Bad Science: Quacks, Hacks, and Big Pharma Flacks

Bad Science: Quacks, Hacks, and Big Pharma Flacks

3.9 17
by Ben Goldacre

Have you ever wondered how one day the media can assert that alcohol is bad for us and the next unashamedly run a story touting the benefits of daily alcohol consumption? Or how a drug that is pulled off the market for causing heart attacks ever got approved in the first place? How can average readers, who aren't medical doctors or Ph.D.s in biochemistry, tell what

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Have you ever wondered how one day the media can assert that alcohol is bad for us and the next unashamedly run a story touting the benefits of daily alcohol consumption? Or how a drug that is pulled off the market for causing heart attacks ever got approved in the first place? How can average readers, who aren't medical doctors or Ph.D.s in biochemistry, tell what they should be paying attention to and what's, well, just more bullshit?

Ben Goldacre has made a point of exposing quack doctors and nutritionists, bogus credentialing programs, and biased scientific studies. He has also taken the media to task for its willingness to throw facts and proof out the window. But he's not here just to tell you what's wrong. Goldacre is here to teach you how to evaluate placebo effects, double-blind studies, and sample sizes, so that you can recognize bad science when you see it. You're about to feel a whole lot better.

Editorial Reviews

Katherine Bouton
Ben Goldacre is exasperated. He's not exactly angry—that would be much less fun to read—except in certain circumstances. He is irked, vexed, bugged, ticked off at the sometimes inadvertent (because of stupidity) but more often deliberate deceptions perpetrated in the name of science. And he wants you, the reader, to share his feelings…[Bad Science is] illustrated with lucid charts and graphs, footnoted…indexed and far more serious than it looks. Depending on your point of view, you'll find it downright snarky or wittily readable.
—The New York Times
Publishers Weekly
Goldacre is the acerbic quackbuster who's a thorn in the side of celebrity nutritionists and alternative medicine practitioners in Britain through his "Bad Science" column in the Guardian. And now this M.D. and formidable investigative journalist brings his eye-popping insistence on rigorous science to this side of the Atlantic. There's plenty to debunk, like the detox footbaths that turn brown whether your feet are in them or not. Or the homeopathic remedies that are no more effective than placebos (i.e., sugar pills). Goldacre's on to Big Pharma as well, skewering the industry's manipulation of statistics and suppression of negative results in clinical trials. The media take their hits as well for fueling the scare over the measles-mumps-rubella vaccine's link to autism--a link that researchers have definitively debunked. And there's hell to pay for the growing legion of nutritionists and the lucrative nutritional supplement business, which come under Goldacre's special derision as "The Nonsense Du Jour" and "intellectual crimes." Not that Goldacre's always so solemn or scolding. His ongoing battle with Brit nutritionist Gillian McKeith is both unsettling and an amusing illustration of how simple it is to pull back the curtain on the wizard of Oz. (Oct.)
From the Publisher
"Great fun for science and statistics geeks, this is challenging in the best sense of the word." —Library Journal
The New York Times Katherine Bouton

Ben Goldacre is exasperated . . . He is irked, vexed, bugged, ticked off at sometimes inadvertent (because of stupidity) but more often deliberate deceptions perpetrated in the name of science. And he wants you, the reader, to share his feelings . . . There's more here than just debunking nonsense. The appearance of 'scienceiness': 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 . . . 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 . . . 'Studies show' is not good enough, he writes: 'The plural of "anecdote" is not data.'
The Washington Post Rachel Saslow

British physician and journalist Ben Goldacre takes aim at quack doctors, pharmaceutical companies and poorly designed studies in extraordinary fashion in Bad Science. He particularly loathes (most) nutritionists, especially Scottish TV personality Gillian McKeith. To prove that her American Association of Nutritional Consultants membership isn't so impressive, Goldacre describes registering his dead cat Hettie for the same credentials online. Goldacre shines in a chapter about bad scientific studies by writing it from the perspective of a make-believe big pharma researcher who needs to bring a mediocre new drug to market. He explains exactly how to skew the data to show a positive result. 'I'm so good at this I scare myself,' he writes. 'Comes from reading too many rubbish trials.'
The Boston Globe Dennis Rosen

