First edition cover
| |
| Author | Ben Goldacre |
|---|---|
| Country | United Kingdom |
| Language | English |
| Subject | Pseudoscience |
| Genre | Non-fiction |
| Publisher | Fourth Estate |
Publication date
| September 2008 |
| Media type | Print (Paperback) |
| Pages | 338 |
| ISBN | 978-0-00-724019-7 |
| OCLC | 259713114 |
| 500 22 | |
| LC Class | Q172.5.E77 G65 2008 |
Bad Science is a book by Ben Goldacre, criticising mainstream media reporting on health and science issues. It was published by Fourth Estate in September 2008. It has been positively reviewed by the British Medical Journal and the Daily Telegraph and has reached the Top 10 bestseller list for Amazon Books. It was shortlisted for the 2009 Samuel Johnson Prize. Bad Science or BadScience is also the title of Goldacre's column in The Guardian and his website.
Contents
Introduction
A
brief introduction (by Goldacre) touching on subjects covered by
subsequent chapters. It bemoans the widespread lack of understanding of
evidence-based science.
Chapter 1: Matter
Chapter 1 is entitled Matter, but is really concerned with the modern trend for Detoxification.
Goldacre looks at three supposed detox treatments: aqua detox (a
footbath detox), Hopi Ear Candles, and detox patches. Each of these
so-called treatments is intended to remove toxins and impurities from
the body.
According to Goldacre, the manufacturers of these detox remedies
are unable or unwilling to state which toxins exactly are being removed
from the body. Goldacre debunks the claims made for each of these
products and says that the whole idea of detox is an invention. There
are no such toxins floating around the body in excessive quantities,
waiting to be removed by detox treatments.
Goldacre has no problem with the idea of someone choosing to give
their body a rest after overindulging, say. That is just common sense.
But he sees detox treatments as the modern equivalent of religious
rituals of purifcation or abstinence. Clearly, such rituals fill a human
need in some way - Goldacre has no problem with that. What is wrong,
however, is to pretend that these detox rituals are based in science.
They are not. At worst, they are supposed quick-fixes that distract from
the genuine lifestyle risk factors for ill health that affect us over
the long term.
Chapter 2: Brain Gym
Brain Gym
is a set of exercises and activities that are supposed to 'enhance the
experience of whole brain learning'. At the time when Goldacre’s book
was written, Brain Gym
was promoted by the Department for Education and used in hundreds of
state schools across the country. But Goldacre says this is
pseudoscience dressed up in clever long phrases and jargon. He goes on
to describe a 2008 study that suggested that people will tend to believe
a bad explanation written in sciencey terms, rather than a good
explanation that isn't decorated with sciencey words.
Some of the underlying ideas in Brain Gym
are sensible: regular breaks, intermittent light exercise and drinking
plenty of water are likely to help children learn. But Goldacre sees the
pseudoscientific explanation around it (such as the 26 special
movements and the ‘brain buttons’ concept) as an attempt to
'proprietorialise' common sense. That is, turn it into something that
you can patent, own, sell and make profit from. He sees this trend
particularly strongly among nutritionists. The corrosive side effect of
this ‘privatisation of common sense’ is that we become dependent on
outside systems and people, instead of taking control ourselves.
Chapter 3: The Progenium XY Complex
In
this short chapter, Goldacre looks at cosmetics - specifically,
moisturizers. According to Goldacre, expensive moisturisers tend to
contain three groups of ingredients: powerful chemicals that were
effective in making skin look younger, before they had to be watered
down because of their side effects; vegetable protein, which does
actually shrink wrinkles temporarily; and esoteric chemicals that are
meant to 'make you believe that all sorts of claims are being made'. But
the manufacturers are very careful to claim only that the moisturiser
as a whole will have beneficial effects - they don't make specific
claims about their 'magic ingredients', because such claims could be
easily challenged by the regulator.
Instead, the magic ingredients (such as the made-up Progenium XY
Complex) are only included to make it sound like some complicated
science is involved. And that is Goldacre's main complaint: The
cosmetics companies sell their products by appealing to the misleading
idea that science is complicated, incomprehensible, and impenetrable.
This is bad because the target audience who are bombarded with this
dubious world view are young women, a group who are under-represented in
science.
Chapter 4: Homeopathy
Goldacre provides an overview of the origins of Homeopathy (its ‘invention’ by Samuel Hahnemann in the late eighteenth century) and the basic ideas that characterise it: ‘like cures like’, the increase in potency by dilution,
succussion, proving, and the collation of remedies in a reference book.
He shows that the levels of dilution used in preparing homeopathic
remedies are so high, that the final ‘medicine’ contains no active
ingredient. He dismisses the idea of ‘water memory’, which has been used in more recent times to explain why homeopathic remedies still work, in spite of extreme dilution.
