But my gut told me the inconceivable was about to take flesh. Sure enough LRB turned down the review. Because, they said, their readers would be baffled by it — piquant given that LRB specializes in complex reviews of the esoteric and the obscure. But it needs something like this to flag up how perilous our position is and how paradoxical — seemingly beyond the capacity of the editors of LRB to follow.
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Whereas other antidepressants lower libido, this drug "may enhance" sexual arousal. Other pharmaceutical companies have been fined for similar misdemeanours. But it is by no means extraordinary.
Bad Pharma is altogether more sombre and grim — a thorough piece of investigative medical journalism. His tales of drug companies buying the opinion of doctors is not the most alarming of his revelations. Goldacre sets out clearly what is wrong with the way drugs get on to the market. New drugs are tested by the companies that make them, often in trials designed to make the drug look good, which are then written up and published in medical journals.
The book gives examples of regulatory bodies handing over page after page containing blacked-out results to academics trying to collect data from unpublished trials, the excuse for non-disclosure being commercial sensitivity. Companies pay doctors to extol the virtues of their drugs on the conference circuit spelling out the sources of information they want doctors to use and fund patient groups to lobby regulators to approve new drugs. Academic journals I work for one, the BMJ are sent research papers and comment pieces that may not always be written by the academics listed as the authors.
If a journal does decide to publish a paper showing the benefits of a drug, it can be rewarded by the company which made it, who might buy up hundreds of thousands worth of reprints glossy versions of the published paper to distribute to doctors to encourage them to prescribe the drug. The vital comparison may be made against a placebo Goldacre gives a harrowing account of how such a trial led to children in India dying when there was a perfectly good drug to treat them or against unusually low or abnormally high doses of the drug — to ensure suitable conclusions as to efficacy and the severity of side-effects.
Poor trials you can at least analyse. Missing data, Goldacre says, poisons the knowledge-well for everyone. Consider rosiglitazone, a new type of diabetes drug, which was greeted with real enthusiasm in Rosiglitazone was lauded for reducing blood sugar levels in people with diabetes and so for reducing heart attacks. Before long, however, John Buse, a doctor from the University of North Carolina became concerned that instead of reducing heart problems, the drug was actually increasing them.
His head of department was rung by GlaxoSmithKline, the company who made the drug; a US Senate Committee later released a report saying Buse had been subject to intimidation.
Later, GSK added up results from many trials and found Buse was right. They released their results, but only after two years. In the drug was taken off the market. Drug companies may say that the problems he identifies have now disappeared. New rules insist they register the details of trials, and publish the results — whether negative or positive.
But as Goldacre points out, little has really changed, because no one checks up. Poor research and bias cannot be placed simply at the door of drug companies. Doctors are often resistant to the notion they could ever be influenced by ads and sponsorship, even though the evidence to the contrary is overwhelming.
They also rely on education paid for by drug companies because unusually among professionals they are loath to pay for it themselves. At the BMJ we are revising our declarations of interest form to say we will seek to work with doctors who have not received financial hand-outs from drug companies funding for research is different. But pharmaceutical companies are, after all, not charities.
They exist to make and sell drugs, some of which work well, and to make a profit for their shareholders. They may talk as if they want to improve healthcare and sometimes they mean it, but only proper regulation from external agencies will make any difference. There is evidence that companies spend much more on marketing than they do on research and development in America Some of what Goldacre wants to see is indeed happening — in America the so called Sunshine Act will mean pharmaceutical companies must say how much they have paid doctors and for which activities.
And websites such as ProPublica already enable any patient to see what his or her doctor has been paid by the industry.
Bad Pharma by Ben Goldacre – review
This unpicked the claims of several forms of alternative medicine, and criticized certain physicians and the media for a lack of critical thinking. Unsurprisingly, these trials tend to produce results that favour the manufacturer. 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. And so are the patient groups.
Not So Bad Pharma