Given the choice, I’d have a miracle pill story

May 6th, 2007 by Ben Goldacre in bad science | 14 Comments »

Ben Goldacre
BMJ 2007;334:932 (5 May),
Media watch

Complex problems have depressingly complex causes, and the solutions are often taxing and unsatisfactory

Looking at popular culture, it seems there’s something very attractive about simple biomedical explanations—and solutions—for complex social and psychological problems.

Four weeks ago the BMJ published a large randomised controlled trial, with a positive result: it showed that one treatment for children at high risk of developing conduct disorder could significantly improve antisocial behaviour (BMJ 2007:334:678-82). It was a well conducted trial, at multiple sites, with a novel result, on a subject specifically called for by NICE, and it even had a compelling cost effectiveness analysis.

Was this miracle pill reported as front page news in the Daily Mail, natural home of miracle cures and sinister hidden scares? Was it followed up on the health pages, with an accompanying photo feature, describing one child’s miraculous recovery, and an interview with a relieved mum with whom we could all identify?

No. In fact, this story was completely ignored by the entire British news media, despite their preoccupation with both antisocial behaviour and miracle cures, for one simple reason: this was not a story about a pill. It was a cheap, practical parenting programme.

At the same time, for over two years now, the newspapers and television stations have gushed praise on an endless stream of largely unpublished and increasingly melodramatic claims made for fish oil pills in schoolchildren.

This represents an interesting disparity. These fish oil “miracle pill” claims are generally made on the basis of unpublished “studies,” with clear involvement of the multimillion pound pharmaceutical companies manufacturing the supplements, which are presented directly to the media with minimal corroborating evidence—no published paper, no statistics, and in essence no science at all. My attempts to get further information about the data behind various of these stories for my Guardian newspaper column have routinely been met with polite but firm obstructiveness.

This is in stark contravention of not just every published guideline on communicating research findings to the public, but also a clear challenge to common sense, since there is no meaningful opinion whatsoever, with the best will in the world, that anybody could sensibly hold about unpublished scientific research, reported only in the form of a press release and a tabloid news story.

Now there may yet turn out to be good evidence for significant benefits for children from fish oil tablets (although, in context, fish oil pills cost more per day than many councils spend on the entire school meal). That’s not my concern right here. What is interesting is where the attention of the media is drawn: weak and unpublished “scientific proof” for a miracle pill receives blanket coverage, while strong evidence for a parenting programme, from a rather prestigious academic journal, is deemed irrelevant.

Explanations abound. Firstly, of course, “pill solves complex social problem” feels more like a news story than a parenting programme does. And there is also the question of how stories are pushed: I’ve not met Hutchings et al, the authors of the parenting study, and if they want to persuade me, I’m perfectly prepared to believe that they are in Soho House until 2 am every night, schmoozing broadcast media journalists with champagne and nibbles, but in reality, I suspect they are modest academics.

Private companies, meanwhile, have top dollar public relations firepower, one single issue to promote, time to foster relationships with interested journalists, and a wily understanding of the desires of the public and the media. It is these wider cultural desires that are the key to exploiting our collective hopes and consumer dreams. Pharmaceutical companies have worked hard, let’s remember, in their direct to consumer advertisements and their lobbying, to push the serotonin hypothesis for depression, even though the scientific evidence for this theory is growing thinner every quarter, and the nutrition supplements industry, for its part, promotes dietary deficiencies as a treatable cause for low mood.

These crude biomedical mechanisms may well enhance the placebo benefits from medication. But I wonder if we also risk disempowering patients, and robbing ourselves of a deeper understanding, when we reframe complex social problems in such mechanistic terms.

The biomedical explanations may be so seductive precisely because of what they edit out. In the media coverage around the launch of pills for “female sexual dysfunction,” it wasn’t just the tablets that were being sold: stories on couples with relationship problems focused on biomedical interventions, and more than that, on hormone tests, or esoteric imaging studies of clitoral blood flow. We don’t want to talk about her feeling tired from over work, or him being exhausted by a new baby, any more than we want to talk about social inequality, the disintegration of local communities, the breakdown of the family, the impact of employment uncertainty, changing expectations and notions of personhood, or any of the other complex, difficult factors that play into the apparent rise of antisocial behaviour and depression.

In the past, medicalisation has been portrayed as something that doctors inflict on an unsuspecting world, and as an expansion of the medical empire: but in reality, biomedical narratives can appeal to us all, because complex problems have depressingly complex causes, and the solutions are often taxing and unsatisfactory. Given the choice, I’d have a miracle pill story, any day.

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14 Responses

  1. Will said,

    May 4, 2007 at 8:11 pm

    I have to disagree there… I find the complex and difficult stories the most interesting of all. They are gritty, taxing, and need to be understood. What’s more interesting still is the interplay between these real factors and the self-deception of society through the media. It’s almost as if society is hiding its head under the pillow because it doesn’t want to confront the tricky things… and the companies that can make a buck will always take advantage of a vulnerable source, cowed by fear.

