The Best Books of 2008
Wednesday, December 31, 2008
This year has seen a fantastic number of books about quackery, scepticism, complementary and alternative medicine and its effects on society. As part of my review of the year, I thought I would look back at some of the best new books.
The year started of really rather well with the publishing of Rose Shapiro's Suckers: How Alternative Medicine Makes Fools of Us All. It is the book that rather set the tone for all others. And it is probably the book I wish I had written or even been good enough to have written.
The year started of really rather well with the publishing of Rose Shapiro's Suckers: How Alternative Medicine Makes Fools of Us All. It is the book that rather set the tone for all others. And it is probably the book I wish I had written or even been good enough to have written. Shapiro tells us that there are two definitions of the word 'sucker' that she had in mind: one who lives at the expense of others, and a gullible or easily deceived person. The theme of this book is that society as a whole is being deceived and is casually accepting of nonsense and fraud in healthcare. She tells us the Alternative Medicine market is worth £4.5 billion in the UK. But it is not just financial damage that is being done, but great intellectual damage.
Suckers has great chapters showing how chiropractors have got away with the biggest fraud of being so closely accepted into the mainstream and the evils of how cancer patients are preyed upon by quacks. What is worse is how our government supports so much of this fraud and how our institutions appear to be so blind to the danger.
Shapiro writes with a passion driven by the anger and dismay of witnessing lives being shortened, unaccountable charlatans and our intellectual culture undermined by leaches on our fallibility. If this was the only book written this year, it would have been enough. The book deserves to be sent to very MP, every NHS administrator and every school.
Damian Thompson has a broader remit in his book as he looks at the growing emergence of what he calls 'counterknowledge' in society. It is not just the sphere of medicine that is suffering from suckers who seek to profit from unproven and spurious theories. Thompson draws in the counterknowledge of the creationist movement and, in particular, says we should be shifting our focus from the American version of this to one much closer to home in the form of Islamic creationism, most prominently voiced in Europe by the Turk, Adnan Oktar. He decries the publishing industry for its venal publishing of the works of pseudo-historians in the wake of the da Vinci code.
Damian Thompson has a broader remit in his book as he looks at the growing emergence of what he calls 'counterknowledge' in society. It is not just the sphere of medicine that is suffering from suckers who seek to profit from unproven and spurious theories. Thompson draws in the counterknowledge of the creationist movement and, in particular, says we should be shifting our focus from the American version of this to one much closer to home in the form of Islamic creationism, most prominently voiced in Europe by the Turk, Adnan Oktar. He decries the publishing industry for its venal publishing of the works of pseudo-historians in the wake of the da Vinci code.
But Counterknowledge also tackles quackery and alternative medicine too. Thompson devotes a chapter to the 'Counterknowledge Industry' and shows how the misrepresentation of knowledge can afford great profits. He discusses Patrick Holford's The Optimum Nutrition Bible and his other business interests and how he has infiltrated mainstream academia with his brand of nutritionism. (He also quotes me at some length, which was a surprise.)
In common with several of these books, it discusses how the result of this casual acceptance of nonsense is not just wasted cash for middle class Europeans, but often wasted lives in Africa. South Africa has suffered enormously with hundreds of thousand of HIV people dying unnecessarily because of government acceptance of counterknowledge.
Healing, Hype or Harm? is a collection of essays collated by Edzard Ernst. Many of the essayists in this book will be familiar to you. What comes across to me again, is the passion of the writers. Quacks like to dismiss so called 'Quackbusters' as mere shills of pharmaceutical companies. This is of course a lie and an absurdity. We see here people deeply concerned about the infiltration of quackery into the healthcare system and how it is undermining important advances in medicine and society.We can read Les Rose on the importance of evidence in healthcare. When health and lives are at risk, why do we so easily accept anecdote as evidence when we never would in a court of law?
Michael Fitzpatrick explores how alternative medicine has hijacked the concepts of compassion in healthcare and then uses this to its advantages. He argues for the reclamation of compassion as an important part of moving forward. David Colquhoun looks at how Universities have bowed under the commercial pressures to teach quackery as if it were science.
Not all the essays here sing from the same hymn sheet. Bruce Charlton argues for a sort of medical apartheid where healing and curing are seen as separate are are not integratable. He argues that alternative medicine is from a medical perspective worthless but that this does not mean that people cannot get value from them. Charlton calls for a separation between the 'New Age' medicine and 'orthodox medicine' and to allow alternative medicine to tackle more spiritual needs. My problem with this is that my guess is most doctors would be happy with this, but the quacks will not feel constrained to just being spiritual in nature. Whilst homeopaths claim to be able to prevent malaria with sugar pills and iridologists claim to be able to diagnose disease by looking in your eyes, then their side of this truce will remain broken.
