Monday, 16 June 2014

David Robert Grimes / Ben Goldacre

(NOTE: the views and arguments presented in this critique are only my opinion. Whilst I believe these opinions provide a vital contribution to the debate emerging in medicine, nothing I say here should be construed as the objective 'truth' - but only an opinion based on evidence and reasoned argument).  

This is a critique of Ben Goldacre's (BG) and David Robert Grimes's (DRG) articles and views expressed during the past few years on topics such as 'alternative' medicine, native and indigenous medicine and wisdom, the placebo effect, and the role of nutrition and other factors to prevent and cure disease. 

In this article, I will argue that both authors have failed to provide a rational and nuanced perspective on this area of healthcare. In part, this could be because they seem to have an intransigent and muddled understanding of some of the key principles in science, logic and medicine. 

Note that both authors have written some excellent articles on other topics. This critique takes a very specific look only at the aforementioned topics, which could be grouped under the umbrella term of ''complementary and lifestyle medicine''. This is an important - arguably the MOST important discussion emerging about modern medicine in developed nations. Why? Because, overwhelmingly, the majority of ill-health, disease, and premature death is related to factors associated with poor diet and poor lifestyle. As such, authors have a huge responsibility to promulgate ideas and information that are accurate and helpful, and - perhaps most importantly - to foster a journalistic and academic environment that encourages people to take responsibility for their own health and well-being

This critique will consider 10 ways in which Ben Goldacre and David Robert Grimes have muddled the topic of complementary and lifestyle medicine. This blog is fairly long, so feel free to read the sections which most interest you. Note, however, that each section informs the others – and so if you want to get the ‘whole picture’, it’s best to read the article in its entirety. 

NOTE: since initially publishing this blog, I have updated it with the addition of 3 further points (a, b, c) which can be found at the end of the article. 

(1) Conflation of True Skepticism with Dogmatic Skepticism – and the misappropriated application of skepticism to science and medicine

Put simply, the difference between these 2 types of skepticism is that a dogmatic skeptic is prejudiced against, or in favour of, certain outcomes. A true skeptic is not.

A true skeptic, as a dictionary states, is ‘one who is undecided as to what is true, one who is looking or inquiring for what is true – an inquirer after facts or reasons’. Thus, a true skeptic (or true scientist) is open minded, eager to consider scientific principles and possible causal mechanisms to generate reasonable hypotheses, and dis-believing of stating something unequivocally to be true in the absence of evidence. Chris French, Professor of Psychology at Goldsmiths University and former Editor-in-Chief of The Skeptic magasine, states that true skepticism is about having reasonable doubt – it is not about knee-jerk dismissal of claims. He also states that true skeptics are ‘moderate’ – they are open minded, have humility when engaging in discussion, and are open to the possibility that they might be wrong.

Dogmatic skeptics, on the other hand, are, as Marcello Truzzi (Professor of Sociology at Eastern Michigan University) says, people whose inquiry starts instead with a pre-conceived notion of what is true. He calls this form of skepticism ‘pathological skepticism’. They are non-believers, which is fundamentally different to being a dis-believer. For dogmatic skeptics, ‘truth’ is equated with ‘evidence’ such that (a) theories without robust evidence are seen as untruths, and can be dismissed as such, and (b) evidence is considered first, rather than the plausibility of scientific principles, logical causal mechanisms, or common sense. They fail to acknowledge that a lack of evidence for something is not evidence against it. Something being dis-proved is fundamentally different to something not having been proved. Also, they often confuse reductive reasoning with objectivity and logic – sometimes, reductive reasoning is not a logical nor objective approach. For example, it is known that sun exposure increases the risk of skin cancer, and so now the medical establishment is warning against sun exposure. However, it is also known that the benefits we receive from sun exposure are protective against many other types of cancer. Furthermore, the risk of skin cancer is dependent on – and works synergistically with – a host of other factors, such as diet. For example, compounds in Green Tea have been shown to protect us from UV damage. There are many other plants that provide a protective role. Clearly, a reductionist model of ''sun exposure = increase skin cancer risk'' is very limited, and side-steps many nuances and ideas that would lead to a more coherent argument. Tragically, diet and lifestyle factors are trivialised and marginalised by dogmatic skeptics and mainstream medicine, time and time and time again. 

Dogmatic skeptics will, of course, deny that they carry a prejudice for certain ideas – in this case, pertaining to complementary and lifestyle medicine. Prejudice is a dirty word. In order to detect prejudice, you just have to examine the tone of their articles, and comments made publicly on sites such as twitter and blog pages. If you do, it will soon become evident that they are very passionate and tirelessly dedicated to debunking aspects of holistic and alternative approaches to medicine that don’t work, and yet so un-enthusiastic and deadpan when accepting results proving the efficacy of treatments outside of the realm of orthodox medicine.

A good example of this is the revelation that nutritional therapies and eating a specific diet can reverse the effects and symptoms of type 2 diabetes. Since type 2 diabetes is a burgeoning epidemic – caused largely by poor lifestyle – and, because DRG and BG write prolifically on matters pertaining to medicine, one would assume that they would advertise such developments in medical understanding with the fervour and dedication they exhibit when debunking spurious health claims. But they don’t. They begrudgingly and reluctantly concede such discoveries. This signals that their skepticism is un-balanced (i.e. pseudo-skeptic) and that their interests are weighted toward ‘debunking’ rather than promulgating inspiring and transformative information. 

