Rapid Responses to:

NEWS: Caroline White Three journals raise doubts on validity of Canadian studies BMJ 2004; 328: 67 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Nutritional supplementation trials

The MAVIS Trial Group   (16 January 2004)

How and what to investigate

Seth D. Roberts, Saul Sternberg   (18 January 2004)

Evidence in an Evidence Based Health Care. The Canadian Connection

Ram B Singh   (20 January 2004)

Contents of News Reports Should be Verified Before Publication

Karl F Bergmann   (24 January 2004)

Every scientific evidence is not always fact: the Canadian studies

Jagdish P Sharma   (25 January 2004)

Nutrient Supplements and Health

Ranjit K. Chandra   (26 January 2004)

The BMJ's continuing doubts on the work of Professor Chandra

Richard Smith   (26 January 2004)

A Compleat Physician-Scientist

Pooja Gupta   (26 January 2004)

There is Still Time for Meeting and Discussion and Apology.

Ram B Singh   (27 January 2004)

A Solution for the Debate

Bum Suk Kim   (28 January 2004)

Concerns about the data

Susan D Shenkin, Martha C Whiteman, Alison Pattie, and Ian J Deary   (28 January 2004)

A Journalist's Recommendation to BMJ

Gillian E Mahoney   (28 January 2004)

There is Still Time for Meeting,Discussion and Apology;Revised.

Ram B Singh   (29 January 2004)

Science or politics

Rakesh Sharma   (29 January 2004)

Irreconcilable Differences

Joseph . C . Obi   (30 January 2004)

News and Nutrition

Rakesh Sharma   (30 January 2004)

dr white should be kind enough to resign

drmanoj saxena   (9 February 2004)

Those accountable for the contents of BMJ should apologize

Karl F Bergmann   (9 February 2004)

Chandra should present himself to the Memorial University of Newfoundland for a full inquiry

Richard Smith   (10 February 2004)

Re: The BMJ's continuing doubts on the work of Professor Chandra

Wasim Maziak   (10 February 2004)

Response from the Editor-in-Chief of Nutrition

Michael M Meguid   (11 February 2004)

Dr Chandra- please provide clear answers to the questions raised

Alan Shenkin   (18 February 2004)

Any one who preaches a gospel should also practice it

Ranjit K Chandra   (19 February 2004)

Have you decided to Spoil the Image of BMJ?

Ram B Singh   (20 February 2004)

Re: Contents of News Reports Should be Verified Before Publication

Shiv Kumar, Rakesh Kumar, Rashmi   (24 February 2004)

Response to Dr. Chandra

Saul Sternberg, Seth Roberts   (29 February 2004)

Re: Every scientific evidence is not always fact: the Canadian studies

Shiv Kumar, Rakesh Kumar, Rashmi   (4 March 2004)

Re: Have you decided to Spoil the Image of BMJ?

Dr.Devan. P.P.   (6 May 2004)

