by Ben Goldacre
Where does all this leave us? There was an observed correlation between low blood levels of these antioxidant nutrients and a higher incidence of cancer and heart disease, and a plausible mechanism for how they could have been preventive: but when you gave them as supplements, it turned out that people were no better off, or were possibly more likely to die. That is, in some respects, a shame, as nice quick fixes are always useful, but there you go. It means that something funny is going on, and it will be interesting to get to the bottom of it and find out what.
More interesting is how uncommon it is for people even to be aware of these findings about antioxidants. There are various reasons why this has happened. Firstly, it’s an unexpected finding, although in that regard antioxidants are hardly an isolated case. Things that work in theory often do not work in practice, and in such cases we need to revise our theories, even if it is painful. Hormone replacement therapy seemed like a good idea for many decades, until the follow-up studies revealed the problems with it, so we changed our views. And calcium supplements once looked like a good idea for osteoporosis, but now it turns out that they probably increase the risk of heart attacks in older women, so we change our view.
It’s a chilling thought that when we think we are doing good, we may actually be doing harm, but it is one we must always be alive to, even in the most innocuous situations. The paediatrician Dr Benjamin Spock wrote a record-breaking best-seller called Baby and Child Care, first published in 1946, which was hugely influential and largely sensible. In it, he confidently recommended that babies should sleep on their tummies. Dr Spock had little to go on, but we now know that this advice is wrong, and the apparently trivial suggestion contained in his book, which was so widely read and followed, has led to thousands, and perhaps even tens of thousands, of avoidable cot deaths. The more people are listening to you, the greater the effects of a small error can be. I find this simple anecdote deeply disturbing.
But of course, there is a more mundane reason why people may not be aware of these findings on antioxidants, or at least may not take them seriously, and that is the phenomenal lobbying power of a large, sometimes rather dirty industry, which sells a lifestyle product that many people feel passionately about. The food supplement industry has engineered itself a beneficent public image, but this is not borne out by the facts. Firstly, there is essentially no difference between the vitamin industry and the pharmaceutical and biotech industries (that is one message of this book, after all: the tricks of the trade are the same the world over). Key players include companies like Roche and Aventis; BioCare, the vitamin pill company that media nutritionist Patrick Holford works for, is part-owned by Elder Pharmaceuticals, and so on. The vitamin industry is also—amusingly—legendary in the world of economics as the setting of the most outrageous price-fixing cartel ever documented. During the 1990s the main offenders were forced to pay the largest criminal fines ever levied in legal history—$1.5 billion in total—after entering guilty pleas with the US Department of Justice and regulators in Canada, Australia and the European Union. That’s quite some cosy cottage industry.
Whenever a piece of evidence is published suggesting that the $50-billion food supplement pill industry’s products are ineffective, or even harmful, an enormous marketing machine lumbers into life, producing spurious and groundless methodological criticisms of the published data in order to muddy the waters—not enough to be noteworthy in a meaningful academic discussion, but that is not their purpose. This is a well-worn risk-management tactic from many industries, including those producing tobacco, asbestos, lead, vinyl chloride, chromium and more. It is called ‘manufacturing doubt’, and in 1969 one tobacco executive was stupid enough to commit it to paper in a memo: ‘Doubt is our product,’ he wrote, ‘since it is the best means of competing with the ‘body of fact’ that exists in the minds of the general public. It is also the means of establishing a controversy.’
Nobody in the media dares to challenge these tactics, where lobbyists raise sciencey-sounding defences of their products, because they feel intimidated, and lack the skills to do so. Even if they did, there would simply be a confusing and technical discussion on the radio, which everyone would switch off, and at most the consumer would hear only ‘controversy’: job done.
I don’t think that food supplement pills are as dangerous as tobacco—few things are—but it’s hard to think of any other kind of pill where research could be published showing a possible increase in death, and industry figures would be wheeled out and given as easy a ride as the vitamin companies’ employees are given when papers are published on their risks. But then, of course, many of them have their own slots in the media to sell their wares and their world view.
