Bad Pharma: How Medicine is Broken, and How We Can Fix It

by Ben Goldacre

'Bad Science' hilariously exposed the tricks that quacks and journalists use to distort science, becoming a 400,000 copy bestseller. Now Ben Goldacre puts the $600bn global pharmaceutical industry under the microscope. What he reveals is a fascinating, terrifying mess. Doctors and patients need good scientific evidence to make informed decisions. But instead, companies run bad trials on their own drugs, which distort and exaggerate the benefits by design. When these trials produce unflattering results, the data is simply buried. All of this is perfectly legal. In fact, even government regulators withhold vitally important data from the people who need it most. Doctors and patient groups have stood by too, and failed to protect us. Instead, they take money and favours, in a world so fractured that medics and nurses are now educated by the drugs industry. The result: patients are harmed in huge numbers. Ben Goldacre is Britain's finest writer on the science behind medicine, and 'Bad Pharma' is the book that finally prompted Parliament to ask why all trial results aren't made publicly available - this edition has been updated with the latest news from the select committee hearings. Let the witty and indefatigable Goldacre show you how medicine went wrong, and what you can do to mend it.

Genres: Nonfiction, Science, Medicine, Health, Politics, Medical, Audiobook

462 pages, Paperback

First published September 25, 2012

About the author

Ben Goldacre is a British science writer and psychiatrist, born in 1974. He is the author of The Guardian newspaper's weekly Bad Science column and a book of the same title, published by Fourth Estate in September 2008.

Goldacre is the son of Michael Goldacre, professor of public health at the University of Oxford, the nephew of science journalist Robyn Williams, and the great-great-grandson of Sir Henry Parkes.

Reviews

[Scott · Rating 1 out of 5]

Currently reading this but not so sure how much more I can take. There is some decent information here. The title is absolutely true. Drug companies are businesses and multibillion dollar corporations are not ethical paragons. They do not publish studies that make their drug look bad or even "as good as." There are sponsored journals that are sponsor biased. Sometimes legit journals want the most interesting "this changes everything" articles rather than another "dog bites man" article to boost readership. That's the media.

The problem with this book is that it is a combination of fact, hyperbole, and omission, not unlike the drug companies themselves. Every other page is "HOW MANY PEOPLE COULD HAVE BEEN SAVED" or "if this makes you as angry as it does me and I'm sure it does, my buddy" (he says that in some manner several times a chapter) that it becomes irritating, pandering, and insulting to any self-respecting critical thinker. Why such overuse of superlatives when simply presenting and explaining the data should be convincing enough.

The omissions are that most if not all physicians heavily distrust any pharmaceutical-sponsored or presented paper. Research that is used as evidence-based treatment is peer-reviewed by other researchers and physicians and statisticians for any possible flaws or oversights in conclusions. There are few things physicians enjoy more than disproving other physicians when it comes to the Truth, as far as science and data are concerned. It's practically the second commandment. Most docs are well versed and tested in statistics. They look at sample size (1000s of people in your study is better than you and grandma), sample location (cultural lifestyles are not alike), as well as outside interests or sponsorships and the number-crunching itself. From this book, it would seem that ONLY drug companies publish research on drugs because it is PROFITABLE otherwise why do research. Any self-respecting researcher or physician can answer that question - because we want to find the BEST treatment for a patient regardless of which drug company it hurts. FUCK the drug companies and all the stat-fudgers and quacks.

It's far from a perfect system. There are always charlatans and opportunists when money is involved. The system does indeed need to change, I just wonder if it can with so many hands in the pot. But for this author to give the constant impression that EVERY drug is a scam, EVERY paper out there is bought and paid for, is disingenuous at best, and the exact charlatanry the author purports to expose at worst, and he's making quite the profit himself. I honestly want to like this book more. I want the facts sifted from the subjective miasma in its pages, so I can tell my patients the facts and not just "read Ben Goldacre's book."

By the way, I have no outside sponsorships to any pharmaceutical companies but I do appreciate the fact that stores like Walgreens, CVS, Kroger, Walmart and others have $4 drug lists to help my patients afford their pills sometimes.

[knig · Rating 5 out of 5]

Stop Press: this should be compulsory reading for anyone…with a pulse, really. I can’t think of a single person who should be excused from the reading rota here.

This is the MOST appalling, horrific, mind-numbing expose on the current state of medicine I had never hoped to see, or know, or be a part of. Ever.

You ever go to the doctor? You a doctor? No? Maybe you expect the doctor, as the specialist, to be able to diagnose and treat you accordingly. I know I do: I go in with my ailments and I like to come out with prescriptions, even better, prescriptions that work. But what exactly is going on behind the scenes? And how do I even begin?

Your doctor has no accurate knowledge AT ALL of any drugs coming into the market, especially any that come on after he’s left medical school. You might as well prescribe your own medicines: you might even have a better success rate, based on probability theory!

The reasons he has no real accurate knowledge are many, but here are the best: drug companies, when applying for a patent, or submitting articles to a medical journal, have to perform medical trials in order to ascertain the efficacy of the drugs. However, they are not required to submit the results of ALL the trials they undertake. Basically, a pharma company can submit ANY result it chooses. So, if 7 out of 10 trials show adverse effects, one shows neutral and two show a slight positive effect (how these anomalies happen is another matter, but by manipulating the type of trial patients you get anomalies in readings), the drug company then submits only the two ‘rigged’ positives, and hey presto, we’re in business. What are the regulators doing in all of this? Nothing, they are on the side of the pharmacological industry. More on that later. A new product is licensed. So, how good is it? Well, no one knows because, you see, drugs are not tested against best in breed, but against placebo, or, in other words, the litmus test is is this drug better than nothing at all? So fine, it might be better than nothing at all, but how does it compare against other drugs on the market for the same condition? No one knows. It might actually be worse than every other drug on the market, but no one, not even the doctors know. It might not even be better than nothing at all, even be killing people, literally, but no one knows: because trial data is withheld (legitimately!). (Remember the seven adverse trials that were swept under the carpet?)has this happened before? Sure, Goldacre gives several examples. Paroxetine prescribed off label for children, and antiarithmic drugs amongst others.

So what exactly does the doctor know? Whatever the pharma company reps decide to tell him. Its as simple as that. How accurate are the reps? Well, I feel physically sick just thinking about it. The chapter is very explicit. Not very.

Where are the regulators in all of this? Secretive and collusive. Various reasons are proffered for this: the regulators themselves quote the MMR debacle and how the public can’t be trusted with the information (unfortunately this seems to include doctors as well!). Goldacre speaks of ‘regulation capture’, or the ‘Stockholm’ syndrome as the rest of us may know it.

Honestly I can go on forever, but the bottom line is this: I’m just surprised we’re not all dead, really. I might have to re-write this review later, I’m jibbering just now, but first I may want to join an action group. Or something.

[Becky · Rating 4 out of 5]

I read Goldacre's book Bad Science very recently, and I enjoyed it so much that I decided to not go for my usual buffer period between very similar books and just jump right into Bad Pharma. And they are very similar books, though this one is actually longer, for all that it is more specialized in one area of badness.

There was a lot of overlap between the two, which is to be expected, I guess, because Goldacre IS a doctor, and lives in this world. I didn't really mind the rehash though, because it gave me a second chance to think about it and absorb the info. I listened to both of these books on audio, and this almost felt like a continuation of the first book, especially because the reader was the same for both.

One thing that I did appreciate was, during his section on bad trials, he mentioned outright fraud, one area where I felt was overlooked in Bad Science. It's a brief mention, but it is its own section, as it should be. Because fraud is everywhere, and even in peer-reviewed science, and systematically reviewed science, it still happens.

