Either it is true that a
medicine
works or it isn't.
Richard-Dawkins-The-Devil-s-Chaplain
In the course of this short paper, he was one of the first to introduce the Theory of Games to evolutionary biology, a develop- ment that was of course to prove so endlessly fruitful in John Maynard Smith's hands.
Can active spite, as opposed to ordinary selfishness, be favoured by natural selection?
Why do so many animals flock, school or herd together when at risk from predators? This paper had another very characteristic title: Geometry for the Selfish Herd.
Why do animals and plants go to such lengths to disperse their progeny far and wide, even when the places they are dispersing to are inferior to the place where they already live? This work was done jointly with Robert May.
In a fundamentally selfish Darwinian world, how can cooperation evolve between unrelated individuals? This work was done jointly with the social scientist Robert Axelrod.
Why do autumn leaves turn so conspicuously red or brown? In a typically audacious - yet compelling - piece of theorizing, Hamilton suspected that the bright colour is a warning given by the tree, a warn- ing to insects not to lay their eggs on this tree, a warning backed up by toxins just as a wasp's yellow and black stripes are backed up by a sting.
This extraordinary idea is typical of that youthful inventiveness which seemed, if anything, to increase as he grew older. It was really quite recently that he proposed a. proper theory for how the hitherto rather ridiculed theory of 'Gaia' could actually be made workable in a true Darwinian model. At his burial on the edge of Wytham Wood this March, his devoted companion Luisa Bozzi spoke some beautiful words over the open grave, in which she made allusion to the astonishing central idea of this paper - that clouds are actually adaptations, made by micro-organisms for their own dispersal. She quoted Bill's remarkable article 'No stone unturned: A bug-hunter's life and death', in which he expressed a wish, when he died, to be laid out on the forest floor in the
101 Amazon jungle and interred by burying beetles as food for their larvae.
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Later, in their children, reared with care by the horned parents out of fist-sized balls moulded from my flesh, I will escape. No worm for me, or sordid fly: rearranged and multiple, I will at last buzz from the soil like bees out of a nest - indeed, buzz louder than bees, almost like a swarm of motor bikes. I shall be borne, beetle by flying beetle, out into the Brazilian wilderness beneath the stars.
Luisa read this, then added her own elegy, inspired by his cloud theory:
Bill, now your body is lying in the Wytham woods, but from here you will reach again your beloved forests. You will live not only in a beetle, but in billions of spores of fungi and algae. Brought by the wind higher up into the troposphere, all of you will form the clouds, and wandering across the oceans, will fall down and fly up again and again, till eventually a drop of rain will join you to the water of the flooded forest of the Amazon. *
Hamilton was garlanded eventually with honours, but in a way this only underlined how slow the world was to recognize him. He won many prizes, including the Crafoord Prize and the Kyoto Prize. Yet his disturbingly candid autobiography reveals a young man tormented by self-doubt and loneliness. Not only did he doubt himself. He was led to doubt even whether the questions that obsessively drove him were of any interest to anybody else at all. Not surprisingly, this even occasionally led him to doubt his sanity.
The experience gave him a lifelong sympathy for underdogs, which may have motivated his recent championing of an unfashionable, not to say reviled, theory of the origin of human AIDS. As you may know, it was this that was to take him on his fateful journey to Africa this year.
Unlike other major prize winners, Bill really needed the money. He was the despair of his financial advisers. He was interested in money only for the good that it could do, usually to others. He was hopeless at accruing the stuff, and he gave away much of what he had. It was entirely characteristic of his financial astuteness that he left a will that was generous but - unwitnessed. Equally characteristic that he bought a house in Michigan at the top of the market, and later sold it at the bottom of the market. Not only did Bill's investment fail to keep up with inflation. He actually made a substantial loss, and could not afford to buy a house in Oxford. Fortunately, the university had a nice house in its gift in Wytham village, and, with Dick Southwood, as ever, quietly
*At the memorial service, Luisa read both these passages herself. The second passage is carved on a bench beside his grave, erected by his sister Dr Mary Bliss in his memory.
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? taking care of him behind the scenes, Bill and his wife Christine and their family found a place where they could thrive.
Every day he cycled into Oxford from Wytham, at enormous speed. So unbecoming was this speed to his great shock of grey hair, it may have accounted for his numerous cycle accidents. Motorists didn't believe that a man of his apparent age could possibly cycle so fast, and they miscalculated, with unfortunate results. I have been unable to document the widely repeated story that on one occasion he shot into a car, landed on the back seat and said, 'Please drive me to the hospital. ' But I have found reliable confirmation of the story that his startup grant from the Royal Society, a cheque for ? 15,000, blew out of his bicycle basket at high speed.
I first met Bill Hamilton when he visited Oxford from London in about 1969 to give a lecture to the Biomathematics Group, and I went along to get my first glimpse of my intellectual hero. I won't say it was a let-down, but he was not, to say the least, a charismatic speaker. There was a blackboard that completely covered one wall. And Bill made the most of it. By the end of the seminar, there wasn't a square inch of wall that was not smothered in equations. Since the blackboard went all the way down to the floor, he had to get on his hands and knees in order to write down there, and this made his murmuring voice even more inaudible. Finally, he stood up and surveyed his handiwork with a slight smile. After a long pause, he pointed to a particular equation (aficionados
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may like to know that it was the now famous 'Price Equation' said: T really like that one. '
) and
I think all his friends have their own stories to illustrate his shy and idiosyncratic charm, and these will doubtless grow into legends over time. Here's one that I have vouched for, as I was the witness myself. He appeared for lunch in New College one day, wearing a large paperclip attached to his glasses. This seemed eccentric, even for Bill, so I asked him: 'Bill, why are you wearing a paperclip on your glasses? ' He looked solemnly at me. 'Do you really want to know? ' he said in his most mournful tone, though I could see his mouth twitching with the effort of suppressing a smile. 'Yes,' I said enthusiastically, T really really want to know. ' 'Well,' he said, T find that my glasses sit heavily on my nose when I am reading. So I use the clip to fasten them to a lock of my hair, which takes some of the weight. ' Then as I laughed, he laughed too, and I can still see that wonderful smile as his face lit up with laughing at himself.
On another occasion, he came to a dinner party at our house. Most of the guests were standing around drinking before dinner, but Bill had
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disappeared into the next room and was investigating my bookshelves. We gradually became aware of a sort of low murmuring sound coming from the next room. 'Help. ' 'Er, Help . . . I think. Er, yes, Help! Help. ' We finally realized that, in his own uniquely understated way, Bill was saying the equivalent of 'HEEEELLLLP! ! ! ! ! ! ' So we rushed in there, to find him, like Inspector Clouseau with the billiard cues, struggling desperately to balance books which were falling all around him as the shelves collapsed in his arms.
Any other scientist of his distinction would expect to be offered a first-class air fare and a generous honorarium before agreeing to go and give a lecture abroad. Bill was invited to a conference in Russia. Characteristically, he forgot to notice that they weren't offering any air fare at all, let alone an honorarium, and he ended up not only paying for his own ticket but obliged to bribe his own way out of the country. Worse, his taxi didn't have enough petrol in its tank to get him to Moscow airport, so Bill had to help the taxi driver as he siphoned petrol out of his cousin's car. As for the conference itself, it turned out when Bill got there that there was no venue for it. Instead, the delegates went for walks in the woods. From time to time, they would reach a clearing and would stop for somebody to present a lecture. Then they'd move on and look for another clearing. Bill had the impression this was an automatic precaution to avoid bugging by the KGB. He had brought slides for his lecture, so they had to go for a night-time ramble, lugging a projector along. They eventually found an old barn and projected his slides on its whitewashed wall. Somehow I cannot imagine any other Crafoord Prizewinner getting himself into this situation.
