Bad Science by Ben Goldacre

A bit off-topic this week in that the book I want to talk about isn't, by most definitions, science fiction or fantasy. However, my excuse is that it includes elements of science, fiction and fantasy – even though it is a non-fiction book about health care!

The author of Bad Science is a doctor working in the National Health Service who also writes a column for a national newspaper (The Guardian) and maintains a website on the same subject. His topic is the way in which the public is misled by claims made about medications and medical treatments; not just by practitioners of alternative and complementary medicine (including nutritionists) but also by pharmaceutical companies and, most of all, the news media. His writing style is journalistic rather than academic and is often hilariously trenchant as he names and shames some very well-known individuals, companies and newspapers. He must have some hard-working lawyers!

Bad Science is not just an entertaining read, it is highly informative. Goldacre not only provides lots of evidence to back up his denunciations, he constantly drives home the essential message concerning medical trials: that many of them do not achieve the quality "gold standard", for which there must be a placebo-taking control group; there must be a completely randomised selection of those in the trial and control groups; and the trials must be conducted under double-blind conditions (that is, neither the participants, nor those doling out the pills to them, know who is getting the trial medicine and who is getting the placebo). Failure to follow these precepts has been shown to have a major distorting effect on the outcome, and the author gives many examples of this.

In the first part of the book, Goldacre's critical eye is turned onto alternative medicine in general and homeopathy in particular. He shows that there is a direct relationship between the results of the trials in this field and the rigorousness of the way in which the trials were conducted. Put simply, trials which are conducted in accordance with the "gold standard" precepts listed above show that homeopathic pills work no better than placebos. As he points out, the link between the mind and the body is powerful and complex, and still not entirely understood (sometimes patients report feeling better even when they have been told that they are being given sugar pills instead of medicine!). Any benefits from alternative medicine appear to be in the ritual associated with them, as with shamanistic magic, which convinces customers that this must be doing them some good.

Next in his firing line come the nutritionists and peddlers of vitamin pills. The author's message is this: to give yourself the best chance of enjoying good health, eat a variety of fresh fruit and vegetables; drink alcohol only in moderation; don't smoke; and take regular exercise. He says that's basically all there is to it; there is no valid evidence that "superfoods" work any better than other fruits and vegetables, or that you can further improve your health by taking vitamin pills or dietary supplements. Amazingly, despite the almost universal acceptance of the idea that taking fish-oil pills for omega-3 fatty acids is good for brain development, there is no trial evidence which supports this for the general population.

Goldacre also takes a swipe at the illogicality of the "detoxing" and "antioxidant" fads, for which he argues that there is no clear case (in fact, the most exhaustive trials of antioxidant vitamin pills show a slightly increased chance of death compared with control groups taking placebos). He points out the tendency of all purveyors of quackery to "cherry-pick" the results of trials, quoting only the few (usually less rigorous) ones which appear to support their claims while ignoring the vast quantity of much larger and more reliable trials which demonstrate no effect beyond placebo.

In the light of the above, one of the intriguing aspects of this subject is the very high profile in the news media (including quality newspapers and the BBC) of alternative medicines, superfoods and vitamin pills, when there is no valid evidence that they work, and plenty that they don't. Goldacre explores this issue too, pointing out the money spent on promotion, the relentless efforts of the practitioners in getting their message across, and their immediate and often aggressive responses to any criticism. What he finds more shameful is that some universities have fallen into the trap and are offering courses in these fields, possibly blinded to the lack of any valid scientific basis by the popularity of the subjects and the universities' need to put on courses which will attract students and earn money.

So why are these "remedies" so popular? Partly, it seems, because we like the idea of a pill which will make our problems go away. The author quotes a recent large-scale trial of whether better parenting techniques could improve the behaviour of problem children, which resulted in dramatic benefits. Yet this was ignored by the news media, which constantly focus on pills and diet instead. I suspect that this may be because parents don't like to consider that it may be their failings which have caused the problems, nor that correcting them will involve a considerable effort over a long period of time. How much easier it is to be able to blame something else, and to dish out a magic pill for it.