I also liked how this book got into some of the non-science badness of the pharmacological industry - advertising and politics and bribery and ultimatums and the like. What I was surprised about though, was that all of this affected the UK, which I (stupidly, I guess) thought wouldn't have that issue because of their National Health Service. We don't have government run healthcare here in the US (and no, the Affordable Care Act doesn't count) and there's so much bullshit surrounding this industry that it boggles the mind. (I'm still waiting on those Death Panels though. I have a few suggestions for useless people who could go on the list.)

Anyway, I'm not trying to go into a political ramblerant here because I am the first one to admit that I don't know nearly enough about it. I just brought that up because I thought that America, with its allowing advertising and its lack of enforced regulations would be the exception, but it seems like this shit goes on all over. Which... makes me feel better? No. Not really. There go my plans of moving to Europe if I get sick. Or if certain other nightmare events come to pass next year.

So. I can't say that this is a very light-hearted set of books, but I think that they are absolutely worth reading. I like that Goldacre provides some ways that things could be improved, though it seems very unlikely that any of his recommendations would actually be put into place, because then that would mean that some people would lose a whole lot of money, and that's just not how this shit works. Disappointing, but hey... what isn't these days?

[Andy · Rating 3 out of 5]

I appreciate how Ben Goldacre is trying to open the eyes of the people to many of the issues relating to science reporting. I check his blog every now and then, but this is the first time I've read his books. As background, I'm a GP in NZ, British by birth and training, closer to the start of my career than the end and I don't see drug reps or attend drug sponsored CME (consciously at least; sometimes it can be difficult to tell). I'm also fairly clued up on the issues he presents here so in someways it was preaching to the converted.

He makes many good points and exposes the day to day manipulative and deceitful practices of the drug companies and particularly highlights just how hard it is to be a doctor and make truly informed decisions. Something that worries myself and most of my colleagues on a day to day basis - am I doing the right thing? I would imagine this book could be quite worrying for the general population and the medicated. For anyone who takes a medicine, this should be required reading.

His style though, after a while, becomes a little much. His passion runs through and starts to take over which distracts from his intent. I felt the early chapters were more straightforward in laying out the facts and more crucially why these facts are important. The later chapters felt like he was just labouring the point and I found my attention starting to wane. Still, despite these issues it's still a worthwhile read.

I think every med/nursing/pharmacy/name your healthcare specialty student should read this during the early stages of their training, firstly to open their eyes, to see what they're going to be up against, but also to promote a fight for change, as Ben so admirably and clearly sets out. An important book, if nothing else it should open your eyes and set you on the path to learn more.

Oh, as an aside, the book is lovingly designed like a pill packet, Braille and everything. Annoyingly though the title on the spine is upside down, in the French manner. Now, I know I can (and indeed have) turned the book upside down to make it fit in, and sure, no-one else is going to know unless they pull it off the shelves to look, but I will know. Every time I see it I'll know. That bugs me. That probably says a lot about me as well.

[The Conspiracy is Capitalism · Rating 4 out of 5]

The flesh-and-bones of Big Pharma’s research and marketing...

The Good:
--While there may be some unsettling notions of Big Pharma, such feelings can easily be diverted to anti-vax and other media sensationalism given the liberal black-hole in critical analysis of political economy. Unlike his previous books that deal with broader topics like media manipulation (Bad Science: Quacks, Hacks, and Big Pharma Flacks and I Think You'll Find It's a Bit More Complicated Than That), in this book Goldacre picks through the flesh and bones of Big Pharma malpractice (or rather, practice for short-term shareholder profit).

--Highlights:
1) Missing data from publication bias: bad results? No problem, just don’t publish it. Who is going to stop you, when you’ve accumulated so much wealth (power) that you can lobby against actual enforcement of trial registers? But what about evidence-based medicine? Pffft, morality is for losers; there can only be one bottom line in business.

2) Bad trials: so how do you even get good results? Well, there are many tricks you can play before resorting to outright falsification:
a) Compare with something useless, like a placebo, even though doctors are interested in how well your drug does against other drug options.
b) If you compare with another drug, you can give that other drug in sub-optimal manners.
c) Test on unrepresentative patients. Ignore dropouts.
d) Stop your trial early once your results start looking good, or keep it going longer to wait for that (random) good news.
e) Test for surrogate outcomes (ex. blood pressure) and extrapolate from that (ex. prevents heart attacks, saves lives).
f) Switch the study’s primary outcome; subgroup cherry-picking.
g) Heck, who needs good results? Just write a good conclusion in your study.

3) Marketing = distorting information (and paying for it!): what a strange system, high drug prices are deemed necessary to cover costs, where marketing is a major cost (marketing/admin twice as much as research and development, i.e. R+D). So, we are paying a premium for Big Pharma to distort evidence-based decision-making in medicine! Besides marketing to patients, there is marketing to doctors via drug reps, medicalization of complex social issues, Pharma-directed continued education, seeding trials (“trials” just to get doctors using the drug), ghost-writing studies, etc.

4) Global: patent property rights preventing production of generic drugs for poor countries; priority of R+D on 1st world problems; how drugs are trialed on poor “volunteers”, and on poor countries with weak regulations.

5) The potential for bigger, better trials using randomized trials integrated into clinical practice via health information technology to fulfill the potential of evidence-based medical decision-making, since large samples + long timescales are much superior to trials to rush a drug onto the market.

The Missing:
--From a political economy perspective, we should expect any industry built on short-term profits for shareholders to have predatory outcomes. The exact manners may be different between say the tobacco industry and the pharmaceutical industry, but common incentive structures bring common behavioral patterns. We are not talking about “drugs are baaaad”; we are considering issues in evidence, pricing, distribution, etc., and for this we must consider the power relations between government, Big Pharma, and the public. This gets into social values and imagination, which is why so much corporate money is poured into public relations, media, think tanks, politics, and higher education. Only great businessmen and private enterprise can command the hordes of workers to drive innovation and bring about optimal social outcomes, we are told…
--While Goldacre touches on the consequences of First World drug companies and global south consequences (neglect from less profitable markets, patent property rights forbidding life-saving affordable generic drugs, testing drugs in poor countries with open markets who will not benefit from them, etc.), this deserves an entire book.
--Overall, this book is targeting a narrow audience (i.e. convincing the medical community) making it a denser read, unlike Goldacre's accessible best-sellers (general public). Lots of touchy doctors out there; let’s not forget that it wasn’t long ago (before the '70s) when Western medicine was predominantly eminence-based medicine!

[Paul · Rating 4 out of 5]

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 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...

[Kaelan Ratcliffe ▪ كايِلان راتكِليف · Rating 4 out of 5]

This Affects You

I'm glad I stopped and read the short (no less impactful) essay The Corporation by Joel Bakan midway through this book, it definitely helped in coping with the subject. I feel like Ben Goldacre has simply stumbled across a more specific problem in a larger mess our world faces today.

What the reader will have introduced to themselves during the 400+ pages of Bad Pharma, is a consistently horrifying expose of the corruption and bad practices that have taken place in a deregulated environment, fostered by corporations - within the pharmaceutical industry - over the last few decades. Goldacre writes in laymen terms, which I appreciated as someone who knows next to nothing about the industry, and provides plenty of background information to keep you in 'the know'. So there really is NO excuse not to read this (especially if you're from the USA and the UK) as it directly affects you and your loved ones.

The bottom line really is the issue that Bakan raises in the above mentioned Corporation; in that there are certain areas of public life the simply SHOULN'T be monetarily driven. It's a big problem, and anyone with half a brain cell should know how corporations are practically infesting the political / public landscape of the USA (especially since Trumps Kleptocracy has come to power), so it's no surprise what's been seen here in Bad Pharma. People are seen as consumers and commodities, and therefore are in service to profit.

My only criticism is how Goldcare seems to still believe in the system, and despite making such a heroic book, makes no mention of how certain governments utterly support these companies in getting away with it. He even goes as far as to mention at time how he doesn't want to get "too political'. Perhaps I'm an old nihilist (I'm really in my mid twenties, I swear), but I don't believe corporations, who's incentive is profit, will change unless they're reigned in by government. Despite this, he's brought real change with the book, and the final section regarding what came after it was released (this is a fourth edition copy I read) brings some glimmer of hope.

