Bad Science

I’ve not met Hutchings et al., the authors of the parenting study that kicked off this chapter – and I’m quite prepared to be told that they are in Soho House until 2 a.m. every night, schmoozing broadcast media journalists with champagne and nibbles – but in reality I suspect they are quiet, 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, our collective hopes and consumer dreams.

The fish-oil story is by no means unique: repeatedly, in a bid to sell pills, people sell a wider explanatory framework, and as George Orwell first noted, the true genius in advertising is to sell you the solution and the problem. Pharmaceutical companies have worked hard, 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 year; and the nutrition supplements industry, for its own market, promotes dietary deficiencies as a treatable cause for low mood (I myself do not have a miracle cure to offer, and repetitively enough, I think that the social causes of these problems are arguably more interesting – and possibly even more amenable to intervention).

These fish-oil stories were a classic example of a phenomenon more widely described as ‘medicalisation’, the expansion of the biomedical remit into domains where it may not be helpful or necessary. In the past, this has been portrayed as something that doctors inflict on a passive and unsuspecting world, an expansion of the medical empire: but in reality it seems that these reductionist biomedical stories can appeal to us all, because complex problems often have depressingly complex causes, and the solutions can be taxing and unsatisfactory.

In its most aggressive form, this process has been characterised as ‘disease-mongering’. It can be seen throughout the world of quack cures – and being alive to it can be like having the scales removed from your eyes – but in big pharma the story goes like this: the low-hanging fruit of medical research has all been harvested, and the industry is rapidly running out of novel molecular entities. They registered fifty a year in the 1990s, but now it’s down to twenty a year, and a lot of those are just copies. They are in trouble.

Because they cannot find new treatments for the diseases we already have, the pill companies instead invent new diseases for the treatments they already have. Recent favourites include Social Anxiety Disorder (a new use for SSRI drugs), Female Sexual Dysfunction (a new use for Viagra in women), night eating syndrome (SSRIs again) and so on: problems, in a real sense, but perhaps not necessarily the stuff of pills, and perhaps not best conceived of in reductionist biomedical terms. In fact, reframing intelligence, loss of libido, shyness and tiredness as medical pill problems could be considered crass, exploitative, and frankly disempowering.

These crude biomedical mechanisms may well enhance the placebo benefits from pills, but they are also seductive precisely because of what they edit out. In the media coverage around the rebranding of Viagra as a treatment for women in the early noughties, and the invention of the new disease Female Sexual Dysfunction, for example, it wasn’t just the tablets that were being sold: it was the explanation.

Glossy magazines told stories about couples with relationship problems, who went to their GP, and the GP didn’t understand their problem (because that is the first paragraph of any medical story in the media). Then they went to the specialist, and he didn’t help either. But then they went to a private clinic. They did blood tests, hormone profiles, esoteric imaging studies of clitoral bloodflow, and they understood: the solution was in a pill, but that was only half the story. It was a mechanical problem. Rarely was there a mention of any other factors: that she was feeling tired from overwork, or he was exhausted from being a new father, and finding it hard to come to terms with the fact that his wife was now the mother of his children, and no longer the vixen he first snogged on the floor of the student union building to the sound of ‘Don’t You Want Me Baby?’ by the Human League in 1983: no. Because we don’t want to talk about these issues, 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 in schools.

But above all we should pay tribute to the genius of this huge fish-oil project, and every other nutritionist who has got their pills into the media, and into schools, because more than anything else, they have sold children, at the most impressionable time of their lives, one very compelling message: that you need to take pills to lead a healthy normal life, that a sensible diet and lifestyle are not enough in themselves, and that a pill can even make up for failings elsewhere. They have pushed their message directly into schools, into families, into the minds of their worried parents, and it is their intention that every child should understand that you need to eat several large, expensive, coloured capsules, six of them, three times a day, and this will improve vital but intangible qualities: concentration, behaviour and intelligence.

This is the greatest benefit to the pill industry, of every complexion. I would prefer fish-oil pills to ritalin, but fish-oil pills are being marketed at every child in the country, and they have undoubtedly won. Friends tell me that in some schools it is considered almost child neglect not to buy these capsules, and its impact on this generation of schoolchildren, reared on pills, will continue to bear rich fruit for all the industries, long after the fish-oil capsules have been forgotten.

Calming down: the apothecary industrial complex

Generating news coverage as a means of increasing brand awareness for a commercial product is a well- trodden path (and it also drives those contentless ‘scientists have found the equation for …’ stories that we shall see in a later chapter). PR companies even calculate something called ‘advertising equivalents’ for the exposure your brand gets for free, and in a period when more newsprint is generated by fewer journalists, it’s inevitable that such shortcuts to colourful copy are welcomed by reporters. News and features stories about a product also carry far more weight in the public imagination than a paid advert, and are more likely to be read or watched.

But there is another, more subtle benefit to be had from editorial coverage of your pseudomedical product: the claims that can be made in advertising and on packaging for food supplements and ‘borderline medical products’ are tightly regulated, but there are no such regulations covering the claims made by journalists.

This rather clever division of labour is one of the more interesting features of the alternative therapy industry. Take a moment to think of all the things that you have come to believe are true, or at least have heard claimed regularly, about different supplements: glucosamine can treat arthritis; antioxidants prevent cancer and heart disease; omega-3 fish oils improve intelligence. These claims are now common currency, a part of our culture as much as ‘dock leaves for stinging nettles’; but you will rarely, if ever, see them being made explicitly on packaging or in advertising material.

Once you realise this, it makes the colour supplements a marginally more interesting read: the alternative therapy columnist will make a dramatic and scientifically untenable claim for glucosamine, stating that it will improve the joint pain of a reader who has written in; the pill company, meanwhile, will have a full-page advertisement for glucosamine, which merely states the dose and possibly makes a bland claim at the level of basic biology, rather than about clinical efficacy: ‘Glucosamine is a known chemical constituent of cartilage.’

Sometimes the overlap is close enough to be amusing. Some examples are predictable. The vitamin pill magnate Patrick Holford, for example, makes sweeping and dramatic claims for all kinds of supplements in his ‘Optimum Nutrition’ books; yet these same claims are not to be found on the labels of his own-brand ‘Optimum Nutrition’ range of vitamin pills (which do feature, however, a photograph of his face).

Alternative health columnist Susan Clark – who has argued, among other things, that water has calories – is another shining example of this fine line that journalists can sometimes tread. She had a column in the Sunday Times, Grazia and the Observer for several years. In the course of these columns she recommended one company’s products, ‘Victoria Health’, with notable frequency: once a month, regular as clockwork, by my reckoning. The papers deny that there was any impropriety, as does she, and I have no reason to doubt this. But she had done paid work for the company in the past, and she has now left her newspaper jobs to take up a full-time position at Victoria Health, writing their in-house magazine. (It’s a scene that is eerily reminiscent of the well-known free flow of employees in America between the pharmaceutical industry regulator and the boards of various pharmaceutical companies: in fact, at the risk of hammering a point home too hard, you will have noticed by now that I am telling the story of all the pill industries, using examples from mainstream media, and you couldn’t put a cigarette paper between them.)

The Royal Pharmaceutical Society was expressing concern at these covert marketing strategies in the mainstream pharmaceutical industry as long ago as 1991: ‘Barred from labelling products with detailed medicinal