Friday, 31 October 2008

Review: Bad Science by Ben Goldacre

Ben Goldacre's Bad Science column in The Guardian, and the namesake blog, are rigorous in scholarship, precise in analysis, and refreshingly reluctant to demonise. An oasis of genuine optimism, Goldacre engages with fad, misconception, and systematic bias in medical and scientific research, and offers up thoughtful solutions to the deep problems in medicine, both mainstream and alternative. Eager to teach, Goldacre peppers his writing with clear explainations of how things work and why some things just ain't so, carefully avoiding away from the oh-so-tempting, mind-closing "you don't know what you're talking about, here's why" approach to sceptical discourse. Instead, he supposes that we could all understand and engage with the science and medicine headlines, if we were armed with the right tools and relieved of a few popular misconceptions. So I had high hopes for his book, also named Bad Science. (I was lucky enough to get a signed copy. Thanks Michael!)

Bad Science reminds me of Darrel Huff's classic How to Lie with Statistics, which was a humourous primer for spotting statistical cons in advertising and the media, and also Stephen Poole's Unspeak, which repurposed close reading as a bullshit-detection system. Increasingly subtle or technical slip-ups are used as worked examples against which increasingly subtle or technical mental tools are deployed. Armed with these tools, we can recognise deception or error in our day to day lives, and we can understand stories in the media in more depth. Goldacre opens with "detox footbath Barbie", introducing the idea of a controlled experiment, and leads us on a brisk but clear tour though the scientific method and medical statistics. Even sophisticated topics like meta-analysis are dealt with honestly and unpatronisingly.

Never accepting a simple answer, Bad Science also takes some time out to elaborate on some of the surprising revelations along the way. The need for experimental controls in medicine (in the context of homeopathy, a subject which Goldacre appreciates has been done to death) is underlined by the amazing power of the placebo effect, and Goldacre takes a brief detour to discuss the potential for this controversial therapy. His discussion of the "antioxidant paradox", that antioxidant suppliments seem to be actively harmful while high blood antioxidant levels are protective, is much more than a simple debunking. Instead he takes the time to discuss the larger implications of this find for our understanding of how the human body works. (This is reminiscent of the writing in Bad Medicine, Wanjek's thoughtfully scattershot romp through medical misconception).

Goldacre also lets rip about some of his pet hates, but is careful to lay the blame with systems and cultures rather than individuals. The idea of science as an intimidating and arbitrary authority figure is prevalent in the media, and is a projection of journalists' own fears, he argues. By depicting science as an ivory tower sending down pronouncements, the media does its best to discourage us from thinking about the stories. On the other hand world-changing studies and daring pioneers make for easy headlines, and the media are all too willing to loft figures like Andrew Wakefield or Deepak Chopra up as new authorities. The real tragedy, he argues, is that the media shakes off any blame when the wind changes, hanging the former heroes out to dry as quacks or shrugging their shoulders about those crazy scientists, always changing their minds.

Mainstream medicine arguably takes even more heat then "alternative", a step up from "bumbling" to "dangerous", and Goldacre goes as far as to describe pharmaceutical industry behavior as "evil". Mercifully few authorities take homeopathy seriously, for example. However catastrophic failures or misuses of science and statistics deceive doctors and policy-makers on the effectiveness of drugs and treatments, while the publication system fails to properly combat these errors. It's here that the book gets most technical, far removed from the sort of material most readers are likely to encounter, and this part of the book offers striking lesson that perhaps shooting down waffle about distance healing isn't the best use of a sceptic's time.

Personal empowerment is a recurring theme of the book. Science need not be an intimidating authority figure, because we could all potentially understand the process. Likewise some problems can only be dealt with at a personal level, not with a magical sciencey-sounding pill or exercise program. When it keeps these goals in mind, Bad Science is a great success. Later chapters quickly turn into stand-alone case studies in an effor to impress on us the importance of understanding science and medicine - we've all got an interest in staying healthy, after all - and come across as more fragmented. It's here that the book's origins in a succession of blog posts and columns begin to shine through. Even so, it's always wittily, clearly, and precisely written. Bad Science is a superb guide to understanding and engaging with the science and medicine in our everyday lives, and I wholeheartedly recommend it.

(Book links help support Cooking Fiasco.)