Bad Science: Quacks, Hacks, and Big Pharma Flacks

by Ben Goldacre

You cannot reason people out of positions they didn’t reason themselves into.

Children can be disgusting, and often they can develop extraordinary talents, but I’ve yet to meet any child who can stimulate his carotid arteries inside his rib cage.

“Something about seeing neuroscience information may encourage people to believe they have received a scientific explanation when they have not.”

You can take a perfectly sensible intervention, like a glass of water and an exercise break, but add nonsense, make it sound more technical, and make yourself sound clever. This will enhance the placebo effect, but you might also wonder whether the primary goal is something much more cynical and lucrative: to make common sense copyrightable, unique, patented, and owned.

Companies still name them on the label, wallowing in the glory of their efficacy at higher potencies, because you don’t have to give the doses of your ingredients, only their ranked order. But these chemicals are usually in your cream at talismanic concentrations, for show only.

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.

after all, a pile of rust is an iron bridge “with some extra oxygen,” and you wouldn’t imagine it would oxygenate your skin.

They suggest, instead, with all the might of their international advertising budgets, their Microcellular Complexes, their Neutrilium XY, their Tenseur Peptidique Végétal, and the rest, that science is about impenetrable nonsense involving equations, molecules, sciencey diagrams, sweeping didactic statements from authority figures in white coats, and that this sciencey-sounding stuff might just as well be made up, concocted, confabulated out of thin air, in order to make money. They sell the idea that science is incomprehensible, with all their might, and they sell this idea mainly to attractive young women, who are disappointingly underrepresented in the sciences.

Homeopathy is perhaps the paradigmatic example of an alternative therapy. It claims the authority of a rich historical heritage, but its history is routinely rewritten for the PR needs of a contemporary market; it has an elaborate and sciencey-sounding framework for how it works, without scientific evidence to demonstrate its veracity; and its proponents are quite clear that the pills will make you better, when in fact they have been thoroughly researched, with innumerable trials, and have been found to perform no better than placebo.

a 30C homeopathic preparation is a dilution of 1 in 10030, or rather 1060, or 1 followed by 60 zeros. To avoid any misunderstandings, this is a dilution of 1 in 1,000,000,000,000,000,000,000,000,000,000,000, 000,000,000,000,000,000,000,000,000, or, to phrase it in the Society of Homeopaths’ terms, “one part per million million million million million million million million million million.”

Maybe some of the water molecules fleshing out my neurons as I decide whether to write “wee” or “urine” in this sentence are now in the bladder of the queen of England (God bless her).

How does a water molecule know to forget every other molecule it’s seen before? How does it know to treat my bruise with its memory of arnica, rather than a memory of Isaac Asimov’s feces?

As Voltaire said, “The art of medicine consists in amusing the patient while nature cures the disease.”

Similarly, people flogging detox will often say that their remedies might make you feel worse at first, as the toxins are extruded from your body; under the terms of these promises, literally anything that happens to you after a treatment is proof of the therapist’s clinical acumen and prescribing skill.

(The placebo control for acupuncture, in case you’re wondering, is sham acupuncture, with fake needles or needles in the “wrong” places, although an amusing complication is that sometimes one school of acupuncturists will claim that another school’s sham needle locations are actually their genuine ones.)

Randomization is another basic concept in clinical trials. We randomly assign patients to the placebo sugar pill group or the homeopathy sugar pill group, because otherwise there is a risk that the doctor or homeopath—consciously or unconsciously—will put patients who they think might do well into the homeopathy group and the no-hopers into the placebo group, thus rigging the results.

Again, I do not speak from prejudice: trials with unclear methods of randomization overstate treatment effects by 30 percent, almost as much as the trials with openly rubbish methods of randomization.

Branthwaite and Cooper did a truly extraordinary study in 1981, looking at 835 women with headaches. It was a four-armed study, in which the subjects were given either aspirin or placebo pills, and these pills in turn were packaged either in blank, bland, neutral boxes or in full, flashy, brand-name packaging. They found—as you’d expect—that aspirin had more of an effect on headaches than sugar pills, but more than that, they found that the packaging itself had a beneficial effect, enhancing the benefit of both the placebo and the aspirin.

