Monday, 5 January 2009

the appliance of science

Bad Science
by Ben Goldacre

Growing up with a Consultant Dermatologist for a father made cosmetics commercials an entertaining experience. You know the sort; 'contains pentipeptides and our most advanced Q10 complex', 'now with Vitamin E and Ceramide R'. My dad was able to translate what lay behind the bamboozling techno-babble, most of the words in those days tended to mean nothing more complicated than 'water' and vitamin E is used in most creams as a preservative but the word vitamin makes it sound like an active ingredient. He also used to point out that the whole point about skin is that it's waterproof, it's designed to stop stuff getting into your body, so most of the very expensive rubbish being advertised tends to just sit on top, contracting skin to 'reduce the appearance of wrinkles' as they very carefully phrase it nowadays. The single most effective thing to put on your skin was, and still is, humble Vaseline (in fact it's amazing that Vaseline don't make more of that) but there's not very much money in that.

Following on from his Guardian column of the same name Ben Goldacre, a doctor and journalist, has published Bad Science, where he attempts to engage us in the science that we are all subjected to and persuaded by on an almost daily basis. He is not a happy man. Not so much because people get things wrong, or portray them inaccurately but because the science behind it isn't really that complex. In fact the revelation of this book is not so much that he lays into some soft targets like Gillian McKeith ('or, to give her full medical title: Gillian McKeith') or homeopathy, giving us all a giggle along the way, but that he attempts to arm us all with the basic scientific tools that will help us to smell a rat. After all, most of what we get now in the press and on the television is statistics and we all know that there are lies, damn lies and then there are statistics.

When I was about 13 at school I once convinced my class that red apples could give you cancer. Having learnt the word 'carcinogenic' (those medical parents can really help you sound clever sometimes) I was able to use that a few times along with pigment and sound terribly convincing even though every word was absolute nonsense. I decided to use my skills as a bullshitter by pursuing a career in acting, but it turns out that they would also have qualified me to be an excellent nutritionist (a title which after all requires no actual qualifications). McKeith is taken to task here for portraying herself as a bonafide medical authority, making very sciencey sounding statements and peppering her books with sciencey looking reference numbers, underneath which there are some fairly glaring and basic scientific errors. Some digging behind her credentials makes things a little clearer. All of which is grist to the mill for someone like me who has always had a dislike of her and her humiliation tactics. If you want some ammunition against 'the awful poo lady' then look no further.

I have also had a personal experience of homeopathy (before I really understood what it all was). I had a touch of the man-flu, was given a pill and told to go to bed with my clothes on, pull the duvet over my head and sweat it out (the pill would aid this by opening the capillaries and aiding blood flow right to the skin's surface). When I woke in the morning after a hot night I felt fine, great in fact and put it all down to the pill. This is the beauty of the placebo. If you believe in the pill, it might just do the trick (which is a gross simplification of the cultural significance of the placebo - explained in much greater detail by Goldacre). It is the fact that the placebo is so interesting a phenomenon, worthy of attention and study, rather than the new-agey sounding nonsense about the 'memory' of water explaining how a substance which has been so diluted as to contain not one molecule of the original substance could have any medical benefit (beyond that of the placebo), which really gets his goat. If homeopathy was to come clean and present itself as a benign resource like horoscopes and crystal dowsing then it might just get away with it but when you read about someone like Peter Chapell, a homeopath who has developed a remedy that can be used to treat the HIV virus, or Matthias Rath who claimed his vitamin treatments could do the same (and who recently dropped his libel case against The Guardian), it makes me think very dark thoughts.

I was really interested to read this book because of the final chapter on the MMR vaccine. Being a young parent means that you are literally bombarded with information, advice, statistics, theories and good old-fashioned fearful paranoia and I'll admit that my steadfast rational approach to just about everything had encountered a little wavering when it came to making a decision that could impact on someone else's life. Goldacre doesn't exactly come out and say it but by calling the chapter The Media's MMR Hoax and showing that after several years of scare-mongering there is no evidence to support a link between the jab and autism, he helped put the issue to bed for me.

The role of the media is a large focus of the book unsurprisingly and it is almost gobsmacking to see how poorly researched, written and constructed some of the stories we have all read really are. The fact that the results which fuelled the MRSA superbug stories came from a poorly qualified man, out of depth and working out of his garden shed would be funny if it weren't so serious (especially given his untimely death from a car accident shortly after the facts of the matter were exposed). The pressure on journalists to provide stories with punchy headlines and stats that have impact leads to a fudging of the numbers, very basic and very misleading mistakes. The pressure on papers to maintain advertising revenue means that articles which should really be written by science correspondents are given to lifestyle or comment writers who don't use the science writers at their disposal to check the science. That's why it might be worth checking out the Bad Science website next time you read that cocaine use amongst schoolchildren has doubled or that you should be drinking gallons of purple grape juice due to its high level of antioxidants.

