//The Pie Man and Ben Goldacre

The Pie Man and Ben Goldacre

Approximately two years ago I published this Pie Man as a riposte to those who used Evidence Based Medicine (EBM) as a blunt instrument to attack homeopathy and CAM exclusively while having nothing to say about the huge swathes of ‘conventional’ medicine that lack the support of evidence. The Pie Man is merely a graphic illustration of a pie diagram in the BMJ’s handbook of Clinical Evidence which can be seen here.

Dr Ben Goldacre, medical columnist of The Guardian is no friend of homeopathy. He testified strongly against it to a select committee in parliament. Fortunately all the draconian recommendations of that committee (including banning NHS homeopathy) were safely kicked into touch by two successive governments. He has also written a book called Bad Science which included an attack on homeopathy.

In my opinion Dr Goldacre’s views slope disappointingly in the direction of determinism, scientism and statism. Nevertheless his latest book entitled: Bad Pharma: How drug companies mislead doctors and harm patients (sic) does explain why the BMJ’s pie is so unflattering of so many ‘conventional’ medical interventions. He also shows that he understands the mantra of the professional investigative journalist: Follow the money! The money in this case utterly dwarfing the money apparently ‘wasted’ by the public on CAM and by the NHS on homeopathy. By writing Bad Pharma, Goldacre shows at least that he doesn’t live in the swamp of disingenuousness that is the natural habitat of those who use Evidence Based Medicine as a weapon to attack homeopathy and CAM exclusively while having  little or nothing to say about the multi-billion dollar ‘quackery’ that is happening within orthodox medicine.

By | 2012-09-25T17:33:22+00:00 September 25th, 2012|Current Affairs|49 Comments

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49 Comments

  1. Ruth September 25, 2012 at 6:18 pm - Reply

    Well said, Doc!
    Been in orthodox practice for 30 years. That pie is quite accurate and should definitely not be ignored. Assailing this travesty should be the top priority for critics of the health care system, including ‘quack hunters’.
    The return on time and energy invested here will utterly dwarf that realized by assailing alternative sectors such as chiropractic, homeopathy, etc. This is pure common sense.

    As of 2009, medical errors in hospitals claimed at least 200,000 lives. This number is getting worse, not better. Imagine losing approx. 4 jumbo jets full of patients per week!

    http://www.scientificamerican.com/blog/post.cfm?id=deaths-from-avoidable-medical-error-2009-08-10

    (this is NOT balanced by arguments that state:”Yes, but look how much good it does!”; this does not justify the bad….which is epidemic.)

    I absolutely agree with you on this:

    >>>>>>>while having little or nothing to say about the multi-billion dollar ‘quackery’ that is happening within orthodox medicine.

    I would advise critics to go for the money, the big game, the jackpot, by assailing the *huge* target in orthodox medicine FIRST, before lashing out at much smaller (and apparently less deadly…unless somebody can prove otherwise) and *relatively* insignificant targets.

    You know I am a skeptic re: ‘alternative medicine’, but it is not possible for me to point fingers in that direction when witnessing an orthodox system that is actively derailing and adversely impacting millions of people.

    • Dr. Kaplan September 27, 2012 at 8:49 am - Reply

      Thanks Ruth,
      Yes, that is the message pure and simple. Quackhunters are strongly advised on purely ethical grounds to hunt down the real heavy weight game first. Not doing this shows incredible prejudice and lack of concern for the welfare of patients.

  2. adzcliff September 27, 2012 at 9:51 am - Reply

    Okay, I’m a Marxist. I believe strongly that the root of social injustice lies in the human obsession with wealth and property. I see a world of the ‘haves’ becoming richer and more comfortable at the expense of the rights and quality of life of the ‘have nots’. I find the idea of property repugnant, and use ‘re-distribution of wealth’ arguments to justify my petty burglary and shop-lifting. People who don’t share my beliefs find my lifestyle criminal and amoral. All this whilst protected bankers continue to get richer, and corporate fraud remains rife. I therefore argue that capitalists ‘are strongly advised on purely ethical grounds to hunt down the real heavy weight game first. Not doing this shows incredible prejudice and lack of concern for the welfare of [society].”

    Question: is it acceptable to deflect criticism of my lifestyle and profession (i.e. petty burglar and shop-lifter) on the grounds that there are greater, more impactful controversies out there? Should petty burglary and shop-lifting be nodded through uncritically until the bigger fish have been fried? Or if not, who’s ethically permitted to voice these criticisms?

    • Dr. Kaplan September 27, 2012 at 5:39 pm - Reply

      Dear Adzcliffe,

      That analogy is faulty. One must look to the reasons why the so-called ‘quackhunters’ attack homeopathy and CAM and not orthodox medicine, where I think we agree, is where the Big Game for genuine quackhunters really is.

      The self-appointed ‘quackhunters’ imo have very little concern for the health of the public. If they did, they would go after the really Big Game in conventional medicine, ideally primarily (because of the huge money and numbers of patients involved) but at least ‘as well as’ attacking what they see as quackery in CAM.