Similarly, a study by Oxford University suggests that B-vitamin supplementation could help protect the brain against the 'shrinkage' associated with memory loss in the elderly. B12 seems to be the key vitamin. B12 can be found in specific foods and so does not have to be taken as a supplement. Exciting news - proper nutrition (and perhaps, supplementation) can mitigate the effects of cognitive decline in the elderly. News worth spreading, surely. But - no - dogmatic skeptics don't seem interested in promulgating positive news from research into nutrition. The pharmaceutical companies certainly don't seem interested, for obvious reasons. And lastly, medically trained 'dieticians' don't seem interested either - they just say keep on eating a 'balanced' (read: mediocre) diet. Funny they should say this, considering the fact that the Oxford study quite clearly states that ''none of the people in the study had vitamin B12 deficiency''. 

Of course, debunking has its place – and Ben Goldacre has done an excellent job of trying to steer the public away from the unsubstantiated belief that vaccines are dangerous and the erroneous belief that ‘Big Pharma’ is scientific and ethical. But let me remind you once again that, in developed nations, poor diet and poor lifestyle is the MAJOR factor in ill-health, disease and premature death. As such, any journalism that does not consider lifestyle medicine in a rational and objective way is, proportionately, more gravely irresponsible. To be fair, Ben Goldacre has made a lot of nuanced and profoundly important points – such as social inequality being a principle driver of ill-health, and the irresponsibility of some alternative healthcare practitioners who dissuade their patients from being vaccinated. These are good points. But they can also be seen as red herring arguments – a case of using socio-economic arguments when it suits his case and using reductionist arguments the rest of the time. Here, I am only discussing the specific arguments pertaining to the application (and rational) of using aspects of lifestyle and complementary medicine. 

David Robert Grimes has often suggested that he would be interested in understanding the psychological attributes of ‘conspiracy theorists’ and deniers of climate change (i.e. the other type of pseudo-skeptic). I agree – this would be fascinating research. But, equally, I think it would be fascinating if the psychological profile which pre-disposes someone to dogmatic skepticism was better understood. I am not a psychologist, but I could imagine that the assumed intellectual prowess felt by using reductive reasoning might make people feel that they truly have an objective grip on reality. Notions of the materialistic divisibility of the universe (and everything in it) might be reassuring at a psychological or intellectual level, regardless of the fact that some fundamental ‘fixed’ truths - especially in physics - rely on unproven assumptions and major philosophical loopholes.

It would not be an exaggeration to say that any scientific research that challenges the materialistic paradigm is considered heresy - because it simply must be wrong. But dogmatism isn’t science, it’s fundamentalism. If you think politics and censorship doesn’t occur in scientific circles, think again. An interesting case study is John Edward Mach, late Professor of Psychiatry at Harvard University.  You will find his story on Wikipedia. The relevant point is not what his research was, but the reaction of the scientific establishment to his research. Luckily, all relevant aspects of alternative and lifestyle medicine discussed here can be explained according to the rational world of classical physics.

Dogmatic skeptics have often been heard to say things like ‘’I know it’s wrong, I just need to work out why’’. Obviously, this is logically in-congruent and dogmatic. Scientists knew the earth was flat until it was discovered to be round, and scientists knew (and still know) things operate according to the laws of classical mechanistic physics until quantum physics came about. The controversy surrounding ‘the hard problem’ in science (i.e. consciousness) is a perfect metaphor for this state of affairs. This is a very exciting topic – and has drawn brilliant and respected scientists to opposing points of view. This debate, and its outcome, has profound and far-reaching consequences, not only in science, but also for society and for academic discourse in every other discipline. Non-locality of consciousness is a fervently debated topic that has attracted some of the best thinkers in philosophy and quantum physics. In turn, evidence for non-locality would prise open the debate for taboo subjects such as parapsychology. But dogmatic skeptics know parapsychology is hocus-pocus. Even if indisputable evidence was presented showing aspects of parapsychology to be true, dogmatic skeptics would say there is error in the data, or that it is fraudulent. You see, it simply cannot be right. Even if it were shown to be true, it must be false. Parapsychology would negate the very foundations of a mechanistic world view, and therefore, it will never be allowed to be true by mainstream science. This attitude is akin in principle to religious fundamentalism.

What do I think? Personally, I would say - of course consciousness is generated by the brain! This seems the most parsimonious and logical conclusion. However, speak to many scientists far cleverer and more knowledgeable about this topic than myself, and they will tell you that locality of consciousness is nothing more than an assumption in science. Whatever the case may be, this article is not about the metaphysics of consciousness, and anyway it’s largely irrelevant to all aspects of alternative or complementary medicine discussed in this article. For example, the placebo effect and mind-body medicine can be explained perfectly using the Darwinian principles of biology. I only raise the example of non-locality to show how dogma is prevalent in scientific institutions.

For dogmatic skeptics, perhaps it is easier to seem clever and rational through becoming a professional debunker rather than by engaging in original research.

Aaron Moritz, in his blog entitled ‘Do extraordinary claims require extraordinary evidence?’ says: ‘’Max Planck, the father of quantum mechanics, is often famously quoted as saying that science progresses one funeral at a time. This outlook, while certainly cynical, rings true to something I think we can all recognize about ourselves: people don’t like to be wrong. Especially when they perceive that being wrong could threaten their identity’’.

(2) Undervaluing and misunderstanding the role of placebo effects in medicine

Let’s begin by asking a simple question: Is it possible that a homeopathic remedy (which is, it can be agreed, 100% placebo) could work better for a specific ailment than a drug that has been proved through clinical trial to work better than placebo? The answer is YES.

Herein lies the paradox and wonder of what is commonly referred to as ‘the’ placebo effect. The truth is, when people refer to ''the'' placebo effect, they should really be saying ''a'' placebo effect - because they are many types of placebo effect which fall on a spectrum from 'very weak' to 'very strong'. This is a nuance which must be made clear, and which Ben Goldacre and David Robert Grimes have failed to elucidate well. DRG has called homeopathy 'useless' and, although Ben Goldacre provides a more nuanced position, he seems driven to use knowledge about placebos to negate research, rather than support its use as a functional component of medicine.