His absent-mindedness was legendary, but was completely unaffected. As Olivia Judson wrote in The Economist, his duties at Oxford required him to give only one undergraduate lecture per year, and he usually forgot to give that. Martin Birch reports that he met Bill one day in the Department of Zoology, and apologized for forgetting to go to Bill's research seminar the day before. 'That's all right,' said Bill. 'As a matter of fact, I forgot it myself. '
I made it a habit, whenever there was a good seminar or research lecture on in the Department, to go to Bill's room five minutes before it started, to tell him about it and encourage him to go. He would look up courteously from whatever he was absorbed in, listen to what I had to say, then rise enthusiastically and accompany me to the seminar. It was no use reminding him more than five minutes ahead of time, or sending him written memos. He would simply become reabsorbed in whatever was his current obsession, and forget everything else. For he was an
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? obsessive. This is surely a large contributor to his success. There were other important ingredients. I love Robert Trivers's musical analogy: 'While the rest of us speak and think in single notes, he thought in chords. ' That is exactly right.
He was also a wonderful naturalist - he almost seemed to prefer the
company of naturalists to that of theorists. Yet he was a much better
mathematician than most biologists, and he had the mathematician's
way of visualizing the abstract and pared-down essence of a situation
before he went on to model it. Though many of his papers were
mathematical, Bill was also a splendidly individual prose stylist. Here's
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how, in his auto-anthology, Narrow Roads of Gene Land,
the reprinting of his 1966 paper on the Moulding of Senescence by Natural Selection. He first transcribes for us a marginal note which he wrote on his own copy of his 1966 paper:
Thus ageing animal should climb down his evolutionary tree: young man's youthful features in trends which made old gorilla.
This leads his older self into a magnificently Hamiltonian set-piece:
Therefore, one last confession. I, too, am probably coward enough to give funds for 'elixir' gerontology if anyone could persuade me that there is hope: at the same time I want there to be none so that I will not be tempted. Elixirs seem to me an anti-eugenical aspiration of the worst kind and to be no way to create a world our descendants can enjoy. Thus thinking, I grimace, rub two un- requestedly bushy eyebrows with the ball of a happily still-opposable thumb, snort through nostrils that each day more resemble the horse-hair bursts of an old Edwardian sofa, and, with my knuckles not yet touching the ground, though nearly, galumph onwards to my next paper.
His poetic imagination is constantly surfacing in little asides, even in his most difficult papers. And, as you would expect, he was a great lover of poets, and carried much poetry in his head, especially that of A. E. Housman. Perhaps he identified his young self with the melancholy protagonist of A Shropshire Lad. In his review of my own first book - and can you imagine my joy at receiving a review from such a quarter? - he quoted these lines:*
From far, from eve and morning And yon twelve-winded sky, The stuff of life to knit me
Blew hither: here am I.
*Read at the Memorial Service by Ruth Hamilton.
EULOGY FOR W. D. HAMILTON
he introduces
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Now - for a breath I tarry
Nor yet disperse apart -
Take my hand quick and tell me, What have you in your heart.
Speak now, and I will answer; How shall I help you, say;
Ere to the wind's twelve quarters I take my endless way.
He ended the same review by quoting Wordsworth's well-known lines on the statue of Newton in the Antechapel of Trinity College, Cambridge. Bill didn't mean it this way, of course, but the last words of the poem fit him as well as they fit Newton, and I want to leave you with them.
. . . a mind forever
Voyaging through strange seas of thought, alone.
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? *Mfa* s Snake Oil
Foreword to the posthumous book Snake Oil and
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John Diamond gave short shrift to those among his many admirers who praised his courage. But there are distinct kinds of courage, and we mustn't confuse them. There's physical fortitude in the face of truly out- rageous fortune, the stoical courage to endure pain and indignity while wrestling heroically with a peculiarly nasty form of cancer. Diamond disclaimed this kind of courage for himself (I think too modestly, and in any case nobody could deny the equivalent in his wonderful wife). He even used the subtitle Because Cowards Get Cancer Too for his moving and I still think brave memoir of his own affliction.
But there's another kind of courage, and here John Diamond is unequivocally up there with the best of them. This is intellectual courage: the courage to stick by your intellectual principles, even when in extremis and sorely tempted by the easy solace that a betrayal might seem to offer. From Socrates through David Hume to today, those led by reason to eschew the security blanket of irrational superstition have always been challenged: 'It's fine for you to talk like that now. Just wait till you are on your deathbed. You'll soon change your tune. ' The solace politely refused by Hume (as we know from Boswell's morbidly curious deathbed visit) was one appropriate to his time. In John Diamond's time, and ours, it is 'alternative' miracle cures, offered when orthodox medicine seems to be failing and may even have given up on us.
When the pathologist has read the runes; when the oracles of X-ray, CT scan and biopsy have spoken and hope is guttering low; when the surgeon enters the room accompanied by 'a tallish man . . . looking embarrassed . . . in hood and gown with a scythe over his shoulder', it is then that the 'alternative' or 'complementary' vultures start circling. This is their moment. This is where they come into their own, for there's money in hope: the more desperate the hope, the richer the pickings. And, to be fair, many pushers of dishonest remedies are motivated by an honest desire to help. Their persistent importunings of
Other Preoccupations by John Diamond
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the gravely ill, their intrusively urgent offers of pills and potions, have a sincerity that rises above the financial greed of the quacks they promote.
Have you tried squid's cartilage? Establishment doctors scorn it, of course, but my aunt is still alive on squid's cartilage two years after her oncologist gave her only six months (well, yes, since you ask, she is having radiotherapy as well). Or there's this wonderful healer who practises the laying on of feet, with astonishing results. Apparently it's all a question of tuning your holistic (or is it holographic? ) energies to the natural frequencies of organic (or is it orgonic? ) cosmic vibrations. You've nothing to lose, you might as well try it. It's ? 500 for a course of treatment, which may sound a lot but what's money when your life is at stake?
As a public figure who wrote, movingly and personally, about the horrible progress of his cancer, John Diamond was more than usually exposed to such siren songs: actively inundated with well-intentioned advice and offers of miracles. He examined the claims, looked for evidence in their favour, found none, saw further that the false hopes they aroused could actually be damaging - and he retained this honesty and clarity of vision to the end. When my time comes, I do not expect to show a quarter of John Diamond's physical fortitude, disavow it though he might. But I very much hope to use him as my model when it comes to intellectual courage.
The obvious and immediate countercharge is one of arrogance. Far from being rational, wasn't John Diamond's 'intellectual courage' really an unreasoning overconfidence in science, a blind and bigoted refusal to contemplate alternative views of the world, and of human health? No, no and no. The accusation would stick if he had bet on orthodox medicine simply because it is orthodox, and shunned alternative medicine simply because it is alternative. But of course he did no such thing. For his purposes (and mine), scientific medicine is defined as the set of practices which submit themselves to the ordeal of being tested. Alternative medicine is defined as that set of practices which cannot be tested, refuse to be tested or consistently fail tests. If a healing technique is demon- strated to have curative properties in properly controlled double-blind trials, it ceases to be alternative. It simply, as Diamond explains, becomes medicine. Conversely, if a technique devised by the President of the Royal College of Physicians consistently fails in double-blind trials, it will cease to be a part of 'orthodox' medicine. Whether it will then become 'alternative' will depend upon whether it is adopted by a sufficiently ambitious quack (there are always sufficiently gullible patients).
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? But isn't it still an arrogance to demand that our method of testing should be the scientific method? By all means use scientific tests for scientific medicine, it may be said. But isn't it only fair that 'alternative' medicine should be tested by 'alternative' tests? No. There is no such thing as an alternative test. Here Diamond takes his stand, and he is right to do so.
Either it is true that a medicine works or it isn't. It cannot be false in the ordinary sense but true in some 'alternative' sense. If a therapy or treatment is anything more than a placebo, properly conducted double- blind trials, statistically analysed, will eventually bring it through with flying colours. Many candidates for recognition as 'orthodox' medicines fail the test and are summarily dropped. The 'alternative' label should not (though, alas, it does) provide immunity from the same fate.
