I mentioned in September that Ben "Bad Science" Goldacre had a new book out, Bad Pharma: How drug companies mislead doctors and harm patients. I was sure at the time that this would be the usual excellent Goldacre fare — lucid, thorough, and important. Now that I'm back from my own book tour, I've had a chance to read it and I'm pleased (or rather, furious — more on this later) to report that this really is the usual, excellent Goldacre stuff.
Bad Pharma is an exhaustive look at the corruption that infests every corner of the pharmaceutical industry, from drug trials to regulatory approval and oversight, to marketing and prescribing and followup research. Systematically, Goldacre lays out the case against pharma, showing that the widespread practices of research suppression, coercion and bribery of journal editors and doctors, propaganda masquerading as mandatory continuing education programmes for doctors, deliberate manipulation of research data, interfering with (or ignoring) regulation, and out-and-out fraud has put all of medicine in jeopardy.
If you're like me, you might be thinking "Oh, yes, of course, it's full of all the usual big-business/regulatory capture stuff," and it is. But what I didn't realise until I read Bad Pharma was that the system isn't just corrupted, it is corrupt. For decades, the evidence for and against medicines that you and I are prescribed every day has been distorted and manipulated to the point where it is now impossible to say whether practically any medicine is better than its competitors, whether it is safe for human consumption — whether, in other words, we should be taking it.
Goldacre shows that pharma companies routinely suppress the findings of their own trials, cherry-picking their publications to show their products in a flattering light. What's more, something like half of all clinical pharma trials are never disclosed. Think of it: if I ran a "clinical trial" on a coin and was allowed to throw away half of my outcomes, I could show that it came up heads every time. If you didn't know that I chucked out all the trials when it came up tails, you'd think that I'd really hit on something. But that's just for starters. Goldacre's chapter on trial manipulation could be called "How to Lie With Statistics: the Pharma Edition," and it is a thorough catalogue of tricks simple and complex for making pills look like miracle cures, even those that do nothing, that cause harm, or that underperform compared to existing medicines.
Goldacre also documents the manipulation of public perception, showing how clever PR stunts create "diseases" out of thin air, and shows how campaigns to spread awareness of "diseases" like Female Sexual Dysfunction were, in fact, marketing for a planned campaign to get Viagra prescribed to women. This is but one prong of the marketing attack. The other is directed at doctors, and involves everything from fake "classes" taught by eminent physicians that are just marketing for a sponsor's drugs (these classes qualify for as continuing education for doctors, who are required to keep their credentials current in order to continue practicing) to fake journals (produced by real journal publishers to the specifications of pharma companies, who are also their major advertisers), and more tricks, some of which had my jaw scraping my chest.
It goes on and on. Bad Pharma is a well-told tale of how indifference, greed, criminality, impotence, and regulatory capture have worked together to put us all at risk. Rich or poor, doctor or patient, we're all in the dark when it comes to the medicines we take every single day. The billions spent by pharma on the distortion of health science have worked: the companies have made back billions more (providing them with a healthy war-chest for continued corruption), and the rest of us are left without any way of knowing whether our treatments are effective.
It would be easy for Bad Pharma to be a counsel of despair, but it's not. At every turn, Goldacre describes simple measures that could stem the tide of corruption and even reverse it. Pharma companies, for example, have the trial data on all of their clinical trials. Simply forcing them to publish this data would allow researchers to re-run the data on treatments and get better advice to doctors and their patients. Goldacre proposes remedies large and small, ways that all of us could do something to help solve this problem. It's hard to write a book that demonstrates bottomless, vast corruption without leaving the reader feeling helpless, but Bad Pharma will leave you ready to fight for a better world, to demand the professional conduct and regulation that promotes the best health outcomes for all of us.