A few summers ago, my son came home from day camp and reported that he saw a “bad magician.” Was the magician incompetent, I asked, or was he evil? The bad scientists Ben Goldacre profiles in his book run this gamut of badness. Gillian McGrath, a nutritionist who claims that eating the darker leaves in plants will “really oxygenate your blood” because their chlorophyll is “high in oxygen” seems more like the former; Matthias Rath, who insists that AIDS can be cured only by his proprietary blend of multivitamins, hews pretty close to the latter.
Goldacre is seriously ticked about the misappropriation of science he sees all around him. As they have for centuries, quacks flat-out lie to the public to sell their useless panaceas, like “detox” foot patches that are designed to emit brown sludge when touching anything at all that is warm and moist, not just your skin. However now they also dress them up with “sciencey” language to give them a patina of truth. Practitioners of homeopathic medicine and peddlers of nutritional supplements refuse to acknowledge when tests show that their elixirs don’t work, or refuse to acknowledge that such tests have even been done, or refuse to release their materials for others to test while simultaneously concealing their own methodologies from outside appraisal. Drug companies suppress negative results, deceive their study subjects, and massage their data until they can report exactly and only what they like. And don’t even get him started on the journalists who ignore anything smacking of being evidence-based in favor of dramatic results that they can’t understand but that they know will whip the populace into frenzy. “If I weren’t writing a light and humorous book about science right now,” Goldacre writes, “I would descend into gales of rage.” It’s hard to blame him; his section on Rath and the one on Andrew Wakefield, who launched the MMR scare by conducting unethical tests on autistic children, reduced me to tears.
Goldacre has no problem admitting, demonstrating and proving exactly how – big pharma (and big agriculture) companies are evil. His problem is with the logic that goes like this: big pharma is evil, therefore homeopathy works and vaccines cause autism. Luckily, in this book he lays out fairly simple ways to begin to fix this logical fallacy. It relies on transparency on the part of the pharmaceuticals companies: he thinks that they should publish their methods section before embarking on a trial, so that everyone knows what their hypothesis is and how they plan to test it. That way if their methodologies are flawed from the start they will be called out on it, and they can’t extrapolate back from whatever they happen to find claiming to have expected it all along. However it also relies on an educated public, one that can spot those methodological flaws right at the outset.
Furthermore he tells us how to become that educated public, without getting too bogged down in statistics. We need to ensure that studies have a reasonable sample size; studying twelve kids, like Wakefield did to make his big link with the MMR vaccine, is not hugely informative. Studies need to be blinded, and randomized, and they need to tell us exactly how they were randomized because some methods are not really random at all. If many people drop out of the study, that should tell us something – like maybe they had bad side effects, or didn’t take their pills, or died, or something else that would affect the results had they not dropped out. Although many people think that comparing a treatment against placebo is still the gold standard, Goldacre points out that that is no longer the case, since no treatment (placebo) is not really an option anymore. Rather, a new treatment must be compared to the current standard of care – and of course the doses of both the old and new treatments must be disclosed. Researchers should measure a real outcome, like heart attacks, not a “surrogate outcome”, like plasma cholesterol levels. And they should report their results as absolute risk rather than as relative risk (ibuprofen causes one extra heart attack among 1,005 people, not a 24% increased risk).
And since you’ve been wondering: the magician at day camp didn’t want to take over the world or anything; he just wasn’t so great at doing tricks. Thankfully.