This reviewer tends to get a little bit squirm-ish each time she spends time on a book which is exposing some combination of shenanigans and cognitive deficiencies--as Bad Science does pretty well--when she simultaneously reads stuff like "Includes a brilliant, shocking and previously unpublishable new chapter" (about Matthias Rath, a prominent ARV drug denier), and "The Sunday Times Top Ten Bestseller" on the cover. A more honest analysis of anything like this should bring a little more understanding of why this all happens, for which various authors could start to look quite close to home (In other words--the profit motive and marketing just gets everywhere, don't you know . . . ).
Ben Goldacre makes a whistle-stop tour of questionable therapies, from ostensibly benign fads that do little more than portray a shoddy way to educate, to profiteering supplement pills masquerading under readily falsifiable claims to improve health, to outright mendacious efforts to divert sick people from mainstream treatment to harmful alternatives. The motivation for all these behaviours is supposedly profit, since the higher profile perpetrators typically have the splendour of their living accommodation described. It was unclear to this reviewer to what extent delusion was supposed to have crept in also, on the part of the purveyors of bad science, that is.
But if non-establishment quackery is contrary to the interests of the consuming public (and dangerously so in some realms), then the legitimate drug business is hardly saintly, and can at best be described as having partially aligned interests with those of patients. However, the economics of medicine is barely touched in the book, other than to be pointed out as mostly distasteful and undesired (see below). This is an omission, although an understandable one, since the subject is a room of books all by itself, and would distract from Goldacre's pro-scientific method message.
The factors behind the success of quackery in the realm of demand are a bit more numerous: People have strong desires to be cured (or to be excused from the effects of unhealthy choices), there is the little-understood "placebo effect", given its own chapter which spends at least half of its words on ethics rather than science, and eventually there are a couple of chapters on heuristics and biases and the ease with which they can be exploited, by bad statistics among other things. Finally there is massive susceptibility to health scares, such as the MMR vaccine hoax which did real medical harm in the UK.
Unfortunately, none of this is actually, explained very scientifically. That might not ordinarily be a problem, but by spending a good deal of the first part of the text vaunting the scientific (evidence-based) method, the author is somewhat self-shorn of much authority to describe what are universally phenomena of social science. And this is a pity because it gives the book too much of a vaccuous "Everyone should be scientific and sceptical in all their ways" call-out, and tinges it with a little too much polemical flavour. This reviewer wonders if that outcome was consciously intended; she doesn't really know.
This early framing also appears to contribute to this reviewer's sense that there were hardly any solutions to the indentified problems in the book, short of uneconomic crusades of the type alluded to by Goldacre's (and The Guardian newspaper's) defence against a lengthy suit launched by the aforementioned Mr Rath (and as admirable as those are, this reviewer finds it hard to build her hopes up that the willing supply of such principled actions as Goldacre's will be anywhere near effective against his foes--there will be nowhere near enough Ben Goldacres, and even fewer media backers ready to kick in the financial muscle). The closest the author gets to improvements to the system is for a national (government maintained) register of clinical trials, with requirements to populate this record before any trial takes place (so that survivorship, or positive-outcome bias can be reduced). This would be hard to enforce without significantly greater regulation of the field, and since it is already one of the most highly regulated businesses it is easy to be sceptical about the likelihood of that, and also to be worried about unintended consequences.
This reviewer should probably state opinion which colours what she perceives as the broader failing of this book, which is also the over-arching failure of the medical industry. And it is that incentive structure compatability throughout is riven with flaws that are never addressed in an economic framework, and the failure of ethics to compensate for this is lamented, but should really be expected. As such, Goldacre's remedy to bad science, which really seems to boil down to people just being more scientific is, well, duh!
