Bad Science (14 page)

That’s not for lack of looking. This is not a case of the medical hegemony’s neglecting to address the holistic needs of the people. In many cases the research has been done and has shown that the more specific claims of nutritionists are actually wrong. The fairy tale of antioxidants is a perfect example. Sensible dietary practices, which we all know about, still stand. But the unjustified, unnecessary overcomplication of this basic dietary advice is, to my mind, one of the greatest crimes of the nutritionist movement. As I have said, I don’t think it’s excessive to talk about consumers paralyzed with confusion in supermarkets.

But what can you do? There’s the rub. The most important take-home message with diet and health is that anyone who ever expresses anything with certainty is basically wrong, because the evidence for cause and effect in this area is almost always weak and circumstantial, and changing an individual person’s diet may not even be where the action is.

What is the best evidence on the benefits of changing an individual person’s diet? There have been randomized controlled trials, for example, in which you take a large group of people, change their diets, and compare their health outcomes with another group, but these have generally shown very disappointing results.

The Multiple Risk Factor Intervention Trial was one of the largest medical research projects ever undertaken in the history of mankind, involving over 12,866 men at risk of cardiovascular events, who went through the trial over seven years. These people were subjected to a phenomenal palaver: questionnaires, twenty-four-hour dietary recall interviews, three-day food records, regular visits, and more. On top of this, there were hugely energetic interventions that were supposed to change the lives of individuals, but which by necessity required that whole families’ eating patterns were transformed: so there were weekly group information sessions for participants—and their wives—individual work, counseling, an intensive education program, and more. The results, to everyone’s disappointment, showed no benefit over the control group (who were not told to change their diet). The Women’s Health Initiative was another huge randomized controlled trial into dietary change, and it gave similarly gave negative results. They all tend to.

Why should this be? The reasons are fascinating, and a window into the complexities of changing health behavior. I can discuss only a few here, but if you are genuinely interested in preventive medicine—and you can cope with uncertainty and the absence of quick-fix gimmicks—then may I recommend you pursue a career in it, because you won’t get on television, but you will be both dealing in sense and doing good.

The most important thing to notice is that these trials require people to turn their entire lives upside down and for about a decade. That’s a big ask; it’s hard enough to get people signed up for participating in a seven-week trial, let alone one that lasts seven years, and this has two interesting effects. First, your participants probably won’t change their diets as much as you want them to, but far from being a failing, this is actually an excellent illustration of what happens in the real world: individual people do not, in reality, change their diets at the drop of a hat, alone, as individuals, for the long term. A dietary change probably requires a change in lifestyle, shopping habits, maybe even what’s in the shops, how you use your time; it might even require that you buy some cooking equipment, change how your family relates to one another, change your work style, and so on.

Second, the people in your “control group” will change their diets too; remember, they’ve agreed voluntarily to take part in a hugely intrusive seven-year-long project that could require massive lifestyle changes, so they may have a greater interest in health than the rest of your population. More than that, they’re also being weighed, measured, and quizzed about their diet, all at regular intervals. Diet and health are suddenly much more at the forefront of their minds. They will change too.

This is not to rubbish the role of diet in health—I bend over backward to find some good in these studies—but it does reflect one of the most important issues, which is that you might not start with goji berries, or vitamin pills, or magic enzyme powders, and in fact, you might not even start with an individual’s changing his or her diet. Piecemeal individual life changes, which go against the grain of your own life and your environment, are hard to make and even harder to maintain. It’s important to see the individual—and the dramatic claims of all lifestyle nutritionists, for that matter—in a wider social context.

Reasonable benefits have been shown in intervention studies—like the North Karelia Project in Finland—in which the public health gang have moved themselves in lock, stock, and barrel to set about changing everything about an entire community’s behavior, liaising with businesses to change the food in shops, modifying whole lifestyles, employing community educators and advocates, improving health care provision, and more, producing some benefits, if you accept that the methodology used justifies a causal inference. (It’s tricky to engineer a control group for this kind of study, so you have to make pragmatic decisions about study design, but read it online and decide for yourself: I’d call it a large and promising case study.)

There are fairly good grounds to believe that many of these lifestyle issues are in fact better addressed at the societal level. One of the most significant “lifestyle” causes of death and disease, after all, is social class. To take a concrete example, in the Bronx of New York City, a poor multiracial borough where the average salary is around $35,000, 25 percent of the population is obese and 27 percent have serious health problems. Just across the East River in Manhattan, where the billionaire Michael Bloomberg lives, surrounded by other wealthy and middle-class people, just 15 percent are obese and 20 percent have serious health problems.