      As I’ve said many times before, most, if not all, of the ‘quackhunters’ who only attack CAM do not have concern for the health of the public . What they are concerned about is the philosophical affront, CAM and homeopathy offer to their deterministic, mechanistic and scientismic view of life. Thus they self-appoint themselves to patrol universities, hospitals and schools to attempt to rid them of ideas which they dislike. They are appalled that ‘The State’ does not support their views – eg when it kicks draconian recommendations to ban NHS homeopathy, into touch. This shows a lack of respect for those who believe that a government should be for the people, of the people and by the people whether scientimists agree with what the people want or not.

  3. Adzcliff September 27, 2012 at 6:35 pm - Reply

    Thanks for that Dr Kaplan.

    With respect, I think the analogy does work: in so far that some of us are seeing mostly well-intended people engaging in a practice that we think is ethically problematic. We then hear them defending their position, and deflecting criticism, by pointing out that there’s a far bigger problem over there, and until we solve or comment on that, we have no right to criticise what they do. (We also hear them telling us what we think and why we think it, but that’s an aside.)

    • Dr. Kaplan September 27, 2012 at 6:39 pm - Reply

      We will have to agree to disagree, Adzcliff. If you really cared about the people being ripped off by quacks, there is no excuse whatsoever for not going for the REALLY BIG GAME and Ben Goldacre shows who they are. I think the self-appointed ‘quackbusters’ care about their precious little post-modern ideas and how to enforce them on the people and don’t care much about patients or their suffering at all. Their silence about the BIG GAME quackery that Ben Goldacre has the honesty to expose, shows this quite clearly imo.

  4. Adzcliff September 27, 2012 at 7:25 pm - Reply

    I like to think I do ‘go after’ your ‘big game’ as well (perhaps you’re talking rhetorically), and if you could point me to a blog where drug company apologists are denying or somehow defending their shameful practices, I’d gladly join you in debating them. However, I’m not sure if/where these blogs exist – primarily because Big Pharma probably prefer to keep silent about what they know they do badly (and don’t look good arguing the anti-science agenda favoured by CAM); and don’t need to defend what they do well. As for ‘Bad Pharma’: my copy arrived today, but I’ve still got 250+ pages of ‘The Rational Optimist’ to get through. No spoilers please!

    • Dr. Kaplan September 27, 2012 at 8:22 pm - Reply

      Yes, Adzcliff you might be right on the money this time. Indeed the BIG GAME quackery continues unabated because they use what they do well to hide what they do badly. And as they are not subjected to a relentless and vindictive attack in the popular press, why should they draw the public’s attention to their weaknesses by ‘defending’ them? I have never met a CAM practitioner or homeopath who was ‘somehow defending his/her shameful practices’. Maybe one or two exist but they great majority in my experience are not ‘shameful’ at all about what they do. On the contrary they spend years and years studying and dedicate themselves to serving others for a very modest income. Nowt to be ashamed about there.

  5. adzcliff September 27, 2012 at 9:46 pm - Reply

    Only I’d add that many of the peddlers of Big Pharma misinformation are medical science graduates to varying degrees, and confidently believe in the cause they’re pushing onto health professionals and patients. Personally, I’m a fan of the ‘No To A Free Lunch Campaign’ and actively avoid drug industry sponsored events; but when I get to chat with drug industry employee friends socially, I think they find me unnecessarily over-informed and a bit of a conspiracy theorist than needs humouring. And I should add that I’ve not met one who isn’t, essentially, a decent person.

    Thanks

    • Dr. Kaplan September 28, 2012 at 9:56 am - Reply

      Okay Adzcliff, I too have not been a fan of the Free Drug Lunch brigade. However I find the average CAM practitioner. a very different animal from the average drug rep The former are dedicated professionals and the latter dedicated salespeople. In the former there are inevitably years of hard work and study whereas in the latter one senses the influence of the corporate sales team. Some may be decent footsoldiers for Big Pharma, but footsoldiers for Big Pharma they most certainly are. CAM practitioners tend to be hardworking health care professionals, totally dedicated to what they do, albeit for generally very modest incomes.

  6. Bill himself September 28, 2012 at 1:06 am - Reply

    I’m amused by Dr. Goldacre’s comment on badscience.net/2012/09/holy-crap-i-just-touched-my-new-book/ “buy one right now, before they all get seized and pulped.”
    I’m sure the book will be well received.

    There should now be a rush of new activism from the skeptic websites aimed at getting orthodox med to put its house in order, even-handedly laying into big pharma with all the avid devotion they have for such things, and fully informing people that much of what they have been told about results in peer-reviewed journals cannot be trusted (again).
    Will this change [WP:RSMED], I wonder?

    So, a quick trawl to see how well Skepticism stands up when Pharma itself is criticised, just to confirm that there is in fact no smidgen of bias whatsoever in their scientific approach to such matters, and that their belligerent attacks on Alt Med have nothing to do with trying to stop the competition.

