Fraud In Published Scientific Papers Rises Dramatically

Supports Chapter One: Trick to Treat

In the first chapter of Trick and Treat, I outlined the vast amount of fraud, ghost-writing, and spin that was to be found in medical journals' articles. 

I wrote that in 2008. As this article from Medical News Today, Weekly Newsletter - 3 October 2012, points out, little has changed. In fact the problem might well be getting worse.

Article Date: 02 Oct 2012 - 12:00 PDT

Fraud, suspected fraud, plagiarism and duplicate publications are the main reasons why scientific papers are retracted today, researchers from the Albert Einstein College of Medicine reported in PNAS (Proceedings of the National Academy of Sciences) today.

Misconduct occurs at ten times the rate it used to in 1975 among scientific papers - scientific papers refers to articles that are published in academic journals. Two thirds of all retractions today are due to misconduct.

Senior author Arturo Casadevall, M.D., Ph.D., the Leo and Julia Forchheimer Chair and professor of microbiology & immunology and professor of medicine at Einstein, and also editor-in-chief of mBio said:

"Biomedical research has become a winner-take-all game-one with perverse incentives that entice scientists to cut corners and, in some instances, falsify data or commit other acts of misconduct."

A survey carried out by the BMJ (British Medical Journal) in January 2012 revealed that 13% of doctors and scientists had seen colleagues deliberately fabricate or change data during their research to make sure that it was published.

The authors examined 2,047 articles that had been retracted from biomedical literature up to the end of May 2012. They had set out to find out why retractions occur. They consulted several secondary sources, including the NIH (National Institutes of Health, the Office of Research Integrity, as well as Retractionwatch.com.

The authors found that:
21% of retractions were due to mistakes (error)

67% of retractions were due to misconduct, which was broken down as:
   - fraud or suspected fraud 43%
   - duplicate publication 14%
   - plagiarism 10%
   - unknown or "miscellaneous" reasons 12%

The problem with very skillful fraud, Dr. Casadevall said, is that it is hard to discover. There are probably several fraudulent papers still published and not retracted because misconduct has not yet been detected.

The authors explained that previous studies that underestimated the extent of scientific misconduct had relied completely on notices of retraction issued by the journal, which are written by the authors of the papers themselves.

Dr. Casadevall said:

"Many of those notices are wrong. Authors commonly write, 'We regret we have to retract our paper because the work is not reproducible,' which is not exactly a lie. The work indeed was not reproducible - because it was fraudulent. Researchers try to protect their labs and their reputations, and these retractions are written in such a way that you often don't know what really happened."

The report showed that higher-impact factor journals seem to have especially high retraction rates. Dr. Casadevall said that today scientists are disproportionately rewarded for publishing lots of papers, which should ideally appear in prestigious journals - most likely this kind of pressure has contributed to the growing number of retractions.

Dr. Casadevall said:

"Particularly if you get your papers accepted in certain journals, you're much more likely to get recognition, grants, prizes and better jobs or promotions. Scientists are human, and some of them will succumb to this pressure, especially when there's so much competition for funding. Perhaps our most telling finding is what happened after 2005, which is when the number of retractions began to skyrocket. That's exactly when NIH funding began to get very tight."

Dr. Casadevall had put forward a number of solutions to address the problem of scientific misconduct in the journal Infection and Immunity, which included:

• There should be more emphasis on the quality of publications rather than how many are published
• When rating journals, there should not be so much emphasis on impact measures
• The research community should aim for more cooperation and collaboration
• More sustainable, stable and reliable resources for research funding should be developed
• Career pathways should offer scientists more flexibility to make sure talented professionals are not loss due to poor funding

Retractions come from very few laboratories

The authors stressed that not all is gloom and doom. Dr. Casadevall explained that 38 laboratories accounted for 43% of all retractions last year. There are thousands and thousands of labs whose scientists publish articles in academic journals.

Dr. Casadevall said:

"So while we're not looking at a systemic disease, so to speak, in the scientific community, our findings do indicate a significant problem that needs to be addressed."

