Ben Goldacre
Saturday September 30, 2006
The Guardian
I wouldn’t want you to think that I’m an overly sensitive person, but sometimes I get a bit upset by Dr Gillian McKeith PhD. There she is on the television, talking about science, making an obese woman cry, in her own back garden, by showing her a tombstone with her own name on it, made out of chocolate. And here she is, in an article headed “I lost 4 stone after telly’s Gillian said You’ll be dead by the time you’re 40” (The Mirror, September 6 2006), where one of her delighted customers describes Gillian’s bedside manner in glowing terms: “Kim MacDonald credits a single movement for changing her life. Sitting on her bed … Gillian said: ‘Do you want to see your daughter get married and have babies? Because the way things are going you’ll have a heart attack at 40’, says Kim, from Cambridge … with tears streaming down her face, Kim agreed to change – and ended up becoming Gillian’s most successful candidate.”
It’s hard to imagine an NHS doctor attaining wealth, the adoration of patients, or professional acclaim by deploying this kind of approach. In fact, it’s hard to imagine a doctor like this having many patients at all, after all the professional complaints against them, and endless meetings with the clinical director, and probably the GMC, to discuss their bedside manner.
I’m not for one moment suggesting that she should be forbidden from practising whatever it is she practises, or censured.
If people want theatrically abusive nutritional advice from someone with qualifications such as a PhD from a non-accredited correspondence course college in the US (which sells its own range of alternative health products online) then that’s fine by me, and she’s absolutely entitled to call herself doctor, even if she does apparently have some slightly odd ideas about science.
They include, to take the briefest example, nutritional energy and photosynthesis, explaining in her 1.5m copies (gosh) bestselling books that chlorophyll is “high in oxygen”; eating it will oxygenate your blood (not without a searchlight up your bum to drive the photosynthesis of oxygen, I would suggest); and that “each sprouting seed is packed with the nutritional energy needed to create a full grown healthy plant” (I have an apple seed in my left hand and an apple tree in my right, for comparison, as I try to work out what she means).
Anyway. I’m not bothered by her nastiness, in the “regulate them” sense of the word: it’s just a lot more extreme than I remembered, and that makes her popularity interesting. Because people elect to see McKeith, to be told off and made to cry, both in her clinic and on her Channel 4 TV shows.
There’s clearly a place in the healthcare market for this kind of Victorian and authoritarian approach. In fact, it seems to me that many of the key traits of alternative therapists are, paradoxically, the key traits of old fashioned paternalistic medicine. They provide certainty, and a sense of expertise: “I know what’s wrong with you,” they say. “I am the expert, I am telling you exactly what to do to get well.” Then, like McKeith, they hand over an ambitious herbal concoction, and some reasonably sensible housewife’s wisdom, with unswerving conviction. It’s not just the medicine that’s old fashioned, the proprietary preparations, the “horny goat weed” in McKeith’s “Fastformula Horny Complex” for men, it’s the whole bedside manner. Gillian is a Victorian doctor.
But stranger than the attraction to her patients is the attraction for us. We choose, in droves, to watch her bully very fat people on television. People racked with low self-esteem, and guilt, are abused, and told they will die young because of their own actions, then they cry, and we watch it, as entertainment, satisfied it’s their own fault. Fatties.
· Please send your bad science to bad.science@guardian.co.uk
Another favourite McKeith quote is here:
“An acid body means that there is an excess of hydrogen ions which combine with oxygen to form water. This excess hydrogren depletes the body’s oxygen. Simply stated, a shortage of oxygen causes cells to break down and die, creating acidosis.”
Watch science nerds try and get to the bottom of what on earth she means by that published statement here.
billgibson said,
October 4, 2006 at 7:08 pm
As we’re all serious scientists and dedicated to advancing our knowledge, you may all like to know the SI equivalents are Urea 39.2, Creanine 769.
Conversion is urea 1 mg/dl = 0.357 mmol/l, Creatnine 1mg/dl = 88.4 micromol/l
I think I deserve bonus points because I worked it out having never had an Omega 3 Fish Oil capsule in my life. If only I’d gone to school in Durham….
Bill
Dr Aust said,
October 4, 2006 at 10:08 pm
Of course, one of the things the problem highlights is that the interpretation benefits from other seemingly basic info… like “had barfed repeatedly”… or “had not passed urine for n hrs”.
This is an interesting point WRT the med students I teach, BTW – they love NUMBERS and TESTS and, at least when interpreting their “paper case scenarios”, tend to largely neglect more mundane “observations”.
On a more acid-base theme, becoming alkalotic by losing acid (vomiting) or acidotic by losing HCO3- (eg cholera) are also concepts students tend to find tricky to grasp.
I guess the thing this discussion shows wot we can ALL agree on is that acids and bases in yer body is a flddly business, about which G McTeeth knows F all squared.
Still on acids and bases: A medical Q for the MBChB gang: is it REALLY possible to acid-load yourself significantly by eating anything FOOD related (cf all the bleatings of the Alt nutrition lobby about “food acidity”?)
..And I mean a food food, not necking 100 grammes of Ammonium Chloride or something like that. Could you really give yourself a metabolic acidosis by eating loads of lemons? And how many would you have to eat in what time frame?
billgibson said,
October 4, 2006 at 10:18 pm
You can make yourself hypertensive and hypokalaemic by eating liquourice allsorts.