The major pharmaceutical companies ("big pharma") are next up for attack. First, the introduction of new medicines to solve real diseases is slowing considerably, so the companies are inventing new medical conditions which their existing medicines are claimed to treat. He quotes "social anxiety disorder", "female sexual dysfunction" and "night eating syndrome" as three examples of problems for which big pharma are peddling their wares, even though they are probably not best treated by taking a pill. Much of the effort in developing new drugs is on devising variations of existing drugs which are sufficiently different to establish a new ten-year period during which the companies have sole rights to make them. And of course, big pharma has no interest in developing cures for the killer diseases which only affect the Third World (no money in them) nor in promoting effective and cheap remedies which use common ingredients which can't be patented (no money in those, either). To be fair, I don't blame the companies for these last two issues – as Goldacre points out, they are profit-making businesses, not charities – but they do highlight the need for some method of funding the companies (or somebody) to carry out such unprofitable but important work.

The author describes in detail the way in which big pharma can distort the results of trials of their new products. For a start, such trials are funded by the companies themselves, and he quotes strong statistical evidence that the source of funding biases the results in favour of the funder. He then describes in considerable detail the different techniques which big pharma uses in order to present trial results in the best possible light (including burying negative outcomes) to get approval for their products and to persuade doctors to prescribe them. Even without such deliberate manipulation, negative outcomes of trials are less well-reported than positive ones anyway, an effect known as "publication bias". All of this results in medicines being presented as far more beneficial than they really are (in fact, it was recently reported in New Scientist that some well-known medicines don't work at all, or work far less well, when patients are not told what they are being given and what they are supposed to do).

Despite all of the above, Goldacre's major criticisms are focused on the news media for the way in which they report science in general and medical science in particular. He takes as examples two recent high-profile issues in the UK; the prevalence of MRSA in hospitals, and the alleged association between MMR vaccinations and autism. The first story was fuelled by positive MRSA readings from hospital swabs taken by undercover journalists, but it transpired that these were processed by a man unqualified to do such work, in an amateur lab in his garden shed. Those samples which were double-checked by proper labs produced different results. Yet the newspapers continued to use the amateur lab because they knew that this would provide positive results, which made for a better scare story (which is not to say that there isn't a problem with MRSA in British hospitals – but its scale was exaggerated).

The attitude of many newspapers to the MMR scare was even more shameful; they accepted the word of one doctor that there was a link with autism, on the basis of one very small-scale study which didn't even meet the minimum standards for a trial. They gave this at least equal weight to the assurances given by the medical profession that there was no link, and ignored huge and properly conducted large-scale studies which demonstrated this. In fact, one newspaper waged a vicious campaign against MMR for several years, until many people were left feeling that there must be something in the story, and that the government and the medical establishment were just trying to cover it up. As a result, take-up of the MMR jab has declined to the point that measles, mumps and rubella, which had been on the way out, are making a comeback.

Perhaps the most depressing aspect of the news media reporting is not that some lower-quality papers uncritically report bad science as if it were fact, but that even the best newspapers – and the BBC, heaven help us – are all guilty of bad science reporting. Most of them have science correspondents who know better, but once a major and exciting (i.e. controversial) science story breaks, the job of covering it is often given to higher-status mainstream reporters who are ignorant of science and proper trial protocols, dumb down the issues, and sometimes ignore the conclusions of scientific studies in order to dig into the data to find nuggets which they can take out of context to fuel the conspiracy fires. While it can be argued that the news media are not entirely to blame for all of this (after all, they only do it because lots of people want to read about such things – we get the news media that we deserve) it is highly irresponsible for them to whip up unfounded panic, resulting in serious medical consequences, in the interest of sales.

One result of all of this "bad science" is an appalling lack of understanding of science, including basic statistics, throughout society. The author quotes a couple of criminal trials which resulted in the defendants being imprisoned for murder on the basis of highly questionable statistical evidence (one of them was later released).

The only criticism I have of the book is that the characteristic which makes it such an entertaining read – the author's unbridled attacks on what he considers to be bad science – also mean that it is more of a polemical work than a balanced account. However, the evidence and analysis which Goldacre provides is compelling, and this is a book which everyone should read. It is similar in its theme (although most of the content is different) to Gilovich's equally important book How We Know What Isn't So, reviewed in this blog on 1 August this year.

The Ten Thousand by Paul Kearney

Kuf is a world with a civilisation in the early iron age, mostly united in a great Empire with the exception of the remote land of the Macht, a people of legendary military prowess who live in independent city-states reminiscent of ancient Greece, and who fight using weapons and tactics similar to the Greek Phalanx. Now there is civil war in the Empire between Ashurnan the Great King and Arkamenes his brother, who has amassed an army to seize the throne. And the devastating spear-head of that army is a force of 10,000 mercenaries of the Macht, brought from overseas to fight in the Empire for the first time in millennia.