Nutritional supplementation trials 16 January 2004
The MAVIS Trial Group, Health Services Research Unit University of Aberdeen, Foresterhill, Aberdeen, Scotland, AB25 2ZD Send response to journal: Re: Nutritional supplementation trials	Dear Editor We note with great interest the discussion of the validity of trials by Professor Ranjit Kumar Chandra, which examined the effect of vitamin and mineral supplementation on infections and cognitive function in older people (1). In 2004 we will be reporting the results of the UK based MAVIS trial (ISRCTN number 66376460) of a readily available standard over the counter multivitamin and mineral preparation (Boots Group plc) in 910 community dwelling people aged 65 years and older. This trial examines the effects of supplementation on participants' numbers of days of infections, antibiotic use, general practice contacts, cognitive function and quality of life. We hope that the MAVIS trial will help to shed more light on this issue. We have no conflicts of interest to declare, and our trial is subject to independent data and steering committee monitoring. Yours sincerely The MAVIS Trial Group The MAVIS Trial Group is: Alison Avenell, Marion K Campbell, Jonathan A Cook, Anne C Milne, Craig R Ramsay, Audrey I Stephen (Health Services Research Unit); Phil Hannaford (Department of General Practice and Primary Care); Geraldine McNeill (Department of Environmental and Occupational Medicine); D Gwyn Seymour (Department of Medicine and Therapeutics); Mary Kilonzo, Luke D Vale (Health Economics Research Unit and Health Services Research Unit); University of Aberdeen AB25 2ZD. The MAVIS trial is sponsored by The Health Foundation. The Health Services Research Unit and Health Economics Research Unit are core funded by the Chief Scientist Office of the Scottish Executive Health Department; however, the views expressed here are those of the authors. (1)White C. Three journals raise doubts on validity of Canadian studies. BMJ 2003; 328: 67. Competing interests: None declared
How and what to investigate 18 January 2004
Seth D. Roberts, Associate Professor of Psychology University of California, Berkeley, California 94720-1650, Saul Sternberg Send response to journal: Re: How and what to investigate	Memorial University officials are apparently now puzzled how to investigate because Chandra will not cooperate. A study that follows 96 subjects for a year generates much more than raw data. Financial records can be examined. Were 96 subjects paid for their participation? Were the necessary supplies purchased? There should be phone records. Persons who worked with Chandra at the time of the doubtful research, such as research assistants, can be questioned. Nor is Chandra’s cooperation required to look for a scientist named Amrit L. Jain, who in 2002 published an article in Nutrition Research, then edited by Chandra, that replicated Chandra’s 1992 Lancet results that we have questioned. We were unable to find any other trace of Jain. The article gave no email address. The mailing address was a rented mailbox not far from Memorial University. The institutional affiliation given for Jain was “the Medical Clinic and Nursing Home, Jaipur, India” (a large city). We have been unable to locate any trace of this institution other than Jain’s article. We agree with Smith that all of Chandra’s published research now deserves scrutiny, given the problems that have already been found and Chandra’s non-cooperation. Such scrutiny could begin with his most-cited articles. We hope that Memorial University will also try to learn why the university declared itself “happy” with research “that bears all the hallmarks of being entirely invented.” Competing interests: None declared
Evidence in an Evidence Based Health Care. The Canadian Connection 20 January 2004
Ram B Singh, Director Medical Hospital and Research Centre, Civil Lines, Moradabad-10(UP)244001, INDIA Send response to journal: Re: Evidence in an Evidence Based Health Care. The Canadian Connection	Sir, I am not pleased to read the content of the news article written by Dr White about the research of Dr R K Chandra.(BMJ,Jan 10,2004,328:67) To us, who admittedly are positively biased for Dr. Chandra, the article is not evidence based. We have been Enjoying the work of Dr Chandra for the last two decades, since it is related to nutrition in health and disease, our interest also, and since it has inspired many studies world-wide. Allow us a few suggestions please: 1.Dr White and Dr Smith, the editor, could be asked to provide Dr Chandra's responses to the questions raised against his studies. 2.Could you investigate the motive of each of those who questioned Dr Chandra's research? If they state fraud, there may be reasons for such an allegation. 3.It would be important to conduct a randomized, controlled trial with financial support from BMJ, to find out the exact contribution of the formulation, which Dr Chandra claims to be beneficial. This would be a constructive step by the editor and would add to the fame of your journal. 4.BMJ has been pioneer in developing the concept of evidence based medicine. Evidence based news would gain from the proposed trial to be carried out by independent investigators chosen by BMJ, involved neither with Dr. Chandra, nor with his critics. 5. Thereby, any unwarranted adverse effects on the mental and physical state of Dr. Chandra could perhaps be reversed. Competing interests: None declared
Contents of News Reports Should be Verified Before Publication 24 January 2004
Karl F Bergmann, Consultant 7 rue Muzy, Geneve 6, Switzerland Send response to journal: Re: Contents of News Reports Should be Verified Before Publication	I am interested in the accuracy of non-peer reviewed items in biomedical journals and find that the somewhat sensational "news" (White C, BMJ 2004:328:67) is flawed; the errors can be verified by a diligent reader. Only two journals (Nutrition,BMJ), not three, had some questions about the Chandra paper (Nutrition 2001;17:709-12). Lancet simply published a letter to its Editor and the author's response;the prestigious journal did the right thing by not taking sides with either party. Chandra's reply to Roberts (Nutrition 2003;19:976-80) covered most of the points raised in the news report. For example, he had already acknowledged the typographic error of stating standard error instead of standard deviation. The number of digits to be remembered and recalled by subjects was NOT 50. Even a high school student, and certainly a physician, can learn within a few weeks how to administer the cognitive tests used by Chandra. Given the number of observations, the frequency and distribution of digits that referred to percentages, not absolute numbers, is acceptable statistically. It is interesting that Debra Spadaro of Nutrition stated that the journal's reviewers were not statisticians (Mahoney J, The Globe and Mail, December 2003). The number of articles published by Chandra in the journal he edits is not "a very large proportion" but less than 5% as per survey of Index Medicus, ISI, Excerpta Medica and other data bases. These errors in the news report by White make it difficult to believe the accuracy of the remaining contents. The readers of widely circulated journals that have a premium on space expect more accurate reporting. It would be wise for readers to disregard this news item. Competing interests: None declared
Every scientific evidence is not always fact: the Canadian studies 25 January 2004
Jagdish P Sharma, Director,JM Maternity and General Hospital SEOHARA,Distt BIJNORE Send response to journal: Re: Every scientific evidence is not always fact: the Canadian studies	Sir,I am deeply touched to read the views of Dr White about Dr R K Chandra in the news item.I have been reading Dr Chandras research on Nutrition and Immunity of which he is the world expert.The BMJ editor is too small in front of his clinical achievements.It seems,he wants to support some people with definite motive just because of racial descrimination which is apparent from following statement from another letter. reply to Roberts (Nutrition 2003;19:976-80) covered most of the points raised in the news report. For example, he had already acknowledged the typographic error of stating standard error instead of standard deviation. The number of digits to be remembered and recalled by subjects was NOT 50. Even a high school student, and certainly a physician, can learn within a few weeks how to administer the cognitive tests used by Chandra. Given the number of observations, the frequency and distribution of digits that referred to percentages, not absolute numbers, is acceptable statistically. It is interesting that Debra Spadaro of Nutrition stated that the journal's reviewers were not statisticians (Mahoney J, The Globe and Mail, December 2003). Thank you Dr J P Sharma,MD Consultant Physician and Director Competing interests: None declared