Study Finds that Carbs Prevent Energy Use

Supports Chapter 19: 'Healthy eating' is fattening

A few days ago, England’s Euro 2012 football team lost a quarter-final match to Italy on penalties. This scenario has happened so regularly that one might call it the ‘England finish’.

It has also happened so regularly that it hasn’t been difficult to see a pattern emerging for some years: England just run out of energy; they aren’t able to sustain 90 minutes of football.

The question is: Why? And the answer, which I have been convinced of for some years, was their rubbish carb-based diet. I am no lover of football, so have never watched a game, but commentaries on news bulletins spell out the form. To précis it, the England team always seem to start the game full of bounce, have most of the possession and often take the lead, then I all goes wrong. At half time they fill up on Jaffa cakes - and are so rubbish during the second half that they lose. But this, is exactly what I would expect. Carbs not only result in reactive hypoglycaemia (you run out of blood glucose), they also raise serotonin, a hormone that makes you sleepy and slows you down. This is why people are advised to have a carb meal before going to bed. But both of these conditions are the last thing you should eat if you have to work – or play football.

Now a study just published in the Journal of the American Medical Association finds another good reason why the carbs, so favoured by the England team’s nutritionists, are so devastating to their game: Carbs, it now appears, as well as everything else that is wrong with them, actively slow down the rate at which your body can use its energy.

Here is the abstract of the study – and an explanation as it is a bit convoluted:

Ebbeling CB, et al. Effects of Dietary Composition on Energy Expenditure During Weight-Loss Maintenance. JAMA 2012;307(24):2627-2634

ABSTRACT

Context Reduced energy expenditure following weight loss is thought to contribute to weight gain. However, the effect of dietary composition on energy expenditure during weight-loss maintenance has not been studied.

Objective To examine the effects of 3 diets differing widely in macronutrient composition and glycemic load on energy expenditure following weight loss.

Design, Setting, and Participants A controlled 3-way crossover design involving 21 overweight and obese young adults conducted at Children’s Hospital Boston and Brigham and Women’s Hospital, Boston, Massachusetts, between June 16, 2006, and June 21, 2010, with recruitment by newspaper advertisements and postings.

Intervention After achieving 10% to 15% weight loss while consuming a run-in diet, participants consumed an isocaloric low-fat diet (60% of energy from carbohydrate, 20% from fat, 20% from protein; high glycemic load), low–glycemic index diet (40% from carbohydrate, 40% from fat, and 20% from protein; moderate glycemic load), and very low-carbohydrate diet (10% from carbohydrate, 60% from fat, and 30% from protein; low glycemic load) in random order, each for 4 weeks.

Main Outcome Measures Primary outcome was resting energy expenditure (REE), with secondary outcomes of total energy expenditure (TEE), hormone levels, and metabolic syndrome components.

Results Compared with the pre–weight-loss baseline, the decrease in REE was greatest with the low-fat diet (mean [95% CI], –205 [–265 to –144] kcal/d), intermediate with the low–glycemic index diet (–166 [–227 to –106] kcal/d), and least with the very low-carbohydrate diet (−138 [–198 to –77] kcal/d; overall P=.03; P for trend by glycemic load=.009). The decrease in TEE showed a similar pattern (mean [95% CI], −423 [–606 to –239] kcal/d; −297 [–479 to –115] kcal/d; and −97 [–281 to 86] kcal/d, respectively; overall P=.003; P for trend by glycemic load<.001). Hormone levels and metabolic syndrome components also varied during weight maintenance by diet (leptin, P<.001; 24-hour urinary cortisol, P=.005; indexes of peripheral [P=.02] and hepatic [P=.03] insulin sensitivity; high-density lipoprotein [HDL] cholesterol, P<.001; non-HDL cholesterol, P<.001; triglycerides, P<.001; plasminogen activator inhibitor 1, P for trend=.04; and C-reactive protein, P for trend=.05), but no consistent favourable pattern emerged.

