BAD PHARMA: How Drug Companies Mislead Doctors and Harm Patients
Ben Goldacre
[McClelland & Stewart, 325 pages]
When it comes to pharmaceuticals, there’s so much people don’t know. In Bad Pharma, British physician Ben Goldacre writes how commercial pharmaceutical companies in both the United States and Europe have almost complete control over the drugs available for doctors to prescribe to patients.
The book outlines the problem with this arrangement, using examples well-supported by empirical data, ranging from 1946 to the present decade. Goldacre points out that governments in both the United States and the United Kingdom have left this issue unresolved, perhaps intentionally, and offers recommendations about how to deal with the problem.
Bad Pharma documents how information from clinical drug trials is often misrepresented. If a trial has negative results, it may never be published by the researchers, who are often employed by pharmaceutical companies. Goldacre outlines the attempts made to create trial registries, which have resulted in only some trials being registered, and he goes over the problems with trials themselves, such as how researchers often select test patients who aren’t representative of the average patient and that they sometimes stop trials early if they see good results.
Goldacre also highlights just how easy it is to get a drug approved and why this approval process is detrimental to patients. All companies must do is prove that the drug is better than a placebo pill, instead of having to prove that it works better than one of the leading drugs in its area of treatment. He discusses the fact that many drugs created these days are actually not very original at all; some drugs use molecules that work almost identically to the ones within the already-established drugs, and others even employ the same molecules in different forms.
Shifting his focus from trials to marketing, Goldacre describes some of the strategies that pharmaceutical companies use to promote their drugs to doctors, which are fraudulent at worst and manipulative at best, such as presenting papers written by ghostwriters employed by pharmaceutical companies but which actually list academics’ name, and how pharmaceutical sales reps give out promotional gifts to hospitals and clinics to help sell their products.
The dominance of the pharmaceutical companies can be restricted, Goldacre argues, by putting some control back in the hands of doctors and patients. Some of the most significant recommendations: doctors must publicly declare the support they’ve received from pharmaceutical companies (whether this has been in the form of money or goods); the name of each person who worked on a paper for an academic journal must be credited; companies must be upfront about “gagging clauses” (which state that trial results must not be published if they are negative).
He also thinks journals should be more picky about what they publish (for example, they must reject papers that show switches in the primary outcomes measured after trials are over). He also believes that all important players in the medical community have the right to know which past studies used unethical methods of research and reporting, and the right to gain access to withheld data, so they have as much correct information as possible about certain drugs when proceeding with future research. He makes the additional recommendation that instead of using smaller trials, those who work in the pharmaceutical field should run larger trials that make use of patient data that has already been collected by doctors and hospitals.
Goldacre’s ideas are all excellent, but neither the pharmaceutical companies, nor the governments in the United States and Europe are likely to support them as their implementation would expose the companies as being somewhat fraudulent and force them to work harder to gain back public trust and produce better drugs. They would likely cause the public to lose trust in doctors and academic journals as well, since it appears as if many have gone along with the pharmaceutical companies’ practices. Governments may not want to reduce the pharmaceutical companies’ dominance, since they know that these companies bring a ton of money into their respective countries.
The other option presented in Bad Pharma sounds much less viable, though—to start over from scratch with drug research, and only use ethical practices this time around. This seems like it would turn back the clock at least 50 years, and possibly cause more deaths than the use of some less-than-stellar drugs would. In all likelihood, the best solution is for the powers that be to release withheld data and admit to the past use of unethical practices like ghostwriting, but to do this so slowly and gradually so that the public doesn’t go into shock and lose all faith in the medical system.
[su_panel background=”#f2f2f2″ color=”#000000″ border=”0px none #ffffff” shadow=”0px 0px 0px #ffffff”]by Erica Roberts
image: sparktography (Creative Commons BY-NC)
