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Description:
‘Bad Science’ hilariously exposed the tricks that quacks and journalists use to distort science, becoming a 400,000 copy best seller. Now Ben Goldacre puts the $600bn global pharmaceutical industry under the microscope. What he reveals is a fascinating, terrifying mess.
Doctors and patients need good scientific evidence to make informed decisions. But instead, companies run bad trials on their own drugs, which distort and exaggerate the benefits by design. When these trials produce unflattering results, the data is simply buried.
All of this is perfectly legal. In fact, even government regulators withhold vitally important data from the people who need it most. Doctors and patient groups have stood by too, and failed to protect us. Instead, they take money and favours, in a world so fractured that medics and nurses are now educated by the drugs industry.
Patients are harmed in huge numbers. . .
Ben Goldacre is Britain’s finest writer on the science behind medicine, and ‘Bad Pharma’ is a clear and witty attack, showing exactly how the science has been distorted, how our systems have been broken, and how easy it would be to fix them.
Bad Pharma (medical)Ben Goldacre (Author)
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A new drug is developed. You want to find out if it works. How can you tell? The answer is that you count. You take two groups of people with the illness, which you hope your drug will treat. You give one of them the drug and the other with a sugar pill. You count and compare the results. Who gets better and who stays ill in each group? Then you know - as much as one can know for sure - whether the treatment in question actually works.
Well, you do have a good idea if you have done the test fairly. Remember: you must count. If you want to rig the result, then you do not count properly. In science, you must keep a record of the misses as well as the hits. If you want to cheat, then don't count the misses. Only count the hits. Count those who seem to get well after being given your new drug but don't count those who don't. Worse, you don't count bad hits - side effects, for instance, which suggest that your new drug harms rather than cures. Hide unflattering data and only publish the data that make your drug look good.
But that's not all. You can compare your new drug against a placebo as opposed to a decent version of the same drug. You can stop the trial early if you get a run of good results before any bad results spoil things. You can measure surrogate outcomes - i.e. changes in blood pressure - rather than whether people live longer if they get your drug or not. You can pay ghost writers to write up the biased results from your trials and then get academics and medics to rubber-stamp them. You can get your marketing reps to assiduously cultivate doctors who are prepared to promote your particular drug. Those doctors may have already formed a positive view of your particular company's drug independently of your blandishments, but you will make sure they get heard, and the sceptical ones aren't. These are just some of the tricks the book describes. It's not about peddling untruths but half-truths. But the practical effect of this is to debase the evidence upon which doctors must base their decisions.
This book's message is not that the drugs don't work. They do work - sometimes. Or they don't work - sometimes. Or they sometimes work or sometimes don't work, depending on all sorts of factors. But we need evidence to know if they do or if they don't work, or if they only work some of the time. Outright fraud is not the problem (mostly). It's methodological dishonesty, which makes it impossible to tell in all too many cases whether the drug a doctor prescribes has good evidence to tell you whether it is likely to cure or to kill. It does not follow from this dismal state of affairs that quack remedies have been vindicated. They haven't. But the tricks of bad pharma practices are a lot more sophisticated, and harder to detect. Above all else, the scientific method, properly applied can tell us (as far as we can know) whether a given remedy is efficacious or not. It is not the method which is at fault, but its distorted application.
If you believe otherwise, then you are mistaken. A book like this presupposes that there is a difference between truth and falsehood, and that the difference can be detected, with tried and tested means to do so. The trials do speak the truth - if they are not muzzled. To get at the truth, you need a complete picture, not a partial one. If you find a body with a knife in its back, you want to find the killer. Corrupt police may decide to frame an innocent man - but does not mean that there is no way of telling who the culprit was, or there is no such thing as the proper use of evidence in criminal justice. If there is no such thing as objective truth, there is no such thing as a lie. The same with medicine. Dodgy use of the method does not mean the method itself is to blame.
One way we can get at the truth is better collection of data. Data are the bread and butter of science, The excellent Cochrane Library does jut that - collects all the hits and misses. The Library is an entirely voluntary collaboration of doctors, which seeks to gather all the data on particular remedies (not just drugs), and score them on how harmful or helpful they are. It scrutinises all would-be remedies, both mainstream and complementary, to the same cold, objective eye. It is worth looking up (enter Cochrane Library in your search engine). This is how the scientific method is supposed to work. It is a beacon of intellectual rigour and honesty. Goldacre rightly sings its praises.
Goldacre's book is restrained and forensic in its tone. There is no bilious hyperbole, just careful analysis. If you want to read a call for the entire system to torn down, rather than fixed, then this isn't the book for you. If you decide that all mainstream medicine is a fraud and start taking quack remedies, then this also is not the book for you. You'd also be making a decision poorly supported by evidence. But the system is broke. And it's broke because the thing that should be its lifeblood - evidence - has been chocked off in too many places because of dodgy methodology.
He offers plenty of practical suggestions for reform, things we can all do and gives examples of initiatives that have worked (the US is well ahead of the UK in this respect). But this is going to take years to fix. First the fur deserves to fly. Hopefully this book will ruffle a lot of feathers, not just those in the pharma industry, but among pusillanimous regulators and complacent senior medics who really ought to know better.
It will be interesting to see what sort of discussion this book provokes in the next few months. Are the offended parties going to engage with Goldacre in print, or are they going to try and silence him in a libel courts? I'm going to put aside a few quid for his defence fund.
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