Nutrient Supplements and Health 26 January 2004
Ranjit K. Chandra, retired Gurgaon India 122 002 Send response to journal: Re: Nutrient Supplements and Health	Nutrient Supplementation and Health I wish first to correct some errors in the report by Caroline White (2004, BMJ 328:67) and then to make additional comments to put the matter in context. In our study, we did not ask the subjects to remember and recount 50 digits. The suggestion that nutritional interventions in general, and not necessarily the supplement we had used, can influence cognitive function (Selhoub J et al. Am J Clin Nutr 2000;71(suppl.):614S) and may affect the development and severity of Alzheimer’s disease (Sano M et al. New Engl J Med 1997;336:1216) is part of published literature. It is necessary to quote verbatim from the letter of Dr Alex Meisen, President of Memorial University, to Dr Richard Smith, Editor of BMJ. Dr Meisen was provided with all the data he sought so that he and his senior advisers in nutrition and statistics who assisted him in the investigation were completely satisfied. He reported his findings as follows. “I am entirely satisfied with Dr Chandra’s explanation of why this paper was submitted so long after the companion article appeared in The Lancet and why a longer follow-up period was not employed. “The reference to Alzheimer’s disease was not a claim, but merely a suggestion. The psychometric testing was conducted by Dr Chandra and I am satisfied that, in the context of a research undertaking, there was nothing improper about this… “The distribution of digit frequency in Table I should never have arisen as an issue. The entries are percentages and not absolute levels of nutrients…A situation where the author is essentially reporting data, which falls only into the tail area of the distribution, is a situation bound to produce a non-random distribution of digits. The distribution of digits in Table II are not strongly skewed and can be explained by the small number of entries (28) where randomness of distribution does not begin to be a factor.” Meisen concluded that “in all respects, I am satisfied that there has been no wrongdoing by Dr. Chandra and I urge you to draw the same conclusions.” It is clear that Meisen and senior professors of statistics and nutrition at Memorial whom he had consulted did not agree with the criticism of the paper by BMJ reviewers. At the same time, Meisen wrote to me acknowledging that I had “promptly responded” to his queries even though I was travelling outside the country. He wrote, “The explanations you provide ….. are, in my view, entirely satisfactory. ….I am quite happy to close this file and I wish to take this opportunity to thank you sincerely for the prompt and thorough manner in which you addressed my queries. Naturally I wish they had not been necessary and I personally regret the anxiety and anguish that dealing with this matter has caused. I wish you continued success throughout the remainder of your career.” Dr. Jack Strawbridge’s comments are at variance with the above noted remarks and conclusions by President Meisen. Strawbridge’s statements to some of the media were also inaccurate and had to be corrected in follow up articles by the same reporters. As opposed to Strawbridge’s assertion that “a very large proportion of his work is in a journal he edits”, only 11 out of more than 190 original articles were published in Nutrition Research. For each of these 11 papers, the identity of the author(s) and place of work was deleted when the manuscripts were sent to reviewers. Most editors do publish at least some of their papers in the journals they manage. Strawbridge does not state why to date the University has not investigated the serious matter of the breaking open of the locks of my office, the desks and the filing cabinets, in my absence and in the absence of my secretary who was in town. This action could be considered a criminal offence. Also, the University and its associated health care center did not take any action on the recorded statement of an employee that she had “tucked away” some of my research files, documents that have not been recovered. I left the University six months prior to mandatory retirement and had discussed this with the Dean and the Chairman of Pediatrics before my paper was submitted to Nutrition and long before any correspondence from Roberts and Sternberg. I am curious, as was Meisen, about the out-of-context comment of the anonymous BMJ in-house editor/reviewer that “You may wish to know that Dr Parfrey is based in Newfoundland”. It probably shows that the reviewer and BMJ may have had some problems with Parfrey’s submissions in the past. His/her comment seems to imply that all work emanating from Memorial University is not acceptable, surely a biased opinion. Since the publication of the correspondence in Nutrition, I have consulted other statisticians who state that from the published paper it is impossible to derive statistical analyses and conclusions of the kind claimed by Roberts and Sternberg. In scientific papers, there is scope for different opinions about analyses. This is particularly true of psychological studies and some authors have pointed out errors in statistics reported in prestigious journals (e.g. White SJ. Brit J Psychiat 1979;135:336). Moreover, differing results from well-designed and conducted studies are not unknown in science, especially in biological and nutritional studies. For example, diametrically opposite conclusions were drawn about the benefit of daily supplemental intake of vitamin E 200 mg among elderly subjects; one study showed beneficial results (Meydani SN et al JAMA 1997;277:1380) whereas another study (Graat J et al JAMA 2002;288:715) showed that the supplement was associated with significant clinical morbidity. Does this mean that the analysis of data and its interpretation in one of the studies is wrong? Despite repeated requests, Drs Roberts, Sternberg and Meguid have failed to indicate sources of their funding, receipt of speaking fees and honoraria. The journal Nutrition is supported by several companies that may have potential conflict of interest. Meguid sent to Drs Roberts and Sternberg my Response to the Commentary by them who then modified their comments and even added a figure, which were not shown to me for a full response. It is most unfortunate that Meguid has contacted many of the media. He also contacted the President of the Spanish Nutrition Society asking her not to invite me to conferences or collaborate with me, failing which he indicated that there could be serious consequences for her. I stand by my research. I am confident that the main conclusions of our study will be confirmed in due course. Ranjit K. Chandra Y-182 Regency Park II DLF Phase IV Gurgaon 122002, India Email: nutres2002@yahoo.com Competing interests: I hold patent for a multinutrient but have not derived any financial gain from it.
The BMJ's continuing doubts on the work of Professor Chandra 26 January 2004