Prince Charles has recently called for ten million pounds of govern- ment money to be spent researching the claims of 'alternative' or 'complementary' medicine. An admirable suggestion, although it is not immediately clear why government, which has to juggle competing priorities, is the appropriate source of money, given that the leading 'alternative' techniques have already been tested - and have failed - again and again and again. John Diamond tells us that the alternative medicine business in Britain has a turnover measured in billions of pounds. Perhaps some small fraction of the profits generated by these medicines could be diverted into testing whether they actually work. This, after all, is what 'orthodox' pharmaceutical companies are expected to do. Could it be that purveyors of alternative medicine know all too well what the upshot of properly conducted trials would be? If so, their reluctance to fund their own nemesis is all too understandable. Never- theless, I hope this research money will come from somewhere, perhaps from Prince Charles's own charitable resources, and I would be happy to serve on an advisory committee to disburse it, if invited to do so. Actually, I suspect that ten million pounds' worth of research is more than would be necessary to see off most of the more popular and lucrative 'alternative' practices.
How might the money be spent? Let's take homeopathy as an example, and let us suppose that we have a large enough fraction of the grant to plan the experiment on a moderately large scale. Having given their consent, 1000 patients will be separated into 500 experimentals (who will receive the homeopathic dose) and 500 controls (who will not). Bending over backwards to respect the 'holistic' principle that every individual must be treated as an individual, we shall not insist on giving all experimental subjects the same dose. Nothing so crude.
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Instead, every patient in the trial shall be examined by a certified homeopath, and an individually tailored therapy prescribed. The different patients need not even receive the same homeopathic substance.
But now comes the all-important double-blind randomization. After every patient's prescription has been written, half of the patients, at random, will be designated controls. The controls will not in fact receive their prescribed dose. Instead, they will be given a dose which is identical in all respects to the prescribed dose but with one crucial difference. The supposed active ingredient is omitted from its prepara- tion. The randomizing will be done by computer, in such a way that nobody will know which patients are experimentals and which controls. The patients themselves won't know; the therapists won't know; the pharmacists preparing the doses won't know, and the doctors judging the results won't know. The bottles of medicine will be identified only by impenetrable code numbers. This is vitally important because nobody denies placebo effects: patients who think they are getting an effective cure feel better than patients who think the opposite.
Each patient will be examined by a team of doctors and homeopaths, both before and after the treatment. The team will write down their judgement for each patient: has this patient got better, stayed the same, or got worse? Only when these verdicts have all been written down and sealed will the randomizing codes in the computer be broken. Only then will we know which patients had received the homeopathic dose and which the control placebo. The results will be analysed statistically to see whether the homeopathic doses had any effect one way or the other. I know which result my shirt is on, but - this is the beauty of good science - I cannot bias the outcome. Nor can the homeopaths who are betting on the opposite. The double-blind experimental design disempowers all such biases. The experiment can be performed by advocates or sceptics, or both working together, and it won't change the result.
There are all sorts of details by which this experimental design could be made more sensitive. The patients could be sorted into 'matched pairs', matched for age, weight, sex, diagnosis, prognosis and preferred homeopathic prescription. The only consistent difference is that one member of each pair is randomly and secretly designated a control, and given a placebo. The statistics then specifically compare each experimental individual with his matched control.
The ultimate matched-pairs design is to use each patient as his own control, receiving the experimental and the control dose successively, and never knowing when the change occurs. The order of administering
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? the two treatments to a given patient would be determined at random, a different random schedule for different patients.
'Matched pairs' and 'own control' experimental designs have the advantage of increasing the sensitivity of the test. Increasing, in other words, the chance of yielding a statistically significant success for homeopathy. Notice that a statistically significant success is not a very demanding criterion. It is not necessary that every patient should feel better on the homeopathic dose than on the control. All we are looking for is a slight advantage to homeopathy over the blind control, an advantage which, however slight, is too great to be attributable to luck, according to the standard methods of statistics. This is what is routinely demanded of orthodox medicines before they are allowed to be advertised and sold as curative. It is rather less than is demanded by a prudent pharmaceutical company before it will invest a lot of money in mass production.
Now we come to an awkward fact about homeopathy in particular, dealt with by John Diamond, but worth stressing here. It is a funda- mental tenet of homeopathic theory that the active ingredient - arnica, bee venom, or whatever it is - must be successively diluted some large number of times, until - all calculations agree - there is not a single molecule of that ingredient remaining. Indeed, homeopaths make the daringly paradoxical claim that the more dilute the solution the more potent its action. The investigative conjuror James Randi has calculated that, after a typical sequence of homeopathic 'succussive' dilutions, there would be one molecule of active ingredient in a vat the size of the solar system! (Actually, in practice, there will be more stray molecules knocking around even in water of the highest attainable purity. )
Now, think what this does. The whole rationale of the experiment is to compare experimental doses (which include the 'active' ingredient) with control doses (which include all the same ingredients except the active one). The two doses must look the same, taste the same, feel the same in the mouth. The only respect in which they differ must be the presence or absence of the putatively curative ingredient. But in the case of homeopathic medicine, the dilution is such that there is no difference between the experimental dose and the control! Both contain the same number of molecules of the active ingredient - zero, or whatever is the minimum attainable in practice. This seems to suggest that a double- blind trial of homeopathy cannot, in principle, succeed. You could even say that a successful result would be diagnostic of a failure to dilute sufficiently!
There is a conceivable loophole, much slithered through by 183
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homeopaths ever since this embarrassing difficulty was brought to their attention. The mode of action of their remedies, they say, is not chemical but physical. They agree that not a single molecule of the active ingredient remains in the bottle that you buy, but this only matters if you insist on thinking chemically. They believe that, by some physical mechanism unknown to physicists, a kind of 'trace' or 'memory' of the active molecules is imprinted on the water molecules used to dilute them. It is the physically imprinted template on the water that cures the patient, not the chemical nature of the original ingredient.
This is a scientific hypothesis in the sense that it is testable. Easy to test, indeed, and although I wouldn't bother to test it myself, this is only because I think our finite supply of time and money would be better spent testing something more plausible. But any homeopath who really believes his theory should be beavering away from dawn to dusk. After all, if the double-blind trials of patient treatments came out reliably and repeatably positive, he would win a Nobel Prize not only in Medicine but in Physics as well. He would have discovered a brand-new principle of physics, perhaps a new fundamental force in the universe. With such a prospect in view, homeopaths must surely be falling over each other in their eagerness to be first into the lab, racing like alternative Watsons and Cricks to claim this glittering scientific crown. Er, actually no they aren't. Can it be that they don't really believe their theory after all?
At this point we scrape the barrel of excuses. 'Some things are true on a human level, but they don't lend themselves to scientific testing. The sceptical atmosphere of the science lab is not conducive to the sensitive forces involved. ' Such excuses are commonly trotted out by practitioners of alternative therapies, including those that don't have homeopathy's peculiar difficulties of principle but which nevertheless consistently fail to pass double-blind tests in practice. John Diamond is a pungently witty writer, and one of the funniest passages of this book is his description of an experimental test of 'kinesiology' by Ray Hyman, my colleague on CSICOP (the Committee for the Scientific Investigation of Claims of the Paranormal).
As it happens, I have personal experience of kinesiology. It was used by the one quack practitioner I have - to my shame - consulted. I had ricked my neck. A therapist specializing in manipulation had been strongly recommended. Manipulation can undoubtedly be very effective, and this woman was available at the weekend, when I didn't like to trouble my normal doctor. Pain and an open mind drove me to give her a try. Before she began the manipulation itself, her diagnostic
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? technique was kinesiology. I had to lie down and stretch out my arm, and she pushed against it, testing my strength. The key to the diagnosis was the effect of vitamin C on my arm-wrestling performance. But I wasn't asked to imbibe the vitamin. Instead (I am not exaggerating, this is the literal truth), a sealed bottle containing vitamin C was placed on my chest. This appeared to cause an immediate and dramatic increase in the strength of my arm, pushing against hers. When I expressed my natural scepticism, she said happily, 'Yes, C is a marvellous vitamin, isn't it! ' Human politeness stopped me walking out there and then, and I even (to avoid hassle) ended up paying her lousy fee.
