February Blog 2014
Lies, Damned Lies and Snollygosters
Have you notices how ‘good’ the lies and deception are getting these days? There was a time when common or garden chicanery was of the blatant kind, of the ‘Elvis found on the moon’ fun kind of nonsense, that is supposed to be seen through, but over recent decades a new army of P.R. experts, medical writers, spin doctors, and lobbyists have grown up whose job it is to smother all pronouncements to the media and even, or especially, in scientific papers, with a patina of obfuscating blather, often couched in such scientific obscurantism that even most experts are taken in. Only the daring can pronounce the Emperor has no clothes. I know you want to know what a snollygoster is… read on.
Whether it is selling tobacco, food, drugs or government policy that clearly leads to a more unequal and therefore I would posit, a less desirable society, the skill and effort that is going into fooling us is being stepped up, and lucrative careers are to be had for those not too squeamish about things like honesty and truth in this age old, but newly spruced up, occupation of gaining our consent or buy-in, under deception.
“Don’t tell my mother I’m a lobbyist. She thinks I play piano in a whorehouse.”
While this might have drawn a wry smile from the Washington cognoscenti today the problem has grown much worse than the joke implies. And it is not confined to the United States. Brussels and London are not far behind. We look with askance at the blatant corruption of many non-democratic countries and yet, at the heart of our own sophisticated culture, have grown up damaging new practices of spin that are corrupting and even destroying the fabric of trust and public discourse. That’s the snollygoster’s, (OED defines a snollygoster as, “A shrewd, unprincipled person, esp, a politician”).
Of course this is an age-old problem, not confined to our own times. All that is happening is that public relations is gaining newer, slicker, twenty-first-century skills, partly as a result of previous strenuous efforts to improve the veracity of public discourse. We should not be surprised, even as we arm ourselves with greater perception to see through the increasingly sophisticated hype, that people want to persuade us in this manner.
The challenge for us today is to wise-up to the waves of deception and misinformation we are daily fed, and not sink into the realm of miss-trust and despondence, let alone the sink hole of cynicism that is so corrosive to hold in ones heart.
Not all lobbying or marketing is detrimental any more than all drug companies are out to profit from your gullibility, and yet it is incumbent on us all to raise our awareness of the slight of mouth that is constantly being used to gain our compliance at every turn, which is why politics today struggles to convince, as more people give up on it all, in a ‘plague on all their houses’ manner.
The skilled spokesperson fronting a think tank funded by Big Tobacco, Big Pharma or Big Food has to steer a careful line between frank dishonesty and careful mystification of the facts, if he or she it to persuade us of the merits of the policy proposal or the benign intentions for our wellbeing of those kindly grocers or pharmacists. The job requires a clever way with words that will say something that sounds plausible and reasonable and at the same time both disguise the truth and protect them from litigation.
Watch out this year when public spirited pressure group to change public health for the better, Action on Sugar, started by cardiologist Dr. Aseem Malhotra, starts to hit the profits of the big sugar dependent food and soda manufacturers. It is to there credit when sometimes these manufacturers are up front and honest about their heavy dependence on selling us sugar, but too often they wheel out spokes persons who say nothing very much in a very plausible way so that the discussion never takes off and little changes.
Big Pharma has now taken this art of deceit to its apotheosis. It is the art of massaging the science so that Evidence Based Medicine, such a plausible idea at its outset, is now, in many ways, starting to look like a busted flush, As GP Des Spence, cogently, put it recently in the BMJ;
“Evidence based medicine (EBM) wrong footed the drug industry for a while in the 1990s. We could fend off the army of pharmaceutical representatives because often their promotional material was devoid of evidence. But the drug industry came to realise that EBM was an opportunity rather than a threat. Research, especially when published in a prestigious journal, was worth more than thousands of sales representatives. Today EBM is a loaded gun at clinicians’ heads. “You better do as the evidence says,” it hisses, leaving no room for discretion or judgment. EBM is now the problem.” [i]
Freud taught us one hundred years ago that all was not quite what it seemed and what we said was not always the whole truth. Research methods showed us that all of us can be unreliable witnesses to what is in front of us, and clinicians, however we may delude ourselves, are as vulnerable as everyone else, for just such problems such tools as double blind trials were developed for testing relatively simple things like drugs effectiveness.