    Credit so far goes to David Colquhoun on dcscience.net for a positive reception of criticism, even if he cannot get his logic right in other respects

    But let’s see, as at 28 September, skeptic sites are not exactly brimming with enthusiasm, perhaps reserving their position in case the book goes down badly with the general public

    Quackwatch:
    Looking for Bad Pharma in entire archive
    – Found 0 matches in 0 files
    quackometer:
    er, no review yet..
    senseaboutscience.org:
    erm, no, nothing so far
    randi.org JREF
    no, too busy making bogus attacks on alt med
    No results found for
    site:www.merseysideskeptics.org.uk/ “Bad Pharma”.
    Your search –
    site:www.1023.org.uk/ ‘Bad Pharma’ – did not match…

    Oh, well, I suppose they’ll get around to it later on …

    Then there are some petty & juvenile remarks by bigPharma groupies & fan-boys on the Amazon page.
    Elsewhere, just a few non-committal remarks, mostly wingeing that Alt Med proponents may have the temerity to suggest that if “the science” is deceitful and a tad unreal concerning orthodox Med, then it may also just possibly be deceitful in negative findings concerning AltMed also. (Just sayin’.)

    And how could that be, without the world coming to an end?

    • Dr. Kaplan September 28, 2012 at 10:02 am - Reply

      Thanks for that highly informative comment, Bill!
      I guess a lot of these organisations are a bit embarrassed when one whom they thought was one of their own, chooses to attack the real quackery in medicine. It’s quite something to be ‘skeptical’ about CAM and trashing it as dishonest etc while conveniently turning a blind eye to the incontravertible and often horrific QUACKERY ON A GRAND SCALE fingered by Ben Goldacre in this book. Of course all this makes perfect sense when you see through the gossamer-thin mask of ‘concern for the public’ that these people wear.

  7. Andy Lewis September 28, 2012 at 3:45 pm - Reply

    Hello Brian

    Just wanted to say that I have not published a review of the book yet as I prefer to actually read books I have opinions about.

    How about you?

    • Dr. Kaplan September 28, 2012 at 5:48 pm - Reply

      My post is obviously not a review. There have been many articles written about Goldacre’s book, including one by the author so the general content is pretty well known. One of your fellow skeptics felt free to cite an entire Goldacre Guardian article here. Note the term ‘rubbish evidence’ Andy – and they are not talking about homeopathic trials either!

      When you have read Bad Pharma, please be sure to let me and my readers know when for the benefit of all sick and vulnerable patients in this country, you publish an appropriate evisceration of the BIG GAME QUACKS of BIG PHARMA (on your website dedicated to exposing quackery) , won’t you Andy.

  8. Ruth September 28, 2012 at 11:09 pm - Reply

    Big Pharma, while having obviously contributed many vital new drugs (among the piles of useless ones), is pernicious at marketing, litigation (a lot of it related to stalling patent expiration), oft-questionable trial design (e.g., in the USA, head-to-head comparisons are not required for registration, unless clinically unavoidable), price gouging (in the USA, Medicare is *not* allowed to negotiate prices directly with them, and there are no price controls) and *hefty* PR in multiple formats (‘engineered consent’; Bernays is still an important influence, as are Von Clausewitz’s Principles of War and the philosophy of Sun Tzu), especially in direct-to-consumer advertising. The list is long.

    Some claims made by critics, e.g., that Pharma suppresses cures for cancer, etc., are very likely untrue, based on my observations, interactions and prior, conscience-suppressing career experience with them.

    They are powerful and employ lobbyists aplenty in Washington DC; they make sure the pols are bought and paid for.

    Never underestimate their ability to ‘create’ new diseases for new drugs.

    We physicians have a responsibility to advocate for patients and thus be aware of the data (even unpublished data is actually reviewed by the FDA, but it is a vexing problem) and prices (medicalletter.org does quite a good job with this). Few do so, relying instead on hype and reps ‘bearing gifts’.

    Their stock prices have done particularly well in the last few years, and are very popular because of the ‘healthy’ dividends paid from the enormous free cash flows. These companies do well for their main customers….the shareholders.

    http://stockcharts.com/freecharts/gallery.html?s=%24drg

    • Dr. Kaplan September 29, 2012 at 1:41 pm - Reply

      Indeed Ruth,
      Thanks for making the mechanism of how they achieve this quite clear. Everything you say strongly brings home the utter hypocrisy of those who trash CAM and homeopathy while having nothing or very little to say about the matrix spun by Big Pharma and Big Business. What is also incredible about this hypocrisy is that many of these guys who exclusively attack CAM and homeopathy for being ‘quackery’ are ostensibly ‘left wing’ (some even Trotskyites) who seem to care little that their views and actions must be receiving standing ovations from the very sort of people they apparently cannot stand – ie arch capitalists!
      I sometimes think that the whole ‘quackbusting campaign’ against CAM might be quite a subtle subterfuge which aims to distract attention away from the REAL BIG GAME QUACKERY that is happening in so-called ORTHODOX MEDICINE. This is not to say that the self-appointed ‘quackbusters’ realise this of course. They have their own scientismic reasons for hating CAM but that they must beloved by Big Pharma is not in question.

      The object of this post about Ben Goldacre’s book (or at least the revealing title and what he himself has written about it) is that although he is pretty scientismic and a bit of a statist, he is at least less than hypocritical when it comes to exposing where the BIG MONEY QUACKERY resides in medicine – in ‘Conventional Medicine’, as Ruth has made abundantly clear on these pages many times.

  9. Andy Lewis September 29, 2012 at 12:56 am - Reply

    I see.