The reason for this phenomenal disparity in health is not that the people in Manhattan are careful to eat goji berries and a handful of Brazil nuts every day, thus ensuring they’re not deficient in selenium, as per nutritionists’ advice. That’s a fantasy and in some respects one of the most destructive features of the whole nutritionist project; it’s a distraction from the real causes of ill health, but also—do stop me if I’m pushing this too far—in some respects, a manifesto of right-wing individualism. You are what you eat, and people die young because they deserve it.
They
choose death, through ignorance and laziness, but
you
choose life, fresh fish, olive oil, and that’s why you’re healthy. You’re going to see eighty. You deserve it. Not like
them
.

Back in the real world, genuine public health interventions to address the social and lifestyle causes of disease are far less lucrative, and far less of a spectacle, than anything a vitamin pill peddler, or a nutritionist, would care to engage with. Who puts the issue of social inequality driving health inequality onto our screens? Where’s the human interest in prohibiting the promotion of bad foods, facilitating access to healthier foods by means of taxation or maintaining a clear labeling system?

Where is the spectacle in “enabling environments” that naturally promote exercise, or urban planning that prioritizes cyclists, pedestrians, and public transport over the car? Or in reducing the ever-increasing inequality between senior executive and shop floor pay? When did you ever hear about elegant ideas like walking school buses, or were stories about their benefits crowded out by the latest urgent front-page food fad news?

I don’t expect nutritionist, or pill peddlers, or anyone in the media to address a single one of these issues, and if you’re honest, neither do you.

This chapter did not appear in the original British edition of this book, because for fifteen months leading up to September 2008 the vitamin pill entrepreneur Matthias Rath was suing me personally, and
The Guardian
, for libel. This strategy brought only mixed success. For all that nutritionists may fantasize in public that any critic is somehow a pawn of big pharma, in private they would do well to remember that like many my age who work in the public sector, I don’t own an apartment.
The Guardian
generously paid for the lawyers, and in September 2008 Rath dropped his case, which had cost in excess of $770,000 to defend. He eventually paid $365,000, leaving
The Guardian
with a large shortfall. Nobody will ever repay me for the endless meetings, the time off work, or the days spent poring over tables filled with endlessly cross-referenced court documents.

On this last point there is, however, one small consolation, and I will spell it out as a cautionary tale: I now know more about Matthias Rath than almost any other person alive. My notes, references, and witness statements, boxed up in the room where I am sitting right now, make a pile as tall as the man himself, and what I will write here is only a tiny fraction of the fuller story that is waiting to be told about him. This chapter, I should also mention, is available free online for anyone who wishes to see it.

Matthias Rath takes us rudely outside the contained, almost academic distance of this book. For the most part we’ve been interested in the intellectual and cultural consequences of bad science, the made-up facts in national newspapers, dubious academic practices in universities, some foolish pill peddling, and so on. But what happens if we take these sleights of hand, these pill-marketing techniques, and transplant them out of our decadent Western context into a situation where things really matter?

In an ideal world this would be only a thought experiment.

AIDS is the opposite of anecdote. Already 25 million people have died from it, 3 million in the last year alone, and 500,000 of those deaths were children. In South Africa it kills 300,000 people every year: that’s 800 people every day, or 1 every two minutes. This one country has 6.3 million people who are HIV positive, including 30 percent of all pregnant women. There are 1.2 million AIDS orphans under the age of seventeen. Most chillingly of all, this disaster has appeared suddenly, and while we were watching: in 1990, just 1 percent of adults in South Africa were HIV positive. Just ten years later, the figure had risen to 25 percent.

It’s hard to mount an emotional response to raw numbers, but on one thing I think we would agree: if you were to walk into a situation with that much death, misery, and disease, you would be very careful to make sure that you knew what you were talking about. For the reasons you are about to read, I suspect that Matthias Rath missed the mark.

This man, we should be clear, is our responsibility. Born and raised in Germany, Rath was the head of cardiovascular research at the Linus Pauling Institute in Menlo Park, California, and even then he had a tendency toward grand gestures, publishing a paper in
The Journal of Orthomolecular Medicine
in 1992 titled “A Unified Theory of Human Cardiovascular Disease Leading the Way to the Abolition of This Disease as a Cause for Human Mortality.” The unified theory was high-dose vitamins.

