Friday, July 30, 2010

Bad Science by Ben Goldacre

bad science
Dr. Ben Goldacre
Fourth Estate - London, 2008
Website: Bad Science

Purpose of this text: to inform the general public about how to better understand modern biomedical news and in particular health related news. He is a British doctor and keeps his focus on the British scene but his lessons are universal and badly needed. In an earlier post  I  made some comments on the chapter in this text "Professor Patrick Holford".

This is a very important book. If you have never read a text on how to read and understand biomedical literature yet read biomedical literature you should read this text.
If you are someone who fits into the following categories you will find this text challenging, in fact I would be surprised if you would even bother to read it. (Take a lesson from me: it is sometimes precisely those with whom we have fundamental disagreements that can teach us something valuable.) The categories are:
  1. If you believe that modern medicine is driven solely by money and prestige and is not contributing to human health in any significant way. (There are problems with the influence of money in modern medicine but that is a problem endemic in our society, just about everything in our lives is influenced by money. Whether or not that is a bad thing is a different question. In modern medicine it is true that too often money has been a very bad thing, from pharmaceutical companies withholding data if not outright lying about their products to "nutrition gurus" speaking bullshit whilst selling pills. The very reason the USA's regulatory body on biomedicine, the FDA, came into existence, was because the world at the time was awash with bullshit artists. We now have the FDA and other regulatory bodies but the bullshit keeps piling up.)
  2. If you believe that all of alternative medicine is scientifically based. 
  3. If you believe that "Science" is a relatively primitive way of looking at the world and that there are others out there who have discovered "greater truths". So it doesn't matter if a health concept is not scientifically based, we have quantum healing, and detox regimes, and energy flows. 
Now, the book itself.

If you are one of those who is wondering what is happening in modern education, consider this opening line from the book:
"Let me tell you about how bad things have become. Children are routinely being taught - by their teachers, in thousands of British state schools - that if they wiggle their heads up and down it will increase blood flow to the frontal lobes .... "
Two questions: what idiot came up with this idea, and, why aren't teachers up in arms about this nonsense?

Possible answers: the idiot is just an idiot with power, a teacher who challenges a powerful idiot may well have their career damaged.

This nodding nonsense is part of what is called Brain Gym. Brain training has become all the rage and there are some people making a fortune out of it. Nearly all of it is complete bollocks. If you want to exercise your brain then try reading something challenging, or think about difficult problems, or find a better way to get things done. Apply your mind to things that are directly relevant to your life. Don't imagine that doing sudoko is somehow going to make your a wunderkid. It won't, it will just make you good at sudoko.

In the first chapter Goldacre examines some detox therapies, debunking them with consummate ease, yet there are people making big payola spruiking this rubbish.

Other chapters address cosmetics, homeopathy, the exorbitant claims about fish oil improving the intelligence of children, the problems with the pharmaceutical industry, the generally abysmal quality of much health reporting, the tricks of the trade(how studies are incorrectly and mischievously interpreted), a great chapter on the Placebo Effect, an excellent chapter on how to examine studies and deal with statistics, and the MMR issue.

The chapters addressing specific nutritionists or medical practices are good critiques, but the real goal of this text is to enable you to become equipped with the cognitive arsenal necessary in order to think for yourself about many of these health reports. It's good advice, take it in and take it seriously. The specific chapters of value here are: The Placebo Effect, The Nonsense du Jour, How the Media Promote the Public Misunderstanding of Science, Bad Stats, Health Scares, Why Clever People Believe Stupid Things. "Is Mainstream Medicine Evil?"is a good chapter to read if you want to understand how much effort and bullshit pharmaceutical companies will use to sell their products. For example, citing one meta analysis, Goldacres mentions how in that study it was found that pharmaceutical company funded studies were four times more likely to produce a favourable result for their product. p. 194

In pages 104ff, under the heading, "The antioxidant dream unravels", the author cites a number of well designed studies showing that antioxidant supplementation actually increased the mortality rate. Counter intuitive, even for cynical me, but intuition is a dangerous tool in this game. Again, to stress, the evidence for pill popping is not clear and unequivocal, but the evidence for a healthy diet is much stronger.

At page 106 he provides a wonderful example of how urban myths, in the minds of some, become facts. He mentions how in WW2 the allies started a rumour that their pilots were eating lots of carrots to improve their night time vision, this rumour was promulgated so as to deceive the Germans about the recently installed radar equipment on night fighters, thereby enabling them to track German aircraft.

Regarding why so much health reporting has gone deeply astray, at page 207 Goldacre makes this statement:
My basic hypothesis is this: the people who run the media are humanities graduates with little understanding of science, who wear this ignorance as a badge of honour.
I live in Australia and am somewhat removed from the "culture wars". I have no personal relationship to Snow's culture wars thesis. For myself, this war between the humanities and science is laughable and silly, if only because  it is impossible to clearly delineate what is a humanities subject and what is a science subject. Nonetheless from various sources I have picked up on this anti-science trend, and this trend is certainly evident in some areas of alternative medicine. I don't know how there can be a culture war because strictly speaking science does not provide a world view. That, again, may reflect my own bias because I believe the concept of "world view" is ridiculous.