  10. Bill himself September 29, 2012 at 12:57 pm - Reply

    Oh, well, I suppose they’ll get around to it later on …

  11. David Eyles September 29, 2012 at 1:03 pm - Reply

    For the record, I have not yet read Goldacre’s new book. But I will say that I have not been alone, amongst those who watch these running battles between homeopaths and those who oppose them, in forming the opinion that Goldacre is something of an anomaly.

    If you read Bad Science carefully will see that he has always been much more concerned with Big Pharma than he has with homeopathy (which he regards as if it is nothing more than a trivial placebo). His Guardian articles that I have read suggests that he is also more concerned with reading and interpreting meta-analyses etc properly, and in pointing out the errors in statistical interpretation so regularly perpetrated by the popular press.

    And whilst he seems quite prepared to take the mick out of homeopathy with the occasional witty aside, he lacks the obsessive venom of many so-called ‘skeptics’. His only really determined attack on homeopaths was at the House of Commons Scientific thingy. Thereafter he has gone quiet; and as Brian has suggested, he has presumably become bored with shooting at rabbits and has moved on to large calibre elephant hunting.

    Sometimes it pays to listen for the dog that did not bark, and in this case I note that Goldacre has not, to my knowledge, overtly supported Sense About Science and other pharmaceutical industry lobbying organisations. He seems at a distance from Singh et al. And given this latest book, it is fairly easy to see why he has maintained and possibly even increased that distance of association.

    Bill has provided us with an excellent summary, so far, of the ‘Skeptics” (lack of) response. I have no doubt that over the next few weeks and months we will see a gradual trickle of lame statements made by these characters, who will be hoping that the whole thing will be forgotten and in the time-honoured socialist fashion, they can spin their way out of it and ‘move on – nothing to see here’.

    I also notice with amusement Andy’s Freudian slip of the syntax and his implied admission that he prefers to form an opinion BEFORE he reads a book. Yes. Quite. That’s what we have been saying about you for some time Andy. It’s just part of your little problem isn’t it?

    It’s easy to see where David Colqhoun is coming from. What you see is what you get. And in his case it is a pharmacist turned pharmacologist who has spent decades chasing molecules from one side of a cell memebrane to another. His work has undoubtedly been funded directly and indirectly by the pharmaceutical industry over the years and so it is understandable that he is going to rail against homeopathy. This he does regularly, with all the vigour and verbal weaponry that only an accomplished academic can muster. But I can forgive him, for he too is an anomaly. Alone amongst the ‘Skeptics’ he is the only scientist who has actually been there and done it. I could probabaly listen to David for hours, if not days, when he is speaking on his own subject of ion channels. In that subject his work is important and, in places, seminal. It’s only when the subject of homeopathy comes up that the red mist descends and he does the equivalent of donning the witch-finder’s cloak and enters the village on horseback looking for vulnerable old women whose only crime is to help out at childbirth and attempt to cure warts. Science is left behind in his search for toads, black cats, the seven-runged philosopher’s ladder and those who will tell him that their crops have failed and their cow has gone down with the ague. It is sad but instructive for the rest of us to witness an otherwise first class mind slip so easily from the rational into blind zealotry (and presumably back again with scarcely a pause for breath).

    Goldacre is very good at attracting publicity. He seems to revel in it. But for his sake, I hope he has referenced every sentence and his lawyers have been through it with a fine tooth comb. This book has been very well publicised and its thrust is clear even before we have read the thing. The whole situation has the feel of BCA vs Singh about it in the sense that it is almost as if Pharma is being taunted into litigation. And Pharma are much, much bigger and richer than the chiropractors. Their lawyers will be better than razor sharp.

    • Dr. Kaplan September 29, 2012 at 1:50 pm - Reply

      Thanks David,
      Always good to read your fine writing and always enjoy your metaphors.

  12. adzcliff September 29, 2012 at 4:11 pm - Reply

    Okay, so Goldacre is an anomaly?

    Perhaps then so is ‘quack-busting’ pharmacologist, and skeptical blogger David Colquhoun when he wrote this in just the last few days:

    “…the alt med fantasists are increasingly irrelevant. An army of nerds has arisen and exposed their delusions, and the harm that they sometimes do,
    The problems of real medicine seem to me to be much more important. Although Ben (and I) have been writing about it for years, it hasn’t stopped the accusations that we are in the pockets of Big Pharma.”

    Perhaps so is neuroscientist, editor/contributor to Science-Based Healthcare and Scientific Review of Alternative Medicine, medical advisor to ‘Quackwatch’, and president of various American sceptical organisations wrote this in an entire article on GSK fraud (July 2012):

    “The GSK settlement, in my opinion, is just the most recent evidence that industry cannot be left to their own devices without proper monitoring and regulation. […]But companies are chiefly motivated by profit, and when billions of dollars are at stake there is a huge motivation to bend the rules. We take for granted that companies are going to distort information when marketing their products to the public.”

    We might also want to take note of Simon Singh’s vocal support for cardiologist Dr Peter Wilmshurst, when being sued by medical device company NMT Medical for publically questioning their representation of data for a cardiac device. Not Big Pharma granted, but still corruption and bully-boy tactics within the (con) medical industry.