Ben Goldacre, a British physician and author, has written a very funny and biting book critiquing what he calls "Bad Science.'' Under this heading he includes homeopathy, cosmetics manufacturers whose claims about their products defy plausibility, proponents of miracle vitamins, and drug companies and physicians who design faulty studies and manipulate the results . . . While it is a very entertaining book, it also provides important insight into the horrifying outcomes that can result when willful anti-intellectualism is allowed equal footing with scientific methodology. Sharon Begley

I hereby make the heretical argument that it is time to stop cramming kids' heads with the Krebs cycle, Ohm's law, and the myriad other facts that constitute today's science curricula. Instead, what we need to teach is the ability to detect Bad Science--BS, if you will. The reason we do science in the first place is so that 'our own atomized experiences and prejudices' don't mislead us, as Ben Goldacre of the London School of Hygiene and Tropical Medicine puts it in his new book, Bad Science: Quacks, Hacks, and Big Pharma Flacks. Understanding what counts as evidence should therefore trump memorizing the structural formulas for alkanes.

Dr. Ben Goldacre's UK bestseller Bad Science: Quacks, Hacks, and Big Pharma Flacks is finally in print in the USA, and Americans are lucky to have it. Goldacre writes a terrific Guardian column analyzing (and debunking) popular science reporting, and has been a star in the effort to set the record straight on woowoo 'nutritionists,' doctors who claim that AIDS can be cured with vitamns, and vaccination/autism scares. Bad Science is more than just a debunking expose (though its that): it's a toolkit for critical thinking, a primer on statistics and valid study design, a guide to meta-analysis and other tools for uncovering and understanding truth . . . The book should be required reading for everyone who cares about health, science, and public policy.
author of The Undercover Economist Tim Harford

One of the best books I've ever read. It completely changed the way I saw the world. And I actually mean it.
author of Intern Sandeep Jauhar

Ben Goldacre lucidly, and irreverently, debunks a frightening amount of pseudoscience, from cosmetics to dietary supplements to alternative medicine. If you want to read one book to become a better-informed consumer and citizen, read Bad Science.
author of The 4-Hour Workweek Timothy Ferriss

This is a much-needed book. Ben Goldacre shows us--with hysterical wit--how to separate the scam artists from real science. In a world of misinformation, this is a rare gem.
Mary Roach

Smart, funny, clear, unflinching: Ben Goldacre is my hero. Bad Science should be kicking up the dust on every high school science curriculum in America.
author of Big Bang and Fermat's Last Theorem Simon Singh

Ben Goldacre uses a brilliant mix of science and wit to challenge and investigate alternative therapists and the big pharmaceutical corporations. Bad Science is an invaluable tool for anybody who wants to protect themselves from the snake-oil salesmen of the twenty-first century.
Library Journal
British doctor Goldacre is in a tizzy and wants you to know about it. He's sick of unproven medical advice, homeopathic treatments, and poor pseudoscientific educational and nutritional programs. He writes the Guardian's "Bad Science" column and feels strongly about the healthy doses of misinformation floating around, buoyed by poorly conducted research studies. Explaining the meaning of randomized, double-blind, placebo studies, he directs his wrath at supplement hucksters past and present. Originally published in the UK, his book has been updated for American audiences—it features both UK and U.S. examples—and includes a chapter he was unable to publish previously because of a lawsuit. Funny and profane, Goldacre discusses the horror of U.S. pharmaceutical marketing campaigns, the value of evidence-based medicine, and how to lie with statistics. From vaccine scares to murder cases, there's something for everyone. VERDICT Great fun for science and statistics geeks, this is challenging in the best sense of the word. Recommended for public, academic, and medical libraries.—Elizabeth Williams, Washoe Cty. Lib. Syst., Reno, NV
Kirkus Reviews

British National Health Service physician Goldacre shoots down what he considers to be quackery.

