Ben Goldacre’s recent Radio 4 programme seeks to place current food faddists (I assume he’s thinking of Gillian McKeith and Ian Marber) in the long tradition of American snake oil salesmen and mountebanks. His programme discusses the history of these travelling showmen and also of food faddists turned businessmen such as Kellogg, Graham and the seller of Hadacol. It’s a good programme, and I recommend it.
However, it’s disingenuous of him to let his listeners infer that there are only two kinds of people providing health services – scientists and quacks. He’s not alone: most of the sceptical commentators out there make a clear distinction between the good and the bad, the sheep and the goats, the disinterested practitioners of empirical science and the cynical and opportunistic pedlars of sugar-pills. In fairness to Ben Goldacre, he’s more a much more subtle thinker than that, but even he tends to simplify the message to make it easy to convey.
It seems to me that there is no neat correlation between sincerity and science, and that it’s more useful if we consider that there might be four categories of people offering to help us with our health.
To make things snappy, I’m calling them the Good Doctors, the Celebrity Surgeons, the Profiteering Quacks and the Sincere WooWoos.
- The Good Doctors are scientifically-minded as well as scientifically-trained, they are men and women of integrity who frequently work in shitty areas and research shitty diseases
- The Celebrity Surgeons specialise in “diseases of the rich”, as Tom Lehrer put it and can be found practising perfectly good plastic surgery in Florida and dentistry in Harley Street. Big Pharma can come into this category of profit-motivated scientists.
- The Profiteering Quacks are the ones Goldacre really dislikes – they don’t let truth, logic or inadequate training stand in the way of getting tv deals and book deals and products on shelves – they know it makes cents.
- The Sincere WooWoos are good people let down by a lack of critical thinking. They are troubled by modern medicine, particularly the cynical and profitable kind, so they they train as homoeopaths or acupuncturists or naturopaths, and then the Hawthorne effect and the Placebo effect builds them an anecdotal evidence base which reinforces their sincere belief in their success
The problem is that the debate ends up at cross purposes. Too many sceptics restrict their criticism to the profiteering quacks without addressing the question of what is troubling about modern medical and surgical practice. And likewise, far too many alternative practitioners throw out the baby of medical science with the bathwater of the profit-motive.
People like Ben Goldacre and John Diamond rightly argue that Profiteering Quacks are dangerous and leech on the vulnerable and insecure simply to make money out of them. But those of us who defend science and evidence-based medicine need to accept that the group that I have flippantly categorised as “Celebrity Surgeons” do exactly the same thing, the only difference being that their interventions which are frequently unnecessary do in fact work – think of Jordan’s boobs and Michael Jackson’s nose if you doubt what I’m saying.
It isn’t enough to attack the woolly-thinking which leads trusting people to accept alternative practices like acupuncture and homoeopathy, we must also understand what it is about these practices which attract patients and practitioners, and what it is about “scientific” or “western” practices” which repel them.