on 19 February 2015
There is a lot of information in this book taken from real-life problems in the pharmaceutical industry and supply of novel drugs. Some are real horror stories, but the fault is one of omission and it's hard to blame anyone under current conditions. Researchers have little incentive to publish research which shows a negative or null outcome and such work is often not brought to wide attention since it may have been done years before a drug is brought onto the market and simply got lost or forgotten. Similarly, work that shows a new drug is less effective than an existing one and has fewer side effects may never get to see the light of day. It all sounds very bad, but when the details are exposed, how it happens all begins to make sense.
The book is not well written: its several hundred pages are split into only 4 chapters which puts a strain on the reader who would like to read a chapter with just one concept, then put the book down and mull it over. This book is like a roller coaster ride from one story to another, lists of conclusions come and go in the middle of chapters, so it all gets a bit jumbled.
BAD PHARMA (Ben Goldacre)
For any person ( layman , doctor , patient) who is interested in how medicines are discovered/created , evaluated , regulated - but highlighting failures of the current systems – this is a must read (IMHO).
Any drug or medicine has (some) positive effects but also with possible side effects which range from trivial to lethal in some members of the population .
In Bad Science Ben Goldacre exposed the poor scientific evidence behind “ Detox” products/ diets , homeopathy and the like. The promotion of Vitamin C as the cure for Aids ( supported by the then SA Government) is a truly sad tale with lethal consequences.
Here he focuses on traditional and new medicines – the evidence that they work accrued by so-called clinical trials - and the recording of potential ( negative) side effects .
Sadly much of the data is missing ( A classic case of “Accentuate the positive , eliminate the negative – as the song goes) to the detriment of really understanding if new medicines work ( or work better than old ones) and in the failed trials many opportunities and problematic side effects have been ignored .This brings the stories up to ca 2012/3.
I am a retired chemist with some previous experience in new chemical creation and drug development but anyone who can follow simple arguments will be educated ,amused, horrified by Ben’s revelations . There is now a common belief that ANY\THING can be fixed by a pill rather than a healthy lifestyle – SCARY.
Once a “designer” of drugs ( such as it was 40 years ago) I am now on the receiving end of medications for diabetes and atrial fibrillation – what Ben has to say about the development and approval of some of these medications is truly scary. Not so much as to how the data is manipulated but the repressed trials that can result in unwanted side effects being missed. There are case histories here of the deliberate blocking of the release of data ( stand up Roche for the testing results on Tamiflu) to independent academics for true statistical analysis
Required reading for any sane person who wishes to assess company or media claims for products or treatments .
on 27 September 2012
This is a fairly good book that could have been a brilliant book.
The contents are magnificent, but muddled, sometimes repetitive, poorly organised, and waffly. Here's a paragraph, chosen at (almost) random: "So these are not isolated problems, they are not on a distant soil, and they are most definitely a thing of the past, because many of them happened recently, and the people concerned are still around, in very senior positions of power." Or
"But before we get there, we need to remember that this isn't simply about fixing the problem, starting from now. Because even if we set aside the ongoing failures of industry and regulators to address these problems, patients are still being harmed, every day, by the actions of the pharmaceutical industry over the past few decades."
Sounds like recorded chit-chat? The trouble is that you can open the book in dozens of places and, between some well-researched examples, read much the same thing.
Ben's first book, Bad Science, was derived from his Guardian columns and benefitted hugely from that. It meant that he rarely addressed a subject twice and when he did so it was for good reason. It also meant that, with spece being limited, he had to make every word work.
On the production side, the publisher has wittily put some (fake) on the pill-packet format. Alas, in their haste, the spine title is printed upside-down (and the publisher's colophon is in the wrong place).
on 27 December 2012
I genuinely did enjoy reading this book. I knew all wasn't well with the pharmaceutical industry but the scale of the problems in evidence based medicine is just breath taking.
The book opened my eyes to journals, and to how medicine is practised in the UK.
I'm glad I read it - it has informed my searching and understanding of 'evidence' and has also helped me to voice some concerns I have with several MPs and MEPs.
Thank you Ben for a great book, easy to read, despite its chucky size, informative, well researched, and somewhat courageous to be one of those who says what few others are willing to, in a well researched concise argument.