    This is beginning to look like ‘quack busters’ are generally interested in the problem unevidence-based healthcare where ever they find it. Unless of course this whole argument rests on whether a certain Andy Lewis has ever dedicated a whole article to the problems of Big Pharma…

    • Dr. Kaplan September 29, 2012 at 7:44 pm - Reply

      Adzcliffe,

      This is not about individuals:
      Just look at some of the organisations that have been set up specifically to trash CAM and have nothing to say about the grand scale quackery in orthodox medicine that totally dwarfs the money involved in CAM.

      Just look at the PR influence on the media of these organisations. See anything like the equivalent attacks on BIG PHARMA QUACKERY? That will be the day.

      I suggest the amount of attention should be exactly proportional to the amounts of money involved. And when I see homeopathy and CAM trashed by an effective PR machine and very little on the QUACKERY OF BIG PHARMA, I see something very ugly indeed. That ugliness is what this ‘argument’ is about. Not Andy Lewis and his articles in which I have no interest whatsoever. That this discussion exists is because I like to answer challenging questions about my own position in the philosophy of medicine and libertarian politics. Until it gets too repetitive and tiresome of course.

  13. David Eyles September 29, 2012 at 11:05 pm - Reply

    Brian,

    You raise an interesting suggestion that the whole of this anti-CAM charade is just a tactic to divert attention away from the mess of the widespread fraud, overselling, fiddling of results in trials etc as conducted by Bad Pharma. You may have a point.

    But it begs the question: Who gains from such a plot and what exactly do they gain?

    The answer seems to me to fall into two parts. The first is the pharmaceutical companies themselves, assuming that the ‘plot’ works in their favour. This problem has been brewing for a number of years now and it was only a matter of time before the truth broke into the wider world. Many in the medical professions (including in CAM) have been aware for some time of the steady drip, drip of bad stuff coming out in papers, reviews, meta-analyses, actual arrests made because of corruption and fraudulent data etc – to say nothing of the very ‘pie man’ graph which you persistently showcase on this blog. So a campaign to create lots of bad news elsewhere is, on the face of it, not a bad one in which to ‘bury bad news’. Almost any form of CAM is an easy target, but homeopathy because of the dilutions paradox, lends itslf to attack, especially from the sections of the medical community which are part of the ‘Establishment’.

    If my memory serves me correctly, this government has been threatened by a number of the largest pharma companies that they would withdraw their research base from this country if the ‘special relationship’ between pharma and the NHS was compromised. In other words, if the NHS cut its drugs bill by the use of generic drugs instead of branded ones. This put the research community into panic and dire warnings were issued. As far as I am aware, this seems to have gone quiet, so I have no doubt that ‘a form of words’ was carefully selected between the DoH and pharma which calmed jangling nerves on both sides. The lessons to be drawn from this is that the university research departments, amongst others, will immediately close ranks in order to preserve their research grants, a huge proportion of which is provided by pharma.

    The gains made by the shock troops of the skeptic world are a little more diverse. It depends upon just how high up the skeptic hierarchy they operate at; and how close they are to the principal fount of most things skeptic – Sense About Science. This organisation has direct links historically with pharma as well as the biotech industry. Whilst some funds have come to them directly from pharma, much seems to come via the Royal Colleges – i.e. the Establishment.

    Thereafter, the money is dissipated to ‘needy’ causes such as Simon Singh during his libel defence. I notice that the Nightingale Collaboration has benefitted from ‘seed funding’ from Singh. So the money appears to travel from one to the other and so on.

    At this level, the whole thing appears to be completely watertight and deniable. For example, Singh consistently denies receiving money from the pharmaceutical industry (as does Andy Lewis). There is no reason why we should disbelieve them. By the time the money arrives from whatever source, it has passed through so many hands that it is crisp and snowy white – well and truly laundered. By the same token, the pharmaceutical industry can honestly say that they have given no money to this bunch of riff raff. They too are not lying. But it should be noticed that when the money is needed, the money just seems to arrive – from somewhere.

    But what about the lower orders – the motley collection of adolescent, spotty and malignant bloggers who chime in so quickly whenever there is an opportunity in CiF or the Telegraph or whatever?

    I contend that for these, no payment from any source is necessary. It is enough to give this sort of skeptic a cause – anything that they can hate – and then they’re off, spitting bile and viciousness into the internet, protected by their anonymity.

    In the interests of even-handedness I should mention that that it is not only the haters of CAM that do this. The campaign of vilification that has hit journalists who have discussed, in very even-handed terms, the work at Columbia University that has failed to find links between two viruses and ME, has been quite horrific; and as far as I can tell is worse than anything homeopaths have experienced from the skeptics.

    But we also need to consider what happens to the pharmaceutical industry if this little campaign, which they may have encouraged or funded or simply turned a blind eye to, goes wrong for them.

    Supposing the homeopaths fight back? Supposing the campaign of vilification is so successful in its coverage that it actually revolts the public (who are much better educated and capable of seeing through spin and bullshit than the patronising skeptics think). Supposing the public spot the inherent hypocrisy in the skeptics’ case and vote with their feet and carry on demanding homeopathy from the NHS regardless? This would put the campaign into deep trouble and rebound upon the very people who stand to gain from it. It would discredit those who have fronted the campaign. I suggest that some of these things have already started to happen.

