Bad Pharma: account of pharmaceutical industry scientific fraud is readable and rigorous

Ben "Bad Science" Goldacre's new book Bad Pharma: How drug companies mislead doctors and harm patients ships today, and Ben has posted the foreword, including this helpful paragraph, which explains the book's entire thesis in one handy blob:

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. Unsurprisingly, these trials tend to produce results that favour the manufacturer. When trials throw up results that companies don’t like, they are perfectly entitled to hide them from doctors and patients, so we only ever see a distorted picture of any drug’s true effects. Regulators see most of the trial data, but only from early on in its life, and even then they don’t give this data to doctors or patients, or even to other parts of government. This distorted evidence is then communicated and applied in a distorted fashion. In their forty years of practice after leaving medical school, doctors hear about what works through ad hoc oral traditions, from sales reps, colleagues or journals. But those colleagues can be in the pay of drug companies – often undisclosed – and the journals are too. And so are the patient groups. And finally, academic papers, which everyone thinks of as objective, are often covertly planned and written by people who work directly for the companies, without disclosure. Sometimes whole academic journals are even owned outright by one drug company. Aside from all this, for several of the most important and enduring problems in medicine, we have no idea what the best treatment is, because it’s not in anyone’s financial interest to conduct any trials at all. These are ongoing problems, and although people have claimed to fix many of them, for the most part, they have failed; so all these problems persist, but worse than ever, because now people can pretend that everything is fine after all.

Ben's got a real knack for combining rigor and readability. He's one of the few people who can use a phrase like "I think you'll find it's a bit more complicated than that" without sounding like a smug jerk. If you want to get a sense of how the book unfolds, you can check out the excerpt the Guardian published earlier this week.

Here’s the foreword to my new book. [BadScience.net]

Bad Pharma: How drug companies mislead doctors and harm patients [Amazon UK]

• [Toffer99]

  Taking a prescription drug? Ever wonder if it was doing any good?

  • [Nutrition Industry]

    Why yes, an antibiotic kept me from dying.  You?

    • [Toffer99]

      I’m on 8 pills a day. I know the Aspirin works, as I bleed like a stuck pig if I cut myself shaving. The rest, who knows. I suppose I could cut them out one at a time, and if I drop dead, that one was working.

• [paul]

  Publication bias is pretty common even in studies undertaken purely for prestige, so it  doesn’t surprise me that the corporate-controlled version would fit right in. Many, many clinical researchers have had the idea that what’s worth publishing is what “succeeds”.

• [Joshua Ochs]

  Why is it we mock people who believe in conspiracies involving JFK, the moon landing, etc, but we readily buy into even larger-scale ones when it suits our interests? The first paragraph quoted alone would require hundreds if not thousands of people to be “in on it”, and yet that is suddenly reasonable just because we like to hate on large companies.

  • [Glen Able]

    It’s not “when it suits our interests”, it’s “when someone like Dr. Goldacre helpfully compiles the facts which show the full story”.

  • [C W]

    Facts of a conspiracy are what separate conspiracy theory from reality.

  • [Nutrition Industry]

    But these aren’t facts.  They are extrapolations.

  • [LaGrange]

    The difference is that there’s no real assumption of conspiracy — just people filtering their own opinions to lower their employment risk, for example. You don’t have a huge amount of telescopes pointed at a single rocket launch, for example, just lots of people working on lots of projects, many of them under pressure to deliver results, and just generally systemic issues that lead to lowered quality. Just like a doctor might give you an antibiotic even though they know that it’s likely unnecessary, but they expect you to pressure them to “do something” — so they do it out of pure expectation of problems.

    And it’s not “all medical research is scam”, just “the process is not as effective as assumed”. Ineffective or harmful drugs fall through the cracks because people involved don’t really want to disappoint their employers, or to argue with people with vested interests.  At that point, straight-up bribes aren’t even necessary.

• [anansi133]

  The banking industry, Big Tobacco, “too big to fail” auto companies, .Big Pharma… And now Citizens United: Is it such a paranoid leap to conclude that a criminal conspiracy is running the planet?

  • [Nutrition Industry]

    Yes, yes you are paranoid.

  • [jhertzli]

     According to Dr. Lewandowsky, you also believe the criminal conspiracy is responsible for the Anthropogenic Global Warming theory.

• [schneidr]

  This book is not about conspiracy theories. Here is a snippet from the first chapter taken from Goldacres own website:

  “This isn’t a simple story of cartoonish evil, and there will be no conspiracy theories. Drug companies are not withholding the secret to curing cancer, nor are they killing us all with vaccines.”
  http://www.badscience.net/2012/09/heres-the-intro-to-my-new-book/ 

• [Paul Harrison]

  I think it’s worth pointing out that this is still so much better than alternative medicine that it’s not funny, because that would be a very easy message to take away from a post like this.

  It’s a rather odd state of affairs when I can walk into a pharmacy [in Australia] and 90% of products on display are snake oil with very carefully worded labelling that sounds exciting but actually make zero health claims, and that have only been tested to the extent of showing they do no active harm.

  I would be interested in your thoughts on how an intelligent consumer of medicine should go about choosing their treatments, and also how a better society would go about this whole business, because I have a hard time imagining it and your’re good at that imagining stuff.

  • [Nutrition Industry]

    Simple.

    If you are sick, seek treatment for your sickness from a person who bases their recommendation on science rather than a belief.  If that person gives you a treatment that doesn’t work, go back and ask for something better.  If it isn’t better then, go to someone who knows more about your sickness.

    If you go to someone who believes they can make you feel well or better, you might die.

    End of Story.

• [Kevin Curry]

  Working in medicine this is quite frustrating. We need to practice evidence based medicine for obvious reasons but most of that said evidence is funded by the very people who stand to gain from it — this is the direct result of how FDA drug testing works by the way. Now I think the book overstates it a bit, most studies are in large patient groups and are fairly well conducted though generalizability is almost always an issue. The problem is that there is no alternative available at this time. Government sponsored drug trials? Who knows?

• [Nutrition Industry]

  Isn’t this a repost of a previous story a few days ago?  I am happy to again put Mr. Bad Science’s points into context, but it seems silly for me to post them over and over again.