Maybe you'll decide for yourself. Either way, read this.

[Dannii Elle · Rating 3 out of 5]

Actual rating 3.5/5 stars.

Ben Goldacre provides the reader with an understanding of the duplicitous nature of drug companies, how their tests and trials are often skewed for optimal results, and how academic journals often fail to publish any trials producing negative outcomes.

All of these factor into the misinformation that doctors are unknowingly passing onto the general public and how many individuals have been provided with the wrong, harmful, or imperfect prescriptions, for a broad range of ailments.

Whilst I appreciated the information this book sought to provide the reader, as well as the passion that Goldacre clearly had on the subject, I found my attention to the minute details waning as the pages continued. I found the general facts appealing but the studies into different trials and companies, as well their results, less so. I often caught myself forgetting many of the facts relating to them as another became introduced.

[الشناوي محمد جبر · Rating 3 out of 5]

شرور شركات الأدوية (فساد صناعة الدواء والسبيل إلي إصلاحه)
بن جولديكر
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أجلت قراءة هذا الكتاب عدة مرات، ولم أكن أتخيل أنني سأطلع فيه علي هذه المعلومات، يتحدث الكتاب عن شركات الادوية وفسادها وكيفية تلاعبها بالتجارب التي تجريها علي الأدوية قبل طرحها للمستهلكين، وذلك بهدف زيادة أرباحها وزيادة سيطرتها علي أسواق الدواء العالمية.
رغم أن العنوان واضح، فهو يتكلم بوضوح عن شرور شركات الأدوية وفساد صناعة الدواء، لكن رغم وضوح العنوان في الدلالة علي اتجاه الكاتب والكتاب إلا أن ما أورده المؤلف بالكتاب يفوق كثيرا ما يوحي به العنوان. فالفساد المقصود بالعنوان بعيد تماما عن توضيح حقيقة ما جري علي أرض الواقع من فساد شركات الدواء.
ليست شركات الدواء _ كما يعتقد البعض (وكنت منهم) _ مهتمة علي الأرجح بالسعي لمصلحة المريض كهدف سام بعيدا عن الأهداف الربحية، بل الهدف الربحي هو الأساس لعملها، وما هدف شفاء المرضي والحرص علي مجاح الدواء معهم إلا هدف فرعي للهدف الأساسي وهو الربح، ولأجل الربح تقع هذه الشركات في مخالفات قد تودي بحياة متعاطي الدواء الذي تنتجه هذه الشركات، فما هي هذه المخالفات التي تم رصدها والتأكد من حدوثها؟
من حق الطبيب ومن حق المريض الاطلاع علي بيانات تجارب الدواء في فترته التجريبية قبل نزوله للسوق التجاري، لكن هذه الشركات تعمد إلي إخفاء تجارب الأدوية طالما لا تتفق مع المعايير المقررة؛ حفظا لأرباحها ومكانتها في السوق العالمي، ولا داعي للبحث عن مصالح المريض.
تقوم شركات الادوية بالتنسيق مع مراقبي الأدوية في بلاد العالم المختلفة، والتنسيق يتم بطرق عديدة غالبا تكون غير شريفة من الناحية الاخلاقية ومخالفة للقانون، هذا التنسيق يتم بموجبة تخفيف الرقابة علي الأدوية والسكوت عن موانع نزولها للأسواق، وقد أكدت البحوث الميدانية أن الكثير من مراقبي الأدوية بعد إحالتهم للتقاعد يتجهون للعمل الفوري بالشركات التي كانوا يراقبون علي أدويتها في أسواق بلادهم.
تقوم الشركات بإجراء تجارب علي الأدوية قبل نزولها الأسواق، لكن هذه التجارب غير دقيقة في الكثير من الاحيان، فالعينات التي يختارها الخبراء تكون معيبة وغير معبرة عن مجتمع مرضي الدواء، وتكون العينة غير ممثلة لمجتمع المرضي، وكثيرا ما تكون العينة صغيرة الحجم جدا بحيث لا تراعي احتمالات الآثار الجانبية لأصحاب الحالات المختلفة، كما أن التجارب قد تتم في ظروف غير علمية دقيقة، كما أن الشركات تقوم كثيرا باستغلال فقراء البلاد الفقيرة في إجراء تجارب علي أدويتها، وكثيرا ما تنشر ادويتها قبل التأكد من فاعليتها، وفي بعض التجارب لا تقوم بتسجيل الحالات الفاشلة وتعتمد فقط نسب التجارب الناجحة وهو أمر شديد الخطورة، إذ يقدم نسب نجاح مضللة وغير حقيقية، وأحيانا تقارن التجارب الناجحة بالدواء المزيف بدلا من أفضل دواء بديل في السوق.
كثير من إجراءات شركات الأدوية في الإعلان عن أدويتها الجديدة تعتبر إجراءات معيبة وتعتمد علي شراء الذمم، هذه الشركات تجذب إليها الأطباء في رحلات ظاهرها مؤتمرات علمية وباطنها تسويق منتجاتها حتي ولو كانت غير جيدة أو علي الأقل ليست الأجود في سوق الدواء، وينم ذلك علي حساب المرضي بالتأكيد.
فاعلية الدواء ومدي نجاحه يعتمد علي لكثير من الخطوات في إثبات جدارة الدواء، وهذه الخطوات للأسف لا تعتمدها شركات الدواء كثيرا أمام حاجتها إلي تحقيق الربح بأي ثمن ولو كان الثمن حياة المرضي الذين تأكد موت الألاف منهم بسبب أدوية غير صالحة للاستخدام.
كتاب ثمين جدا ومهم جدا الاطلاع عليه.
............................

[Bastian Greshake Tzovaras · Rating 5 out of 5]

Okay, somehow Goodreads didn't save the last review I tried to write. So I'll try again:

If I only had read this book a day earlier I could have flagged it as the most depressing read of 2012. It made me cry out loud and swear a lot (just ask my girlfriend who had to listen to it for the most time).

Bad Pharma gives a great overview on how medicine is failing patients (aka each of us) all the time. Publication bias, missing access to raw data and all the other nuisances which might be familiar to you from other fields of science also apply to medicine. The only catch being: In medicine this lack of knowledge, often facilitated by lacking access to data, is killing people, virtually every day.

We don't know how drugs compare to each other, serious side effects are not as well known as they should be, organisations which approve drugs feel it's their job to protect pharmaceutical companies and MDs get most (if not all) of their post-graduation training delivered from drug companies. Are you already feeling depressed?

Goldacre does a great job of describing all those broken parts, even if you're not too familiar with the health system in the UK or the EU. And he makes clear: It's not that our medicine is controlled by mind-bending lizard-alien-conspiracies but that it's simply an effect of a system full of idiosyncrasies and normal people, with all their failures. His british humour often saves you from more serious depressions and he helpfully gives lots of ideas how the system could be fixed.

[John · Rating 5 out of 5]

This is an outstanding book and everyone should read it. It took me about 3 sittings to get through it as I found rage slowly building as I read it and had to get up and pace around the house a bit.

The book systematically works through all the ways in which the practice of evidence based medicine is being distorted by the big pharmaceutical companies. It identifies all of the perverse incentives that make those distortions an unavoidable part of doing business, and then helpfully identifies ways to fix things.

My only problem with the book is it gives ammunition to "alternative medicine" proponents, as it highlights a lot of problems with "western medicine". To that I say - evidence based medicine is still the best method we've got. This book highlights how big pharma can distort the way evidence based practice works, alternative medicine can't even muster enough evidence to sit at the table.

