Sunday, September 28, 2008

Tackling the epidemic of `bad science'

In his new book, Ben Goldacre takes a welcome swipe at quackery, but misses the wider abuse of science for political ends.

Ben Goldacre's weekly column in the Guardian has been a breath of fresh air through the world of science journalism. A junior hospital doctor, Goldacre has done more to challenge the junk science promoted by quacks and charlatans than most elite scientists and science writers. He has exposed health gurus, such as Gillian McKeith and Patrick Holford, who claim prestigious academic qualifications and titles and enjoy the endorsement of major media organisations (newspapers, television, publishers) as well as the commercial benefits of the $10billion food supplement industry.

A book based on his column, Bad Science, offers a more comprehensive critique of some of these familiar targets while providing a primer in evidence-based medicine for the general reader. Like Goldacre's column, his book is enlightening, shocking and often hilarious.

Bad Science offers an entertaining romp through the wacky world of the once alternative, but now sadly mainstream, homeopaths and nutrititionists. Goldacre ridicules their sugar pills, their homeopathic solutions with `memories' of dissolved molecules, their detox regimes, vitamins, anti-oxidants and supplements. This is a market in which McKeith's `Fast Formula Horny Goat Weed Complex' for enhanced sexual satisfaction (now withdrawn after complaints from the medicines regulatory authorities) once competed with Holford's `Q-Link' pendant offering protection against electromagnetic radiation (constituents worth 0.5 pence, retail price 69.99 pounds). Goldacre also exposes the preposterous claims of the promoters of `Brain Gym' techniques, now apparently widely used in UK schools, and the bogus research claiming that omega-3 fish oils can improve exam performance.

Yet other examples of pseudoscience that have, arguably, greater influence on the life and health of the nation remain curiously neglected in Goldacre's account. For example, as recent contributions to spiked have argued, controversies over population, passive smoking, the HIV/Aids epidemic and the links between diet and health are characterised by the subordination of science to propaganda. Indeed, all these issues provide examples of the sort of statistical scams and scientific sharp practice (such as extrapolation from inadequate data, confusion of observational and intervention studies, over-interpretation of laboratory studies, cherry picking and data dredging) that Goldacre describes.

While Bad Science savages the nutritionists' dogmatic dietary advice, Goldacre repeatedly endorses the benefits of what he characterises as a `healthy lifestyle'. With uncharacteristic adherence to dull convention, Goldacre repeats the litany that people should be advised to stop smoking, to follow a `healthy diet' of fruit, vegetables and natural fibre and take regular exercise. But, whereas there is strong evidence against smoking, the same cannot be said for recommending any particular diet - and even less for the virtues of exercise. It is striking that, though Goldacre subsequently acknowledges that two major intervention studies - the Multiple Risk Factor Intervention Trial (MRFIT) and the Women's Health Initiative - failed to show any benefit from dietary change, in defiance of his own strictures about evidence-based medicine, he continues to preach the healthy-living gospel.

`Why do clever people believe stupid things?', asks Goldacre. Part of his explanation for the popular impact of pseudoscience goes some way towards explaining the inconsistency of his own approach: `Our values are socially reinforced by conformity, by the company we keep', he writes, emphasising the `phenomenal impact of conformity'. It appears that while Goldacre is prepared to challenge some of the anti-scientific prejudices of his Guardian readers, he shares some of the wider values that have acquired a pervasive influence in modern society.

These include a pessimistic outlook towards the prospects for nature and society, reflected in the popularity of apocalyptic and doomsday scenarios of all kinds, and notably in a willingness to embrace the likelihood of catastrophe from epidemic disease (whether in the form of AIDS, mad cow disease, SARS, bird flu or mere obesity). They also include a misanthropic outlook towards humanity, expressed in contemptuous attitudes towards the masses, notably towards people who vote for George Bush or against the EU, those who smoke or are overweight. A third theme is a growing sympathy for authoritarian interventions to deal with social problems, whether the issue is AIDS, banning smoking, banning trans fats, or banning advertising for `junk food'.

A combination of these attitudes - among scientists and politicians as much as in the general public - leads to an inclination to turn a blind eye towards pseudoscience if it furthers the wider social agenda that follows from them.

Goldacre is ambivalent in his attitude towards the public. On the one hand, he proclaims - almost as an afterthought in his epilogue - that `people aren't stupid'. On the other, in the course of a familiar radical tirade against the evils of direct advertising in the USA by Big Pharma, he writes that `patients are so much more easily led than doctors by drug company advertising'. Again forsaking his scientific principles, he provides no evidence for a proposition that is no more than a personal prejudice, though no doubt one shared by most of his medical colleagues and his Guardian readers. In fact, Goldacre's account provides numerous examples of how doctors have been misled by drug companies. I see no reason why patients, provided they have access to the appropriate information, should not be capable of making rational decisions in these matters.

