Has Dr John Briffa taken leave of his senses?
The British Diabetic Association, or Diabetes UK as it is now called, is one of the longest established and most respected medical charities in the country. I routinely advise all my diabetic patients to join it.
Dr John Briffa is a qualified doctor and a purveyor of various concoctions of vitamins and minerals, some of which he has "designed" himself. A couple of days ago, we looked at BioCare SucroGuard (Blood Glucose Support).
Sucroguard® is specially formulated by John Briffa.Dr Briffa trys to flog this patent medicine to treat patients who need “blood glucose support”. I have yet to find a reputable doctor who would endorse this product. If there is one, do email me.
Dr Briffa has today moved on from flogging his pills to mounting a savage attack on Diabetes UK. Take a look at this latest post on his blog. You would do well to FURL it (I have) because I suspect that, once Diabetes UK’s lawyers see it, it will be taken down.
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It's only a few hours later, and already Dr John Briffa's blog has disappeared in its entirety. Maybe it will be back. Maybe it will not. In case it is not, this is what he said:
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Dr Briffa accuses Diabetes UK of deliberately and maliciously encouraging diabetics to eat an inappropriate diet, knowing that such a diet will make their diabetes deteriorate, thus increasing their need for medication. I use the word “maliciously” deliberately for Dr Briffa implies that Diabetes UK are doing this to increase the revenue of drug companies that make financial contributions to Diabetes UK.
I read that Douglas Smallwood, chief executive of Diabetes UK, has said it is a “tragedy” that many diabetics do not take their prescribed medication. My opinion is that the real tragedy here is the fact that Diabetes UK gives advice which makes it more likely to need that medication in the first place.Dr Crippen is more cynical than most, and NHS BLOG DOCTOR has in the past not hesitated to criticise the relationship of Big Pharma and the medical profession. But this allegation from Dr Briffa is outrageous. It is without doubt defamatory. How long before he is visited by the lawyers and the GMC? Dr Briffa is likely to be called upon to justify his claims in a more formal forum than the blogosphere. Woe betide him if he cannot.
I don’t want to come across unduly cynical, but is it right that a diabetes charity should have a less-than-transparent financial relationship with the drug industry. And is it right that this charity should be giving nutritional advice that, at the end of the day, looks likely to benefit the pharmaceutical industry. And after all of this, should it then go on to partner with that pharmaceutical industry in ‘research’ highlighting the need for people to take their diabetes medication. Or did I miss something? Dr Briffa
Until that happens, I would advise any diabetic who has been unsettled by Dr Briffa and his “nutritionist” advice to contact their GP or a properly qualified dietician who is a member of the British Dietetic Society. Take a look at the British Dietetic Association's excellent Diabetes : your food choices, and compare what they say with the advice given by Diabetes UK. They seem to be in complete agreement. Maybe the British Dietetic Association is trying to poison diabetics as well. Maybe Dr John Briffa has taken leave of his senses.
It beggars belief.
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Expect a lot more on this from the “bad science” blogoshphere. Pyjamas in Bananas is already on to it.
Labels: defamation, Dr John Briffa
43 Comments:
He can join Tim Kendall in the queue . . .
Think it has gone already ....
It is still there me for: see Down for everyone or just me? In all of its startling assertions.
You know that point when you are exercising when the perspiration runs into your eyes and stings? Reading it is like that. I recommend having mood smoothers to hand.
Unduly cynical should not be used at the semantic equivalence of 'unduly creative, a tad spittle-flecked and conspiracy-worldly as to my suspicions'.
This is not being a fearless maverick and speaking up against the orthodoxy, as you point out, this is stirring alarm among people with diabetes.
As the saying goes, it is not enough that you feel persecuted to claim the mantle of Galileo (which is unspoken but there), you should also be right.
Dr Briffa reports that:
"Diabetes UK’s advice on this matter starts like this: “At each meal include starchy carbohydrate foods such as bread, pasta, chapattis, potatoes, yam, noodles, rice and cereals.”
but omits the next bit from the Diabetes UK site:
"...All varieties are fine but try to include those that are more slowly absorbed (have a lower glycaemic index) as these won’t affect your blood glucose levels as much. Better choices include:
• Pasta
• Basmati or easy cook rice
• Grainy breads such as granary, pumpernickel and rye
• New potatoes, sweet potato and yam
• Porridge oats, All Bran and natural muesli.