Just as Freud taught us something useful and true, if one follows his line of thinking too rigidly one ends up not being able to believe anything. And sadly this has come about with much of the science that underpins our drug culture and supports the values, beliefs behaviour and funding of much public health.
We have been teaching clinicians no longer to believe the evidence of their own senses, but to rely on research and laboritory results above everything, so that too often old-fashioned clinicians, like myself, who still look and listen hard with their patients and actually touch them, hear regularly from patients that no one has actually touched/physically examined their complaint effectively before. It was interesting and encouraging to see the Institute of Functional Medicine recently highlighting the taking of a physical nutritional exam as a key highlight of their upcoming conference when they said,
“…as the time allotted for patient visits continues to shrink and more of the focus in medicine shifts to laboratory testing, the detailed physical exam has become somewhat of a lost art. This is unfortunate, because with a trained eye, a clinician can detect the signs of many underlying imbalances and nutritional insufficiencies right in their office. This critical information can help guide the choices made about subsequent lab testing or even suggest appropriate treatments right on the spot”. Institute for Functional Medicine > Home.
Fifty years ago with the uncovering of the shock of the thalidomide scandal, we also stood back, after the death and deformity, and tried to set about erecting barriers to such horrors occurring again in the drug industry.And yet with each sober effort to correct some wrong and setting up failsafe systems to avoid further suffering, we seem doomed by our own ingenuity and often, morally unguided intelligence, to invent new ways to circumvent our own protective devises.
Just as the United Nations in part, so far has failed to fulfil its youthful promise, so Democracy and the Quango’s to which we devolved power, seem, too often, to be co-opted by smart people, with profit to make out of our own gullible natures, who out-maneuver us by buying up our elected representatives, and weaving a web of cleaver deceit wrapped up in the name of science or government protection.
Trust in our leadership and its ability to work for our best interest has declined. But perhaps this is, on balance, a good thing, in the sense that we were always being lied to, as we learnt to our cost in the past, but now the lies are better dressed and much more sophisticated. The caveat emptor rule now has to be applied to previously trusted institutions, formally outside the rough and tumble of commerce.
When senior pharmaceutical research professors like Dr. Peter Grøtzsche, head of the Scandinavian arm of the prestigious Cochrane Collaboration, liken the state of the drug industry to organized crime, in his latest hard hitting book, you know that something has gone badly wrong.
In case you think this is just drug bashing from the lunatic fringe, nobody is saying that all drugs are bad, or all health care is run by Mafioso, clearly there is a place for everything and many of us have good reason to be grateful to the wonders of modern drug treatment. Many, who toil in the National Health Service, as we saw above, are only too aware of the shortcomings and corruption, but can do little to alter the increasingly un-level playing field.
Sadly some of them, like medical journalist and scientism sympathiser Ben Goldacre, who write so skilfully of the ills of Bad Pharma cannot resist the temptation to bash any non-allopathic medical system he does not understand. Not that there should be a special no-criticism zone for cosy, cuddly, green things, but rather, like many of his diehard, materialistic ‘Sense about Science” coterie, which is partly soponsored by Big Pharma, Goldacre seems to have an emotional blind spot when it comes to anything outside his experience of allopathic medicine.
Goldacre, like so many of those in the Positivist, new atheist, materialistic wing of society, is on an intense, almost inquisitional mission to dismiss and discredit. It appears this vituperative spite that slides round the corners of his, otherwise carefully constructed and eminently rational stance on bad science, are, at this point, no longer driven by a high-minded wish to put right bad science but rather degenerate into highly charged attempts to belittle and pour distain on things outside his understanding. This becomes the cloak to attack all sorts of medical insights he chooses to dismiss as quackery. While some of his attacks may have merit, the underlying fervour that emanates from these quarters and the slightly demonic intensity the writing, character assasinations, witchhunts and converstations start to take on, tell us something about the limited world view that they emanate from.
