Authors: Ben Goldacre
Tags: #General, #Life Sciences, #Health & Fitness, #Errors, #Health Care Issues, #Essays, #Scientific, #Science
Many watching her TV show quite naturally assumed she was a medical doctor. And why not? There she was, examining patients, performing and interpreting blood tests, wearing a white coat, surrounded by test tubes, “Dr. McKeith,” “the diet doctor,” giving diagnoses, talking authoritatively about treatment, using complex scientific terminology with all the authority she could muster, and sticking irrigation equipment nice and invasively right up into people’s rectums.
Now, to be fair, I should mention something about the doctorate, but I should also be clear: I don’t think this is the most important part of the story. It’s the funniest and most memorable part of the story, but the real action is whether McKeith is capable of truly behaving like the nutritional science academic she claims to be.
And the scholarliness of her work is a thing to behold. She produces lengthy documents that have an air of “referenciness,” with nice little superscript numbers, that talk about trials, and studies, and research, and papers…but when you follow the numbers, and check the references, it’s shocking how often they aren’t what she claimed them to be in the main body of the text, or they refer to funny little magazines and books, such as
Delicious, Creative Living
,
Healthy Eating
, and my favorite,
Spiritual Nutrition and the Rainbow Diet
, rather than proper academic journals.
She even does this in the book
Miracle Superfood
, which, we are told, is the published form of her Ph.D. “In laboratory experiments with anemic animals, red-blood cell counts have returned to normal within four or five days when chlorophyll was given,” she says. Her reference for this experimental data is a magazine titled
Health Store News
. “In the heart,” she explains, “chlorophyll aids in the transmission of nerve impulses that control contraction,” a statement that is referenced to the second issue of a magazine titled
Earthletter
. Fair enough, if that’s what you want to read—I’m bending over to be reasonable here—but it’s clearly not a suitable source to reference that claim. This is her Ph.D., remember.
To me this is cargo cult science, as Professor Richard Feynman described it more than thirty years ago, in reference to the similarities between pseudoscientists and the religious activities on a few small Melanesian islands in the 1950s:
During the war they saw aeroplanes with lots of good materials, and they want the same thing to happen now. So they’ve arranged to make things like runways, to put fires along the sides of the runways, to make a wooden hut for a man to sit in, with two wooden pieces on his head as headphones and bars of bamboo sticking out like antennas—he’s the controller—and they wait for the aeroplanes to land. They’re doing everything right. The form is perfect. It looks exactly the way it looked before. But it doesn’t work. No aeroplanes land.
Like the rituals of the cargo cult, the form of McKeith’s pseudo-academic work is superficially correct: the superscript numbers are there, the technical words are scattered about, she talks about research and trials and findings; but the substance is lacking. I actually don’t find this very funny. It makes me quite depressed to think about her, sitting up, perhaps alone, studiously and earnestly typing this stuff out.
McKeith’s Ph.D. is from Clayton College of Natural Health, a nonaccredited correspondence course college, which, unusual for an academic institution, also sells its own range of vitamin pills through its website. Her master’s degree is from the same august institution. At current Clayton prices, it’s $6,400 in fees for the Ph.D., and less for the master’s, but if you pay for both at once you get a $300 discount (and if you really want to push the boat out, Clayton has a package deal: two doctorates and a master’s for $12,100 all in).
On her CV, posted on her management website, McKeith claimed to have a Ph.D. from the rather good American College of Nutrition. When this was pointed out, her representative explained that this was merely a mistake, made by a Spanish work experience kid who posted the wrong CV. The attentive reader may have noticed that the very same claim about the American College of Nutrition was also in one of her books from several years previously.
In 2007 a regular from my website—I could barely contain my pride—took McKeith to the Advertising Standards Authority, complaining about her using the title “doctor” on the basis of a qualification gained by correspondence course from a nonaccredited American college, and won. The ASA came to the view that McKeith’s advertising breached two clauses of the Committee of Advertising Practice code: “substantiation” and “truthfulness.”
