Review: Bad Science by Ben Goldacre

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Ben Goldacre is a doctor who writes a column called Bad Science in the Guardian every Saturday, and has also got a blog by the same title as the book, whose content consists largely of debunking health scares, press reporting of science, and quacks and quackery of various types, including homeopathy and “nutritionists”. The book is essentially a distillation of his blogs and columns over the years into a book with a beginning, a middle and an end, from a few examples of products being sold based on spurious science, homeopathy, the placebo effect, the claims of self-styled nutritionists, the shoddy press reporting of science stories, concluding with the two most notorious recent British health scares: the “MRSA on hospital door-knobs” affair and MMR.

Goldacre notes that there are an awful lot of products out there which profit from people’s ignorance of science, for example, by offering “detox” products which do not detoxify you at all, and a “brain gym” for children which, while it may help improve children’s concentration, offers completely unscientific explanations for why (and a Newsnight report, linked off the Bad Science website, shows children parroting this nonsense). Many of these products had received gushing endorsements in the press, but they used pretty basic methods to produce the illusion of drawing toxins out of the body when, in fact, the sludge made out to be toxins came from the products themselves.

In roughly the first half of the book, Goldacre emphasises the standard scientific methods of testing for whether a medical product or intervention works: usually, a randomised, controlled trial; controlled meaning that one group of patients receives the new treatment and the other, known as the “control” group, receives either the most effective currently available treatment, or a placebo, to eliminate the possibility that the benefit of the treatment might be merely psychological, since the psychological effects of merely receiving treatment, or receiving what looks like a sophisticated treatment, are considerable. Many of the “trials” heralded in the media, for example the notorious “fish oil capsules” given to children in Durham a few years ago, involved no control group at all, fatally compromising them. He does not dwell on alternative medicine such as chiropractic, concentrating on the obviously unscientific, particularly homeopathy, in which pills are given out which are nothing more than sugar pills, any trace of the original substance likely to have disappeared in the massive dilutions (as in, to be sure of having a single molecule of it, you would have to have a container bigger than the earth).

The middle of the book is given over to debunking two major figures in “nutritionism”, namely Gillian McKeith and Patrick Holford. (Nutritionists call themselves that because they cannot use the term dietician, as it is a protected medical term.) The first is a well-known TV nutritionist, the second the “academic linchpin” of the movement. The first is discovered to have acquired advanced degrees from an unaccredited “university” in the USA, and used them to build up her reputation, while making unscientific claims again and again in her books while selling illegal medicines. The second runs an institution whose degrees are accredited through the University of Bedfordshire, formerly Luton, which has come under investigation for its lax accreditation standards, has claimed that vitamin C is a better treatment for AIDS than AZT, and his books reference a researcher whose work is a classic case study in research fraud.

After this, there are some more general and theoretical chapters, building up a crescendo before the discussion of the two biggest health scares of recent years. He tears into the ways the media manipulate statistics, notably by presenting relative risk increases rather than the actual risk increases (for example, by claiming a doubling of risk caused by eating a given food, without mentioning that the increased risk is still miniscule), and by rounding figures up or down so that, say, a 1.4% risk increased to 1.9% can be called a “doubling” (i.e. 1% to 2%), when the real relative increase is less than half of that. There is a chapter on how the drug companies manipulate the testing data to promote their products, and why (because they need to make money, and because they are having trouble inventing new drugs, so they have to find new uses for old ones), and on how the media misreport science stories, for example, by having science stories, particularly major ones, written by general journalists who are not science graduates, and by pitting cold assertions by authority figures against the emotional testimony of victims’ parents when there is a scare.

Finally, we get to the MRSA and MMR scares (you can read an extract here). The first was caused by the press, eager to get a scandal about filthy hospitals, sending swabs from doorknobs and window-sills taken by undercover journalists working as cleaners to “the lab that always gives positive results”, which was actually not a lab at all but a garden shed fitted out with kitchen equipment, run by a man with a bought doctorate who was also selling anti-MRSA kits on the side. The media hailed him as a hero, and when real scientists took swabs from the same hospitals and sent them to labs with universally negative results, the media ignored them. As for the MMR scare, the whole thing was based one tiny study by Andrew Wakefield, who had filed a patent application for a single measles vaccine, and in any case the mass media coverage of it did not begin until three years after it was published, and even then, findings contrary to those in Wakefield’s paper, which actually was nothing other than a set of clinical anecdotes or a “case series”, were ignored. He also tackles a few of the favourite claims of the anti-vaccine movement, among them that vaccines have not caused drops in incidences of diseases, but rather, improvements in living standards and hygiene have (his graphs shows that the incidence of measles dropped precipitously when the vaccine was introduced).

Goldacre’s book pulls few punches; he dissects claim after claim in the writings of McKeith and Holford, some of whose mistakes even a GCSE biology student would identify, but others require the attention of more of a trained mind, such as the Vitamin C AIDS claim (actually, perhaps it doesn’t; if Vitamin C really was a better treatment for AIDS than AZT, we would surely know about it). While he does make a few sideswipes at the food supplements and vitamins industry, which is a multi-billion dollar affair despite the “alternative” pretensions surrounding it, the issue of vitamins and AIDS could not be examined in much detail as he and the Guardian were being sued by a vitamin pill magnate at the time, who had taken out advertisements in South African newspapers denouncing combination therapy. That was settled in September, and Goldacre has said that he plans to write another book on the subject. I have to say, to read a comprehensive debunking which lowers a wealthy high-profile quack to below the level of a 14-year-old in knowledge is intensely satisfying.

One qualm I do have concerns the treatment of the MMR scare: he dismisses the possibility of offering single vaccines, citing the reduced incidence of measles after the MMR was introduced; under the pre-MMR regime, all children were offered the measles vaccine, while girls were inoculated against rubella in early secondary school, so that they could not pass it onto their unborn children. This had the effect of protecting against the two biggest risks, and of the three, measles was the big killer - it can cause blindness or brain damage, and there is a fatal post-measles encephalitis which develops a few years after the initial infection. Offering single vaccines, particularly against measles, would have eliminated the fake vaccine racket which went on a the time, in which measles jabs were offered which were dispensed out of a container, not out of individual vials, which meant they might not be effective. It would also have given parents peace of mind and reduced, if not eliminated, the upsurges of some of these diseases which have occurred since the scare. I do not dispute that protecting people against mumps is a good thing, but it was obviously not so pressing that vaccines against mumps were not introduced when measles inoculations first were; it is a bigger danger to adult men than it is to children, as rubella is a bigger danger to pregnant women, hence the vaccinations of adolescent girls. Parents want to protect their children, and it is easier to live with oneself if harm comes to one’s child which one could have prevented than if one actually caused or faciliated that harm. There was also the suspicion that that the NHS stood firm behind MMR mainly for financial reasons, even if the convenience argument (that there are more appointments to miss and more painful injections with the single vaccines) is a valid one. While I do not dispute that a triple vaccine is a good thing (although, at the time, I would not have used it if I had children), single vaccines, even if only against measles, would have been a valuable second line of defence.

However, that is, as far as can be told, in the past, and he cannot be accused of simply giving a stock NHS response on this issue. Generally, the book is valuable as it gives ammunition against the claims of profiteering quacks and the headline-grabbing manipulation of statistics and misreporting of science in the media. As someone whose exposure to academic science ceased when I was 16, I found that this book explains a lot about scientific method in plain English, and that I understood most of it. Anyone who has been encouraged to go for some sort of “alternative” therapy which sounds too good, or too counter-intuitive, to be true, would do well to read this.

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