Ben Goldacre tells Julian Baggini why he expects rigour in the reporting of scienceAll intelligent, reflective people know that the news full of sloppy reporting, hasty inferences and dubious statistics. You might think it used to be different or that it was forever thus. Either way, what we now need are valiant knights of truth to expose BS wherever it is found and shame the news services into upping their game. Philosophers, perhaps, ready to step up and become heroes?
Not quite. There’s the economist Tim Harford, whose BBC radio programme More or Less exposes the misuse of statistics, often by the very channel that employs him. But the template for this rigorous dissection of the media, in the media, was established by a then junior doctor, Ben Goldacre. His Bad Science column for the Guardian, which has been running for seven years, targets unsubstantiated claims backed by pseudo-science, unproven alternative treatments, sharp practice by pharmaceutical companies and faulty reporting of evidence and statistic-based stories. It has spawned an internationally popular website and a best-selling book of the same name.
It turns out, however, that philosophy has after all had a role to play in this welcome injection of clear thinking into the public square. For as well as being a doctor, Goldacre has an MA in philosophy from King’s College London, squeezed into the middle of his six-year medical training.
Goldacre is certainly no slouch. When we meet, it is later than we planned because he has been working all night, fallen asleep at ten in the morning and slept through our appointment. All apologies, he fuels himself with coffee, and starts to tell me about how this interest in philosophy emerged “kind of tangentially”.
“I was a really nerdy kid and when I was 15, I really, really wanted to be a neuroscientist when I grew up.” His interest had been sparked by reading Oliver Sacks, but primarily by watching Colin Blakemore’s 1988 television show, The Mind Machine.
“I tracked down, ridiculously, Colin Blakemore through the phone book and rang him up when I was 16 and said, ‘Look, I want to be you when I grow up. Should I do medicine, physiology or experimental psychology?’ And he said, ‘you should do medicine because even if you don’t become a doctor, the panoramic grounding that you get in the whole of biomedical science is really handy and also they work you really hard.’”
So he took Blakemore’s advice, and came across more odd neuropsychology cases at undergraduate medical school, such as “people who have blind sight, where they’re aware of something on some level to the extent that they can respond to it or catch a ball, but they report that they’re blind and they can’t describe anything in their visual sphere because they’ve lost the most basic part of their visual cortex, V1.”
All this built on his essentially philosophical fascination with “the idea that reality was constructed by chemical processes in the brain,” something which had been reinforced by a typical British teenage discovery, “that if you distort the chemical balance of your brain with a lot of coffee, which is my current favourite experiment, or by drinking alcohol or something, then you change your subjective experience of the world around you. And that really reinforced the sense that there was something worth studying here.”
That something, however, was as much a body of knowledge as a way of thinking.
“When I applied for the masters in philosophy I remember very explicitly writing on the application form that although philosophy was interesting, what I really wanted to do was have one-to-one tutorials with a philosophy tutor, because I wanted to learn the tools that they used as well as the factual substance of the arguments.”
Goldacre came to respect “the meticulous precision” of philosophy, which is “an entirely different kind of precision to science, because science is all kind of thrown together. Science is basically, ‘well, we reckon, because of this finding, this finding and this finding, that CD4 cells probably do this in the immune system.’ To the extent that you get ‘well, we reckon’ in philosophy, it’s a bit more highly specified.”
Goldacre got interested in “the quite hard-nosed end of philosophy of language”, such as the work of Frege and Saul Kripke, whom Goldacre remembers coming through King’s to give a talk.
“It was a real vision of what a philosopher should be. He was kind of short, and really shrivelled and had almost horizontal brown teeth sticking out of the front of his mouth. He was being followed around by this very attractive women in her late twenties with a notepad and a pen in her hand at all times. I asked somebody what they deal was here, and they said, well he’s never really written anything down. Naming and Necessity, his great work, is just cobbled together from transcripts of his essays, and they’re worried he’s going to die. So that woman is following Saul Kripke around, writing down everything he says on the off-chance that he says something really clever before he clocks off.”
