by Ben Goldacre
Meanwhile, Dr Nield is now one individual facing a large company. Individual doctors and scientists are commonly asked for their opinion on whether or not medical interventions work. It’s plainly in our collective interest that they give honest answers, without fear that their lives will be taken over for years on end by a major company with money and a distorted sense of reputation. It’s obviously unhelpful, for society, that people risk losing a house’s worth of money even if they successfully defend a libel case, as has happened so many times recently.
With the law in its current state, doctors and scientists might be wise simply to stop giving any view about any drug or other health-related product that is marketed for commercial purposes, in any forum, and make it clear that from now on, decisions about efficacy should be made solely by the manufacturers. Good luck with that.
The Return of Dr McKeith
Guardian, 19 July 2010
What do you do, as a campaigner for libel reform, when a litigious millionaire calls you a liar? This ethical quandary was presented to me last week when the Twitter account of Gillian McKeith – or to give her full medical title, ‘Gillian McKeith’ – called my book Bad Science ‘lies’.
Now, firstly, there is little doubt that this is actionable, and probably undefendable. ‘Lies’ – from personal experience of trying – is one word you can never use in England. Even if you can show that someone is obviously wrong, even if you can show that they probably knew they were wrong, you still need to show that they deliberately distorted the truth, and that’s almost always impossible, without direct access to their thoughts. They might just have been mistaken, after all. Or sloppy. Or stupid.
So, for my pleasure, I have a strong case against the litigious millionaire. And I have a reasonably good reputation for honesty to defend. And although I believe libel laws stifle debate in science at great risk to public health, there’s no issue of science here.
But I’ve always believed that in most cases a simple correction, with the same prominence as the initial libel, should be sufficient. That’s why I contacted @gillianmckeith, firstly to explain that I’d be happy to debate my concerns about her work, and secondly, to make a simple request: could she please just tweet ‘Bad Science by Ben Goldacre is not lies’. That would be fine with me.
But by now all hell had broken loose. @gillianmckeith’s Twitter feed was filled with abuse to a random passing tweeter, and rambling, detailed tweets from McKeith explaining how her PhD from a non-accredited correspondence-course college was entirely valid. Then they all disappeared. Then the tone shifted: instead of first-person stuff about Gillian’s life, lots of third-person PR tweets appeared. Then they disappeared. Then, as over a thousand people were tweeting about her, making it the top trending topic on Twitter, @gillianmckeith announced, ‘Do you really believe this is real twitter site for the GM?’
Yes, replied the geeks. Well, the Twitter account @gillianmckeith is linked to from gillianmckeith.info, explained some. Then that link was deleted. But, explained others, only half-deleted. If you look at the ‘source code’ for the page, the link is still there, just temporarily inactivated. And that Twitter account is still linked from gillianmckeith.tv, Gillian’s YouTube page, and in fact her whole empire. Yes, we really do believe this is the real Twitter site for the real Gillian McKeith. If you’re going to play silly buggers online, at least do it competently. And really, very seriously, don’t call investigative journalists liars. You never know: we might sue too.
QUACKS
The Noble and Ancient Tradition of Moron-Baiting
Guardian, 29 May 2010
This week a man called Martin Gardner died, aged ninety-five. His popular maths column in Scientific American (and fifty books on the subject) spanned the decades, but in 1952 he published a book, In the Name of Science, on pseudoscience, quacks and credulous journalists. How much do you think has changed over sixty years?
Immanuel Velikovsky had just published his best-selling book Worlds in Collision, explaining how a comet which flew out of Jupiter, and zipped past the earth twice, had then caused the earth to stop spinning, so that the Red Sea would part at precisely the moment when Moses held out his hand. Cars and planes, he explained, are propelled by fuel refined from ‘remnants of the intruding star that poured fire and sticky vapour’ on the earth. Several years later the comet returned: a precipitate of carbohydrates that had formed in its tail fell to earth in the form of Manna which kept the Israelites fed for forty years.