The high fibre varieties of starchy foods will also help to maintain the health of your digestive system and prevent problems such as constipation."
Why the selective quoting, I wonder?
It is, I think, legitimate for patient groups to be careful of getting too close to the pharmas and the 'astroturf' phenomenon is rightly deplored. But all the major patient charities receive educational grants etc from the industry: this does not mean there are strings attached. To believe so is, I think, to cross the line into conspiracy thinking.
Your links to the BDA and Diabates UK advice are the wrong way round. Great blog, blah, blah, blah.
david
thanks and apologies; now corrected
John
t is, I think, legitimate for patient groups to be careful of getting too close to the pharmas and the 'astroturf' phenomenon is rightly deplored. But all the major patient charities receive educational grants etc from the industry: this does not mean there are strings attached. To believe so is, I think, to cross the line into conspiracy thinking.
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Claire, it's worse than that; much worse.
Briffa is saying that Diabetes UK is DELIBERATELY advising diabetics to eat a diet that HARMS their health and aggravates their diabetes so that they will have to take more medication sold by the drug companies that give money to Diabetes UK.
That is appallingly defamatory.
John
That's incredible. And perhaps a little ironic, given the warnings that Briffa has previously issued to commenters on various blogs who have criticised him. One word he used was 'defamatory'.
If a media shrink gets a three month ban for stealing other people's work, how much of a ban does a doctor get for deliberately steering patients away from sound medical advice? Is it time for the GMC to involve themselves? Or is GMC approval unnecessary to be a practicing wibble-meister?
I totally agree re the defamation, but....a lot of carbohydrate is going to put your blood sugar up considerably, whether high or medium high in the GI stakes. As most of the foods labelled medium GI are actually pretty high, when you look at the index. Just because Dr JB can be a twonk doesn't mean his writings are automatically wrong, or that those by "official" bodies such as the BDA are correct.
You have to get your calories from somewhere, the fad of fat phobia means that there is only protein or carbohydrate left to recommend for significant calories. If the guidelines were to advocate restricted carbohydrate (as in the not too distant past), then you are by default advocating a high fat diet. Which is a career death sentence to anyone working in the NHS
You have to be GMC registered (as Dr Briffa is) to say you are a "integrative physician" or "holistic doctor". Of course, you don't need a medical licence (or degree), or indeed any sort of degree or qualification at all, to call yourself an "integrative therapist" or even "nutritionist".
The term "therapist" is a kind of Wibble version of Dr C's much hated Govt NewSpeak "health care professional"... while "practitioner" is a similarly slippery word in both conventional and alternative spheres.
I would be pretty sure that it is significantly more expensive to see a wibble-meister with a medical degree and GMC registration (the integrative physician) than it is to see a bog-standard "nutritionist" trained (I use the word loosely) by somewhere like Patrick Holford's Institute of Optimum Nutrition.
Of course, at some private "Integrative Medicine" operations you get both in one package - see e.g. here:
"New patients will be seen by the Nutritionist first, followed by a half hour consultation with Dr... The cost of the joint consultation will be £245.00 and will last approximately 90 minutes."
It will be extra, of course, for actual treatments, such as "vitamin infusions, chelation and heavy metal detoxification" administered by the practise nurse.
oh dear god
Just checked out Dr Wendy Denning.
Chelation.
Chelation?
How do these people get away with it?
J
Yes, it is a bit of a shocker, isn't it?
"Heavy metal detoxification".. hmmm. Are there that many aluminium smelters or electroplating workers consulting fashionable London private integrative doctors, do you suppose? One imagines not.
There might, however, be plenty of worried folk with amalgam fillings, or who have given their kids vaccines.
*sigh*
Dr C
excellent post. Hope you don't mind me exploiting your hospitality to show comments I tried to post - several times- onto Briffa's Bog without success. I think this could be a new Intolerance Factor (diabetes pun, there)
http://jkn.com/View?j=912225.421546931238
And to 'Anonymous' -
'Fat phobia' is a fetish of the nutnutritIONista rather than the NHS worker. This incorrect assumption, repeated ad nauseum, is getting a tad irritating.
Please don't believe everything that Dr B, Ex-Prof H, no-longer Dr McK et al spout about their professionally qualified competitors.