What was needed (I doubt if that woman would even have under- stood the point) was a series of double-blind trials, in which neither she nor I was allowed to know whether the bottle contained the alleged active ingredient or something else. This was what Professor Hyman, in John Diamond's hilarious description of a similar case, undertook. When, predictably, the 'alternative' technique ignominiously flunked the double-blind test, its practitioner delivered himself of the following immortal response: 'You see? That is why we never do double-blind testing any more. It never works! '
A large part of the history of science, especially medical science, has been a progressive weaning away from the superficial seductiveness of individual stories that seem - but only seem - to show a pattern. The human mind is a wanton storyteller and, even more, a profligate seeker after pattern. We see faces in clouds and tortillas, fortunes in tea leaves and planetary movements. It is quite difficult to prove a real pattern as distinct from a superficial illusion. The human mind has to learn to mistrust its native tendency to run away with itself and see pattern where there is only randomness. That is what statistics are for, and that is why no drug or therapeutic technique should be adopted until it has been proved by a statistically analysed experiment, in which the fallible pattern-seeking proclivities of the human mind have been systematically taken out of the picture. Personal stories are never good evidence for any general trend.
In spite of this, doctors have been heard to begin a judgement with something like, 'The trials all say otherwise, but in my clinical experience . . . ' This might constitute better grounds for changing your doctor than a suable malpractice! That, at least, would seem to follow from all that I have been saying. But it is an exaggeration. Certainly, before a medicine is certified for wide use, it must be properly tested and given the imprimatur of statistical significance. But a mature doctor's clinical experience is at least an excellent guide to which hypotheses
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might be worth going to the trouble and expense of testing. And there's more that can be said. Rightly or wrongly (often rightly) we actually do take the personal judgement of a respected human individual seriously. This is so with aesthetic judgements, which is why a famous critic can make or break a play on Broadway or Shaftesbury Avenue. Whether we like it or not, people are swayed by anecdote, by the particular, by the personal.
And this, almost paradoxically, helps to make John Diamond such a powerful advocate. He is a man whom we like and admire for his personal story, and whose opinions we want to read because he expresses them so well. People who might not listen to a set of nameless statistics, intoned by a faceless scientist or doctor, will listen to John Diamond, not just because he writes engagingly, but because he was dying while he wrote and he knew it: dying in spite of the best efforts of the very medical practices he was defending against opponents whose only weapon is anecdote. But there is really no paradox. He may gain our ear because of his singular qualities and his human story. But what we hear when we listen to him is not anecdotal. It stands up to rigorous examination. It would be sensible and compelling in its own right even if its author had not previously earned our admiration and our affection.
John Diamond was never going to go gentle into that good night. When he did go it was with guns blazing, for the splendidly polemical chapters of Snake Oil occupied him right up to the end, working against . . . not so much the clock as time's winged chariot itself. He does not rage against the dying of the light, nor against his wicked cancer, nor against cruel fate. What would be the point, for what would they care? His targets are capable of wincing when hit. They are targets that deserve to be hit hard, targets whose neutralization would leave the world a better place: cynical charlatans (or honestly foolish dreamers) who prey on gullible unfortunates. And the best part is that although this gallant man is dead, his guns are not silenced. He left a strong emplacement. This posthumous book launches his broadside. Open fire, and don't stop.
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? 5
EVEN THE RANKS OF TUSCANY
Stephen Jay Gould and I did not tire the sun with talking and send him down the sky. We were cordial enough when we met, but it would be disingenuous to suggest that we were close. Our academic differences have even been spun out to book length, by the philosopher Kim Sterelny in Dawkins vs Gould: Survival of the Fittest,^ while Andrew Brown, in The Darwin Wars: How Stupid Genes Became Selfish Gods,TM goes so far as to divide modern Darwinians into 'Gouldians' and 'Dawkinsians'. Yet, despite our differences, it is not just the respect due to the dead that leads me to include in this book a section on Stephen Gould with a largely positive tone.
'And even the ranks of Tuscany' (Steve would have completed the
quotation from his formidable literary memory) 'Could scarce forebear to
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cheer'. Macaulay celebrated the admiration that can unite enemies in
death. Enemies is too strong a word for a purely academic dispute, but
admiration is not, and we were shoulder to shoulder on so much. In his
review of my own Climbing Mount Improbable, Steve invoked a collegiality 08
between us, which I reciprocated, in the face of a shared enemy:'
In this important uphill battle for informing a hesitant (if not outrightly hostile) public about the claims of Darwinian evolution, and for explaining both the beauty and power of this revolutionary view of life, I feel collegially entwined with Richard Dawkins in a common enterprise.
He was never ashamed of his immodesty, and I hope I may be forgiven for
sharing with my readers the one occasion when he was good enough to
include me in it: 'Richard and I are the two people who write about
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evolution best . . . ' There was a 'but' of course, but I must press on.
The book reviews that follow, spaced many years apart, show what I hope will be read as an equal collegiality, even where they are critical. Ever Since Darwin was the first collection of Gould's celebrated essays from Natural History. It set the tone for all ten of them, and the 'barbed rave' tone of Rejoicing in Multifarious Nature (5. 1) could also serve for any.
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The Art of the Developable (5. 2), though written in 1983, has not pre- viously been published. It is a joint review of Peter Medawar's Pluto's Republic and the third of Gould's collections of essays from Natural History. It was commissioned by the New York Review of Books but eventually, for reasons that I no longer recall, the publication fell through. Years later I sent the review to Steve, and he expressed warm disappointment that it had never been published. Medawar was one of my intellectual heroes, and Gould's too: it was another thing we had in common. My title, 'The Art of the Developable', unites Medawar's Art of the SolubleTM with Gould's long interest in the evolution of development.
Wonderful Life is, in my view, a beautiful and a misguided book. It is also misguiding: its enthusiastic rhetoric leading other authors to absurd conclusions far beyond Dr Gould's intentions. I developed this aspect fully in 'Huge Cloudy Symbols of a High Romance', one of the chapters of my Unweaving the Rainbow. Reprinted here as Hallucigenia, Wiwaxia and Friends (5. 3), the title given it by the Sunday Telegraph, is my review of Wonderful Life itself.
Human Chauvinism and Evolutionary Progress (5. 4) is my review of Full House, a book that was renamed by the British publishers Life's Grandeur. The review was published as a matched pair with Steve's review of Climbing Mount Improbable. The Editor of Evolution thought it would be amusing to invite each of us to review the other's book simultaneously, knowing the existence, but not the content of the other's review. Gould's review had the characteristic title 'Self-help for a hedgehog stuck on a molehill'. Full House is all about the idea of progress in evolution. I agree with Gould's objections to progress as he saw it. But in this review I develop two alternative meanings of progress which I think are important and are not vulnerable to his objections. My intention was not just to review a book but to make a contribution to evolutionary thinking.
Stephen Gould was my exact contemporary but I always thought of him as senior, probably because his prodigious learning seemed to belong to a more cultivated era. His lifelong colleague Niles Eldredge, who was kind enough to send me the text of his moving eulogy, said that he had lost an elder brother. Years ago it seemed natural to me to ask Steve's advice when I was travelling in America and was invited to have a televised 'debate' with a creationist. He said that he always refused such invitations, not because he was afraid of 'losing' the debate (the idea is laughable) but for a subtler reason which I accepted and never forgot. Shortly before his last illness began, I wrote to him, reminding him of his advice to me and proposing that we might publish a joint letter, offering the same advice to others. He enthusiastically agreed, and suggested that I should prepare a
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? draft on which we could later work together. I did so but, sadly, 'later' nev? r came. When I heard of his sudden death, I wrote to Niles Eldredge, asking if he thought Steve would have wished me to publish the letter anyway. Niles encouraged me to do so, and, as Unfinished Correspondence with a Darwinian Heavyweight (5. 5), it closes this section.
For good or ill, Steve Gould had a huge influence on American scientific culture, and on balance the good came out on top. It is pleasing that, just before his death, he managed to complete both his magnum opus on evolution and his ten-volume cycle of essays from Natural History. Although we disagreed about much, we shared much too, including a spellbound delight in the wonders of the natural world, and a passionate conviction that such wonders deserve nothing less than a purely naturalistic explanation.