Conclusion Among overweight and obese young adults compared with pre–weightloss energy expenditure, isocaloric feeding following 10% to 15% weight loss resulted in decreases in REE and TEE that were greatest with the low-fat diet, intermediate with the low–glycemic index diet, and least with the very low-carbohydrate diet.

What it means

This is a study looking at weight loss, but in a different way from normal. Usually, scientists look at the amount of weight lost and/or for how long. This one is different; here they are considering how the different macronutrients affect energy usage. To make it confusing, the authors don't talk about energy usage, they talk in terms of 'decrease' in amount of energy used.

The study looks at two aspects of energy usage. A person has to use a certain amount of energy just to keep their body alive: These are things like the heart beating, brain working, keeping the body warm, etc, which they call “resting energy expenditure” (REE). This is relatively constant at approximately 1,500 kcals for an average-sized person. On top of that is the amount of energy we use when we do work or exercise. The total of the two is the total energy expenditure (TEE).

Here we have three different diets with same amount of calories, but with different ratios of carbs, proteins and fats. In this respect it is similar to the Dunlop & Lyon study of 1932 and Kekwick & Pawan’s 1956 study, both of which found that the lowest carb diet was the best for weight loss. With a similar finding, this latest study tells us why. When they ate the 60% carb diet, the participants used the least energy. It even cut the amount of energy used to maintain the body (REE). The diet on which they used the most energy (both REE and TEE) was the diet which had the least carbs and most fats.

Diet and exercise

So, if you are counting calories and exercising to lose weight, as the ‘experts’ say you should, then, obviously, when you exercise, you want to use as much energy as possible. There isn’t much point in jogging lots of boring miles if you are not going to use up energy – and thus weight - right? But this study shows that if you eat the diet these incompetent ‘experts’ advise you to eat, you won’t lose as much as you would if your diet was high-fat, low-carb!

And if you are an England footballer, you really don’t want to have to eat a diet that destroys your ability to use all your energy. Or a nutritionist/dietician who insists on it!

Now, Statins May Increase Heart Attack Risk!

Supports Chapter 2: What's Behind The Screens?

It is widely believed that atherosclerosis, the 'furring up' of the arteries, narrows the coronary arteries and makes a heart attack more likely in two ways: Firstly, a clot in a partially blocked artery is more likely to block it completely, cutting off the blood supply downstream; and secondly, the atherosclerosis itself may block the artery with a similar result.

Many laymen have been led to believe that cholesterol is to blame for the blockage, or 'plaque', but this is hotly disputed. Much more likely, it seems, is that calcification of the artery wall, which hardens the artery wall making it less pliable, is the cause.

Statin Use Tied to Faster Plaque Buildup

A small observational American study of war veterans with diabetes and advanced coronary heart disease has found that those who regularly took statins had accelerated progression of calcification. This current analysis included 197 participants with type 2 diabetes from the Risk Factors, Atherosclerosis, and Clinical Events in Diabetes (RACED) study, a substudy of the Veterans Affairs Diabetes Trial (VADT) study.

Study participants who were frequent statin users were found to have significantly more coronary plaque advancement than those who were less frequent users (P<0.001), according to Aramesh Saremi, MD, and colleagues from the Phoenix VA Health Care System in Arizona.

The results remained the same even after adjusting for age, duration of diabetes, hypertension, cardiovascular events, baseline coronary artery calcium, race and ethnicity, blood pressure, total cholesterol/high density lipoprotein cholesterol (HDL-C), and body mass index, Saremi's team reported here at the annual meeting of the American Diabetes Association.

But Cam Patterson, MD, from the Center for Heart and Vascular Care at the University of North Carolina at Chapel Hill, and who was not involved in this study, warned that it would be a 'horrible mistake to infer that strict compliance with statin use is somehow causally associated with progression of atherosclerosis. Adding that he thought that such a conclusion is definitively a false one.