So far, this could just as well be historical fiction as fantasy, apart from details of geography and the presence of two moons. Particularly since there is nothing magical or mysterious in the world of Kuf, except for The Curse of God – five thousand sets of impenetrable armour so black that it reflects no light, presented to the Macht by a deity, according to their legends. However, while the Macht appear to be human as we know them, the people of the Empire come in a far wider variety of sizes, shapes and colours than we are used to.

The story initially focuses on two young Macht, Rictus and Gasca, who enlist in the mercenary army. Other principal characters are Jason and Phiron, Macht leaders, Tiryn, the mistress-slave of Arkamenes, and General Vorus, a renegade Macht who leads the Great King's army. The viewpoint shifts between characters from scene to scene.

In many ways this is a straightforward story; there are no mysteries to be revealed, no unexpected plot twists or other major surprises. The tale of the civil war follows its own relentless logic, step by step, as the invading army fights its way across much of the Empire. The strength of the book is in its battle scenes, of which there are many. The author belongs to the gritty realism school of writing, and the fear, panic, confusion and brutality of battle are powerfully evoked, as are the campaigning problems of hunger, thirst, heat, cold, and body lice. The result is a gripping account which draws in the reader and had this reviewer shivering with the tension of the build-up to the final climactic battle.

There is much strong writing here, the only disappointment being the ending, which I found rather unsatisfying. Nevertheless The Ten Thousand is a must-read for enthusiasts of epic battle fantasies.

Some films plus the BFS

I'm slowly catching up with recent SFF films, and saw a couple of them last week. One is The Day After Tomorrow, about the sudden onset of a new ice age. An average-quality disaster movie requiring a high-than-average suspension of disbelief. This is due to the plot making no sense climatologically, especially because of the improbability (to put it mildly) of the suddenness and severity of the cooling effect (ambient temperature falling to minus 150 degrees in a few seconds?). Climate change is obviously a difficult subject for Hollywood. Unlike major earthquakes, tsunamis, hurricanes and volcanic eruptions, which are catastrophic short-term events, climate change takes – at least – years, and usually decades, to produce dramatic results. Rather too long a timeframe for an exciting film, so they decided to exaggerate everything by a few orders of magnitude. And, as is commonplace with Hollywood products, there is a strong focus on the family in the centre of the storm (although not to the same ridiculous extent as the remake of The War of the Worlds which I've written about previously). As is usual with modern disaster movies, the real star of the show is the CGI of the disaster itself, with a massive storm surge crashing into New York.

The other film I've seen is King Kong – the recent version. A good film, with well-played characters and a most impressive, and expressive, Kong. This one is about relationships too, but then it's meant to be. Naomi Watts provides a credibly appealing focus for the beast's affections, and their story is handled well. The only complaint I have is that the film is too long, partly because the director seems to have overindulged himself in playing for ages with an array of CGI monsters on Kong's island chasing and devouring sundry members of the cast. I kept wanting to cut these peripheral scenes short as I watched them.
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Also time to catch up with some of the material from the British Fantasy Society
which has been disgorged by my letterbox over the past few months – they are an industrious lot! Regular offerings include Prism, which is mostly reviews with a few comment columns. As usual, the coverage is wide, including fantasy, horror, science fiction and graphical fiction (or comics, as I used to call them in my youth). I read (as well as write) a lot more reviews than novels these days, as I find this a useful way of discovering new authors to try.

Then there is Dark Horizons, a mix of short stories, poetry, interviews, news and chat, sprinkled with illustrations. The current issue (#53) offers a remarkably varied selection of tales, including dark fantasy, horror and comedy. My pick of the bunch is Paul Campbell's Timeless, about a middle-aged woman who is given the opportunity to review one of the key turning points of her life; a relationship which failed to work. This might sound unpromising but it is an original tale, beautifully told.

I'm still working through a couple of BFS booklets. One is A Dick and Jane Primer for Adults, a very strange and intriguing collection of stories all written on the theme (and mostly in the style) of the children's series but with an adult – and sometimes nightmarish – perspective. The other is Fantasy & SF: the Roots of Genre, which consists of extracts from two books of criticism: Rhetorics of Fantasy by Farah Mendlesohn and What It Is We Do When We Read Science Fiction by Paul Kincaid, with an introduction by Niall Harrison [edit to add: ooops, this last one is from the British Science Fiction Association - with apologies to them!].

