Ben Goldacre Quotes

Doctors are generally nice people, and eager to please. They will get bounced into giving people what they want, and a lot of patients have been persuaded, through whatever social processes are at play in the world, that pills fix things. I'll rephrase that for something that's coming later in this chapter: a lot of people have been convinced that they're patients.

Homeopathy pills are, after all, empty little sugar pills which seem to work, and so they embody [..] how we can be misled into thinking that any intervention is more effective than it really is.

You cannot reason people out of positions they didn't reason themselves into

When you prescribe a new drug, often you are prescribing something that has only been tested in a few thousand people for a very short period of time, perhaps only six months, and that's not long enough to know whether there are any medium- or long-term side effects.

In general, drug companies are reasonably good at developing new treatments, and there's also a lot of good in the industry.

In an ideal world, you might imagine that scientific papers were only cited by academics on the basis of their content. This might be true. But lots of other stuff can have an influence.

scaremongers - who unquestioningly champion anecdotal data, while meticulously examining every large, carefully conducted study on the same subject for any small chink that would permit them to dismiss it entirely.

Like most things in the story the natural sciences can tell about the world, it's all so beautiful, so gracefully simple, yet so rewardingly complex, so neatly connected - not to mention true - that I can't even begin to imagine why anyone would ever want to believe some New Age 'alternative' nonsense instead. I would go so far as to say that even if we are all under the control of a benevolent God, and the whole of reality turns out to be down to some flaky spiritual 'energy' that only alternative therapists can truly harness, that's still neither so interesting nor so graceful as the most basic stuff I was taught at school about how plants work.

Two large trials of antioxidants were set up after Peto's paper (which rather gives the lie to nutritionists' claims that vitamins are never studied because they cannot be patented: in fact there have been a great many such trials, although the food supplement industry, estimated by one report to be worth over $50 billion globally, rarely deigns to fund them). One was in Finland, where 30,000 participants at high risk of lung cancer were recruited, and randomised to receive either ß-carotene, vitamin E, or both, or neither. Not only were there more lung cancers among the people receiving the supposedly protective ß-carotene supplements, compared with placebo, but this vitamin group also had more deaths overall, from both lung cancer and heart disease. The results of the other trial were almost worse. It was called the 'Carotene and Retinol Efficacy Trial', or 'CARET', in honour of the high p-carotene content of carrots. It's interesting to note, while we're here, that carrots were the source of one of the great disinformation coups of World War II, when the Germans couldn't understand how our pilots could see their planes coming from huge distances, even in the dark. To stop them trying to work out if we'd invented anything clever like radar (which we had), the British instead started an elaborate and entirely made-up nutritionist rumour. Carotenes in carrots, they explained, are transported to the eye and converted to retinal, which is the molecule that detects light in the

There is an almost linear relationship between the methodological quality of a homeopathy trial and the result it gives. The worse the study - which is to say, the less it is a "fair test" - the more likely it is to find that homeopathy is better than placebo.

Sham ultrasound is beneficial for dental pain, placebo operations have been shown to be beneficial in knee pain (the surgeon just makes fake keyhole surgery holes in the side and mucks about for a bit as if he's doing something useful), and placebo operations have even been shown to improve angina. That's

I spend a lot of time talking to people who disagree with me - I would go so far as to say that it's my favourite leisure activity,

Children can be disgusting, and often they can develop extraordinary talents, but I'm yet to meet any child who can stimulate his carotid arteries inside his ribcage.

Classically, cosmetics companies will take highly theoretical, textbookish information about the way that cells work - the components at a molecular level or the behavior of cells in a glass dish - and then pretend it's the same as the ultimate issue of whether something makes you look nice. "This molecular component," they say, with a flourish, "is crucial for collagen formation." And that will be perfectly true (along with many other amino acids which are used by your body to assemble protein in joints, skin, and everywhere else), but there is no reason to believe that anyone is deficient in it or that smearing it on your face will make any difference to your appearance. In general, you don't absorb things very well through your skin, because its purpose is to be relatively impermeable. When you sit in a bath of baked beans for charity, you do not get fat, nor do you start farting.

people who are incompetent suffer a dual burden: not only are they incompetent, but they may also be too incompetent to assay their own incompetence, because the skills which underlie an ability to make a correct judgement are the same as the skills required to recognise a correct judgement.