This ties in with a valid criticism of RCTs - or randomised controlled trials. Here, a drug or treatment is tested against a placebo. But, in the case of pharmaceutical drugs, the efficacy of the drug is put in the relatively unchallenged position of being tested against one of the weakest forms of placebo - a dummy pill of the same size and colour as the pill containing the active ingredient. Now, I am assuming (and it is an optimistic assumption) that the goal of conventional medicine is to heal or treat people in the most effective way with the least possible side effects. What if the drug was tested against the whole spectrum of possible placebo effects - from the weakest (dummy pill) to the strongest (perhaps something like acupuncture). Would the drug still out-perform all of them? For a large swathe of medical conditions (particularly psycho-somatic and stress related conditions) the answer would probably be a resounding NO. Indeed, it is for this reason why homeopathy could work better than a drug that has been approved by clinical trial. The efficacy of relatively strong placebos - like homeopathy or acupuncture - are undervalued because they are pitted against relatively strong placebos, i.e. themselves!!! We are faced with a ridiculous situation where the effectiveness of a treatment is measured by how it compares relative to placebo, rather than simply how effective it is in helping a patientThis is why there is an urgent need for out-come based trials instead of RCTs, and this will be discussed later.

Medicine should seek to utilise and maximise the placebo effect as much as possible. Hippocrates - the Father of modern medicine - knew this when he spoke of ‘intrinsic factors’ crucial to healing and prevention of disease. Anyone who dismisses the placebo effect or says things like ''it's just the placebo effect'' clearly has an incomplete vision of medicine and of the founding ethos of modern medicine itself.

Unfortunately, the placebo effect is as much a victim of semantics as it is of misunderstanding. It has come to be seen as a 'nuisance' or even a negative thing in scientific discourse. Replace the term 'placebo effect' with a descriptive definition of what it is, and academic discussions about it begin to seem like an ironical satire straight out of Monty Python. Indeed, we can parody this with a dialogue. Here, 'the placebo effect' has been replaced with an accurate descriptive definition of what it is - ''an intrinsic set of Darwinian healing mechanisms evolved over 3.5 billion years to produce the most powerful natural pharmacopoeia in the known universe''. 

Jack: ''hello mate, you won't believe what happened. I had this really bad stomach ache and I took this magic potion and now I feel a lot better''.

Dogmatic Skeptic: ''haha dude, you've been duped! You got better for no other reason than the fact that the magic potion triggered your intrinsic set of Darwinian healing mechanisms evolved over 3.5 billion years to produce the most powerful natural pharmacopoeia in the known universe''.

Jack: ''ah no, you cannot be serious! You mean to say the only reason I got better is because the magic potion I took triggered my intrinsic set of Darwinian healing mechanisms evolved over 3.5 billion years to produce the most powerful natural pharmacopoeia in the known universe? Shit, I've been duped! It's not a magic potion at all! Give me something that truly works!''

Of course, the placebo effect must be used wisely and ethically in medicine, and any reasonable and sensible person would consider this. What’s truly shocking is how common it is for pharmaceutical drugs to be prescribed unwisely and unethically by conventional doctors. For example, Prozac is dished out like candy even though doctors must be or should be aware of the evidence that Prozac works no better than placebo for a lot of users and carries the proven risk of serious side effects.

(3) Obsession with RCTs as the foundation of Evidence Based Medicine (EBM)

One major criticism of RCTs is that they are designed specifically to test whether a drug or intervention works better than a placebo control.

This criticism might sound counter-intuitive, but analyse it for a while and you will discover its validity. Because there are many placebo strengths – from very weak to very strong – the overall healing effect of a drug or treatment is likely to be over-valued when it is tested against a weak placebo (e.g. bland dummy pill) and under-valued when it is tested against a stronger placebo (e.g. acupuncture).

As mentioned, this presents the erroneous situation in medicine where we can value a treatment with a relatively weak healing effect just because it works better than a placebo and dismiss a treatment with a stronger healing effect just because it works no better than a strong placebo effect. If we simply consider actual efficacy / healing effect, this situation often positively biases results from pharmaceutical trials and negatively biases results from trials looking at complementary or holistic approaches to healthcare (where many approaches can be used synergistically, making the RCT model redundant anyway).

A much better and fairer approach is to use out-come based trials. Here, you consider all the possible approaches to a health condition or disease - both conventional and alternative – and apply it to randomised groups of patients. For example, we could divide patients with, say, gastric ulcers into 10 different treatment groups – conventional drugs / acupuncture / herbal remedies / nutritional therapies etc., and then simply observe changes in prognosis over time. Here, we are not primarily interested in the relative influence of placebo effect in healing – we are simply interested in the magnitude and efficacy of the healing response itself. (Note: as a function of cost effectiveness). 

Another valid criticism of RCTs – and ‘Evidence Based Medicine’ in general – is that its fervent proponents such as Ben Goldacre and David Robert Grimes seem to inculcate an academic atmosphere which undermines the need for the precautionary principle, and, for basic common sense. This was illustrated by a brilliant satirical piece in the British Medical Journal nicknamed ‘The Parachute Article’ which questions the use of parachutes when jumping out a plane on the grounds that there has been no systematic review of randomised controlled trials to validate their use. Revealingly, Ben Goldacre dismissed the article as a ‘passive-aggressive epidemiology paper’, apparently avoiding or misunderstanding its profound relevance to wider medical and social discourse. As I shall discuss later, skeptics seem to have a very poor understanding of – and attribute little social relevance to – the precautionary principle. 