There’s some Goldacre-added colour to this story, but in essence it’s true: Kripke’s verbal fluency far exceeds his ability to write and a lot of his brilliant ideas only live on in recordings and notes of his talks.
It is difficult, however, to combine an interest in the abstractions of philosophy of language with the day-to-reality of medicine. “The thing about going off to medical school is that it’s a giant maelstrom. You’re basically put on this conveyor belt of human experience in which you hold little old ladies’ hands as they die, abandoned by their families; you talk to builders twice your height and width about impotence, when you’re both the same age; you deliver babies; you help cut somebody open, with a knife – it’s surprising how difficult it is to make yourself do that – and put your hands inside their abdomen and help somebody pull out a main trunk artery that runs down the centre of their guts; and it’s all just kind of overwhelming. To be honest, being a medical student and in particular being a junior doctor feels like a massive black hole out of which I just fell at the other end with a whole different set of values and agendas.
“Once I came out of that, and now, all of my interests in terms of what I think about from day to day, are entirely concrete, particularly in terms of evidence-based medicine. It seems to me that there are some incredibly simple problems in the world about people not applying the basic reasoning and evidence-précising tools that we have.”
But if the kind of reasoning skills we need in the real world are actually quite basic, then what was the value of all that philosophical rigour?
“I suppose the irritating Oxbridge ponce perspective is probably: a good grounding in thinking really carefully about anything is helpful for thinking carefully about anything else. So I suppose to that extent, it’s useful. And the kind of brutal and unforgiving precision is something I explicitly sought out and am really grateful for.”
So the hard thing about transferring philosophical skills is putting the basics into practice, not mastering anything beyond an undergraduate syllabus?
“Absolutely. To be honest, the thing that has helped me empathise with and try to argue in a friendly and helpful way with bad reasoning and the people who engage in it, has been entirely from the real, practical work. In medicine you come across so many difficult and conflicted situations of people dong things against their own best interests or against their own stated priorities, and you get so many concessions being made to practicality by doctors, health care systems and health care professionals. The thing that’s probably most informed my strategies and approaches for dealing with irrationality has all been from the practical world of medicine, of the uneasy accord between practicality and ideal, or the way that we all basically fight our fundamentally dysfunctional personalities to do something useful with our lives.”
The rigour of philosophy did leave him with a sense that “it’s really important to have high expectations of people and very high expectations of what they’re going to say and what sense it’s going to make, and not give any quarter if they’re ambiguous, or unclear or inconsistent. Although we might take that for granted, actually there a quite a lot of paths you could take through life where nobody would ever call you up on any of that stuff at all.”
A medicine-related example, however, made me wonder whether a training in philosophy can sometimes be a risk factor for – in the technical sense of making more likely – certain forms of bad reasoning. A few years back, the editor of the leading medical journal, the Lancet, said that if he had known that the author of a controversial paper linking MMR vaccines with autism had received £50,000 from an organisation working on behalf of parents who believed their children had already been harmed by MMR, he would not have published it. One philosopher confidentially stated on a discussion group that this was bad reasoning, an example of the genetic fallacy. That is to say, arguments need to be assessed on their merits, not their origins. Hence the funding was irrelevant. But this purely logical point misses the critical psychological fact that experimenter bias is a real problem in medicine, and that conflicts of interest need to be revealed.
“One important thing to recognise always is that an extremely good tool has to be used in the right situations,” comments Goldcre. “Philosophy is one of those tools, but I’m not sure it’s the meta-tool which tells you which tool to use.
“There’s something very seductive about the absolute precision and clarity you can get in some philosophical arguments that I think can be self-flattering and a bit misleading, and that’s a real danger. Because one thing that you really learn in medicine is that having a particular professional qualification or educational background is certainly a risk factor for competence in a particular area, but it is not a guarantee.”