Dr. McKeith sidestepped the publication of a damning ASA draft adjudication at the last minute by accepting—“voluntarily”—not to call herself doctor in her advertising anymore. In the news coverage that followed, McKeith suggested that the adjudication was concerned only with whether she had presented herself as a medical doctor. Again, this is not true. A copy of that draft adjudication has fallen into my lap—imagine that—and it specifically says that people seeing the ads would reasonably expect her to have either a medical degree or a Ph.D. from an accredited university.
She even managed to get one of her corrections into a profile on her in my own newspaper,
The Guardian
:
Doubt has also been cast on the value of McKeith’s certified membership of the American Association of Nutritional Consultants, especially since
Guardian
journalist Ben Goldacre managed to buy the same membership online for his dead cat for $60. McKeith’s spokeswoman says of this membership: “Gillian has ‘professional membership,’ which is membership designed for practicing nutritional and dietary professionals, and is distinct from ‘associate membership,’ which is open to all individuals. To gain professional membership Gillian provided proof of her degree and three professional references.’”
Well. My dead cat Hettie is also a “certified professional member” of the American Association of Nutritional Consultants. I have the certificate hanging in my bathroom. Perhaps it didn’t even occur to the journalist that McKeith could be wrong. More likely, in the tradition of nervous journalists, I suspect that she was hurried, on deadline, and felt she had to get McKeith’s “right of reply” in, even if it cast doubts on—I’ll admit my beef here—my own hard-won investigative revelations about my dead cat. I mean, I don’t sign my dead cat up to bogus professional organizations for the good of my health, you know. It may sound disproportionate to suggest that I will continue to point out these obfuscations for as long as they are made, but I will, because to me there is a strange fascination in tracking their true extent.
If you contact the Australasian College of Health Sciences (Portland, Oregon), where McKeith has a “pending diploma in herbal medicine,” it says it can’t tell you anything about its students. If you contact Clayton College of Natural Health to ask where you can read her Ph.D. it says you can’t. What kinds of organizations are these? If I said I had a Ph.D. from Cambridge, U.S. or U.K. (I have neither, and I claim no great authority), it would take you only a day to find it in their library.
For me the most concerning aspect of the way she responds to questioning of her scientific ideas is exemplified by a story from 2000, when Dr. McKeith approached a retired professor of nutritional medicine from the University of London. Shortly after the publication of her book
Living Food for Health
, John Garrow wrote an article about some of the bizarre scientific claims Dr. McKeith was making, and his piece was published in a fairly obscure medical newsletter. He was struck by the strength with which she presented her credentials as a scientist (“I continue every day to research, test and write furiously so that you may benefit…” etc). He has since said that he assumed—like many others—that she was a proper doctor. Sorry: a medical doctor. Sorry: a qualified, conventional medical doctor who has attended an accredited medical school.
In this book McKeith promised to explain how you can “boost your energy, heal your organs and cells, detoxify your body, strengthen your kidneys, improve your digestion, strengthen your immune system, reduce cholesterol and high blood pressure, break down fat, cellulose and starch, activate the enzyme energies of your body, strengthen your spleen and liver function, increase mental and physical endurance, regulate your blood sugar, and lessen hunger cravings and lose weight.”
These are not modest goals, but her thesis was that they all were possible with a diet rich in enzymes from “live” raw food—fruits, vegetables, seeds, nuts, and especially live sprouts, which are “the food sources of digestive enzymes.” She even offered “combination living food powder for clinical purposes,” in case people didn’t want to change their diets, and explained that she used this for “clinical trials” with patients at her clinic.
Garrow was skeptical of her claims. Apart from anything else, as emeritus professor of human nutrition at the University of London, he knew that human animals have their own digestive enzymes, and any plant enzyme you eat is likely to be digested like any other protein. As any professor of nutrition, and indeed many high school biology students, could tell you.