Here we will see that pharmaceutical companies spend tens of billions of pounds every year trying to change the treatment decisions of doctors: in fact, they spend twice as much on marketing and advertising as they do on the research and development of new drugs. Since we all want doctors to prescribe medicine based on evidence, and evidence is universal, there is only one possible reason for such huge spends: to distort evidence-based practice.

If a scientist sidesteps their scientific peers, and chooses to take an apparently changeable, frightening and technical scientific case directly to the public, then that is a deliberate decision, and one that can't realistically go unnoticed.

The placebo effect is one of the most fascinating things in the whole of medicine. It's not just about taking a pill, and your performance and your pain getting better. It's about our beliefs and expectations. It's about the cultural meaning of a treatment.

This process of professionalising the obvious fosters a sense of mystery around science, and health advice, which is unnecessary and destructive. More than anything, more than the unnecessary ownership of the obvious, it is disempowering.

Eat lots of fruit and vegetables, and live your whole life in every way as well as you can: exercise regularly as part of your daily routine, avoid obesity, don't drink too much, don't smoke, and don't get distracted from the real, basic, simple causes of ill health.

There are many ways in which journalists can mislead a reader with science: they can cherry-pick the evidence, or massage the statistics; they can pit hysteria and emotion against cold, bland statements from authority figures.

If I was writing a lifestyle book it would have the same advice on every page, and you'd know it all already. Eat lots of fruit and vegetables, and live your whole life in every way as well as you can: exercise regularly as part of your daily routine, avoid obesity, don't drink too much, don't smoke, and don't get distracted from the real, basic, simple causes of ill health. But as we will see, even these things are hard to do on your own, and in reality require wholesale social and political changes.

What is odd, perhaps, is how the primacy of patient autonomy and informed consent over efficacy - which is what we're talking about here - was presumed, but not actively discussed within the medical profession. Although the authoritative and paternalistic reassurance of the Victorian doctor who 'blinds with science' is a thing of the past in medicine, the success of the alternative therapy movement - whose practitioners mislead, mystify and blind their patients with sciencey-sounding 'authoritative' explanations, like the most patronising Victorian doctor imaginable - suggests that there may still be a market for that kind of approach.

Paul Broca, for example, was a famous French craniologist in the nineteenth century whose name is given to Broca's area, the part of the frontal lobe involved in the generation of speech (which is wiped out in many stroke victims). Among his other interests, Broca used to measure brains, and he was always rather perturbed by the fact that the German brains came out a hundred grams heavier than French brains. So he decided that other factors, such as overall body weight, should also be taken into account when measuring brain size: this explained the larger Germanic brains to his satisfaction. But for his prominent work on how men have larger brains than women, he didn't make any such adjustments. Whether by accident or by design, it's a kludge.

The real threat from cranks is not that their customers might die
there is the odd case, although it seems crass to harp on about them - but that they systematically the public's understanding about the very nature of evidence.

You cannot reason people out of a position that they did not reason themselves into.

Like many doctors, I was frankly traumatized by some of the experiences I had early on in my career. When you lean over a patient in an emergency room, trying to bring a dead body back to life, you are entirely focused on the job at hand. On the other side of a thin curtain, you can hear that person's husband or wife howling and wailing, knowing that the person they loved and lived with for fifty years is dying, begging the staff to do all they can, phoning their children, struggling to speak through tears to form the words and communicate the horror, telling them to come, quickly. I have memories from cubicles that I will never be able to deal with, and they upset me even now.