I would like to see this made into a documentary so that those who do not have the time to read it can access some of the information in it too.
on 8 November 2012
Ben Goldacre's recent book 'Bad Pharma' makes some important points, but also seriously misrepresents the work of professional medical writers. We (the Global Alliance of Publication Professionals [GAPP]) wish first to set the record straight about what professional medical writers do, but also to indicate where we are in agreement about some of the sensible and important points that Goldacre makes.
Goldacre appears to use the terms 'medical writers' and 'ghostwriters' interchangeably. This is unfortunate, as he thereby misses a crucially important distinction. Ghostwriters are individuals who contribute to the writing of papers that are published in the peer-reviewed biomedical literature, and whose name does not appear on the paper. They hide their involvement and funding source. This is widely agreed to be unethical, and Goldacre is right to condemn it. We condemn it.
However, Goldacre then creates a thoroughly misleading impression by implying that ghostwriting is the norm among professional medical writers. Many professional medical writers make ethical and necessary contributions to published papers, with full and transparent disclosure of their role and funding source. The reality of the working life of many professional medical writers, who work in close collaboration with named authors and have full access to all the data they need to ensure that papers are written in an unbiased manner, is very different to the caricatures of unethical ghostwriting that Goldacre describes. He supports his caricatures with cherry-picked examples of papers that were written, often long in the past, with scant regard for ethical standards. Those examples are indeed deplorable, but based on our experience (and we have over 120 years of experience in the medical writing profession between us) we believe those examples were probably rare even at the time when those abuses took place, before today's proliferation of anti-ghostwriting guidelines were in existence.
We recognise that ghostwriting is a problem, and that it still exists. However, professional medical writers' associations, such as EMWA, AMWA, and ISMPP (which are certainly not, as Goldacre describes them, "ghostwriters' associations") have been making strenuous efforts to reduce the incidence of ghostwriting, and those efforts have been bearing fruit. Research from these associations  and medical journal editors  indicates that ghostwriting has indeed become less common in recent years.
It is important to recognise the valuable contribution that ethical medical writers can bring to publications. Research shows that papers written with the assistance of professional medical writers are less likely to be retracted for misconduct  and are more likely to be compliant with reporting guidelines . Professional medical writers also provide a valuable resource which can help ensure that papers get published, rather than languish in file drawers.
Where we do agree with Goldacre is that we share his desire to see all clinical research published. GAPP supports all efforts to ensure that all clinical research, from both pharma and academia, is published in peer-reviewed journals in a timely manner. Non-publication remains a problem and we have outlined how this problem could be solved in a recent editorial . We were pleased to see Goldacre's recent tweet in support of our editorial, noting that we were ethical professionals! We also agree with Goldacre that historic problems of publication bias must be addressed. Many studies were completed long in the past, were never published at the time, and are still relevant to today's medical practice. We agree that it would be highly desirable if journals could organise an amnesty for old trials so that those historic, but still relevant, trials could be published.
We would suggest, however, that without the assistance of professional medical writers, such a huge scale of publication is most unlikely ever to happen.
Adam Jacobs, on behalf of fellow GAPP members Karen Woolley, Cindy Hamilton, Art Gertel, and Gene Snyder.
1. Hamilton CW, Jacobs A. Evidence of decreased ghostwriting in a series of three surveys of medical communicators conducted between 2005 and 2011 (abstract). AMWA J. 2012;27(3):115
2. Wislar JS, Flanagin A, Fontanarosa PB, et al. Honorary and ghost authorship in high impact biomedical journals: a cross sectional survey. BMJ. 2011;343:d6128
3. Woolley KL, Lew RA, Stretton S, et al. Lack of involvement of medical writers and the pharmaceutical industry in publications retracted for misconduct: a systematic, controlled, retrospective study. Curr Med Res Opin. 2011;27(6):1175-1182
4. Jacobs A. Adherence to the CONSORT guideline in papers written by professional medical writers. Write Stuff. 2010;19(3):196-200
5. Woolley KL, Gertel A, Hamilton C, et al. Poor compliance with reporting research results - we know it's a problem... how do we fix it? Curr Med Res Opin. 2012 doi:10.1185/03007995.2012.739152
on 3 May 2014
Perhaps the most important things to say at the start of a review of Bad Pharma is that I think that Goldacre argues convincingly for a sound central thesis. I accept the argument that there are serious flaws in the pharmaceutical industry’s approach to the research, discovery, production and marketing of drugs, and in the pharmaceutical industry’s relationship with doctors (and vice versa). Goldacre’s clear elucidation of many of the issues deserves praise, and makes this a worthy book.