(4) Mis-representing ‘alternative’ / complementary medicine

David Robert Grimes is particularly fond of the slogan ''Alternative medicines fall into 2 categories – treatments that have not been proved to work, and treatments that have been proved not to work. Treatments that have been proved to work are simply called medicine''.

The problem with this slogan is not only that it’s disingenuous – it’s also both incredibly misleading and simply wrong.

Why? Because there are many treatments firmly associated with the ‘alternative medicine’ camp that have been proven to be medically efficacious through clinical trial BUT are not – and probably will never be – called ‘medicine’. These include (to name but a few) – mind body techniques such as yoga and meditation, various nutritional therapies, aspects of Chinese and indigenous medicine, and various strong placebo treatments. ‘Alternative’ just means alternative to orthodox – it doesn't mean it doesn't work. For cancer, ‘alternative’ just means alternative to chemotherapy, radiotherapy and surgery. Don’t think there are any alternatives? Think again. Watch this TED talk by William Li where he discusses the ‘medical revolution’ of using nutrition to starve cancer – a process called angiogenesis: Is the medical establishment going to start calling food 'medicine'? I don’t think so. Why not, if it is medicinal? The answer to this question speaks volumes.

It is partly because skeptics don’t sympathise with the philosophy of alternative medicine, and partly because they misunderstand the ethos of medicine itself, that they promulgate this fundamental error. Put simply, ‘medicine’ is any treatment that heals or makes better. Indeed, this was certainly the ethos promoted by Hippocrates, the Father of modern medicine, who said, among many other similar things – ‘let food be thy medicine and medicine thy food’

(5) Inaccurate definition of ‘Medicine’ and ‘Doctor’

Unfortunately, and to the detriment of our society, the word ‘medicine’ has become synonymous with ‘giving drugs’ - but this is radically different from the original meaning of the word.

The word ‘medicine’ comes from an ancient Indo-Iranian root that translates to ''thoughtful action to establish order''.  This same linguistic root also gives us the words ‘meditate’ and ‘measure’.

Furthermore, the word ‘Doctor’ originally comes from the Greek for ‘teacher’.

Clearly, something has been lost in translation. Firstly, modern orthodox healthcare medicine is wildly out of touch with the founding ethos of modern medicine itself – so much so, that if Hippocrates were alive today he might well consider orthodox medicine to be the alternative version. More alarmingly perhaps, the idea of a dialectical and educational relationship between doctor and patient has been supplanted by the concept of the doctor as an authoritarian agency who just tells the patient what to do.

The rise of type 2 diabetes in affluent nations is perfectly symbolic of this point. No amount of pharmaceutical drugs or medical intervention could parallel the efficacy of simply getting patients to eat an excellent diet and adjust their lifestyle habits. This is what works best. If Doctors practiced medicine according to the founding ethos of Hippocrates and modern medicine itself, then disease epidemics related to poor lifestyle could be tackled in a more mature, scientific and intelligent way. 

(6) Precautionary Principle – what Precautionary Principle?

The need to enforce the precautionary principle is directly related to the scientific plausibility or likelihood of a specific claim, a point Ben Goldacre and David Robert Grimes seem to miss completely. The precautionary principle is used precisely because there is insufficient evidence!

For example, if someone makes a claim that light bulbs cause cancer, we can be sure that the plausibility of this statement is incredibly low. In this case, the precautionary principle is not applicable – indeed, it would be ridiculous. Now, consider the claim that synthetic Agro-Chemicals (e.g. pesticides) are bad for you. The veracity of this statement is of a much higher plausibility – in fact, it is almost certain to be true. As Dr. Andrew Weil says, we know pesticides can’t be good for us, the only question is how bad they are. We know that pesticides have catastrophic effects on other species. For example, the consensus view in science is that Colony Collapse Disorder in bees is largely due to contamination from pesticides. Also, we do know that pesticides are bad for humans – they can have negative effects all systems of the body. However, there might not be any broad-scale epidemiological evidence at present for the long-term health impact of relatively low concentrations of Agro-Chemicals (i.e. found in foods). 

A recent study discussed in this article in The Guardian suggests that the evidence in support of organic food is growing stronger: This study will, no doubt, be berated by some members of the skeptic community. It should be noted, however, that it is perfectly consistent with scientific principles that organic food should contain a different nutrient profile to non-organic food. Why? Because nutrients and phyto-chemicals in plants are produced in response to environmental conditions. Since plants grown organically need to be more resistant to pests and fungi, and because they need are generally grown on more nutrient rich soil, we would fully expect organic plants to exhibit different bio-chemical profiles.  

Tragically, skeptics have got away with (and keep getting away with) an irresponsible neglect of the precautionary principle. 

This neglect might stem in part from a type of denialism or ‘black or white’ thinking. Whether or not this is the case, what is clear is that they get the need for evidence totally back-to-front regarding the precautionary principle. They would say, ''where’s the evidence that pesticides are detrimental to human health''. The correct question is ''where’s the evidence that pesticides are not detrimental to human health''. You only have to look back in history to see that many negative health impacts could have been avoided by simply asking the correct question. DDT is one example, among thousands.

It should be a legal requirement that, where the scientific plausibility for a specific claim is high, evidence must be produced to negate the claim, rather than support it.

Not only do Ben Goldacre and David Robert Grimes ridicule organic food, they also rail against many highly plausible and sensible scientific claims which, as of yet, have little evidence to support them.