The science editor of the New York Herald Tribune called this book ‘a magnificent piece of scholarly research’. But while the correspondents of Reader’s Digest and Harper’s Magazine heaped praise upon Velikovsky, his publishers received a flood of letters from scientists. A boycott was organised of all their academic textbooks, the editor who commissioned the book was sacked, and Velikovsky moved to Doubleday, which had no textbook imprint to worry about (and was delighted to have a best-seller).
This was an era when serious people took bullshit more seriously. While today homeopathy is taught in universities eager to serve popular demand, the most notable predecessor to Gardner’s Fads and Fallacies was Higher Foolishness, written in 1927 by David Starr Jordan, the first president of Stanford University. The American Medical Association campaigned hard against press publicity for quacks, and bullshit seemed more pressing. There were signs of a relapse into religious fundamentalism, driven in part by bizarre beliefs such as Velikovsky’s, and the indulgence of pseudoscience was playing its part, live and in colour, in some very bad situations.
The bizarre racial theories of the Nazi anthropologists were fresh in the memory, and in Russia things were little better. During the 1930s, communism had turned its back on evolution and Mendelian inheritance, preferring the theories of Trofim Lysenko on the inheritance of acquired characteristics, which sat better with its notions of heritable self-improvement. Sadly, Lysenkoism ran contrary to the experimental evidence, and could only be maintained by sending Russia’s geneticists to die in Siberian labour camps, so that by 1949 Russian children were being taught that the revolution had shattered the hereditary structure of the Soviet people, with each generation growing up finer than the last as a result.
But alongside concrete outcomes like death camps, Gardner never loses sight of the parallel tragedy. Harper’s Magazine – notable for its recent promotion of Aids denialism – was then pushing Gerald Heard’s book Is Another World Watching?, which explained that tiny flying saucers have visited earth, piloted by two-inch super-intelligent bee people from the planet Mars. At a time when the shelves were filled with magazines called things like Life, True and Doubt, a widespread passion for knowledge was being regularly derailed into nonsense.
So, Gardner has the same fun we have with the homeopaths (while complaining that Marlene Dietrich is a fan), the vitamin-pill peddlers, the anti-vaccination campaigners and the chiropractors, and above all captures their character, which endures: the self-imposed isolation from the corrective of academic criticism, the persecution complex, the grandiosity, the denouncement of critics as being in the pay of darker forces, and the enjoyment of jargon like ‘electroencephaloneuromentimpograph’, a machine devised by the son of the founder of chiropractic.
I have a copy of the first edition of In the Name of Science (they’re cheap), but subsequent editions are much more desirable, because they include a supplementary introduction where Gardner takes delight in his hate mail, and especially the mutual indignation that each target expresses at being unfairly associated with the others, whom they regard as the true charlatans.1 In sixty years nothing has changed. The best we can hope for is the simple, enduring pleasure of baiting morons.
How Do You Regulate Wu?
Guardian, 20 February 2010
You might have read about the case of Ying Wu this week: a fully qualified traditional Chinese-medicine doctor operating out of a shop in Chelmsford who for several years prescribed high doses of a dangerous banned substance to
treat the acne of senior civil servant Patricia Booth, fifty-eight, reassuring her that the pills were as safe as Coca-Cola. Following this her patient has lost both kidneys, developed urinary tract cancer, had a heart attack, and is now on dialysis three times a week. Judge Jeremy Roberts gave Wu a two-year conditional discharge, saying she did not know the pills were dangerous and could not be blamed, because the practice of traditional Chinese medicine is totally unregulated in Britain, a situation which he suggests should be remedied.