Finally, a book arrived in the mail the other day, Houses on the Borderland, a substantial 300-pager with six novellas; "unsettling tales of the macabre", according to the blurb. I was a bit puzzled because I hadn't ordered it, until it dawned on me that it was another publication of the BFS that was included in my subscription. As I said, they really are busy people. All I can add is "keep up the good work!"

Interzone 218

October's issue of the SFF magazine might be regarded as the "Chris Beckett special", as it includes a long interview with the British author plus three of his short stories. I have to confess I hadn't been aware of him before, but was intrigued by his background (as a social worker and now a university lecturer) and his transgenre approach to fiction. Not an easy interview to summarise, but I share his liking for marginal territories and other, hidden, worlds.

Poppyfields (by Chris Beckett, illustrated by Vincent Chong) concerns the relationship between Angus Wendering, an unambitious office worker, and two women; his ambitious wife and a mysterious girl who appears out of nowhere in a patch of wasteland called Poppyfields. This wasteland is central to the story; a large development site, locked in a legal tangle, which has reverted to a natural haven which attracts birdwatcher Angus to spend time there. The girl comes from an alternate Earth and has her own particular agenda. The story has charm, especially in the descriptions of Poppyfields, the flavour of which brought to mind Grahame Wright's Jog Rummage (reviewed on this blog a year ago) despite that being very different in other respects. My only criticism is that I found the ending a little too pat to be satisfying.

The way in which the compliant Angus is ruthlessly manipulated by both of the women in his life is amusing, and there is an echo of that in Beckett's next story, Greenland. This is illustrated by Warwick Fraser-Coombe, the illustration being repeated in colour on the cover. It is set in a grim future in which global warming has turned England into a semi-tropical land swamped by refugees from countries made uninhabitable by climate change. Juan Fernandez is one of these refugees, an educated man struggling to find any employment to enable him to support his demanding wife and their young child. The dream of everyone is to escape to Greenland, which is now a pleasantly habitable land. An opportunity arises to achieve this if Juan agrees to participate in an experiment using a matter replicator/transmitter to send a copy of himself to an orbiting space station, but there is an unforeseen consequence.

In Rat Island by the same author (illustrated by Daniel Bristow-Bailey) a man looks back at the photos he took as a young boy in an England which is only slightly in our future. The man's circumstances are not explained other than comments which indicate that fundamental changes have taken place; he describes our time as a period of:
"Incredible folly, blind recklessness, it all now seems – blazing electric light for no purpose at all except advertising and decoration – but it was a golden age, one of the pinnacles of history. We lived in a great global empire of light and plenty, fuelled by the ancient energy of ancient suns stored up over millions of years and burned up by us in one great, glorious hundred-year binge."
The focus of the story is on the boy's experiences as he and his younger sister visit their father, a prominent civil servant in a London which is, all unknowing, on the verge of disaster. His life is changed forever when his drunken father reveals to him exactly what is happening.

These last two stories were as intriguing and well-written as the first, but I found their dark mood a bit depressing; I don't mind reading such stories occasionally, but I prefer them to be surrounded by less gloomy tales.

There are three other stories in this issue.

IF, by Daniel Akselrod and Lenny Royter, concerns a brain insert known as the IF Chip, which creates an imaginary speaking companion (usually in toy animal form) programmed to teach, guide, and be a friend to children; a great boon for busy parents. The problem is that when the chips are removed in adulthood, the companions refuse to go away. The plot concerns the attempts of Richard, a medical scientist, to cope with his intrusive toy camel while struggling to develop a serum which will banish such companions for good. An amusing tale, well told, with a rather old-fashioned feel (which is not a criticism).

His Master's Voice by Hannu Rajaniemi, illustrated by Paul Drummond, is a strange tale of an intelligent talking dog and his equally modified cat companion who are searching for the master who adapted them and who has been incarcerated for his crime of creating a clone of himself. I never did entirely figure out what was going on.

The Corner of the Circle by Tim Lees (illustrated by Warwick Fraser-Coombe) is offbeat in a different way. A teenage boy occasionally visits a relative in a near-future New York, and forms a relationship with an intriguing woman who becomes an honorary aunt. The focus is entirely upon this relationship, and the visits by aliens using a nearby portal as a transport nexus for their spaceships seem peripheral to the plot.

The rest of the magazine contains the usual news and reviews, including an interview with Charles Stross. At least the stills from the films reviewed include only two pictures of characters holding guns this time; last issue there were four, which seems a little excessive (especially since one picture included two of them). I have nothing against guns – I shoot them when I get the chance – but I do find Hollywood's preoccupation with them somewhat tiresome.