Tuesday, November 2, 2010
New York Times book Review, By KATHERINE BOUTON Published: November 1, 2010
There's more here than just debunking nonsense. The appearance of "scienciness": the diagrams and graphs, the experiments (where exactly was that study published?) that prove their efficacy are all superficially plausible, with enough of a "hassle barrier" to deter a closer look. Dr. Goldacre (a very boyish-looking 36-year-old British physician and author of the popular weekly "Bad Science" column in The Guardian) shows us why that closer look is necessary and how to do it.
You'll get a good grounding in the importance of evidence-based medicine (the dearth of which is a "gaping" hole in our culture). You'll learn how to weigh the results of competing trials using a funnel plot, the value of meta-analysis and the Cochrane Collaboration. He points out common methodological flaws: failure to blind the researchers to what is being tested and who is in a control group, misunderstanding randomization, ignoring the natural process of regression to the mean, the bias toward positive results in publication. "Studies show" is not good enough, he writes: "The plural of 'anecdote' is not data."
Dr. Goldacre has his favorite nemeses, one of the most prominent being the popular British TV nutritionist Gillian McKeith, whose books and diet supplements are wildly successful. According to her Web site, "Gillian McKeith earned a Doctorate (PhD) in Holistic Nutrition from the American Holistic College of Nutrition, which is now known as the Clayton College of Natural Health." (The college closed in July of this year.) Clayton was not accredited, and offered a correspondence course to get a Ph.D. that cost $6,400. She is also a "certified professional member" of the American Association of Nutritional Consultants, where, Dr. Goldacre writes, he managed to get certification for Hettie, his dead cat, for $60. Ms. McKeith has agreed not to call herself "Dr." anymore.
There's nothing wrong, he says, with the substance of her diet ("anyone who tells you to eat more fresh fruits and vegetables is all right by me") any more than with diets that advise drinking plenty of water and moderate alcohol intake and exercise. What he does object to is the "proprietorialization of common sense." Adding sciency flourishes and a big price tag to the advice may 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."
Sometimes bad science is downright harmful, and in the chapter titled "The Doctor Will Sue You Now," the usually affable Dr. Goldacre is indeed angry, and rightly so. The chapter did not appear in the original British edition of the book because the doctor in question, Dr. Matthias Rath, a vitamin pill entrepreneur, was suing The Guardian and Dr. Goldacre personally on a libel complaint. He dropped the case (after the Guardian had amassed $770,000 in legal expenses) paying $365,000 in court costs. Dr. Rath, formerly head of cardiovascular research at the Linus Pauling Institute in Menlo Park, Calif., and founder of the nonprofit Dr. Rath Research Institute, is, according to his Web site, "the founder of Cellular Medicine, the groundbreaking new health concept that identifies nutritional deficiencies at the cellular level as the root cause of many chronic diseases."
Dr. Rath's ads in Britain for his high-dose vitamins have claimed that "90 percent of patients receiving chemotherapy for cancer die with months of starting treatment" and suggested that three million lives could be saved if people stopped being treated with "poisonous compounds." He took his campaign to South Africa, where AIDS was killing 300,000 people a year, and in newspaper ads proclaimed that "the answer to the AIDS epidemic is here." The ads asked, "Why should South Africans continue to be poisoned with AZT? There is a natural answer to AIDS." That answer was multivitamin supplements, which he said "cut the risk of developing AIDS in half."
"Tragically," as Dr. Goldacre writes, Dr. Rath found a willing ear in Thabo Mbeki. Despite condemnation by the United Nations, the Harvard School of Public Health and numerous South African health organizations, Dr. Rath's influence was pervasive. Various studies have estimated that had the South African government used antiretroviral drugs for prevention and treatment, more than 300,000 unnecessary deaths could have been prevented.
You don't have to buy the book to read the whole sorry story, which is readily available online. Dr. Goldacre believes in the widest possible dissemination of information. But if you do buy the book, you'll find it illustrated with lucid charts and graphs, footnoted (I'd have liked more of these), indexed and far more serious than it looks. Depending on your point of view, you'll find it downright snarky or wittily readable.
BAD SCIENCE Quacks, Hacks, and Big Pharma Flacks.By Ben Goldacre. Faber and Faber. 288pages $15
Posted by Seth Kalichman at 10:49 AM