It’s all in the title

September 16th, 2004 by Ben Goldacre in bad science, dangers, herbal remedies, nutritionists, PhDs, doctors, and qualifications, times | 2 Comments »

Ben Goldacre
Thursday September 16, 2004
The Guardian

· It’s hard to know who to trust these days, what with pseudoscientists pretending to have all kinds of qualifications and quoting authorities all over the shop. Susan Clark’s consistently entertaining “What’s The Alternative?” column in the Sunday Times recommends artemisinin this week, as an alternative herbal malaria prophylaxis for someone travelling to Asia. “The Global Fund to Fight Aids, Tuberculosis and Malaria is funding the shift to artemisinin-based combination therapies in 26 countries,” she says. Sounds good. I’ll do you a favour, and spare you the rant about how chloroquine costs 20 cents per treatment while fashionable ideas like artemisinin cost $2.40, and stick to more important facts. Like: artemisinin is a treatment for malaria, not a preventive measure, because its half-life is too short, and the excellent and sensible Global Fund does not recommend it as a prophylaxis, nor does it endorse anything, as it is just a funding body. Perhaps Susan Clark can’t tell the difference. Here’s hoping her readers are a bit more cautious.

· So who do you trust? What about a “consultant podiatric surgeon”? Sounds a bit like “consultant orthopaedic surgeon”, doesn’t it? Or “consultant vascular surgeon”? Except a consultant podiatric surgeon is just a chiropodist who has decided to charge a bit more. Nice move, but it’s hard to prove that the public have been misled here. Sorry, I mean to say they have “misunderstood” the innocent phonetic coincidence between “consultant orthopaedic surgeon” and “consultant podiatric surgeon”. So the British Orthopaedic Trainees Association has surveyed 262 members of the public, and what do you know: 95% thought that consultant podiatric surgeons had qualified as doctors, while only 9.5% thought chiropodists were doctors. Ker-ching. Mind you, 97.3% thought consultant orthopaedic surgeons had been to medical school, and even a few junior doctors got the answers wrong. In a world full of “Dr Gillian McKeith PhDs”, until the government starts protecting professional titles, and regulating all the people who have popped up to make money out of our obsession with health, I can’t start to think about the financial gain for these wily characters because (holds head sanctimoniously aloft), there are actually rather serious issues about what goes through the heads of people who think they’re giving informed consent to treatment by self-appointed professionals.

Prion and on and on

July 22nd, 2004 by Ben Goldacre in alternative medicine, bad science, herbal remedies, scare stories, times, very basic science | 2 Comments »

Ben Goldacre
Thursday July 22, 2004
The Guardian

· Bad Science business as usual in the British “news” media. Several of you were delighted to spot the Times worrying us about BSE all over again, with a picture of what caused it: not a prion, mysteriously, but a picture of a nice big bacterium. And It was labelled as the “BSE virus”, which will come as news to the people who spend their time worrying about what to do with the teeny prion molecules on surgical implements. For future reference, the bacteria are the big roundish things with lots of other stuff going on inside them, and the prions are the bendy wee molecules.

· Perry Groves has been reading the Independent on Sunday. “It appears to have taken the viewpoint that all nanoscience is dangerous,” she writes. “It then blows any credibility it may have had for this position with the sentence ‘Nanotechnology, which is set to revolutionise industry and everyday life, deals with particles so small the laws of physics no longer apply.’” So that’s very small, then.

· The naive quest to find some intellectual consistency in the world of alternative therapies continues unabated. Reader Guy Herbert always thought the point of traditional Chinese and Ayurvedic medicine (mysteriously conflated by western magpies) was that old was good, and ideas changing in the light of new evidence was a sinister modern invention. Until he read the London Evening Standard: “Cupping is a healing technique in Chinese and Ayurvedic medicine that involves the placing of glass jars over acupuncture points. This creates a vacuum that increases blood circulation and detoxification.” “So,” he writes, with glorious pedantry, “at least now they accept Harvey’s blood circulation theory. But surely something as modern as the 17th century can’t be any good?”

· And the ever vigilant Andy Mabbett sends us news that the Birmingham Evening Mail has exclusive rights on a major breakthrough in microbiology, with a story about a former lorry driver who has “invented a wonder cream which could spell the end of hospital superbugs”. Over to our truck driving genius: “We found it killed everything. It was the first potion that killed every known bacteria.” That’s every known bacteria. “Managing infection outbreaks costs the NHS over £1bn annually,” said Mr Watts, his main investor and the chairman of a recruitment agency. No wonder the Evening Mail think he’s “set to make a fortune”.