Garrow read McKeith’s book closely, as have I. These “clinical trials” seemed to be a few anecdotes about how incredibly well her patients felt after seeing her. No controls, no placebo, no attempt to quantify or measure improvements. So Garrow made a modest proposal in a fairly obscure medical newsletter. I am quoting it in its entirety, partly because it is a rather elegantly written exposition of the scientific method by an eminent academic authority on the science of nutrition, but mainly because I want you to see how politely he stated his case:
I also am a clinical nutritionist, and I believe that many of the statements in this book are wrong. My hypothesis is that any benefits which Dr. McKeith has observed in her patients who take her living food powder have nothing to do with their enzyme content. If I am correct, then patients given powder which has been heated above 118°F for twenty minutes will do just as well as patients given the active powder. This amount of heat would destroy all enzymes, but make little change to other nutrients apart from vitamin C, so both groups of patients should receive a small supplement of vitamin C (say 60mg/day). However, if Dr. McKeith is correct, it should be easy to deduce from the boosting of energy, etc., which patients received the active powder and which the inactivated one.
Here, then, is a testable hypothesis by which nutritional science might be advanced. I hope that Dr. McKeith’s instincts, as a fellow-scientist, will impel her to accept this challenge. As a further inducement I suggest we each post, say, £1,000, with an independent stakeholder. If we carry out the test, and I am proved wrong, she will of course collect my stake, and I will publish a fulsome apology in this newsletter. If the results show that she is wrong I will donate her stake to HealthWatch [a medical campaigning group], and suggest that she should tell the 1,500 patients on her waiting list that further research has shown that the claimed benefits of her diet have not been observed under controlled conditions. We scientists have a noble tradition of formally withdrawing our publications if subsequent research shows the results are not reproducible—don’t we?
Sadly, McKeith—who, to the best of my knowledge, despite all her claims about her extensive “research,” has never published in a proper “Pubmed-listed” peer-reviewed academic journal—did not take up this offer to collaborate on a piece of research with a professor of nutrition. Instead Garrow received a call from McKeith’s lawyer husband, Howard Magaziner, accusing him of defamation and promising legal action. Garrow, an immensely affable and relaxed old academic, shrugged this off with style. He told me, “I said, ‘Sue me.’ I’m still waiting.” His offer of one thousand pounds still stands.
But there is one vital issue we have not yet covered. Because despite the way McKeith seems to respond to criticism or questioning of her ideas, the unusually complicated story of her qualifications, despite her theatrical abusiveness, and the public humiliation pantomime of her shows, in which the emotionally vulnerable and obese cry on television, despite her apparently misunderstanding some of the most basic aspects of high school biology, despite doling out “scientific” advice in a white coat, despite the dubious quality of the work she presents as somehow being of “academic” standard, despite the unpleasantness of the food she endorses, there are still many who will claim: “You can say what you like about McKeith, but she has improved the people’s diet.”
On this, let me be very clear, for I will say it once again: anyone who tells you to eat more fresh fruits and vegetables is all right by me. If that were the end of it, I’d be nutritionists’ biggest fan, because I’m all in favor of “evidence-based interventions to improve the nation’s health,” as they used to say to us in medical school.
Let’s look at the evidence. Diet has been studied very extensively, and there are some things that we know with a fair degree of certainty: there is reasonably convincing evidence that having a diet rich in fresh fruit and vegetables, with natural sources of dietary fiber, avoiding obesity, moderating one’s intake of alcohol, cutting out cigarettes, and taking physical exercise are protective against such things as cancer and heart disease.
Nutritionists don’t stop there, because they can’t; they have to manufacture complication, to justify the existence of their profession. These new nutritionists have a major commercial problem with the evidence. There’s nothing very professional or proprietary about “Eat your greens,” so they have had to push things further. But unfortunately for them, the technical, confusing, overcomplicated, tinkering interventions that they promote—the enzymes, the exotic berries—are very frequently not supported by convincing evidence.