'The patients who were more compliant with statin therapy had much higher calcium scores at baseline, so these are obviously patients who had a substantially greater propensity for atherosclerosis to begin with,' Patterson said. He suggested that patients who already have vascular disease are more likely to be compliant with their statins.

Saremi does not disagree with Patterson; the progression of calcification may be linked to the healing of soft plaque initiated by statin therapy.

'It's important now to determine whether this progression of calcification leads to cardiovascular events.

She also suggested that if diabetics are put on statins earlier in the course of their disease, when their calcium scores are low, there may not be such a rapid advancement of calcification. But this is unsupported supposition.



In this substudy, 36 patients reported less frequent statin use, while 161 reported more frequent use. The mean age of patients was 61 and the average follow-up was 4.6 years.
In the unadjusted model, researchers found that every 10% increase in statin use was associated with a 0.41 mm³ increase in coronary calcium progression (P<0.01), which did not change much in the adjusted model: 0.33 mm³ increase (P=0.04).

When researchers excluded those with prior or new cardiovascular events, the risk for calcium progression remained the same.

Saremi and colleagues speculated that statins may enhance the density of calcification as part of the healing process, potentially contributing to plaque stabilization and decreased cardiovascular disease events . But this is more unsupported speculation (they don't like to give up on statins, even though statins have also been shown to increase diabetes risk). However, they did also suggest that the advancement of plaque in type 2 diabetics who frequently took statins may lessen the medication's overall benefit.

Reference:

Saremi A, et al. Progression of vascular calcification is increased with statin use in the Veterans Affairs Diabetes Trial (VADT)" ADA 2012; Abstract 426-P.

Doctors to go on strike. I hope it is a long one!

Doctors strike -- and death rates fall

Doctors don't often go on strike, but it has happened sufficiently often for a disturbing trend to be noticed. During the rare times that they have gone on strike -- in several countries -- the death rate has always gone down.

In 2000, Israeli doctors employed in public hospitals pursued a course of industrial action. This included the cancellation of outpatient clinics and the postponement of all routine surgery. And this limited strike action had some unusual consequences. Throughout Israel, while the doctors were on strike, death rates fell. The coastal city of Netanya has only one hospital whose staff members had a 'no strike' clause in their contracts. As a result, doctors in Netanya continued to work normally -- and death rates remained stubbornly the same, failing to reflect the reduction that was shown in almost all of the rest of the country.[1]

And it wasn't the first time; doctors in Israel went on strike in 1973, and reduced their total daily patient contacts from 65,000 to just 7,000. The strike lasted a month and during that time the death rate, according to the Jerusalem Burial Society, dropped by half.

It doesn't just happen in Israel. The 1960s saw physicians in Canada go on strike and the mortality rate dropped. In 1976, in Bogota, Colombia, doctors refused to treat all but emergency cases for a period of 52 days, and in that time the death rate fell by 35%.[2]

In the same year the death rate dropped 18% during a 'slow-down' by doctors in Los Angeles. After the strike, deaths rates jumped to 3% above normal for more than five weeks as the Los Angeles doctors caught up on their paperwork.[3]

And it is a standing joke among cardiologists that death rates fall during their conferences because fewer of them are attempting to cure moribund patients by doing dangerous surgery.

So, it's a fair assumption that the longer doctors strike, the safer we are likely to be.

References
1.    Siegel-Itzkovich J. Doctors' strike in Israel may be good for health. BMJ 2000; 320:1561.
2.    Horne, Ross. Health & Survival In The 21st Century. HarperCollins Publishers Pty Limited, Australia, 1997. Chapter 11.
3.    Science News, 28 Oct 1978; 114: 293.

See Chapter one of Trick & Treat: How 'healthy eating' is making us ill

Heart failure and vitamin D. But what about sunlight?

