Ben Goldacre*, Bad Pharma: how drug companies mislead doctors and harm patients, London: Fourth Estate, 2012, 430pp; reviewed by Daphna Whitmore**
We hope that doctors are prescribing treatments, making life and death decisions, based on solid science.
They aren’t because the science has been corrupted. Medicine is broken and Goldacre is blowing the whistle.
“Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques which are flawed by design, in such a way that they exaggerate the benefits of treatments.”
Goldacre is not denying drug companies have produced great drugs that are saving lives “on an epic scale”; but this doesn’t give them the right to “hide data, mislead doctors and harm patients”.
In Bad Pharma he shows how they do it.
The pharmaceutical industry sets the stage for positive trials for their drugs. Unflattering trials don’t see the light of day. This is Goldacre’s central point: evidence based medicine isn’t possible when at least half the trials conducted are buried. Even if drug companies were forced to publish all their studies from hereon the problem wouldn’t be fixed because we need to know all there is to know about the medicines currently in use. Goldacre is on a mission to get all trials, past, present and future, published.
There’s a lot else that’s wrong with how pharmaceuticals are produced. Taking part in drug trials is not popular, but people who do so expect they are helping advance science and they are told they are. But if the trial results are buried those volunteers have been lied to. It’s often the poor who are ‘volunteers’. Until the 1980s in the US trials were conducted on prisoners. Today volunteering for a clinical trial is a source of income for people with few options such as students, the unemployed, and the homeless.
The Declaration of Helsiniki set out a code of ethics for human experimentation and was revised in 2000 to stipulate that research is justified if the population from whom trial participants come from would benefit from the results.
The $600 billion a year pharmaceutical industry has enormous economic sway and uses masterful marketing. For instance, maybe as many as a third of academic medical papers are ghost written by the drug companies, with the ‘author’ doing little more than reading over the paper and making a few tweaks. The research, the data collection and analysis, the selection of tables, the drafts and referencing is done by the drug company promoting its product, and then is published without ever acknowledging the characters in the background. The reader assumes the work to be an independent piece of research by the author. For the ‘author’ having papers published means extra income and academic promotion. These tainted papers remain sources of medical knowledge for years to come. Goldacre proposes a simple immediate improvement: ‘film credits’, where absolutely all the contributors are described at the end of the paper. It should be a universal practice he says.
Goldacre shines light in many of the dark corners of the pharmaceutical industry and has practical suggestions for how to fix the mess, but he doesn’t take on the profit system. It’s understandable because he wants to get the drug companies sorted right now. His impatience is refreshing.
The drug industry spends about twice as much on marketing and promotion as it does on research and development. It’s an absurd waste of resource that prevents scientific progress. It’s particularly galling considering that in most developed countries pharmaceuticals are funded out of the public purse.
Standing up to the pharmaceutical giants is a fine stand and Goldacre does it superbly. His book is speaking to us, calling on us to fix the mess.
Let sunshine in, let many eyes spot problems and find solutions. That’s his message.
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*Ben Goldacre is a best-selling author, broadcaster, medical doctor and academic who specialises in unpicking dodgy scientific claims from drug companies, newspapers, government reports, PR people and quacks. His book Bad Science has sold over 400,000 copies. Ben has written since 2003 for the Guardian a weekly Bad Science column. His blog is worth checking out: http://www.badscience.net/
** Daphna Whitmore is a nurse.
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