For example, Ben Goldacre is unconvinced by the idea that excessive computer use at a young age could have negative effects on childhood psychological development. You can research his ongoing debate about this with Susan Greenfield and Aric Sigman on the web. David Robert Grimes, on the other hand, is unconvinced by the idea that the total death count from Chernobyl and Fukushima exceeds 43. In both cases, these authors seem to insist on proof from direct causation even though they are happy to use correlation data in support of other assertions. Perhaps David Robert Grimes would like to debate nuclear power with Professor Michio kaku – who is very out-spoken about its negative side, particularly about Fukushima. But some skeptics seem to avoid intelligent debate at all costs – something which will be addressed later. 

Both authors resist the idea that novel EMFs (Electro-Magnetic Frequencies) from devices such as internet routers and Wi-Fi could have negative health effects, even though there is some evidence that childhood leukaemia rates are positively correlated with proximity to high voltage power lines. They resist the idea simply because the evidence for the claim is weak (or so they say) rather than because they have examined the scientific principles surrounding the claim and concluded that the scientific plausibility is low. 

I will not comment further on these claims here – I only mention them to highlight some other case studies on the precautionary principle.  

By demanding that public health policies should be structured solely around evidence, in these cases skeptics are inadvertently consenting to mass social and medical Guinea Pig experiments. 

(7) Attacking the Out-liers

Ben Goldacre and David Robert Grimes are both in the habit of concentrating their attacks on the outliers – people or therapies which quite obviously fall into the category of quackery. Fair enough, you might say – quacks should be exposed, it only to protect those members of society who are not aware of the dubious claim of a product. Fair enough. I agree. But there is a danger that the outlier becomes the perfect Straw Man, which polarises and antagonises the debate between different approaches to medicine, and jeopardises any rational debate on the topic of ‘integrated medicine’. Furthermore, both these authors rarely suggest any alternatives nor direct the reader toward more nuanced and reasonable research.

For example, there is a video of Ben Goldacre on YouTube where he discusses the quackery surrounding ‘detox’ products. He gives a demonstration of such a product – a phony foot-bath detox device that claims to be able to extract toxins from a person’s body. Goldacre uses a toy doll for the experiment – and when a brownish sludge develops in the foot bath, it becomes obvious that it’s a quack product. Fair enough. However, Goldacre’s discussion surrounding the topic of detox reveals pitfalls in his argument. Firstly, he speaks at length about how healthy lifestyle over the long-term is more important than quick fixes and how the correlation between social inequality and ill-health is a far more important topic. These are both true, and excellent points – but it doesn’t deal with the specific question at hand, which is whether there are products or therapies which improve the process of detoxification in the body. Secondly, he doesn’t say that there are actually products and therapies that have been clinically proven to help the process of detox. Milk Thistle, for example, is well known to protect the liver and therefore enhance its detoxification efficacy. Also, Sauna has been shown to be an effective therapeutic tool for stimulating the body’s natural detox mechanisms. Furthermore, there is a growing body of research to suggest that various phytochemical and mineral supplements might be effective chelation agents for the removal of heavy metals and pollutants from the body.

‘Detox’ is actually not a trivial matter – since we know that the accumulation of pollutants in the body (such as various forms of plastic, heavy metals and other pollutants) can have serious effects on the endocrine and neurological systems. For example, certain pollutants can cause estrogenic effects, and estrogenic imbalances have been linked to specific cancers. Many pollutants are novel compounds that have been introduced into the environment, and which are category 1 carcinogens. 

More alarmingly, when Ben Goldacre goes on to talk about how long-term health can be improved generally, he says ''it’s quite difficult to have a meaningful impact on your long-term health risk outcome''. It seems irresponsible that Ben Goldacre should appeal to the ‘genetic roulette’ aspect of health rather than reflect on broad-scale epidemiological studies which show conclusively that your lifestyle (e.g. diet, exercise and psychological well-being) significantly and substantially impact your long-term health risk outcome.

In a similar vein, David Robert Grimes seems to relish debunking the outliers – and this is especially evident in his articles on cancer. For example, he berates organisations that make dubious claims for alternative cancer therapies, but always fails to provide a nuanced, balanced or helpful perspective on the current debate in cancer research. There are some very reasonable organisations that take a more integrated approach to cancer care, using the best of both conventional and alternative therapies. Here, ‘alternative’ simply means alternative to chemotherapy, radiotherapy and surgery. Two such organisations are the Arizona Centre for Integrated Medicine, and the Hippocrates Health Institute. If you are unaware that there even is a debate on cancer, you might want to watch this TED video by William Li where he discusses the ‘medical revolution’ of using nutrition to starve cancer – a process called angiogenesis:

(8) Attacking Nutritionists – Supporting Dieticians

The way Ben Goldacre and David Robert Grimes attack nutritionists is deeply symbolic of the central premise which inspired me to write this article.

To understand this point clearly, it must be remembered that the majority of ill-health, disease and premature death in developed nations is, overwhelmingly, due to poor diet and poor lifestyle. When dogmatic skeptics mercilessly and tirelessly attack nutritionists for ‘not being medically trained’ or ‘not providing peer-reviewed evidence to back up their advice’ they are missing the point entirely by not seeing the bigger picture, and they’re also making fundamental errors in logic and objective reasoning.

Why? Because the most important things to remedy a situation where people are getting sicker through poor lifestyle are not more academic papers or academic qualifications – the most important things are inspirationpassion and encouragement.

Through epidemiological and cross-cultural studies, science has already come to the robust understanding that health in developed countries is very strongly correlated to healthy lifestyle – and this includes physical and psycho-social / psycho-emotional factors.  In this sense, reductionist science (including many aspects of Evidence Based Medicine such as RCTs) really has very little to offer. Health and lifestyle medicine are co-dependent in a deeply social way.

