Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients

Given that pharmaceutical companies are multi-billion dollars businesses and with a voice so powerful that theirs can even impact how governments go about their public health policies, you could be excused to accuse them of being nothing but yet other corporates plagued by corporate culture -motivated by greed and profits, with not much humanistic/ empathetic moral values left. And in fact, there are many out there indulging in conspiracy theories whereas such companies are just that, supposedly going as far as to, either make us sick on purpose, or, worse, withdrawing/ preventing treatments against deadly illnesses to be found so as to keep selling us their products! So there goes: is pharma 'bad'?

First thing first: Ben Goldacre firmly show more rejects conspiracy theories and the idea that Big Pharma is evil. If you have no trust in science, the medical world, the various forms of medications that have been developed over the past decades, and are here just to look for some Big Pharma-bashing then pass on. This book isn't for you. What Ben Goldacre does is, on the contrary, to denounce how a whole culture surrounding how the pharmaceutical world operates can leads to unethical, even, dangerous, decisions for us all. How so?

His main point of concerns are the clinical trials necessary before a drug is (or not) released onto the market. As he demonstrates, there are a lot of issues with such trials! He questions who are the participants being used as guinea pigs, both from an ethical perspective and a scientific ones (for such people often time are not even representative of the patients the drugs being tested will ultimately be sold out to!). He challenges who runs them in the first place (mostly: the manufacturers -so much for objectivity!) as much as who will then sell them out to doctors once out (mostly: sale representatives and other people paid for by... the manufacturers! -so much for not having a vested financial interest...). He outlines the 'missing data' problem that is, results not being published when negative and/or unfaltering; leading to the rest of the medical community being half-ignorant of the research having been performed. He also points to the 'side-effects data' issue that is, results being published when the drug worked on some tested patients, but leaving us in the dark as to how many others had dropped from the trial because the drug in question had negative side-effects on them. Clinical trials, though, are just the tip of the iceberg.

The issue indeed is that, since independent reviewers and regulators rely on such published studies when it comes to regulate drugs, they end up as not being as informed as we assume them to be. The Cochrane Foundation, for instance, relies on published data to perform its systematic reviews and meta-analyses, but since not all data are published (again: the missing data problem) it obviously impact its understanding. Likewise, there are other issues whereas various regulators don't share the data they might have with each other, leading to some drugs being over-hyped when, really, they shouldn't...

This is a deeply, well-researched book. Clocking at 400 pages+, it's also wide ranging in its concerns and questioning. For instance, the author also tackles the issue of disease-mongering (the medicalisation of our society); so-called 'me too' drugs and why they too can have a negative impact on the research; the problem of drugs staying on the market and still being prescribed when new evidence have shown that they might not be so relevant after all (e.g. SSRI anti-depressants); and, yes, of course, these major cases when drugs had been released and with questioning, when not dreadful/ deadly consequences (e.g. Tamiflu, paroxetine, Trovan etc.).

In the end, then, this is a must-read for anyone concerned about ethical issues surrounding the medical research and the companies mostly controlling it. It is, above all, especially relevant and compelling since, again, the author doesn't bash and attack for the sake of bashing and attacking, let alone participate in a bogus fearmongering by peddling silly conspiracy theories. He is, in fact, crystal clear about that: Big Pharma is not evil, and its purpose is certainly not to hurt you. Remaining rational and embracing a scientific way of thinking all throughout, he actually offers potential solutions that could counter-act the flaws pertaining to an industry those work affects us all. It's rigorous, panic-free yet deeply challenging and critical, and very, very important. Brilliant! show less

Pretty good, does exactly what it says on the tin and is written in a pretty informal and entertaining style that makes it a breeze to read. I don't know enough about the subject to comment on stuff he's missed out or anything like that. Would say he's way too optimistic about stuff like transparency as a cure all and doesn't see how much these problems are baked into a capitalist pharmaceutical industry but ah well can't expect everything. I appreciate his suggestions about how to change things - even though they're obviously limited it's at least a start and could inspire people to do good things. More books should have stuff like that. Enjoyable interesting and also horrifying book.

Bad Pharma is over ten years old, but many of the problems it exposes to a lay audience are still relevant today. It looks at the gaps in how a medicine is developed through to release to market and follow up monitoring and suggests ways that the process can be improved. Some of these have been implemented in the years since publication, but there is still a way to go for complete transparency.