Richard Smith, Editor BMJ Send response to journal: Re: The BMJ's continuing doubts on the work of Professor Chandra	Unfortunately Professor Chandra tells only part of the story in his long rapid response. Firstly. we were wrong to suggest that Chandra’s paper showed that participants could remember 50 digits, and we will be correcting this error in the next issue of the journal. The words appearing in the paper are “Digit span forward (score)”. It isn’t clear what this test is and what the results mean, but we accept that we were wrong to suggest that it meant that participants could remember 50 digits. Professor Chandra quotes Professor Meisen’s letter at length, but that letter was dated 2 April 2001. In response to that letter I went back to our reviewers and consulted our ethics committee. We remained convinced that there were major problems with Chandra’s paper, and so I wrote back on 30 November 2001 and asked the university to clarify what form its investigation had taken. In particular I wanted to know if the university had examined the raw data of the study. Professor Meisen wrote back on 3 January 2002 to say that university had not asked to see the raw data. He acknowledged that we had raised new issues and said that the university would review them and get back to us. As I didn’t hear further I wrote again to the university. On 19 August 2002 I received a letter from Professor Strawbridge, director of faculty relations, in which he said that Professor Chandra had resigned. Nevertheless, the university expected Professor Chandra to respond. On 12 November 2002 I received a further letter from Dr Strawbridge, explaining that Professor Chandra could not help with queries because in his words “all my papers are in storage and some pertaining to this study were mislaid…” Professor Chandra provided an address in Switzerland. Professor Chandra has not given an adequate answer to important questions about his work. Major doubts about all of his work will persist until he cooperates with the university—and perhaps some independent experts—in a full inquiry. In his rapid response Professor Chandra refers to a comment supposedly from the BMJ on a Dr Parfrey. I don’t know where this comes from, but we have no doubts about the work of a Dr Parfrey. Nor do we think for a moment that “all work emanating from Memorial University is not acceptable.” I sympathise with the university in its predicament. It is hard to investigate the work of somebody who has left both the employment of the university and the country. Yet there seems to be no other body that can provide any sort of answer to the important question of whether Professor Chandra’s work can be trusted. I hope that the university will manage to provide some answer. Richard Smith, Editor, BMJ Competing interests: I'm the editor of the BMJ and acountable for all it contains.
A Compleat Physician-Scientist 26 January 2004
Pooja Gupta, Research Assistant University of Delhi, Delhi 110007, India Send response to journal: Re: A Compleat Physician-Scientist	The report by Caroline White (BMJ 2004;328:67) is disappointing. It is short on verifiable facts and long on quotes by Roberts, Meguid and Strawbridge, some of which contain inaccurate information as also pointed out by others. It is also not right to quote anonymous reviewers of BMJ. If unexpected results were to be criticized as being "too good to be true" and ignored, many of the valuable discoveries in medicine would not have been put into practice much to the disadvantage of patients. Research done for partial fulfillment of requirements for more than 50 MSc, PhD and MD theses and hundreds of papers has had its origin from the publications and original ideas of Dr. R.K. Chandra. These works have confirmed the conclusions of Dr Chandra's papers. His papers have been the subject of many journal clubs and student assignments and have invariably been lauded as model studies. I have never worked with Dr Chandra but have had the opportunity to listen to a few of his lectures and have attended one bedside tutorial. I do not know of many other individuals who first learns all the methods that are to go into the planning and conduct of a study. These methods may be in the fields of nutrition, biochemistry, microbiology, immunology, psychology, anthropometry, histopathology and others. For example, for his recent studies on Alzheimer's disease patients in India who do not understand English, he has translated the relevant dementia rating scales into Hindi. Comments about Jain make amusing reading. He studied in Rajasthan and Delhi, and practiced for many years in Udaipur and Jaipur before leaving India to spend time with his family in Canada and the UK. If one were to try and contact a person in India based on telephone directories or postal address, more than half the population of Indian cities would be found missing! Hundreds of trainees vouchsafe that Dr Chandra is one of the most brilliant researchers, a compassionate superb clinician and a teacher par excellence. He can be described as the compleat doctor-scientist. Competing interests: None declared
There is Still Time for Meeting and Discussion and Apology. 27 January 2004
Ram B Singh, Director,Medical Hospital and Research Centre Moradabad(UP)244001,India Send response to journal: Re: There is Still Time for Meeting and Discussion and Apology.	Sir,I did not want to enter into the controversy but it seems, it is important that the editor and Dr Chandra should sit for discussion, some issues along with impartial refrees,at least one to be suggested by Dr Chandra.The problem with the editor is that he believes more to refrees that are antagonist to the status and work of Dr Chandra.I think,the editor should maintain an impartial view and should give all opportunities to the authors.After all,it is the authors that make a journal. I invite both the editor and Chandra at New Delhi for a possible solution,provided both the party agree,to save the reputation of the journal. Competing interests: None declared
A Solution for the Debate 28 January 2004
Bum Suk Kim, Research Scientist Retired Yonsei University. Seoul 120-749, Korea Send response to journal: Re: A Solution for the Debate	I suggest that any one who is surprised by the results of the study by Prof. R.K. Chandra should repeat it and publish the results for all readers to see. Of course, opposite results may be obtained in two studies, especially in biological and medical fields. The literature is full of such anomalies. One example about vitamin E dose, immunity and infection was mentioned by Dr. Chandra. I have never met Dr. Chandra but in Asia, particularly in Korea, he commands immense respect for his many original academic contributions, easy-to-understand teaching abilities, and compassion. As Editor, he is objective and impartial. He rejected some of my articles but went to great lengths to explain the reasons for the decision. He devoted much time to correct the English language of our papers before they could be published. Many students in Korea have done work based on his contributions and extend his observations. I have carefully read Chandra's paper and find no major problems with study design and conclusions. My colleagues who are experts in psychiatry and nutrition concur. Editors should always be impartial. It is unfortunate that Dr. Meguid editor of Nutrition and Dr. Smith editor of BMJ have made statements that uninterested readers would interpret as biased and prejudiced. It is time to end this debate by following the suggestions I have given. Competing interests: None declared
Concerns about the data 28 January 2004
Susan D Shenkin, MRC Clinical Training Fellow Department of Psychology, Edinburgh University, 7 George Square, EH8 9JZ, Martha C Whiteman, Alison Pattie, and Ian J Deary Send response to journal: Re: Concerns about the data	As the research group who initially raised some concerns (1) on the data reported in Dr Chandra’s trial of supplementation and cognitive function (2), we were interested to see the continued debate following the report in the BMJ (3). We would like to bring the focus of this discussion away from personal comments on Dr Chandra himself, and back to the data reported in his study. As Dr Chandra himself points out (4), data can be interpreted in various ways, but we have concerns about his report of the raw data themselves, particularly the mini-mental state examination (MMSE) (5) score. His study published in Nutrition (2) is reported as a randomised controlled trial of a trace element and vitamin supplement in an “apparently healthy” group of 86 people aged over 65 from the middle socioeconomic class, “none [of whom] suffered from any form of psychiatric illness or dementia”. We were surprised to see in his paper that the mean MMSE score in this healthy group at baseline was 18 (SD 3) in the group who received supplement and 21 (SD 2) in the placebo group. The MMSE is scored out of 30, and a score of less than 26 would conventionally be classified as indicative of mild cognitive impairment, and less than 22 indicative of significant cognitive impairment. Dr Chandra refers to the test in his letters as an “adapted MMSE” (6) and a “modified MMSE,” (7) but the original article referenced the standard MMSE by Folstein et al (5). Therefore, people with a mean MMSE of 18 cannot be considered cognitively normal. This concern was published in a letter in Nutrition (1), and although Dr Chandra replied (6), he did not answer this specific point. We have written back to Nutrition indicating this and asking for clarification (8). Whatever the explanation for this MMSE score, the increase in MMSE following 12 months of supplementation is astounding. In the placebo group the MMSE remained essentially unchanged, decreasing slightly from 21 (SD 2) to 20 (SD 3), but in the treatment group the MMSE