This updated version of the UK edition, published in 2008, begins with the statement, "Homeopaths are morons." However, the author's real targets are not proponents of alternative medicine—although he considers their remedies to be no more effective than "sugar pills"—but the ignorance of the vast public who are led astray by media hype and advertisers. The author writes the weekly "Bad Science" column for The Guardian, which, like the book, is intended to help people "who are angry about the evils of the pharmaceutical industry and nervous about the role of profit in health care." While his dismissal of concerns about the use of MMR vaccine—an immunization shot against measles, mumps and rubella which many suspect may trigger autism in some children—are a bit cavalier, his purpose in writing is not to defend "big pharma" but to give the reader the tools to understand "how a health myth can be created, fostered, and maintained by the alternative medicine industry, using all the tricks on you, the public that big pharma uses on doctors." This edition includes an account of a libel suit filed against Goldacre and The Guardian, which was settled (in his favor) in 2008. The author had investigated the nefarious activities of a group of big-money entrepreneurs who had spread a conspiracy theory in South Africa. In order to market vitamins as a replacement for antiretroviral therapy in the treatment of AIDS, they circulated the big lie that the pharmaceuticals not only did not retard the disease but were responsible for its spread. For Goldacre, it is these "journalists and miracle cure merchants" who undermine people's understanding of the scientific basis for good medicine.

The author's attacks on alternative medicine are often misguided, but he provides a valuable service in exposing the countless examples of bad science being perpetrated throughout the medical community and in the press.

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Bad Science

Quacks, Hacks, and Big Pharma Flacks

By Ben Goldacre

Faber and Faber, Inc.

Copyright © 2010 Ben Goldacre
All rights reserved.
ISBN: 978-1-4299-6709-9



I spend a lot of time talking to people who disagree with me — I would go so far as to say that it's my favorite leisure activity — and repeatedly I meet individuals who are eager to share their views on science despite the fact that they have never done an experiment. They have never tested an idea for themselves, using their own hands, or seen the results of that test, using their own eyes, and they have never thought carefully about what those results mean for the idea they are testing, using their own brain. To these people "science" is a monolith, a mystery, and an authority, rather than a method.

Dismantling our early, more outrageous pseudoscientific claims is an excellent way to learn the basics of science, partly because science is largely about disproving theories, but also because the lack of scientific knowledge among miracle cure artistes, marketers, and journalists gives us some very simple ideas to test. Their knowledge of science is rudimentary, so as well as making basic errors of reasoning, they rely on notions like magnetism, oxygen, water, "energy," and toxins — ideas from high school-level science and all very much within the realm of kitchen chemistry.

Detox and the Theater of Goo

Since you'll want your first experiment to be authentically messy, we'll start with detox. Detox footbaths have been promoted un-critically in some very embarrassing articles in the New York Daily News, the Telegraph, the Mirror, The Sunday Times (London), GQ magazine, and various TV shows. Here is a taster from the New York Daily News: it's a story about Ally Shapiro, a fourteen-year-old who went to a "detox" center run by Roni DeLuz, author of 21 Pounds in 21 Days: The Martha's Vineyard Diet.

"The first day I did it," says Shapiro, "the water was completely black by the end." By day three, twenty minutes in the footbath generated a copper-colored sludge — the color of the flushed buildup from her joints related to arthritis, DeLuz explained. The hypothesis from these companies is very clear: your body is full of "toxins," whatever those may be; your feet are filled with special "pores" (discovered by ancient Chinese scientists, no less); you put your feet in the bath, the toxins are extracted, and the water goes brown. Is the brown in the water because of the toxins? Or is that merely theater?