The book is divided into just six chapters and starts with examining clinical trials. It discusses how data can be massaged into the preferred outcome, how information can be counted in different ways and how the aim of the trial can be altered. This isn’t new to anyone who has read books on evidence-based medicine, but it’s a good refresher show more to remind yourself of what to look for (e.g. comparative graphs with different scales, so the benefit of one medication seems to be much bigger and trials that compare a medication against a very average competitor – or placebo). It also reviews the trials process from phases I to III and the lack of post-marketing data. This is where the role of the regulators comes in to monitor new medications after they’ve been released and detect any ‘safety signals’ – new side effects that might not have been seen in the patients in the trials (who are usually the perfect patient and don’t reflect the average person who needs the tablet). The focus is mainly on the UK and EU (the UK being part of the European Union at the time) but it shows how the regulators lack complete information and their lack of ability to get it from the drug companies. The book then covers ‘bad trials’ using the information from the early chapters before branching out into ‘bad marketing’ which discusses the marketing plans used (and the money spent) to launch a new medicine. (Marketing budgets are often equivalent or more than what’s spent to create and test the medication).

Throughout, Goldacre suggests ways that the average person can make a difference which generally involve asking doctors about their interactions with drug companies and any money/education they receive from drug companies. It’s intimated that the regulator doesn’t think the public can handle information on side effects and what’s good/bad. Given that people now routinely ask Dr Google or ChatGPT about medical problems, I do wonder if their stance has changed. (Not being from the UK, I can’t comment). Goldacre does make drug companies the villain of the book, and there are many reasons why. However, in this day and age there generally isn’t money to support education for clinicians outside the drug companies. That includes the venue, the speaker (because who would spend hours on a presentation for free), any catering and the preparation that goes into organising the event. These days you’d need to be part of a professional organisation (which costs money too) to access education which may have external funding too. It’s hard to find truly independent, high quality education, particularly in specialist fields like cancer. I think too that clinicians are becoming increasingly aware of evidence-based medicine and questioning the flashy marketing flyers and looking at the individual papers for flaws. This is probably easier in a specialty rather than broad fields of medicine like GP.

The book does get a little repetitive at times (maybe deliberately to ensure the message is received) so I found it easier to read in small chunks. Goldacre’s passion for the subject is obvious and his writing style to easy to understand, particularly in breaking down complex issues. Definitely a thought provoking read.

http://samstillreading.wordpress.com show less

Ben Goldacre is a very angry man, with good reason. In this book he lays out how the pharmaceutical industry has distorted drug research in pursuit of profit, sometimes intentionally, sometimes entirely without malice but with equally devastating effects for patient welfare. This matters because patients are prescribed less effective drugs, or drugs which are outright harmful, at huge financial expense to those paying for the drugs. This isn’t a conspiracy theory book; Goldacre is quite clear that many valuable drugs have come out of the industry, and that most of the people who work in it want to make better drugs. He sets out in detail how and why bias is introduced into both research and prescribing practices, putting it in show more layman’s terms but linking to the research papers and court documents that back up what he’s saying. He also addresses the failings of the current regulatory system, and proposes ways to improve things — pointing out that unless real controls with serious financial penalties are put in place, even those companies which genuinely want to reform will be under commercial pressure to continue with bad practice in a race to the bottom.

It’s a dense and at times exhausting read. But Goldacre has done a decent job of making the issue accessible to a wide audience with a direct interest, from patients to practising doctors and academics. You can skim a lot of the book to get the general gist, or you can read it in details without following the links, or you can dig into research material he drew on and has laid out in meticulous footnotes and citations. He concludes the original edition with practical suggestions about what individual people can do to improve things, often simply by asking questions.

I read the second edition, which has a “what happened next” chapter about the reaction to the first edition. As he had predicted, there was a backlash in an attempt to discredit him — but there was also a lot of covert feedback from industry personnel acknowledging the problems and considering how to improve things. While there’s always a “the lurkers support me in email” issue with uncredited sources, he does also offer some examples of companies which have publicly moved to improve transparency.

Bad Pharma is an angry but rational examination of a real problem that affects millions of people, including almost anyone reading this review. It’s a worthwhile read, even if it makes for uncomfortable reading for patients, doctors and companies alike. show less

Iedereen weet dat de farmaceutische industrie, zoals vele andere industrieën, geplaagd wordt door corruptie, omkoping, enz... Money makes the world go around, ook en zeker in deze sector. Dit boek, althans de flaptekst, sprak me aan, omdat ik eens wou weten wat Ben Goldacre te vertellen heeft over die medische industrie. Veel, zo blijkt uit deze klomp die ik met gemengde gevoelens "uitgelezen" heb.