Under his model, “bullshit” is a form of falsehood distinct from lying: the liar knows and cares about the truth but deliberately sets out to mislead; the truth speaker knows the truth and is trying to give it to us; the bullshitter, meanwhile, does not care about the truth and is simply trying to impress us:

Every time you read in a newspaper that “moderate alcohol intake” is associated with some improved health outcome—less heart disease, less obesity, anything—to gales of delight from the alcohol industry, and, of course, from your friends, who say, “Ooh, well, you see, it’s better for me to drink a little…” as they drink a lot—you are almost certainly witnessing a journalist of limited intellect, overinterpreting a study with huge confounding variables.

But you have to be very cautious about how you extrapolate from what happens to some cells in a dish on a laboratory bench to the complex system of a living human being, where things can work in completely the opposite way from what laboratory work would suggest. Anything can kill cells in a test tube. Fairy liquid will kill cells in a test tube, but you don’t take it to cure cancer.

What if you’ve just got a point to prove? There are few opinions

so absurd that you couldn’t find at least one person with a Ph.D. somewhere in the world to endorse them for you; and similarly, there are few propositions in medicine so ridiculous that you couldn’t conjure up some kind of published experimental evidence somewhere to support them, if you didn’t mind its being a tenuous relationship and cherry-picked the literature, quoting only the studies that were in your favor.

Second, just because antioxidants are involved in doing something good, why should eating more of them necessarily make that process more efficient? I know it makes sense superficially; but so do a lot of things, and that’s what’s really interesting about science (and this story in particular): sometimes the results aren’t quite what you might expect.

It’s interesting to note, while we’re here, that carrots were the source of one of the great disinformation coups of World War II, when the Germans couldn’t understand how our pilots could see their planes coming from huge distances, even in the dark. To stop them from trying to work out if we’d invented anything clever like radar (as we had), the British instead started an elaborate and entirely made-up nutritionist rumor. Carotenes in carrots, they explained, are transported to the eye and converted to retinal, which is the molecule that detects light in the eye (this is basically true and is a plausible mechanism, like those we’ve already dealt with), so, went the story, doubtless with much chortling behind their excellent RAF mustaches, we have been feeding our chaps huge plates of carrots, to jolly good effect.

The more people are listening to you, the greater the effects of a small error can be.

“Hadacol,” said Groucho, “what’s that good for?” “Well,” said LeBlanc, “it was good for about five and a half million dollars for me last year.” The point I am making is that there is nothing new under the sun. There have always been health gurus selling magic potions, and there always will be.

Piecemeal individual life changes, which go against the grain of your own life and your environment, are hard to make and even harder to maintain.

There are fairly good grounds to believe that many of these lifestyle issues are in fact better addressed at the societal level. One of the most significant “lifestyle” causes of death and disease, after all, is social class.

Your life is in disarray; your restless legs/migraine/cholesterol have taken over; all is panic; there is no sense anywhere. Then, when you take the right pill, suddenly the screen brightens up into a warm yellow, granny’s laughing, the kids are laughing, the dog’s tail is wagging, some nauseating child is playing with the hose on the lawn, spraying a rainbow of water into the sunshine while absolutely laughing his head off as all your relationships suddenly become successful again. All you have to do is “ask your doctor” and life will be good.

We have a disproportionately high opinion of ourselves, which is nice. A large majority of the public think they are more fair-minded, less prejudiced, more intelligent, and more skilled at driving than the average person, when of course, only half of us can be better than the median.

unlikely combinations of events will always happen, somewhere, to some people, entirely by chance. Drawing a target around them after the fact tells us nothing at all.

At the risk of initiating mass panic, I feel duty bound to point out that if MMR still scares you, then so should everything in medicine and indeed many of the everyday lifestyle risk exposures you encounter, because there are a huge number of things that are far less well researched, with a far lower level of certainty about their safety.

Anybody can understand anything, as long as it is clearly explained, but, more than that, if they are sufficiently interested. What determines an audience’s understanding is not so much scientific knowledge as motivation: patients who are ill, with an important decision to make about treatment, can be very motivated indeed.

Whatever the wealthy pill peddlers try to tell you, with their brand-building conspiracy theories, big pharma isn’t afraid of the food supplement pill industry; it is the food supplement pill industry.

Unmediated access to niche expertise is the future, and you know, science isn’t hard—academics around the world explain hugely complicated ideas to ignorant eighteen-year-olds every September—it just requires motivation.