Wednesday, 25 March 2009

Bad Science by Ben Goldacre

(Photo by Kerstin Rogers)


Dr Ben Goldacre is two people in one. On the one hand he is a Skeptic Knight and has a reputation as a debunker of “pseudoscience” and promoter of rational thought and scientific enquiry in medicine. But he is also a virulent opponent of the Pharmaceutical industry and its greed. He’d be far easier to deal with if he were merely the former and not the latter. It’s hard to assess a person who won’t fit into the boxes I’m used to fitting them into!

I went to see him give a live lecture a few months ago and wrote a report: http://hpanwo.blogspot.com/2008/09/skeptic-in-pub-15908.html . I was accompanied by my friend and fellow blogger Ms Marmitelover (see links column and the link in the lecture article to Marmite’s own report). Goldacre has an extensive website called “badscience” which contains articles, merchandise and radio shows: http://www.badscience.net/ . And lately I’ve borrowed a copy of his book, also entitled Bad Science. I should point out before I review the book that Goldacre has been the target of several lawsuits. Most significantly he was sued by the German doctor and nutrition campaigner Mathias Rath. This I consider a mistake for two reasons. Firstly I think it is highly immoral and destructive to use the legal system as a weapon to gag people who merely criticize you. The legal system must never be used to counter free speech because to do so is not only unethical but highly unwise when you consider that the legal system is becoming more and more authoritarian every day and that, like a muscle, the more you exercise it the stronger it gets. People who exploit this emerging tyranny for their own selfish ends are forging their own shackles, as well as everyone else’s. They themselves, as well as their opponents, will one day be gagged totally and permanently by the New World Order. The second reason for not trying to sue Goldacre is simply because he is not a threat to that which he opposes! If you are a purveyor of alternative remedies or a nutritionist then you are in no danger of losing any business through Goldacre’s work. This is because of the style of the book. Although the author claims that one of the objectives of his book is to teach his readers how to conduct their own personal enquiries and experiments to judge for themselves whether something they believe is true or false, this is not an educational book. If education of an impartial readership is Goldy’s aim then he shoots well wide of the mark. Bad Science is a belligerent polemic that uses words like “quack” and “quackery”, “nonsense”, “foolishness”, “dangerous” in almost every other sentence; especially at the beginning of the book. He describes celebrities who fear the MMR vaccine as “blowing on their toy trumpets” and also refers to what he calls “MMR-dodging north-London middle-class humanities graduates”. You can’t educate people by browbeating them. This kind of cudgel-diplomacy will cause readers to put up their defences and turn away. Anyone on the fence over the issue of alternative medicine will never be persuaded to abandon their position; on the contrary they will be knocked down decisively onto the pro-side by the book’s violence. Goldacre clearly feels strongly about what he writes about; but he completely fails to “murder his darlings” and therefore will win few converts. Because of this I’d say that this book is more aimed at fellow Skeptics or people like myself who are interested in the philosophy of science.

