Bad Science (Goldacre book)

Each chapter deals with a specific aspect of bad science, often to illustrate a wider point. For example, the chapter on homeopathy becomes the point where he explains the placebo effect, regression to the mean (that is, the natural cycle of the disease), placebo-controlled trials (including the need for randomisation and double blinding), meta-analyses like the Cochrane Collaboration and publication bias.

The subjects of each chapter (numbers reflect later editions) are:

1. The alternative medicine phenomenon of detoxification. He looks at three supposed detox treatments that can be debunked with simple science experiments, and uses this to explain some basics of science.
2. Brain Gym, a set of exercises and activities that are supposed to "enhance the experience of whole brain learning". At the time when Goldacre’s book was written, Brain Gym was promoted by the Department for Education and used in hundreds of state schools across the country. Goldacre dismisses the program's claims as pseudoscience, with a mix of nonsense and commonsense ideas. He describes it as an attempt to 'proprietorialise' common sense (i.e. turning it into something that you can patent, own, sell and make profit from). He also discusses evidence that people are more likely to believe an explanation if it sounds like science.
3. Cosmetics. According to Goldacre, expensive anti-wrinkle creams often contain an elaborate mix of chemicals that have little effect on what the product does. Only a few chemicals can effectively reduce wrinkles without having unwanted side effects, such as vaseline and vegetable proteins. His main complaint is that the cosmetics companies sell their products by appealing to the misleading idea that science is complicated, incomprehensible, and impenetrable. This is bad because the target audience who are bombarded with this dubious world view are young women, a group who are under-represented in science.
4. Homeopathy, an alternative medicine based off the theory that ‘like cures like’ and that very high dilutions strengthen the treatment. While Goldacre suggests "conceptual holes" in the theory, his main issue is that it ultimately does not work. He explains how evidence-based medicine works and how homeopathy has not met these standards.
5. The placebo effect. Already introduced in the previous chapter, Goldacre discusses it in further detail. He notes factors that can enhance the placebo effect, such as higher prices, fancy packaging, theatrical procedures and a confident attitude in the doctor. He also discusses the ethical issues of the placebo. He concludes the placebo effect is possibly justifiable if used in conjunction with effective conventional treatments, but it does not justify alternative medicine.
6. Nutritionism, which Goldacre does not consider to be proper science but has been accepted as so by the media. He says nutritionists often misrepresent legitimate scientific research, make claims based on weak observations, over-interpreted surrogate outcomes in animal and tissue culture experiments and cherry picked published research.
7. Gillian McKeith, a nutritionist who presented You Are What You Eat on Channel 4. Though presented as a medical doctor, her degree was neither medical nor accredited. Goldacre noted factual errors in her claims, such as those on chlorophyll. He compares her writings and advice to a Melanesian cargo cult; it looked scientific but lacked the substance. Goldacre argues that micro-regulating a person's diet has little effect on their health, and it is more important to try to lead a generally healthy lifestyle. He also argues that general health of the population correlates with affluence better than anything else.
8. The claim that fish oil capsules make children smarter, especially the "Durham trial" that promoted these. Goldacre notes these trials lacked control groups and were wide open to a range of confounding factors. He notes how the education authorities failed to publish any results and backtracked on earlier claims. He discusses the media's preference for simple science stories and role in promoting dubious health products. Parallels are drawn between the Equazen company behind the Durham fish oil trials and the Efamol company's promotion of evening primrose oil.
9. Patrick Holford, a best-selling author, media commentator, businessman and founder of the Institute for Optimum Nutrition (which has trained most of the UK's "nutrition therapists"). Goldacre notes how Holford helped present nutritionism as a scientific discipline to the media, and forged links with some British universities. He says Holford is promoting unproven claims about vitamin pills by misinterpreting and cherry picking favourable results from medical literature.
10. Matthias Rath, a vitamin salesman. This chapter was not present in the original edition, as Rath was suing Goldacre at the time for libel.[4] After Goldacre won, it has been included in later editions[5] and Goldacre has made it freely available online.[6] In this chapter, he discusses how Rath travelled to Africa to promote vitamin pills as treatments for HIV/AIDS, and how these ideas were met with sympathy by the government of Thabo Mbeki in South Africa.
11. Mainstream medicine. Goldacre notes that a surprisingly low proportion of conventional medical activity (50 to 80%) is truly "evidence-based". The efforts of the medical profession to weed out bad treatments are seen to be hampered by the withholding or distortion of evidence by drug companies. He explains the science and economics of drug development, with criticism of the lack of independence of industrial research and the neglect of Third World diseases. Some underhand tricks used by drug companies to engineer positive trial results for their products are explored. The publication bias produced by researchers not publishing negative results is illustrated with funnel plots. Examples are made of the SSRI antidepressants and Vioxx drugs. Reform of trials registers to prevent abuses is proposed. The ethics of drug advertising and manipulation of patient advocacy groups are questioned.
12. The role of media in misrepresenting science. Goldacre blames this on the preponderance of humanities graduates in journalism, and the media for wacky, breakthrough or scare stories. These includes stories about formulas for "the perfect boiled egg" or "most depressing day of the year" and a speculation that the human race will evolve into two separate races. These were in fact publicity stunts for companies. Goldacre blames the lack of sensational medical breakthroughs since a golden age of discovery between 1935 and 1975, with medicine making only gradual improvements since.
13. Cognitive biases. In a chapter titled "Why Clever People Believe Stupid Things", Goldacre explains some of the appeal of alternative medicine ideas. Biases mentioned include confirmation bias, the availability heuristic, illusory superiority and the clustering illusion (the misperception of random data). It also discusses Solomon Asch's classic study of social conformity.
14. The cases of Sally Clark and Lucia de Berk. Goldacre says poor understanding and presentation of statistics played an important part in their criminal trials.
15. The MRSA hoax. Goldacre accuses the press of selectively choosing to use a "laboratory" that kept giving positive MRSA results when other pathology labs were producing none. The laboratory was in fact a garden shed, run by Chris Malyszewicz, who was treated by the press as an "expert" but had no relevant qualifications. Goldacre believes the press were far more to blame for the misinformation than Malyszewicz. Goldacre argues that journalists have been poor at uncovering medical scandals. For example, it was doctors and not journalists who discovered the thalidomide tragedy - only covering well the political issue of compensation.
16. Andrew Wakefield and the MMR vaccine controversy. Goldacre argues that while Wakefield's paper began the hoax about MMR causing autism, the greatest blame for the misinformation lies with the media, who should have realised that Wakefield's paper provided no evidence of a link.

The hardback and first paperback editions did not include an index. Several indexes were prepared by bloggers, including one prepared by Oliblog.[7] The latest paperback issue includes a full index.

• Bad Pharma (2012) by Ben Goldacre

• Goldacre's website badscience.net
• "Bad Science", Goldacre's column for The Guardian