Supports Chapter Eleven: Our irrational fear of sunlight

Vitamin D, just like all other vitamins, is essential not just to our health, but to life itself. Vitamin D is actually not really a vitamin, because our bodies can synthsize it from cholesterol in our skin with the action of the ultra-violet end of the spectrum of sunlight. But as the specific wavelength - UVB - is attenuated by the atmosphere, there is no point in sunbathing when the sun is low in the sky. We have to be in the sun, with as little clothing on as possible, and no sunscreen, when the sun is so high in the sky that our shadow is no longer than we are. In other words, in the middle of the day. But that is exactly what we are told by the 'experts' not to do!

There is very little food which contains vitamin D. And vitamin D is one of the four fat-soluble vitamins (the others are A, E, and K). But fat is 'bad for us', isn't it! So the incompetent 'experts' also advise us to shun the only foods which can help.

It should come as no surprise, therefore, that severe vitamin D deficiency is a widespread health problem throughout the industrialised world.

Now a study just published in the European Journal of Heart Failure points out a growing serious health issue caused by this misguided advice. The Abstract of that study is below:

---

Israel Gotsman, Ayelet Shauer, Donna R. Zwas, et al. Vitamin D deficiency is a predictor of reduced survival in patients with heart failure; vitamin D supplementation improves outcome. Eur J Heart Fail (2012) 14 (4):357-366.doi: 10.1093/eurjhf/hfr175

Abstract

Aims Vitamin D deficiency is a highly prevalent, global phenomenon. The prevalence in heart failure (HF) patients and its effect on outcome are less clear. We evaluated vitamin D levels and vitamin D supplementation in patients with HF and its effect on mortality.

Methods and results 25-Hydroxyvitamin D [25(OH)D] levels were evaluated in HF patients from a health maintenance organization (HMO), and compared them with those of the rest of the members of the HMO. Patients with HF (n = 3009) had a lower median 25(OH)D level compared with the control group (n = 46 825): 36.9 nmol/L (interquartile range 23.2–55.9) vs. 40.7 nmol/L (26.7–56.9), respectively, P < 0.00001. The percentage of patients with vitamin D deficiency [25(OH)D <25 nmol/L] was higher in patients with HF compared with the control group (28% vs. 22%, P < 0.00001). Only 8.8% of the HF patients had optimal 25(OH)D levels (≥75 nmol/L). Median clinical follow-up was 518 days. Cox regression analysis demonstrated that vitamin D deficiency was an independent predictor of increased mortality in patients with HF [hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.21–1.92, P < 0.001] and in the control group (HR 1.91, 95% CI 1.48–2.46, P < 0.00001). Vitamin D supplementation was independently associated with reduced mortality in HF patients (HR 0.68, 95% CI 0.54–0.85, P < 0.0001). Parameters associated with vitamin D deficiency in HF patients were decreased previous solar radiation exposure, body mass index, diabetes, female gender, pulse, and decreased calcium and haemoglobin levels.

Conclusions Vitamin D deficiency is highly prevalent in HF patients and is a significant predictor of reduced survival. Vitamin D supplementation was associated with improved outcome.

---

Comment
Note the last sentence. "Vitamin D supplementation" improves survival. So they only consider treating the problem after it has been caused. What's wrong with advising people to get out in the sun more?

Incidentally, I do get out in the sun as much as possible. It doesn't need a lot: half an hour a day at midday is sufficient. I had my serum vitamin D checked a couple of weeks ago. It was 150.8nmol/L. And I aim to keep it that way.

Study finds red meat may not be edible - but only in the US

Supports
Chapter 5: Fats: from tonic to toxic
Chapter 23: Cancer: disease of civilization

Many in the UK will have heard on the news today that yet another study from Harvard University [1] has linked the eating of red and processed meat with an increased risk of heart disease and cancer.

This study is largely nonsense and quite irrelevant to us in the UK. There are lots of similar accusations about red meat, which really only apply (perhaps) to processed meat. The two are always lumped together just as saturated fats and trans fats are, even though the former is healthy and latter is harmful.