Like most of the Skeptics that I’ve come across, Goldy presents his case as one of unimpeachable simplicity. In fact his catchphrase is a ridicule of what he often hears homeopath’s say: “It’s a bit more complicated than that” and you can even buy T-shirts and baby’s bibs from his website with those words on them! In the section of his book on homeopathy he repeats a lot of the material he presented in the lecture that I link to above and reckons that the reason homeopathy sometimes comes out as successful is because of flaws in the clinical trials. The subjects might not have been selected randomly; some researchers use the date and time of the patients’ clinic appointments or their date of birth, but Goldy says this is not good enough, although he doesn’t really explain why. Apparently even tossing a coin is not an adequate way to divide subjects into the group which gets the treatment and the control-placebo group which is used to compare the treatment group with! According to the author, prejudices and bad recording can cause willfulness and a lack of “blinding” by whoever tosses the coin. Goldy goes to great lengths to explain how clinical trials by properly-trained personnel can still be done very badly and can fall foul to a number of different fallacies; in a way this contradicts the feeling of simplicity that I picked up earlier in the book. I often find this with Skeptics, as I said above. They’ll say: “There’s clearly no evidence whatsoever for (EG: the existence of ghosts); it’s very, very simple”. But then when serious studies are done to say that there actually is such evidence, they’ll come out with all kinds of convoluted reasons why this research was misleading. This mixture of simplicity and complexity sometimes ties my brain up in knots and I spent a lot of effort with Bad Science unraveling those knots. The concept of meta-analysis sounds good on first hearing. With meta-analysis you can take the information from lots of independent studies and draw an overreaching conclusion from the trends in each separate one. But this process also seems to be a way of weeding out inconvenient anomalies. This is especially the case when, as Goldy says, so many trials suffer from flaws. There is a tool in meta-analysis for grading each individual experiment into ranks of importance based on how flawed or un-flawed they are. It’s called “jading”. However the example Goldy provides includes a meta-analysis of homeopathy drug trials where positive results are gleaned from a high-ranking experiment. Goldy’s explanation?: It’s a “stitch-up”. Supposing it’s not a stitch-up, eh? But meta-analysis gives us a loophole for glossing over such aberrations and sticking by our guns without investigating them. Seeing as scientists spend so long at university learning the arts of experiment why do so many of them suffer from these supposed fallacies and commit such terrible errors of judgment? My own department at work is currently conducting trials of a new EEG machine and is selecting patients to be guinea pigs who have a “0” at the end of their hospital number; isn’t that randomization enough? Goldacre actually explores these tendencies to logical fallacy in a chapter called Why Do Clever People Believe Stupid Things? which echoes the insulting title of the Skeptic propaganda piece by Michael Shermer: Why Do People Believe Weird Things? Here he discuses how people are biased towards positive results, misunderstand coincidence and statistics to see patterns where there are none, are bad at assessing their own abilities and fall foul to cultural prejudices. He claims that the process of obtaining and interpreting scientific evidence isn’t taught in schools; well yes it is. I clearly recall being shown by my science teacher at school how to write up a scientific experiment. He’d show me how to put down my theory, purpose, hypothesis, method and conclusion in the proper way, how to draw diagrams and graphs; and he stressed how important it was: “If you die half-way though an experiment all your work will be lost unless somebody else can read your papers and understand how to pick it up where you left off.” Another thing that bothered me was that at no point in the book did Goldy ever acknowledge the possibility that he too might occasionally suffer from any of the fallacies he lists. This is especially important because he bolsters his case on every subject he writes about with “properly conducted” scientific trials; in other words: properly conducted according to his own standards. The author comes across as a super-confident “above all that crap” adjudicator. He ends his introduction with this classic line: “And if by the end (of reading the book) you… still disagree with me than I offer you this: You’ll still be wrong, but you’ll be wrong with a lot more panache and flair than you could possibility manage right now”. There you have it: dissent will not be accepted by the author. He will never agree to differ!

There’s another thing: scientists are capable of deceit, sometimes very grossly. Take the Piltdown Man fossil and the Hockey-Stick Hoax which I’ve written about on forums: http://www.davidicke.com/forum/showthread.php?t=1204 (I am also sure I wrote a blog article on the Hockey-Stick Hoax but it has vanished, like my one about the Solway Firth Spaceman!), where scientists deliberately massaged figures to make it look like all climate change in the last thousand years is caused by human pollution. Goldacre also relates how he has been attacked for his views. He has been slandered, called names, had abuse hurled at him and even been issued with death-threats! Many people are so unhappy with the way he supposedly demolishes their paradigm that he claims they fly into “tantrums”. I don’t deny that this is true and I think it’s very improper to treat Goldacre like that just because of his opinions; but I want to make sure nobody thinks that it’s just Skeptics who suffer from this kind of bullying and that none of them ever perpetrate similar behavior. Let me give you an example of what somebody said to me when I contradicted his Skeptical stance on several matters: “You’re a fucking loony (as well as) a racist… Jew-Hater! I can’t believe they let a fat, bald child-abusing cunt like you work in a hospital!... A little slapping might be in order!” (NB: All the above allegations are utterly false) Goldy is unwilling to accept anything at all that doesn’t come from accredited scientific sources and is not gathered by proper scientific methods. At one point he makes the statement: “The plural of anecdote is not data”. Here I differ with him the most. Suppose thousands of people came to you and told you a UFO had flown low over their town, but sadly none of those thousands of people had a camera handy at the time so there was no photographic evidence. No hard data at all, just lots of anecdotes... some of them from the town’s mayor, chief of police and consultant at the local hospital. Would you believe them, or at least admit there was a case to answer there? Most people would say yes, and this is the situation we’re in with alternative medicine. If many people have told you their positive experiences with acupuncture, homeopathy or detox then it’s wise to take their stories seriously, placebo effect notwithstanding.

