Q&A: Dr. Ben Goldacre Wants His Book to Ruin Your Christmas

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courtesy Rhys Stacker

Dr. Ben Goldacre is best known for his “Bad Science” column in the British newspaper the Guardian, in which he skewers, with almost unseemly glee, misguided science reporting and the misleading marketing of medical treatments and nutritional supplements. His book Bad Science: Quacks, Hacks and Big Pharma Flacks, published in October in the U.S., furthers his witty assault on ignorance and lazy thinking.

His definition of good discussions of science? “Bloodbaths” during which researchers engage in “consensual intellectual sadomasochism” in order to develop the most effective methods of analyzing data. (More on Time.com: Mind Reading: Do Humans Prefer Free Love Over the Bonds of Nuclear Family?)

I spoke to Goldacre recently at the Barnes and Noble bookstore on E. 86th St. in Manhattan, just before a well-attended reading.

Why do so many people see Big Pharma as evil and profit-driven, but fail to question the profit motives of people selling nutritional supplements and alternative medicine?

It’s fascinating to me because as far as I’m concerned, Big Pharma and Big Quacker are both cut from exactly the same cloth. They use the same tricks [to] distort evidence and confuse their audience. Big Pharma uses slightly more complicated versions because their audience, as doctors, is a little bit more sophisticated. It always surprises me that people imagine that they’re making some great stand against capitalism by buying products from the $50 billion global food supplements industry rather than the $550 billion dollar global pharmaceutical industry.

[It’s also about] everyday phenomena like regression to the mean, where, your back pain has a natural cycle. It comes and it goes, and if you do something when it’s at its absolute worst then inevitably it was going to get better and inevitably you’re going to think that whatever you did made it better, whether that’s some dreadful operation that some irresponsible surgeon has consented to do, whether it’s some magic pill or some spoon bending ritual that some quack has offered to perform, or disemboweling a goat and dragging the entrails ’round your neck. (More on Time.com: Mind Reading: An Interview with Oliver Sacks)

There’s also the placebo effect which is extraordinary, fascinating and the most bizarre phenomenon in the whole of medicine.

I don’t think people really understand it. How can you have a green sugar pill working better than a blue sugar pill?

It’s really far out. People imagine that the placebo effect is something to do with you taking a pill that doesn’t have any medicine in it but you get better. In fact, the pill is entirely irrelevant. It’s about manipulating your beliefs and expectations, and that’s been demonstrated in a really fascinating series of experiments comparing one kind of placebo to another.

From these we know that four sugar pills a day clears gastric ulcers faster than two sugar pills a day, and that’s an outrageous finding. We know that red sugar pills work more effectively as stimulants, and blue sugar pills work more effectively as sedatives. We know that packaging makes a difference.

So, the brand name actually is better…

Yeah, who knew? Isn’t that funny, all the skeptic clever [kids] telling their parents, “Why do you buy brand-name Advil, when you can just get any ibruprofen — it’s all the same molecule?” Actually, they were wrong, the brand name is more effective because of our beliefs and expectations. When you pop that pill, you’re thinking about the TV ad where the woman’s sitting there and there’s that red pulsing animation in her hair and then the little blue arrows come out of her tummy and go into her bloodstream and go to her brain and the pain is neutralized. It’s all of that cultural memory that is making the link between the packaging and the increased pain relief. (More on Time.com: Mind Reading: What It’s Like When You Can’t Recognize Anyone)

To me, that’s more amazing than any kind of made up crap to do with crystal healing. Because this is the real story of the power of the mind over the body.

You write about vaccine scares in your book. Why do vaccines in particular attract such fear?

Firstly, being injected with a needle hurts, so it’s primed to attract anxiety. Maybe the worst junkie in the world fetishizes needles, but in general people don’t, and children cry when you give it to them. It’s also got a second problem, which is that the benefits are quite remote.

Vaccine scares have been with us forever. In the book, there’s a story from Scientific American in 1880 describing a meeting of anti-vaccine conspiracy theorists. [They’re] saying, “Why are we bothering giving smallpox vaccine? There hasn’t been a case of smallpox for a whole year. This is ridiculous.” And everybody else is saying, “Well, I don’t know, man, that might be because we’ve been having smallpox vaccine.” And they say, no, and they ban the vaccine and the next year a whole bunch of people die from smallpox — and that was 130 years ago.

Vaccine scares are cultural and political products. They’re not a reaction to the evidence. Ten years ago in the U.K. we had our huge scare that the MMR vaccine causes autism — that didn’t happen anywhere outside the U.K. There was a tiny touch of it in Japan, but basically nothing in America. Meanwhile, in America, two years ago, I think, was your big scare about thimerosal preservative causing autism, that didn’t happen anywhere outside of America. (More on Time.com: Mind Reading: An Author Takes Back Her Accusation of Incest)

How do we get people to pay more attention to the research evidence, rather than making choices based on anecdote or authority?

I don’t think you can. You set yourself up for a heart-dropping lifetime of misery and feeling like a failure if you say my objective is to make people, who don’t want to pay attention to evidence, pay attention to evidence. To me, what I’m interested in is telling people about how this stuff works. I genuinely don’t care if people want to spend money on quack remedies; I’m very happy to see it as a voluntary self-administered tax on scientific ignorance. (More on TIME.com: Mind Reading: Antonio Damasio on Developing a Self)

It’s surprising to me how new the notion of evidence-based medicine is.

It took from [the biblical] Daniel to about 1960 for us to get trials right. And it took until about 1990 for us to get the importance of doing a systematic review instead of just chaotically putting together studies. It’s extraordinary really to think that up ’til 15 years ago it was perfectly acceptable for people to conduct experiments in a very careful and controlled way, [but] when it came to the second step of collating that evidence together, they would do it in a totally haphazard fashion where they would allow all their preconceptions and biases to let them cherry-pick evidence.

One area that seems to attract bad science is illegal drug use. Why do you think that is?

That’s just one instance of a more general phenomenon. People have to have a motivation for distorting the scientific evidence. In the case of the drug war, people want to sell you an idea, they want to say that cannabis today is different from cannabis when they were teenagers so that they can be morally justified in having an otherwise inconsistent stance for themselves and for their children. (More on Time.com: Mind Reading: Discussing the Dark Side of Medicine with Author Carl Elliott)

It tells you a lot about the way that people want to use science as a rhetorical device. If a parent doesn’t feel comfortable saying, “My moral views have changed,” or they don’t feel comfortable saying, “This is just a moral thing for me,” they want to dress things up in science. They want to say, “I’m completely objective, and when I was a kid it was good, but now…”

What kind of reaction have you gotten to your book in the U.K.?

I get a lot of emails from people who’ve read the book. It always makes me laugh when people say, “I’ve read your book and I bought one for my sister who’s really into homeopathy and vitamin pills.” Ha ha ha. I’m sadistically pleased at the thought that my book is being given in anger as much as in love, and that it’s ruining Christmases up and down the country. That’s a happy feeling for me.