Can active spite, as opposed to ordinary selfishness, be favoured by natural selection?
Why do so many animals flock, school or herd together when at risk from predators? This paper had another very characteristic title: Geometry for the Selfish Herd.
Why do animals and plants go to such lengths to disperse their progeny far and wide, even when the places they are dispersing to are inferior to the place where they already live? This work was done jointly with Robert May.
In a fundamentally selfish Darwinian world, how can cooperation evolve between unrelated individuals? This work was done jointly with the social scientist Robert Axelrod.
Why do autumn leaves turn so conspicuously red or brown? In a typically audacious - yet compelling - piece of theorizing, Hamilton suspected that the bright colour is a warning given by the tree, a warn- ing to insects not to lay their eggs on this tree, a warning backed up by toxins just as a wasp's yellow and black stripes are backed up by a sting.
This extraordinary idea is typical of that youthful inventiveness which seemed, if anything, to increase as he grew older. It was really quite recently that he proposed a. proper theory for how the hitherto rather ridiculed theory of 'Gaia' could actually be made workable in a true Darwinian model. At his burial on the edge of Wytham Wood this March, his devoted companion Luisa Bozzi spoke some beautiful words over the open grave, in which she made allusion to the astonishing central idea of this paper - that clouds are actually adaptations, made by micro-organisms for their own dispersal. She quoted Bill's remarkable article 'No stone unturned: A bug-hunter's life and death', in which he expressed a wish, when he died, to be laid out on the forest floor in the
101 Amazon jungle and interred by burying beetles as food for their larvae.
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Later, in their children, reared with care by the horned parents out of fist-sized balls moulded from my flesh, I will escape. No worm for me, or sordid fly: rearranged and multiple, I will at last buzz from the soil like bees out of a nest - indeed, buzz louder than bees, almost like a swarm of motor bikes. I shall be borne, beetle by flying beetle, out into the Brazilian wilderness beneath the stars.
Luisa read this, then added her own elegy, inspired by his cloud theory:
Bill, now your body is lying in the Wytham woods, but from here you will reach again your beloved forests. You will live not only in a beetle, but in billions of spores of fungi and algae. Brought by the wind higher up into the troposphere, all of you will form the clouds, and wandering across the oceans, will fall down and fly up again and again, till eventually a drop of rain will join you to the water of the flooded forest of the Amazon. *
Hamilton was garlanded eventually with honours, but in a way this only underlined how slow the world was to recognize him. He won many prizes, including the Crafoord Prize and the Kyoto Prize. Yet his disturbingly candid autobiography reveals a young man tormented by self-doubt and loneliness. Not only did he doubt himself. He was led to doubt even whether the questions that obsessively drove him were of any interest to anybody else at all. Not surprisingly, this even occasionally led him to doubt his sanity.
The experience gave him a lifelong sympathy for underdogs, which may have motivated his recent championing of an unfashionable, not to say reviled, theory of the origin of human AIDS. As you may know, it was this that was to take him on his fateful journey to Africa this year.
Unlike other major prize winners, Bill really needed the money. He was the despair of his financial advisers. He was interested in money only for the good that it could do, usually to others. He was hopeless at accruing the stuff, and he gave away much of what he had. It was entirely characteristic of his financial astuteness that he left a will that was generous but - unwitnessed. Equally characteristic that he bought a house in Michigan at the top of the market, and later sold it at the bottom of the market. Not only did Bill's investment fail to keep up with inflation. He actually made a substantial loss, and could not afford to buy a house in Oxford. Fortunately, the university had a nice house in its gift in Wytham village, and, with Dick Southwood, as ever, quietly
*At the memorial service, Luisa read both these passages herself. The second passage is carved on a bench beside his grave, erected by his sister Dr Mary Bliss in his memory.
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? taking care of him behind the scenes, Bill and his wife Christine and their family found a place where they could thrive.
Every day he cycled into Oxford from Wytham, at enormous speed. So unbecoming was this speed to his great shock of grey hair, it may have accounted for his numerous cycle accidents. Motorists didn't believe that a man of his apparent age could possibly cycle so fast, and they miscalculated, with unfortunate results. I have been unable to document the widely repeated story that on one occasion he shot into a car, landed on the back seat and said, 'Please drive me to the hospital. ' But I have found reliable confirmation of the story that his startup grant from the Royal Society, a cheque for ? 15,000, blew out of his bicycle basket at high speed.
I first met Bill Hamilton when he visited Oxford from London in about 1969 to give a lecture to the Biomathematics Group, and I went along to get my first glimpse of my intellectual hero. I won't say it was a let-down, but he was not, to say the least, a charismatic speaker. There was a blackboard that completely covered one wall. And Bill made the most of it. By the end of the seminar, there wasn't a square inch of wall that was not smothered in equations. Since the blackboard went all the way down to the floor, he had to get on his hands and knees in order to write down there, and this made his murmuring voice even more inaudible. Finally, he stood up and surveyed his handiwork with a slight smile. After a long pause, he pointed to a particular equation (aficionados
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may like to know that it was the now famous 'Price Equation' said: T really like that one. '
) and
I think all his friends have their own stories to illustrate his shy and idiosyncratic charm, and these will doubtless grow into legends over time. Here's one that I have vouched for, as I was the witness myself. He appeared for lunch in New College one day, wearing a large paperclip attached to his glasses. This seemed eccentric, even for Bill, so I asked him: 'Bill, why are you wearing a paperclip on your glasses? ' He looked solemnly at me. 'Do you really want to know? ' he said in his most mournful tone, though I could see his mouth twitching with the effort of suppressing a smile. 'Yes,' I said enthusiastically, T really really want to know. ' 'Well,' he said, T find that my glasses sit heavily on my nose when I am reading. So I use the clip to fasten them to a lock of my hair, which takes some of the weight. ' Then as I laughed, he laughed too, and I can still see that wonderful smile as his face lit up with laughing at himself.
On another occasion, he came to a dinner party at our house. Most of the guests were standing around drinking before dinner, but Bill had
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disappeared into the next room and was investigating my bookshelves. We gradually became aware of a sort of low murmuring sound coming from the next room. 'Help. ' 'Er, Help . . . I think. Er, yes, Help! Help. ' We finally realized that, in his own uniquely understated way, Bill was saying the equivalent of 'HEEEELLLLP! ! ! ! ! ! ' So we rushed in there, to find him, like Inspector Clouseau with the billiard cues, struggling desperately to balance books which were falling all around him as the shelves collapsed in his arms.
Any other scientist of his distinction would expect to be offered a first-class air fare and a generous honorarium before agreeing to go and give a lecture abroad. Bill was invited to a conference in Russia. Characteristically, he forgot to notice that they weren't offering any air fare at all, let alone an honorarium, and he ended up not only paying for his own ticket but obliged to bribe his own way out of the country. Worse, his taxi didn't have enough petrol in its tank to get him to Moscow airport, so Bill had to help the taxi driver as he siphoned petrol out of his cousin's car. As for the conference itself, it turned out when Bill got there that there was no venue for it. Instead, the delegates went for walks in the woods. From time to time, they would reach a clearing and would stop for somebody to present a lecture. Then they'd move on and look for another clearing. Bill had the impression this was an automatic precaution to avoid bugging by the KGB. He had brought slides for his lecture, so they had to go for a night-time ramble, lugging a projector along. They eventually found an old barn and projected his slides on its whitewashed wall. Somehow I cannot imagine any other Crafoord Prizewinner getting himself into this situation.