Er passeert veel de revue: van proeven/testen (trials) over hoe nieuwe medicijnen uitgevonden worden tot het marketingaspect. De inhoud verteer je niet op enkele dagen, tenzij je er echt voor gaat. Het is zwaar; ik heb het boek eigenlijk niet van A tot Z gelezen, vooral veel diagonaal gelezen na enkele hoofdstukken, want Goldacre wijdt soms show more te veel uit, waardoor ie in herhaling valt of zaken vertelt waar jij (als niet-Brit of niet-Amerikaan) niet zoveel aan hebt.

Bij proeven gaat het dan o.a. over ontbrekende gegevens, over het feit dat niet alles verteld wordt of waarbij bepaalde elementen (bijv. bijwerkingen) geminimaliseerd worden. Proeven worden verdergezet zelfs als er x-aantal personen afhaken of bepaalde resultaten worden niet openbaar gemaakt, omdat het bedrijf in kwestie een slechte naam zou geven of schadeclaims creëren.

Ook heeft Goldacre het over nieuwe versies van bepaalde medicijnen die dan worden gepromoot, terwijl de oudere veel beter werkten. Maar toch moet dat nieuwe product zo veel en goed mogelijk gepromoot worden, want er moet geld verdiend worden. Soms worden voor die nieuwe versies zelfs geen testen gedaan.

Er volgt ook een heel groot stuk over trials (proeven) zelf, niet hoe er data (al dan niet opzettelijk) weggelaten worden in de resultaten en publicaties.

In het Marketinggedeelte gaat het dan o.a. over reclame voor medicatie, verkooppraktijken naar dokters/ziekenhuizen/... toe, met de nodige "voordelen" en "cadeaus", en hoe die reclame en promotie ten dele ervoor zorgt dat die specifieke producten toch voorgeschreven worden, zelfs al heeft de patiënt in kwestie er geen baat bij en zou hij/zij beter een ander medicament voorgeschreven krijgen.

Na het lezen van enkele hoofdstukken ben ik beginnen letten op reclame op TV voor medicatie. Normaal gezien sta je daar niet bij stil, al krijg je die reclamespots keer op keer te zien. Maar waarom wordt voor bepaalde producten zoveel reclame gemaakt? Bijv. Gaviscon (voorheen Rennie) voor maagzuur, Rhinospray (neusspray), Nurofen, en ga zo maar door. Men zet de mensen op die manier aan, na voldoende "indoctrinatie", om die producten te gebruiken als ze ook maar iets van de symptomen hebben.

En dat kaart Goldacre ook aan: Dat men op de duur, via allerlei manieren (waaronder vragenlijstjes op websites), ziektebeelden gaat creëren en mensen doet geloven dat men dan ook aan een dergelijk ziektebeeld lijdt, ook al hebben ze eerder 'neen' dan 'ja' geantwoord op de vragen. En natuurlijk bestaat er dan de nodige medicatie om dat probleem aan te pakken. Of wat had je gedacht?

Goldacre heeft het verder, naar het einde toe, ook over de misstappen en veroordelingen van farmaceutische reuzen als Eli Lilly, Pfizer, GlaxoSmithKline (GSK), ...

Andere partijen die aangevallen worden zijn, vanzelfsprekend, de politiek en daaraan gerelateerde organisaties, scholen, de pers, en meer.

Geld blijft een kernelement doorheen het boek, omdat het gebruikt wordt om nieuwe medicijnen op de markt te brengen, de nodige promo te voeren, de nodige goedkeuringen/licenties/... te bekomen, en ga zo maar door. Of wat met, bijvoorbeeld, de dreigende Mexicaanse griep van enkele jaren geleden, waarvoor een hoop vaccins werd gemaakt, maar veel daarvan niet werd gebruikt (althans in België), omdat ze eigenlijk niet nodig waren? Ofte: De bevolking werd opgejut, bang gemaakt voor wat? Tenzij uiteraard in die landen waar het virus wél had toegeslagen.

Hij geeft ook voorstellen over wat de patiënt of de dokter zelf kan doen om steeds correct te handelen en ingelicht te worden. Een logisch voorbeeld is: uitwisseling van informatie tussen patiënt en dokter, zodat de dokter een gerichtere diagnose kan stellen en gepaste(re) medicatie voorschrijven. En dat is nodig, dat je als patiënt niet steeds alles aan de dokter overlaat: het moet een win-winsituatie zijn. Jij weet beter dan de dokter hoe je je voelt, welke impact de voorgeschreven medicatie (niet) heeft, ... waardoor je beter gewapend bent om geen meuk voorgeschreven te krijgen. Maar het betekent niet dat je je dan slimmer dan de dokter moet wanen, zeker niet. Het gaat erom dat jouw gezondheid op punt blijft en daarvoor heb je een zekere mondigheid voor nodig.

