Bad Pharma

If you have previously read Bad Science by Ben Goldacre, it's doubtful you need me to do anything other than point out that he has a new book. Oh, and it's subtitled How Drug Companies Mislead Doctors and Harm Patients, and it's written with the same indignant determination, clear explanation, and appreciation for real science as Bad Science.

If you haven't read Bad Science, I recommend it. You don't have to read it before Bad Pharma, but it's a more approachable start, and a funnier book. Bad Science opens with some obviously horrible examples, and slowly develops the tools required to analyze more advanced and deceptive quackery. Bad Pharma jumps straight into the deep end of statistical biases in data, how and why they're introduced, and why they undermine your health care.

This is a more serious book than Bad Science, since it lacks the medical quackery that is so ludicrous it's funny. Everything in Bad Science is successfully sold to someone — there are people who believe in candling — but most readers of the book can laugh a bit that anyone would believe in such things before getting to the parts of the book where the quackery is widespread and kills people. Bad Pharma focuses on the mainstream pharmaceutical industry and the way that it distorts the scientific process, which leads to serious consequences quite quickly.

Goldacre is more pointedly on a mission here than in his previous book. This is not just an exposé. It includes detailed recommendations for how to make the drug evaluation process better, and some specific ethical recommendations for doctors to avoid being unduly influenced by drug company marketing. But before that, he provides the best detailed explanation of how the drug research and approval process is supposed to work that I've seen. There's also a lot of good information about how to detect trials and related studies that haven't been done properly, and how to separate marketing language from scientific evidence. Goldacre wisely does not get into all the details of how to do a trial properly, which would be way beyond the scope of this book, but he does provide valuable rules of thumb and red flags that indicate when someone is probably not doing the trial properly.

A point that's both frustrating and enlightening, and made very well by this book, is that fixing many of the problems with the drug approval process is not that difficult. Fixing all of them would be exceedingly difficult, of course, since they involve humans, complex financial motivations, the effectiveness of propaganda, and talented people who are paid well to create favorable impressions for new drugs. But we could get quite significant benefits from a few straightforward enhancements of the existing drug approval process, such as requiring that all clinical trials be pre-registered and all trial results published as a prerequisite for any drug approval. Goldacre makes his case for these changes forcefully and persuasively, and with justified anger. The current situation is bad enough for people like me who are only potential patients with no urgent medical issues. For a practicing doctor like Goldacre, it's infuriating to be actively denied the information required to effectively save people's lives.

Normally, I find books like this interesting, but depressing and frustratingly limited. It's easy to write books about abuses that currently exist, or the limitations of the current approach. It's much harder to do what Goldacre does here: clearly describe the goals and ideals of drug testing for the lay reader, detail how the current approaches fall short of that goals, and then propose practical and concrete ways to correct the situation. And keep the details interesting and entertaining enough that I enjoyed reading every page of a nearly 400 page book.

This is not a book that will fill you with trust or enthusiasm for the medical establishment (anywhere in the world). But it's still oddly comforting: we do know how to do these things properly, and occasionally we even act on that knowledge. These problems are serious, but they should provoke outrage partly because they're correctable and yet aren't being corrected. And there are doctors like Goldacre who are trying to push medicine towards proper use of evidence, research, and knowledge, instead of commercial manipulation. Recommended if you have any interest at all in how medicine or scientific research is actually done, and what its pitfalls look like.

Rating: 8 out of 10

Reviewed: 2014-12-24