His absent-mindedness was legendary, but was completely unaffected. As Olivia Judson wrote in The Economist, his duties at Oxford required him to give only one undergraduate lecture per year, and he usually forgot to give that. Martin Birch reports that he met Bill one day in the Department of Zoology, and apologized for forgetting to go to Bill's research seminar the day before. 'That's all right,' said Bill. 'As a matter of fact, I forgot it myself. '
I made it a habit, whenever there was a good seminar or research lecture on in the Department, to go to Bill's room five minutes before it started, to tell him about it and encourage him to go. He would look up courteously from whatever he was absorbed in, listen to what I had to say, then rise enthusiastically and accompany me to the seminar. It was no use reminding him more than five minutes ahead of time, or sending him written memos. He would simply become reabsorbed in whatever was his current obsession, and forget everything else. For he was an
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? obsessive. This is surely a large contributor to his success. There were other important ingredients. I love Robert Trivers's musical analogy: 'While the rest of us speak and think in single notes, he thought in chords. ' That is exactly right.
He was also a wonderful naturalist - he almost seemed to prefer the
company of naturalists to that of theorists. Yet he was a much better
mathematician than most biologists, and he had the mathematician's
way of visualizing the abstract and pared-down essence of a situation
before he went on to model it. Though many of his papers were
mathematical, Bill was also a splendidly individual prose stylist. Here's
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how, in his auto-anthology, Narrow Roads of Gene Land,
the reprinting of his 1966 paper on the Moulding of Senescence by Natural Selection. He first transcribes for us a marginal note which he wrote on his own copy of his 1966 paper:
Thus ageing animal should climb down his evolutionary tree: young man's youthful features in trends which made old gorilla.
This leads his older self into a magnificently Hamiltonian set-piece:
Therefore, one last confession. I, too, am probably coward enough to give funds for 'elixir' gerontology if anyone could persuade me that there is hope: at the same time I want there to be none so that I will not be tempted. Elixirs seem to me an anti-eugenical aspiration of the worst kind and to be no way to create a world our descendants can enjoy. Thus thinking, I grimace, rub two un- requestedly bushy eyebrows with the ball of a happily still-opposable thumb, snort through nostrils that each day more resemble the horse-hair bursts of an old Edwardian sofa, and, with my knuckles not yet touching the ground, though nearly, galumph onwards to my next paper.
His poetic imagination is constantly surfacing in little asides, even in his most difficult papers. And, as you would expect, he was a great lover of poets, and carried much poetry in his head, especially that of A. E. Housman. Perhaps he identified his young self with the melancholy protagonist of A Shropshire Lad. In his review of my own first book - and can you imagine my joy at receiving a review from such a quarter? - he quoted these lines:*
From far, from eve and morning And yon twelve-winded sky, The stuff of life to knit me
Blew hither: here am I.
*Read at the Memorial Service by Ruth Hamilton.
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he introduces
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Now - for a breath I tarry
Nor yet disperse apart -
Take my hand quick and tell me, What have you in your heart.
Speak now, and I will answer; How shall I help you, say;
Ere to the wind's twelve quarters I take my endless way.
He ended the same review by quoting Wordsworth's well-known lines on the statue of Newton in the Antechapel of Trinity College, Cambridge. Bill didn't mean it this way, of course, but the last words of the poem fit him as well as they fit Newton, and I want to leave you with them.
. . . a mind forever
Voyaging through strange seas of thought, alone.
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? *Mfa* s Snake Oil
Foreword to the posthumous book Snake Oil and
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John Diamond gave short shrift to those among his many admirers who praised his courage. But there are distinct kinds of courage, and we mustn't confuse them. There's physical fortitude in the face of truly out- rageous fortune, the stoical courage to endure pain and indignity while wrestling heroically with a peculiarly nasty form of cancer. Diamond disclaimed this kind of courage for himself (I think too modestly, and in any case nobody could deny the equivalent in his wonderful wife). He even used the subtitle Because Cowards Get Cancer Too for his moving and I still think brave memoir of his own affliction.
But there's another kind of courage, and here John Diamond is unequivocally up there with the best of them. This is intellectual courage: the courage to stick by your intellectual principles, even when in extremis and sorely tempted by the easy solace that a betrayal might seem to offer. From Socrates through David Hume to today, those led by reason to eschew the security blanket of irrational superstition have always been challenged: 'It's fine for you to talk like that now. Just wait till you are on your deathbed. You'll soon change your tune. ' The solace politely refused by Hume (as we know from Boswell's morbidly curious deathbed visit) was one appropriate to his time. In John Diamond's time, and ours, it is 'alternative' miracle cures, offered when orthodox medicine seems to be failing and may even have given up on us.
When the pathologist has read the runes; when the oracles of X-ray, CT scan and biopsy have spoken and hope is guttering low; when the surgeon enters the room accompanied by 'a tallish man . . . looking embarrassed . . . in hood and gown with a scythe over his shoulder', it is then that the 'alternative' or 'complementary' vultures start circling. This is their moment. This is where they come into their own, for there's money in hope: the more desperate the hope, the richer the pickings. And, to be fair, many pushers of dishonest remedies are motivated by an honest desire to help. Their persistent importunings of
Other Preoccupations by John Diamond
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the gravely ill, their intrusively urgent offers of pills and potions, have a sincerity that rises above the financial greed of the quacks they promote.
Have you tried squid's cartilage? Establishment doctors scorn it, of course, but my aunt is still alive on squid's cartilage two years after her oncologist gave her only six months (well, yes, since you ask, she is having radiotherapy as well). Or there's this wonderful healer who practises the laying on of feet, with astonishing results. Apparently it's all a question of tuning your holistic (or is it holographic? ) energies to the natural frequencies of organic (or is it orgonic? ) cosmic vibrations. You've nothing to lose, you might as well try it. It's ? 500 for a course of treatment, which may sound a lot but what's money when your life is at stake?
As a public figure who wrote, movingly and personally, about the horrible progress of his cancer, John Diamond was more than usually exposed to such siren songs: actively inundated with well-intentioned advice and offers of miracles. He examined the claims, looked for evidence in their favour, found none, saw further that the false hopes they aroused could actually be damaging - and he retained this honesty and clarity of vision to the end. When my time comes, I do not expect to show a quarter of John Diamond's physical fortitude, disavow it though he might. But I very much hope to use him as my model when it comes to intellectual courage.
The obvious and immediate countercharge is one of arrogance. Far from being rational, wasn't John Diamond's 'intellectual courage' really an unreasoning overconfidence in science, a blind and bigoted refusal to contemplate alternative views of the world, and of human health? No, no and no. The accusation would stick if he had bet on orthodox medicine simply because it is orthodox, and shunned alternative medicine simply because it is alternative. But of course he did no such thing. For his purposes (and mine), scientific medicine is defined as the set of practices which submit themselves to the ordeal of being tested. Alternative medicine is defined as that set of practices which cannot be tested, refuse to be tested or consistently fail tests. If a healing technique is demon- strated to have curative properties in properly controlled double-blind trials, it ceases to be alternative. It simply, as Diamond explains, becomes medicine. Conversely, if a technique devised by the President of the Royal College of Physicians consistently fails in double-blind trials, it will cease to be a part of 'orthodox' medicine. Whether it will then become 'alternative' will depend upon whether it is adopted by a sufficiently ambitious quack (there are always sufficiently gullible patients).
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? But isn't it still an arrogance to demand that our method of testing should be the scientific method? By all means use scientific tests for scientific medicine, it may be said. But isn't it only fair that 'alternative' medicine should be tested by 'alternative' tests? No. There is no such thing as an alternative test. Here Diamond takes his stand, and he is right to do so.
Either it is true that a medicine works or it isn't. It cannot be false in the ordinary sense but true in some 'alternative' sense. If a therapy or treatment is anything more than a placebo, properly conducted double- blind trials, statistically analysed, will eventually bring it through with flying colours. Many candidates for recognition as 'orthodox' medicines fail the test and are summarily dropped. The 'alternative' label should not (though, alas, it does) provide immunity from the same fate.