[Duncan · Rating 5 out of 5]

Here Ben Goldacre follows up on his previous book, Bad Science, by turning his spotlight solely on the pharmaceuticals industry. This is a terrifying book because it argues in great detail that our understanding of the efficacy of many drugs and the extent of their side effects is fundamentally flawed.

Goldacre starts with the criticism he finds most damning: namely, when drug companies conduct a trial and the results don't support their own medecine, they frequently fail to publish the results - or they use dishonest tricks - there's a chapter on ways that trials are intentionally flawed by design to yield positive results for the sponsoring company - like re-analysing the data until they find some random subset that can be written up as positive, and then pretending that was what they were testing for all along.

From the perspective of the pharmaceutical companies, their goal is simply to make money. The problem is that when the published literature on virtually all of our medicines is dominated by one-sided information, it is impossible for anyone in the medical profession to practice based on the evidence - and as Ben Goldacre details, this has caused unnecessary pain and suffering, and even death, to enormous numbers of real people. One example is of a heart drug estimated to have killed around 100,000 people before proper trial data revealed the dangers.

Missing data badly analysed means doctors cannot possibly make the best decisions when prescribing drugs. In many cases, your doctor has no true idea which drug would likely be the best for you because the literature they study is full of disinformation. Think about that the next time your doctor prescribes you any medicine, as mine did yesterday.

The remainder of the book is dedicated to examining how this situation is possible. Goldacre writes about medical journals that fail to act in the interests of patients, as well as highly secretive regulators who neither hold drugs companies to account nor allow the data to reach the public domain so independent researchers can analyse the findings.

In the last chapter, Goldacre discusses marketing and the techniques pharmaceuticals companies use, spending tens of billions of dollars each year, to make their drugs look better than they are in order to increase sales.

This is a deeply worrying book because it argues that the whole system for approving and regulating drugs, and disseminating accurate information on them, is broken. There have been some attempts to address these issues as researchers unveil the depths of these problems, but all of these attempts have been 'fake fixes' in the words of the author.

Crucially, although Goldacre discusses individual cases of specific drugs throughout this book, most of the arguments are built on systematic reviews of the literature, which involve researchers collecting evidence from large numbers of trials to avoid the bias produced by collecting only small samples. This shows that the problems described in this book are not one-off cases, exceptions to the norm, but rather the norm itself. The enormous fines levied on many of the world's largest drugs companies (e.g. $3 billion for GSK in July 2012, $2.3 billion for Pfizer in Sept 2009, etc.) also bear out the argument that all of this wrongdoing is standard practice in the industry, and their recency shows that the fixes have indeed been fake.

The book is a little repetitive in places. I think Goldacre wrote it this way to keep reminding lay people of the full range and gravity of his arguments. Overall, it wasn't quite as enjoyable a read as Bad Science - but it is a far more important work. This should be considered essential reading.

[Darrell · Rating 5 out of 5]

"The story of the serotonin hypothesis for depression, and its enthusiastic promotion by drug companies, is part of a wide process that has been called 'disease-mongering' or 'medicalisation', where diagnostic categories are widened, whole new diagnoses are invented, and normal variants of human experience are pathologised, so they can be treated with pills."

Ben Goldacre touched on the evils of the pharmaceutical industry in his previous book, Bad Science, and this book greatly expands upon those chapters. Unlike Bad Science, which read like a series of blog posts, Bad Pharma is much more cohesive and better written. The biggest surprise for me was that the theory that depression is a chemical imbalance caused by low levels of serotonin isn't true. It's a myth spread by marketing companies.

There are major problems with the pharmaceutical industry from misleading or missing data, testing dangerous drugs on prisoners or the homeless, regulators with conflicts of interest, academic journals not being proper gate keepers, patient groups being funded by the pharmaceutical industry, deceptive marketing, drug reps who bribe doctors, and more.

GlaxoSmithKline knew from trials that their antidepressant paroxetine caused increased suicide in children, and they knew the drug was being prescribed to children, yet they kept these trials hidden to increase their profits.

Roche has refused to share its trail data on Tamiflu. It appears Tamiflu does help you recover from the flu a few hours sooner than you would on your own, but there's no evidence it reduces cases of pneumonia or death, which is the reason countries are currently stockpiling it.

During a clinical trial that took place in Nigeria, Pfizer withheld the effective dose of an antibiotic known to work so they could test their new antibiotic. Eleven children died as a result. When Pfizer was brought to court, it ran a smear campaign against one of the Nigerian officials to try to make the court case go away.

Nexium is almost exactly the same as omeprazole, but it costs much more because the patent ran out on omeprazole. AstraZeneca changed the drug slightly to get a new patent, not because Nexium is any more effective than omeprazole, but because they wanted to make more money.

A drug called Midodrine was approved by the FDA despite the fact it performed no better than a placebo in trials. The FDA did eventually threaten to take the ineffective drug off the market, but a special interest patient's group demanded the drug remain available because they claimed it worked for them, not realizing they were simply experiencing the placebo effect.

Nobody knows for sure which drug is the best one for any given condition. This is because when industry tests their own drugs, they test it against a placebo or a different dose of their competitor's drug. They have no incentive to test their drug fairly against their competitors. How to solve this problem? Government needs to step in and perform the head to head trials. This is a win for everybody. Even the CEOs of big pharmaceutical companies presumably want to know which treatment is the most effective for themselves and their families. Bizarrely, when President Obama proposed that the US government do just this, Republicans were opposed. Apparently, Republicans do not want to know which drug is the best medical care available.

With all these problems in the pharmaceutical industry should we all switch to alternative medicine? No. As we saw in Ben Goldacre's previous book, Bad Science, alternative medicine is guilty of these same crimes and more, not to mention that the pharmaceutical industry owns most of the alternative medicine companies anyway. As bad as drug companies can be, they still do more good than harm. Merck's drug Vioxx was taken off the market due to increasing the risk of heart attack, but taking Vioxx is still safer than driving a car.

[Jim · Rating 5 out of 5]

I really liked another book by Goldacre, Bad Science, & his web site so I read this even though I'm not much for taking any medications. Woah, what a mess. Between this & Rigor Mortis: How Sloppy Science Creates Worthless Cures, Crushes Hope, and Wastes Billions, I'm really discouraged by the state of affairs.

I've heard a lot of people denigrate Big Pharma for a variety of reasons. A lot of it sounds like a conspiracy theory, so I discounted it. The truth isn't somewhere in between as I'd thought though. It's definitely on the conspiracy theory side & it's not just a problem in the US, but all over. Norway gets kudos, but even they are victims of a poorly managed system. They can't help it.

The system is broken from the start. Industry is too involved in every step, there's very little transparency, too much money, too little & toothless oversight. Goldacre points out the flaws very well, if in more repetitive detail than I wanted, but he also provides his ideas on how the problems can be fixed every step of the way. I REALLY appreciated that. It's easy to complain, but a complaint without a solution is just whining. Goldacre is not a whiner. I think he's a little optimistic & overreaching at times with his suggestions, but at least he has them. They're not bad ideas, just very unlikely to be implemented.

I highly recommend this to everyone, but especially if you're regularly taking a medication that's new & expensive. You'll find out what facts to go looking for & you'll see that even though it is new & shiny, it might not be better - It may be a hell of a lot worse - than the existing generic brand. I know I have a lot of questions for my health professionals.

My edition was very well narrated, but make sure you get the PDF with it & or an ebook. It really helps.

[Janel · Rating 4 out of 5]

The first thing you need to know about this book is Goldacre doesn’t shy away from the fact that it is an attack on the pharmaceutical industry, he’s here to tell the reader some home truths: problems, fixes, and suggestions on what we can do. The issues Goldacre is addressing have evolved over time, and now it’s fair to say:

“Medicine is broken.”

Medicine is one of those topics that you may know bits and pieces about, may have heard rumours and chatter, but, unless you’re in the field of medicine, it’s really hard to know where to begin when it comes to separating the facts from the myths. Bad Pharma is a great place to begin!