The antioxidant story is an excellent example of how wary we should be of blindly following hunches based on laboratory-level and theoretical data, and naively assuming, in a reductionist manner, that this must automatically map onto dietary and supplement advice, as the media nutritionists would have us do. It is an object lesson in what an unreliable source of research information these characters can be, and we would all do well to remember this story the next time someone tries to persuade us with blood test data, or talk about molecules, or theories based on vast, interlocking metabolism diagrams, that we should buy their book, their wacky diet, or their bottle of pills.
More than anything it illustrates how this atomised, overcomplicated view of diet can be used to mislead and oversell. I don’t think it’s melodramatic to speak of people disempowered and paralysed by confusion, with all the unnecessarily complex and conflicting messages about food. If you’re really worried, you can buy Fruitella Plus with added vitamins A, C, E and calcium, and during Christmas 2007 two new antioxidant products came on the market, the ultimate expression of how nutritionism has perverted and distorted our common sense about food. Choxi+ is milk chocolate with ‘extra antioxidants’. The Daily Mirror says it’s ‘too good to be true’. It’s ‘chocolate that is good for you, as well as seductive’, according to the Daily Telegraph. ‘Guilt free’, says the Daily Mail: it’s ‘the chocolate bar that’s ‘healthier’ than 5lb of apples’. The company even ‘recommends’ two pieces of its chocolate a day. Meanwhile, Sainsbury’s is promoting Red Heart wine—with extra antioxidants—as if drinking the stuff was a duty to your grandchildren.
If I was writing a lifestyle book it would have the same advice on every page, and you’d know it all already. Eat lots of fruit and vegetables, and live your whole life in every way as well as you can: exercise regularly as part of your daily routine, avoid obesity, don’t drink too much, don’t smoke, and don’t get distracted from the real, basic, simple causes of ill health. But as we will see, even these things are hard to do on your own, and in reality require wholesale social and political changes.
7 Dr Gillian McKeith PhD
I’m going to push the boat out here, and suggest that since you’ve bought this book you may already be harbouring some suspicions about multi-millionaire pill entrepreneur and clinical nutritionist Gillian McKeith (or, to give her full medical title: Gillian McKeith).
She is an empire, a prime-time TV’ celebrity, a best-selling author. She has her own range of foods and mysterious powders, she has pills to give you an erection, and her face is in every health food store in the country. Scottish Conservative politicians want her to advise the government. The Soil Association gave her a prize for educating the public. But to anyone who knows even the slightest bit about science, she is a joke.
The most important thing to recognise is that there is nothing new here. Although the contemporary nutritionism movement likes to present itself as a thoroughly modern and evidence-based enterprise, the food-guru industry, with its outlandish promises, moralising and sexual obsessions, goes back at least two centuries.
Like our modern food gurus, the historical figures of nutritionism were mostly enthusiastic lay people, and they all claimed to understand nutritional science, evidence and medicine better than the s
cientists and doctors of their era. The advice and the products may have shifted with prevailing religious and moral notions, but they have always played to the market, be it puritan or liberal, New Age or Christian.
Graham crackers are a digestive biscuit invented in the nineteenth century by Sylvester Graham, the first great advocate of vegetarianism and nutritionism as we would know it, and proprietor of the world’s first health food shop. Like his descendants today, Graham mixed up sensible notions—such as cutting down on cigarettes and alcohol—with some other, rather more esoteric, ideas which he concocted for himself. He warned that ketchup and mustard, for example, can cause ‘insanity’.
I’ve got no great beef with the organic food movement (even if its claims are a little unrealistic), but it’s still interesting to note that Graham’s health food store—in 1837—heavily promoted its food as being grown according to ‘physiological principles’ on ‘virgin unvitiated soil’. By the retro-fetishism of the time, this was soil which had not been ‘subjected’ to ‘overstimulation’…by manure.