In Britain, however, the culture wars seem to be pronounced. Consider this statement from Sir Robert Winston, made on an Australian current affairs program, Lateline, some months ago.
It's no longer satisfactory for people to say, rather proudly, "of course I didn't do science at school" believing that therefore "because I know Hamlet I don't need to know science". 
If you said in a public gathering "I'm not interested in Hamlet," you'd be regarded as a Philistine, but you can get away with that with chemistry. 
And I think we need to be absolutely sure that we build much better science education, we explain to children the wonderment of science.
 Bad Science is precisely about building better science education. The tragedy is that this should be taught in schools.

Goldacre quotes Stephen Jay Gould. This statement by Gould is extremely important, please heed it.

When people learn no tools of judgement and merely follow their hopes, the seeds of political manipulation are sown. 

Amen to that. So how can we develop these tools? In relation to health reporting Goldacre's text is replete with valuable advice on this matter.

At page 240 Goldacre provides a very valuable way to report statistical data. He relies on "natural frequencies" and provides this example.

Assuming that having a heart attack in your fifties is 50% higher if you have high cholesterol. Sounds worrying.  Reporting this as natural frequencies we then have:

Out of a hundred men with normal cholesterol 4 will be expected to have a heart attack, with high cholesterol it is 6 out of hundred men will have heart attacks.

Read the following pages on this, it is a very good way to approach statistical reporting.

Great text, should be read by everyone interested in health reporting.

Let me state my position:

Dr. Goldacre offers no specific health advice, that is not the purpose of this text. At best he simply says, "eat more fruits and vegetables, get more exercise, avoid bad habits". He may have more in mind, I don't know, but I do believe in the judicious use of pills. For example, I occasionally go through a bottle of magnesium tablets, my cue being the arrival of cramps. In my case, apart from a possible genetic association(my mother also experienced cramps) perhaps all the coffee drinking is washing the magnesium out of my system. Not sure, don't care, I just know that magnesium deficiency is common and I demonstrate a cardinal symptom for that deficiency. I do occasionally try different supplemental regimes which are designed to induce specific effects, particularly in relation to cerebral health and energy. Last year I combined two of these regimes and went hypomanic for a few weeks!

In my experience most people who are into the health thing are relying on their favourite authority figure, reading magazines and web pages, they may even go so far as to read the occasional abstract, but with the exception of my friend in New York I don't know anyone who has demonstrated that they have a friggin' clue about how to handle all that information.

I do occasionally take a multi-vitamin but only because I am a very sparse eater, often going for 24 hours without food. However, the data on pill popping is very disappointing and even comes out with negative results, particularly in relation to beta-carotene and vitamin A. I have a few problematic insights into this apparent conundrum but that's another story. Funny though, all those people filing themselves up with vitamin A thinking more is better. I have a completely different perspective on these issues, I believe that nutrient imbalance can be as dangerous as nutrient deficiency, I believe that evolution has given rise to biological processes that are simultaneously finely tuned to towards optimal function within a relatively narrow range of nutrient resources but also with a remarkably wide window of tolerance for nutrient imbalances and shortfalls that allows sufficient but sub-optimal function. Complex, adaptive, "self modulating" system dynamics.  

The "Health" Industry is just that: an industry. Don't be fooled by their all things sugar and sweet theme, these people are out to get money and it is your money they want. They will beguile you with trips to Acronym City, my description of how I think about all this stuff, in my head it is all just signs and pointers to ideas, the words don't matter, the information does. They throw around concepts from Acronym City not to inform you but to impress you. The very reason I created the description of Acronym City was so that I could say to friends, "look, I can't explain this any further without going to Acronym City and we don't want to go there."

The single biggest contribution of alternative medicine to modern health has been its emphasis on preventative health. The conventional medical community did neglect this aspect of health but keep in mind that doctors are there to treat disease, not provide lifestyle counselling. In this day and age any adult who needs to learn about healthy living has either been living in a cave or just doesn't care. With the exception of addressing pathologies I don't think doctors should be in the business of lifestyle counselling.

I believe that some of the current dietary crazes, from high antioxidant intake to large amounts of omega 3 fats, are, as has so often happened, going to backfire on us.

I'll go metaphysical here and assert that I believe Life is intrinsically dissipative. That is, contrary to the popular view that aging is an aberration, a consequence of things breaking down, I wonder if aging is intrinsic, an inevitable function of biological processes. Nothing stays the same forever, except perhaps the hope of immortality. Life may be shaking its fist at the Second Law of Thermodynamics but eventually physics wins. It always does.

There are a number of studies like this one. Read it carefully and you'll realise just how much we don't know about healthy living. 

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