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Friday, 3 June 2011

Critical Thinking for Health and Medicine

31 July 2010 015Image by EadaoinFlynn via Flickr"Bad Science" is a modern classic of scientific sceptical movement. Its importance and influence easily rank it alongside the defining works of Carl Sagan, Martin Gardener, James Randi, Michael Shermer, David Aaronvitch, Christopher Hitchens, Richard Dawkins, Carol Tavris, Paul Kurtz, Sam Harris and Phil Plait. My rather unscientific mind put it on my "to read" list for way too long. As I learnt more about the scientific method and critical thinking from subjects I was more comfortable with like history or the social sciences, I slowly made my way to Goldacre's book with trepidation.

As it turns out, and according to Goldacre, this is the problem. The general public are confused by science and therefore untrusting of it, which makes them more susceptible to pseudoscience, quackery and manipulation on a grand scale. Whether it is buying ineffective "natural" cures from nutritionist quacks to over-priced and under-tested drugs from devious pharmaceutical companies, Ben Goldacre fears that an ignorant public is being duped and the consequences can be catastrophic.

As you might have guessed by now, the science of the book is generally focused on the medical and healthcare industries. The roots of the book and its title come from a regular column the author wrote and still writes for the left-leaning "Guardian" newspaper, where he wrote from the perspective of a full-time NHS doctor. His contentious column has more then ruffled enough feathers in the respective industries he investigates and criticizes. "Bad Science" the book was written in 2008, when the backlash against nonsense in many forms was really kicking off and people were beginning to be called to account. At this time Andrew Wakefield was being investigated by the Medical Council for the MMR hysteria his unethical research paper caused and Goldacre had just come to the end of a lengthy court battle with vitamin pill guru Matthias Rath who was personally suing both the author and "The Guardian". Subsequently "The Doctor Will Sue You Now", which deals with Rath's history and the influence he has had on South Africa's AIDS denial, is a special bonus chapter inserted at the end of the section dealing with nutritionists in the 2009 paperback edition of the book. Since this edition has been published we've also had Simon Singh win his landmark court case against the British Chiropractic Association and the steady growth of the sceptical movement.

Many sceptical books consist of a collection of different topics, which are often grouped into sections. Goldacre is no different in this respect except that each chapter "follows a natural crescendo" starting with low scale pseudoscience building up to its more damaging end, which then moves onto another even more damaging area and so on until we see a global picture of bad education, misinformation, disinformation, victims and certain people unscrupulously making a ridiculous amount of money from their respective branches of bad science.

Having worked in academic circles and wearing a liberal socialist attitude on his sleeve, Goldacre clearly believes the key is education and from the first chapter onwards he takes on the role as the teacher. If the problem is a distrust and misunderstanding of science, then it is up to those involved in science to bring it to the people. He begins by explaining some simple experiments anyone can set up at home to bust the myths of detoxing, a craze that has come and gone since at least the days of enema, yoghurt and celibacy obsessed John Harvey Kellog. The ridiculous "Brain Gym" that has seduced many junior schools in the developed world gets the first special focus in the book.

Next the cosmetics industry gets a well-deserved kicking. It's among one of my increasing number of bugbears to see yet another commercial that bamboozles you with what Goldacre would call "sciency" stuff regarding over-priced moisturizers and shampoos. Not only do we get given simple and inexpensive instructions to make our own cosmetics or buy very cheap yet equally good alternatives to the big brands, but we also find out just how the companies get to say the rubbish they throw at us. Due to laws brought in 1990s that restricted the dosages of these ingredients, the most effective ingredients ever to be put in moisturizers now only show up as "talismanic concentrations". It goes on to decode the "sciency" sounding stuff that either means nothing or implies something that is not possible - for example that your body could or would ever need to absorb fish DNA!

This leads the author onto a far more common enemy of scepticism: the Royals favoured pseudoscience, homeopathy. However, if he is going to tread on ground worn well by his colleagues, Goldacre clearly wishes to be thorough and this is the first of his longer chapters. The result is perhaps one of the most detailed and well-researched debunkings of homeopathy I have yet read. He details its history and the supposed "logic" behind its dilution method. We then go through its troubled attempts by academics to legitimize the practice in the medical science world. A key part of homeopathy is the sugar pills commonly used by its doctors, which leads onto the fascinating nature of the placebo effect. Keeping his teaching hat on Goldacre provides a chapter explaining how the placebo effect works, why placebos are used as part of the scientific process of testing and finally why the placebo effect is so powerful.

A chapter on fashionable nonsense provides us with an introduction to Goldacre's second job, that of a journalist. He sees media representation and bad biased research in major publications to be at the root of a lot of the problems associated with bad science. This particular chapter focuses on the way the nutritionist industry has been invented and promoted by the media. Food has become an obsession with reports on either its apparent miraculous or demonic properties. Goldacre reveals how easily peddlers of fad diets, supplements and vitamin pills have become celebrities and millionaires based on pseudoscientific claptrap.

