The nerd cheerleader
Ben Goldacre is a doctor, writer, and champion of evidence based medicine
Ben Goldacre is a doctor, academic, and science writer. He trained in medicine at the University of Oxford and at University College London Medical School, where he qualified. He began his Bad Science column for the Guardian in 2003, debunking false or misleading scientific claims made by the drug industry and the media. He is author of the bestselling book Bad Science and last year published his second book, Bad Pharma.
What prompted you to take up journalism and begin your column, Bad Science?
I’ve always written generally and so, like anybody who knows anything about medicine or science, I often found reading mainstream media frustrating. Firstly, because there wasn’t much good nerd content around and, secondly, because when newspapers and other media did try to write about things I knew about they often seemed to get it badly wrong. Quite a lot has changed since then. I think there’s still not enough mainstream content for nerds, but the explosion of online content has changed things. It wouldn’t occur to me now to go to a mainstream outlet for information about science. On the issue of people getting stuff wrong in mainstream media, I see little progress, but all of the pressures that drive people to histrionic overstatement and invention are still there. Silly stories get traffic and that’s a reality we have to face.
So you don’t think there’s much that can be done to improve scientific reporting in mainstream media?
I think you can add in good stuff, but it will always be difficult to take away the bad stuff. Part of my reason for wanting to help the public better understand how to appraise the evidence for a given claim is that I don’t think there’s any route to stop people making false claims. All you can do is change the water into which those false claims land and make people more discriminating consumers. There’s a huge amount of positive stuff to be done, but it’s not around stopping bad journalists writing bad stories.
Alternative medicine has featured a lot in your writing. What interested you about it?
I view alternative therapies as baby steps for anybody wanting to understand the basics of evidence based medicine, but also baby steps for understanding the broader issues around the politics and culture of medicine and where some of the distortions can come from. Also, quackery and bad behaviour by drug companies are things that people often see as opposites, but I see them as basically the same thing: it’s people trying to distort evidence to sell their product.
What can alternative medicine teach us about evidence based medicine?
I think it’s a good teaching tool for explaining the basis of evidence based medicine. In homeopathy, for example, you have a group of sugar pills with no medicine in them that seem to perform better than placebo. So it’s a group of sugar pills that seem to perform better than a group of sugar pills simply through flawed trial design, cherry picking studies, and so on. That’s a great way to explain how a trial should be designed: why it matters whether they’re big, why it matters that they’re blinded, why it matters that you have proper allocation concealment.
It’s also a fascinating lens through which to look at the role of medicine and science in culture. What an extraordinary thing that there are huge numbers of people who will buy dummy sugar pills with no medicine in them that have been shown overall, when you put all the fair tests together, to perform no better than placebo. I think it provides huge food for thought around how the public view medicine, science, and doctors.
Your writing identifies a lot of failings in the systems of science and medicine; does that give you a bleak view of the state of healthcare?
Talking about problems in science is just a gimmick for talking about how things work. The fact that one homeopath cherrypicks some data, well it’s reasonably interesting if you’re interested in homeopathy, but it’s also a great opportunity to say to people: did you know about systematic reviews and meta-analyses? Also, the problems are kind of where the action is. At any medical conference you’ll find people tearing each other’s ideas apart and that’s what you see in academic journal articles too—people critically appraising the evidence for each other’s claims. That’s what science is about.
How can medical students ensure they become doctors who are evidence based in their practice?
I didn’t realise this when I was at medical school but you forget that one day you’ll be out there on your own. You qualify as a doctor in your 20s. You’re spat out as a specialist in your 30s, and then you go off and you practise medicine independently for three, or, for this generation, maybe four, decades. Now, you won’t have Professor McAllister around to tell you what to prescribe for those three or four decades, and you won’t have a membership course or an exam to force you to learn this stuff. Meanwhile, medicine will change unrecognisably around you. I think one of the things that we’ve understated at medical school is the fact that you’re going to need to find ways to keep up to date and the tools to learn for four decades of unimaginable change. That’s what evidence based medicine teaching is about and that’s why it needs to be taken very seriously.
Do you think the new generation of doctors will need to be more proactive in seeking out information themselves?
Much as there’s a lot that individuals can do, I think we also need better systems for getting the information that we already have together and putting it into practice more efficiently. We half-invented evidence based practice about 30 or 40 years ago and then we awarded ourselves a point and started to act as if we had substantiated it perfectly, but we haven’t. We’re quite unsystematic about how we identify unresolved questions in medicine and disseminate evidence. We spend money on infrastructure to get patients from one hospital to another, but we’ve been less cut-throat about making sure that our systems for getting information around are as perfect as they could be.
You’re part of the open data initiative alltrials.net. Can you explain more about this project?
There are lots of interesting problems in evidence based medicine, and I think that one of the most important is that the best currently available evidence shows that the chances of a trial of medicines we use today being published is roughly 50/50. And trials with positive results are about twice as likely to be published as trials with negative results. This is a festering sore for evidence based medicine. So we set up alltrials.net, calling on people to commit to registering all trials (not just the new ones, but past ones as well), to publishing the brief summary results, and to publishing, where available, clinical study reports minus identifiable patient data. So far more than 80 patient groups have signed up, NICE, the royal colleges, and GlaxoSmithKline, one of the biggest drug companies in the world. To me, alltrials.net is an interesting illustration of what happens if you just stand still with a flag pole and say “this is best practice, who’s with us?” It turns out that quite a lot of people are.
You describe yourself as a nerd cheerleader. Have you always wanted to crusade the issues you do or have you just become more drawn into them over time?
I don’t think I do crusade. I find things that I think are interesting and I write about them. The fact that sometimes there are people who very strongly disagree only goes to demonstrate that it’s a risk factor for something being interesting. The areas where science is most contested and where the most problems exist are the areas where things haven’t been fixed for a reason.
Do you have any advice for medical students who are interested in journalism or science writing?
Anybody who wants to write should just get on and write and not be too hung up on whether it’s mainstream or not. Good content will find its audience.
EDITORIAL, p9 LIFE, p10, EDUCATION, p29, PERSONAL VIEW, p42
Correspondence to: email@example.com
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.
Cite this as: Student BMJ 2013;21:f1607