increased from 18 (SD 3) to 28 (SD 4), i.e. an increase in 10 points. This compares with a typical mean response of 1.84 MMSE points (95% CI, 0.53 to 3.15) for the best available treatment at present for dementia (donepezil, a cholinesterase inhibitor) (9). We feel that there is still some concern over the cognitive tests and procedures used which could be clarified by Dr Chandra’s description of the exact tests used. As both Dr Sharma (10) and Dr Bergmann (11) state (identically) in their rapid responses: “Even a high school student, and certainly a physician, can learn within a few weeks how to administer the cognitive tests used by Chandra.” It should therefore surely be simple for him to clarify the exact methodology he used. We also believe that many of the issues raised may be resolved if Dr Chandra made his original data available for reanalysis. Some of our group belong to the American Psychological Association, which requires that authors in their journals make data available for possible re-analysis up to five years after publication. In the present case the proper course of action would be for Dr Chandra to indicate a willingness to submit the data for analysis by other, impartial, researchers. Numerous sources have requested this on many occasions, and if Dr Chandra “stand[s] by [his] research” (4) we would urge him to make the raw data available for reanalysis. References 1. Shenkin SD, Whiteman MC, Pattie A, Deary IJ. Supplementation and the elderly: dramatic results? Nutrition 2002;18:364 2. Chandra RK. Effect of vitamin and trace-element supplementation on cognitive function in elderly subjects. Nutrition 2001;17:709-12. 3. White C. Three journals raise doubts on validity of Canadian studies. BMJ 2003; 328: 67 4. Chandra R.K Nutrient supplements and health. http://bmj.bmjjournals.com/cgi/eletters/328/7431/67#48308 5. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state." A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189. 6. Chandra RK. Response to the comments of Shenkin et al. Nutrition 2002;18:364-365 7. Chandra RK. Can nutrient supplements improve functional outcome in the elderly? Nutrition 2003;19:978-980. 8. Shenkin SD, Whiteman MC, Pattie A, Deary IJ. Continued concern about nutritional supplements and cognitive function in the elderly. Nutrition 2004 (in press) 9. Birks JS. Harvey R. Donepezil for dementia due to Alzheimer's disease. Cochrane Database of Systematic Reviews. 2003; (3):CD001190. 10. Sharma JP. Every scientific evidence is not always fact: the Canadian studies. http://bmj.bmjjournals.com/cgi/eletters/328/7431/67#48042 11. Bergmann, KF. Contents of news reports should be verified before publication. http://bmj.bmjjournals.com/cgi/eletters/328/7431/67#48042 Competing interests: My father (A Shenkin) is European editor of Nutrition, but has had no input into our group's discussions, conclusions, or letters
A Journalist's Recommendation to BMJ 28 January 2004
Gillian E Mahoney, Freelance Journalist 3044 Bloor Street West, Toronto M8X 2Y8, Canada Send response to journal: Re: A Journalist's Recommendation to BMJ	I am a free lance journalist with degrees in Psychology and Law. I am currently in India doing a story on the country's health system, especially malnutrition and infections. I have read the exchange of letters on the news item by Caroline White (BMJ 2004;328:67) and all related publications. Most readers would conclude that the contents of the news report is easily contradicted by quickly confirmed facts. For instance, the statement in it that is attributed to Strawbridge about the proportion of articles that Chandra submitted to the journal he edits is grossly incorrect and should have been checked prior to publication. Similarly, Richard Smith, editor of BMJ, acknowledges BMJ's mistake when it raised the issue of the number of digits to be recalled by subjects in Chandra's study. I have been able to gain access to the correspondence between BMJ and President Meisen. Editor Smith's denial about the BMJ in-house editor writing about Dr Parfrey being in Newfoundland is not supported by his own letter dated 19 December 2000 to Meisen. Following the investigation suggested by BMJ, Meisen wrote to Chandra on 2nd April 2001 that "you suggest that I raise with the editor of the British Medical Journal the matter of Dr Parfrey's name being mentioned in the addendum to the original communication", namely "You may wish to know that Dr Parfrey is based in Newfoundland" in the commentary by the BMJ in-house editor. By not fully accepting the results of the investigation by Meisen and senior professors at Memorial University, Smith seems to doubt their methods of inquiry and conclusions. This seems most unfair to Meisen, his advisers, and Chandra. What assurance do these individuals have that one more inquiry would satisfy BMJ? In the last few weeks, I have met a number of doctors and researchers in many provinces in India all of whom have a very high regard for Chandra and full confidence in all his contributions from 1961 to date. Some have re-examined the conclusions of his studies and confirmed them again. After reading the BMJ news item, some plan to cancel their subscriptions to BMJ publications and will ask their libraries to do the same. In the interest of fair journalism, it is time for BMJ to put an end to this matter by apologizing to its readers for the incorrect contents and the sensational defamatory headlines of the news item by Caroline White. Competing interests: None declared
There is Still Time for Meeting,Discussion and Apology;Revised. 29 January 2004
Ram B Singh, Director,Medical Hospital and Research Centre Moradabad(UP)244001,India Send response to journal: Re: There is Still Time for Meeting,Discussion and Apology;Revised.	Sir,It is important that the editor and Dr Chandra should sit for discussion, on some controversial issues along with impartial refrees,at least one to be suggested by Dr Chandra.The problem with the editor is that he believes more to refrees that are antagonist to the status and work of Dr Chandra.I think,the editor should maintain an impartial view and should give all opportunities to the authors.After all,it is the authors that make a journal. I invite both the editor and Chandra at New Delhi for a possible solution,provided both the party agree,to save the reputation of the journal. The editor has gently admitted two of his mistakes in the White's news indicating his enthusiasm to defame Dr Chandra for this he should pay the damages.For other questions raised by opponent group and readers,I would request the editor to once again request Meisen to conduct the inquiry pointing to the questions raised.However,he should assure Dr Chandra that no further inquiry would be done and Meisens findings would be respected by both the groups. Regarding apparently health subjects,it should be noted that we do not exclude a disease or abnormality by tests.It simply means that none of the subjects reported any problem. However,on testing,they may report their problems. Finally,any body can speak untruth at occasions,for example when I requested Sharon to give me the email address of Dr Chandra,I was informed that his address is not available in the BMJ office but next day Chandra informed me that he has email correspondence with Sharon for the last few days.This does not mean that Sharon wants to do any conspiracy but it is just a matter of human nature.ANY WAY,THE EDITOR MUST BE CAUTIOUS ABOUT THE ADVISES OF ANTAGONISTS EXPERTS WHO ARE DANGEROUS AND WHO ARE RESPONSIBLE FOR DEFAMING DR Chandra. R B Singh Competing interests: None declared
Science or politics 29 January 2004
Rakesh Sharma, Consultant Nutritionist-Scientist BigGym Health Center and Columbia University, New York, NY 10033 Send response to journal: Re: Science or politics	Sir, I am interested to know the contributions of Caroline White if any single research paper is available to read more about her expertise in the vitamin experimental or clinical research before to disregard the concepts inspired by Professor R.K.Chandra in last two decades. I request her personally to convince all of the nutrition-physician community by her authentic response to contradict the biochemical basis of JAVAAN 50 clinical trial as questioned in her letter. Her positive scientific response will certainly inspire new research idea as contributory to the research reported by Professor R.K.Chandra. In last, I appreciate her for information of political minds in nutrition science. Thanks. Rakesh Sharma, Ph.D.,MB-Ph.D Competing interests: None declared
Irreconcilable Differences 30 January 2004