Expect to be shocked and outraged! Let me give you an example: there were seven studies conducted into the effectiveness of an antidepressant drug – five had negative outcomes, only two had positive outcomes, and those were the two which were published. Those two positive studies form the research that is influencing prescribing, but the true effects of said antidepressant are unknown because the other five studies never saw the light of day! These are the practices that exist. Also, it cannot be overlooked that drug companies own some major journals so it’s hard to establish what’s reputable and trustworthy data to begin with. These, and so much more, are the topics Goldacre breaks down in an easily understandable way.

What’s really good about this book is Goldacre doesn’t just tear the industry apart, he offers solutions and fixes. Solutions and fixes that are realistic, and quite frankly baffling as to why they are not already in practice.

Reading this book, you’ll come across subject specific terminology, and acronyms; Goldacre explains these where necessary. Where not knowing the acronym or terminology will have no impact on your understanding, it is not explained, and this may be frustrating to those who are easily annoyed if they don’t know the meaning of specific jargon . As a trainee mental health nurse, a lot of the terminology was familiar, and the subject itself is of great interest me. To read, or listen, to this book in its entirety, I believe you have to have an interest in the subject beyond a casual chat with friends where you put the ‘world to rights’. You have to want to know and understand, and have a strong interest in the flaws of the industry, or I fear you’ll lose interest in this book once the shock-factor wears off.

Goldacre raises so many valid points in this book, it is extremely well researched. It doesn’t read like the ramblings of a conspiracy theorist – you just know it’s rooted in truth; it makes too much sense not to be. In book form, while the topic interests me, I don’t know if I’d have picked it up for fear of it being too dense, and statistical. I’m glad I listened to it – Jot Davies is an excellent narrator – it wasn’t as dense as I thought it’d be (but that might be because I listened to it, rather than read it), it was detail-heavy, but in an accessible way, and it’s an audiobook I absolutely recommend if the topic interests you.

[Malcolm · Rating 5 out of 5]

This is a great instance of science not standing up to scrutiny by its own methods.

One of the great crimes of health care is that it is dominated by companies whose primary concern is profit, not necessarily our health; these are not the private health providers but drug companies. I have been around this area for years, from my days as a trade union campaign organiser in the public health sector and now in a university School of Sport and Exercise with a strong strand dealing with public health; I though I knew how the drug companies worked and their shenanigans….. how wrong was I?

Ben Goldacre takes us through the life cycle of drug development, from development to testing to trials to marketing revealing the ways drug companies conceal data that shows their drugs in a bad light, how they develop replicas of other drugs rather than new ones to treat new conditions, how they tweak their existing drugs to keep them in patent and therefore maintain profits and how they corrupt the health care sector in their interests, not the interests of patients or public health.

Along the way see the extent to which drug trials (most of which are industry funded) are skewed toward the positive – good for marketing, not good for science. We also find ourselves in the middle of the revolving door between industry and the regulators. We see the ways drug reps use non-medical incentives to get their products prescribed, and the way drug companies hire academics for their names only on ghost written (by the company) scholarly papers and in some cases publish their own journals masquerading as scholarly, scientific journals. I’ve been watching this industry for years – the case is thoroughly believable.

Goldacre’s real strength is two-fold. First, he brings the methods of scholarly scientific research to his critique of the drug companies – that is, he uses the methods they claim to use to test their claims, and finds them wanting. Second, he writes well (some of the faux chumminess/jokiness of Bad Science has gone) and can explain quite complex medical and scientific procedures (as well as the statistical analyses underpinning his work) in clear, accessible language.

It is likely to be slightly less accessible or read than Bad Science but to my mind it is a much more important book and should bring to the public debate a more informed tone that allows us as lay, non-scientists, non-medics to challenge the power of big pharma.

Read it, dammit! And then demand that your legislators control this industry. And check out Goldacre’s on-going work at http://www.badscience.net/

[Bill · Rating 4 out of 5]

This book is not unbiased, but it is largely fair. The "bad" examples really happened, and some of the behaviors are still widespread - like failure to publish clinical trial results even years after the trial has been completed. As someone who's worked for two of the biggest firms, I'm still unhappy by the lack of transparency. But I do see signs of improvement. No company wants to have a reputation of being the lowest of the low. More people should read this book, and demand better accountability from their own doctors, and the companies and regulatory agencies too.

[Mohamed al-Jamri · Rating 3 out of 5]

Medicine is broken.

"We are going to see that the whole edifice of medicine is broken, because the evidence we use to make decisions is hopelessly and systematically distorted. And this is no small thing. Because in medicine doctors and patients use abstract data to make decisions in the very real world of flesh and blood. If those decisions are misguided they can result in death and suffering and pain."

The whole book is written to defend the following paragraph:
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.
"It's possible for good people in perversely designed systems to casually perpetrate acts of great harm on strangers - sometimes without ever realizing it."

The book is for everyone. This is pop science, so it will not contain fine details.

Systematic reviews highest quality.

Chapter 1: Missing Data.

Company funded studies produce more positive results than independent (or government funded) ones. 22% more likely to be positive. For their own drugs 78%.

Systematic reviews show companies give positive results 4 times more likely for their drugs.

Hiding negative results.

Tricks to make all company sponsored studies positive.

Why missing data is important. Rebocsatine for depression. Even when you're doing your best as a doctor reading the data and critically appraising it, you can still be mislead, because much data -often negative/bad results- is not published.

This is still happening, all over the world, for all drugs, and it's entirely legal!

TGN1214 trial on humans. Disastrous side effects. Not published data could have prevented it.

80% of first on human studies are not published even after 8 years.

This is about real people who die due to not publishing (e.g anti arrhythmatic for MI patients killed ~100k people, while publishing a study could have prevented this).

Importance of systematic reviews. Steroids for premature births. Meta-analysis. Blobbogram (aka Forest plot). Cochrane reviews.i

Study on anti-depressants in 2008 about drugs from 1987 to 2004 showed there were 38 positive results and 37 negative. In the Academic journals these translated to 48 positive and 3 negative results! Such distortion..

The evidence is overwhelming that negative trials are published less often or changed to appear positive. This is a systematic problem for all drug companies. This can cause unnecessary harm, suffering and death. Also it fools governments into oaying more money for expensive drugs that may be just as good as the old cheap ones.

Even in other branches of science, nefative results are less likely to published than positive results.

Journals are not to blame.

Not publishing negative results is unethical. Universities ans wthical committees have failed us.

Companies have the right to stop some studies at anytime for any reason. This introduces huye amount of bias and is not mentioned in the literature. They also can choose not to publish studies. And who can see the data; they can even prevent researchers working in the trial from analyzing and sharing data.

Researchers who try to fight the system are intimidated.

Patients are lied to by consent forms since if data is not published this does not lead to increase in our knowledge. Recruitment is already hard, this only makes it worse.

Suggests many solutions for the problem including setting trial registers.

Pre-registration as a condition for publishing in well known journals. Didn't work. Wasn't applied on ground.

EU register kept secret. Why call it a register if it's not public?

Lists many solutions by EMA EU and FDA that didn't work. Fake assurances.

Problems faced when trying to get data from regulators:
1. Information is held from regulators. Done legally. Prescription for other uses with no separate market approval as formally required (i.e. off label). Patent extention. (GSK paroxatine for children. Ineffective and leads to increase in suicide. Prescribed off label).
2. Regulators make it hard to access the data they do have. Messy websites. Documents with no title or table or contents.
3. Regulators withhold study records that they do have. Protection of commercial interests of companies, or personal data. Really? The EMA (EU regulator) was complicit with the companies and withheld data under fake excuses.

Regulators don't understand the difference in decision making they have to do (wether the drug should be in the market at all) and that done by doctors (is this drug suitable for this specific patient in front of me). They paternalisticly think they made the checking for doctors who don't need to get all the data.

Summary at end of chapter. This us research misconduct on a grand universal scale.

