Science fiction and fantasy                                            

Bad Pharma

by Ben Goldacre


Aside from the occasional Harold Shipman, the medical profession has the reputation of being full of generally decent people working to improve our health. It's a reputation Ben Goldacre undermines every which way in Bad Pharma. "Medicine is broken", he proclaims at the start, and he follows that up with evidence of a corrupt, dangerous system at every stage from the research into new drugs to the doctor's choice of what to prescribe.

There are bold claims. The content of this book points to a huge scandal that puts into doubt vast swathes of the medical knowledge we have supposedly gained in recent years. It makes me wonder why no-one has thought to expose it before. Could the author be exaggerating?

First, the book deals with clinical trials, and the ways these can be distorted, often for financial gain. This can be through the flawed design of an experiment, or because of who is selected to take part, or due to when the testing ends. Journals only publish a subset of trials, and the author shows how this can be biased in favour of those that produce exciting headlines, or because the companies that sponsor trials don't bother to publish those results that put their product in a bad light. I won't list all of the ways trial data can be rendered useless, because that's what the book is for, and there are a lot of them. However, the book creates a strong impression that wherever money is involved, the truth is the first victim.

Regulators are supposed to protect the public and ensure that only well-tested and safe drugs reach the market. But again Ben Goldacre demonstrates how systems that are meant to keep us safe fail. It's a story of secrecy, too-close relationships, and legal ineffectiveness. The author explains, with examples, how this is allowed to happen, and what stands in the way of better regulation.

The end of the book deals with marketing, whether to patients or doctors, and the work of drug reps. This activity is all about selling a product rather than helping to uncover the best treatment for each individual, and there are details of how the two goals work in opposition to each other. There's also an examination of ghost-written academic papers, a practice which seems intellectually dishonest at the very least.

"A quarter of the pharmaceutical industry's revenue is spent on marketing, twice as much as it spends on research and development, and this all comes from your money, for your drugs," Goldacre states.

The discussion is backed up with extensive facts, figures, legal cases, and other evidence. Although the author warns that some of the explanations are complex, I found the text clear and easy to understand. The book as a whole is very readable, but that's largely because what it reveals is so horrible. The wrong medication can kill, and here we have details of companies routinely obscuring the truth about which ones are best for people, either through greed, incompetence, or negligence. It's damning.

The good part is, in each section the author ends with suggestions of how to tackle the problems he has outlined. It's part science, part a call to arms for a political campaign. There's also a compelling argument for maintaining the NHS in there, thanks to the data collection it makes possible. Goldacre's conclusions wouldn't seem all that urgent if they were presented in isolation, but the back up of all of the arguments and data within this book reveals them to be matters of life and death. This is an incendiary book, and everyone who isn't immortal or already dead should read it.

12th October 2013

Book Details

Year: 2012

Categories: Books


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5 star rating

Review © Ros Jackson

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