Joseph . C . Obi, Chief Consultant WellnessClinics.co.uk Send response to journal: Re: Irreconcilable Differences	No Victor ; No Vanquished... Professors Richard Smith and Ranjit Chandra should please kindly 'get divorced' ; to bring this whole unhealthy 'forced marriage' to immediate closure. Editor Richard Smith rightfully has his own 'raft' of logical reasons for refusing to publish what he has (all but) classified as 'dodgy bits of shady research'...while Immunologist Ranjit Chandra obviously has 'strategic reasons' for (Shock !!! Horror !!! Holy MBBS !!!) not delegating specific tasks like Psychometric or Cognitive Testing to either a 'Psychiatrist' or 'Psychologist'. Furthermore, one million clinical research articles are solidly rejected by editors every single year ; and so I don't see any reason why this particular series of exceedingly controversial methodology is suddenly hitting the 'Mudslingers Alley' of BMJ.com !!! Professors Smith and Chandra are both 'Unrepentant Academic Heavyweights'; and I frantically fear that this 'Chronic Personality Feud' may actually be doing more harm than good to innocent little 'Clinical Dogsbodies' (like me) who are trying extremely hard to come up with scientifically acceptable 'Alternative Products'. Competing interests: Dr Joseph Chikelue Obi MBBS MD MPH DSc FRIPH FACAM is also the Chairman of the General Wellness Assembly (GWA); an International Professional Body for Independent Wellness Consultants.He has recently just accepted an unpaid role as an 'NHS Champion' for the rights of Older People ;and also humbly invented the 'Omnipill'.
News and Nutrition 30 January 2004
Rakesh Sharma, Consultant Nutritionist-Scientist BigGym Health Center and Columbia University, New York, NY 10033 Send response to journal: Re: News and Nutrition	Sir, I requested in my first letter for correcting and compromising this political ordeal mutually without loosing trust and without disappointing BMJ readers and public who are inspired by magical success of nutriceuticals as alternative medicines since ages. Still that letter is not posted. It further raises serious doubts as if Caroline White "newsmaker" planted defamation on behalf of Dr. Smith and others against Professor Chandra to make money or otherwise. I shall be grateful if my first letter is posted and any doubt related with biochemistry or nutrition basis of hypothesis or ideas of Professor Chandra are judged without prejudice(not by newsmakers for street public but for nutrition professionals). It will help us not to pay attention for non-nutrition news worldwide and help us to be aware of 'newsmakers' so-called nutritionists. Thanks. Rakesh Sharma Competing interests: None declared
dr white should be kind enough to resign 9 February 2004
drmanoj saxena, private clinic metro pathology centre Send response to journal: Re: dr white should be kind enough to resign	it was really surprising to read about the views of dr white about dr chandra whose calibre is well known thruout the world.i think dr chandra does not need any certificate from dr white.dr white's statement has raised doubts about the functioning of BMJ in toto.The management of journal should ask dr white to resign,otherwise the reputation of BMJ will godown like anything and dr white will solely be responsible for that. Dr.Manoj Saxena Competing interests: None declared
Those accountable for the contents of BMJ should apologize 9 February 2004
Karl F Bergmann, Scientist Journalist Geneve 6, Suisse Send response to journal: Re: Those accountable for the contents of BMJ should apologize	The debate emanating from Caroline White's item has pointed out several errors in her statements. (She admits to two of these in her correction addendum). It is also unfair for a journalist to quote extensively the views of her paymaster, the editor of BMJ, who is a party to the disputed story. Moreover, it is unethical for White to create headlines from the comments of and attribute statements from the in-house editor who continues to wear the veil of anonymity, thereby making it impossible for an impartial reader to check his credibility or know the sources of his funding that indicate that the individual is in conflict of interest. BMJ claims an open review policy in which the identity of reviewers/editors is revealed;in this instance the identity of the individual remains hidden. Why? It is also evident that Strawbridge's statements quoted by White are in error. The BMJ editor Richard Smith defends White but there are two obvious errors in his comments as well. He admits to one about the number of digits,now admitted also by White. Similarly the denial of the reference to Parfrey in the in-house editor's comments is in error, as per Meisen's letter to Chandra in which he quotes Smith and the attached house editor's remarks. These are enough grounds for a law suit for defamation and for a public interest litigation. I note that Susan Shenkin did not disclose any conflict of interest in her first letter to Nutrition (2002;18:364). She does so now. However, coeditor Alan Shenkin did not disclose any conflict (Nutrition 2003;19:955) whereas his daughter Susan Shenkin thinks differently and discloses her relationship to him. Both Shenkins and editor Meguid do not disclose the financial support in terms of grants and speaking fees from companies that deal in nutritional supplements. Those who have been most vocal in their negative comments about the Chandra study results have wasted a lot of time, almost 30 months, in stead of repeating the study. The latter would be the most scientific and ethical way to voicing a different view point. Given the above facts, most publications and the editor accountable for their contents would apologize to the person concerned, in this instance Chandra. And the matter can end there with an out-of-court settlement. (Recently, the New York Times let go of the services of senior editors in an instance of wrong and unfair reporting). If this does not happen soon, the growing resentment against BMJ would result in the cancellation of many personal and library subscriptions to the journal and allied publications, amounting to substantial financial loss to the British Medical Association (BMA). Moreover, many authors will think twice before submitting their papers to this group of journals. When that happens, there will be many red faces and the members of BMA and the bosses at BMA will not be pleased. Competing interests: None declared
Chandra should present himself to the Memorial University of Newfoundland for a full inquiry 10 February 2004
Richard Smith, Editor BMJ Send response to journal: Re: Chandra should present himself to the Memorial University of Newfoundland for a full inquiry	Very serious questions have been raised about the work of Professor Chandra, and those questions can be satisfactorily answered only by Professor Chandra cooperating fully with an inquiry conducted by the Memorial University of Newfoundland--preferably with independent input. If he does not cooperate then the questions will remain, and his critics will reach their own conclusions. Currently he is not cooperating. Nobody should attack Caroline White, the BMJ journalist who wrote our story. She did an excellent job in difficult circumstances. I am the person to attack. I initiated the complaint to the university and the news story. There are many ways by which people attack stories that they don't like. One is to make attacks on the author rather than on his or her ideas and words. Another is to find a small error in a piece and then suggest that the whole piece is incorrect. Both of these methods have been used in this case--and they should be seen for what they are, diversions from the main issue. Richard Smith, editor, BMJ Competing interests: I'm the editor of the BMJ and accountablwe for all it contains. I asked the Memorial University of Newfoundland to investigate Chandra's work.
Re: The BMJ's continuing doubts on the work of Professor Chandra 10 February 2004