Sadly I suspect these battle lines between medical fundamentaslism and a more open, enquiring and well informed insight, will aways be there, boring though it is. For it is hard to imagine what evidence would change such set and closed minds brought up and schooled so successfully in this closed loop. As a recent editorial in the magnificent What Doctors Dont Tell You journal nicely puts it, “Science is afterall an open minded persuite of truth without fear or favour, and scientism is a solidified set of beliefs around which certain academics, industries and professions are framed”. (November 2013).
To step out of this frame and see the wider world takes a certain independence of thought and a wider education as well as, in our more fearful and corraled arena of public debate, courage, to buck the conventional straight jacket. Sadly there has grown up in recent years a virilance and aggressive hostility that tinges the so called skeptic brigade. There are certain shiboleths, ‘pseudoscience’ being a popular smear, that you can learn to notice that may be a sign that what you are reading could possibly be vering from balanced arguement and be degenerating into emotive character assasination. Even Harvard Professor of Psychology Richard McNally, sometime of that inclination states, “The term ‘pseudoscience’ has become little more than an inflammatory buzzword for quickly dismissing one’s opponents in media sound-bites”.
Of course as we all know, good, well-intentioned people can be deceived and sometimes, when we get together with others we can be persuaded to do things we may regret when called to account, as we saw so disastrously happened, in the financial sector and the economic meltdown of recent years.
Who would think, as Grøtzsche claims in his book, “Deadly Medicines and Organised Crime: How Big Pharma has Corrupted Health Care” that Big Pharma is now guilty of all the offenses of organised crime, from extortion and fraud to bribery, embeezzlement , and political corruption. The idea that the anti inflammatory effect of non-steroidal anti-inflammatory drugs (NSAIDs) is largely a hoax and they don’t actually reduce inflammation any better than paracetamol, comes as a suprise to most people. That they have greater damaging side effects like gastrointestinal bleeding and heart attacks is not generally fully understood by many of the people swollowing them. For more on inflammation as a driver for much chronic ill health see; here
For a fuller and more detailed account of how all this works in the corrupted world of making and selling drugs, you could do a lot worse than spend some time watching the lecture with the excellent Professor David Healy of the Institute of Psychological Medicine & Clinical Neurosciences, Cardiff University, here as he uncovers the dark arts of massaging the science we have all been taught is the gold standard, on which we should trust our health.
From ghost writing of studies to non-publication of studies, to the mysteries of miscoding of data, the lack of access to that data and finally the use of statistics to obscure, the science of obfuscation is now highly sophisticated and almost certainly unknown to the majority who remain trusting of the organisations, that themselves are unable to ascertain the true facts for our benefit.
So next time you see a health claim for a sugar coated cereal, or get invited to swallow a drug, or hear of a policy being sold to your government by a plausible sounding think tank, stop and ask yourself, whose interest are they working for, yours or the people who are paying their salary.
It is a sad state of affairs to be in, to be sure, but it is probably even more true today than it was in his day, as Thomas Jefferson said, that the price if freedom is perpetual vigilance, and just like your phone has evolved from that black Bakelite lump in the drafty hall, owned by the friendly post office, so too the art of persuasion has evolved like that amazing smart phone snug in your pocket.
We all need to beware and take back our power.
[i] BMJ 2014;348:g22
Book of the Month
This winter I have been enjoying exploring the life and some of the works of this master of Victorian English fiction with all its highs of brilliant, touching and amusing characterization and all its lows of, outrageous sentimentality and emotional manipulation of the first order.
But for all his sickly sentiment, often badly drawn female characters and his own surprisingly inept parenting, Dickens was a master and he comes across as a tireless fighter for justice for the down trodden and, as Claire Tomalin puts it in this consummate biography, “He left a trail like a meteor and everyone finds their own version of Charles Dickens.”
She takes us carefully and comprehensively through his roller-coaster shortish life and leaves us at the end considering Dickens as;
“Simply the great hard-working writer, who set nineteenth-century London before our eyes and who noticed and celebrated the small people living on the margins of society.”
As a companion to his own works, as a modern assessment of an extraordinary body of work and a fascinating, at times contradictory life, Tomlin has done the great writer proud. For those looking to know the man from which such a torrent of work came forth, there can be few better places to turn. You can be sure Dickens would have had some pungent things to say about those snollygosters of our time just as he did so well in exposing the liars and cheats of his own day.