I also, for the most part, enjoyed the conversational tone which Goldacre employs throughout. Normally, I’m irritated by excessive informality in tone, but Goldcare seems to strike a well-judged balance between formality and informality which worked well for me.
I hope, then, that it’s clear that I think this is an excellent book which is well worth reading, for both a general and specialist audience. This is an unambiguous recommendation. But there were a few niggles within that I felt I couldn’t ignore in the context of a review.
Firstly, there are occasions when Goldacre uses slightly sensationalist language without a clear explanation as to why. For example, he repeatedly refers to things – particularly emails – as “secret”, which he seems to use as a synonym for “unpublished”. To me, there is an important difference between something being unpublished, and something being secret. The latter refers to something that has been deliberately hidden and guarded, whereas the former is something that has merely not been conducted in the public sphere. Perhaps Goldcare has a justification for calling things “secret” which isn’t made explicit on every occasion, or perhaps he doesn’t. I don’t know, but I think that use of the term should be openly justified. There are other similar examples where I’d quibble over the use of particular words, too. But these are minor, minor points.
Goldacre argues that the drive for private profits lies behind much of the wrongdoing in the pharmaceutical industry. I think this is probably fair, but there were two points here that I don’t think he discussed in quite the detail I would have liked.
Firstly, the fact that drug companies pursue profits is not really the fault of the drug companies: it is the way we have chosen to structure our society. It could be argued that the pharmaceutical industry should be brought into the public sector, which could serve to remove the drive for profit. I think this is probably unworkable, and could’ve been demolished as a suggestion in a couple of paragraphs, but to me, omitting this discussion meant that there was a bit of a mismatch between saying that profit is the root of all evil within the industry, and a bunch of solutions that don’t address that central point.
Secondly, that motivation doesn’t (presumably) apply to the public sector. I think there are issues in public sector research that are not dissimilar to those seen in the pharmaceutical industry. In particular, there seems to be a frequent problem of publicly funded studies being underpowered. Granted, Goldacre talks a lot about public bodies like the MHRA, but I think that exploring the problems specifically with publicly funded research would have been an interesting exercise, and might have helped reduce criticism that Goldacre is unfairly singling out the pharmaceutical industry.
I also have slight concerns about Goldacre’s demand that every study should be published. In principle, I agree with this completely, and can see the argument for it. But I worry that there are probably oodles of really bad quality trials that are unpublished. So firstly, where do these get published? No journal is going to want to publish a terrible study. And secondly, given that Goldacre also describes a paucity of the skills required to critically appraise studies, is there not at least some risk that bad trials will not be recognised as such? I’m not sure how we navigate around this problem. I suspect Goldacre would argue that if all trials are brought out into the open, then the wheat will separate itself from the chaff, but I’m not entirely convinced.
Overall, I should emphasise again, this is a great read, and an important book. I think it is well worth reading, and I think the niggles I have with it are testament to the fact that the book was engaging and made me consider its arguments. It comes highly recommended.
Review originally posted at [...]
on 20 October 2012
My second Ben Goldacre book...I am working my way slowly through his hard work :-)
His book Bad Science educates and this book goes further and is shocking in it's information.
I feel strongly that his research and work should be read by everyone who is a patient or has been one...and that is everyone.?
Most of the medicinal drugs have names which will be recognized ...the use of statins and cholesterol drugs are handed out and eaten like sweets...and drug companies and media help make conditions to suffer from.
Goldacre is a doctor, an educator with a light touch...read the book and then do your own research it's all there on the net....
We can read up to date research having more time than hard pressed G.P,s who may not sometimes be au fait with what the latest findings are....
on 4 October 2012
I was initally skeptical about the book, wondering where Dr Goldacre's bias lie; which is also a question he asks of those who run drug trials and also those who are asked to publish results. However, even if a page is true, it is a horrifying thought.
Worth a read, it will make you think again about how evidence based, Evidence Based Practice really is.
on 30 September 2012
This book is sets out in terrifying detail all the ways in which the pharmaceutical industry distort the practice of medicine. It shows how the industry makes medicines look effective when they are not, hides side effects, and then markets drugs to people who do not need them, while the regulators that are supposed to protect us are complicit in the process. It's really well writtent, with a wealth of evidence to back up the claims, and you will be demanding change after you have read it.
on 10 January 2015
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 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.