Bad Science

Bad Science, Quacks, Hacks and Big Pharma Flacks, by Ben Goldacre ★★★★
This book was recommended to me by Dr. Tate, and is an enjoyable read. It is not about science, per se, but about research and science in health care. It is a book that I wish most people (who choose to be opinionated about health care problems) would read. The slightly less than excellent rating is not because it was a mediocre book, but for reasons to be explained below. The book is good because he hits at many of the issues that is encountered by popular medicine, whether it be conventional or alternative. So many people are deeply opinionated in things they know little about, and health care ranks at the top of the list. The book has 12 chapters, which I’ll briefly review.
Chapter 1, Matter, is an attack on a potpourri of crazy alternative health options, focusing on detoxification methods. Sadly, these treatments suggest that they are based on “science”, though worthwhile studies are virtually non-existent. Chapter 2, Brain Gym, attacks a ritual that I guess is quite popular in the British school system, but was exported from the US. In it, students go through a number of silly rituals to improve their “brain power”. Such a concept needs minimal argument as the method is so ad hoc and untested. Chapter 3 Homeopathy, is explored in a bit more depth. Goldacre’s biggest rant is against the extremely shoddy nature of their studies, as he begins to explore with the reader what it takes to engage in a legitimate clinical study. As a side comment, these were issues that were even of serious concern to the bench scientist. He spends some time introducing the issue of the Cochrane collaboration, and organization of scientist/statisticians which will take a given topic, research as many studies as possible that addressed the given topic, combine the studies through fancy statistical analysis, and then come to a conclusion. Chapter 4 is about the placebo effect, clarifying in many ways the power of a placebo. Chapter 5, titled The nonsense du jour, explores more about issues of bad science, how studies are poorly controlled, etc., but then focuses on nutritional studies and and anti-oxidants. Chapter 7, Nutritionists, develops an all out attack on people making ridiculous food claims, which are most plentiful. Chapter 8, The doctor will sue you now, goes into a personal story of Dr. Goldacre being sued by Dr. Matthias Rath for libel regarding Rath’s claims for the benefit of high dose vitamins, but lacking any substantial research to support that claim. Of course, the claim is so typical, that physicians and Bid Medicine are in collusion against alternative treatments, yet alternative treatment practitioners do not repel those claims by offering a legitimate scientific study. Which leads to chapter 9, Is mainstream medicine evil? Here, Goldacre takes a hard look at big Pharma, and instances where they have twisted or concealed data. The example used was of Vioxx, whose problem would never had been found if sloppy science was being used. But, Goldacre makes a claim that big Pharma has gone wrong in the past, and how pressures on the pharmaceutical industry will continue to manifest serious problems. In this chapter, I think that Goldacre was a little too kind to big Pharma. Yet, he also published an entire book attacking Big Pharma, so, perhaps he is leaving much to another book. Chapter 10, Why clever people believe stupid things, summarizes why very intelligent people, including those who have had scientific training, can be so wrong with healthcare studies. Not understanding randomization and statistics, preformed bias, drawing conclusions after the fact of the study all lead to wrong conclusions. This is probably the best chapter in the book. Chapter 11, Bad Stats, hits even harder on how study design, randomization, abuse of data, lack of critical thinking, etc., has led to so many false conclusions, and even major lawsuits, where the uncritical mind (especially lawyers) can draw conclusions from data that just isn’t there. Chapter 12, The MMR hoax, is a rant about the bad science used to suggest that the MMR vaccine is bad for you, causes autism, etc., etc.. His case is strong. I’m glad he didn’t attack the fight against the flu vaccine, whose science is pathetic. So, the book is good about detailing how bad science, bad statistics, and bad thinking can lead so many people (including very bright people, scientists, doctors) to wrong conclusions regarding issues related to health.
So, what did I not like about the book? I felt that Goldacre was completely lacking in humility, and his assumption that science can avoid issues of investigator bias are wrong. His assumption that with “good” science, all truth will be fore coming is fitting of a positivist mindset, which has been otherwise been thoroughly destroyed as a philosophic construct. Science depends on paradigms which so often are just plain wrong. It’s been shown that predictably, paradigms will change every 20-40 years, whether it be in health care, or in the hard sciences. He remains hyper-critical about everybody but himself. This is the greatest failure of this book, and Ben could use a dose of humility.