The competence of the citizenry is what Goldacre is trying to improve, but I wonder if he underestimates how difficult it is for people to go away and check their facts as thoroughly as he’d like them to. For instance, a health food shop near me put up a poster in the window reporting that chlorinated tap water was so toxic that a pregnant woman risked birth defects for her unborn child even if she stood close to a boiling kettle. It seems preposterous, but it quoted doctors and cited a journal as a source. I was so livid I went home and looked it up: sure enough, the actual journal paper made no such claim and what was printed was a typically scare-mongering story from the Daily Mail. Oh, and by the way, the shop sold filtered tap water at 35p a litre – bring your own bottle.
The point is, all this took time and the familiarity with the style of an academic journal paper required to make sense of it. Isn’t this too much to ask of most people, especially given the sheer number of such dodgy claims they come across?
“There are two problems here. One is are you intellectually capable? Do you have the basic intellectual horsepower? And the second thing is, are you motivated? And I think what people are generally lacking is the motivation, But to an extent it’s habit. All you’re really asking of that poster, when we talk about going to primary sources, is how do you know? If the person who is telling you that is expressing it in lay terms, then it’s reasonable to expect that they’ll be able to tell you how they know, in lay terms, And if they can’t do that, if it immediately just becomes, ‘oh well it’s in this paper here,’ then you already know that you’re in trouble.
“I think this comes back to this point you made earlier, which is that it’s often not about failures of reasoning that lead people into these blind allies, into irrationality. It’s not because of a lack of intellectual horsepower or reasoning skills. It’s because of something else. It’s because of a whole complex interlocking web of social and cultural and political and personal issues that people bring to a problem. When somebody says standing next to a boiling kettle can give you birth defects, as a pregnant woman, what they’re actually saying is, ‘I’m really freaked out by modernity. I just don’t like new stuff. I wish it could be a bit like it was when I was a kid, and I think that means rural, because I remember spending a lot of time in the garden.’ That’s a very crude, stylised version of it, but, you know this world.
“If you look at why people choose alternative therapies, there have been huge quantities of survey data collected on this. It’s got nothing to do with IQ. It’s got nothing to do with how much scientific knowledge you have. People have done studies of how much you know about medicine, how much training you’ve had in medicine – no difference between the two, people still go for alternative therapies. The one thing that consistently comes out that has been associated with people choosing alternative therapies is that you’ve had a bad personal experience with mainstream medicine. It’s an opportunity to talk about reasoning and understanding, when you critique it, but the reason why people choose that stuff has nothing to do with reasoning and understanding and everything to do with personal experience.”
Does Goldacre see any evidence that he’s upped the game even of the newspaper he writes for, in term of the accuracy of their science reporting?
“No, absolutely not. You wouldn’t want to set out doing the kind of thing that I do thinking you were going to change the world. I view my mission statement very much as to amuse and to inform, but to have what in evidence-based medicine we would call a concrete real-world outcome would be insane.
“I hope that what I and a few others have managed to do is firm up some boundaries and draw some clear lines. I fondly imagine at my most optimistic that what you see a little bit more of now is people engaging in a little more clear labelling of bullshit. People are a little more inclined to clearly label speculation as speculation, maybe.
“But more importantly, on the other side of that line, I think that people who always vaguely suspected that homeopathy was bullshit, that drug companies were a bit dodgy, that front-page newspaper stories misrepresent statistics, now understand the truth of those statements in much greater depth and detail and they’re a bit less likely to make concessions to people when they’re barraged with endless references and papers that are cherry-picked and stuff. I genuinely think, ten years ago when you had people in health care commissioning, saying well ‘we’ll have a few alternative therapies available on our services here, because maybe there’s something in it, they talk about quantum, it sounds ok, some of it.’ Now people say, ‘We know it’s bollocks, we know it doesn’t work better than the placebo effect, but some people really like it, so for practical, political reasons, we’re having it.’
“I thought the guy from Boots, his explanation in the select committee recently was admirably transparent, and the kind of thing that I’d like to see much more of. He just said, there’s no evidence that homoeopathy works but people want to buy it, and we’re a business, so we sell it.”
And that is rationality making progress, inch by inch.