Soon these food marketing techniques were picked up by more overtly puritanical religious zealots like John Harvey Kellogg, the man behind the cornflake. Kellogg was a natural healer, anti-masturbation campaigner, and health food advocate, promoting his granola bars as the route to abstinence, temperance and solid morals. He ran a sanatorium for private clients, using ‘holistic’ techniques, including Gillian McKeith’s favourite, colonic irrigation.
Kellogg was also a keen anti-masturbation campaigner. He advocated exposing the tissue on the end of the penis, so that it smarted with friction during acts of self-pollution (and you do have to wonder about the motives of anyone who thinks the problem through in that much detail). Here is a particularly enjoyable passage from his Treatment for Self-Abuse and its Effects (1888), in which Kellogg outlines his views on circumcision:
The operation should be performed by a surgeon without administering an anesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment. In females, the author has found the application of pure carbolic acid to the clitoris an excellent means of allaying the abnormal excitement.
By the early twentieth century a man called Bernard Macfadden had updated the nutritionism model for contemporary moral values, and so became the most commercially successful health guru of his time. He changed his Christian name from Bernard to Bernarr, because it sounded more like the roar of a lion (this is completely true), and ran a successful magazine called Physical Culture, featuring beautiful bodies doing healthy things. The pseudoscience and the posturing were the same, but he used liberal sexuality to his advantage, selling his granola bars as a food that would promote a muscular, thrusting, lustful lifestyle in that decadent rush that flooded the populations of the West between the wars.*
≡ Interestingly, Macfadden’s food product range was complemented by a more unusual invention of his own. The ‘Peniscope was a popular suction device designed to enlarge the male organ which is still used by many today, in a modestly updated form. Since this may be your only opportunity to learn about the data on penis enlargement, it’s worih mentioning that there is, in fact, some evidence that stretching devices can increase penis size. Gillian McKeith’s ‘Wild Pink’ and ‘Horny Goat Weed’ sex supplement pills, however, sold for ‘maintaining erections, orgasmic pleasure, ejaculation…lubrication, satisfaction, and arousal’, could claim no such evidence for efficacy (and in 2007, after much complaining, these seedy and rather old–fashioned products were declared illegal by the Medicines and Healthcare Products Regulatory Agency, or MHRA). I mention this only because, rather charmingly, it means that Macfadden’s Peniscope may have a better evidence base for its claims than either his own food products or McKeith’s Horny Goat penis pills.
More recently there was Dudley J. LeBlanc, a Louisiana Senator and the man behind Hadacol (‘I had’da call it something’). It cured everything, cost $100 a year for the recommended dose, and to Dudley’s open amazement, it sold in millions. ‘They came in to buy Hadacol,’ said one pharmacist, ‘when they didn’t have money to buy food. They had holes in their shoes and they paid $3.50 for a bottle of Hadacol.’
LeBlanc made no medicinal claims, but pushed customer testimonials to an eager media. He appointed a medical director who had been convicted in California of practising medicine with no licence and no medical degree. A diabetic patient almost died when she gave up insulin to treat herself with Hadacol, but nobody cared. ‘It’s a craze. It’s a culture. It’s a political movement,’ said Newsweek.
It’s easy to underestimate the phenomenal and enduring commercial appeal of these kinds of products and claims throughout history. By 1950 Hadacol’s sales were over $20 million, with an advertising spend of $1 million a month, in 700 daily papers and on 528 radio stations. LeBlanc took a travelling medicine show of 130 vehicles on a tour of 3,800 miles through the South. Entry was paid in Hadacol bottle tops, and the shows starred Groucho and Chico Marx, Mickey Rooney, Judy Garland, and educational exhibitions of scantily clad women illustrating ‘the history of the bathing suit’. Dixieland bands played songs like ‘Hadacol Boogie’ and ‘Who Put the Pep in Grandma?’.