A royal mess

July 1st, 2004 by Ben Goldacre in alternative medicine, bad science, dangers, death, herbal remedies, nutritionists, PhDs, doctors, and qualifications, references, statistics | 5 Comments »

Ben Goldacre
Thursday July 1, 2004
The Guardian

· I always thought the monarchy was there to remind us that inherited wealth and privilege are alive and well, and to stop us falling into the American trap of imagining that we live in a meritocracy: but apparently it’s there to set the health research agenda. Prince Charles is keen that we should not ignore the experience of the one person he met who got better with the Gerson nutritional regime for treating cancer. Let’s ignore the fact that the American Cancer Society regard it as dangerous; that in two years San Diego county hospitals treated 13 patients with campylobacter sepsis from the Gerson clinic, probably due to the raw calves’ liver injections; that several patients have been admitted comatose with low sodium levels; and that caffeine enemas are jolly dangerous and have been associated with severe colitis, infections and death. No. Let’s focus on the research already done on Gerson. One long-term study of 21 patients (by a naturopath, no less) found that only one was alive five years after treatment. In 1986, researchers found that despite their claims, some patients from the Gerson clinic were not even followed up. There are papers claiming efficacy for nutritional therapy that find a positive effect, but without bothering to give us the figures. Since then, a handful of studies have been done, suggesting a minor positive effect, but the flaws in their methodologies render them worthless.

· Let’s get this straight: research is not difficult, and it doesn’t need a lot of money. Lots of medical research is done by junior doctors, in their “spare time”. Alternative therapists are welcome to research money, but it would be nice if some of the money they get could go towards keeping follow-up records, which doesn’t cost much, and even do some proper statistics. So if you’re a quack and you’re angry about the lack of evidence supporting your ideas, here are some fun ideas for the holidays. Buy How to Read a Paper: The Basics of Evidence-Based Medicine by Trisha Greenhalgh (BMJ Books), an excellent introduction to how research works. It’s even available free online. Make friends with someone in a university or hospital, and you can use their audit department or statistics advisory service to help you design the study, often for free. But please, at least put the figures in your paper. And register your studies on the national database, so we can have a good laugh when you turn up negative findings.

Wort warning

May 20th, 2004 by Ben Goldacre in bad science, dangers, herbal remedies | 2 Comments »

Wort warning

Ben Goldacre
Thursday May 20, 2004
The Guardian

Talk about bad science here

· People often ask why I get so grumpy about the lack of intellectual rigour in alternative medicine. “What’s so bad,” they say, “about people believing whatever they want, if it makes them feel better?” What’s so bad is that sometimes, when people mix and match ideas, and believe that “natural” means “safe”, they can concoct some pretty dangerous suggestions.

Over to Richard Brook, chief executive of mental health charity Mind. “Prozac or cognitive behavioural therapy?” the Independent asked him last week. “CBT every time,” he replied, and fair enough. “I’m a strong supporter of non-medicated approaches, which also include exercise, improving social contacts, diet” he said. Excellent advice so far. “And possibly homeopathic remedies such as St John’s Wort.”

Now, homeopathic remedies are pretty close to pure water, and that’s not going to do you any good or any harm. But St John’s Wort contains a drug that is very similar to Prozac, which can interact dangerously with many antidepressants and numerous other medications. And unfortunately, as they say, not a lot of people know that. Researchers at King’s College London questioned 929 people, visiting four pharmacies in London, and found that when they asked people which medicines they were taking, 41% did not mention herbal remedies, because they did not think of them as medicines. Seven per cent were taking potentially dangerous combinations of herbal remedies and prescription medicines, and the most common was taking St John’s Wort at the same time as SSRIs, the class of antidepressants that includes Prozac. What’s more, taking St John’s Wort with the oral contraceptive pill can cause side effects and stop the pill working. Even pharmacists can believe the hype. In 21 visits to buy St John’s Wort, five Which? researchers were given unsatisfactory advice, twice they didn’t need to see a pharmacist, and one pharmacist said it was “fine to take with the pill”.

· About a quarter of prescription drugs are derived from plant sources and just because something comes from a plant doesn’t mean it’s safe. Aspirin comes from willow bark, but it will still make your haemorrhoids bleed. Diamorphine was made from opium poppy extract, in the same lab as aspirin, by the same bloke, two weeks later, using the same process (acetylation), 107 years ago this summer, since you ask. Diamorphine is also known as heroin, and although it’s undoubtedly effective, it has a few side effects that might worry you.

This slightly odd letter was printed the following week.