One way to test this is to go along and have an Aqua Detox treatment yourself at a health spa, beauty salon, or any of the thousands of places they are available online, and take your feet out of the bath when the therapist leaves the room. If the water goes brown without your feet in it, then it wasn't your feet or your toxins that did it. That is a controlled experiment; everything is the same in both conditions, except for the presence or absence of your feet.

There are disadvantages with this experimental method (and there is an important lesson here — that we must often weigh up the benefits and practicalities of different forms of research, which will become important in later chapters). From a practical perspective, the "feet out" experiment involves subterfuge, which may make you uncomfortable. But it is also expensive: one session of Aqua Detox will cost more than the components to build your own detox device, a perfect model of the real one.

You will need:

• One car battery charger

• Two large nails

• Kitchen salt

• Warm water

• One Barbie doll

• A full analytic laboratory (optional)

This experiment involves electricity and water. In a world of hurricane hunters and volcanologists, we must accept that everyone sets their own level of risk tolerance. You might well give yourself a nasty electric shock if you perform this experiment at home, and it could easily blow the wiring in your house. It is not safe, but it is in some sense relevant to your understanding of MMR, homeopathy, postmodernist critiques of science, and the evils of big pharma. DO NOT BUILD IT.

When you switch your Barbie Detox machine on, you will see that the water goes brown, due to a very simple process called electrolysis; the iron electrodes rust, essentially, and the brown rustgoes into the water. But there is something more happening in there, something you might half remember from chemistry at school. There is salt in the water. The proper scientific term for household salt is "sodium chloride" in solution, this means that there are chloride ions floating around, which have a negative charge (and sodium ions, which have a positive charge). The red connector on your car battery charger is a "positive electrode," and here negatively charged electrons are stolen away from the negatively charged chloride ions, resulting in the production of free chlorine gas.

So chlorine gas is given off by the Barbie Detox bath, and indeed by the Aqua Detox footbath, and the people who use this product have elegantly woven that distinctive chlorine aroma into their story: it's the chemicals, they explain; it's the chlorine coming out of your body, from all the plastic packaging on your food and all those years bathing in chemical swimming pools. "It has been interesting to see the color of the water change and smell the chlorine leaving my body," says one testimonial for the similar product Emerald Detox. At another sales site: "The first time she tried the Q2 [Energy Spa], her business partner said his eyes were burning from all the chlorine that was coming out of her, leftover [sic] from her childhood and early adulthood." All that chemically chlorine gas that has accumulated in your body over the years. It's a frightening thought.

But there is something else we need to check. Are there toxins in the water? Here we encounter a new problem: What do they mean by toxins? I've asked the manufacturers of many detox products this question time and again, but they demur. They wave their hands, they talk about stressful modern lifestyles, they talk about pollution, they talk about junk food, but they will not tell me the name of a single chemical that I can measure. "What toxins are being extracted from the body with your treatment?" I ask. "Tell me what is in the water, and I will look for it in a laboratory." I have never been given an answer.

After much of their hedging and fudging, I chose two chemicals pretty much at random: creatinine and urea. These are common breakdown products from your body's metabolism, and your kidneys get rid of them in urine. Through a friend, I went for a genuine Aqua Detox treatment, took a sample of brown water, and used the disproportionately state-of-the-art analytic facilities of St. Mary's Hospital in London to hunt for these two chemical "toxins." There were no toxins in the water. Just lots of brown, rusty iron.

Now, with findings like these, scientists might take a step back and revise their ideas about what is going on with the footbaths. We don't really expect the manufacturers to do that, but what they say in response to these findings is very interesting, at least to me, because it sets up a pattern that we will see repeated throughout the world of pseudoscience: instead of addressing the criticisms, or embracing the new findings in a new model, they seem to shift the goalposts and retreat, crucially, into untestable positions.