This sounds attractive, and has been loudly welcomed by alternative therapists, who see regulation as the path to legitimacy. It’s worth noting, in passing, that we do already have systems in place for dealing with dangerous substances (these pills are banned), false claims on the high street (like the regional Offices of Fair Trading, which chose not to use its powers here), and people prescribing treatments which have both powerful effects and dangerous side effects (like doctors, who make bad calls often enough that it’s hard to imagine why you’d want people with weaker training handing out dangerous pills).
But special regulation for alternative therapists raises one very simple problem: it’s extremely hard to regulate practitioners who make claims based on faith more than evidence. In such a situation, what is your yardstick for whether a clinical decision was reasonable?
Current attempts at regulation have exposed these contradictions. The Complementary and Natural Healthcare Council (or OfQuack, as it is affectionately known) has a Code of Conduct which forbids alternative therapists making claims without evidence. Blogger Simon Perry complained about every single reflexologist on its register, on the day they joined, if they were claiming to treat things like arthritis, infertility, babies with colic, and so on. All were told off, but the CNHC decided that their fitness to practise was not impaired, because its reflexology expert said that the practitioners would have honestly believed their claims to be reasonable, since they would have been trained to believe that they could treat these complaints.
So is the training the problem? The government’s review into regulation of alternative therapists has recommended that it should be compulsory to have a university degree in alternative therapies, and that universities should run such courses. And what is taught on these courses? You cannot know, because the universities have gone to shameful lengths over many years, to the point of multiple appeals at the highest level with the Information Commissioner, to keep the contents of these science degrees a closely guarded secret.
I and Professor David Colquhoun of UCL have obtained occasional course materials from students themselves, who thought they were going to be taught the scientific evidence base for alternative medicine, and have been dismayed by what they received. You can see why the universities wanted to hide them. Handouts from the Bachelor of Science degree in Chinese Medicine at Westminster University, for example, show students being taught – on a science degree – that the spleen is ‘the root of post-heaven essence’, ‘houses thought (and is affected by pensiveness/over thinking)’ and is responsible for the ‘transformation of qi energy’, ‘keeping the muscles warm and firm’.
‘Marrow helps fill the brain’. ‘Sin Jiao assists the lungs’ “dispersing function”, spreading fluids to skin in form of fine mist or vapour (so it helps regulate fluid production …)’. We also see the traditional anti-vaccine rhetoric – a core marketing tool for alternative therapists – as students are taught that vaccination is a significant cause of cancer.
One lecture by Niki Lawrence on ‘Herbal Approaches for Patients with Cancer’, meanwhile, discusses the difficulties of the Cancer Act, which was specifically designed to protect patients from the more dangerous extremes of alternative therapists’ self-belief. ‘Legally you cannot claim to cure cancer,’ it begins, on a slide headed ‘Cancer Treatment and the Law’. ‘This is not a problem because: we treat patients not diseases.’ Niki then romps on to explain that poke-root is ‘especially valuable in the treatment of breast, throat and uterus cancer’, Thuja occidentalis is ‘indicated for cancers of possible viral origin, e.g. colon/rectal, uterine, breast, lung’, and Centella asiatica ‘inhibits the recurrence of cancer’.
It is a tragedy that someone has contracted a fatal condition and is on dialysis. What worries me is that when you try to slot the square peg of fanciful overclaiming and faith-based medicine into the round hole of serious regulation and university teaching, you create more problems and confusion than you started with.
Blame Everyone But Yourselves
Guardian, 26 July 2008
Like the practitioners of many professions that kill with some regularity, doctors have elaborate systems for seeing what went wrong afterwards. The answer is rarely ‘Brian did it.’ This week the papers have been alive with criticism of quack nutritionism after the case of Dawn Page, a fifty-two-year-old mother of two who ended up being treated on intensive care, with seizures brought on by sodium deficiency, and left with permanent brain damage. She had been following the advice of ‘nutritional therapist’ Barbara Nash. Ms Nash denies liability. Her insurers paid out £810,000.
I will now defend the nutritional therapist Barbara Nash.