Science can be complex, but bad science is often pretty simple. Goldacre's book is eye-opening and provocative whilst always attempting to be fair rather than personally vindictive (well, he almost pulls that one off). It could have been better ordered, powered as it is by the digressive and slightly chaotic energy of a self-confessed geek but what's refreshing is that he credits his readers with some intelligence and places the ball firmly in our court.


John Self 5 January 2009 at 11:27  

An excellent review (slightly better than the book in my view, which I liked but didn't love - or didn't love as much as I expected to, which might not be the same thing).

Further fruitful reading on the subject of bad science is to be had, surprisingly enough, in Derren Brown's book Tricks of the Mind (which for some reason has become the third most viewed post on my blog). Your flu-pill experience sounds a little like this anecdote which Brown recounts:

"A woman at a Christian house-group I once attended was telling us how she had dealt with getting a cold. She had sat on her bed and shouted, ‘No, Satan, I will not have this cold. In the name of Jesus I tell you to get out. Get out!’ Stern stuff. ‘And do you know,’ she continued, ‘after a few days it was gone.’"

William Rycroft 5 January 2009 at 11:53  

Thanks John. The placebo thing is really interesting, especially learning that the number of pills, their colour, and the price paid for them can all have an impact. At the end of the day if you believe something is going to make you better that's the single best thing you can do to help yourself get well.

On the BBC website today is this article: http://news.bbc.co.uk/1/hi/health/7808348.stm
perfectly timed for all those people with New Year detox plans. Save your money people, you have a thing called a liver which is specifically designed to do just that.

John Self 8 January 2009 at 15:00  

Another book which touches, fictionally, on the subject is my evergreen favourite Dr Haggard's Disease by Patrick McGrath. He's a GP on the south coast in the 1930s, and when taking over the practice, his predecessor shows him the three jars of sugar pills, each a different colour, and reminds him always to make great show of choosing the 'right' one for the parient. "The body has tremendous powers to heal itself, but it's got to be persuaded." He also uses an inert liquid placebo called Mist Explo.

There's an interesting paper which touches on the subject here, from the point of view of patients insisting on being given some medicine by their doctors, so doctors gave them a placebo. Near the bottom of the page (below Fig. 8):

"Although doctors might appear to be ‘fobbing off’ their patients with stock medicines, in fact practitioners complained that patients expected to leave the surgery with a bottle of medicine (most drugs were dispensed in liquid rather than tablet form in this period). They were therefore forced to act in response to patient demand. Some of these frequently prescribed medicines had little pretensions to do any good. Elsewhere in her book, Digby reports that one doctor handed out coloured aspirins. In another practice, one of the stock medicines ‘was labelled “Mist. ADT” or “Mist. Any Damn Thing” [‘Mist.’ is an abbreviation of the Latin word for ‘mixture’ ] which was given to “somebody you thought there was nothing wrong with, and you could do nothing for”’. More alarmingly, another practitioner prescribed a mixture … called Mist. Explo. It was a clear yellow liquid made from a few bright yellow crystals dissolved in water. The crystals were apt to ignite if left to dry in the sunlight, hence the name Mist Explosive. I don't remember the exact chemistry of this wonder drug but it was a derivative of picric acid and quite harmless when well diluted and used as a bitter tonic."

Sarah 10 January 2009 at 06:20  

My dad is a science graduate, and watching tv with him is a painful experience. He takes great exception to examples of bad science like cosmetics ads, cancer cure news reports etc and is quite vocal about this!

With that in mind, I bought this book for him for Xmas. It sounds like I'll have to read it after him.

William Rycroft 10 January 2009 at 10:18  

And the award for most well-researched comment goes to John Self. Fascinating stuff, I'll have to keep a closer eye on my GP next time I visit. I noticed you mentioned Dr Haggard's Disease in the comments about The Holy City and have noticed your penchant for McGrath. I've only read Asylum myself, but seem to remember enjoying it although I haven't picked up anything of his since. Maybe Dr Haggard will be the one.

Sarah, welcome, and thanks for your comments. Bad Science is worth a read if only so that next time you spot some bad science on the TV you can beat your dad to it.

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