Picture this scene, it’s not an unfamiliar one. You wake up one morning feeling unwell. The temperature you are running foreshadows a rather nasty, chesty cough. Like millions worldwide (at least those fortunate to live in countries such as the UK where we truly have a universal healthcare system), you pick up the phone and call your doctor, booking an appointment that will lead, you hope, to the person in whose qualifications and experience you put your trust diagnosing you and prescribing the best medicine for your condition based on their higher level of medical knowledge and the greater quality and quantity of information available to them. Exchange ‘chesty cough’ for ‘cancer’ or ‘heart disease’ and suddenly the trust you are placing in the doctor behind the surgery door becomes much greater. But that’s OK because they have studied longer and harder to enable them to interpret the huge volume of information on possible treatments available which baffles and slightly intimidates you. They are qualified and informed enough to be your guide. There might be reasons why you, the layman, cannot find the information you need but for doctors, good, high quality, unbiased information on drugs and treatment plans must be actively available and readily accessible. This is the way it is. It has to be right because you’re trusting them with the most valuable commodity you have – your health. It might surprise you to know that you are wrong, as Ben Goldacre goes on to explain in his latest book, Bad Pharma.
Goldacre documents a horrifying selection of ways that data available on drugs is withheld, manipulated, presented with bias or misrepresented, not just to the public but to the medical community. From missing trial data to inappropriate statistical techniques, bad regulation to poorly designed trials, through to the nefarious techniques used to influence doctors via marketing, pharmaceutical company pressure in the form of representatives or conferences, influence in a wide sphere that is difficult to quantify or define, or through the dreadful medical writing industry with its industry sanctioned plagiarism. The list is long and the implications for decisions made worldwide about practical healthcare are severe.
This is an incredibly well-argued and documented piece of work. I would expect no less from Ben Goldacre. The standards that he holds others to are evident in his own work. This book is evidence rich and the explanations are neither too heavily ‘sciencey’ to leave a lay reader behind nor too simplistic to irritate a scientist. Goldacre is exceptionally good at pitching his work ‘just right’, a rare talent in non-fiction science writing. At times, he even points out where bias might be seen to exist in his argument. In the end though, hard facts are difficult to refute and this book is full of hard, ugly, difficult facts that need to be talked about openly.
This book doesn’t hate the pharmaceutical industry, after all we wouldn’t have many medicines without them, it hates the practices that devalue the benefits the industry brings. I didn’t come away from the final chapter wanting to shoot the industry down, rather I found this book acted as a call to arms to demand of every level of our healthcare provision industry standards and openness that live up to the trust we place in them. Each chapter explicitly documents what people can do to affect the issues raised.
Read this book. I use the imperative because what is documented here is IMPORTANT. I shouted that because that’s the tone I’ve been using when I talk about this book. I feel empowered by this book to, even in a small way, affect change. Now, when I go to my local surgery and see that they are a surgery that actively participates in medical research, when I sit in the local A&E looking at posters soliciting research subjects, I am armed with questions that challenge the quality of the research they are doing. I believe we all have a responsibility to make information available that helps assess and develop the drugs we take. We cannot rely on everyone else to do this for us. If everyone thought along those lines, there would be no information available. Now I feel I can ask the questions that ensure that this research is genuine, quality research rather than just a shell for drug company advertising. I think Dr Goldacre might have made me just a little bit more militant and that’s fine by me.