Prince Charles has recently called for ten million pounds of govern- ment money to be spent researching the claims of 'alternative' or 'complementary' medicine. An admirable suggestion, although it is not immediately clear why government, which has to juggle competing priorities, is the appropriate source of money, given that the leading 'alternative' techniques have already been tested - and have failed - again and again and again. John Diamond tells us that the alternative medicine business in Britain has a turnover measured in billions of pounds. Perhaps some small fraction of the profits generated by these medicines could be diverted into testing whether they actually work. This, after all, is what 'orthodox' pharmaceutical companies are expected to do. Could it be that purveyors of alternative medicine know all too well what the upshot of properly conducted trials would be? If so, their reluctance to fund their own nemesis is all too understandable. Never- theless, I hope this research money will come from somewhere, perhaps from Prince Charles's own charitable resources, and I would be happy to serve on an advisory committee to disburse it, if invited to do so. Actually, I suspect that ten million pounds' worth of research is more than would be necessary to see off most of the more popular and lucrative 'alternative' practices.
How might the money be spent? Let's take homeopathy as an example, and let us suppose that we have a large enough fraction of the grant to plan the experiment on a moderately large scale. Having given their consent, 1000 patients will be separated into 500 experimentals (who will receive the homeopathic dose) and 500 controls (who will not). Bending over backwards to respect the 'holistic' principle that every individual must be treated as an individual, we shall not insist on giving all experimental subjects the same dose. Nothing so crude.
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Instead, every patient in the trial shall be examined by a certified homeopath, and an individually tailored therapy prescribed. The different patients need not even receive the same homeopathic substance.
But now comes the all-important double-blind randomization. After every patient's prescription has been written, half of the patients, at random, will be designated controls. The controls will not in fact receive their prescribed dose. Instead, they will be given a dose which is identical in all respects to the prescribed dose but with one crucial difference. The supposed active ingredient is omitted from its prepara- tion. The randomizing will be done by computer, in such a way that nobody will know which patients are experimentals and which controls. The patients themselves won't know; the therapists won't know; the pharmacists preparing the doses won't know, and the doctors judging the results won't know. The bottles of medicine will be identified only by impenetrable code numbers. This is vitally important because nobody denies placebo effects: patients who think they are getting an effective cure feel better than patients who think the opposite.
Each patient will be examined by a team of doctors and homeopaths, both before and after the treatment. The team will write down their judgement for each patient: has this patient got better, stayed the same, or got worse? Only when these verdicts have all been written down and sealed will the randomizing codes in the computer be broken. Only then will we know which patients had received the homeopathic dose and which the control placebo. The results will be analysed statistically to see whether the homeopathic doses had any effect one way or the other. I know which result my shirt is on, but - this is the beauty of good science - I cannot bias the outcome. Nor can the homeopaths who are betting on the opposite. The double-blind experimental design disempowers all such biases. The experiment can be performed by advocates or sceptics, or both working together, and it won't change the result.
There are all sorts of details by which this experimental design could be made more sensitive. The patients could be sorted into 'matched pairs', matched for age, weight, sex, diagnosis, prognosis and preferred homeopathic prescription. The only consistent difference is that one member of each pair is randomly and secretly designated a control, and given a placebo. The statistics then specifically compare each experimental individual with his matched control.
The ultimate matched-pairs design is to use each patient as his own control, receiving the experimental and the control dose successively, and never knowing when the change occurs. The order of administering
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? the two treatments to a given patient would be determined at random, a different random schedule for different patients.
'Matched pairs' and 'own control' experimental designs have the advantage of increasing the sensitivity of the test. Increasing, in other words, the chance of yielding a statistically significant success for homeopathy. Notice that a statistically significant success is not a very demanding criterion. It is not necessary that every patient should feel better on the homeopathic dose than on the control. All we are looking for is a slight advantage to homeopathy over the blind control, an advantage which, however slight, is too great to be attributable to luck, according to the standard methods of statistics. This is what is routinely demanded of orthodox medicines before they are allowed to be advertised and sold as curative. It is rather less than is demanded by a prudent pharmaceutical company before it will invest a lot of money in mass production.
Now we come to an awkward fact about homeopathy in particular, dealt with by John Diamond, but worth stressing here. It is a funda- mental tenet of homeopathic theory that the active ingredient - arnica, bee venom, or whatever it is - must be successively diluted some large number of times, until - all calculations agree - there is not a single molecule of that ingredient remaining. Indeed, homeopaths make the daringly paradoxical claim that the more dilute the solution the more potent its action. The investigative conjuror James Randi has calculated that, after a typical sequence of homeopathic 'succussive' dilutions, there would be one molecule of active ingredient in a vat the size of the solar system! (Actually, in practice, there will be more stray molecules knocking around even in water of the highest attainable purity. )
Now, think what this does. The whole rationale of the experiment is to compare experimental doses (which include the 'active' ingredient) with control doses (which include all the same ingredients except the active one). The two doses must look the same, taste the same, feel the same in the mouth. The only respect in which they differ must be the presence or absence of the putatively curative ingredient. But in the case of homeopathic medicine, the dilution is such that there is no difference between the experimental dose and the control! Both contain the same number of molecules of the active ingredient - zero, or whatever is the minimum attainable in practice. This seems to suggest that a double- blind trial of homeopathy cannot, in principle, succeed. You could even say that a successful result would be diagnostic of a failure to dilute sufficiently!
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homeopaths ever since this embarrassing difficulty was brought to their attention. The mode of action of their remedies, they say, is not chemical but physical. They agree that not a single molecule of the active ingredient remains in the bottle that you buy, but this only matters if you insist on thinking chemically. They believe that, by some physical mechanism unknown to physicists, a kind of 'trace' or 'memory' of the active molecules is imprinted on the water molecules used to dilute them. It is the physically imprinted template on the water that cures the patient, not the chemical nature of the original ingredient.
This is a scientific hypothesis in the sense that it is testable. Easy to test, indeed, and although I wouldn't bother to test it myself, this is only because I think our finite supply of time and money would be better spent testing something more plausible. But any homeopath who really believes his theory should be beavering away from dawn to dusk. After all, if the double-blind trials of patient treatments came out reliably and repeatably positive, he would win a Nobel Prize not only in Medicine but in Physics as well. He would have discovered a brand-new principle of physics, perhaps a new fundamental force in the universe. With such a prospect in view, homeopaths must surely be falling over each other in their eagerness to be first into the lab, racing like alternative Watsons and Cricks to claim this glittering scientific crown. Er, actually no they aren't. Can it be that they don't really believe their theory after all?
At this point we scrape the barrel of excuses. 'Some things are true on a human level, but they don't lend themselves to scientific testing. The sceptical atmosphere of the science lab is not conducive to the sensitive forces involved. ' Such excuses are commonly trotted out by practitioners of alternative therapies, including those that don't have homeopathy's peculiar difficulties of principle but which nevertheless consistently fail to pass double-blind tests in practice. John Diamond is a pungently witty writer, and one of the funniest passages of this book is his description of an experimental test of 'kinesiology' by Ray Hyman, my colleague on CSICOP (the Committee for the Scientific Investigation of Claims of the Paranormal).
As it happens, I have personal experience of kinesiology. It was used by the one quack practitioner I have - to my shame - consulted. I had ricked my neck. A therapist specializing in manipulation had been strongly recommended. Manipulation can undoubtedly be very effective, and this woman was available at the weekend, when I didn't like to trouble my normal doctor. Pain and an open mind drove me to give her a try. Before she began the manipulation itself, her diagnostic
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? technique was kinesiology. I had to lie down and stretch out my arm, and she pushed against it, testing my strength. The key to the diagnosis was the effect of vitamin C on my arm-wrestling performance. But I wasn't asked to imbibe the vitamin. Instead (I am not exaggerating, this is the literal truth), a sealed bottle containing vitamin C was placed on my chest. This appeared to cause an immediate and dramatic increase in the strength of my arm, pushing against hers. When I expressed my natural scepticism, she said happily, 'Yes, C is a marvellous vitamin, isn't it! ' Human politeness stopped me walking out there and then, and I even (to avoid hassle) ended up paying her lousy fee.