The chapter in which Goldy talks about the placebo effect is very interesting indeed and some of the stories he relates I’ve read about already in other books. The power of the mind over the body is something that is far deeper than even Goldy is willing to go in the book; although he does go into it to a satisfying depth, to his credit. There are numerous cases of people being given a useless sugar pill and being told it is a powerful drug, and then recovering because they truly believe that the pill is a real drug. Not only that, but experiments have been done where some people were taken to a party where some were given glasses of special brew and others glasses of alcohol-free beer. Some of the “control group” on the alcohol-free beer became tipsy too! It’s quite good news for me, as a hospital porter, because if the state of a patient’s mind has such a powerful effect on their physical health then I can administer my own treatment to my patients simply by making them feel better; being sympathetic and friendly to them. This is something I’ve done throughout my career anyway and Goldy’s statement confirms that I’ve been doing the right thing. Thanks, Ben!

Goldy is often portrayed by his opponents as an establishment figure; some even claim that he is in the pay of Big Pharma, but this I find most unlikely; although he may be being used as “controlled opposition”. He is, almost paradoxically by some viewpoints, in many ways a rebel who champions freely-available medicine for the entire world’s people and opposes the terrible greed and murderous imperialism of Big Pharma. He riles against Monsanto and the patented seed tyranny. What’s more I know someone who used to hang out a lot with Goldy when he was a student here at Oxford, and he says that Goldy was very much a “hippy” and into “alternative lifestyles”. In a sense he doesn’t draw much of a line between the so-called “Quack” remedies he derides and the various unscientific products of Big Pharma. In fact he says in as many words that Big Pharma and what he wittily calls “Big Quacka” are the same thing. As I explain in my linked review of his lecture he doesn’t know that half of it! However I find myself in agreement with Goldy over many things. For instance he scorns the way so many different isolated medical dysfunctions and syndromes have emerged out of the woodwork in the last few years, usually with sibilant acronyms like ADHD , ADD and OCD for which Big Pharma always has a pill ready as the solution. He mentions Asperger’s Syndrome, a condition that I myself was once diagnosed with (although I luckily managed to get a second opinion that said otherwise!). Goldy says that a lot of these conditions simply don’t exist and are delusionary interpretations of social and psychological problems as medical illnesses. A lot of older men have recently been awarded with a whole doseit-box full of remedies for sexual dysfunction, including Viagra and various chemical aphrodisiacs. But the truth is that most of these men’s problems are not medical, but psychological. They feel trapped in a long-term relationship with someone they are simply no longer attracted to. When these men have affairs or new relationships their impotence is magically cured! (The way Goldy wrote it in the book, and delivered it at his lecture, was a bit facetious. He said: “The woman he is married to is no longer the sex-kitten he first met on the dance floor gyrating to The Human League in 1983”; as if the whole situation was just the woman’s fault. It was this that Marmitelover was so offended by at the lecture. Interestingly Viagra is now prescribed to women as a treatment for frigidity; maybe the sinewy, muscular young hunk these women first met on the dance floor in 1983 is no longer so attractive either!). I recall the way Prozac was pushed onto the American public when it was first invented when I watched Episode 2 of The Trap by Adam Curtis; I strongly recommend it: http://video.google.com/videoplay?docid=-1087742888040457650&ei=XSPKSdLREIPO-Abok4mmDQ&q=the+trap+episode+2 . The media have also played a terribly destructive role in promoting health scares, according to Goldacre. In fact I completely share his disdain for the mainstream media and often think that it is a bad place to get information on medical issues… in fact it is a bad place to get information on anything! The “MMR hoax” as Goldy calls it has a whole chapter devoted to it in the book. I actually recommend watching the various vaccine debates on DVD or online before making a decision whether or not to vaccinate your child. The concerns over the safety of vaccines are not confined to the scandal instituted by Dr Wakefield. As I said in the lecture review, Goldy criticizes the lightweights of alternative medicine, but never mentions what I see as far more credible characters. He does mention Dr Arpad Pusztai and calls him a “joker”. Well I’ll be seeing Dr Pusztai live at a conference in a couple of months so I’ll let you know what I think of him. I personally doubt that vaccines are the entire cause of the rise in autism, although they may well be a factor. We currently live in such a toxic, unnatural, stress-factory of a society that finding causal links for any emerging pathology is a bit of a pick-and-mix!