Oh, but Dr C rocks.......
er
typo
I meant 'Blog'
Yes, I am not sure that Dr Briffa believes in freedom of of speech. Many comments never appear
J
I love the way so much of the Nutritionstas' over-complicated dietary flim-flam can be replaced by taglines like Michael Pollan's:
"Eat food. Not too much. Mostly plants"
BTW, for an extended thread dealing (sometimes even humorously) with Dr Briffa's interesting way with comments he doesn't like, see the discussion here.
Diabetes patients (most of whom are late onset), are given a diet sheet (divided into 3 food groups) to work from. It's somewhat punitive but doable nonetheless. However the nurse will always say that a little bit of what you fancy on a festive occasion from the 'forbidden' one does no harm.
HOWEVER, I'm skeptical of 'charitable organisations'. Call me paranoid, please feel free, but I can't help feeling that someone is making money off the back of someone's else's illness... Does it matter how it's done? You know at least from where I'm standing I can see that Briffa weird and I personally wouldn't give his opinions the time of day. However Diabetes UK, as you rightly point out, has been running for decades. What still no cure? Forgive me for feeling skeptical.
That was very illuminating, Catherine. Both the annotated version of the post and the introduction to the Briffa Intolerance Factor. Perhaps this might become an integral part of MSE in the future.
Somebody disagrees with you and cites some science/basic commonsense. Do you:
i) respond thoughtfully to the comment
ii) send the comment into limbo?
Do dietitians ever have referrals of patients who have some misunderstandings based on their interpretation of Former Visiting Professor Patrick Holford, Never-was-a-medical-doctor-or-meaningful-PhD McKeith et al.?
John - small typo, second last paragraph - "nutrionist" should be "nutritionist". Otherwise, brilliant post.
I think you are in danger of dismissing possible useful information because of its source.
Many people with diabetes find that the only way they can get good control is to limit the amount of carbohydrates they eat. This has been discussed for years on internet forums and recent research seems to support this too.
http://www.ncbi.nlm.nih.gov/pubmed/18495047?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
Low-carbohydrate diet in type 2 diabetes: stable improvement of bodyweight and glycemic control during 44 months follow-up.
"CONCLUSION: Advice to obese patients with type 2 diabetes to follow a 20% carbohydrate diet with some caloric restriction has lasting effects on bodyweight and glycemic control."
http://www.ncbi.nlm.nih.gov/pubmed/18469290?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
Protein in optimal health: heart disease and type 2 diabetes.
"High-protein, low-carbohydrate diets have also been investigated for treatment of type 2 diabetes with positive effects on glycemic regulation, including reducing fasting blood glucose, postprandial glucose and insulin responses, and the percentage of glycated hemoglobin."
A Low Carbohydrate Diet in Type 1 Diabetes: Clinical Experience
http://www.dsolve.com/component/option,com_docman/task,doc_download/gid,24/
"Due to failure to achieve control twenty-two patients with type 1 diabetes with symptomatic fluctuating blood glucose started on a diet limited to 70-90g carbohydrates per day and were taught to match the insulin doses accordingly. The caloric requirements were covered by an increased intake of protein and fat. The purpose was to reduce the blood glucose fluctuations, the rate of hypoglycaemia and to improve HbA1c.
After three and 12 months the rate of hypoglycaemia was significantly lowered from 2.9 + 2.0 to 0.2 + 0.3 and 0.5 + 0.5 episodes per week respectively. The HbA1c level was significantly lowered from 7.5 + 0.9% to 6.4 + 0.7% after three months and was still after 12 months 6.4 + 0.8%. The meal insulin requirements were reduced from 21.1 + 6.7 I.U./day to 12.7 + 3.5 I.U./day and 12.4 + 2.6 I.U./day after three and 12 months respectively.
Furthermore the triglyceride level was significantly lowered whereas the levels for total cholesterol and HDL-cholesterol were unchanged.
Conclusion: the present report shows that a 70-90 g carbohydrate diet is a feasible long-term alternative in the treatment of type 1 diabetes and leads to improved glycaemic control."