    I am in two minds as whether such a campaign of obfuscation has actually been deliberately conducted by the pharmaceutical industry. If they have done so then they are guilty of strategic misjudgement on a grand scale. If the fight against CAM was started by them for that purpose then they started too early and too little. For Complementary Medicine has worked hard in the last five years and we are now seeing more and more good, high quality research coming through. This is, little by little, confounding the skeptics case that ‘It isn’t science’. And now, finally, the arrogance of the pharmaceutical industry’s own egregious behaviour has left it high and dry – and exposed to public censure.

    This finally brings us back to Goldacre who has done us the service of collating a good deal of the problems caused by the pharmaceutical industry’s abject failure to keep its own house in order. Not only has Goldacre published it in his ‘EBM-Lite’ style, but he has also taken it to the very heart of the Establishment – exactly where it will hurt pharma most.

    In the end analysis, it does not matter if the skeptics have taken pharma’s shilling or not. When Josef Stalin realised that members of the bourgeousie intelligentsia were enthusiastically embracing socialism, he described them, contemptuously, as ‘Useful fools’ and then crushed them in his purges.

    And finally, my apologies for such a long ramble,

    David.

    • Dr. Kaplan September 30, 2012 at 11:55 am - Reply

      David, A ramble from you is worth two skeptics in the bush. Actually many more. What you say rings very true indeed. I cannot prove that the attack on CAM is a deliberate distraction from the BIG GAME QUACKERY in conventional medicine. It just occurred to me that in a recession when there is less money around, they realised that they needed a much bigger share of the smaller pot available in order to keep their shareholders happy, so thoughts of attacking the ‘opposition’ may have occurred to them. And yes, ‘following the money’ has never been an easy route but thanks for some of your insights into how money is being used by certain organisations dedicated to denigrating CAM whilst have nowt to say about BIG GAME QUACKERY in conventional medicine.

      My point remains simple: People who actually care about suffering patients clearly understand that the BIG GAME QUACKERY being fingered by Goldacre utterly dwarfs any alleged quackery by homeopaths and CAM practitioners. We are talking about factors of many hundred or perhaps thousands. From this I deduce there are two types of commentators who choose to use EBM to attack CAM exclusively while apparently seeing the BIG GAME QUACKERY of Big Pharma as being of little interest to them.

      1. Those who have the interests of Big Pharma at heart – for whatever reason.
      2. Those who care about their own personal ideology more than they do about suffering patients and their wishes or democracy or liberty. These ‘political types’ have always been with us, always ready to trump the choice of the ‘ignorant’ masses with what seems rational to them.

      As long as human beings are imperfect, there will always be arguments for extending the power of government to deal with these imperfections. The only logical stopping place is totalitarianism — unless we realize that tolerating imperfections is the price of freedom. Dr. Thomas Sowell

      This is what those who called for a ban on NHS homeopathy failed to appreciate.

  14. adzcliff September 30, 2012 at 9:26 am - Reply

    I should add that second quote was by Steve Novella – must’ve lost his name in the edit…

  15. Ruth October 1, 2012 at 1:42 am - Reply

    Big Pharma is but one component of the overall ‘Big Game’ concept.
    There is not much angst about CAM within Pharma companies. It hardly threatens their huge footprint in any meaningful way. Some have invested in it. Also, some prestigious clinical organizations, such as The Mayo Clinic, routinely include CAM advice for many disorders.
    http://www.mayoclinic.com/health/insomnia/DS00187/DSECTION=alternative-medicine

    https://store.mayoclinic.com/products/books/Details.cfm?mpid=61&trkid=21242S198705050&mc_id=comlinkpilot&placement=bottom

    In the USA, insurance companies (including Pharmacy Benefit Managers), hospitals, related services (such as pathology and clinical chemistry labs), and physicians play *huge* roles in the overall equation of highly dysfunctional care (not business, where we are number ONE!). We rank a lowly 37th (NEJM, Jan 2010) in overall quality of care. There is a correlation. I see it every day.

    The bottom line is money, not less illness. Illness is the substrate for secondary and tertiary care. Cardiologists would have a collective heart attack if a hugely preventive panacea emerged for cardiovascular diseases. Hospitals would become bankrupt if patient traffic decreased by a relatively small fraction.

    Careful of selectively assailing Big Pharma as a principal culprit. Without the others listed above, they would not be so aggressively enabled. It is all a combined effort, based on the principles of self-organizing behavior around common interests. Always follow the money.

    Ruth

    • Dr. Kaplan October 1, 2012 at 9:17 am - Reply

      Hi Ruth,
      Thanks for that and for those interesting links – esp. the one to the Mayo Clinic’s Book of Alternative Medicine. Opponents of CAM here, would be horrified if such a book (eg one associated with a major private conventional medical clinic) appeared here but then again the USA has always been much more ready to hear ‘alternative’ and new opinions on just about anything. Well perhaps they were not so keen on communism 😉
      Yes, agreed too that the hustle is not confined to Big Pharma. What is clear to me is that the prime beneficiaries of the way healthcare works in the USA includes many various groups and interests with one quite important exeption – the patients.

  16. Andy Lewis October 1, 2012 at 10:36 am - Reply

    The level of hypocrisy here is quite astonishing.

    Some like me merely states the obvious – that homeopathy is a pseudoscientific hangover from prescientific medicine and should not be funded by NHS – and all I get is a continuous smear attack.

