Bad Science

Ben Goldacre is a medical doctor, which is why the bad science in this book is all biological, mostly related to health - it's what he knows about. It's also mostly what we hear about, in terms of science, from mainstream media such as newspapers, magazines and television, as he observes, with evidence.

Goldacre starts with the simplest ideas of how to conduct medical trials, introducing concepts such as control groups, blinding, double blinding and randomisation whilst demolishing the claims of various quacks and charlatans. As the book goes along the ideas do get more sophisticated but are always clearly explained and never really demanding of the intellect - and the exposure of malicious malpractise, fraud, incompetence, bogus experts with made up or bought qualifications and ignorant or malicious scaremongering go on - and on - and on!

Goldacre writes with humour but also and more powerfully with anger - there is barely contained rage hiding on almost every page and as I read on it was hard not to feel that rage, too - and fear and horror. The chapter about how the South African AIDS treatment policy was subverted from the use of anti-retroviral drugs to the promotion of vitamin pills is sickening. He also continually flatters the reader by saying he is clever and then going on to say that the concepts he is explaining are not difficult - which seems a little contradictory to me; if the concepts aren't difficult one isn't smart because one understands them.

By the way, he does believe his entire readership is male - but does the evidence back that up? No! Tut, tut, Dr. Goldacre! This illustrates a point not made in the book, which is very relevent; we are bombarded with advertising and PR claims and even the most determinedly, habitually sceptical of us will sometimes fail to see the wood for the trees. We cannot check every single claim made to us - am I going to check all of Goldacre's references? No. But I should do - why should I believe him more than the next guy or gal? Because he has nothing to gain? Not so! He makes a living in part by writing, so he is under a temptation to try to increase his sales by the same sensationalising techniques he accuses other journalists of. In the end you have to trust some-one - there's no escaping it - and sometimes you might make a wrong judgement about whom.

This can be quite subtle - a number of times Goldacre mentions methods employed by pharmaceutical companies to disguise the fact that SSRI anti-depressants are not much more effective than placebos. I once heard a woman (name forgotten) on a Radio 4 discussion program pushing an agenda of essentially claiming that depression is best treated by non-pharmaceutical therapies and is not different from sadness anyway. Her contention was that "anti-depressants do not work much better than placebos." This is wrong! "But Goldacre says in his book that's true!" you (may) cry! No, he doesn't. He says that SSRI anti-depressants appear not to work much better than placebos when all the available evidence is taken into consideration. Anti-depressents are not all SSRIs - there are SNRIs and tricyclics to my certain knowledge and most likely a number of other types. This woman was using the exposure of bad science on the part of pharmaceutical companies as her method of attempting to perpetrate bad science (and consequent misery, harm and possible deaths) on the general public! Trials comparing an SNRI drug with a number of SSRI drugs showed that the SNRI is more effective than the SSRIs. Trials on SSRIs show that they have more effect on more severely depressed people - in other words people who are not merely sad and actually need therapeutic intervention. The story of SSRI efficacy research is not over - we have discovered that we haven't yet asked the right questions about them. (Just to be absolutely clear - I do not disagree with Goldacre's statements about SSRI efficacy - as far as they go. More work needs to be done to elucidate just how depressed a person needs to be for prescription of antidepressant drugs to be a worthwhile therapy. I doubt he'd disagree with my view, either.)

So I discovered what this woman's fallacious claim was, months afterwards and fortuitously, because I simply do not have time to investigate every claim I'm exposed to. I can tackle many by applying logic and arithmatic, in my head and fairly quickly but problems arise when the only way to check is to read the original research.

This is also where Goldacre struggles; he concedes that attempting to improve the standard of scientific journalism or entirely eliminating the negative effects of the profit motive from pharmaceutical research are not practical goals. So what are we meant to do? Goldacre has a few fairly small suggestions at a policy level that look as if they should make a notable difference but ultimately he says - read my book - then check claims yourself, 'cos you'll know how. Post your findings on the net. He also says it doesn't matter if he only reaches a small number of people.

He's saying some is better than none, I suppose - and that if we each did a bit the total would be large - but here's the rub - should I trust what's being said on the badscience website - or should I check it out for myself? Because that regular poster might have a hidden agenda and false qualifications and PR company backing and pharmaceutical company stock.

So who are you going to trust and how are you going to decide?

Well, if you trust me (and I'm not claiming you should) buy this book and read it. Soon.