Bad Science: Quacks, Hacks, and Big Pharma Flacks

by Ben Goldacre

Today, scientists and doctors find themselves outnumbered and outgunned by vast armies of individuals who feel entitled to pass judgment on matters of evidence—an admirable aspiration—without troubling themselves to obtain a basic understanding of the issues.

we get our information from the very people who have repeatedly demonstrated themselves to be incapable of reading, interpreting, and bearing reliable witness to the scientific evidence.

In terms of basic human biochemistry, detox is a meaningless concept.

Like so much of the nonsense in bad science, “detox” pseudoscience isn’t something done to us, by venal and exploitative outsiders; it is a cultural product, a recurring theme, and we do it to ourselves.

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.

Hahnemann’s theories differed from the competition because he decided—and there’s no better word for it—that if he could find a substance that would induce the symptoms of a disease in a healthy individual, it could be used to treat the same symptoms in a sick person.

The theory of like cures like, which he conjured up on that day, is, in essence, the first principle of homeopathy.

the key feature of homeopathy that most people would recognize today: he decided—again, that’s the only word for it—that if you diluted a substance, this would “potentize” its ability to cure symptoms, “enhancing” its “spirit-like medicinal powers,” and at the same time, as luck would have it, also reducing its side effects.

he went further than this: the more you dilute a substance, the more powerful it becomes at treating the symptoms it would otherwise induce.

A group of volunteers, anywhere from one person to a couple of dozen, come together and take six doses of the remedy being “proved,” at a range of dilutions, over the course of two days, keeping a diary of the mental, physical, and emotional sensations, including dreams, experienced over this time.

this long, unsystematic list of symptoms and dreams from a small number of people will become the “symptom picture” for that remedy, written in a big book and revered, in some cases, for all time.

For a start, you can’t be sure if the experiences the “provers” are having are caused by the substance they’re taking or by something entirely unrelated.

Hahnemann professed, and indeed recommended, complete ignorance of the physiological processes going on inside the body; he treated it as a black box,

Most people know that homeopathic remedies are diluted to such an extent that there will be no molecules of it left in the dose you get.

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.”

Imagine a sphere of water with a diameter of ninety million miles (the distance from the Earth to the sun). It takes light eight minutes to travel that distance. Picture a sphere of water that size, with one molecule of a substance in it: that’s a 30C dilution.

At a homeopathic dilution of 200C (you can buy much higher dilutions from any homeopathic supplier) the treating substance is diluted more than the total number of atoms in the universe, and by an enormously huge margin.

How have homeopaths dealt with the arrival of this new knowledge? By saying that the absent molecules are irrelevant, because “water has a memory.”

If water has a memory, as homeopaths claim, and a 1 in 1060 dilution is fine, then by now all water must surely be a health-giving homeopathic dilution of all the molecules in the world.

How does it know to treat my bruise with its memory of arnica, rather than a memory of Isaac Asimov’s feces?

I wrote this in the newspaper once, and a homeopath complained to the Press Complaints Commission.

You have to bang the flask of water briskly ten times on a leather and horsehair surface, and that’s what makes the water remember a molecule. Because I did not mention this, he explaine...

what you actually take, in general, is a little sugar pill, not a teaspoon of homeopathically diluted water, so they should start thinking about the memory of sugar too.

The memory of sugar, which is remembering something that was being remembered by water (after a dilution greater than the number of atoms in the universe) but then got passed on to the sugar as it dried.

They would say: “All I know is, I feel as if it works. I get better when I take homeopathy.”

“Well, perhaps that was the placebo effect.”

We know that two sugar pills are a more effective treatment than one sugar pill, for example, and we know that saltwater injections are a more effective treatment for pain than sugar pills, not because saltwater injections have any biological action on the body, but because an injection feels like a more dramatic intervention.

the color of pills, their packaging, how much you pay for them, and even the beliefs of the people handing the pills over are all important factors.

placebo operations can be effective for knee pain and ev...

we might reply: “I accept that, but perhaps your improvement is because of the placebo effect,” and they cannot answer no, because they have no possible way of knowing whether they got better through the placebo effect or not.

“Regression to the mean” is basically another phrase for the phenomenon whereby, as alternative therapists like to say, all things have a natural cycle.

many illnesses have what is called a natural history: they are bad, and then they get better.

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

An even more extreme version of regression to the mean is what is known as the Sports Illustrated jinx. Whenever a sportsman appears on the cover of Sports Illustrated, goes the story, he is soon to fall from grace.

when someone goes further and says, “Homeopathy works,” or mutters about “science,” then that’s a problem.

Over the course of many years, a team of Australian oncologists followed 2,337 terminal cancer patients in palliative care. They died, on average, after five months. But around 1 percent of them were still alive after five years.

“miracles” occur routinely, in 1 percent of cases by their definition, and without any specific intervention.

these trials have been done on homeopathy, and it seems that overall, homeopathy does no better than placebo.

Blood pressure readings are an inexact technique, like ECG interpretation, X-ray interpretation, pain scores, and many other measurements that are routinely used in clinical trials.

Some of the biggest figures in evidence-based medicine got together and did a review of blinding in all kinds of trials of medical drugs and found that trials with inadequate blinding exaggerated the benefits of the treatments being studied by 17 percent.

As with blinding, people have studied the effect of randomization in huge reviews of large numbers of trials and found that the ones with dodgy methods of randomization overestimate treatment effects by 41 percent.

trials with unclear methods of randomization overstate treatment effects by 30 percent,

studies that don’t report their methods fully do overstate the benefits of the treatments, by around 25 percent.

this very phrase has been effectively banned from the British Medical Journal for many years, on the ground that it adds nothing;

the hand-waving, superficially open-minded call for “more research” is meaningless and unhelpful.

Drug companies, more than most, know the benefits of good branding; they spend more on PR, after all, than they do on research and development.

Route of administration has an effect as well: saltwater injections have been shown in three separate experiments to be more effective than sugar pills for blood pressure, for headaches, and for postoperative pain, not because of any physical benefit of saltwater injection over sugar pills—there isn’t one—but because, as everyone knows, an injection is a much more dramatic intervention than just taking a pill.

Sham ultrasound is beneficial for dental pain, placebo operations have been shown to be beneficial in knee pain (the surgeon just makes fake keyhole surgery holes in the side and mucks about for a bit as if she were doing something useful), and placebo operations have even been shown to improve angina.

both what the doctor says and what the doctor believes have an effect on healing.