Ben Goldacre
Saturday February 11, 2006
The Guardian
Let me take you back to 2005, and one of several Bad Science stories about Susan Clark and her What’s The Alternative column in the Sunday Times. She’s no longer in that post – if you’re lucky we’ll have room to talk about her successor soon – but she stood out on account of her Read the rest of this entry »
Ben Goldacre
Thursday June 2, 2005
The Guardian
Talk about bad science
· OK, hands up. I hate nutritionists and phoney diet marketers. I hate them because they confuse evidence and theory. I hate them because they make sweeping assertions that something will work in the real world on the basis of tenuous laboratory data. And they either do not understand that, or they do and they are being dishonest. In either case, I hate them. I hate them because they are richer than me. And lastly, and this is a tricky one, I hate them because they give dangerous advice.
· At first glance, they give quite sensible advice. Dr Gillian McKeith PhD – for all the awful poo business and her bizarre misunderstanding of basic science about things like photosynthesis – promotes a pretty normal, sensible, healthy diet. The GI diet, for all the guff that goes with it, does too. And the grandiose nutritionism-peddling columnists from Sunday magazines, even if they do recommend you eat some particular nut because it contains lots of vitamin G and selenium, are still basically recommending fruit and veg. Everyone knows basic dietary advice, and they don’t need a nutritionist, doctor, alternative therapist or journalist, to tell them. They need their mum.
· But the trouble is this: nutritionists and their kin sell the idea that diet is somehow more complicated than that; something that requires access to arcane and detailed knowledge to which only they have access; knowledge of the breakdown of exactly what is in each food. And so the shopper is paralysed. But do I need vitamins L and Y this week? Or calcium? Or protein? Or no protein? What kind of fat did you say again? Because when you sell the idea that eating well is complicated, that foods are made of immemorable combinations of chemicals, then you prime the market for Fruittella Plus “with added calcium and vitamins B, C and E”, and 7-Up Plus from Cadbury’s “with calcium and vitamin C” and the rest. I could go on. In fact, market research company Mintel’s new Global Products Database has identified a trend among confectionery manufacturers to fortify their products with vitamins and minerals. Mintel watch you eat. Their reports have chapter headings such as “continued focus on indulgence in desserts” and “focus on children in processed poultry sector”. And they are watching your every little irrationality so that somebody, somewhere, can take advantage of it. The moral? Eat your greens. Or the bogeymen will come and get you with their weird processed chicken army.
Ben Goldacre
Thursday May 26, 2005
The Guardian
· I’d like to open with a sanctimonious moment. I don’t expect anyone else in the world to follow suit, but from now on, if I refer to published academic research, I’ll be giving the full reference, at the foot of the column if there’s space, or at least on the web version. Why this is not standard media practice has always mystified me. “Science communicators” do read original papers and critically appraise them before writing about them, don’t they?
· Anyway, we’ll come back to testicles later. Meanwhile, there are two outbreaks of polio in Yemen and Indonesia. The strain of poliovirus originated – pay attention – in the Kano province in northern Nigeria. What, you may ask, has this got to do with your gonads – or indeed those of the man you love? Well, a couple of years ago Kano was the focal point of a Nigerian Muslim boycott of polio vaccination. Imams claimed that the vaccine was dangerous, poisoned, contaminated and part of a US plot to spread Aids or infertility in the Islamic world. Five Nigerian states boycotted it. Because, as any trendy MMR-dodging north London middle class humanities graduate couple with children would agree, just because vaccination has almost eradicated polio – a debilitating disease which as recently as 1988 was endemic in 125 countries – does not mean it is necessarily a good thing.
· This brings us back to testicles. Because, sadly, the natural world does not quite share my sense of retributive justice, nor does the paramyxovirus that causes mumps. If it were infecting only the innocent unvaccinated offspring of humanities graduates with no understanding of risk, I’d pretend to be sad on their behalf. But no. There were 8,104 cases of mumps confirmed in the UK last year, up from a combined total of 3,907 for all the previous five years, chart fans.
· But mumps cases last year were predominantly in young adults, because young adults as a herd have the lowest immunity. And one in five young men who get mumps can expect orchitis, a new joy for fans of infected and inflamed testicles. If your balls hurt and you’re infertile, you might wish to thank, for their peculiar interpretation and eulogising on the dangers of MMR: Andrew Wakefield, Nigella Lawson, Libby Purves, Suzanne Moore, Lynda Lee-Potter, The Daily Mail, Leo Blair’s tight-lipped parents, and, let’s be fair, every single national newspaper.
BMJ 2005 May 14;330: 1119-20
Nutritional information
Ben Goldacre
Thursday March 3, 2005
The Guardian
I hereby take the credit for coining the term Nutritionism: “The practice of promoting flimsily unevidenced assertions about the benefits of expensive supplements, or shortlived and unhelpfully overcomplicated eating fads, in healthy or ill individuals.” I accused Angela Dowden of just this. “Where have you seen me promote these?” she replied, indignantly.
Here is the first Google result for ‘Angela Dowden nutritionist’: www.healthspan.co.uk/articles/article.aspx?Id=112, a pill-pusher with a dubious “select your condition” way of selling tablets. Here’s Angela: “Eye strain: Which fruit? Bilberries. How they help: These European cousins of American blueberries contain anthocyanin antioxidants which strengthen the blood vessels supplying the retina in the eye. Bilberry extracts have been shown to treat visual fatigue caused by prolonged reading and working in dim light.” There is nothing, in 84 bilberry references on medline or pubmed, to support this. Having had to read 84 extremely boring abstracts to prove my point, I’m in the mood to cause trouble.
