The Van Tulleken twins tackle Medicine in the Media: Allergy overdiagnosis, cold-water swimming and humanitarian crises

By Dani Bancroft, current Public Health MSc student at LSHTM

The first MARCH event of the year began with a talk from BBC presenters Chris and Xand Van Tulleken discussing health industry conflicts of interest, popular science myths and Xand’s time working in Sudan.

As celebrity advocates of healthy living and alumni of LSHTM you may already be familiar with the twins, who are common faces on our screens with their topical investigative shows, such as BBC Horizon.

For the MARCH event on January 15th the duo gave us a whistle stop tour of several areas of special interest to them during their careers; the role of the infant formula industry in the diagnosis of cow’s milk protein allergy, whether hangovers are really caused by dehydration, the relationship between anti-depressants and cold-water immersion therapy, and the challenge of remaining apolitical when delivering medical aid in conflict zones.

Breastfeeding and overdiagnosis

Although the brothers often collaborate, Chris is currently working towards a PhD in Molecular Virology at UCL, and is particularly interested in the relationship between the “explosion in the diagnosis of cow’s milk allergy” and any conflicts of interest that may be present in the substitute formula industry.

In a new article for the BMJ, Chris examined data to see whether an increase in the number of breastfeeding mothers prescribed specialist formula for their infant is an indicator for the rise in cow’s milk protein allergy.

Instead, what he found was that many of the clinical studies, charities and advocacy groups he was looking at had also received funding from manufacturers of treatments for cow’s milk formula.

The WHO international code of marketing practice for breast milk substitutes explicitly says: “No one involved in infant nutrition should develop conflicts of interest with the manufacturers of infant formula”, and Chris explained this is essential to combat misleading marketing practices.

It also serves to prevent infant commerciogenic malnutrition, which is when infant starvation is caused by the inappropriate promotion of infant formula in place of breastfeeding in areas of low income or poor water supply. Chris said, “It doesn’t matter if [the conflict] doesn’t have any effect, just that the conflict of interest exists…and this is because the effect can also be subconscious.”

“The Doctor Who Gave Up Drugs”

Having also presented the BBC series The Doctor Who Gave Up Drugs, Chris told the audience how he became hooked on cold-water swimming after a cold dip in the Arctic ocean for the BBC’s Operation Iceberg.

As it rises in popularity, there is claim that cold-water immersion therapy might cross-adapt the sympathetic nervous system to help you tackle psychological stresses and physical stress of the cold. Some believe this mechanism could even supersede the effects of prescribed anti-depressants. On investigation, Chris found this biological case for cold water swimming plausible despite the current evidence being inconclusive, and mostly driven by enthusiasts of the practice.

However, this also led the BBC team to critique studies on the mechanisms by which anti-depressants work and how we prescribe them. They found that in the latest meta-analysis, 78% of these studies were funded by manufacturers of anti-depressants, again highlighting possible industry bias.

Chris states that the BBC series has served as a springboard for peer-review, and a way to see whether there was any merit to what could “very easily be a dud hypothesis”. Nonetheless, all of this did little to put him off his new hobby. “I do occasionally haul my lab off to go cold water swimming so I’m a bit of an evangelist for it, and that definitely does give me a particular bias”.

Medicine in conflict zones

Xand followed a different path during his medical career, boosted by a Master’s in Public Health and a second diploma, this time in International Humanitarian Assistance. He shared some of his experience working for Médecins du Monde (Doctors of the World) in Darfur, Western Sudan. His talk probed the complex role medical NGOs and the media play in assisting humanitarian crises, and political and ethical challenges their presence can create.

Xand has also worked for Merlin and the WHO in low-middle income countries, and is now a contributing editor to the first edition of the Oxford Handbook of Humanitarian Medicine.

Find out more about the twins’ backgrounds and current projects here.

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