Saturday, March 03, 2007

Truthiness and Referenciness Make the Case for IgG Food Intolerance Tests

A young boy and his dog in a position of prayer
And please let Shinga read some decent research papers before she explodes*.

Prof. Ernst has frequently and elegantly rebutted the claim that CAM treatments and therapies are not amenable to standard forms of scientific investigation. However, hand in hand with the claims that CAM is not suited to scrutiny, it seems that there is a certain truthiness and referenciness that predominates in the claims of scientific support for some of these treatments.
Dr Ben Goldacre, used this word to suggest a supposed scholarly reference that wasn't a real one: "The scholarliness of her work is a thing to behold: she produces lengthy documents that have an air of 'referenciness' ... but when you follow the numbers, and check the references, it's shocking how often they aren't what she claimed them to be." ...Stephen Colbert's "truthiness"...describes things that a person claims to know, without regard to evidence, logic, intellectual examination, or actual facts.
Truthiness and referenciness are rife in the claims made for the role of IgG testing in the diagnosis of food intolerance. These claims are in stark contrast to the position statements of various relevant professional organisations.

Some might argue that it is putting the umption before the ass to make any claims about IgG levels and food intolerance until such time as researchers, clinical allergists and immunologists agree whether IgG levels are protective or indicative of a harmful response.

Lately there has been some YorkTest excitement about the value of IgG-guided elimination diets in the amelioration of various symptoms and chronic conditions: 10 Years of NHS treatment and still we're ill says study. They are so pleased with the results of this paper that an enthusiast who works for them may even have founded an e-petition, calling for the provision of intolerance tests on the NHS.

I must re-iterate that I readily admit that what I know about IgG testing for food intolerances could be written on a postcard, leaving plenty of room for the address and a stamp. Nonetheless, I have profound reservations about the value of the Hardman and Hart paper that is the basis for YorkTest's Testing Times report and I doubt that it is a useful contribution to the literature that assesses IgG testing for food intolerance.

Kenny Tranquille is a Nutritional Therapist. According to his profile, he
completed his extensive training at London’s Institute for Optimum Nutrition (ION) and since graduating, has established a strong following and helped hundreds of individuals to feel fantastic and regain their health. BUPA & Ernst & Young are among some [of] the leading companies that have invited Kenny to run workshops and seminars. He is frequent lecturer at the Institute for Optimum Nutrition and a student tutor.
Kenny Tranquille trumpets the report in Testing Times - The Facts.
The UK's largest ever study into Food Intolerance was published this week and makes interesting reading - it contains all the reasons why you would go down the Food Intolerance route to get yourself better...over 3 out of 4 get better...90% recommend out [sic] service to others...over 6 out of 10 feel the benefit within three weeks.
I don't know what Kenny Tranquille lectures in at the Institute for Optimum Nutrition but I trust that it is neither critical thinking nor the interpretation of research.

The Testing Times report is the basis for the Hardman and Hart paper. It is an audit of a customer satisfaction survey. It depends entirely upon self-report. It adds nothing to the literature on the alleged relationship between IgG levels and food intolerance.

The study finds that people who:
  • have a range of symptoms or conditions
  • believe that they have food problems
  • believe that they have food intolerances
  • believe that the measurement of IgG levels is an acceptable proxy for food intolerance
  • believe that a food elimination diet guided by IgG levels will mitigate their symptoms
  • were not asked to provide verification for the nature or duration of their symptoms
  • were not asked to describe the treatments that they had previously tried or were currently following
  • were not asked if they had previously experimented with elimination diets or allergen avoidance
  • paid for the 113 foodSCAN test
  • implemented some form of the dietary advice (not otherwise specified) to follow an elimination diet for a few weeks
  • responded to the survey (conducted over an unspecified period of time and with considerable confusion over which version of the questionnaire they received)
reported a subjective improvement in their assessment of their symptoms. Despite the attacks being made on the NHS, it is not clearly stated that every one of these participants had consulted a GP or other healthcare worker about these symptoms or conditions.

The study is an audit of anecdotes. I would hope that most people would be able to see that this study is a lengthy way of saying, "Because I said so" - by the respondents, and, as such, resembles truthiness rather than clinical rigour. Even the authors do not attempt to place this study within the context of the clinical literature in their discussion of their findings although I do feel that they considerably over-claim the value of their findings.

I feel like I'm trapped in the scene where Father Ted is trying to explain perspective to Dougal by using toy cows as props and pointing to cows in a far-away field:
Father Ted: Now concentrate this time, Dougal. These
[he points to some plastic cows on the table]
Father Ted: are very small; those
[pointing at some cows out of the window]
Father Ted: are far away...
Sound science...wishful thinking. Verifiable evidence...anecdote. Customer satisfaction survey...significant contribution to the scientific literature.

*I am grateful to Chrysalis Angel for permission to use this image.

Labels: , , , , , , , , , , , ,

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