But there is more to this. Think of all the peoples in the world - Maasai, Inuit, Samburu, Marsh Arabs, Naga, and many more - who, when they lived exclusively or largely on red meat, DIDN'T get any form of cancer or heart disease.[2-8] There is also no evidence that eating red meat increases cancer and heart disease risk in UK or in mainland Europe. [9]. (See also page 102 of T&T)

The right - healthy - way

You see, all this red-meat-cancer stuff is confined entirely to the US. And it is not difficult to see why this might be so. Firstly look at the way most cattle are farmed today in the US - in concentrated animal feed operations (CAFOs), where the animals are not fed their proper diet of fibrous grasses and vetches, but starchy and omega-6 rich genetically modified soy and cereal grains. This ruins the health of the cattle so that they have to be dosed with antibiotics, it changes the fatty acid components of their body fat, and it reduces the amount of conjugated linoleic acid (CLA). And CLA is a powerful anti-cancer agent, which Americans cut off and don't eat!

The wrong - unhealthy - way

And, as we all know, the US is so fat-phobic that even healthy animal fats are trimmed off and replaced with starchy and sugary carbs - which DO increase the risk of both diseases.

None of those things applies in the UK (except the fat-phobia). Incidentally, there is no evidence I know of that the processed meats found throughout Europe - bacon, ham, sausage, salami, wurst, cabernossi, chorizo, cassoulet, etc, are harmful in any way either.

What this latest study really demonstrates (if it demonstrates anything at all) is that the red meat produced and processed in the US might be unhealthy, if consumed as part of a carb-rich diet. Which may be why the health of the US population is about the worst in the industrialised world.

References
1. Pan A, Sun Q, Bernstein AM, et al. Red Meat Consumption and Mortality. Arch Intern Med. doi:10.1001/archinternmed.2011.2287.
2. Hoffman FL. The Mortality from Cancer Throughout the World. Newark, NJ: The Prudential Press, 1915.
3. Cope, J. Cancer: Civilization and Degeneration. London: 1932.
4. Berglas A. Cancer: Nature, Cause and Cure. Paris: Institute Pasteur, 1957.
5. McCarrison R. Studies in Deficiency Disease. Cornell University Library, 1921.
6. Jenness D. The Copper Eskimos. Vol. XII, Report of the Canadian Arctic Expedition, 1913-18. Ottawa: The King’s Printer, 1923.
7. Stefansson V. Cancer: Disease Of Civilization? American Book-Stratford Press, Inc. 1960, Chapter 14.
8. Mann GV (ed). Coronary Heart Disease: The dietary sense and nonsense. London: Veritas Society, 1993.
9. Cox BD, Whichelow MJ. Frequent consumption of red meat is not a risk factor for cancer. BMJ 1997; 315: 1018.

Which is more reliable: a registered dietician or an unregistered nutritional therapist?

This is an example of why I wrote Trick and Treat

In January 2012, The Daily Mail published an article which began:

Nutrition therapists condemned as 'quacks' who put patients' health at risk
Nutrition therapists have been condemned as quacks and accused of putting the health of the sick – including those suffering from breast cancer – at risk.
An industry has grown up based on the concept that ‘food doctor’ nutritionists can cure patients’ ills and allergies through diet.
However at least some of the practitioners, who charge up to £80 for a consultation, are providing advice that could harm health, a study by the consumer watchdog Which? found.
Read more: http://www.dailymail.co.uk/health/article-2087167/Nutrition-therapists-condemned-quacks-patients-health-risk.html

The article told readers that Which? had found nutritional therapists who gave questionable advice, had charged high fees for it and were unlicensed. Well, they might have a point but there may also be another side to this story.

Which?'s questionable methods

The first point is that Which?'s research methods and basic criteria are suspect. I have been on the receiving end of a Which? story so I can write this with some authority.

Back in 2001, Which? magazine tested the 14 best-selling slimming diet books to see if the dietary advice they gave worked. My book, Eat Fat, Get Thin! was one of those they 'tested'. But Which? did not actually test them at all. Instead, they looked to see if the books recommended 'healthy eating' and, if they didn't, they were adjudged to be of no benefit, an were not recommended. But, as I knew then, and as much more recent research has confirmed, healthy eating is a cause of obesity. So, as I was more knowledgeable, I wrote Eat Fat, Get Thin! to be of value to people wanting to lose weight, not to put more weight on. And for that reason, Eat Fat, Get Thin! did not fit with their preconceived, but totally wrong criteria. The full story is at http://www.second-opinions.co.uk/which.html

Is the same thing happening here?

