Nutritional support is a key issue in the management of any patient in hospital but Des Spence is correct when he says the evidence for these supplements is poor! NICE has been wrong about so much in the past - for example, activated protein C in septic shock - that we really cannot have much confidence in their judgement! There are too many commercial interests at play and Des is right when he says we should put more emphasis on feeding decent food to our patients! In my experience, patients languish in hospital with nurses and dieticians paying little interest in how much GOOD food they get to eat! Whilst we are quite prepared to pay for 7 days of meropenem and vancomycin (plus monitoring) we are still only coughing up 5 - 10 British pounds per day for food ...! What can you get for that?

Competing interests: None declared