    Eyles accuses people like me of “spitting bile and viciousness” whilst calling people like me “riff raff, adolescent, spotty and malignant bloggers”. Anyone spot the irony?

    And Eyles then smothers his little rant with absurd insinuations that Pharma funds people like me and Singh.

    Descent into conspiracy theory and smear – rather than discuss science. You say “I like to answer challenging questions about my own position in the philosophy of medicine and libertarian politics”. We see no evidence of that. As soon as your position is challenged you start screaming that I have no right to challenge you.

    Dr Kaplan – you ought to be ashamed of yourself for allowing the debate to sink to such depths.

    • Dr. Kaplan October 1, 2012 at 11:30 am - Reply

      Andy,
      I am sorry you don’t approve of my moderation of the debate. In my defence, some of your ‘skeptic colleagues’ eg D. Colquhoun have even complimented me on publishing the comments of people who strongly disagree with my views. However I am also honour bound to publish other commentators views of your comments.

      Regarding your allegations of me ‘screaming that I have no right to challenge you.’ Are you serious? Where exactly do I say this? Surely the fact that I both publish and answer your repetitive questions on my site shows that I do indeed respect your right to ‘challenge’ me. I just think you are wrong and illiberal (for which I have given clear reasons) and I don’t consider saying that to be an ad hominem attack.

      I have pointed you in the direction of the philosophy of medicine that is the ethos of my approach in healthcare – but you expressed no interest in reading it even though the work of the erudite E.K. Ledermann is based on a solid foundation in medicine, psychiatry and Kantian epistemology.

      The idea of people like you and the anti-CAM agitators (who have nothing to say about the BIG GAME QUACKERY in orthodox medicine) accusing me of making ad hominem remarks is utterly ridiculous. It can be explained only by Freud’s theory of projection. What we really dislike about ourselves, we project on to other people and then attack those people for it.

      The bottom line of our interaction will always be represented by my challenge to meet you in public debate. Your reasons for refusing this ( that I am not a serious enough commentator on these matters) is utterly risible in the light of the thousands of words of yours that have appeared -with my consent- in the comments section of this blog.

      A public debate would reveal what a relatively neutral audience thinks of our opinions on homeopathy, CAM, the NHS and authoritarian and libertarian politics. Forgive me if you find my answers to any further comments/questions from you on my site to be on the succinct side as we do seem to be going around in circles now.

  17. Andy Lewis October 1, 2012 at 9:38 pm - Reply

    Happy to leave the obvious evidence of what I say about our discussions for all to see.

    • Dr. Kaplan October 1, 2012 at 10:01 pm - Reply

      Not sure I understand that sentence Andy. But if it means: Let what we have said in the comments section of my posts represent our views, then I’m certainly okay with that. Too bad about a live debate then, but at least it will always be clear to readers that I was up for it and you were not.

  18. Andy Lewis October 1, 2012 at 11:21 pm - Reply

    I am always up for live debates. But as you well know Dr Kaplan, they have to be with people who want to debate.

    People who are happy to smear their opponents and block discussion are not worthy of debate.

    • Dr. Kaplan October 2, 2012 at 8:40 am - Reply

      If that were the case, I would come off very, very badly in the proposed debate, wouldn’t I Andy? You have written thousands of words here and spent considerable time doing so. A couple of hours of live debate would be an ideal opportunity to show me and my alleged ‘blocking’ tactics up in front of an audience – a neutral observer might think. A more plausible reason for you declining, is that it is you who would be exposed.

      As to: ‘People who are happy to smear their opponents and block discussion’
      Psychological Projection: Psychological projection or projection bias is a psychological defense mechanism where a person subconsciously denies his or her own attributes, thoughts, and emotions, which are then ascribed to the outside world, usually to other people. More here.

  19. Andy Lewis October 7, 2012 at 8:21 pm - Reply

    I have now read Goldacre’s new book and may well write about it.

    Have you read it yet Dr Kaplan? Or are your opinions still based on what you believe is in the book?

    Was also delighted to see that I was mentioned in the books acknowledgements. Very few homeopaths mentioned. Actually, none.

    • Dr. Kaplan October 8, 2012 at 9:42 am - Reply

      Well congratulations to you Andy! Good of one of your ‘co-skeptics’ to include you in his book. Goldacre differs from you in that he realises that the real BIG GAME QUACKERY in terms of sheer numbers of patients and the money involved is in orthodox medicine. As he says on the first page: “Medicine is broken,” and “the people you should have been able to trust to fix problems have failed you.” Medicine is broken. Strong words hey Andy? And by ‘broken’ the good Dr Goldacre is not talking about a small NHS budget for homeopathy – that’s for sure. That is the point of this post: Anybody who cares about the nation’s health must focus on the big game quackery in medicine rather than on CAM and NHS homeopathy. Those who eschew eviscerating the BIG GAME QUACKERY in orthodox medicine in favour of trashing homeopathy and CAM clearly show that what they care about is espousing their own scientismic, deterministic and intolerant ideology – not the physical or psychological health of the citizens of the UK. The publication of this book is embarrassing for those who use EBM as a blunt instrument to attack homeopathy and CAM exclusively.

