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. When they pervert the activities of people who should know better - medicines regulators, or universities - it throws sharp relief onto the role of science and evidence in culture. Characters from this community who wonder why people keep writing about them should look at their libel cases and their awesomely bad behaviour under fire. You are a comedy factory. Don’t go changing.
Next: the real story of how the world works is much weirder than anything a quack can make up. The placebo effect is maddening, the nocebo effect more so, but the research on how we make decisions, and are misled by heuristics and mental shortcuts, is the wildest of all. Knowing about these belief-hacks gives you thrills, and power.
Pharmaceutical companies can behave dismally. Most important, they still won’t publish all the results of all the clinical trials conducted on humans. This is indefensible, and because we tolerate it, we don’t know the true effect sizes of the medicines that we give. This absurd situation mocks the whole of medicine: we need legislation to fix it, and popular movements to drive that. I’ll join yours.
Journalists can mislead the public about the answers of evidence-based medicine, which is bad. But they also mislead us on the methods and techniques. We live in a new era of doctors and patients - at our best - making decisions together. For that collaboration to work, everyone needs to understand how we know if something is good for us, or bad for us. The basics of evidence-based medicine, of trials, meta-analyses, cohort studies and the like should be taught in schools and waiting rooms. It’s interesting, but it’s also life and death: people care about it.
Politicians misuse evidence, and distort it to shameful degrees. But more than that, there are endless cases where we could do randomised trials on policies - old and new - to find out if they achieve the outcomes they’re aiming for. There is no honourable excuse for failing to use the fairest tests we can design.
Real scientists can behave as badly as anyone else. Science isn’t about authority, or white coats, it’s about following a method. That method is build 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 judgement calls about how those results support a hypothesis. Anyone blurring these lines is iffy.
… Last, nerds are more powerful than we know. Changing mainstream media will be hard, but you can help create parallel options. 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.
But it’s worth it, for one simple reason: pulling bad science apart is the best teaching gimmick I know for explaining how good science works. I’m not a policeman, and I’ve never set out to produce a long list of what’s right and what’s wrong. For me, things have to be interestingly wrong, and the methods are all that matter.
— Ben Goldacre, I Think You’ll Find It’s A Bit More Complicated Than That