I doubt very much that you’d be able to significantly alter your acid/base balance with any food though – the body has some really amazing ways of correcting for a disturbance, and when they go wrong it’s fairly serious. Anyone we see on the wards with any degree of acidosis makes us run round shouting STAT! and things like that. We don’t need to, but it’s fun.
Seriously, though, any food sufficiently acidic to mess about woth your pH would make you feel very ill and vomit. Evolution is fucking brilliant like that.
Bill
Dr Aust said,
October 4, 2006 at 11:33 pm
Thanks Bill, that’s what I thought – and Mrs Dr Aust, formerly a battle-hardened med reg, couldn’t think of any either. But good to hear others say it too.
Any chance we could persuade Dr McT to have the juice from a kilo of lemons instilled into her stomach via multi-barrel cannula, with repeat blood gas analysis and online stomach pH measurement?
Now that’s something I would set the HDrecorder for.
David Mingay said,
October 5, 2006 at 1:28 am
Re #48. When they say the government of Tibet, they mean the government-in-exile of Tibet; in other words some monks living over the border in India (I sympathise with them politically but not medically). When they say the Tibetan Medical college, they mean the Tibetan Medical and Astrological college, which was set up by said monks to study horoscopes and dish out useless herbs.
The real (Chinese-run) government in Tibet provides an appalling medical service which discriminates against Tibetans. If idiots in the West gave their surplus cash to helping proper medicine in Tibet rather than frittering it away on wolfberries, the world would be a better place.
Ben Goldacre said,
October 5, 2006 at 3:21 am
a genuinely serious academic once emailed me once suggesting that eating acidic foods could deplete the calcium salts in your bones as they are used as a buffer. it was one of those situations where i frankly couldn’t be bothered to to look into it any further as it sounded a bit unlikely and i wasn;t that bothered either way, but if there are any renal physicians/clinicalbiochemists etc out there who know… incidentally, dr aust mentioned that his wife used to be a medical reg. i should point out for those who don’t know that they are the hardest cleverest people in the world.
Dr Aust said,
October 5, 2006 at 2:45 pm
We (me and Mrs Dr Aust, aka “The Doc”) had a think about this and the most “test case” scenario we could come up with was the very rare people with specific (mostly genetic) defects of kidney acid secretion (renal tubular acidosis), who are actually given oral sodium bicarb.
Since they can’t excrete “metabolic acid” properly, and actually need to take oral alkali to “mop up” the metabolic acid, you would think they would be the absolute test case of people who would need to avoid “acidic foods”.
However, as far as I have been able to find out there is no hint these people are told to avoid “acid foods”. One US pediatric site with info on R Tubular Acidosis specifically said “diet changes to avoid acid foods don’t make any difference”.
– Implication being that the metabolic acid produced by your body going about its work is quantitatively more important than any acid in the foods you eat. reminds me a bit of dietary vs. “body-made” cholesterol.
The Doc stresses that people with these renal acid handling defects are v. rare – says she never saw one in 8+ yrs of hospital medicine, including a spell as a renal SHO (but had to learn all the syndromes periodically for exams…!).
Having said all the above, I HAVE dug up a learned opinion article in JASN (Journal of the American Soc Nephrol) which does argue that people should eat “alkaline foods”:
jasn.asnjournals.org/cgi/content/full/13/8/2186
[Ben – this paper also alludes to the evidence your email correspondent was probably talking about re acidity and bones, see their refs 34-36. ]
But…! …it turns out that eating alkaline foods equals – wait for it –
“increased dietary intake of fruits and vegetables ”
…hooray! Six portions of fruit and veg…again!
– I always like it when learned high-powered science turns out to support simple common-sense everyone-already-knews-this diet advice (“eat properly” – see above) rather than the obscurantist Boggleberry-bollocks of the alt “nutritionist” gang.
Jeremy Zeid said,
October 7, 2006 at 2:49 am
Look, let’s forget the niceties, the woman is a QUACK., pure and simple.
As for that cobblers abouit chlorophyll and that absolute tosh regarding Hydrogen ions… Does nobody check out this rubbish prior to transmission?
And why do people like this get away with it?? Because we let them, we are so eager to be told what to do. certainty in an uncertain world.
Carry this microchip, you’ll “be safe”. Give us your fingerprints for your “security”. take this pill to make your mind “right”. Give us your DNA, “just in case”. And the best laugh…. Look at your poo, it’s the wrong colour and texture, you’re gonna DIE….. QUACKERY pure and simple, worse it’s legal accepted quackery. certainty in an uncertain “war on terror” world.
Jeremy Zeid said,
October 7, 2006 at 10:17 am
I wish I could coin it by making people examine their own crap. As for the TV companies that actually make a programme examining shit, AND it gets decent ratings… All I know is that the fox that crapped in my driveway yesterday was not eating enough fruit and vegetables… Like it or not, there is big money to be made from the gullible, the insecure and those who just love to be in on a fad. No wonder I have an overdraft….
Mat Tautou said,
December 12, 2006 at 12:59 pm
Good Old Dr Poo! She was trying to find ways in to Suma Wholefoods, one of the Uk biggest whole foods suppliers (and the largest European worker’s collective) not too long back.
I’m reliably informed that dear Gillian’s vanity is as fragile as her right to her title. Whilst admirers are allowed to gaze upon her fair form, contractual obligation, no less, states that her age must never be questioned…
Please note how I refrain from making the Dr Poo in her Turdis joke…
funkyfarmacist said,
November 25, 2008 at 2:31 pm
Does she use the Bristol poo scale in her work?
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