GPs have even been known to agree with a low-carbohydrate diet for people with diabetes and also express disappointment in Diabetes UK:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1570767
Low carbohydrate diets for diabetes control
Obviously more research with larger groups over longer periods are needed before any conclusions can be reached. Any risks or disadvantages must be set against the know benefits (huge) of a lower HbA1c. But I wouldn't dismiss the idea out of hand.
I think you are in danger of dismissing possible useful information because of its source.
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Not at all. I am very happy to discuss ways of improving diabetic diets, as is the BDA and Diabetes UK.
In my medical life time I have seen huge changes in recommendations in particular the move away from high fat low carb diets.It may well be that the current recommendations are not perfect. Fine. Let's all discuss them.
There is however an immutable underlying problem. You have to get (say) 2000 calories into the patient and you only have protein, fat and carbs to choose from.
If Dr Briffa wants to make a case for a change in the balance THAT IS ABSOLUTELY FINE. He does not have any recognised qualifications in dietetics other than his medical degree, but he is still entitled to put his opinion. What he is NOT entitled to do though is suggest that a respected charitable organisation, to which many diabetics belong, is DELIBERATELY TRYING TO MAKE DIABETICS ILL to force them to take more drugs and thus generate more profits for the drug companies that support Diabetes UK.
It's outrageous
John
Claire, it's worse than that; much worse.
Briffa is saying that Diabetes UK is DELIBERATELY advising diabetics to eat a diet that HARMS their health and aggravates their diabetes so that they will have to take more medication sold by the drug companies that give money to Diabetes UK.
That is appallingly defamatory.
John
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sounds like a conspiracy theory to me! Pretty similar to the accusations of anti-immunisation zealots, i.e. that immunisations are the cause of chronic disease, which then generates income for doctors and Big Pharma. Conspiracy- and scaremongering seems to integral part to the alt.med worldview.
Regardless of current ins and outs of diabetic dietary advice,
John Briffa accusing someone of exploiting ill people's nutritional uncertainties in order to profit from sales of pills?
Pot......Kettle
The egregious aspect to Briffa's post was the suggestion that Diabetes UK have no interest in the wellbeing of diabetics to the point where they are conniving in making them ill.
"Many people with diabetes find that the only way they can get good control is to limit the amount of carbohydrates they eat."
The more that is known about diabetes, the more that diabetologists are moving towards the notion that there will prove to be several distinct sub-types of diabetes and it is not beyond the realms of possibility that major new classes such as Type 3 and 4 will emerge (NYT gives a good overview).
Different proportions of macronutrients may work for different people depending on their circumstances, lifestyle and form of diabetes. When speaking broadly, I would imagine that Diabetes UK, the BDA etc. have to promote a diet that is thought to do least harm overall. And, the danger is that high-fat diets may cause problems with people with cardiovascular co-morbidities and that high-protein diets may be contra-indicated for people who already have some renal damage. Sadly, given subtle symptoms and the delay in realising that there is a problem, there may already be kidney damage by the time of diagnosis.
Dietary advice may change to being more tailored if the haptoglobin test (not the best explanation but I needed an online reference) is validated and proves clinically useful. At present (and this needs much wider validation) if looks like people with diabetes who have the less desirable haptoglobin variants (in the context of diabetes) are substantially more likely to develop cardiovascular, renal or other complications that suggest both macro- and micro-vascular damages.
Until such time as there are tests that allow better individualisation, there is much to be said for the broadbrush public message to be one that promotes the inclusion of carbs with a lower GL in the diet (as the BDA and Diabetes UK recommend).
Dr Briffa's post is still up.
This post has been removed by the author.
its odd
I can't access it at home (I thought he had blocked me) but I can at work,and at other places
Strange
JOhn
"The egregious aspect to Briffa's post was the suggestion that Diabetes UK have no interest in the wellbeing of diabetics to the point where they are conniving in making them ill..."
Agreed, and it will be interesting to see if he can be called to account for the insinuations he has made.
Regarding transparency in the relationship between patient groups and pharma, it's interesting to note that the House of Commons Health Committe in 2005 singled out Diabetes UK as one of only two patient groups to explain their funding policy:
"The Influence of the Pharmaceutical Industry" March 2005, p. 76 point 268
http://tinyurl.com/8zxcq
http://www.parliament.the-stationery-office.co.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf
On this wider point, I have some sympathy the concerns of people like Paul Flynn MP. The best strategy to prevent smears like that against Diabetes UK gaining traction in public opinion is to have a policy of transparency about funding.
