Lift Up Your Hearts!

Bad Science:  Quacks, Hacks, and Big Pharma Flacks, by Ben Goldacre (Faber and Faber, New York, 2010)

Bad Science was hard to read.  Not because the material is difficult (it's not), nor because I disagree with the author's positions (though sometimes I do), but because it is 258 pages of sneer.  Since Goldacre repeatedly states that he is bending over backwards to give his adversaries as much credit as possible, perhaps the sneer is unintentional, but it is no less an impediment.

Furthermore, casual statements like the one in which he implies that belief in a benevolent God is equivalent to believing in "flaky spiritual 'energy' that only alternative therapists can truly harness" unnecessarily alienates a large part of his potential audience. He continues this theme in the chapter on AIDS, where he dismisses those who point out that the single most effective method of preventing AIDS transmission is to avoid sex outside of marriage and the use of illegal drugs, calling them as irrational as those who offer AIDS sufferers beetroot and garlic instead of antiretroviral drugs.  He mocks Christian development agencies, implying that providing medical care, clean water, and the means to grow food and earn an income just isn't worthwhile if you don't also provide access to birth control and abortion.  Such statements do not give me confidence in the rationality of his approach to the other issues in the book.

And finally, if one is hoping to be a proponent of the rational, the scholarly, and the credentialed, it seems foolish to pepper your book with expletives.  They make the writing unpleasant to read, and seem as inappropriate in this setting as showing up with tattered jeans and multiple body piercings for a job interview at a bank.

So it's time to dust off my very own proverb:  The wise man recognizes truth in the words of his enemies.  Goldacre is inconsistent, I'll admit—excoriating the press for publishing frightening reports without backing them up with well-documented, respected, scientific research, for example, while casually and without documentation blaming Dr. Benjamin Spock for tens of thousands of avoidable deaths through his recommendation that babies sleep on their stomachs.  But mixed in with the chaff there are some very good points, and helpful hints for navigating the mess of contradictory news reports, especially in the field of medicine and health, that leave us throwing our hands up in despair of ever learning the truth.

If I had a T-shirt slogan for this whole book, it would be: "I think you'll find it's a bit more complicated than that."

Amen.  That's what he says, and what I'd say to him.  :)  Having worked in a research lab that published, in respected medical journals, the kinds of academic, peer-reviewed papers Goldacre holds up as a gold standard, I know that the system isn't quite as reliable and free of politics and prejudice as he would like us to believe.  It may be the best we have, and pretty good at that, but it has enough of the smell of a "good ol' boy" network to give me sympathy for those who take their findings directly to the media.

The chapter on the Placebo Effect is probably itself worth reading the book.  Why are injections more effective than pills?  Why does the color of the pill matter?  Why does the packaging matter?  How does the Placebo Effect help explain the greater effectiveness of name-brand drugs over generics of the same composition?

Useful, too, is the chapter on statistics and the reporting of data:  Why do drug companies like to compare the effectiveness of a new product to a placebo, when a much more useful comparison is with the effectiveness of the best production already in use?  How are figures from discredited studies or bad mathematics like a bad urban legend?  How can a report that there was "almost no change in patterns of [student] drug use, drinking or smoking since 2000" end up reported in the London Times as "Cocaine floods the playground:  Use of the addictive drug by children doubles in a year"?  (Much of the answer to the last lies in a misuse of statistics, but an immediately understandable factor is rounding error:  1.9 is not twice 1.4, but the one was rounded up and the other down.)

The story of a nurse jailed for the supposed murder of several of her patients is a fascinating example of the deadliness of statistics (and poor sampling technique) in the hands of a prosecutor who doesn't understand them.

Goldacre takes on a lot of sacred cows, from homeopathy to the pharmaceutical industry to the MMR vaccine scare.  Even I can recognize that for all his studies and statistics, he has misunderstood and oversimplified much.  But Bad Science is still a valuable book to read whether it changes your mind on anything or not.  It will make you more aware of what might, or might not, be behind the health information you learn from your doctor, your newspaper, the Internet, or your best friend.  A healthy skepticism is the servant of truth.

If you can get past the sneering and the profanity, you'll find Bad Science worth checking out.