The value of a scientific publication goes beyond this simple benefit, of all relevant information appearing, unambiguously, in one place. It's also a way to communicate your ideas to your scientific peers, and invite them to express an informed view.

Bad things happen when problems are protected by a force field of tediousness.

If you put me in charge of the medical research budget, I would cancel all primary research, I would cancel all new trials, for just one year, and I would spend the money exclusively on making sure that we make the best possible use of the clinical evidence that we already have.

Repeat after me: pharma being shit does not mean magic beans cure cancer.

Science isn't about authority or white coats; it's about following a method. That method is built on core principles: precision and transparency; being clear about your methods; being honest about your results; and drawing a clear line between the results, on the one hand, and your judgment calls about how those results support a hypothesis.

Amazing things happen when you pull individual pieces of information together into larger linked datasets: meaning emerges, as you produce facts from figures.

More academics should blog, post videos, post audio, post lectures, offer articles and more. You'll enjoy it: I've had threats and blackmail, abuse, smears and formal complaints with forged documentation.

I hope that you will be asked to participate in a trial at some stage in your disease

As it is a major component of blood, water is vital for transporting oxygen to the brain. Heaven forbid that your blood should dry out.

Just just because there are flaws in aircraft design that doesn't mean flying carpets exist.

In the past, [medicalization]has been portrayed as something that doctors inflict on a passive and un-suspecting world - an expansion of the Medical Empire. But in reality, it seems that these reductionist bio-medical stories can appeal to us all, because complex problems often have depressingly-complex causes, and the solutions can be taxing, and unsatisfactory.

Alternative therapists don't kill many people, but they do make a great teaching tool for the basics of evidence-based medicine, because their efforts to distort science are so extreme.

The American Academy of Pediatrics officially supports breastfeeding, but receives about half a million dollars from Ross, manufacturers of Similac infant formula.

Torture the data, and it will confess to anything, as

Data is the fabric of the modern world: just like we walk down pavements, so we trace routes through data, and build knowledge and products out of it.

Science has authority, not because of white coats, or titles, but because of precision and transparency: you explain your theory, set out your evidence, and reference the studies that support your case.

Sociologists of regulation - such people exist - talk about something called 'regulatory capture'. This is the process whereby a state regulator ends up promoting the interests of the industry it is supposed to monitor, at the expense of the public interest. It can happen for a number of reasons, and many of them are very human. For example, if you work in the technical business o f drug approval and pharmacovigilance, who can you chat to about your day's work? To your partner, it's all baffling and pedantic; but to the people in the regulatory affairs division of the companies you work with every day, they understand. You have so much in common with them. So industry bodies - not even necessarily the pharmaceutical companies themselves - might offer things as intangible as friendship, and opportunities to socialize.

We are human, we are irrational, we have foibles, and the power of the mind over the body is greater than anything you have previously imagined.

And if, by the end [of this book], you reckon you might still disagree with me, then I offer you this: you'll still be wrong, but you'll be wrong with a lot more panache and flair than you could possibly manage right now.

natural frequencies are the only sensible way to communicate risk.

... sometimes you need to be imaginative about what kinds of research you do, compromise and be driven by the questions that need answering, rather than the tools available to you.

[I]t seems to me that a lot of the stranger ideas people have about medicine derive from an emotional struggle with the very notion of a pharmaceutical industry. Whatever our political leanings, we all feel nervous about profit taking any role in the caring professions, but that feeling has nowhere to go. Big pharma is evil; I would agree with that premise. But because people don't understand exactly how big pharma is evil, their anger gets diverted away from valid criticisms - its role in distorting data, for example, or withholding lifesaving AIDS drugs from the developing world - and channeled into infantile fantasies. "Big pharma is evil," goes the line of reasoning; "therefore homeopathy works and the MMR vaccine causes autism." This is probably not helpful.

