Book Review: Bad Pharma

BEN Goldacre makes a pointed if rather mischievous observation in the introduction to his most recent book – Bad Pharma. “Today, when an academic or doctor tells you that they are working for the pharmaceutical industry, they often do so with a look of quiet embarrassment.”

Just what might engender this embarrassment is the subject of over 400 pages of compelling argument – how a £600 billion industry reaps vast profits by routinely misleading doctors, patients and regulators over the efficacy of some of the drugs it produces.

Goldacre writes: “Drugs are tested by 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 to exaggerate the benefits of treatments. Unsurprisingly, these trials tend to produce results that favour the manufacturer.”

The book is unashamedly “pop science” but a much more demanding read than his previous bestseller Bad Science. Goldacre sets out in painstaking detail his case against the current system of drug development and evaluation. “Some of this stuff is hard,” he admits. “That’s precisely why these problems have been ignored.” But this is not to say Bad Pharma is a dull read. The book is enlivened by Goldacre’s passion and, at points, raw anger over how doctors making prescribing decisions in good faith and on the available evidence can be cynically misled over the best treatment for their patients.

Much of the material is shocking – case after case of pharma companies knowingly suppressing data from negative clinical trials to ensure drugs are marketable, often with the unwitting connivance of regulators. He describes drug trials rigged to yield desired results, doctors paid to extol the virtues of a particular drug, journals publishing positive reviews on the promise of expensive advertising and reprints, ghost-written articles by industry insiders – the rot is deep and many years in the making.

There are solutions such as well-policed registers to ensure negative clinical trials are not buried – and Goldacre does see encouraging signs. Certainly this is an important book that needed to be written.