Wasim Maziak, Director, Syrian Center fo Tobacco Studies Aleppo-Syria Send response to journal: Re: Re: The BMJ's continuing doubts on the work of Professor Chandra	Sir- The use of part of a confidential review in the dramatic way Ms. White has done in relation to Dr. Chandra’s study (big blue centered font), is a major breach to scientific publishing principles as well as to common sense. Now that reviewer has become a party in any further investigation of this issue, whether he wanted it or not. How we will be encouraged to do paper reviews for journals if this can subject us to such an outcome. Now whether the reviewer agrees to use his review or not does not change the matter much; that is a confidential process of scientific evaluation has been used out of its purpose and context to damage the reputation of an individual. Besides what is the persuasive logic behind posting that statement? This like presenting an argument that God exists by quoting part of the Bible. Regardless of the quality of Dr. Chandra’s research, presenting the issue of the validity of scientific data in a lay journal’s style is inappropriate. We all know how scientific results can be criticized or debated, what the BMJ has done is of little relevance in this regard. Dr. Smith should be reminded that neither Memorial University or Dr. Chandra’s non-responsiveness to his questions makes the accused guilty. This is the duty of a special inquiry or a judicial process. He also should be reminded that the least we expect from an editor is to respect the integrity of researchers and scientists, so I’m really disturbed by the title of Dr. Smith’s response “The BMJ's continuing doubts on the work of Professor Chandra”. This is changing the issue from questioning the validity of a research work to damaging the integrity of a researcher. In essence, the BMJ allowed itself to go on and damage the reputation of a person based on suspicions and allegations Competing interests: None declared
Response from the Editor-in-Chief of Nutrition 11 February 2004
Michael M Meguid, Editor-in-Chief, Nutrition Send response to journal: Re: Response from the Editor-in-Chief of Nutrition	Dear Sir, Concerning the Chandra debate: if Dr. Chandra was to provide the details of the study methodology and the original data as requested by his critics, wouldn’t the debate end? The scientific process encompasses: 1. the careful conduct of the researcher and/or by his/her team and the acquisition of credible data; 2. the description of the research in a manuscript, with presentation of the data and logical interpretation, such that fellow scientists can reproduce the data; 3. a peer review system of the manuscript prior to publication ; 4. following its publication, withstanding the scrutiny of the data by readers of the paper; 5. in the long-term, the independent reproducibility of the data based on the methods reported in the paper. In the past, Nutrition’s readers have occasionally raised issues based on point number 4, above, and these have always been satisfactorily resolved by open discussion and, if necessary to satisfy statistical concerns, by disclosure of the data. With regard to Dr Chandra’s study, the controversy over the veracity of the data could have been resolved at an early stage, and can still be easily resolved were Dr Chandra to provide the details of the study methodology and the original data to his critics. Until now, despite contrary claims, he has failed to provide specific answers to questions about the methodology, nor access to the data. Why? Competing interests: I have no financial or intellectual conflict of interest.
Dr Chandra- please provide clear answers to the questions raised 18 February 2004
Alan Shenkin, Professor of Clinical Chemistry University of Liverpool, Liverpool, L69 3GA Send response to journal: Re: Dr Chandra- please provide clear answers to the questions raised	In the rapid responses following Caroline White’s report of concerns about the study published by Dr Chandra in Nutrition, a number of correspondents have felt it more appropriate to attack the motives of those who have asked questions about Dr Chandra’s paper, rather than ask for Dr Chandra to reply to the specific concerns raised about the methodology and results of his trial. I am a researcher who has spent most of his academic life working in the field of micronutrients, and over the years I have heavily quoted Dr Chandra’s work in my publications. Together with most other workers in this field, I am constantly seeking examples of functional effects of micronutrients, over and above prevention of deficiency states. Having had no involvement in its pre-publication assessment, I was therefore delighted to see his paper when it was published in Nutrition in 2001. By coincidence, my daughter is a research fellow interested in influences on cognitive ageing so I drew her attention to it. It was her research group in the Department of Psychology in the University of Edinburgh which raised the initial questions, (expanded by Roberts and Sternberg) which still remain to be answered. None of us involved in academic work in this field are seeking anything other than clarification of aspects of the methodology and the data. From my point of view, I would very much like Dr Chandra to provide clear answers to these simple questions, so that in future articles I write I can quote his paper in Nutrition with a full understanding of the methods and the results. Competing interests: Competing interests: I am European Editor of the journal Nutrition. In the past, I have received research grants for studies on micronutrient supplements, but currently I have no financial link with any company involved with such supplements.
Any one who preaches a gospel should also practice it 19 February 2004
Ranjit K Chandra, Consultant Physician Y-182 Regency Park DLF Phase IV, Gurgaon 122002, India Send response to journal: Re: Any one who preaches a gospel should also practice it	I have full faith in the expertise and impartiality of President Alex Meisen of Memorial University. I had provided all the information he had asked for including relevant raw data so that the accuracy of numbers, digits and statistics in my paper could be verified. After extensive review in which he was aided was senior professors in the relevant subjects, Meisen wrote to BMJ editor Richard Smith on 02 April 2001, saying "In all respects, I am satisfied that there has been no wrongdoing by Dr. Chandra and I urge you to draw the same conclusion". There is no assurance that yet another inquiry by Memorial University would satisfy those who have been critical of my study. Will they believe the conclusions of a new inquiry? This could go on for ever and ever, ad nauseatum. The research files and spare serum samples of most of my studies conducted in Newfoundland and patient files over a 20-year period are stored in more than fifty large movers's boxes and two deep freezers that were handed over to the office of the Dean of Medicine when I left St. John's. I am willing to attempt retrieval of all available data relevant to the study. This will be time consuming and expensive. Before I do this, I must: 1. Receive the raw data from Michael Meguid for studies reported in Nutrition Research (2001;21:395). This request was made prior to the submission of my manuscript to Nutrition and has been pending for three years. Meguid should not, nor should any one else making comments on my paper, expect others to comply with similar requests when he is unwilling to do it. 2. Know the action taken by the Memorial University administration on the breaking of locks of my office, desks and filing cabinets. A list of the files that were obviously missing was provided immediately to Dean Ian Bowmer. The list was not all-inclusive and a second list was given to Bowmer after a few weeks. I seek an apology from the individual who authorized this break in. The episode has all the makings of the infamous Watergate. Surely, this cannot be condoned in law-abiding Canada. 3. Receive an erratum statement and apology from Jack Strawbridge for making inaccurate statements, such as the proportion of my papers in Nutrition Research, the dates of my resignation and leaving St. John's. These statements were quoted in print by Caroline White and by Barbara Sweet. 4. Be provided with a complete list of souces of funding, speaker fees and honoraria for all individuals critical of my paper (Roberts, Sternberg, Meguid, Smith, Susan Shenkin, Alan Shenkin, and the BMJ in- house editor whose comments started this debate). It is quite possible that some of these individuals received funds from industry that deals with nutritional supplements or pharmaceutical companies that deal with medications for disorders of cognitive functions and therefore may well be in conflict of interest. 5. Be informed of the identity of the BMJ in-house editor whose comments form the bulk of White's item and who continues to wear the burqa (veil) of anonymity even though BMJ claims to have an open review policy. I stand by my research. The study design was described in clear terms, the methods used were referenced by published citations, and the conclusions were preliminary and cautious. Any competent reader has all the information needed to repeat the study. As many individuals have remarked, the best test to verify the conclusions of any research is to repeat the study using an almost identical design and intervention. This has now happened. The main conclusions of my study have been confirmed by at least two other groups of investigators who will be sending their papers for publication in the next few months, but obviously not to BMJ or Nutrition, nor would they wish parties to this debate to be expert reviewers of the manuscripts. Finally, any one still in doubt about any aspect of my study can write to me directly, making sure that he/she has read my paper as also the earlier responses in Nutrition (2003;19:976-980) and in these columns. The shoe cannot be worn on one foot only. Any one who preaches a gospel should also practice it. Competing interests: I hold patent for a multinutrient and have not derived any financial benefit from this.