In other essays we see John Garrow ask why we do not see more CAM in court, Edzard Ernst looks at the ethics of CAM, Terry Polevoy on the support insurance companies give to chiropractors and James Randi on the daftness and flummery of quackery.
In perhaps the most moving essay we read Michael Baum looking at the concepts of holism in medicine and the vapidness of CAMs view of holism. He looks at the examples of young women with breast cancer and how their complete lives play crucial roles in deciding what are the best courses of treatment. Baum does this in a way that no quack could ever come close to and tells us how, "alternative versions of holism are arid and closed belief systems, locked in a time warp, incapable of making progress yet quick to deny progress in the fields of scientific medicine'.
Next we had the long awaited Bad Science by Ben Goldacre. Readers of his column in the Guardian and his blog will be familiar with the themes. However, we can now read Goldacre without the limitations of a word length in a newspaper column. As such, we can explore in full why MMR was a hoax and why Gillian McKeith is an absurdity. Homeopathy is used as an exemplar for the teaching of evidence based medicine and Patrick Holford (again) gets a thorough systematic review of his claims by his 'crazed stalker'.
Next we had the long awaited Bad Science by Ben Goldacre. Readers of his column in the Guardian and his blog will be familiar with the themes. However, we can now read Goldacre without the limitations of a word length in a newspaper column. As such, we can explore in full why MMR was a hoax and why Gillian McKeith is an absurdity. Homeopathy is used as an exemplar for the teaching of evidence based medicine and Patrick Holford (again) gets a thorough systematic review of his claims by his 'crazed stalker'.Goldacre has created many enemies in his column - mostly, homeopaths, nutritionists and anti-vax protesters. If any of them were intellectually honest enough to read this book, they may well be in for a shock. Although on the surface the book is telling us why various forms of quackery are nonsense, it has a far more important theme - how pharmaceutical companies can deceive us about real medicine. Indeed, we are regularly told how quacks and Big Pharma use exactly the same tricks to convince us their treatments are real. Finding out what is real is the important step and the book guides us through the process. Goldacre is often portrayed by his detractors as a shill for commercial pharmaceutical companies. This book shows the shallowness of this claim. In the chapter Is Mainstream Medicine Evil? we are talked through the process of how drugs hit the market and how this can go wrong - sometimes through the deliberate corruption of evidence by the drug companies.
Throughout, Goldacre carefully explains the importance of evidence, how to interpret it and how this process can go wrong, to the benefit of quacks and drug companies, and the harm of us as individuals. But, for me, what came through was his deep seated and proud nerdiness of enjoying science, and his lament that the media either ignore science or deliberately corrupted it to create sellable stories and controversy.
Perhaps, one of the most important chapters in Goldacre's book was one that was left out. As it was going to press, the Guardian and Goldacre were being sued by arch-quack Matthias Rath for an article that pointed out his role in exploiting people with HIV in South Africa. For legal reasons, the chapter in Bad Science could not appear. (I understand this will be corrected in the forthcoming paperback version.)
Perhaps, one of the most important chapters in Goldacre's book was one that was left out. As it was going to press, the Guardian and Goldacre were being sued by arch-quack Matthias Rath for an article that pointed out his role in exploiting people with HIV in South Africa. For legal reasons, the chapter in Bad Science could not appear. (I understand this will be corrected in the forthcoming paperback version.)
There were no such restrictions on Richard Wilson in his book Don't Get Fooled Again: The Sceptic's Guide to Life where he devotes most of a chapter to the evils of Dr Rath. Whereas Goldacre looked at the dangers of nonsense more from a personal and UK point of view, Wilson takes on a more global and political perspective. He tells us how the whole areas of Russian science was hijacked by fake experts during the Soviet era who were more adept at playing political games than honestly seeking truth. Lysenko was the master at this as he held back Russian and Chinese biology and agriculture for decades as ideology became more important than evidence. The consequences of this were the death of millions through starvation.
Rath is portrayed as a modern Lysenko as his ideas have enraptured South African politicians. Again hundreds of thousand have died as a result of ideological AIDS denialist nonsense.
