The hole in our culture is gaping: evidence-based medicine, the ultimate applied science, contains some of the cleverest ideas from the past two centuries, it has saved millions of lives, but there has never once been a single exhibit on the subject in London’s Science Museum.
This is not for a lack of interest. We are obsessed with health—half of all science stories in the media are medical—and are repeatedly bombarded with sciencey-sounding claims and stories. But… we get our information from the very people who have repeatedly demonstrated themselves to be incapable of reading, interpreting and bearing reliable witness to the scientific evidence.
Guardian columnist and NHS doctor Ben Goldacre had had enough of the fad diets, homeopathy claims, alarmist medical “news”, cherry-picked and over-interpreted study results that make headlines. In Bad Science he not only shows how he easily obtained a nutritionist certification for his dead cat, but examines the impact of concepts like placebo effect and regression to the mean within bogus medical and supplement claims, body chemistry in relation to health and beauty claims, and so much more that’s relevant to the onslaught of poorly interpreted data we receive via media, marketing, and unqualified influencers.
I hope I can read and critically appraise medical academic literature—something common to all recent medical graduates—and I apply this pedestrian skill to the millionaire businesspeople who drive our culture’s understanding of science.
A big theme is “it’s a bit more complicated than that.” Goldacre reminds of this constantly, because one of the biggest problems is how journalists without medical backgrounds, lifestyle/wellness gurus, and marketers either over-interpret or cherry-pick data to make a story or sell products. There are kernels of truth or evidence, but it’s never as sweeping, generalized or easily applied as they indicate.
He explains how to recognize the hallmarks of bad or misinterpreted data and better understand how this relates to things like “miracle cures, MMR, the evils of big pharma, the likelihood of a given vegetable preventing cancer, the dumbing down of science reporting, dubious health scares, the merits of anecdotal evidence, the relationship between body and mind, the science of irrationality, the medicalization of everyday life, and more.”
For example, curcumin is often cited for its health-giving properties because there’s evidence of certain behaviors in lab tests. So a popular news story translates that to advising you to eat more curry, but: “put the theoretical claims in the context of your body. Very little of the curcumin you eat is absorbed. You have to eat a few grams of it to reach significant detectable serum levels, but to get a few grams of curcumin, you’d have to eat 100g of turmeric: and good luck with that. Between research and recipe, there’s a lot more to think about than the nutritionists might tell you.”
His style is effective, consisting of giving a straightforward explanation then breaking it down further with a more scientific analysis. This isn’t dense and was generally understandable even for my non-sciencey brain, but there were some I’ll need to reread. Which is fine — I’m endlessly thrilled this book exists and does so much mythbusting, and it’s so readable that it’s fun to revisit.
Sometimes even the more thorough explanations aren’t even all that scientific, which makes it all the more embarrassing that we accept flimsy claims from companies so readily without even the excuse of complicated science obfuscating the truth. Like here:
Classically, cosmetics companies will take highly theoretical, textbookish information about the way that cells work—the components at a molecular level, or the behavior of cells in a glass dish—and then pretend it’s the same as the ultimate issue of whether something makes you look nice… In general, you don’t absorb things very well through your skin, because its purpose is to be relatively impermeable. When you sit in a bath of baked beans for charity you do not get fat, nor do you start farting.
It’s having to say things like this that drives home how hard it must be being a doctor in a world that embraces pseudoscience. How are they not rolling their eyes out of their heads on the daily?
One of my favorite topics, also covered in The Angry Chef, is the debunking of the wellness movement’s biggest faceless villain, toxins, vanquished through various detox methods which are always unpleasant and often expensive. They’re also useless. As Goldacre explains, “That burgers and beer can have negative effects on your body is certainly true, for a number of reasons; but the notion that they leave a specific residue, which can be extruded by a specific process, a physiological system called detox, is a marketing invention.”
He also covers the concept of “regression to the mean,” a deceptively simple one behind many bogus health claims, also covered by the Angry Chef. It’s “basically another phrase for the phenomenon whereby, as alternative therapists like to say, all things have a natural cycle.” You start feeling better after you’ve been at your worst, essentially, which is also when you turn to a therapy that you later credit as having been the solution.
Two of his nemeses are author and nutritionist of dubious credentials Gillian McKeith and the Daily Mail, the latter of which he points out “has become engaged in a bizarre ongoing ontological project, diligently sifting through all the inanimate objects of the universe in order to categorise them as a cause of—or cure for—cancer.” Which is hilarious but sadly true.
As informative as this was, sometimes the truth is really depressing. Like we learned here, this always just comes down to money, and if consumers can be confused enough that we don’t know what to believe, that equals profit. Here’s a bummer:
Whenever a piece of evidence is published suggesting that the $50-billion food supplement pill industry’s products are ineffective, or even harmful, an enormous marketing machine lumbers into life, producing spurious and groundless methodological criticisms of the published data in order to muddy the waters—not enough to be noteworthy in a meaningful academic discussion, but that is not their purpose.
This is a well-worn risk-management tactic from many industries, including those producing tobacco, asbestos, lead, vinyl chloride, chromium and more. It is called ‘manufacturing doubt’, and in 1969 one tobacco executive was stupid enough to commit it to paper in a memo: ‘Doubt is our product,’ he wrote, ‘since it is the best means of competing with the ‘body of fact’ that exists in the minds of the general public. It is also the means of establishing a controversy.
It’s also full of interesting factoids: did you know that Sylvester Graham, graham cracker inventor and the “first great advocate of vegetarianism and nutritionism as we would know it,” also believed that ketchup and mustard could cause insanity? In addition to the historical background underpinning ridiculous beliefs and pseudoscience claims, sometimes his conclusions are so simple as to be obvious, yet there are a lot of people who need to hear them. Like when he writes, “these are just stories, and the plural of anecdote is not data.” I might have actually squealed. That line just applies to so much.
This was originally published in 2008, and it’s unfortunate how little has changed in the meantime. If anything, some has gotten worse. All the more reason to disseminate this book widely. It ought to be taught in schools; in fact, it opens with an eyebrow-raising practice from UK schools that I can’t believe even happens.
But it closes on a hopeful note, encouraging other science and medical professionals to spread awareness and give critical appraisal similarly, emphasizing that “knowledge is beautiful, and because if only a hundred people share your passion, that is enough.” I appreciate his efforts so much. This is essential reading as basic due diligence for understanding the claims we’re presented with.
Bad Science: Quacks, Hacks, and Big Pharma Flacks
by Ben Goldacre