The Senator used Hadacol’s success to drive his political career, and his competitors, the Longs—descended from the Democrat reformer Huey Long—panicked, launching their own patent medicine called ‘Vita-Long’. By 1951 LeBlanc was spending more in advertising that he was making in sales, and in February of that year, shortly after he sold the company- and shortly before it folded—he appeared on the TV show You Bet Your Life with his old friend Groucho Marx. ‘Hadacol,’ said Groucho, ‘what’s that good for?’Well,’ said LeBlanc, ‘it was good for about five and a half million dollars for me last year.’
The point I am making is that there is nothing new under the sun. There have always been health gurus selling magic potions. But I am not a consumer journalist, and I don’t care if people have unusual qualifications, or sell silly substances. McKeith is, for me, very simply a menace to the public understanding of science. She has a mainstream prime-time television nutrition show, yet she seems to misunderstand not nuances, but the most basic aspects of biology, things that a schoolchild could put her straight on.
I first noticed Dr Gillian McKeith when a reader sent in a clipping from the Radio Times about her first series on Channel 4. McKeith was styled, very strikingly, as a white-coated academic and scientific authority on nutrition, a ‘clinical nutritionist’, posing in laboratories, surrounded by test tubes, and talking about diagnoses and molecules. She was also quoted here saying something a fourteen-year-old doing GCSE biology could easily have identified as pure nonsense: recommending spinach, and the darker leaves on plants, because they contain more chlorophyll. According to McKeith these are ‘high in oxygen’ and will ‘really oxygenate your blood’. This same claim is repeated all over her books.
Forgive me for patronising, but before we go on you may need a little refresher on the miracle of photosynthesis. Chlorophyll is a small green molecule which is found in chloroplasts, the miniature factories in plant cells that take the energy from sunlight and use it to convert carbon dioxide and water into sugar and oxygen. Using this process, called photosynthesis, plants store the energy from sunlight in the form of sugar (high in calories, as you know), and they can then use this sugar energy to make everything else they need: like protein, and fibre, and flowers, and corn on the cob, and bark, and leaves, and amazing traps that eat flies, and cures for cancer, and tomatoes, and wispy dandelions, and conkers, and chillies, and all the other amazing things that the plant world has going on.
Meanwhile, you breathe in the oxygen that the plants give off during this process—essentially as a byproduct of their sugar manufacturing—and you also eat the plants, or you eat animals that eat the plants, or you build houses out of wood, or you make painkiller from willow bark, or any of the other amazing things
that happen with plants. You also breathe out carbon dioxide, and the plants can combine that with water to make more sugar again, using the energy from sunlight, and so the cycle continues.
Like most things in the story the natural sciences can tell about the world, it’s all so beautiful, so gracefully simple, yet so rewardingly complex, so neatly connected—not to mention true—that I can’t even begin to imagine why anyone would ever want to believe some New Age ‘alternative’ nonsense instead. I would go so far as to say that even if we are all under the control of a benevolent God, and the whole of reality turns out to be down to some flaky spiritual ‘energy’ that only alternative therapists can truly harness, that’s still neither so interesting nor so graceful as the most basic stuff I was taught at school about how plants work.
Is chlorophyll ‘high in oxygen’? No. It helps to make oxygen. In sunlight. And it’s pretty dark in your bowels: in fact, if there’s any light in there at all then something’s gone badly wrong. So any chlorophyll you eat will not create oxygen, and even if it did, even if Dr Gillian McKeith PhD stuck a searchlight right up your bum to prove her point, and your salad began photosyn-thesising, even if she insufflated your guts with carbon dioxide through a tube, to give the chloroplasts something to work with, and by some miracle you really did start to produce oxygen in there, you still wouldn’t absorb a significant amount of it through your bowel, because your bowel is adapted to absorb food, while your lungs are optimised to absorb oxygen. You do not have gills in your bowels. Neither, since we’ve mentioned them, do fish. And while we’re talking about it, you probably don’t want oxygen inside your abdomen anyway: in keyhole surgery, surgeons have to inflate your abdomen to help them see what they’re doing, but they don’t use oxygen, because there’s methane fart gas in there too, and we don’t want anyone catching fire on the inside. There is no oxygen in your bowel.