Wilson offers a partial solution to some of the problem by suggesting that the regulation of politicians is too light and that we should be holding them to account through the law not just the ballot box. The self regulation of politicians fails. Lying to us should be punishable in court. In the UK, this suggestion was put forward to MPs, most of whom thought is somehow naive. Only 37 out of 646 MPs backed a proposed law saying that it would be an offense for a politician to knowingly lie or deceive.
Heavy weight science writer Simon Singh wades in next in a partnership with Britain's only professor of complementary medicine, Edzard Ernst. In Trick or Treatment: Alternative Medicine on Trial, Singh and Ernst take a systematic approach to evaluating the evidence for a wide range of alternative medicines. In doing so, they again show us how evidence works, why it is important and why we can reliably know whether a treatment works or not. The result is a near rejection of almost all forms of alternative medicine. They take pains to point out when the evidence suggests that some things do work, but I am sure that the surprising thing for many people new to this sort of book is just how little alternative medicine comes through unscathed. Acupuncture is widely accepted as a treatment that does work. However, after reviewing its history and evidence one is left with the impression that it is little more than a scam. Homeopathy is easily dismissed. Although the authors go through rather useful review and history of all the meta-analyses on the subject - something homeopaths never do. Chiropractic is exposed as nonsense - and at times, dangerous nonsense that should be avoided at all costs. Common herbal remedies are tabulated and their evidence base rated. (Most are poor or medium.) Finally, the pair review reasons why alternative medicine might be so popular despite its appalling evidence base and point out who the real villains and culprits are in this state of affairs.
Between them, these books paint a consistent picture of a society that is enamoured with nonsense and how this can cause both personal harm and even catastrophic disaster to societies. However, if we are to overturn the tide of nonsense, it will not be sufficient to replace the day time television quacks with new authorities such as Singh, Ernst and Goldacre. The impact of nonsense and quackery on society will only really diminish when more people understand how their beliefs are manipulated and distorted by the tricks and canards of charlatans.
Between them, these books paint a consistent picture of a society that is enamoured with nonsense and how this can cause both personal harm and even catastrophic disaster to societies. However, if we are to overturn the tide of nonsense, it will not be sufficient to replace the day time television quacks with new authorities such as Singh, Ernst and Goldacre. The impact of nonsense and quackery on society will only really diminish when more people understand how their beliefs are manipulated and distorted by the tricks and canards of charlatans. Although, we live in a scientific age, and almost all our children are taught science at school, few appear to come out of education with a deep understanding of how science works and how to recognise good arguments based on evidence. My final book is by the Philosopher Julian Baggini and is probably the one I might recommend giving to your family quack if you wanted to attempt to change their mind about things. In The Duck that Won the Lottery (And 99 Other Bad Arguments), Baggini dissects 100 logical fallacies and how they have manifested themselves in the media recently.
This book would also be a good mental workout for the dedicated sceptic. The joy of this book for me was that each logical fallacy is presented in an accessible style but then pushed to see if it always applies. Is it always wrong to pursue ad hominem attacks? What about arguments from authority? At the end of each chapter Baggini poses a question or two in order to test the limits of the applicability of arguments. Good fun and not academic - and also, I must say, I disagree with some of the arguments. But I guess that is the point. Being a sceptic can never be formulaic. We cannot just simply repeat logical rules to expose truth and falsehood. We must always be alert and always thinking. That is the true nature of science and that is what separates it from the dogmas and ideologies of alternative medicine.
This book would also be a good mental workout for the dedicated sceptic. The joy of this book for me was that each logical fallacy is presented in an accessible style but then pushed to see if it always applies. Is it always wrong to pursue ad hominem attacks? What about arguments from authority? At the end of each chapter Baggini poses a question or two in order to test the limits of the applicability of arguments. Good fun and not academic - and also, I must say, I disagree with some of the arguments. But I guess that is the point. Being a sceptic can never be formulaic. We cannot just simply repeat logical rules to expose truth and falsehood. We must always be alert and always thinking. That is the true nature of science and that is what separates it from the dogmas and ideologies of alternative medicine.
All these books are available to buy from the new Quackometer Bookstore. I set up the bookstore to make recommendations of further reading on the subject of quackery. It is run by Amazon and a small percentage of any purchases you make will come to me and help set off the few costs I bear on this site. Click on one of the book images to be taken to the bookstore.
Happy New Year.
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Update: Competition!
I have a spare copy of Suckers and Bad Science. Who should I send them too and why? Who do you think is most deserbing and/or in desperate need of each? Pleave leave answers below...
Labels: Ben Goldacre, chiropractors, edzard ernst, evidence based medicine, Gillian McKeith, quacks