Tamflue case. Chochrine makes a mistake in their systematic review. Because their methods are transparent, this mistake is picked up by a Japanese doctor. They started working to fix this. Rosh, the company manufacturing tamflue held back the needed data. Discrepancies in data given to different regulators. The trials were designed to give favorable results.

Regulators are fallible. Rosey Glitazone for DM causing increased risk of heart problems.

Benifits of data sharing and how it leads to great results. Suggestions to increase public sharing of data.

Chapter 2: Where do new drugs come from

3 phases then regulator.

Ethical problems for trial participants. People who earn living from participating in trials (Genie Pigs). Abuses they endure and intimidations.

Commercialization of trials (CROs). Moving trials to low cost countries: e.g. India, China, Romania and Argentina.

This raises ethical (abuse, fairness) and scientific questions (quality, applicability etc). The Helsinki Declaration is not respected and recent changes made it ok to violate it while outside US and EU.

Chapter 3: Bad Regulators, getting your drug approved.

Pressures on regulators. Sociology of regulators. Regulatory Capture. Free movement of staff. Conflicts of Interest (in FDA etc who have commercial conflicts of interest). Corruption evidence very hard to gather in these situations.

The FDA has become an agent of the industry!?

Drugs in trials on patients should be compared to the current best treatment of the condition, and not to placebos. The Helsinki Declaration was amended in 2000 to specifically emphasize this point.

The parameters taken into account are sometimes not mortality and MI rate, but blood cholesterol levels (LDH etc). This can be misleading as surrogate outcomes don't always lead to the results we want. Example of CAST trial on anti-arrhythmatics for MI patients such an example. The rhythm was fixed, but mortality rate increased!

Accelerated approvals. FDA performance was assessed for decades by number of drugs approved per year which led to the "December Effect" with many drugs rushed in last weeks of year. Companies of course push for fast approvals for more profits. Urgent approval policy created after HIV epidemic. Abused by companies for drugs such Milidrum. Patient advocacy groups pressure. Post-approval trial promises are usually not fulfilled. Case of Iressa for small cell cancer.

Effects on innovation. If companies don't have to produce drugs better than those already available, they simply won't. This keads ti the "me too" phenomenon where instead of developing new drugs companies just manufacture their own drug of the same class e.g. SSRIs. Leads to waste of money time etc instead of developing new good drugs.

"Me again" phenomenon, changing enantima from right handedness to left handedness e.g. omeprazole and S omeprazole (Nexium).

Comparative effectiveness research. Vital.

Government should fund research. The price of overpriced medications outweights the price of doing research (to prevent it). e.g. treatment of hypertension amlodipine vs chlortalidone (cheap as effective and with no serious side effects).

Monitoring side effects. Spontaneous reporting. Database studies.

Regulators have a big duty to report side effects. A separate organization should be set with powers to withdraw drugs from market. Suggests solutions.

Chapter 4: Bad Trials

Tricks:
1. Outright fraud.
2. Test your drugs on ideal patients.
3. Test your drug against something useless (wrong dose, rotue, freq etc).
4. Make trials too short (surrogate measures).
5. Stop trials early (peeking, major side effects).
6. Stop trials late.
7. Small trials
8. Packaging/mixing findings
9. Per protocol vs intention to treat analysis.
10. Switching the primary outcome after the study ends. Drawing the target after you throw the dart.
11. Dodgy subgroup analysis (patients). Cherry picking among false positives.
12. Selective use of trials.
13. Seeding trials. To advertise drugs to doctors under the guise of research.
14. Pretend it's all positive regardless. Relative risk and absolute risk. Numbers needed to treat.
15. Industry funded systematic reviews!

Chapter 5: Bigger Simpler trials.

Observational studies. Take data from doctor notes without needing to make big costly trials. Statins (simvastatin and atolvastatin). What if this becomes the normal state of affairs, trial as a routine continuous activity in all clinical practice.

Ethical committees being an ass sometimes and putting unnecessary barriers for useful studies (20 mins consent form).

Chapter 6: Marketing

Doctors can read all papers. We need ways of communicating new information to doctors to save costs and increase efficiency.

Companies teach doctors aftet they graduate. Hold conferences. Many covert ways of advertisement. They spend twice on marketing and promotion than on R&D. Marketing is used to pervert the evidence-based practice.

Ads to patients directly. Only few countries allow this. Changes patient behavior to the worse. People are turned into patients. News drugs get more ads. It is people and patients who pay for the ad campaigns as the cost of drugs goes up due to ads.

Celebrity endorsement. Use of individual stories to market it. Depression-serotonin relationship has little support in academia. Pathologizing of normal human experiences, disease mongering. SSRIs and depression checklist.

Social anxiety disorder. Female sexual disfunction.

Patient groups. Drug reps. Free meals. Dealing with doctors based on their type. Gifts. Tricks. Flights. Entertainment. IMS data show to drug companies what doctors prescribe and so they double check on their promises. There are other ways to get the data too.

Don't see deugs reps and ban them from your faculty. Drug rep ban stand. Other advices.

Ghost writers of journal academic articles.

Academic journals. Their income from advertisement is mainly from pharmaceutical companies. Reprint orders. Conferences as trade fairs. CME teaching most sponsored by big pharma and used to promote drugs including those to be used off label and other tricks/transgressions.

We need proper regulations on Big Pharma and not an outright ban. Conflic of Interest should be declared. Other conflicts of interest not related to Big Pharma.

Afterward: Better Data

Missing data is biggest problem. All distortions can be corrected by check systematic reviews, but missing data cannot; it poisons the well for everyone, rich and poor.

Defends the book against predictable replies & criticisms and moves to the attack!

Many parts contain Bombardment of information, even for me. Too much details. It's on the borderline between pop science and science.

At end of each chapter suggestions to what to do. Book is partly written to doctors and partly to normal people/patients.

[Tanja Berg · Rating 3 out of 5]

A very interesting read about how medicine is developed, released and distributed. It suffers mostly from being dry and detailed. This is not a conspiracy book. It's about facts, some of them quite complicated, particularly if you are unfamiliar with scientific methodolgy.

One of the problems is missing data. Most of the trials that are negative, that do not have the result the sponsor (the pharmaceutical industry, usually) hoped for, are never published. The data is extremely difficult to get at, protected by the very regulators who should protect the public.

Another problem is bad trials. Trials that change what they are looking for along the way, where results are peeked at, that are too short, too long or otherwise badly constructed.

Then there is the marketing. I thought that the pharmaceutical industry spent most of their money developing new drugs because the process from finding a new active molecule to an approved medicine is so long. I was wrong! Apparently the pharmaceutical companies spend most of their budget on advertising! Some of this is done in such a way that it is not very obvious, such as celebrities dropping names and hints. The industry also sends around drug representatives to hosptials and doctor's offices to push their drugs. They pay for dinners, educations and other perks.

Wait a minute, they do WHAT? They BRIBE doctors to prescribe the drugs made by the company the reps work for and this is okay?! This is truly reprehensible and it is something that is forbidden by law in other segments of industry. I am not allowed to give as much as pen to a person working for a state-owned company because it might influence their decision in my favor. Most doctors work for the state, so I don't understand this dichtomy.

So yes, there are definitely problems. The book has many examples and suggestions on how to improve things. Let me remind you that although there are multitude of problems with traditional medicine, they do not even approach the issues that "alternative" medicine have, so don't even go there. Homeopathic "medicine" by definition has no active ingredients. Here in Norway you can advertise for alternative medicine or treatments and they do not have to have any proven result at all. That is still worse than the regular industry, for all its faults. For the safety of all of us, things should be improved though. The ethics are certainly questionable to say the least.

[Donna Brown]

Bad Pharma is actually a fairly scary book to pick up when you’ve just collected a prescription from the chemist but I’d heard a lot about Bad Science (which I’ve since read) and thought Bad Pharma would be incredibly interesting. I certainly wasn’t wrong.