As with Richard Dawkins’ The God Delusion (which I review here: http://hpanwo.blogspot.com/2008/04/god-delusion-by-richard-dawkins.html ) I was surprised by Bad Science’s lack of scope. I refer to The Shaman’s Apprentice story in my lecture review; well I say the same for the book. Goldy flies over the surface of the Complimentary and Alternative Medical Ocean and sinks the easy slow-moving targets like HMS Gillian McKeith, but never even addresses the far more deadly and potent submarines that cruise untouched beneath the waves. Submarines called HMS Dr Len Horowitz, USS Rima Laibow, USS Lynne McTaggart, HMS Masaru Emoto and others. I was very pleasantly surprised that Goldy doesn’t take a pop at herbal remedies. These are treatments that I myself have used (I’ve never used homeopathy nor nutritional supplements, but I might consider it if the need arose). He doesn’t explain how I took the herbal-based Stellaria cream for my eczema and it worked where hydrocortisone failed. I had faith in both so how come the “placebo effect” only took hold with the Stellaria? He briefly mentions the case of a supposedly fake Shaman in Canada but that’s it! I’ve met so many others who’ve had similar encouraging results with herbs; and as I say above, the plural of anecdote is data! Herbalist practitioners have recently come across an unexpected and intriguing problem. The herb Echinacea has been used by healers in medicinal intervention probably since prehistoric times and is still popular today. Traditionally it is acquired by locating and gathering from the wild. The practitioner simply goes to a place where the plant grows, walks around until they find one and then harvests it. But a few years ago somebody had what they thought was the bright idea of cultivating it. They planted seeds in a pot or their garden and grew it themselves to make the drug much easier and cheaper to produce. But then their patients started complaining that the medicine was no longer working. For some reason the cultivated Echinacea was having no effect; even if it was grown in strictly organic conditions. However the Echinacea gathered from the wild in the good old Paleolithic way still worked. Why? The Skeptic might claim that this is an irrelevant observation because it’s not been researched. But I repeat what I said about the plural of anecdote. They might also claim that Herbalists provide unreliable testimony because they are “mystically and intuitively inclined. The most gullible members of society”, but then I would remind them of the fiasco of the “Avebury Carlos”. Even the so-called “most gullible members of society” have turned out to be much better witnesses than Skeppers previously thought. A few years ago, some engineers built a fake UFO out of a model plane and flew it over Avebury, an ancient sacred site and a gathering place for mystics and pagans. The intention was to fool them and therefore show them up for being dupes, but in a way the plan backfired. The hippies at Avebury did indeed report seeing a UFO, but they reported pretty much what they saw, describing the craft accurately. There were none of the embellishments and exaggerations that the hoaxers were banking on. The Echinacea conundrum shows that there is a hell of a lot we still have to learn about the human body, the human mind, medicine, the natural world, the universe itself and the relationships between them all. If Masaru Emoto, along with others, are correct and that thoughts and words can change inorganic substance than this transforms medical research into a whole new ball-game! Bad Science is a book I’d recommend to everyone, not for the worldview it promotes, but for what it reveals about Western philosophy and its scientific paradigm; and perhaps the weaknesses and limitations of both. Goldy may scoff at the “It’s a bit more complicated than that” line… but in fact it is!

Finally: Here’s a debate between Ben Goldacre and Peter Fisher, a pro-homeopathy doctor, just to show you that there is more than just one side to science: http://video.google.com/videoplay?docid=-7371556318217026586&ei=QjHKSazwDY6y-Aa8w4nRAQ&q=ben+goldacre

Addendum: The previous edition of "Bad Science", the one I read, had a chapter in it about Matthias Rath that was cut out by the publishers for legal reasons. With the conclusion of the legal case that chapter can now be found in the new edition and Goldy has put it up on his website for free: http://www.badscience.net/2009/04/matthias-rath-steal-this-chapter/

39 comments:

Ben Emlyn-Jones said...

Addendum: The previous edition of "Bad Science", the one I read, had a chapter in it about Matthias Rath that was cut out by the publishers for legal reasons. With ther conclusion of the legal case that chapter can now be found in the new edition and Goldy has put it up on his website for free:

http://www.badscience.net/2009/04/matthias-rath-steal-this-chapter/

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