Bad Science - Ben Goldacre - 4/5

Qu'est-ce que "Bad Science" ?

Ben Goldacre est un écrivain scientifique docteur en médecine, chroniqueur dans le Guardian dans la rubrique "Bad Science". Il a rassemblé dans ce livre ses articles, mais sous une forme bien plus étendue que dans le Guardian. Il passe au crible tout ce qui ne fonctionne, pas ou mal ou bizarrement dans et autour de la santé.

Tout y passe : alternatives à la médecine, laboratoires qui esquivent les règles les plus élémentaires de qualité, études "scientifiques" qui n'en ont que le nom, journalistes sans culture scientifique choisissant des "sommités" fictives, techniques des laboratoires pour embellir leurs résultats.

Mais ce livre n'est pas qu'une attaque en règle contre tout ce mal science.
C'est aussi une bonne occasion d'apprendre ce qui différencie un test clinique rigoureux d'une étude fantaisiste.
Notre mauvaise science est parfois volontaire, parfois malveillante, parfois naïve. C'est aussi un produit de notre culture qui cherche le remède, le produit qui marche tout le temps, pour tout.
Alors que la réalité est plus complexe. Il est alors bien tentant de se jeter sur la nouvelle étude non reproduite, non étayée.
J'ai aussi beaucoup appris sur les placebos. Ils ont fait eux-mêmes l'objet d'études, de comparaisons.
Leur effet est bien plus que le "cerveau agit sur le corps".

Un livre fascinant bien qu'un peu répétitif parfois (le livre rassemble des chroniques presque hebdomadaires à l'origine ce qui explique sans doute les redites)

PS : Attention c'est en anglais

Pour aller plus loin :
Bad science dans le Guardian

Citations :

I think that the social causes of these problems are arguably more interesting—and possibly even more amenable to intervention
Believing in things which have no evidence carries its own corrosive intellectual side-effects, just as prescribing a pill in itself carries risks: it medicalises problems, as we will see, it can reinforce destructive beliefs
All of these studies favoured homeopathy. All deserve to be ignored, for the simple reason that each was not a ‘fair test’ of homeopathy, simply on account of these methodological flaws
As Voltaire said: ‘The art of medicine consists in amusing the patient while nature cures the disease.’
People who are incompetent suffer a dual burden: not only are they incompetent, but they may also be too incompetent to assay their own incompetence, because the skills which underlie an ability to make a correct judgement are the same as the skills required to recognise a correct judgement
If I had a T–shirt slogan for this whole book it would be: ‘I think you’ll find it’s a bit more complicated than that’
The people who run the media are humanities graduates with little understanding of science, who wear their ignorance as a badge of honour
Research conducted at Cardiff University in 2007 showed that 80 per cent of all broadsheet news stories were ‘wholly, mainly or partially constructed from second-hand material, provided by news agencies and by the public relations industry
There is an almost linear relationship between the methodological quality of a homeopathy trial and the result it gives. The worse the study—which is to say, the less it is a ‘fair test’—the more likely it is to find that homeopathy is better than placebo
As George Orwell first noted, the true genius in advertising is to sell you the solution and the problem
We see causal relationships where there are none.
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.
We know that two sugar pills are a more effective treatment than one sugar pill, for example, and we know that salt-water injections are a more effective treatment for pain than sugar pills, not because salt-water injections have any biological action on the body, but because an injection feels like a more dramatic intervention. We know that the colour of pills, their packaging, how much you pay for them and even the beliefs of the people handing the pills over are all important factors. We know that placebo operations can be effective for knee pain, and even for angina. The placebo effect works on animals and children. It is highly potent, and very sneaky.
The placebo is not about the mechanics of a sugar pill, it is about the cultural meaning of an intervention, which includes, amongst other things, your expectations, and the expectations of the people tending to you and measuring you.
Two hundred patients with abnormal symptoms, but no signs of any concrete medical diagnosis, were divided randomly into two groups. The patients in one group were told, ‘I cannot be certain of what the matter is with you,’ and two weeks later only 39 per cent were better; the other group were given a firm diagnosis, with no messing about, and confidently told they would be better within a few days. Sixty-four per cent of that group got better in two weeks
Smoking, to everybody’s genuine surprise—one single risk factor—turned out to cause almost all lung cancer
Who puts the issue of social inequality driving health inequality onto our screens? Where’s the human interest in prohibiting the promotion of bad foods, facilitating access to healthier foods by means of taxation, or maintaining a clear labelling system?
The ones with dodgy methods of randomisation overestimate treatment effects by 41 per cent.
The memory of sugar, which is remembering something that was being remembered by water (after a dilution greater than the number of atoms in the universe) but then got passed on to the sugar as it dried
From the state of current knowledge, around 13 per cent of all treatments have good evidence, and a further 21 per cent are likely to be beneficial.
It turns out, depending on speciality, that between 50 and 80 per cent of all medical activity is ‘evidence-based’.
Either way. Today, similarly, there are often situations where people want treatment, but medicine has little to offer—lots of back pain, stress at work, medically unexplained fatigue and most common colds, to give just a few examples. Going through a theatre of medical treatment, and trying every medication in the book, will give you only side-effects. A sugar pill in these circumstances seems a very sensible option, as long as it can be administered cautiously, and ideally with a minimum of deceit.
Pseudoscience isn’t something done to us, by venal and exploitative outsiders: it is a cultural product, a recurring theme, and we do it to ourselves.
Scientific knowledge—and sensible dietary advice—is free and in the public domain. Anyone can use it, understand it, sell it, or simply give it away. Most people know what constitutes a healthy diet already. If you want to make money out of it, you have to make a space for yourself in the market: and to do this, you must overcomplicate it, attach your own dubious stamp.
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
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
There have been over a hundred randomised placebo-controlled trials of homeopathy, and the time has come to stop. Homeopathy pills work no better than placebo pills, we know that much. But there is room for more interesting research.
In some cases they will be people who turn their backs on the scientific method as a ‘flawed paradigm’; and yet it seems their great new paradigm is simply ‘unfair tests
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.

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