As far as Goldacre is concerned, it’s fine if someone wants to take a homeopathic remedy
because ‘it made me feel better last time’. However, the experience of
an individual (or a small group of people) cannot be used to as a basis
for saying that homeopathy works or that it is science. First of all, an
individual can have no way of knowing if they got better because of the
homeopathic remedy they took, the placebo effect or regression to the mean (that is, the natural cycle of the disease). Secondly, homeopathic remedies should be subjected to a ‘fair test’: a placebo-controlled trial. In fact, such tests have been carried out for homeopathic remedies and it has been shown that they are no better than placebo.
Goldacre says that some individual trials have shown that a
homeopathic remedy works. But usually these trials are found to have
methodological flaws. Typical problems with these trials have included a
poor quality approach to blinding or randomization. Another problem is
that trials of homeopathic remedies often don’t provide full information
about the methods used. Poor quality research studies tend to
exaggerate positive results. Goldacre provides a summary of a paper by
Ernst et al, which suggested that this has occurred in studies of
homeopathic arnica.
That said, Goldacre does concede that the overall experience of going
to see a homeopath does seem to have a positive effect on some patients,
and that would be worth investigating further.
What we really need, says Goldacre, is meta-analyses. This is when the results of smaller research studies are pooled and analysed together as a single group. The Cochrane Collaboration
was set up to carry out systematic reviews and meta-analyses. A
landmark study by Shang et al (2005), which looked at a vast number of
homeopathic trials, again found that homeopathic remedies perform no
better than placebo.
Goldacre criticises the homeopathic community for their lack of
understanding of how to carry out high quality research, their lack of
openness and transparency, their unwillingness to submit their research
to full and proper scrutiny, their rejection of justified academic
criticism and their overall aggressiveness. Using the specific example
of an interview with Elizabeth Thompson, he illustrates how homeopaths
will use nuanced language to avoid actually admitting that their pills
don’t work.
Chapter 5: The Placebo Effect
Examples
of the power of the mind over pain, anxiety and depression are
presented with 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, but 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.
Chapter 6: The Nonsense du Jour
Nutritionists
are accused of misusing science and mystifying diet to bamboozle the
public. Misrepresentations of the results of legitimate scientific
research to lend bogus authority to nutritionist theories, while
ignoring alternative explanations are cited in evidence. The use of weak
circumstantial associations between diet and health found in
observational studies as if they proved nutritionist claims is
criticised. 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 favored view is contrasted with the systematic review designed to minimise 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
Chapter 7: Dr Gillian McKeith PhD
The Scottish TV diet guru and self-styled "doctor" Gillian McKeith
and her scientific claims are dissected. 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.
Chapter 8: 'Pill Solves Complex Social Problem'
The claim that fish oil
capsules make children smarter is examined. The book probes the
methodological weaknesses of the widely publicised "Durham trial" where
the pills were given to children to improve their school performance and
behaviour, 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, with their refusal to divulge
any data through Freedom of Information Requests
specifically mentioned. 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: Professor Patrick Holford
The influence of the best-selling author, media commentator, businessman and founder of the Institute for Optimum Nutrition (which has trained most of the UK's "nutrition therapists") is acknowledged. 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 favourable results from the medical literature, in order
to market his vitamin pills. 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 criticised for their past associations with Holford and the ION.
Chapter 10: Is Mainstream Medicine Evil?
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 seen to be
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. Examples are made of the SSRI antidepressants and Vioxx
drugs. Reform of trials registers to prevent abuses is proposed. The
ethics of drug advertising and manipulation of patient advocacy groups
are questioned.
Chapter 11: How the Media Promote the Public Misunderstanding of Science
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 criticised. 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 LSE)
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
This chapter 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.
Chapter 13: Bad Stats
This 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.
Chapter 14: Health Scares
In this chapter, the author claims that the press selectively used a "laboratory" that gave positive MRSA results where other pathology labs found none. Creating an "expert" from Chris Malyszewicz who worked from a garden shed.
Goldacre notes 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.
Chapter 15: The Media's MMR Hoax
Andrew Wakefield and the MMR vaccine controversy.
The author continues to discuss the lab results in previous chapter and
discusses the MRSA mix up in hospitals wrong patients get wrong
results.
Index
The
hardback and first paperback editions did not include an index. Several
indexes were prepared by bloggers, including one prepared by Oliblog. The latest paperback issue includes a full index.
Previously unpublished chapter: "The Doctor Will Sue You Now"
Further
to the release of this book a resolution of the legal status of one of
the chapters has come about since Goldacre won a libel case filed
against him by Matthias Rath.
The post dated 9 April 2009 states: "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". Additionally, this full chapter is included as chapter 10 in the New Paperback Edition.
In this chapter the author explains its origin, its reasons for
being excluded, and describes his personal reasons and tribulations in
the said legal resolution. It contains an account of his anger at being
gagged due to legal/financial restrictions, his support by the Guardian (for whom he writes) and his now encyclopedic knowledge of the subject in question.