Some of them now deny that toxins come out in the footbath (which would stop me measuring them); your body is somehow informed that it is time to release toxins in the normal way — whatever that is, and whatever the toxins are — only more so. Some of them now admit that the water goes a bit brown without your feet in it, but "not as much." Many of them tell lengthy stories about the "bioenergetic field," which they say cannot be measured except by how well you are feeling. All of them talk about how stressful modern life is.

That may well be true. But it has nothing to do with their footbath, which is all about theater, and theater is the common theme for all detox products, as we shall see. On with the brown goo.

Ear Candles

You might think that Hopi ear candles are easy targets. But their efficacy has still been cheerfully promoted by The Independent, The Observer, and the BBC, to name just a few respected British news outlets. They pop up endlessly in American local papers desperate to fill space, from the Alameda Times-Star to the Syracuse Post-Standard. Since journalists like to present themselves as authoritative purveyors of scientific information, I'll let the internationally respected BBC explain how these hollow wax tubes, Hopi ear candles, will detox your body: "The candles work by vaporizing their ingredients once lit, causing convectional air flow towards the first chamber of the ear. The candle creates a mild suction which lets the vapors gently massage the eardrum and auditory canal. Once the candle is placed in the ear it forms a seal which enables wax and other impurities to be drawn out of the ear." The proof comes when you open a candle up and discover that it is filled with a familiar waxy orange substance, which must surely be earwax. If you'd like to test this yourself, you will need: an ear, a clothespin, some poster putty, a dusty floor, some scissors, and two ear candles.

If you light one ear candle, and hold it over some dust, you will find little evidence of any suction. Before you rush to publish your finding in a peer-reviewed academic journal, someone has beaten you to it: a paper published in the medical journal Laryngoscope used expensive tympanometry equipment and found — as you have — that ear candles exert no suction. There is no truth to the claim that doctors dismiss alternative therapies out of hand.

But what if the wax and toxins are being drawn into the candle by some other, more esoteric route, as is often claimed?

For this you will need to do something called a controlled experiment, comparing the results of two different situations, where one is the experimental condition, the other is the control condition, and the only difference is the thing you're interested in testing. This is why you have two candles.

Put one ear candle in someone's ear, as per the manufacturer's instructions, and leave it there until it burns down. Put the other candle in the clothespin, and stand it upright using the Blu-Tack; this is the "control arm" in your experiment. The point of a control is simple: we need to minimize the differences between the two setups, so that the only real difference between them is the single factor you're studying, which in this case must be: "Is it my ear that produces the orange goo?"

Take your two candles back inside and cut them open. In the "ear" candle, you will find a waxy orange substance. In the "picnic table control," you will find a waxy orange substance. There is only one internationally recognized method for identifying something as earwax: pick some up on the end of your finger, and touch it with your tongue. If your experiment had the same results as mine, both of them taste a lot like candle wax.

Does the ear candle remove earwax from your ears? You can't tell, but a published study followed patients during a full program of ear candling and found no reduction. For all that you might have learned something useful here about the experimental method, there is something more significant you should have picked up: it is expensive, tedious, and time-consuming to test every whim concocted out of thin air by therapists selling unlikely miracle cures. But it can be done, and it is done.

Detox Patches and the Hassle Barrier

Last in our brown sludge detox triptych comes the detox foot patch. These are available in most health food stores or from your local Avon lady (this is true). They look like teabags, with a foil backing that you stick onto your foot using an adhesive edging, before you get into bed. When you wake up the next morning, there is a strange-smelling, sticky brown sludge attached to the bottom of your foot and inside the teabag. This sludge — you may spot a pattern here — is said to be "toxins." Except it's not. By now you can probably come up with a quick experiment to show that. I'll give you one option in a footnote.

An experiment is one way of determining whether an observable effect — sludge — is related to a given process. But you can also pull things apart on a more theoretical level. If you examine the list of ingredients in these patches, you will see that they have been very carefully designed.