This is pretty much a damaging expose of the pharmaceutical industry’s involvement in modern medicine. Not necessarily their manufacture and distribution of tablets that do improve people’s lives every day but more the unnecessary peddling of drugs that either do very little or are no more effective than drugs already on the market. We’ve all seen the washing powder ads for something ‘new and improved’, only to find out two months later that it’s got one slight miniscule change. How ludicrous would it be if the drug companies did something similar and then got it under patent for 10 years so they could charge incredibly high prices for it? Well, they do.

Delving into issues such as pricing, drug trials, suppression of research and trial reports, Goldacre uncovers how strong the hold over our medication is and calls for changes across the board, citing things that patients, doctors, governments, researchers and the drug companies can do.

I’m sure Goldacre didn’t make any drug rep friends via this book – and I’m quite sure he doesn’t care. It’s refreshing to read something that is so focussed on what’s right, regardless of the waves it makes. That said, having now gone back and read Bad Science, it’s not really a surprise. This is an absolutely fascinating read for anyone who has had any involvement with our health system or ever taken any medication whatsoever. So, that’s pretty much everyone!

This review was originally published on Tweedle Dee and Tweedle Dave

[Charlene · Rating 3 out of 5]

I didn't quite know what to expect with this book. After I read the title, I wondered if it might be driven by conspiracy theory. It was anything but. Goldacre focuses mainly on missing data-- how it gets lost, how its absence affects how trustworthy the findings are, and what that means for the subsequent care recommendations made from incomplete data. I remember learning about the file drawer affect in which papers that do not include a strong finding are never published, and thus kept out of meta data. Far from insignificant, a lack of finding is important information when trying to understand treatment for various issues. The file drawer affect is not the only problem at hand when trying to get a full understanding of the issue of concern. Goldacre does a great job of highlighting that many concerns we need to be aware of, and take measures to correct, if we are to have any real understanding of any medical concerns we attempt to study.

[Atila Iamarino · Rating 5 out of 5]

Muito completo e revoltante. Conta todo tipo de sacanagem que a indústria farmacêutica reconhecidamente faz, tudo com citações. Recomendo a todos, me fez repensar muito sobre como consumimos remédio, sobre o papel do médico e até sobre o papel dos periódicos que publicam os estudos. Bom para quem quer perder um pouco mais de esperança na humanidade.

[Osama Aghbar · Rating 2 out of 5]

الكتاب ممتاز جدا للمشتغلين في قطاع الصيدلة والمستخدمين للأدوية
لقد أحببت قراءة الكتاب لأني عكفت على تأليف كتاب بعنوان
المكملات الغذائية ليست كلها تعمل
ولقد استفدت من هذا الكتاب كثيرا
مواضيع الكتاب بشكل عام تتحدث عن الأمور التالية:

يعرض المؤلف في هذا الكتاب قصة الدواء في عجالة ويبدو الأمر مخيفا بحيث تظن الكاتب يبالغ فيما يقول

استشرى الفساد في صناعة الأدوية؛ فكثيرًا ما يُطرَح الدواء في الأسواق ثمسرعان ما تَظهر
آثارُه الجانبية الوخيمة ويَثبت فشله.

نتصوَّر أن إنتاج الدواء مبنيٌّ على الأدلة وعلى نتائج اختباراتٍ سليمة، لكن، في واقع الأمر، هذه الاختبارات غالبًا ما تكون مَعيبةً لدرجةٍ كبيرة


الفصل الأول : من أين تأتي نتائج التجارب
تلاعُب شركات الأدوية في نتائج الأبحاث
دواعي الاهتمام بمشكلة إخفاء البيانات
لماذا لا يتم نشر بيانات التجارب كاملة
ما هو مقدار ما يتم إخفاؤه من بيانات التجارب
أسباب إخفاء التجارِب ذات النتائج السلبية

الفصل الثاني : من أين تأتي العقاقير الجديدة
- من أين تأتي العقاقير
- من المختبر إلى السوق
- التجارب المبكرة

الفصل الثالث : عدم كفاءة الرقابة على الأدوية
- الضغوط التي يتعرض لها المراقبون
- التصديق على عقار جديد
- أبحاث مقارنة الفاعلية
- ملاحظة الآثار الجانبية

الفصل الرابع : النتائج المعيبة
النتائج المعيبة هي تلك التي تضخم الفوائد وتهون من الأضرار
- الغش الصريح
- اختبار العقار مقابل شيء تافه
- التجارب السريعة
- التجارب التي تتوقف قبل أوانها
- التجارب الصغيرة جدا
- تجارب تتجهل المرضى المنسحبين منها
- تغيير النتائج بعد انتهاء التجارب
- التجارب التسويقية
- التظاهر بأن النتائج إيجابية مهما كانت

الفصل الخامس: تجارب أكبر وأبسط

الفصل السادس : التسويق
- الإستعانة بالمشاهر في ترويج المنتجات
- المتاجرة بالمرض
- مندوبو شركات الأدوية

خاتمة : بيانات أفضل

[Zach · Rating 4 out of 5]

This is a great overview into one of the largest health and economic problems today. As someone with experience in both the world of research and clinical medicine, I can say that the information in this book is accurate. The information is presented in a surprisingly non-biased and non 'conspiracy theory' way. The organization is such that there is wonderful flow and each idea builds on itself. I appreciate the fact that there are proposed solutions to the problems, many of which have the potential to be revolutionary. I would recommend this read to anyone even remotely involved with medicine: from practicing physicians or scientists to someone interested in working in health; concerned patients to patients' family members.

[Erika · Rating 1 out of 5]

Had to add a new shelf -- demagoguery -- for this one. Good God. But then again, his website says he frequently gives speeches in rock venues, so what do you expect.

[Paul Evans · Rating 4 out of 5]

This book is an in-depth investigation of the whole pharmaceutical/med research industry but as someone who has been in healthcare for over 30 years and have written papers and assignments looking at drug research it really is making me question whether I have all the facts. As someone now on meds for blood pressure am I on the right ones, am on the best ones, has my GP been swayed by the drug rep? All these questions are something I would have never thought about before.
The authors style and presentation may not suit some readers but he is obviously passionate about it and it would be interesting to see if anything has changed 12 years after the 1st edition. A must read for healthcare practitioners.

[Gendou · Rating 2 out of 5]

I wanted to like this book. It's about an important issue, made clear in the title. My problem with this book is that it's one-sided and comes off more as fear mongering than justified skepticism. Goldacre seems to have embraced the conspiracy theory point of view so toxic to this real problem. In order to paint medical science in a scary light, Goldacre starts the book with a gory description of the TGN1412 incident, just to frighten his readers.

He often argues from false dichotomy and paints an all-or-nothing black-and-white picture of some imaginary island of pure science, surrounded by a sea of corruption. This just isn't how science works.

There really are problems with actual corruption, harmful wishful thinking, and problems with the system. These are the major points he brings up ordered, in my opinion, from worst to least problematic:

* Pharmaceutical representatives promoting their drugs to doctors.

* Direct advertising of drugs to consumers in the US and Australia.

* Cherry picking from among published studies.

* Publication bias whereby unfavorable industry-funded studies aren't published.

* Serious weaknesses in experimental design like switching primary outcomes, reliance on dodgy sub-group analysis, and ending trials earlier (or even later) than originally planned.