      I think I’ve made this point many times Andy. I have little interest in repeating it to you any more. Nor is this debate leading anywhere. You have declined to meet me in front of an audience that might shed some light on who is making the better case here. This is apparently on the basis that I am somehow not qualified to debate this issue with you.This is risible and you know it. If it were true, a live debate would be just the place to make me look foolish. Apparently my qualifications of an MBBCh, FFHom in homeopathy and 30 years experience in medicine over which time I have seen thousands of patients, do not match your obviously superior qualifications which I am still waiting for you to provide.. Provide real reasons for not being prepared to meet me in live debate or don’t expect me to answer any more of your questions which are clearly designed to needle me rather than to stimulate any form of useful debate. Otherwise the last statement in this conversation is going to be:

      FACT: I have challenged you to a live debate and you have declined.

      All readers may draw their own inferences from that simple fact.

  20. Andy Lewis October 8, 2012 at 11:15 am - Reply

    If you actually read Goldacre’s book rather than just speculate about it, you would see that the book actually is calling for more evidence based medicine, not a retreat into cultish medicine like homeopathy.

    Your blinkers prevent you from seeing that you are a very clear example of why medicine is broken. If homeopathy can survive in the medical community then something is very wrong. That is why I write about it and it is somehting you will never understand.

  21. Andy Lewis October 8, 2012 at 11:23 am - Reply

    And to answer your question for the umpteenth time. I do not take you seriously. You are interesting because of the way you defend your beliefs not that is a real debate to be had. You block all attempts to look at evidence, try desperately to state that the only question that matters is one of liberty and choice, but then refuse to look at the limits of choice and how that might impact homeopathy. And when pushed to engage on these issues, you revert to personal attack and attempts to deny people like me have a right to examine such positions.

    That is not debate, it is hiding inside an intellectual black hole. As such, a debate would just be pantomime.

  22. paul October 8, 2012 at 11:18 pm - Reply

    perhaps if one were to look under contradiction, haughty and cowardice? one might understand where he’s coming from?

  23. adzcliff October 8, 2012 at 11:50 pm - Reply

    Paul, I’d take another look at that post.

    It might be argued that it’s one of the most unkind, vindictive and bullying posts that’s appeared on this blog. At around a 1000 words of insult (glib, shallow, superficial, aggressive, manipulative, mean-spirited, officious, petty, mean, stingy, financially untrustworthy, narcissistic, high-handed, haughty, disingenuous, greedy, selfish, demonic, parasitic, spiritually dead, poisonous, an emotional vampire…), it makes me wonder how many more pejoratives you own to have someone believe they’re beneath contempt…

    • Dr. Kaplan October 9, 2012 at 8:46 am - Reply

      Yes, I think you have a point Adzcliff. I’m in favour of freedom of speech but I’ll take that (mainly cut and pasted) comment down. Might have been better to suggest ‘bullying’ tactics here and simply give the reference (below). I have commented on ‘psychological projection’ in the detractors of CAM. It is the ‘skeptics’ who make ad hominem attacks. I don’t consider terms like ‘authoritarian’, ‘deterministic’, ‘mechanistic’ etc. (all terms I have used). ad hominem attacks at all. However I have certainly been subject to insulting remarks by ‘skeptics’. Anyway a reader of these posts can make up his own mind about the comments made on this blog.

  24. adzcliff October 9, 2012 at 9:17 am - Reply

    Thanks for the reply Dr Kaplan, but I’m not sure it needs taking down necessarily. Unless, on reflection, Paul wants it withdrawn, or Andy’s feeling particularly offended by it, I think it provides a useful illustration of how far some folk will go to attack the player and not the ball…

  25. adzcliff October 9, 2012 at 9:22 am - Reply

    …and if it’s your view that ‘it’s the skeptics than make the ad hominem attacks’ (I think that’s an over-simplification of the issue), then deleting Paul’s post would certainly help preserve that view.

    Thanks.

  26. paul October 9, 2012 at 5:31 pm - Reply

    Yes upon reflection my post was made without much thought and included much that was inapropriate and apologise for placing it on your blog. I agree with Dr Kaplan that readers should make up their own minds about the behaviour and comments made.

    It is though interesting to note that he is delighted to get a mention in Mr Goladacres book, and that his own site clearly states it is a boon to weak minds!! I am sure it is a great boon to all the weak minds who post there.

  27. paul November 4, 2012 at 5:06 pm - Reply

    adzcliff,
    it one reads the approach by the skeptic movement it is possible to see that the whole basis of their argument is to attack the players whilst shouting at the referee “I played the ball” and then becoming indignant when this is then pointed out

  28. adzcliff November 15, 2012 at 11:01 pm - Reply

    Thanks Paul.

    ‘The whole basis of their argument’? I’m not sure what you mean? Do you have any examples?

    Adzcliff

  29. Johnny November 16, 2012 at 7:43 pm - Reply

    Just wondering how Andy Lewis’s wife didn’t die of embarrassment when he turned up to a skeptic party (what a laugh that must have been) as a Rastafarian. How embarrassing!!

  30. Ben Goldacre's Bad Pharma December 27, 2012 at 3:46 pm - Reply

    […] Smith has explained in this thought-provoking video response to Bad Pharma. It’s also not hard to find reviews of the book by quacks who seem to be using it for exactly that purpose. I’m sure that […]

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