When I say ‘social’ I do not mean this in the same way Ben Goldacre uses the term when highlighting that social inequality is strongly correlated to health risk outcome. This is a great point, but it is also a great red herring when used out of context. I mean ‘social’ in the sense that medicine itself is intrinsically a social as much as a scientific discipline. The founding ethos of modern medicine is echoed in the linguistic root of the terms ‘medicine’ and ‘doctor’ which uphold the idea that medicine is as much an art as a science – requiring an educational and dialectical relationship between doctor and patient to consider ’thoughtful action to establish order’.

Accordingly, you are more likely to develop and maintain a healthy lifestyle if you are inspired to become interested in your health and this, in turn, is more likely to happen if a healthcare practitioner or community of like-minded people have inculcated a sense of passion and sovereignty for one’s own health and well-being. It is interesting to consider that you are more likely to improve your long-term health risk outcome by seeing a psychologist than by visiting a conventional doctor.

Tragically, some skeptics believe that ‘dietitians’ should be more trusted and respected than ‘nutritionists’ for the only reason that dieticians are likely to have an academic qualification. This is profoundly arrogant and prejudiced, and - most importantly - misses the point, yet again. For everyone’s sake, leave your intellectual snobbery at the door. 

This situation is analogous to saying you rate one yoga instructor higher than another just because they've got a PhD in sports science. Who gives a shit? It’s totally irrelevant, for all the aforementioned reasons.

Have you ever heard a dietitian talk about things such as growing your own food, eating sprouted seeds or harvesting wild food, the benefits of fermented foods, juicing green leafy vegetables, collecting spring water, raw food or saunas? No, I thought not. Dietitians don’t inspire people to educate themselves and become self-empowered over their own health and well-being. All they seem to do is promote a ‘balanced diet’.

When a dietitian uses the term ‘balanced diet’ it is rather meaningless. They’re not promoting a balanced diet at all – they’re promoting a mediocre diet. Eating a mixture of good and bad food doesn't equate to balance. There’s no such thing as a balanced diet – your diet is either excellent, or good, or not so good, or average, or poor etc. To borrow a term from politics and economics, dietitians are interested in keeping the population just above the ‘poverty line’ of health – that is, keeping them un-sick rather than positively flourishing. I've heard dietitians say things like ‘frosted cornflakes for breakfast can be part of a healthy, balanced diet’. No, it can’t. It can be part of a mediocre diet, for sure. There is no place for artificial sugary ‘dead’ food such as cornflakes in the diet. A recent report by the UN World Health Organization has stated unequivocally that sugar intake must be drastically reduced if the world is to stand any chance at all of mitigating the burgeoning lifestyle-disease epidemic. The slogan ‘5 a day’ is nonsensical. Considering what our chimpanzee cousins eat every day, the slogan ‘100 a day’ would be far more appropriate.

Arguably, diet is one of the least important factors in maintaining good health. Psychological factors such as low stress, loving relationships, genuine social networks and enjoyable / nurturing work environments are key to health, both at a personal and societal level. Good health is about realising what’s most important – and thus, about realising the limitations of focusing on diet if one doesn't address other aspects of lifestyle. Since nutritionists take a holistic approach to health, they are perhaps more likely to advocate beneficial relaxation therapies such as yoga and meditation.

(9) Un-professionalism and intellectual dishonesty

Now, I don’t mind at all if someone like Ben Goldacre is scathing and aggressive about ‘Big Pharma’. Am I advocating a double standard here? No. Some of the antics of the pharmaceutical industry are truly appalling, unethical and corrupt. Many alternative health care practitioners and nutritionists might be wrong about certain things, but they are generally well-meaning. Vitriol has to be apportioned proportionately. Revealingly, David Robert Grimes seems very reluctant to slam ‘Big Pharma’, but relishes scathing and vitriolic attacks on seemingly all aspects of alternative medicine. This shows an unbalanced (i.e. biased) application of skeptical reasoning. 

In one of his articles, BG says ''stick with me, science is fun when you’re making people look stupid''. In the same vein, DRG believes people who believe in conspiracy theories have a ‘lower cognitive complexity in thinking patterns’ than people who are, well, like him. What he fails to mention is that his idea of a conspiracy theory (such as anti-fluoridation) often has very little to do with conspiracy, and simply much more to do with opposing points of view. 

Husting et al. in their article ‘Dangerous Machinery: ‘Conspiracy Theorist’ as a Trans-personal Strategy of Exclusion’ say;

In a culture of fear, we should expect the rise of new mechanisms of social control to deflect distrust, anxiety, and threat. Relying on the analysis of popular and academic texts, we examine one such mechanism, the label conspiracy theory, and explore how it works in public discourse to “go meta” by sidestepping the examination of evidence. Our findings suggest that authors use the conspiracy theorist label as (1) a routinized strategy of exclusion; (2) a reframing mechanism that deflects questions or concerns about power, corruption, and motive; and (3) an attack upon the personhood and competence of the questioner. This label becomes dangerous machinery at the transpersonal levels of media and academic discourse, symbolically stripping the claimant of the status of reasonable interlocutor—often to avoid the need to account for one's own action or speech. We argue that this and similar mechanisms simultaneously control the flow of information and symbolically demobilize certain voices and issues in public discourse

Dogmatic skeptics love picking the low-hanging fruit and have developed sophisticated methods to thwart intelligent criticism. They avoid intelligent debate at all costs. If they want a serious debate, there are plenty of people I could point them in the direction of. Rupert Sheldrake, Andrew Weil, Chris French, Roger Penrose, Michio kaku. There are hundreds of people they could engage with, but they prefer to pick the low hanging fruit. 

(10) Nature of Evidence

Both Ben Goldacre and David Robert Grimes put a premium on peer-reviewed evidence from RCTs - Randomised Controlled Trials. All other types and sources of evidence are seen as inferior.

