administration; the newspapers are filled with an amazing story about a finger that ‘grew back’ through the use of special sciencey ‘pixie dust’ (I quote again), although the claim has been around for three years, unpublished in any academic journal, and severed fingertips grow back by themselves anyway; more ‘hidden data’ scandals are exposed from the vaults of big pharma every month; quacks and cranks continue to parade themselves on television quoting fantastical studies to universal approbation; and there will always be new scares, because they sell so very well, and they make journalists feel alive.
To anyone who feels their ideas have been challenged by this book, or who has been made angry by it – to the people who feature in it, I suppose – I would say this: You win. You really do. I would hope there might be room for you to reconsider, to change your stance in the light of what might be new information (as I will happily do, if there is ever an opportunity to update this book). But you will not need to, because, as we both know, you collectively have almost full-spectrum dominance: your own slots in every newspaper and magazine in Britain, and front-page coverage for your scare stories. You affect outsider swagger, bizarrely, from the sofas of daytime television. Your ideas – bogus though they may be – have immense superficial plausibility, they can be expressed rapidly, they are endlessly repeated, and they are believed by enough people for you to make very comfortable livings, and to have enormous cultural influence. You win.
It’s not the spectacular individual stories that are the problem, so much as the constant daily grind of stupid little ones. This will not end, and so I will now abuse my position by telling you, very briefly, exactly what I think is wrong, and some of what can be done to fix it.
The process of obtaining and interpreting evidence isn’t taught in schools, nor are the basics of evidence- based medicine and epidemiology, yet these are obviously the scientific issues which are most on people’s minds. This is not idle speculation. You will remember that this book began by noticing that there has never been an exhibit on evidence-based medicine in London’s Science Museum.
A five-decade survey of post-war science coverage in the UK by the same institution shows – and this is officially the last piece of data in the book – that in the 1950s science reporting was about engineering and inventions, but by the 1990s everything had changed. Science coverage now tends to come from the world of medicine, and the stories are of what will kill you, or save you. Perhaps it is narcissism, or fear, but the science of health is important to people, and at the very time when we need it the most, our ability to think around the issue is being energetically distorted by the media, corporate lobbies and, frankly, cranks.
Without anybody noticing, bullshit has become an extremely important public health issue, and for reasons that go far beyond the obvious hysteria around immediate harms: the odd measles tragedy, or a homeopath’s unnecessary malaria case. Doctors today are keen – as it said in our medical school notes – to work ‘collaboratively with the patient towards an optimum health outcome’. They discuss evidence with their patients, so that they can make their own decisions about treatments.
I don’t generally talk or write about being a doctor – it’s mawkish and tedious, and I’ve no desire to preach from authority – but working in the NHS you meet patients from every conceivable walk of life, in huge numbers, discussing some of the most important issues in their lives. This has consistently taught me one thing: people aren’t stupid. Anybody can understand anything, as long as it is clearly explained – but more than that, if they are sufficiently interested. What determines an audience’s understanding is not so much scientific knowledge, but motivation: patients who are ill, with an important decision to make about treatment, can be very motivated indeed.
But journalists and miracle-cure merchants sabotage this process of shared decision-making, diligently, brick by brick, making lengthy and bogus criticisms of the process of systematic review (because they don’t like the findings of just one), extrapolating from lab-dish data, misrepresenting the sense and value of trials, carefully and collectively undermining the nation’s understanding of the very notion of what it means for there to be evidence for an activity. In this regard they are, to my mind, guilty of an unforgivable crime.
You’ll notice, I hope, that I’m more interested in the cultural impact of nonsense – the medicalisation of everyday life, the undermining of sense – and in general I blame systems more than particular people. While I do go through the background of some individuals, this is largely to illustrate the extent to which they have been misrepresented by the media, who are so desperate to present their favoured authority figures as somehow mainstream. I am not surprised that there are individual entrepreneurs, but I am unimpressed that the media carry their assertions as true. I am not surprised that there are people with odd ideas about medicine, or that they sell those ideas. But I am spectacularly, supremely, incandescently unimpressed when a university starts to offer BSc science courses in them. I do not blame individual journalists (for the most part), but I do blame whole systems of editors, and the people who buy newspapers with values they profess to despise. Specifically, I do not blame Andrew Wakefield for the MMR scare (although he’s done things I hope I would not), and I find it – let’s be very clear once again – spectacularly distasteful that the media are now revving up to hold him singly responsible for their own crimes, in regard to that debacle.
Similarly, while I could reel out a few stories of alternative therapists’ customers who’ve died unnecessarily, it seems to me that people who choose to see alternative therapists (except for nutrition therapists, who have worked
Economists and doctors talk about ‘opportunity costs’, the things you could have done, but didn’t, because you were distracted by doing something less useful. To my mind, the greatest harm posed by the avalanche of nonsense we have seen in this book is best conceived of as the ‘opportunity cost of bullshit’.
We have have somehow become collectively obsessed with these absurd, thinly evidenced individual tinkerings in diet, distracting us from simple healthy eating advice; but more than that, as we saw, distracting us from the other important lifestyle risk factors for ill health which cannot be sold, or commodified.
Doctors, similarly, have been captivated by the commercial success of alternative therapists. They could learn from the best of the research into the placebo effect, and the meaning response in healing, and apply that to everyday clinical practice, augmenting treatments which are in themselves also effective: but instead, there is a fashion among huge numbers of them to indulge childish fantasies about magic pills, massages or needles. That is not forward-looking, or inclusive, and it does nothing about the untherapeutic nature of rushed consultations in decaying buildings. It also requires, frequently, that you lie to patients. ‘The true cost of something,’ as the
On a larger scale, many people are angry about the evils of the pharmaceutical industry, and nervous about the role of profit in healthcare; but these are formless and uncalibrated intuitions, so the valuable political energy that comes from this outrage is funnelled – wasted – through infantile issues like the miraculous properties of vitamin pills, or the evils of MMR. Just because big pharma can behave badly, that does not mean that sugar pills work better than placebo, nor does it mean that MMR causes autism. Whatever the wealthy pill peddlers try to tell you, with their brand-building conspiracy theories, big pharma isn’t
To engage meaningfully in a political process of managing the evils of big pharma, we need to understand a little about the business of evidence: only then can we understand why transparency is so important in pharmaceutical research, for example, or the details of how it can be made to work, or concoct new and imaginative solutions.
But the greatest opportunity cost comes, of course, in the media, which has failed science so spectacularly, getting stuff wrong, and dumbing down. No amount of training will ever improve the wildly inaccurate stories, because newspapers already have specialist health and science correspondents who understand science. Editors will always – cynically – sideline those people, and give stupid stories to generalists, for the simple reason that they want stupid stories. Science is beyond their intellectual horizon, so they assume you can just make it up anyway. In an era when mainstream media is in fear for its life, their claims to act as effective gatekeepers to information are somewhat undermined by the content of pretty much every column or blog entry I’ve ever written.
To academics, and scientists of all shades, I would say this: you cannot ever possibly prevent newspapers