He first developed a power base from sales in Europe, selling his pills with tactics that will be very familiar to you from the rest of this book, albeit slightly more aggressive. In the U.K., his ads claimed that “90 percent of patients receiving chemotherapy for cancer die within months of starting treatment” and suggested that three million lives could be saved if cancer patients stopped being treated by conventional medicine. The pharmaceutical industry was deliberately letting people die for financial gain, he explained. Cancer treatments were “poisonous compounds” with “not even one effective treatment.”

The decision to embark on treatment for cancer can be the most difficult that an individual or a family will ever take, representing a close balance between well-documented benefits and equally well-documented side effects. Ads like these might play especially strongly on your conscience if your mother had just lost all her hair to chemotherapy, for example, in the hope of staying alive just long enough to see your son speak.

There was some limited regulatory response in Europe, but it was generally as weak as that faced by the other characters in this book. The Advertising Standards Authority criticized one of his ads in the U.K., but that is essentially all it is able to do. Rath was ordered by a Berlin court to stop claiming that his vitamins could cure cancer or face a $335,000 fine.

But sales were strong, and Matthias Rath still has many supporters in Europe, as you will shortly see. He walked into South Africa with all the acclaim, self-confidence, and wealth he had amassed as a successful vitamin pill entrepreneur in Europe and America, and began to take out full-page ads in newspapers.

“The answer to the AIDS epidemic is here,” he proclaimed. Antiretroviral drugs were poisonous and a conspiracy to kill patients and make money. stop aids genocide by the drugs cartel, said one headline. “Why should South Africans continue to be poisoned with AZT? There is a natural answer to AIDS.” The answer came in the form of vitamin pills. “Multivitamin treatment is more effective than any toxic AIDS drug.” “Multivitamins cut the risk of developing AIDS in half.”

Rath’s company ran clinics reflecting these ideas, and in 2005 he decided to run a trial of his vitamins in a township near Cape Town called Khayelitsha, giving his own formulation, VitaCell, to people with advanced AIDS. In 2008 this trial was declared illegal by the Cape High Court of South Africa. Although Rath says that none of his participants had been on antiretroviral drugs, some relatives have given statements saying that they had been and were actively told to stop using them.

Tragically, Matthias Rath had taken these ideas to exactly the right place. Thabo Mbeki, the president of South Africa at the time, was well known as an AIDS dissident, and to international horror, while people died at the rate of one every two minutes in his country, he gave credence and support to the claims of a small band of campaigners who variously claim that AIDS does not exist, that it is not caused by HIV, that antiretroviral medication does more harm than good, and so on.

At various times during the peak of the AIDS epidemic in South Africa its government argued that HIV is not the cause of AIDS and that antiretroviral drugs are not useful for patients. It refused to roll out proper treatment programs, it refused to accept free donations of drugs, and it refused to accept grant money from the Global Fund to buy drugs.

One study estimates that if the South African national government had used antiretroviral drugs for prevention and treatment at the same rate as the Western Cape Province (which defied national policy on the issue), around 171,000 new HIV infections and 343,000 deaths could have been prevented between 1999 and 2007. Another study estimates that between 2000 and 2005 there were 330,000 unnecessary deaths, 2.2 million person-years lost, and 35,000 babies unnecessarily born with HIV because of the failure to implement a cheap and simple mother-to-child transmission prevention program. Between one and three doses of an ARV drug can reduce transmission dramatically. The cost is negligible. It was not available.

Interestingly, Matthias Rath’s colleague and employee, a South African barrister named Anthony Brink, takes the credit for introducing Thabo Mbeki to many of these ideas. Brink stumbled on the AIDS dissident material in the mid-1990s and, after much surfing and reading, became convinced that it must be right. In 1999 he wrote an article about AZT in a Johannesburg newspaper titled “A Medicine from Hell.” This led to a public exchange with a leading virologist. Brink contacted Mbeki, sending him copies of the debate, and was welcomed as an expert. This is a chilling testament to the danger of elevating cranks by engaging with them.

In his initial letter of motivation for employment to Matthias Rath, Brink described himself as “South Africa’s leading AIDS dissident, best known for my whistle-blowing exposé of the toxicity and inefficacy of AIDS drugs, and for my political activism in this regard, which caused President Mbeki and Health Minister Dr. Tshabalala-Msimang to repudiate the drugs in 1999.”