The current regulations -- for companies, doctors and researchers -- create perverse incentives; and we'll have better luck fixing those broken systems than we will ever have trying to rid the world of avarice

At school you were taught about chemicals in test tubes, equations to describe motion, and maybe something on photosynthesis - about which more later - but in all likelihood you were taught nothing about death, risk, statistics, and the science of what will kill or cure you.

The plural of anecdotes is not data

Just one thing gives me hope, and that is the steady trickle of emails I receive on the subject from children, ecstatic with delight at the stupidity of their teachers:

I'd like to submit to Bad Science my teacher who gave us a handout which says that 'Water is best absorbed by the body when provided in frequent small amounts.' What I want to know is this. If I drink too much in one go, will it leak out of my arsehole instead?

'Anton', 2006

Thank you Anton.

In females, the author has found the application of pure carbolic acid to the clitoris an excellent means of allaying the abnormal excitement.

Most bloggers have no institutional credibility, and so they must build it, by linking transparently, and allowing you to easily double check their work. But more than anything, because linking sources is such an easy thing to do, and the motivations for avoiding links are so dubious, I've detected myself using a new rule of thumb: if you don't link to primary sources, I just don't trust you.

More than that, these adverts sell a dubious world view. They sell the idea that science is not about the delicate relationship between evidence and theory. They suggest, instead, with all the might of their international advertising budgets, their Microcellular Complexes, their Neutrillium XY, their Tenseur Peptidique Végétal and the rest, that science is about impenetrable nonsense involving equations, molecules, sciencey diagrams, sweeping didactic statements from authority figures in white coats, and that this sciencey-sounding stuff might just as well be made up, concocted, confabulated out of thin air, in order to make money. They sell the idea that science is incomprehensible, with all their might, and they sell this idea mainly to attractive young women, who are disappointingly under-represented in the sciences.

Positive findings are around twice as likely to be published as negative findings. This is a cancer at the core of evidence-based medicine.

There is essentially no difference between the vitamin industry and the pharmaceutical and biotech industries (that

Randomisation is not a new idea. It was first proposed in the seventeenth century by John Baptista van Helmont, a Belgian radical who challenged the academics of his day to test their treatments like blood-letting and purging (based on 'theory') against his own, which he said were based more on clinical experience: 'Let us take out of the hospitals, out of the Camps, or from elsewhere, two hundred, or five hundred poor People, that have Fevers, Pleurisies, etc. Let us divide them into half, let us cast lots, that one half of them may fall to my share, and the other to yours … We shall see how many funerals both of us shall have.

Doctors and patients need as much data as possible to make an informed decision about what treatment is best.

There is actually quite a lot of crossover between the quacks and drug companies. They use the same tricks and tactics to bamboozle people into buying their pills, but drug firms can afford to use slightly more sophisticated versions.

Dr Stewart Wolf took the placebo effect to the limit. He took two women who were suffering with nausea and vomiting, one of them pregnant, and told them he had a treatment which would improve their symptoms. In fact he passed a tube down into their stomachs (so that they wouldn't taste the revolting bitterness) and administered ipecac, a drug that which should actually induce nausea and vomiting. Not only did the patients' symptoms improve, but their gastric contractions - which ipecac should worsen - were reduced. His results suggest - albeit it in a very small sample - that a drug could be made to have the opposite effect to what you would predict from the pharmacology, simply by manipulating people's expectations. In this case, the placebo effect outgunned even the pharmacological influences. More

We are talking about a programme which claims that 'processed foods do not contain water', possibly the single most rapidly falsifiable statement I've seen all week. What about soup?

The American Academy of Nutrition and Dietetics is sponsored by Coca-Cola.

Transparency and detail are everything in science.

A review of trials of acupuncture for back pain showed that the studies that were properly blinded showed a tiny benefit for acupuncture, which was not "statistically significant" (we'll come back to what that means later). Meanwhile, the trials that were not blinded - the ones in which the patients knew whether they were in the treatment group or not - showed a massive, statistically significant benefit for acupuncture.