VINE VOICEon 18 December 2012
Disclosure: I do patient reported outcomes research for top 20 pharma companies
I love science, and I love medicine. Truly, some of the most incredible inventions of our species have been the successful development of amazing compounds from antibiotics and antiretrovirals to insulin and levodopa to modern biologic drugs which help us to lead better lives despite illness. And yet, somewhere along the way, the industry that has arguably done the most to improve life for human beings (in the developed world at least) has taken a curious deviation away from science, and lost its way. As it turns out, marketing is more effective than science in persuading doctors to write prescriptions, and it's cheaper too. Full scale clinical trials are expensive, career-making (or ending), difficult, and time-consuming, and often fail to deliver anything like the transformational benefits that older (now cheap and generic) pills once did.
In this thoroughly researched, engaging, and intensely catalytic account, psychiatrist and truth-seeker Dr Ben Goldacre systematically diagnoses the faults not just with pharma, but with the entire system of evidence based medicine, in which none of us are blameless.
The broad brush strokes are that:
* Pharma builds clinical trials with what can kindly be described as "gamesmanship", systematically biases the literature by with-holding data, drags its feet to comply with transparency measures, ensures its message is heard clearer and louder than anyone else's, and on occasion gets caught doing things it knows it shouldn't.
* Some doctors, whether through cognitive dissonance, ambition or just plain commercialism, use their own reputation to persuade their colleagues that pharma's drugs are more effective than they really are, allow themselves to be unwittingly beguiled by personable drug reps, and take advantage of free education that is systematically biased rather than pay out of their own pocket to keep up to date
* Regulators are buffeted by their own agendas and are relatively toothless in pursuing bad actors in the system or holding people to account for abusing trust
* Journal editors and peer reviewers let things through that they shouldn't - although as with many of these actors the traditions and systems within which they operate make it hard for them to do their job properly
* Patient charities repeat the lobbying policies of their pharma patrons such as protesting against generics or biosimilars or collaborating with commercial PR firms to lobby for access to expensive drugs
* Just about everyone left over outside that group is in rather an all-too-chummy relationship with the biggest pharma companies and are not well motivated to rock the boat or support whistle blowers.
So far, so doomed, right?
Not so. Each chapter (again, presented with specific case studies, footnotes, and more detail on the badscience.net website) ends with clear instructions on how each of these groups (as well as you, the reader) can do something about this. That's what transforms this from an articulate diatribe to a true call to arms, and for me the clearest set of people who can influence this are the patients.
Never will you find another group of people who are so clearly "aligned" to ensure that the entire product of the pharmaceutical industry is better outcomes, instead of higher sales volume. With the right support, patients can spot the holes in trial protocols, they can lobby their patient organisations, they can ask their doctors awkward questions, and whether they know it yet or not they're also the ones with the biggest lever here. Pharma needs patients to volunteer for trials, to be adherent to their medications, and to be engaged enough in their condition to want to be talking to their doctor about the right treatment for them. With a book like this as their guide, no empowered patient can have any doubt about where to make a start.
And everyone else? We should read this book to know how to support them, prepare institutions to mediate the new dialogue, and prepare for the rehabilitation of "bad pharma" to help the companies that really mean to do so to reassert their moral authority and honor the social contract they've been given. There really is no other path to take.