`The greatest problem of all is dumbing down', concludes Goldacre. But this problem starts at the top, among scientists who share the loss of confidence and authority that afflicts the elite of contemporary society. The very fact that it has been left to a junior hospital doctor to take the lead in challenging important areas of pseudoscience in modern society reflects the abdication of responsibility by the scientific establishment. This - rather than the role of the media, abject though that has been - is the real lesson of the imbroglio over the MMR vaccine, itself the subject of an excellent chapter in Bad Science.

Senior scientists must take up their responsibility to explain and defend science in public, and to set their own house in order by tackling fraud, exposing junk science and calling a halt to the abuse of university titles and academic qualifications. Then, even the arts graduates who (to Goldacre's distaste) dominate the media will soon learn to read a paper critically and provide an informed account to their readers.

As the autism expert Laura Schreibman puts it in her book The Science and Fiction of Autism: `One need not be a scientist in order to know how to evaluate information critically; one just needs to be appropriately critical.'


Britain: An endless diet of government intervention

Health authorities and food campaigners have pursued their pet projects by promoting scare stories about children's health.

Next week sees the start of celebrity chef Jamie Oliver's campaign to change the way children are fed. But while providing children with better meals and facilities at school is a worthy enough aim, lecturing the nation's parents about how they are setting up their kids for a (short) lifetime of ill-health is simply nauseating.

While campaigners call for more government intervention into our eating habits, it is surely time to call a halt. The last thing we need is a further expansion of schemes and initiatives.

We have been led to believe that we are facing a timebomb of ill-health that can only be defused by changing the way our children eat. That might be justified if children were dropping like flies from disease. In fact, the opposite is true. According to figures for England and Wales, in 1981 there were 30 deaths for every 100,000 children aged between one and 14 years. In 2006, that had more than halved to 14 deaths per 100,000. Death in childhood was rare and has become even rarer in the last 25 years or so.

Are children becoming sicker? Clearly, serious infectious disease is largely a thing of the past. Obesity may be increasing, but obesity is not a disease; at most, it is associated with a number of chronic conditions. The most obvious of these in relation to children is the apparent emergence of type-2 diabetes among children, something previously considered to be a condition of middle age. Yet research published in Diabetes Care in 2007 suggests that type-2 diabetes remains unusual in children under the age of 17. The researchers undertook a year-long survey of 2,665 consultant paediatricians in the UK and Ireland. During this period, 67 cases of type-2 diabetes were reported, all of them in the UK, suggesting an overall incidence of 5.3 cases per million children.

So, type-2 diabetes in children would seem to be, if not a one-in-a-million occurrence, not far off. Furthermore, while there is a strong association between being overweight and type-2 diabetes, the association with ethnic status is worrying. As the authors note: `The incidence rates for South Asians and blacks are an alarming 3.5 times and 11 times higher, respectively, than in whites.' This ethnic differential continues into adulthood. If the government were really serious about tackling type-2 diabetes, it would do better to devote a substantial research effort to understanding this differential rather than lecturing the whole population about our personal habits.

Nor is it the case that there is mass malnutrition among children. According to Family Food 2006, the average UK family is getting all the protein and energy required, plus plenty of vitamins and minerals. The average household now spends just 10 per cent of its income on food and non-alcoholic drinks. Food has never been so readily available and in such variety. Even where children do have rather limited tastes, we should chill out. While nutritionists may be sniffy about about children eating cheeseburger, chips and fish fingers all the time, such foods do actually provide a fair proportion of a child's nutritional needs. They may not be perfect, but such eating habits are highly unlikely to result in an epidemic of disease, either.

But there is a more fundamental principle at stake: it is not the government's business to interfere in our personal lives except in the most exceptional circumstances. Yet we are subject to endless health advice both from official sources and through the popular media, from shows like Honey, We're Killing the Kids to the much-praised but frankly hectoring series by Jamie Oliver on school meals. If that were not enough, that intervention is increasingly direct, with parents receiving letters home about their children's supposed weight problems and being given strict instructions about what to put in their lunchboxes.

It seems that the government, the health authorities and a variety of different campaigners see it as their job to overrule parents about how their children should eat. In reality, the vast majority of parents endeavour to get their children to eat well, but in the absence of eating well, they make pragmatic, personal decisions about how to ensure they eat something. Current levels of intervention are unlikely to help matters and are an insult to the decision-making abilities of parents.

If children's food is a top priority, then make school meals free, or at least cheap, at the point of delivery and give them the time and surroundings to eat them comfortably. That's not a health strategy, that's just common decency. If adults would not tolerate being forced to queue up for ages to receive mediocre food in a hall so crowded that there is often nowhere to sit, why should we assume our children should put up with it? And let those meals taste of something; salt in recent years has been treated in school canteens like it is a chemical weapon rather than a fundamental requirement of good cooking. It is noticeable that the new cookbook produced by the government to teach kids how to prepare their own meals avoids salt or sneaks it into recipes in stock. No wonder children are rejecting such bland offerings.

But before the first school bell of the day sounds, and after hometime, it would be far better if the government, the health authorities and the self-appointed guardians of our diets did what children up and down the country do at lunchtime: bugger off.


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