Many people in the SBM community have expressed concern about a lawsuit currently happening in Australia. Dr. Adam Smith, a Melbourne GP, is being sued for defamation by naturopathy, Farrah Agustin-Bunch. It my opinion this looks like a classic case of using legal thuggery to silence and intimidate legitimate commentary. Smith says he was concerned by the extreme claims being made by Agustin-Bunch and wanted to “do a good deed” by providing some scientific response. Looking at Agustin-Bunch’s website it looks like she has a history of responding to such criticism by going on the attack, trying to turn the tables on her critics and, at least in this case, suing them.
Unfortunately for Smith, the laws in Australia are are defamation friendly. Sydney has been called the defamation capital of the world. He is reportedly already out of pocket $600,000 dollars in legal fees, and will likely spend two million before things are done. But to his credit he is not backing down.
To get the flavor of Agustin-Bunch’s strategy, I found a 2018 Quackwatch article about her, and her response. Quackwatch is a consumer protection website focuses on bogus medical claims and treatments, founded by Stephen Barrett and now run by CFI. Smith and Barrett take exception to the fact that Agustin-Bunch is promoting the typical range of dietary solutions to all problems, selling her “pixie dust” magnesium supplement and Boston-C supplements for many things, including cancer. On the package the Boston-C supplement claims it “supports immune system function” and “natural detoxification and cleansing”. We have heard these claims before. The Philippines FDA, where her clinic is, has shut down her clinic and cited her for selling products that are not approved.
To fight back against Barrett she quotes the following criticism:
“The Quackbusters, founded by the disgraced, unlicensed psychiatrist, Stephen Barrett, are a ubiquitous shadow network in the world of health and medicine with a unique talent.
Now that is defamation. Stephen Barrett is only “unlicensed” because he is retired. He was fully licensed when practicing. He is not “disgraced” by any objective measure, and she cites no cause or justification for this claim. (He had no complaints against his license, which was in good standing when he retired.) She tries to diminish Dr. Barrett by saying he has no “reported medical training since 1961”. That was the year he completed his residency. He was in practice until 1993, which means he had to keep up with his continuing medical education requirements, so her statement is false.
There is more, but actually that is likely the point – keep her critics defending themselves from her own baseless accusations rather than discussing the dubious nature of her medical advice. She is setting up a battle of authority (rather than evidence) and then relentless attacks her critics. I want to focus, rather, on one claim she makes as part of her push back against Quackwatch. She quotes Barrett as writing:
“I recommend steering clear of: Anyone who suggests that most diseases are caused by faulty nutrition. Although some diseases are diet-related, most are not.”
She takes this out of context then takes a number of other quotes from medical sources out of context to create a false impression. She writes:
“Increasing cancer rates also cannot be attributed to genetic factors, which are directly implicated in, at most, 5 – 10 percent of all cancers. I firmly believe that upwards of 90 – 95 percent of cancer incidence originates from lifestyle and environmental factors, with diet being far and away the primary causal component in cancer incidence today.”
For support she does not have definitive references in the medical literature, but misleading quotes. Here is just one representative example:
The National Academy of Sciences contradicts Stephen Barrett.
“In most Western countries, including the United States, diet-related chronic diseases represent the single largest cause of morbidity and mortality.”
She is conflating diet and nutrition. In the West, in developed nations, the contribution of diet to disease is largely not from malnutrition – not something that can be fixed with supplements – but from obesity and consuming too much of certain things, like meat, sugar, and fat. She uses conclusions that are really about obesity to justify prescribing supplements for cancer.
Let’s look at the actual evidence. A 2019 study looking at 80,000 new cancer cases in the US found that only 5.2% were attributable to diet. That is what Dr. Barrett is talking about, and directly contradicts Agustin-Bunch’s narrative. A 2020 review of diet and cancer published in BMJ made very direct conclusions from the data.
“High dose vitamin or mineral supplements have not reduced cancer risk in well nourished populations and might increase risk; for example, high dose β carotene might increase the risk of lung cancer. Vitamin and mineral supplements should not be used for cancer prevention, although they can be important for other aspects of health, such as folic acid supplements for women before conception.
What about eating fruits and vegetables, rather than supplements?
“In the 2018 World Cancer Research Fund report neither fruits nor vegetables were considered to be convincingly or probably associated with the risk of any cancer.”
They leave the door open for a small effect for some cancers, most notable colon cancer, which makes sense. About 10% of cancers likely result from genetics. This does not mean the rest is environmental and lifestyle factors, as Agustin-Bunch false concludes. The evidence, in fact, suggests that as much as 65% of cancers are just due to bad luck. The rest are due to known significant causes, like smoking and obesity. There is some controversy over how exactly to interpret the data on “bad luck” as a cause for cancer, but either way it is still a major cause.
But that doesn’t sell supplements. Supplement sellers need to create the narrative that most health issues are cause by poor nutrition and that their special products are the best way to treat that – but the evidence is just not on their side. When called out on their misleading claims, it is common for them to go on the attack. They claim there is a conspiracy, scientists don’t actually know what they are talking about, they attack specific critics, they claim that they have some special knowledge, and when they can, they use legal thuggery.
What they can’t use is legitimate science, because it does not support their marketing narrative.