Firstly, peer-reviewed evidence is not infallible, as highlighted by this report in the Journal of the Royal Society of Medicine entitled: ‘Peer review – a flawed process at the heart of science and journals’ ( Furthermore, non-peer reviewed evidence is not automatically wrong. The process of peer-review can be illustrated using this analogy: Imagine someone told you they put 10 pounds into a charity box. Now, in one scenario there were observers to lay testament to the claim, and in another scenario there were no observers. Peer review is analogous to the first scenario – i.e. there are people to check and validate the claim, and critically observe it. Non-peer review is analogous to the second scenario – i.e. there is nothing to validate the veracity of the claim.

However, a scientific experiment that has not been peer reviewed is not necessarily flawed. In fact, there’s no evidence that it is. We simply cannot be certain that it is accurate, experimentally and statistically. Even for peer reviewed evidence there is no guarantee that it is accurate, because we cannot be certain of the neutrality of the observers (i.e. peer reviewers). There might be strong conflicts of interest.

Therefore, when Ben Goldacre and David Robert Grimes exalt peer review, they are not being objective nor are they exercising due skepticism about the process of peer review itself.

Secondly, there are many different types of evidence – not just that arising from RCTs.

Consider the case of Green Tea. Recently, RCTs have shown the efficacy of Green Tea to help with a wide variety of health issues, including skin cancer. However, Green Tea has been revered for thousands of years for its health protective properties. Was this long-held belief simply unsubstantiated speculation? Well, no. Foods and herbs that have been used for thousands of years are subject to a process that can be called cultural natural selection – a process whereby the physical and psychological experiences of people over thousands of years are registered in the collective psyche, and passed on down the generations, perhaps in the form of folklore and the indigenous wisdom traditions still present today.

The case studies that could be named where the efficacy of indigenous plant medicines have been verified by the modern clinical RCT trial are very numerous. Another wonderful example is Chaga Mushroon (Inonotus obliquus), revered by Siberian Shamans for thousands of years for its health promoting properties – and recently confirmed by modern science. Of course, it is good to know ‘conclusively’ if specific plant remedies have a beneficial effect beyond placebo – and so RCTs are welcome. But the point is – we shouldn’t automatically dismiss something just because it hasn't been subject to an RCT, especially if it has been used for millennia by ancient cultures.

So, one needs to remember that lack of clinical evidence for something is NOT evidence against it. Unless something has been tested by clinical trial, it cannot simply be dismissed. We should also bear in mind that research funding is heavily weighted in favour of substances that can be patented, and so only an infinitely small fraction of natural compounds have been tested by medical trial. Indeed, it is in the interest of pharmaceutical companies to de-value the role that natural (i.e. non-patentable) compounds could play in disease prevention, cure and management. Finally, dogmatic skeptics fail to acknowledge when experimental evidence for specific claims is difficult to obtain. This is the case, for example, for (1) EMFs (2) computer use and child psychological development. There are inherent difficulties with testing these claims. Here, even though something is scientifically plausible and ‘makes sense’, the complexity of investigating the claim might rule out a ‘proof’ with low statistical error. Yet again, the lack of evidence for something is NOT evidence against it – and, where scientific plausibility is high, the precautionary principle must be adopted.

A favourite slogan of David Robert Grimes is Carl Sagan’s dictum ‘extraordinary claims require extraordinary evidence’. Unfortunately, Dr. Grimes has fundamentally misunderstood it. For example, he scoffs at the idea that compounds from cannabis could cure cancer, even though compounds from two plants – the Rosy Periwinkle and the Pacific Yew – are used as chemotherapy agents in mainstream medicine. There’s nothing extraordinary at all about compounds from Cannabis, or any other plant, having chemotherapeutic properties. It all boils down to the nature of the biochemical interaction of a compound with a cancer cell – some will work, others won’t. What would be extraordinary is if there aren't thousands of plants out there with chemotherapeutic properties. Science has a lot of research still to do. 

Similarly, David Robert Grimes thinks the idea that magnetic wave therapy could destroy tumours to be inconceivable. But this idea is based on exactly the same principle as radiotherapy treatment. The only difference is magnitude – magnetic waves and radiotherapy waves both belong to the electromagnetic spectrum. Yes, magnetic waves might be far too weak to have a biological effect, but the principle is the same. That’s why the idea – although far-fetched – is so un-extraordinary. Tell me that you can make squirrels shoot out of your ass by doing transcendental yoga, and I would call that an extraordinary claim.

Ironically, in appealing to the consensus view in science, dogmatic skeptics often accept ideas with no evidence. And when ideas are suggested which they don’t like, they require infinite amounts of evidence for it to be proved. Aaron Moritz says:

‘’Unfortunately, the phrase about extraordinary evidence is thrown around as if it were a shield that could protect one from having to consider any information that might upset their current worldview. Evidence standards become artificially high for claims these people don’t like, and artificially low for the claims they do like. Even if it isn't the intent, the function of such a rule becomes the maintenance of the status quo. Those who are looked up to and who’s opinions are thought highly of tend to be the ones whose influence determines what is and isn't extraordinary.  Scientific consensus devolves into an ideological popularity contest’’. 

(a) Asking the right question - to me, the most important thing is to ask the right question. In schools and academic institutions we are praised according to the quality of the answers we provide to a given question, but we are rarely taught that the most important thing is to pose the best question. The quality of a question is the limiting factor on the relevance an article or opinion will have for improving the welfare of people and the environment. To use an analogy - the quality of one's answer to a specific question might be an 'A+', but if the quality of the question is only a 'D+', then the overall relevance of the answer can never be above a 'D+'.