Goldacre schetst een donker beeld van de farmaceutische industrie, da's waar. In het nawoord, waarin hij een update geeft over wat er gebeurd is sinds de eerste publicatie van het boek, probeert hij de criticasters van woord te dienen door (nogmaals) aan te geven dat zijn onderzoek gebaseerd is op wat hij zelf meegemaakt heeft en slechts voorbeelden van medicatie gaf om zijn voorbeelden beter te onderbouwen, vulling te geven, zodat je als lezer niet zelf moest proberen uit te vissen waar het over ging.

Zoals met alles dien je Goldacres betoog niet voor de volle 100% te slikken, zeker niet. Corruptie en de macht van het geld zijn zeker aanwezig in de farmaceutische industrie en nog geen klein beetje. Maar die industrie heeft de voorbije jaren ook veel goede geneesmiddelen uitgevonden. Het is dus geen zwart-witverhaal. Maar 'Bad Pharma' zet je wel aan het denken, zou je aan het denken moeten zetten, want de pers zal het niet voor jou doen. Jezelf inlichten, je lichaam laten vertellen wat er scheelt, ... het kan allemaal helpen om, als je dan ziek bent en medicatie nodig hebt, dit gerichter te laten gebeuren. show less

It is possible to be so cynical that nothing that Goldacre describes is in the least surprising, but at the same time to be interested in the mechanism.

Goldacre is currently making the problems described in this book is life's work. The book is meant to persuade people: patients, doctors and workers in the pharmaceutical industry, to make changes for the better. He suggests actions that people in all these groups could take. Some suggestions seem hopelessly naive, but perhaps they are included as satire.

Goldacre addresses the book to a lay audience unfamiliar with statistics, using well-chosen analogies to get his point across. He uses identical phrasing throughout the book, to remind those less familiar with statistics, what effect the show more behavior he is discussing has on the best available knowledge about a particular drug.

On a personal note, a near relative of mine nearly died from an adverse reaction to a medication he had been prescribed for bursitis in his elbow. We do not know if previous adverse reactions had been covered up by the industry, or if his reaction made it into the medical literature.

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2017/11/11

This book was good enough that after finishing it on audio, I reread it in physical form. It is copiously footnoted. And the author deserves extra points for directly addressing the entities that might be planning to sue him in snarky British fashion. show less

Goldacre has a way of making complex science subjects accessible to the wider public. His first book, Bad Science, highlighted the way that the media dealt with reporting science, and in this book he concentrates his ire onto the $600 billion global pharmacy industry, now dominated by a handful of behemoths.

And what he reveals is frankly terrifying. He details the way that the industry hides a large majority of the trial data, the way that the legislation requiring data to be published is ignored by companies, and in the EU it is still secret in some cases. There is loads of detail on the way that the data is cherry picked to demonstrate that a particular drug is so much better than the competition. There is lots of detail on the show more appalling way that the industry is regulated, even though it is very heavily regulated, most of it is ineffective and not enforced, and where the regulation could be improved to help patients and save lives these are not enforced or are not enacted on after lobbying from the industry.

The biggest chapter though is on the marketing that these companies employ. Their budgets for marketing are normally twice the R&D budgets, which gives you some idea of where their priorities lie. He explains how they sponsor various ‘conferences’ and provided sweeteners to medical professionals at all levels, from lunches to flights to what most people would consider bribes. The nefarious dealings of the drugs rep are dealt with too, from the pressure that they put onto doctors to use their medicines and the way that they collect data directly from surgeries and pharmacies. A lot of academic papers are ghost written, and a leading figure puts their name to it, shocking really.

There is some details on NICE, but not a huge amount. He looks at the way that they select the drugs for use in treatment, noting that even they do not have access to all the trail data for each medicine that they consider.

He also writes about how a lot of the drug companies fund patient groups either overtly with cash donations or covertly by funding particular conferences and so on. They have been proven to use them to exert pressure on national agencies (FDA and NICE) to supply the latest drugs regardless of the cost; i.e. £50K spent with a group means that they get their £21k per patient drug treatment approved, even though the trial evidence is not there or is at best not proven to be any more effective than the current items on the market. A real scandal.

Throughout the book he does give suggestions on how the situation can be improved but he does realise that they is an endemic problem and powerful vested interests do hold sway. Even just enforcing the current rules would make a difference, but it seems unlikely at the moment.

The phrase for illegal drugs used to be: Just Say No. Perhaps it should apply to legal drugs too... show less