Book Review: What Can We Do About ‘Bad Pharma’?

The National Committee of PharmAware, a UK-based student organisation, review ‘Bad Pharma’ by Ben Goldacre.

Medical students are taught to make decisions for patients on the basis of the best available evidence. What they are invariably not taught is that the evidence is often withheld, analysed inappropriately, and presented in a biased fashion. As the situation currently stands, doctors could end up actively harming patients without even realising; a horrifying thought which is eruditely laid out in Ben Goldacre’s new book ‘Bad Pharma’.

Anyone who has sat through a 9am epidemiology lecture can tell you that evidence-based practice (EBP) is hard to grasp at the best of times. EBP is a rather gruelling topic that is under-emphasised in today’s medical education, but one that Goldacre manages to make accessible. ‘Bad Pharma’ builds beautifully on the work of ‘Bad Science’ – while the title implies it is a sequel, the two books easily stand alone. Having said that, this book is by no means an easy read due to the remarkable volume of information conveyed. Goldacre faces the challenge of trying to write a good, readable popular science book like ‘Bad Science’, and a serious, thoroughly researched piece of scientific literature. This is an energetic and ambitious project, which demonstrates the difficulty of synthesising these two aims.

Some may claim this book is too controversial. We disagree. Despite the negative portrait of the industry painted by the author, it avoids any hint of conspiracy theory. Goldacre draws out the multifarious failings of a complex system without creating monsters. From its provocative opening statement, ‘Medicine is broken’, this book will intrigue any reader, whether or not they work in healthcare. It implies something bigger than simple poor practice on the part of pharmaceutical companies; that, in fact, corruption affects the entire process of drug production and use. Goldacre outlines all of the extensive evidence supporting this claim in the first paragraphs and chapters, and then uses the remainder of the book to expand in greater detail on these central themes.

‘Bad Pharma’ explores the problems of missing clinical trial data, the failings of drug regulators, and the insidious influence exerted on prescribing. Evidence explaining these central themes is given and analysed clearly, leaving little room for argument, and is consistently done with great character and humour. Where there is any room for debate, this is clearly stated.

However, there is still a major concern with this book. This is a popular science book written to be read by any interested party, not necessarily with a background in medicine or academia; this includes the clinical trial participants that we hold in such high esteem. Volunteers enter into trials in the belief that they will help improve future treatments, and often go to extraordinary lengths to help in this research, affecting their social, financial, and working lives to do so. With this in mind, could this information deter future volunteers from participating in what now appear to be extremely corrupt clinical trials? Could ‘Bad Pharma’ sway readers into cynicism, and rejection of mainstream medical research completely?

It is obvious from our perspective that this is not the intention. Instead, it is very clear that this book represents not just an opportunity to educate people about the system’s failings, but a call to action. Goldacre has written an informative book, but also a practical guide to education and advocacy. The close of each chapter contains a bibliography of the literature used and guidance on what the reader can do, whatever their background. The content of ‘Bad Pharma’ is not only intended as a critique, but as a way to empower concerned readers to further inform themselves and take action.

‘Bad Pharma’ by no means makes happy reading, and demonstrates how deeply damaged the system of production and marketing of drugs has become. The challenges seem almost insurmountable, but Goldacre is not one for despair, and there are rays of light such as the American Sunshine Act and the existence of ProPublica, not to mention the army of nerds who campaign tirelessly on these issues and helped Bad Pharma to take over the Twittersphere. Clearly, where there is a will, there is a way.

Goldacre’s book is timely, important, and essential reading for anyone who cares about medical research and practice. It should be found in every doctor’s office and hospital reading room. It may alarm some with the volume of information it conveys and the brutal manner in which the industry is dissected. Yet, the fact that the book is addressed “To whom it may concern,” makes clear that understanding and tackling bad science is something for which we are all responsible.

‘Bad Pharma: How drug companies mislead doctors and harm patients’ by Ben Goldacre is published by Fourth Estate (£13.99). ISBN: 9780007350742.

Authors: The PharmAware National Committee – Beth Hall, David Carroll, Hannah Barton, Nathan Cantley, Alice Clarke. PharmAware is a student-led network, part of Medsin-UK, which aims to raise awareness of the importance of evidence-based medicine and ethical interactions between health professionals and the pharmaceutical industry. They can be found on Twitter (@PharmAware) and on their website (http://pharmaware.co.uk).

Ben Goldacre will be speaking at “We Have a Drug Problem” in London on November 24^th-25^th which is part organized by PharmAware. The authors declare no further competing interests.

Books reviewed in Speaking of Medicine are independent of the book’s publisher. Reviewers do not receive a fee but are allowed to keep the review copy of the book. In this instance the authors reviewed their own copy of the book.