Comment is Free - A Reply

Last week I wrote a piece about Dawkins's 2-part documentary The Enemies of Reason for the Guardian's web site. You can read the piece here.

The piece attracted a large number of responses from readers. I will try to address the main issues raised here.

Firstly, a number of posters asked about the factual basis for some of the claims I made. CommanderKeen asked for a source for the claim that:

The pharmaceutical companies receive far more in public subidies than is spent supporting alternative medicine.

Under the formula agreed by government and business at the end of 2004, 28% of the money paid for branded drugs is a earmarked to support research and development (see this BMJ article for more about the scheme). The NHS spend £10.3 billion on drugs annually according to the Department of Health. 80% of NHS drugs are covered by the agreement, according to Pharmacy Management, ie £8.24 billion. Of this £2.3 billion is therefore an r&d subsidy.

Figures for spending on alternative health are more difficult to come by. But last year the Times estimated that NHS spending on CAT was around £450 million. How much of this could legitimately called a subsidy is less clear. The £10 million spent helping to refurbish the homeopathic hospital, perhaps. Anyway, total taxpayer funding for CAT (which incudes sports massage, GP-referred acupuncture and so on) is around a fifth of the allocated subsidy for the pharmaceutical companies. This is separate from the fixed profits that the companies enjoy on sales to the NHS. We ought also to bear in mind the state support for tertiary science education, which provides the pharmaceutical industry with trained staff, and the state support for basic research, which often feeds into commercial product development.

CommanderKeen also asked for a soource for the claim that:

[Public money] overwhelmingly goes on marketing treatments for lifestyle complaints.

According to Rachel Cohen of Medecins san Frontieres in 2000 'no drugs were being developed to treat tuberculosis, compared with 8 for impotence or erectile dysfunction and 7 for baldness' (quoted in The Corporation, Joel Bakan, Constable: London, 2004, p.49). These figures broadly generalise, I think, for understandable commercial reasons.

I might have added that almost all major breakthroughs in pharmaceutical medicine have depended on fundamental research by state and academic institutions. Much of the original work on the BCG vaccine was done at the Pasteur Institute, for example.

The key question is whether the corporations are safe custodians of the public health research agenda. Should we give them vast sums of money for research? Or should we look to find other ways to promote innovation in medical science and public health policy (the two are not always identical)?

I don't mean to imply that Big Pharma is worse than other businesses in any essential sense, by the way. Dawkins spent an hour talking about medicine; Big Pharma is relevant in that context. It is important to recognise that there is more to this than an anti-capitalist critique. The sector enjoys very high profit margins while receiving very considerable public support.

Theophobic asked for background on the following:

States and corporations habitually use rational means to promote irrationality in target populations. They exploit the prestige of science to marginalise their critics. They cook up marketing strategies that sound scientific but are no more than mythmaking.

State propaganda standardly promotes false beliefs and hence irrational ones. In the USA much of the population thought the 9/11 hijackers were Iraqi; they thought that Saddam Hussein was behind the attacks; that Bush was invading to avenge an assassination attempt on his father and so on. Similar campaigns for war were run in 1916-17 in the US, in the late 30s, in the late 40s (to help kick off the Cold War), in the 80s (against the Sandinistas) and so on.

Corporations promote irrational beliefs about their products, quite standardly. It's called advertising. They also promote irrational beliefs about themselves. This is called Corporate Social Responsibility.

The best example of science in the service of myth I have come across is the 'serotonin myth', which David Healy discusses in Let Them Eat Prozac (New York University Press, New York, 2006). We all think that Prozac and the other SSRIs work by raising the level of serotonin in the bloodstream. In fact we have no idea how the SSRIs work. Which, I grant you, isn't as snappy from a marketing point of view.

On the use of the prestige of science to discredit legitimate critics, I suggest you go and look at Sourcewatch; they provide a handy list of business-funded think tanks. If you look at the work of these think tanks, you will see that they often accuse critics of business of technophobia, or irrationality.

(Theophobic - on the matter of the 'deep time machine', I don't accept that the universe is a machine, much less a time machine. Machines are made for a purpose. It is no more than whimsy to call the universe a machine)

Aside from these matters of fact, there are two related themes in objections to the piece. One is that Dawkins can't be expected to take on everything. There are plenty of people researching the problem of state and corporate mendacity, so there is no great harm in his focussing on homeopaths and whatnot (henrykrinkel, Everytimereferee etc).

The difficulty I have with this is that Dawkins couched his argument explicitly in terms of a defence of the Enlightenment tradition of free inquiry and open debate. He claims to see a rising tide of superstition and magical thinking among the public and a growing distrust of science. He further claims that alternative and complementary practitioners (charlatans as he would see it) are central to explaining the public's growing distrust. My own view is that the factual basis for this claim is pretty shaky. There is some considerable concern about the structure of the medical/scientific system (the medical industrial complex, to sound a more polemical note). Some of that is stoked by the anti-rational claims of snake oil types. But some of it derives from legitimate anxieties about the corruption, danger, waste, and wasted opportunities, in the current mechanisms for research funding. If you are serious about defending the Enlightenment you need to be careful to register the difference. It might even be possible to do a little research into the link between CAM and distrust of conventional medicine.

The second main objection (Mujokan, for example) is that alternative therapists are more serious as a threat to reason because they reject science, rather than manipulating it for their own ends, as the corporations do - 'misuse of science is bad, but at least it requires acceptance of science'. I think this is an interesting point. It suggests a different way of ordering priorities, one in which radical differences at the level of theory matter more than the material impact of various agents on the wider society. So a rationalist must care more about what an openly irrational agent gets up to than they do about someone who is also rational, but happens to be engaged in deceit. This is part explains the prominence of postmodernism in attempts to defend the Enlightenment. Because some postmodernists claim to be 'radically sceptical' about the Enlightenment project (and inded sometimes define themselves against any such project) they excite the hostility of those who see themselves as the Enlightenment's defenders.

I would reject this way of thinking, though. Even if we limit ourselves to CAM, it doesn't seem obvious that a rational materialist conman is less of a worry than a well-intentioned, but deluded, advocate of some kind of esoteric treatment. Both should be treated with extreme caution, but the former seems more morally disgraceful. Looking more widely, rational agents who promote irrationality in pursuit of their goals are much more powerful than the mostly good-natured types who really think that crystals or magnets are the answer to the world's woes. Indeed in part it is their open-eyed use of rational means (polling, research, experiment, etc) to promote delusional ideas in the wider population that makes them so powerful.

The clash between faith and reason, between the rational and the irrational, and so on, is dramatically appealing. It feels urgent and brave to attack the irrational on the terms that Dawkins does. I just don't think it is.

I hope that clarifies my position a little.