Then I remember. She’s “one of Britain’s most high-profile nutritional experts,” says the Mail. She’s a “registered nutritionist”, says the Mirror. Registered? With whom? The Nutrition Society: Angela tells me she thinks the register and the term “registered nutritionist” (or RNutr) have official status as a protected term. In fact they have none. But there might still be a register, which enforces some professional accountability. I go to the society’s website. I’d like to see the regulations, and make a complaint about Angela Dowden (RNutr) peddling invented nonsense, please. Nothing. I contact the “registrar”. Eleven emails later, we establish that no information is available to the public on how to complain, and no single document describes the regulatory process, standards expected of registrants, or how complaints are dealt with. My dead cat could do better.
So, I’ve submitted my complaint. I just put a stamp on it and hoped for the best. The society has decided not to make its “inquiries” public, except, of course, that I’ll be telling you everything I can wring out of it on this one; because my real accusation of incompetence is not about the fool Dowden, but about the Nutrition Society, which gives these fools their authority. This is not a one-off. This is “nutritionism”. Who watches the watchdog? Bizarrely, I think it might be you and I.
Please send your bad science to bad.science@guardian.co.uk
Ben Goldacre
Thursday November 11, 2004
The Guardian
· Ah, Susan Clark of the Sunday Times (What’s the Alternative?), how I love her. This time she’s giving advice about which natural substances are safe to take with warfarin. First, she bemoans the dearth of research on the subject. Then she ignores the useful stuff in what we do know. “As a simple guideline, patients who are taking warfarin should avoid any natural remedies that have an action on the cardiovascular system.” I have no idea where that idea came from: but warfarin is famous for being interfered with by other drugs. St John’s Wort, for example, is a very popular drug – herb, collection of drugs in a plant, whatever – that reduces the plasma concentration of warfarin, along with phenytoin and rifampicin: that’s not because they’re active on the cardiovascular system, that’s probably because they interfere with liver enzymes, which means it makes them work harder. Those enzymes also break down warfarin, so if they’re working harder, they break down the warfarin more too, so there’s less of it around in your blood, and you’re more likely to have another nasty clot and die. Likewise, ginseng reduces the plasma levels of warfarin, so they shouldn’t be mixed either. And lots of others.
· So: stand by for the kind of nerdy, and usefully boring science story you’ll see in a paper when I am prime minister of the world government. In a recent study, 2,600 patients on warfarin were sent a questionnaire on what alternative therapies they took: 1,360 responded (believe me, that’s a high response rate) and a whole 19.2% of those responders were, it turned out, taking one or more complementary therapies. Ninety-two per cent of them hadn’t thought to mention this to their doctor. Only 28.3% of all respondents had even thought that herbal medicines could interfere with prescription drugs. Because hardly anybody’s telling them. And, the patients who were taking the complementary therapies – the ones you’d hope would be aware of the risks – were even less likely to think they might interfere with prescription drugs (at a statistical significance of P<0.001, which means there’s a one in 1,000 possibility of that finding occurring by chance).
· Now, doctors have a responsibility to ask about alternative therapies. Patients have a responsibility to themselves to volunteer the information. And the PR arm of the alternative therapy industry, the ones who write articles in national newspapers, have a responsibility to know their onions, and share their knowledge.
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.
Ben Goldacre
Thursday July 15, 2004
The Guardian
· Pointing out that the current American government is manipulative, deceitful and interventionist is hardly news: although it hadn’t occurred to naive little me that it’d started meddling in science. The Bush administration has decreed that the World Health Organisation must clear US government-funded researchers with the health and human sciences department, before they can speak at conferences. Nice. The editor of the Journal of the American Medical Association, the largest US academic journal, has already criticised the ban on authors of papers on Aids going to conferences, talking about their work and sharing knowledge, just because they have ideas counter to the Bush administration.
· The man who decides who can speak is William Steiger. His qualifications are a PhD in Latin American history and having George Bush Snr as godfather. He was behind the attack on WHO’s reasonable suggestion that no more than 10% of people’s energy intake should come from sugar: he said there was no supporting scientific evidence. The US has a 25% guideline. That’s a quarter of your dietary intake of energy “safely” coming from pure sugar.
· It gets worse. The American “Union of Concerned Scientists” has collected the signatures of dozens of Nobel prizewinners, in protest at government interference in “independent scientific review panels”. You can read the full report at www.ucsusa.org, but it’s pretty depressing. It includes examples of the Bush administration blocking research and twisting evidence on issues as diverse as safe levels in lead poisoning, the environmental impact of mining, farming, drug abuse and patterns of infectious diseases. It’s practically impossible to research a lot of these things without being part of government infrastructure.
· Funny things happen when political ideologies start interfering with science. Trofim Lysenko was the top Soviet biologist for decades: he thought natural selection was too individualistic, and spent his career growing plants really close together, in the hope they would develop collectivist tendencies. Challenge him and you were out of a job. Governments that interfere with science, with the lies of alternative therapists, the fluff of cosmetics adverts, and childish dramatisations of science stories in the news, all contribute to the popular impression that it is nonsense concocted by boffins pursuing their own peculiar agendas. And that’s bad.