Wort warning

May 20th, 2004 by Ben Goldacre in alternative medicine, bad science, dangers, herbal remedies, homeopathy | 2 Comments »

Ben Goldacre
Thursday May 20, 2004
The Guardian

· People often ask why I get so grumpy about the lack of intellectual rigour in alternative medicine. “What’s so bad,” they say, “about people believing whatever they want, if it makes them feel better?” What’s so bad is that sometimes, when people mix and match ideas, and believe that “natural” means “safe”, they can concoct some pretty dangerous suggestions.

Over to Richard Brook, chief executive of mental health charity Mind. “Prozac or cognitive behavioural therapy?” the Independent asked him last week. “CBT every time,” he replied, and fair enough. “I’m a strong supporter of non-medicated approaches, which also include exercise, improving social contacts, diet” he said. Excellent advice so far. “And possibly homeopathic remedies such as St John’s Wort.”

Now, homeopathic remedies are pretty close to pure water, and that’s not going to do you any good or any harm. But St John’s Wort contains a drug that is very similar to Prozac, which can interact dangerously with many antidepressants and numerous other medications. And unfortunately, as they say, not a lot of people know that. Researchers at King’s College London questioned 929 people, visiting four pharmacies in London, and found that when they asked people which medicines they were taking, 41% did not mention herbal remedies, because they did not think of them as medicines. Seven per cent were taking potentially dangerous combinations of herbal remedies and prescription medicines, and the most common was taking St John’s Wort at the same time as SSRIs, the class of antidepressants that includes Prozac. What’s more, taking St John’s Wort with the oral contraceptive pill can cause side effects and stop the pill working. Even pharmacists can believe the hype. In 21 visits to buy St John’s Wort, five Which? researchers were given unsatisfactory advice, twice they didn’t need to see a pharmacist, and one pharmacist said it was “fine to take with the pill”.

· About a quarter of prescription drugs are derived from plant sources and just because something comes from a plant doesn’t mean it’s safe. Aspirin comes from willow bark, but it will still make your haemorrhoids bleed. Diamorphine was made from opium poppy extract, in the same lab as aspirin, by the same bloke, two weeks later, using the same process (acetylation), 107 years ago this summer, since you ask. Diamorphine is also known as heroin, and although it’s undoubtedly effective, it has a few side effects that might worry you.

Can anal retention help you beat depression?

September 18th, 2003 by Ben Goldacre in bad science, express, herbal remedies, new scientist, references, times, weight loss | 5 Comments »

Can anal retention help you beat depression?

Ben Goldacre
Thursday September 18, 2003
The Guardian

Talk bad science

· You might wonder why I’m being so anally retentive about everything this week. I can only say in my defence that I’ve been doing my best to follow Hiroyuki Nishigaki’s excellent book: “How to Good-Bye Depression: If You Constrict Anus 100 Times Everyday. Malarkey? or Effective Way?” available now on Amazon (£14.49).

· The Independent on Sunday managed to infuriate me by carrying an interesting story about comfort eating in rats – apparently it blocks the effect of a hormone implicated in stress – but then not bothering to tell us anything as useful, or crucial to the story, as which hormone. Meanwhile their books section, as is traditional, carried a string of articles that nobody without a PhD in literature could possibly understand.

· The Times on Saturday managed to cheer me up by starting a flatteringly derivative bad science column called “Junk Medicine”. “Chelation therapists, magnet pushers, Cherie and Carole: you are being watched,” sounded eerily familiar, so I decided to watch the Times closely. On Sunday my vigilance was rewarded when its sister paper told us: “The remedy that has performed well in trials to reduce the pain of postherpetic neuralgia is reishi (Ganoderma lucidum).” When they say “performed well in trials” I presume they mean the one trial that was done, in 1998, of four people, with no control group. Find out more at the writer’s awkwardly confident www.whatreallyworks.co.uk, or come chat with me on their excellently unpoliced message boards…

· Meanwhile the Sunday Express claimed “clinical research published in the journal Life Sciences” showed pycnogenol, an extract of pine bark, to be effective at treating blood pressure over 12 weeks. This study is not on medline, or in the Life Sciences index, or in the latest edition of the journal.

· After this orgy of pickiness I was dizzy with over-excitement at spotting some bad science in New Scientist: “A new kind of machine … locates and measures your body fat. It could then tell you exactly where you could do with losing a few pounds and even advise you on exercises for your problem areas.” Normally I wouldn’t dare to question the überboffins, but this sounds a lot like the “spot reducing” myth, the idea that muscles use fat from overlying tissue rather than the whole body, which is widely regarded as rubbish.