The first thing on the list is "pyroligneous acid," or wood vinegar. This is a brown powder that is highly hygroscopic, a word that simply means it attracts and absorbs water, like those little silica bags that come in electronic equipment packaging. If there is any moisture around, wood vinegar will absorb it and make a brown mush that feels warm against your skin.

What is the other major ingredient, impressively listed as "hydrolyzed carbohydrate"? A carbohydrate is a long string of sugar molecules all stuck together. Starch is a carbohydrate, for example, and in your body this is broken down gradually into the individual sugar molecules by your digestive enzymes, so that you can absorb it. The process of breaking down a carbohydrate molecule into its individual sugars is called hydrolysis. So "hydrolyzed carbohydrate," as you might have worked out by now, for all that it sounds sciencey, basically means "sugar." Obviously sugar goes sticky in sweat.

Is there anything more to these patches than that? Yes. There is a new device, which we should call the hassle barrier, another recurring theme in the more advanced forms of foolishness that we shall be reviewing later. There are huge numbers of different brands, and many of them offer excellent and lengthy documents full of science to prove that they work: they have diagrams and graphs and the appearance of scienciness, but the key elements are missing. There are experiments, they say, which prove that detox patches do something ... but they don't tell you what these experiments consisted of, or what their "methods" were; they offer only decorous graphs of "results."

To focus on the methods is to miss the point of these apparent "experiments": they aren't about the methods; they're about the positive result, the graph, and the appearance of science. These are superficially plausible totems to frighten off a questioning journalist, a hassle barrier, and this is another recurring theme, which we will see — in more complex forms — around many of the more advanced areas of bad science. You will come to love the details.

If It's not Science, What is it?

But there is something important happening here, with detox, and I don't think it's enough just to say, "All this is nonsense." The detox phenomenon is interesting because it represents one of the most grandiose innovations of marketers, lifestyle gurus, and alternative therapists: the invention of a whole new physiological process. In terms of basic human biochemistry, detox is a meaningless concept. It doesn't cleave nature at the joints. There is nothing on the "detox system" in a medical textbook. That burgers and beer can have negative effects on your body is certainly true, for a number of reasons; but the notion that they leave a specific residue, which can be extruded by a specific process, a physiological system called detox, is a marketing invention.

If you look at a metabolic flowchart, the gigantic wall-size maps of all the molecules in your body, detailing the way that food is broken down into its constituent parts, and then those components are converted between each other, and then those new building blocks are assembled into muscle, and bone, and tongue, and bile, and sweat, and booger, and hair, and skin, and sperm, and brain, and everything that makes you you, it's hard to pick out one thing that is the "detox system."

Because it has no scientific meaning, detox is much better understood as a cultural product. Like the best pseudoscientific inventions, it deliberately blends useful common sense with outlandish, medicalized fantasy. In some respects, how much you buy into this reflects how self-dramatizing you want to be or, in less damning terms, how much you enjoy ritual in your daily life. When I go through busy periods of partying, drinking, sleep deprivation, and convenience eating, I usually decide — eventually — that I need a bit of a rest. So I have a few nights in, reading at home, and eating more salad than usual. Models and celebrities, meanwhile, "detox" with Master Cleanse and the Fruit Flush Diet.

On one thing we must be absolutely clear, because this is a recurring theme throughout the world of bad science: there is nothing wrong with the notion of eating healthily and abstaining from various risk factors for ill health like excessive alcohol use. But that is not what detox is about; these are quick-fix health drives, constructed from the outset as short term, while lifestyle risk factors for ill health have their impact over a lifetime. But I am even willing to agree that some people might try a five-day detox and remember (or even learn) what it's like to eat vegetables, and that gets no criticism from me.


Excerpted from Bad Science by Ben Goldacre. Copyright © 2010 Ben Goldacre. Excerpted by permission of Faber and Faber, Inc..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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