Okay, I give dietary advice, if asked, but I wouldn't suggest to a breast cancer sufferer that she disregard her oncologist's advice, just cut sugar out of her diet, and keep her fingers crossed. But I might well point her in the direction of published research so that she can make an informed decision.

For example, the statistics for conventional breast cancer treatment are woefully bad at best, so a no-sugar diet might well work as effectively as (or even better than), say, chemotherapy, which is about 1.5% effective in breast cancer – and has lots of quality-of-life destroying adverse side effects. (Morgan G, et al. The Contribution of Cytotoxic Chemotherapy to 5-year Survival in Adult Malignancies. Clinical Oncology 2004; 16: 549-560. doi:10.1016/j.clon.2004.06.007)

Is registration a sign of quality?

The other point that the Daily Mail's article makes is that nutritional therapists are not registered or regulated, whereas dieticians are. And as the British Dietetic Association says: ‘Anybody can set up shop as a nutrition therapist, with no qualifications. Registered dieticians working in the UK are educated to degree level and must be registered with the Health Professions Council.’

But is that a guarantee of getting good advice? In my experience it is not.

In 2001, I was the interviewer and nutritional adviser in a documentary video which was attempting to sort out the confusion caused by books like mine and Atkins and the obvious conflict with current dietary advice. We interviewed nutritionists, dieticians and doctors as well as people attempting to lose weight. The doctors were fine: they knew that they didn't know much about diet. However, we found that registered nutritionists and dieticians were, to put it bluntly, ignorant, incompetent and arrogant. They were qualified; they knew their stuff – except they didn't! You can read about one of the interviews at http://www.second-opinions.co.uk/why-eat-5-portions-1.html.

She was not alone. We interviewed two others. Neither of them knew much about foods, nutrients and the effects on the body of even basics such as carbohydrates and fats. One openly admitted, when she asked for and I showed her the questions to come – they were about ketones and the effects of exercise – that she couldn't answer any of them! In fact, by the third interview, an NF registered nutritionist, it was obvious even to our nutritionally-uneducated production crew that the interviewees were completely ignorant of even the basic facts and could do little more than waffle. After the first three, we didn't interview any others: they were obviously going to be a waste of money.

In the end we didn't use any of these interviews in the documentary. We would have loved to, but couldn't: it would have ruined their careers.

Why are people going to unregistered nutritional therapists?

Registered nutritionists and dieticians effectively cost patients nothing: they are NHS-funded. To consult a nutritional therapist, on the other hand, is expensive. As the Daily Mail article points out, they might charge £80 ($120.00US) an hour. So why are people turning away from the registered dieticians and going to the alternatives?

There can only be one answer: They are dissatisfied with the NHS. And, from talking to many of them, I know that it is the sheer incompetence, indifference and inability to look outside the box they encounter within the ranks of registered dieticians.

I used to lecture on diabetes in hospitals to NHS diabetes staff. The NHS paid for me to do so. But the doctors, I found out, did not like what I was teaching – despite the fact that everything I said was backed by solid evidence and research published in their own medical journals. They had been taught one thing (and learned nothing) and nothing I said or was published subsequently was going to alter their minds or their treatment protocols. And so, diseases such as diabetes, obesity and other conditions associated with these diseases, continue to spiral upwards exponentially, while an ignorant and arrogant – but all powerful – regulated and registered 'health industry' bemoans the facts and suggests it's all the fault of their patients.

The bottom line

As I see it, any patient has two options: The first is to read articles on the Internet and select a nutritional therapist who might or might not know what they are talking about, or go to a qualified member of the British Dietetic Association and be sure that they don't.