Bad Science

bad science

Bad Science‘ is a 2008 book by British physician and science writer Ben Goldacre, criticizing mainstream media reporting on health and science issues. The book contains extended and revised versions of many of his ‘Guardian’ columns.

The book discusses topics such as detoxification (Aqua Detox, ear candles etc.) that can easily be shown to be bogus by simple experiments, and discusses the ‘detox phenomenon’ and purification rituals. He also addresses the claims for Brain Gym, a program of specific physical exercises that its commercial promoters claim can create new pathways in the brain. The uncritical adoption of this program by sections of the British school system is derided.

Goldacre used the example of homeopathy to prompt a discussion of the nature of scientific evidence, with reference to the placebo effect, regression to the mean, and the importance of blind testing and randomization in the design of fair clinical trials. Having concluded that homeopathic pills have been shown to work no better than placebo pills, the author suggests homeopathy may still have psychological benefits which could be the subject of further study.

The placebo effect is discussed further as Goldacre addresses the power of the mind over pain, anxiety, and depression, as indicated by studies showing how higher prices, fancy packaging, theatrical procedures, and a confident attitude in the doctor all contribute to the relief of symptoms. In patients with no specific diagnosed condition, even a fake diagnosis and prognosis with no other treatment helps recovery. However, ethical and time constraints usually prevent doctors from giving this reassurance. Exploiting the placebo effect is presented as possibly justifiable if used in conjunction with effective conventional treatments. The author links its use by alternative medicine practitioners with the diversion of patients away from effective treatments and the undermining of public health campaigns on AIDS and malaria.

In chapter 6, nutritionists are accused of misusing science and mystifying diet to bamboozle the public. Misrepresentations of the results of legitimate scientific research lend bogus authority to nutritionist theories, while ignoring alternative explanations cited in evidence. The use of weak circumstantial associations between diet and health found in observational studies is criticized. The unjustified over-interpretation of surrogate outcomes in animal (or tissue culture) experiments as proving human health benefits is explored. The cherry picking of published research to support a favoured view is contrasted with the systematic review designed to minimize such bias. The supposed benefits of antioxidants are questioned with studies showing they may be ineffective or even harmful in some cases. The methods used by the food supplement industry to manufacture doubt about any critical scientific reports are likened to those previously used by the tobacco and asbestos industries.

Goldacre sets aside a chapter to address Scottish TV diet guru and self-styled ‘doctor’ Gillian McKeith. Statements exemplifying her scientific knowledge include that the consumption of dark-leaved vegetables like spinach ‘will really oxygenate your blood’ as they are high in chlorophyll, and that ‘each sprouting seed is packed with the nutritional energy needed to create a fully-grown, healthy plant.’ She is described masquerading as a genuine medical doctor on her TV reality/health shows. Her publications are compared with a Melanesian cargo cult; superficially correct but lacking any scientific substance. Her belief in the special nutritional value of plant enzymes (which are broken down in the gut like any other proteins) is ridiculed. The general problems involved in establishing any firm links between diet and health are examined.

The claim that fish oil capsules make children smarter is examined. The book probes the methodological weaknesses of the widely publicized ‘Durham trial’ where the pills were given to children to improve their school performance and behavior, but without any control groups and wide open to a range of confounding factors. The failure to publish any results and backtracking on earlier claims by the education authorities is slated. The media’s preference for simple science stories and role in promoting dubious health products is highlighted. Parallels are drawn between the Equazen company behind the Durham fish oil trials and the Efamol company’s promotion of evening primrose oil.

Chapter 9 is devoted to Professor Patrick Holford, best-selling author, media commentator, businessman and founder of the Institute for Optimum Nutrition (which has trained most of the UK’s ‘nutrition therapists’). Holford’s success in presenting nutritionism as a scientific discipline in the media, and forging links with some British universities is also noted. The book judges that his success is based on misinterpreting and cherry-picking favorable results from the medical literature. His promotion of vitamin C in preference to AZT as a treatment for AIDS, vitamin E to prevent heart attacks, and vitamin A to treat autism are all condemned as lacking in sound evidential support. His reliance on the work of discredited fellow nutritionist Dr. R.K. Chandra is likewise slated. The Universities of Luton and Teesside are criticized for their past associations with Holford and the ION.

Taking the broadview of Western medicine, the book remarks on the relatively low percentage of conventional medical activity (50 to 80%) which could be called ‘evidence-based.’ The efforts of the medical profession to weed out bad treatments are hampered by the withholding or distortion of evidence by drug companies. The science and economics of drug development are outlined, with criticism of the lack of independence of industrial research and the neglect of Third World diseases. Some underhand tricks used by drug companies to engineer positive trial results for their products are explored. The publication bias produced by researchers not publishing negative results is illustrated with funnel plots.

The misrepresentation of science and scientists in the media is attributed to the preponderance of humanities graduates in journalism. The dumbing-down of science to produce easily assimilated wacky, breakthrough, or scare stories is criticized. Wacky ‘formula stories’ like those for ‘the perfect boiled egg’ or ‘most depressing day of the year’ are revealed to be the product of PR companies using biddable academics to add weight to their marketing campaigns. Among other examples, the speculation by Dr. Oliver Curry (a political theorist at the London School of Economics) that the human race will evolve into two separate races, presented as a science story across the British media, is exposed as a PR stunt for a men’s TV channel. The relative scarcity of sensational medical breakthroughs since a golden age of discovery between 1935 and 1975, is seen as motivating the production of dumbed-down stories which trumpet unpublished research and ill-founded speculation. An inability to evaluate the soundness of scientific evidence is seen to give undeserved prominence to marginal figures with fringe views.

Chapter 12, ‘Why Clever People Believe Stupid Things,’ is a brief introduction to the research on cognitive biases, which, Goldacre argues, explain some of the appeal of alternative medicine ideas. Biases mentioned include confirmation bias, the availability heuristic, illusory superiority and the clustering illusion (the misperception of random data). It also discusses Solomon Asch’s classic study of social conformity. The following chapter covers the cases of Sally Clark and Lucia de Berk, in which the author says poor understanding and presentation of statistics played an important part in their criminal trials.

Goldacre closes the book by noting how the ‘Daily Mirror’ once managed to combine ‘three all-time classic bogus science stories’ into one editorial: the Arpad Pusztai affair of GM crops, Andrew Wakefield and the MMR vaccine controversy, and Chris Malyszewicz and the MRSA hoax. On the other hand journalists were very poor in uncovering or reporting on the thalidomide tragedy – only covering well the ultimate political issue of compensation.

After the release of the book, Goldacre won a libel case case filed against him by Matthias Rath, who had been holding up publication of a chapter. In 2009 Goldacre released the material, stating: ‘This is the ‘missing chapter’ about vitamin pill salesman Matthias Rath. Sadly I was unable to write about him at the time that book was initially published, as he was suing my ass in the High Court.’ The full chapter has been made universally available under a Creative Commons license with the title, ‘The Doctor Will Sue You Now.’

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