  2. Nellie Dean said,

    May 4, 2007 at 10:39 pm


  3. jackpt said,

    May 5, 2007 at 12:53 am

    The media is a feedback loop, it’s difficult to gauge the extent of its influence or the degree to which it reflects the public. But the media is out of touch. The simplistic way in which it portrays complex issues is anachronistic in a wired world. Because in order to maintain the interest of people like myself the media is going to have to offer better quality than the Internet. Many Internet voices at least have the excuse of being unpaid amateurs.

  4. raygirvan said,

    May 6, 2007 at 12:58 pm

    This would be the Incredible Years basic parenting programme? Quite probably, the papers know that it presents a solution that readers don’t want to hear. It’s not a quick or easy fix, and it requires parents to modify their own behaviour (no-one wants to be told they’re part of the problem, or that their parenting skills need improving).

  5. Robert Carnegie said,

    May 6, 2007 at 8:37 pm

    A detail on the fish oil thing, how feasible is it to cut out the pharmaceutical company and just feed school students on fish?

    I know, I know, solving the wrong problem… but it’s not like fish is -bad- for you, in moderation. In batter with chips though… excuse me, I feel hungry now. Must remember: trans fats, trans fats.

  6. j said,

    May 8, 2007 at 2:41 am

    “A detail on the fish oil thing, how feasible is it to cut out the pharmaceutical company and just feed school students on fish?”

    In terms of random info, it actually works out about the same price or less to get a ‘dose’ of fish oil from tinned sardines/pilchards as from some of the dearer brands of fish oil.

  7. Mojo said,

    May 8, 2007 at 10:18 am

    Nice article about the entire British news media ignoring a story, but couldn’t it have been published in your Guardian column rather than in the same journal the story originally appeared in?

  8. Wonko said,

    May 11, 2007 at 10:26 am

    I suppose it would be crude to point out that the designers of parenting programmes are less likely to provide much in the way of advertising revenue whereas the manufacturers of fish oil pills are likely to buy whole page spreads on the adjacent page to the story – a practice very common in magazines and supplements.

  9. Diotima said,

    May 23, 2007 at 10:43 am

    What is your line on NICE’s decision to urge GPs to prescribe fish oil pills for patients who have had a heart attack? (Along with pious insistance on adopting a ‘mediterranean’ diet)?

  10. gingerninja said,

    May 28, 2007 at 10:20 pm

    a digression-

    “Pharmaceutical companies have worked hard, let’s remember, in their direct to consumer advertisements and their lobbying, to push the serotonin hypothesis for depression, even though the scientific evidence for this theory is growing thinner every quarter,”

    Please could we have a bad science article on this or can you point me in the direction of some good info? That is a gem to me- I’ve been saying that for ages but most sceptical/scientific types of the armchair variety I’ve discussed it with, say that the serotonin hypothesis has been proven.

  11. Robert Carnegie said,

    June 20, 2007 at 1:03 am

    If it’s any help, an early Google result for serotonin-hypothesis is “Death to the Serotonin Hypothesis”. They are evidently quite worked up about it 🙂

    I suppose that a “strong serotonin hypothesis” would be that depression consists of a deficiency of (available) serotonin in the brain. Since serotonin is a chemical, and depression is a state of mind, it isn’t entirely clear how these join up.

    On the other hand, when prescribed by my doctor, I found fluoxetine, the well-known SSRI, gently but firmly effective, not always comfortable. I find arguments that it is no better than placebo very surprising. Amongst possible explanations are that a particularly strong placebo was used or that some people do well on it and some people do worse than on nothing, or at least on a placebo.

  12. Cedders said,

    August 16, 2007 at 10:10 am

    I’d be interested in a Bad Science column on the serotonin hypothesis too. It’s an example not so much of “bad” science as a valid hypothesis that seemed plausible in the 1970s but has only persisted because of Big Pharma PR. David Healy, in _The Antidepressant Era_ describes the historical accidents that led to the hypothesis, concluding that it is “more marketing than science”. One of the very few pieces of favourable evidence for the hypothesis was that 15% of people given reserpine (an anti-serotonergic drug) developed depression. Healy points out the conveniently forgotten fact that the first drug to pass a randomised controlled trial for depression was in fact reserpine!

    Whatever the mechanism for antidepressants’ action (endocrine and GABA-related effects also having been suggested), the serotonin hypothesis is false. If it were true, effectiveness would follow the change in serotonin levels, such that 100% of people would respond in the first day, not around two-thirds after 4 weeks.

  13. Ben Goldacre said,

    August 16, 2007 at 1:06 pm

    haven’t i written about this already? or am i confusing you with medical students. ive certainly spoken about it approximately one million times, maybe let me know if a topical hook for it appears…

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