Step forward "Dr" Gillian McKeith for the next chapter, which singles her out for special treatment. McKeith is a perfect representation of the nutritionist industry. She acquired her qualification through a non-accredited university and "volunteered" to give up her title of "Dr" after pressure from academics who challenged that it was not legitimate. She has made her fortune out the diet plans, TV shows and books she has based on her flawed view of nutrition. Referencing directly from her work, Goldacre reveals ridiculous claims like somehow eating spinach and the darker leaves of plants will "oxygenate your blood". Somehow McKeith, who spends a lot of her time posing in a white coat in a laboratory or being rude to fat people on prime time TV, got the whole idea of photosynthesis mixed up in a big way.

We explore the "Durham Trials" debacle in the next chapter, where we read about the way scientific testing is seriously misrepresented. This chapter concerns a school that famously agreed to partake in trials that were to test whether the consumption of Omega-3 fish oils improved examination performance in their students. The whole process was flawed from the very beginning and elaborate example of the media's obsession with miracle pill cures. Despite Goldacre's investigation causing the headmaster involved with the whole sham trials to become seriously stressed, in the end the pill won the day. Omega-3 fish oils have become hugely popular in the supplement world, which nicely dovetails into the next chapter on Professor Patrick Holford.

Holford seems to be at the very centre of the nutritionist movement, dealing with the academic side of things. Like McKeith he has become a very wealthy man and health food stores have a lot to thank him for as more people flock to pick up untested and largely ineffective food supplements as an alternative to conventional treatments. Holford has also done a lot to promote conspiracy theories regarding mass produced food and drug companies. Among his very silly claims are that oranges no longer contain vitamin C. After this chapter we have special extra one, "The Doctor Will Sue You Now", which reveals alternative medicine's vitamin industry at its most destructive. Here we read about how South African politicians and the general public have bought into the idea that AIDS either does not exist or that the treatments offered by the western world are part of a conspiracy to kill them. From 2000 to the time of the book's second publication cases of AIDS rose from 1% of the population to 25%. On the back of this we have vitamin pill salesman extraordinaire Matthias Rath who has made a fortune selling his vitamin pills as the healthy alternative to conventional AIDS treatments. It's a shocking chapter that I offer to the next person who tells me that conspiracy theories don't cause any harm or that alternative remedies are always on the side for good.

When the subject of "Big Pharma" crops up I usually send out my conspiracy theory probe. It's a term now that is beloved of those who buy into the sort of nonsense that Holford and Rath peddle. Read most regular sceptic's writings, such as Skeptoid podcaster Brian Dunning, and you will see that whenever "Big Pharma" is being mentioned it is often in reference to some very stupid ideas about shadow industries repressing good nutritionist and holistic therapy heroes of the world. However, Goldacre is not afraid to go after them and bring them to account over the stuff that is legitimately bad. It's ironic that he has been called a stooge of "Big Pharma" on many occasions considering the criticism he has brought against for real crimes they have committed.

In fact, their industry does make even more money than the ridiculously lucrative nutritionist empire. It's no grand conspiracy of Illuminati proportions, but documented manipulation of facts and trials of certain drugs. We learn from the author just how a new drug gets tested and sold, and how the data can be distorted in order to market it effectively. Goldacre highlights one of the big problems in science. Its boom is over. It lasted for around half a century, where many amazing breakthroughs were made in medical science and healthcare. However, today it creeps at a snail's pace and the pharmaceutical industry is stuck with the problem with how to re-market essentially the same drugs. Worse still, certain treatments go criminally under-promoted because they cannot be patented.

The next five chapters focus on the biggest culprits in the spreading of bad information, anti-science ideas, conspiracy theories and mass hysteria: the media. He looks at how scientists with no media skills are often portrayed as bland villains in corduroy when compared to the renegade "experts" who are championed by newspapers and television. There is a chapter on how bad statistics are used and manipulated to make a good story and then we look at two big media hoaxes: MRSA and MMR. Both of these caused health scare hysteria on a grand scale resulting in real problems for the general public.

"Bad Science" is a reference book that every household should own. Science is a tough subject, especially for those who have no direct interest in the way it works. However, it is very much a part of our lives and the key to our progress. Unfortunately ignorance of it has very real consequences and this is never more evident than when we are discussing health and medical issues. Ben Goldacre does a fine job explaining everything in lay terms - particularly good for science dummies like me - and yet writing in a mature manner about very serious topics. He has a great sense of humour that is nicely balanced with deep research both as a man of science and as an investigative journalist. Given the appalling lack of research many journalist exhibit - and I urge you to read Dan Gardner's "Risk" for more evidence on this issue. Goldacre seemed to have carefully picked his subject matter, steering away from buffoonery typically targeted by his fellow sceptics. This means we don't go over too much common ground already trodden by other sceptical writers. Goldacre chooses to go for footnotes and endnotes for his referencing. His endnotes, as he tells us, have been kept to a minimum in order to keep the book entertaining. However, there is enough contained throughout the book in order for a reader follow up. Furthermore, it is all linked into his website, which I also recommend.
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