.asp?n=72535-equazen-galenica-omega-eye-q

    Galenica snaps up UK omega-3 leader Equazen

    05/12/2006 – UK omega-3 company Equazen has been purchased by Swiss pharma company Galenica, a move that looks set to take the brand to new heights in the competitive global market – and free up its founder to focus on new research in the field.

    Equazen claims much of the credit for the consumer on its home turf in the UK; its eye q supplement brand is the market leader, claiming around 30 per cent of the market. The sale to Galenica, the terms of which have not been disclosed, looks set to propel the brand into new international markets.

    According to Euromonitor International, the omega-3 market grew by 243 per cent between 2003 and 2005. The sector has proved energetic at all levels of the supply chain, with a spate of deals between fish oil suppliers, technology providers, and manufacturers.

    Much of the buzz has stemmed from scientific research into the benefits of omega-3, and Equazen’s products have been used in some most groundbreaking studies, particularly in the Oxford-Durham study, which concluded that omega-3 can aid children’s behaviour and concentration.

    Founded in 1999, Equazen’s 2005 sales ex factory were £8.7m (c €12.9m). As well as eye q for cognitive function, its range is made up of other consumer- and condition-specific products, such as cardiozen for cardiovascular health, mumomega for pregnancy and equavision for eye health.

    In a climate where there are clear opportunities to be seized but where the market is becoming increasingly crowded, Equazen considered its options to leverage its success to date for the future.

    “As a family-run company we had to look very closely at our ability to hold our position in the UK trade sector and thought it would be wiser to run with a larger group,” founder and CEO Adam Kelliher told NutraIngredients.com.

    Galenica, a public listed company with a strong presence in the Swiss health care market, had a 2005 turnover of €1.4bn. It is currently making inroads into the UK OTC sector: with Equazen added to the Potters herbal medicine company it acquired in 2003 it ranks amongst the top 15 OTC healthcare companies in the UK.

    Equazen had several approaches, but some were interested solely in the brand and would have shut down operations, which would have meant lack of continuity in staff and standing in the marketplace.

    Kelliher described Galenica as “well-resourced, deeply committed to OTC naturals, and a perfect fit for accelerating the growth of Equazen”.

    On an international level Equazen has a strong distribution presence in Europe, Australia, New Zealand and South Africa. But Galenica is present in 90 countries, “so it has a lot of strength in areas we don’t”.

    In particular, the transaction gives scope for entry into untouched parts of Europe, Asia, and North America.

    Kelliher will stay on to lead Equazen through a transitional period of at least six month.

    But he will still have an ongoing commercial relationship with the company since after this he will shift his attention to Equateq, the company he started in January to focus on research and cutting-edge applications of omega-3.

    When Equazen acquired the oil processing plant and research facility in the Outer Hebrides, Equazen was to be Equateq’s main customer, using 60 per cent of the oil produced.

    Despite the mounting interest, Kelliher said that the sector is still in its infancy as more research brings to light different applications for human health.

    Part of the challenge is commercialising that research: “Research has to have relevance for people buying products,” he said.

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