In 2000, the now-infamous International AIDS Conference took place in Durban. Mbeki’s presidential advisory panel beforehand was packed with AIDS dissidents, including Peter Duesberg and David Rasnick. On the first day, Rasnick suggested that all HIV testing should be banned on principle and that South Africa should stop screening supplies of blood for HIV. “If I had the power to outlaw the HIV antibody test,” he said, “I would do it across the board.” When African physicians gave testimony about the drastic change AIDS had caused in their clinics and hospitals, Rasnick said he had not seen “any evidence” of an AIDS catastrophe. The media were not allowed in, but one reporter from
The Village Voice
was present. Peter Duesberg, he said, “gave a presentation so removed from African medical reality that it left several local doctors shaking their heads.” It wasn’t AIDS that was killing babies and children, said the dissidents; it was the antiretroviral medication.

President Mbeki sent a letter to world leaders comparing the struggle of the “AIDS dissidents” with the struggle against apartheid.
The Washington Post
described the reaction at the White House: “So stunned were some officials by the letter’s tone and timing—during final preparations for July’s conference in Durban—that at least two of them, according to diplomatic sources, felt obliged to check whether it was genuine.” Hundreds of delegates walked out of Mbeki’s address to the conference in disgust, but many more described themselves as dazed and confused. More than five thousand researchers and activists around the world signed up to the Durban Declaration, a document that specifically addressed and repudiated the claims and concerns—at least the more moderate ones—of the AIDS dissidents. Specifically, it addressed the charge that people were simply dying of poverty:

It did them no good. Until 2003 the South African government refused, as a matter of principle, to roll out proper antiretroviral medication programs, and even then the process was halfhearted. This madness was overturned only after a massive campaign by grassroots organizations such as the Treatment Action Campaign, but even after the ANC cabinet voted to allow medication to be given, there was still resistance. In mid-2005, at least 85 percent of HIV positive people who needed antiretroviral drugs were still refused them. That’s around a million people.

This resistance, of course, went deeper than just one man; much of it came from Mbeki’s health minister, Manto Tshabalala-Msimang. An ardent critic of medical drugs for HIV, she would cheerfully go on television to talk up their dangers, talk down their benefits, and became irritable and evasive when asked how many patients were receiving effective treatment. She declared in 2005 that she would not be “pressured” into meeting the target of three million patients on antiretroviral medication, that people had ignored the importance of nutrition, and that she would continue to warn patients of the side effects of antiretrovirals, saying: “We have been vindicated in this regard. We are what we eat.”

It’s an eerily familiar catchphrase. Tshabalala-Msimang also went on record to praise the work of Matthias Rath and refused to investigate his activities. Most joyfully of all, she was a staunch advocate of the kind of weekend glossy magazine–style nutritionism that will by now be very familiar to you.

The remedies she advocated for AIDS are beetroot, garlic, lemons, and African potatoes. A fairly typical quote, from the health minister in a country where eight hundred people die every day from AIDS, was this: “Raw garlic and a skin of the lemon—not only do they give you a beautiful face and skin but they also protect you from disease.” South Africa’s stand at the 2006 World AIDS Conference in Toronto was described by delegates as the “salad stall.” It consisted of some garlic, some beetroot, African potato, and assorted other vegetables. Some boxes of antiretroviral drugs were added later, but they were reportedly borrowed at the last minute from other conference delegates.

Alternative therapists like to suggest that their treatments and ideas have not been sufficiently researched. As you now know, this is often untrue, and in the case of the health minister’s favored vegetables, research had indeed been done, with results that were far from promising. Interviewed on SABC about this, Tshabalala-Msimang gave the kind of responses you’d expect to hear at any North London dinner party discussion of alternative therapies.

First she was asked about work from the University of Stellenbosch that suggested that her chosen plant, African potato, might be actively dangerous for people on AIDS drugs. One study on African potato in HIV had to be terminated prematurely, because the patients who received the plant extract developed severe bone marrow suppression and a drop in their CD4 cell count—which is a bad thing—after eight weeks. On top of this, when extract from the same vegetable was given to cats with feline immunodeficiency virus, they succumbed to full-blown feline AIDS faster than their nontreated controls. African potato does not look like a good bet.