Neutral whites

September 4th, 2003 by Ben Goldacre in alternative medicine, bad science, cosmetics, herbal remedies, magnets | 5 Comments »

Neutral whites

Ben Goldacre
Thursday September 4, 2003
The Guardian

Talk bad science

· When I was a lad, washing powder adverts were all about men in white coats on housewives’ doorsteps; now international biotech firms have to wear a kaftan and beads just to get your attention. New Persil Aloe Vera contains “Aloe Vera extract, well known to be gentle on skin … a touch of nature for all the family wash”. If I can be the man in the white coat for a moment: aloe vera has been shown “in tests” to accelerate wound healing, which might count as gentle, but [turns earnestly to camera ignoring baffled housewife] “a touch” of nature is just about all you’ll get once it’s been through two rinse cycles and a drum spinning at 1200rpm.

· And while I’m still in anally retentive mode: Bach’s Flower Remedies were not, as the unendingly credulous Times stated last week, “discovered” by Dr Bach in the 1930s. Species and laws are “discovered”; esoteric moneyspinners, no matter how well-meaning and fluffy they may be, are “concocted”.

· And now to our star bad science activist from Birmingham, who, sadly, wishes to remain anonymous. A firm called Neutralec is apparently on to something big. That funny shading you sometimes get on your carpets, where the weave points in different directions? Electromagnetic waves, apparently. I turn to the website (www.field-free.co.uk). I start to worry when I see the pictures of big dark rectangles in fitted shagpile that were apparently caused by a broken video recorder that was 2m away in the loft and wasn’t even plugged in. The website says I can get rid of this sort of thing by plugging a little ceramic sphere (that costs £60) into my earth loop through the three-pin plug on the wall, and this will also protect me from electromagnetic radiation. Or will it? In among the testimonials (“Neither I or anyone else has experienced a headache since … Twelve months later … her husband had not experienced any fits whatsoever!”) they seem to be hedging their bets: “We are not in any way suggesting that the Neutraliser will cure any specific illness or prevent disease.” Well, as the Guardian legal department often say, as they rap my sarcastic little knuckles: that’s certainly what you’re implying. Where others would have held their heads in disbelief, our masked crusader wrote to Solihull trading standards, asking: “How many gullible souls have to part with £60 before someone makes a stand?” So far, no response. If you need any help, trading standards, a nation of scientists is at your disposal.

Size does matter

August 7th, 2003 by Ben Goldacre in alternative medicine, bad science, herbal remedies | 2 Comments »

Size does matter

Ben Goldacre
Thursday August 7, 2003
The Guardian

Talk bad science

· I wouldn’t want you to think that I am in any way worried about the size of my penis. But since the bad science email address now seems to be overflowing with “scientifically proven” ways to improve my “visual impact” and “give her more than ever”, I thought it was about time we put these chaps to the test.

VigRX, a herbal preparation whose name might possibly remind you of another drug, have a “laboratory team of Albion Medical Doctors” to tell you “how VigRX works”. I presume they’re the guys with no name in the white coats with the stethoscopes at the top of every page. They have a nice little graph of their own study of four men (four, count them) with an increase in girth, length, and mass, and then list the eight herbs they use. Although they don’t even bother – weirdly – to claim that any of them will increase the size of your penis, only one (ginseng) has any evidence even showing an increase in arousal. One convincing study, they claim, for ginkgo biloba (“78%…”) doesn’t seem to exist on MedLine: there are two studies for muira puama and ginkgo biloba showing an increase in libido – but that is in women – and neither study could apparently be bothered to fuss with a placebo control.

· Many companies offer expensive books detailing exercise regimes, on the grounds that repeated vigorous stretching of the connective tissue in the walls of the two big [coughs] chambers that run up either side of the penis will give them a greater volume, which intuitively makes sense. Although there’s never any data of course, only gushing testimonials. Several companies claim to sell pills that increase erectile strength, which will then also stretch the chambers over time. No data to support this, again, although I did find one paper where a monkey died after its 56th injection of the impotence drug papaverine, so be careful.

In fact, the only method I could find that was validated by peer-reviewed literature was surgery, which seems a bit extreme, although plenty of centres are offering it for “penile dysmorphophobia”, where you just think you have a small willy. The penis is opened up, and bits of vein from elsewhere are sewn in as an annexe to the two chambers that run up either side. Although I’ve not seen that offered in return for your credit card details in spam emails. And do please be careful where you go for your operation: one published case report from last year described a man who came back from Saudi Arabia having paid to have four large stones embedded subcutaneously. The pictures are exactly what you’d expect.