What was needed (I doubt if that woman would even have under- stood the point) was a series of double-blind trials, in which neither she nor I was allowed to know whether the bottle contained the alleged active ingredient or something else. This was what Professor Hyman, in John Diamond's hilarious description of a similar case, undertook. When, predictably, the 'alternative' technique ignominiously flunked the double-blind test, its practitioner delivered himself of the following immortal response: 'You see? That is why we never do double-blind testing any more. It never works! '
A large part of the history of science, especially medical science, has been a progressive weaning away from the superficial seductiveness of individual stories that seem - but only seem - to show a pattern. The human mind is a wanton storyteller and, even more, a profligate seeker after pattern. We see faces in clouds and tortillas, fortunes in tea leaves and planetary movements. It is quite difficult to prove a real pattern as distinct from a superficial illusion. The human mind has to learn to mistrust its native tendency to run away with itself and see pattern where there is only randomness. That is what statistics are for, and that is why no drug or therapeutic technique should be adopted until it has been proved by a statistically analysed experiment, in which the fallible pattern-seeking proclivities of the human mind have been systematically taken out of the picture. Personal stories are never good evidence for any general trend.
In spite of this, doctors have been heard to begin a judgement with something like, 'The trials all say otherwise, but in my clinical experience . . . ' This might constitute better grounds for changing your doctor than a suable malpractice! That, at least, would seem to follow from all that I have been saying. But it is an exaggeration. Certainly, before a medicine is certified for wide use, it must be properly tested and given the imprimatur of statistical significance. But a mature doctor's clinical experience is at least an excellent guide to which hypotheses
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might be worth going to the trouble and expense of testing. And there's more that can be said. Rightly or wrongly (often rightly) we actually do take the personal judgement of a respected human individual seriously. This is so with aesthetic judgements, which is why a famous critic can make or break a play on Broadway or Shaftesbury Avenue. Whether we like it or not, people are swayed by anecdote, by the particular, by the personal.
And this, almost paradoxically, helps to make John Diamond such a powerful advocate. He is a man whom we like and admire for his personal story, and whose opinions we want to read because he expresses them so well. People who might not listen to a set of nameless statistics, intoned by a faceless scientist or doctor, will listen to John Diamond, not just because he writes engagingly, but because he was dying while he wrote and he knew it: dying in spite of the best efforts of the very medical practices he was defending against opponents whose only weapon is anecdote. But there is really no paradox. He may gain our ear because of his singular qualities and his human story. But what we hear when we listen to him is not anecdotal. It stands up to rigorous examination. It would be sensible and compelling in its own right even if its author had not previously earned our admiration and our affection.
John Diamond was never going to go gentle into that good night. When he did go it was with guns blazing, for the splendidly polemical chapters of Snake Oil occupied him right up to the end, working against . . . not so much the clock as time's winged chariot itself. He does not rage against the dying of the light, nor against his wicked cancer, nor against cruel fate. What would be the point, for what would they care? His targets are capable of wincing when hit. They are targets that deserve to be hit hard, targets whose neutralization would leave the world a better place: cynical charlatans (or honestly foolish dreamers) who prey on gullible unfortunates. And the best part is that although this gallant man is dead, his guns are not silenced. He left a strong emplacement. This posthumous book launches his broadside. Open fire, and don't stop.
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? 5
EVEN THE RANKS OF TUSCANY
Stephen Jay Gould and I did not tire the sun with talking and send him down the sky. We were cordial enough when we met, but it would be disingenuous to suggest that we were close. Our academic differences have even been spun out to book length, by the philosopher Kim Sterelny in Dawkins vs Gould: Survival of the Fittest,^ while Andrew Brown, in The Darwin Wars: How Stupid Genes Became Selfish Gods,TM goes so far as to divide modern Darwinians into 'Gouldians' and 'Dawkinsians'. Yet, despite our differences, it is not just the respect due to the dead that leads me to include in this book a section on Stephen Gould with a largely positive tone.
'And even the ranks of Tuscany' (Steve would have completed the
quotation from his formidable literary memory) 'Could scarce forebear to
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cheer'. Macaulay celebrated the admiration that can unite enemies in
death. Enemies is too strong a word for a purely academic dispute, but
admiration is not, and we were shoulder to shoulder on so much. In his
review of my own Climbing Mount Improbable, Steve invoked a collegiality 08
between us, which I reciprocated, in the face of a shared enemy:'
In this important uphill battle for informing a hesitant (if not outrightly hostile) public about the claims of Darwinian evolution, and for explaining both the beauty and power of this revolutionary view of life, I feel collegially entwined with Richard Dawkins in a common enterprise.
He was never ashamed of his immodesty, and I hope I may be forgiven for
sharing with my readers the one occasion when he was good enough to
include me in it: 'Richard and I are the two people who write about
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evolution best . . . ' There was a 'but' of course, but I must press on.
The book reviews that follow, spaced many years apart, show what I hope will be read as an equal collegiality, even where they are critical. Ever Since Darwin was the first collection of Gould's celebrated essays from Natural History. It set the tone for all ten of them, and the 'barbed rave' tone of Rejoicing in Multifarious Nature (5. 1) could also serve for any.
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? EVEN THE RANKS OF TUSCANY
The Art of the Developable (5. 2), though written in 1983, has not pre- viously been published. It is a joint review of Peter Medawar's Pluto's Republic and the third of Gould's collections of essays from Natural History. It was commissioned by the New York Review of Books but eventually, for reasons that I no longer recall, the publication fell through. Years later I sent the review to Steve, and he expressed warm disappointment that it had never been published. Medawar was one of my intellectual heroes, and Gould's too: it was another thing we had in common. My title, 'The Art of the Developable', unites Medawar's Art of the SolubleTM with Gould's long interest in the evolution of development.
Wonderful Life is, in my view, a beautiful and a misguided book. It is also misguiding: its enthusiastic rhetoric leading other authors to absurd conclusions far beyond Dr Gould's intentions. I developed this aspect fully in 'Huge Cloudy Symbols of a High Romance', one of the chapters of my Unweaving the Rainbow. Reprinted here as Hallucigenia, Wiwaxia and Friends (5. 3), the title given it by the Sunday Telegraph, is my review of Wonderful Life itself.
Human Chauvinism and Evolutionary Progress (5. 4) is my review of Full House, a book that was renamed by the British publishers Life's Grandeur. The review was published as a matched pair with Steve's review of Climbing Mount Improbable. The Editor of Evolution thought it would be amusing to invite each of us to review the other's book simultaneously, knowing the existence, but not the content of the other's review. Gould's review had the characteristic title 'Self-help for a hedgehog stuck on a molehill'. Full House is all about the idea of progress in evolution. I agree with Gould's objections to progress as he saw it. But in this review I develop two alternative meanings of progress which I think are important and are not vulnerable to his objections. My intention was not just to review a book but to make a contribution to evolutionary thinking.
Stephen Gould was my exact contemporary but I always thought of him as senior, probably because his prodigious learning seemed to belong to a more cultivated era. His lifelong colleague Niles Eldredge, who was kind enough to send me the text of his moving eulogy, said that he had lost an elder brother. Years ago it seemed natural to me to ask Steve's advice when I was travelling in America and was invited to have a televised 'debate' with a creationist. He said that he always refused such invitations, not because he was afraid of 'losing' the debate (the idea is laughable) but for a subtler reason which I accepted and never forgot. Shortly before his last illness began, I wrote to him, reminding him of his advice to me and proposing that we might publish a joint letter, offering the same advice to others. He enthusiastically agreed, and suggested that I should prepare a
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? draft on which we could later work together. I did so but, sadly, 'later' nev? r came. When I heard of his sudden death, I wrote to Niles Eldredge, asking if he thought Steve would have wished me to publish the letter anyway. Niles encouraged me to do so, and, as Unfinished Correspondence with a Darwinian Heavyweight (5. 5), it closes this section.
For good or ill, Steve Gould had a huge influence on American scientific culture, and on balance the good came out on top. It is pleasing that, just before his death, he managed to complete both his magnum opus on evolution and his ten-volume cycle of essays from Natural History. Although we disagreed about much, we shared much too, including a spellbound delight in the wonders of the natural world, and a passionate conviction that such wonders deserve nothing less than a purely naturalistic explanation.