For example, DRG has written articles about the debate on water fluoridation. But - however much brilliant science and statistical analyses you could use to prove that fluoridated water is not harmful (at low levels) and/or that fluoridated water offers protection against tooth decay - the quality of the question of whether water should be fluoridated is only about a 'D+'. Why? Because the protective role of good diet, good lifestyle and good dental hygiene is orders of magnitude more important for the prevention of tooth decay than drinking fluoridated water. 

If you don't believe this, think about this hypothetical experiment: In this experiment there are 3 treatments: (a) for 2 years, eat an excellent diet and keep an excellent dental hygiene regime (and drink un-fluoridated water) (b) for 2 years, drink fluoridated water, but eat a terrible diet and don't brush your teeth (c) for 2 years, follow the first (a) regime, but drink fluoridated water.

If you were to do this, regime 'a' would undoubtedly lead to much better dental health than regime 'b'. Arguably, regime 'c' would result in the best dental health, but the added benefit of fluoridated water would be negligible - orders of magnitude less effective than eating good food and maintaining a perfect dental health regime. Indeed, it could be argued that the negligible benefit provided by drinking fluoridated water might be counteracted anyway by a complacency toward dental health inculcated by journalists who promulgate the 'benefits' of drinking fluoridated water for the prevention of tooth decay. 

I am not automatically against the enforced 'medicalisation' of the general public - but at least we could do it with more beneficial nutrients, such as vitamin D or folic acid (a type of B-vitamin). 

Another example of a poor question is illustrated by the debate about 'statins' at the moment. Even the most impressive statistical models and scientific studies cannot disguise the fact that the scientists debating this idea are asking a very poor question. Surely, a life of regular exercise, good food and a good lifestyle is far more protective against heart attacks and strokes than taking a pill. The question should not be - what pill can we develop . It should be -  what are the root causes for the epidemic in heart disease and strokes? Let's get to the root cause of the problems in society, instead of skirting around the periphery by constantly only seeking to treat the symptoms. It seems that when respected journalists like Ben Goldacre discuss topics like statins, their very participation (regardless of whether they agree of disagree) gives credence to a discussion which distracts everyone from more urgent, and more profound, questions. 

A final example is Ben Goldacre's book Bad Science. I applaud and respect Ben Goldacre for writing this book, but I feel that, still, a relatively poor question is being asked. The book criticises the antics of the pharmaceutical industry, which is a good thing. But Ben Goldacre is not against pharmaceutical drugs per se. In my opinion, a far deeper question is to confront the medicalisation of society head on, and ask why the prescription of drugs has sky-rocketed. I have no doubt that the vast majority of prescription drugs in developed countries are for ailments that are directly related to poor diet, poor lifestyle and/or poor emotional well-being. 

We are all used to politicians and government asking poor questions. It's just a shame that some journalists are asking equally poor questions. It appears that, in newspapers, only a certain stratum of wisdom is encouraged; - and only certain shades of nuance are allowed, to give people the illusion they're being invited to think critically about a situation. 

(b) Double Standards - I feel that, sometimes, Ben Goldacre and David Robert Grimes are inconsistent in the way they approach arguments. For example, when berating detox products, Ben Goldacre suggests we consider health in a more 'holistic' sense - i.e it's more important to lead a healthy lifestyle over the long term than buy in to quick fixes like detox products. Yes, I agree. But when Goldacre criticises the organic food movement for extolling the health benefits of organic food, he accuses them of 'gamesmanship' when they insist on seeing the 'broad-scale', 'holistic' benefits of organic food, i.e. for the environment and for wildlife. 

For organic food, you simply can't separate the arguments. What is bad for the environment is bad for us - it really is as simple as that. 'Holistic' means the 'whole' picture; - therefore, it means reality. 

It seems that, depending on what Ben Goldacre and David Robert Grimes want to argue, they either choose reductionist argument or more nuanced positions. But if a journalist is able to select the questions which they choose to answer, I don't see how we can be sure that they are giving a meaningful and undistorted view of the whole picture. 

In DRG's case, this inconsistency is illustrated when he says that the total death count from both Chernobyl and Fukushima is 43 - and yet he says that ''1.3 million people a year die as a result of pollution from coal-burning plants''. This is actually a misquote from the WHO report, which actually says ''Urban outdoor air pollution is estimated to cause 1.3 million deaths worldwide per year''. These statements sound similar, but they are actually different. 

Here, DRG only considers deaths from absolute direct causation for nuclear accidents, but is happy to use a misquote from a WHO report to urge that 1.3 million people die every year as a result of coal-burning plants. He doesn't concede that the nuclear fallout from Chernobyl and Fukushina are a likely major contributory factor in far more deaths (e.g. from cancer) than 43. 

(c) Homeostasis - Lastly, some skeptics seem to have a confused understanding and uncritical acceptance of the process of homeostasis - or 'balance maintenance' - within the body. For example, Ben Goldacre is critical of detox products not only because a lot of them don't work, but also because he seems to promulgate the idea that 'the body will work it out'. 

True, the body is an incredible organism, with powerful and wonderful mechanisms for self-regulation. But, like an elastic band that eventually looses it's resilience when over-stretched, the body has it's limits. This is seen in type-2 diabetes, which is (usually) caused by the body eventually succumbing to the long-term onslaught the insulin system is subjected to by the regular intake of bad food. 

Also, just because the body is amazing at homeostasis does't mean that yanking the body out of balance doesn't have negative effects. For example, if you get drunk, the body will recover, but this recovery will require resources (such as energy and nutrients) that could have detrimental effects on the rest of the body, especially over the long term. 

Let's end on a philosophical note: You can spend your whole life studying honey - you can even get a PhD and become a professor in honey - without ever having tasted it. Don't waste your life in your head. Taste the honey!