“When speaking broadly, I would imagine that Diabetes UK, the BDA etc. have to promote a diet that is thought to do least harm overall.”
I would imagine that's a false compromise and the right thing to do in those circumstances would be to not speak broadly in the first place.
Anyway..., I do wish the “authorities” would do something about Sideshow Briffa and his medicine show (and others like him). He's really “burnt the lot” this time.
plh.
Well, as a type one diabetic it's good to know that my 7 years of eating a diet in which my carbohydrates came mainly from chocolate and cakes rather than 'starches' will have done me no harm.
Oh, hang on, what about the 20+ admissions with DKA, the proliferative retinopathy which I'm now having laser treatment for, and the in-patient treatment in an eating disorder unit; at the grand old age of 26.
Admittedly, it wasn't all the diets doing - the deliberate insulin omission as a form of weight less was also a key player; but this man
is despicable.
Diabetes UK 'is one of the longest established and most respected medical charities in the country.' Damn right, the support and information it offers both patients and healthcare professionals is of an excelelnt standard
"I can't access it at home (I thought he had blocked me) but I can at work,and at other places"
I once found I was unable to reach Briffa's blog, but when I used Mozilla I could get back on. No idea why I couldn't get on previously, I just assumed Dr B had blocked me because he was upset with me for writing those nasty comments about his views on MMR.
PS - Did anyone see the rather interesting statement Briffa made on his blog about Horton? Available on jkn.
While I am generally against the use of libel laws to persecute bloggers, and have not resorted to law for those who have libelled me in public forums, it would be poetic justice if Horton and Diabetes UK went after Briffa.
re jdc's comment 3:33 pm, just to say I am not the Claire who posted a comment on the Briffa blog piece there!
better change my username, will use claireob in future!
Has anyone noticed how various 'alternative practitioners' are swift to accuse the mainstream medical profession and 'Big Pharma' of being callous mercenaries? Callous mercenaries who won't adopt their magical treatment because it's not possible for them to turn a profit or some other reason, strange how so few explain their own ability to make a tidy sum?
talk about mob psychology
Since I actually started following Diabetes UK's guidelines with regard to exercise and a low GI diet, I've lowered my blood sugar levels substantially and have been able to reduce my medication. Do the big pharma paymasters know about this failure in the grand plan?
Looks like I won't be needing Briffa's patented snake-oil either. Funny how he doesn't mention his own lucrative financial interests in all of this. Or maybe not so funny come to think of it.
You might like this article in the Guardian. "The long awaited review into the future of the NHS by Lord Darzi will next week propose a big boost in the size of independent nurse-led provision of primary care, similar in ambition to the rise of independent foundation hospitals."
My company private health Care starts in 3 days thank god
"Since I actually started following Diabetes UK's guidelines with regard to exercise and a low GI diet, I've lowered my blood sugar levels substantially and have been able to reduce my medication. Do the big pharma paymasters know about this failure in the grand plan? "
Having anticipated the implications of your diet we have purchased the world's entire supply of starchy carbohydrates. Indeed, it is us, the big pharma paymasters, who are responsible for the rising price of food and thus malnutrition in poor countries bwahahaha...
We control everything, resistance is futile, we are the big pharma paymasters.
In my medical life time I have seen huge changes in recommendations in particular the move away from high fat low carb diets.It may well be that the current recommendations are not perfect. Fine. Let's all discuss them.
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I think some of you are missing the point. It's well known that excess insulin is very dangerous to us regardless of whether it's produced by our body or injected in the case of diabetes. Why on earth would any reputable doctor or medical agency tell a diabetic it's okay to chow down on those carbohydrates and eat the occasional piece of cake...just make sure you shoot up with additional insulin? Many of us do believe that borders on malpractice.
Good article.Especially the above.We end up with a justice system again, where many innocent people are locked up again on the basis of an anonymous witness who may have a grudge financial interest etc in cooperating with the Police or whoever wants the defendant put away.
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Hi - I've posted on my blog about the use of anectdotal evidence to drive clinical research, using the Biffa-Diabetes-UK fiasco as the central example. I would be interested in your views.
Are we Underrating the Anectodal?
Thanks,
Methuselah
Pay Now Live Later
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