Cures for quacks

June 19th, 2003 by Ben Goldacre in alternative medicine, bad science, dangers, herbal remedies, water | 8 Comments »

Ben Goldacre
Thursday June 19, 2003
The Guardian

· The plural of anecdote is not data. Although it’s always very tempting. So although I’ll contain my evil desires to titillate you with tales of patients who’ve needed liver transplants after taking Chinese herbal remedies, I’m very amused by an article in the Lancet about a Chinese remedy company who seem to be putting artificial drugs in their potions. Spes capsules were examined by physicians treating a patient who developed Cushing’s Syndrome and were found to contain betamethasone, a potent synthetic glucocorticoid you wouldn’t expect to find in any magic herb. They also found alprazolam, a synthetic benzodiazepine much like the addictive “mother’s little helpers” of the 60s, which might go some way to explain the improvement in “quality of life” claimed for Spes. Neither was mentioned on the label. Alternative therapy fans might bear in mind that, if a herbal remedy works it’s probably got something potent in it.

· A BMJ paper recently found that children being treated with Chinese herbal skin creams for eczema were on average receiving five times the recommended adult dose of dexamethasone, a potent steroid. Which makes it very amusing that the alternative medicine lobby has ganged up against an EU directive to use proper ingredients labels and submit to regulation, like anyone else peddling a medicine. They say it’s part of a campaign by the medical establishment to discredit their products, and 5,000 people marched against the regulations in London last Sunday. They had Tory MP John Redwood lambasting the EU for over-regulating us. But even the Daily Mail, champion of anecdotal evidence, favourably reported a study of 200,000 people that showed a 0.4% increase in deaths from all causes in people taking beta-carotene supplements, and no benefit at all from vitamin E.

· 200,000 people seems to be enough for a study disproving alternative therapies to be taken seriously. If you’re in the business of promoting pseudoscience, standards seem to be less stringent. Last weekend’s Sunday Telegraph devoted the whole of page 3 to alternative therapy porn, with a story on how drinking the Queen’s Royal Deeside spring water improved arthritis symptoms in two-thirds of patients. It was a study of 34 patients over three months and there was no control group. It’s hard to imagine an experiment where it would have been easier to come up with a convincing placebo. Water.

Apes and antibiotics

April 17th, 2003 by Ben Goldacre in bad science, cosmetics, herbal remedies, scare stories | 7 Comments »

Apes and antibiotics

Ben Goldacre
Thursday April 17, 2003
The Guardian

New: Talk about Bad science

· The terrifying epidemic of inaccurate fear-mongering continues to rage over the Sars virus. Dominik Diamond of the Daily Star blames you, the general public, for creating the super virus: “We’ve wasted our defences against this, by demanding antibiotics at the mere hint of a sniffle.” Clever boy. Perhaps there’s a GCSE biology student out there who could explain to him why antibiotics only kill bacteria, and not viruses.

· Although we are, of course, right to worry, war is nothing compared to the glorious might of the natural world. Remember: politics killed only between seven and 10 million men and women in the first world war; the influenza epidemic bagged 21 million a year later. Morality is vanity, I tell you. The scientists are fighting a much bigger game.

· And so, with almost painful inevitability, we move on to Crap Cure of the Week. US regulators have ordered the chancers flogging the wonder-pill “Cellasene” to reimburse their customers $12m (£7.6m) over claims, now withdrawn, that their expensive blend of herbs and crushed grape seeds “eliminates” cellulite. I was more interested in their promise of a wholesale personality change, giving me a bottom and thighs that, apparently, I would be “eager to show off”. Thank God you can still buy Cellasene Forte in Boots at only £29.99.

· If only the Cellasene salespeople had followed the lead of Elemis, who have just won the Professional Beauty Awards 2003 prize for “Best Marketing and Promotions”. The key to pseudo-scientific cosmetics marketing is, as they demonstrate, to generate publicity material that means nothing and to steer well clear of testable hypotheses: “We use Absolutes, the purest form of living energy . . . Elemis plant essential oils are most potent and . . . have an immense capacity for oxygenating the skin.” Sold.

· And finally, we turn to the extraordinary letters pages of the Daily Mail, whose reactionary Victorian values seem to go well beyond the family: “Evolution is absurd. Are there any scientists who still believe in it?” Gulp. And, most terrifyingly: “If man evolved from apes, why are there still apes around?”

Dr Goldacre will be back next week.

Please send your favourite bad science to: bad.science@guardian.co.uk