* Subtle weaknesses in experimental design, like reliance on markers and surrogate outcome, conducting study on unrepresentative populations, and choosing a placebo control, as opposed to direct comparison between competing drugs. Goldacre actually calls placebo control "rubbish" which I find strange, because on the one hand, placebo works, and on the other hand, it's the definition of a perfect experimental control. He really wants direct comparison between drugs. So do I. But that doesn't make placebo control "rubbish" at all. He loses a lot of credibility with me because it sounds like he's trying to fool his audience. Also, the scientific method makes markers and surrogate outcomes a valid measure for rejecting the null hypothesis. He just says poo-poo to markers and surrogate outcomes, like cholesterol or blood sugar, which is simply wrong, because they are important and relevant to disease. Sometimes our assumed markers don't really do what we think, but when the mechanism is well-understood, the surrogate outcome is just as good as the ultimate outcome. Because science. As for studies on unrepresentative population, this is valid science which, like any study, can be misinterpreted by anyone who forgets or wants us to forget the population doesn't represent a doctor's average patient. That's part of the challenge of interpretation, and no strong reason to dismiss a study outright. Yet Goldacre includes this as if it's some tool used by the evil conspirators to sell their drugs to people who don't need them. That's just a bit too paranoid of an accusation for my taste.

* Lack of transparency in direct access to unpublished work and raw data. Goldacre is quick to point out the Cochrane Collaboration and the hurdles they face in persuading companies to hand over data. This strikes me as insolent whining. It would be awesome to setup special data systems to improve transparency. Demanding companies to conduct free investigative work for you in attempt to undermine confidence in their product is unreasonable. He calls this "withholding" which is just wrong. It's resistance to obnoxious, threatening harassment. Goldacre loses a lot of credibility by trying to hide the morality of this issue behind empty accusations of conspiracy theory.

* Gag clauses on industry-funded research contracts, and their secrecy. Goldacre espouses a "just label it" policy for gag clauses. This makes him seem ignorant of some of the basics of contract law. It's also illogical. We can just assume that standard gag clauses are on all industry contracts. Forced labeling (gag-free, gluten-free, or fat-free, etc.) only serves as a phony badge of honor for any study which didn't include such a warning label.

* Some PDF files on the FDA website aren't searchable. Is this really a serious problem? Really?

[V. · Rating 5 out of 5]

Aviso à navegação: esta review vai alongar-se mais do que devia.
Este 1º semestre, tive uma unidade curricular denominada "Bioética e Biossegurança", onde são discutidos os pontos morais e éticos aceitáveis na ciência e investigação e que deverão estar sempre presentes na mente se queremos fazer boa ciência. E na bibliografia, relativamente ao módulo Biossegurança, este livro figurava como bibliografia. Na altura, a professora apenas nos disponibilizou o capítulo relativo aos ensaios clínicos visto que o nosso debate iria debruçar-se sobre eles. No entanto, apenas esse capítulo foi o suficiente para me abrir a curiosidade para saber que nem sempre todas as pessoas que, neste caso, trabalham na indústria farmacêutica estão realmente interessadas no bem-estar de doentes e pessoas que necessitam realmente de medicamentos para sobreviverem dia-a-dia, e que em maior parte dos casos apenas estão em interessadas em vender um medicamento porque irá dar imenso lucro à farmacêutica em questão.
Este livro é aterrador e surpreendente. O autor, um médico, vai realmente ao fundo da questão, fazendo referências a dados, e dando-nos a conhecer o mundo onde as ligações com médicos, a publicitação de medicamentos para influenciar os doentes, os dados em falta de inúmeros ensaios clínicos, a não publicação de estudos que demonstram efeitos secundários e adversos, e como tudo isto induz médicos em erro (não deixando de referir que muitos também colaboram com a indústria) e como, em todas as vezes, o doente acaba por sofrer muito mais com a cura porque realmente não se mostrar tudo.
E a triste realidade, como caso do ensaio clínico da Bial onde faleceu, salvo erro, um "voluntário" (sim, encontra-se entre-aspas porque normalmente são, tal como a notícia refere, estudantes - e é necessário pagar as propinas, e são caras; portanto, será ético pessoas em dificuldades económicas verem o voluntariado nestes ensaios como uma forma de terem algumas economias?) ter falecido na sequência de uma dose de medicamente mais elevada, onde na primeira fase, os testes são feitos em indivíduos saudáveis de forma a saber os efeitos secundários.
São inúmeras as questões éticas com que nos debatemos neste livro, e acabamos por perceber que é necessário ter cuidado com aquilo que tomamos, porque nem sempre por ser um medicamento novo é bom, aliás, até poderá ser mau porque não se sabe realmente tudo sobre ele, e que os genéricos não são mais do que a mesma produção de um medicamento de uma outra empresa simplesmente porque a patente expirou e a empresa que o fabricou inicialmente já não tem os direitos sobre ele.
Aconselho este livro, acho que nos abre os horizontes relativamente ao que realmente se passa nesta indústria que, muitas vezes, vê apenas em termos económicos e não éticos, mas leva-nos a um maior espírito crítico relativo ao que consumimos; não deixando de significar que todas as farmacêuticas são más, quero acreditar que existe muito boa gente a trabalhar para essas empresas que fazem realmente coisas notáveis e que existe por aí farmacêuticas realmente boas que se preocupam mais com os doentes. Ou seja, há que ter um maior espírito crítico relativamente à realidade.

[Jeff · Rating 5 out of 5]

At first sight this might be seen as another piece of new-age anti-pharma ranting: Big Pharma is Bad and therefore we should not trust it or use its products, turning our backs on the knowledge that has extended life-spans and improved our health during our lives.

To make such an assumption would be to do this book a grave injustice; Ben Goldacre is himself a doctor and believes whole-heartedly in the benefits that modern medicine has brought to humankind. What he objects to is, as shown in his columns for The Guardian and his previous book, Bad Science, is the distortion or abandonment of scientific evidence. In that earlier book, much of his wrath was targeted at the so-called complimentary practitioners who all too often make claims that are completely unsupported by anything akin to objective evidence. Now he's turned his gaze at the mainstream medical-profession and it's not at all pretty.

Goldacre believes in evidence-based medicine: the use of all the collected evidence to guide doctors as to the best possible treatment for each patient. Unfortunately, he finds systemic evidence that the entire chain from the pharmaceutical companies through the regulators to many of the doctors themselves conspires against sound practice. Even those who are of good will and above personal reproach are working in a system that prevents them from consistently providing the best service to patients which is, after all, supposed to be the aim of the pharmaceutical-medical industry.

In many cases, the problems appear to be at least in part unwitting (GPs not realising how much their prescribing patterns are affected by contact with suppliers), in others understandable (of course pharmaceutical companies will try to influence GPs to prescribe their profitable products) but in other cases they definitely appear to be deliberate, from the obfuscation and secrecy of so many regulatory agencies to the withholding of and manipulation of research studies.

Occasionally I felt that too much was, perhaps, being made of small parts of the whole and yet it is because each small part contributes to a system that is demonstrably flawed that they have the importance that they do; I would agree with Goldacre's contention that each of the flaws needs to be tackled from the smallest to the largest.

This is not an uplifting book. It will not give you confidence in your GP nor make you happier about the way that medicine is practised today. In that sense, it galls me to have to award the book five stars yet I feel obliged to do so: it is, for the most part, an easy read that sets out clearly and with reams of supporting evidence a real problem and this book should be recommended reading for everyone ... and compulsory reading for those involved in regulating our healthcare.

[Andy · Rating 4 out of 5]

Very well researched muckraking about the corruption of medical information. This is what serious non-fiction/journalism is supposed to do.

Some negative reviews here of this book implied that the author is making this stuff up or exaggerating, because even if Big Pharma lies that doesn't have any impact on doctors, who are trained to see through those lies. Goldacre goes over some of the research showing how that's not true: most doctors believe what they're told by experts, or even drug reps. Moreover, Goldacre is not some lone crank saying this. An editor of the New England Journal of Medicine wrote a similar book about how the NEJM, as the main gatekeeper of medical information in the U.S., can't keep the phony baloney out of its own pages. In any case, probably the main point Goldacre is trying to make is how the drug companies hide bad results, so even if you are a super nerd doctor and critically read the primary literature, it doesn't matter because the relevant studies were never published in the first place.