Have you decided to Spoil the Image of BMJ? 20 February 2004
Ram B Singh, Director,Medical Hospital and Research Centre Moradabad(UP)244001,India Send response to journal: Re: Have you decided to Spoil the Image of BMJ?	Sir, It is a common human tendency to emphasise your strength and shirk your weaknesses,which is clear from the recent correspondence from Dr Chandra and BMJ editor.Dr Smith,the editor has honestly admitted that Dr Caroline writes for him rather than for herself,which is very great of him.However,Dr Smith has pointed out that Dr Chandra has ignored several points,while answering the allegations which is quite natural because he wants to defend.What is unnatural is,that so far their is no apology from editorial board of BMJ for the mistakes in the news article blaming Dr Chandra which indicates,conflict of interest,simply to damage his reputation. The editor is insisting that Dr Chandra should submit himself for the inquiry to his University authorities.In case,the inquiry is in favour of Dr Chandra,can BMJ promise to pay him UK pounds one million as damages to his reputation and would not insist for another inquiry.If the dispute continues,it would definitely damage the reputation of BMJ and BMA, which is still silent. R B Singh Competing interests: Dr Chandra is known to me for the last 20 years and both work on clinical nutrition
Re: Contents of News Reports Should be Verified Before Publication 24 February 2004
Shiv Kumar, private practitioner Bokaro Steel City, Jharkhand, India-827006, Rakesh Kumar, Rashmi Send response to journal: Re: Re: Contents of News Reports Should be Verified Before Publication	This response appears unusual and it appears as though it is written by Dr. Chandra himself posing as Karl F Bergmann. Is it possible to investigate whether the person (Bergmann) exists at the Switzerland address provided and the place that has been used to write the response? The details provided in this response are too accurate and precise to be known to people other than Dr. Chandra. Competing interests: None declared
Response to Dr. Chandra 29 February 2004
Saul Sternberg, Professor of Psychology University of Pennsylvania, Philadelphia 19104-6228, Seth Roberts Send response to journal: Re: Response to Dr. Chandra	We would like to respond to several statements by Dr. Chandra in his Rapid Responses of January 26 (1) and February 19 (2). First, “since the publication of the correspondence in Nutrition,” Dr. Chandra wrote, “I have consulted other statisticians who state that from the published paper it is impossible to derive statistical analyses and conclusions of the kind claimed by Roberts and Sternberg” (1). It is curious that he did not consult them before writing his reply (3) to our letter (4). We encourage these statisticians to make public their criticisms of our analyses and conclusions. Second, "despite repeated requests,” Dr. Chandra wrote,” Drs. Roberts, Sternberg and Meguid have failed to indicate sources of their funding, receipt of speaking fees and honoraria” (1). We have no idea what “repeated requests” he refers to. Email to Dr. Chandra asking him what he meant has not been answered. In both (4) and (5) we stated that we had no conflicts of interest. In his later Rapid Response, Dr. Chandra wrote that perhaps we had “received funds from industry that deals with nutritional supplements or pharmaceutical companies that deal with medications for disorders of cognitive functions and therefore may well be in conflict of interest” (2). We have received no such funds. Third, Dr. Chandra stated that he has “not received any financial benefit from [his multinutrient patent]” (2). This leaves open the possibility that his children have received financial benefits from it. According to a March 2003 press release from the Javaan Corporation (available on February 28, 2004 at www.javaancorp.com/press-releases/company-fact-sheet.pdf), located in Somerville, Massachusetts, “Ms. Amrita Chandra, 32, founded Javaan Corporation with the mission to produce quality nutritional products based on the research of her father, Dr. Ranjit K. Chandra, an internationally renowned expert in nutritional immunology.” The press release describes in detail the Nutrition study that we criticized. Finally, Dr. Chandra wrote, "I stand by my research. ... the methods used were referenced by published citations" (2). This is not entirely correct. No citation was given for the test of "long-term memory recall" he claimed to have used (6), a test whose existence we questioned (4). Fortunately Dr. Chandra has offered (2) to answer questions about his work (“any one still in doubt about any aspect of my study can write to me directly”). Anyone with questions about the accuracy of our criticisms here or earlier (4, 5) can write to Dr. Chandra and, via a Rapid Response, inform bmj readers of his answer. 1. Chandra RK Nutrient supplements and health. (26 January 2004) http://bmj.bmjjournals.com/cgi/eletters/328/7431/67#47651 2. Chandra RK .Any one who preaches a gospel should also practice it. (19 February 2004). http://bmj.bmjjournals.com/cgi/eletters/328/7431/67#50788 3. Chandra RK. Can nutrient supplements improve functional outcome in the elderly? Nutrition 2003; 19: 978-80. 4. Roberts S, Sternberg S. Do nutritional supplements improve cognitive function in the elderly? Nutrition 2003; 19: 976-8. 5. Carpenter KC, Roberts S, Sternberg S. Nutrition and immune function: a 1992 report. Lancet 2003; 361: 2247. 6. Chandra RK. Effect of vitamin and trace element supplementation on cognitive function in elderly subjects. Nutrition 2001; 17: 709-12. Competing interests: We are the authors of a letter in Nutrition (4) criticizing Dr. Chandra’s 2001 Nutrition article (6) and co-authors of a letter in The Lancet (5) criticizing an earlier article by Dr. Chandra.
Re: Every scientific evidence is not always fact: the Canadian studies 4 March 2004
Shiv Kumar, Private practitioner Bokaro Steel City, Jharkhand, India-827006, Rakesh Kumar, Rashmi Send response to journal: Re: Re: Every scientific evidence is not always fact: the Canadian studies	It is amazing to see the degree of similarity in this response and the one by "Karl F Bergmann". This response is word-by-word similar to the third paragraph of "Bergmann"'s response. We feel that both these responses are written by Dr. Chandra himself or through his close friends/relatives. Could these be verified in some manner? Competing interests: None declared
Re: Have you decided to Spoil the Image of BMJ? 6 May 2004
Dr.Devan. P.P., Consultant Mangalore Send response to journal: Re: Re: Have you decided to Spoil the Image of BMJ?	I have been following Dr.Chandra'swork for several years in the American Jn of Clinical Nutrition and based mostly on his work, mainly practise nutrition medicine. There are a large no. of patients whom i have treated, applying his discoveries and who have completely recovered from recurrent infections like chronic tonsillitis, sinusitis etc. The effect of improvement on memorary recall in the elderly is amazing...to this end , my patients and myself remain indebted to Dr.Chandra for his seminal work. Using his discoveries , i have been able to build a substantial practice. This is my practical, first hand experience. In this regard, the current controversy seems to be unwarrented, since i can vouch for the practical application of his work. The essence of knowledge is knowing it to apply it and get consistent results. Dr.Devan.P.P. Consultant ENT specialist Bejai, Mangalore, India Competing interests: None declared