There is no doubt that people who declare themselves to be healthcare practitioners are a risk, by virtue of their sheer, uncalibrated self-belief. It must take strong nerves to tell a customer, as they follow ‘the Amazing Hydration Diet’ – dramatically increasing water intake, and reducing salt intake – that their uncontrollable vomiting is simply ‘part of the detoxification process’. Perhaps it was done with the reassuring tones of a clinician. In fact, Mrs Page’s lawyers explained, at this point she was told by Ms Nash to increase her water intake to six pints a day.
But I put it to the kangaroo court of the international news media – since this story has now spread as far as America and Australia – that Barbara Nash’s confidence in her own judgement cannot be viewed outside its social context.
After completing the rigorous training at the ‘College of Natural Nutrition’, anyone would naturally believe themselves to be appropriately qualified, and able to give advice confidently. That is certainly the impression I have from reading the college’s website. Barbara Nash’s confidence in her own abilities seems entirely congruent with that world view. This college operates legally and is well promoted.
Then there are the professional bodies. They have been rather keen to distance themselves from Barbara Nash. In the Daily Telegraph, for example: ‘The British Association for Applied Nutrition and Nutritional Therapy (BANT) which has its own code of conduct, said Mrs Nash was not a member.’ This is not the entire truth. Barbara Nash is advertised on yell.com as a member of BANT. In fact, she was indeed a member of BANT, until last year.
Membership of BANT carries such privileges as ‘a listing in the BANT Directory of Practitioners, which is available to the public, and entry on the BANT website’, and ‘acknowledgement of professional status by the Nutritional Therapy Council’. Endorsed in this way by these bodies, Barbara Nash has every reason to hold her own clinical abilities in high regard. The episode with Dawn Page on intensive care occurred in 2001. These honours were conferred upon her by BANT in 2005.
And of course we should not forget the wider social context: food has become the bollocks du jour, with no regard for accuracy whatsoever. This month, the Daily Telegraph was printing advice from a self-declared nutrition therapist on folic acid in pregnancy that may actually increase the risk of disabling neural-tube defects in babies, in the same week that it ran a news story telling women that red wine prevents breast cancer, when actually it increases it; and the sofas of daytime television are filled with self-declared nutritionists, because they give us what we want to hear: technical, complicated, sciencey-sounding health advice.
Looking at Barbara Nash’s website, I see she carries testimonials from her own appearances on ITV Central’s Shape Up for Summer slot: ‘When I met Barbara [who was the nutritionist for this programme] I wasn’t really sure how her e
ating plan would help me … However, it did involve one aspect that I found very difficult to follow, drinking four pints of water a day. I would be the first person to say that I was sceptical but as I had volunteered to take part, I felt that I at least owed it to everyone to try. Was I surprised by the results!’
Promoted, endorsed, trained and buoyed, Barbara Nash has every good reason to think that what she is doing is sensible and correct. Dawn Page – for all that you might think, in an unkind moment, that she was a little gullible – similarly had every reason to believe that Nash was competent. Their view on Nash’s competence, and everyone else’s, is quite reasonably reinforced by the College of Natural Nutrition, the British Association of Nutritional Therapists, Central TV, and every single journalist, editor, commissioner and producer who has shepherded the bizarre world of made-up nutritional nonsense into our lives.
The specific harm done in this one episode is tragic. It always is. The real measure of professionalism is how you investigate, and what you change. No system would be perfect, but in this case, everyone is queuing up to hold out Barbara Nash as solely responsible. When you miss the real cause, you can be sure that the problem will rise again.
MAGIC BOXES
ADE 651: WTF?
Guardian, 14 November 2009
It’s always interesting when people take pseudoscience out of its natural habitat – Islington – and off into a place where the stakes are quite high. Like the polio vaccine scare in Nigeria. Or Aids denialism in South Africa. Or detecting bombs in Iraq, where the New York Times and magician James Randi have uncovered some nonsense of epic proportions.