05/01/2014

Bad Pharma

Ben Goldacre
2012

Ben Goldacre's previous book, Bad Science, was a brilliantly indignant rant (if something so measured in tone and so completely referenced can be called a rant) against some very obvious, yet entirely deserving targets. As such, it didn't surprise, except sometimes in the lengths to which people will go to fleece their fellow humans.

Bad Pharma, however, is a real eye-opener. My general assumption - and, I think, that of the general public - was that medicine was, on the whole, benign. Sure, there are good and bad doctors, good and bad hospitals even (see recent news passim), but overall my expectation is that medical practitioners are well informed and that the pharmaceutical industry is there to serve the public.

Well, it turns out this might not entirely be the case. This book documents the lengths to which those companies will go to fix the market. Goldacre treads a fine line and never makes outright claims of deceit (except in documented legal cases) but his overall point is clear. Big Pharma designs deliberately skewed trials, lies about the results, hides unfavourable ones completely, bribes regulators, politicians and doctors, and even invents diseases (for which they already have "cures" of course) - all in pursuit of a profit. As a result, our doctors are working with out-of-date, incorrect, wildly compromised data.

This affects our health. Everyone's health. And it's ridiculous that this should be the case. Why would people go out of their way to damage other people for a quick profit? As he says, in what to me is a key paragraph:
On this issue, since people with resources often defend the pharmaceutical companies from deserved criticism, it's worth remembering one thing: health care really is one of those areas where we are, in a very real sense, in it together. If you're super-rich, in the top 0.2 per cent of the population, you can buy pretty much anything you want. But however rich you are, if you become sick you can't innovate new medicines overnight, because that takes time, and more money than even you have. And you can't know the true effects of the medicines we have today, because nobody does, if they've not been properly tested, and if some results go missing in action. The most expensive doctors in the world don't know better than anyone else, since any trained person can critically read the best systematic reviews of a given drug, what it will do to your life expectancy, and there is no hack, no workaround, for this broken system. Even if you are super-rich, even if you make $10 million a year, you are right here in it with the rest of us.
(Chapter 3: Bad regulators, p150)

In a different light however, this is all entirely expected. Capitalism, as has been almost said by many people, isn't the best system possible, it's merely the best we know of. All the problems in the book, real and as in need of solutions as they are, are symptomatic of capitalism - a system that tries to mitigate against people's instincts to compete with each other by using money as a proxy, as Douglas Adams so brilliantly said,
This planet [had] a problem, which was this: most of the people living on it were unhappy for pretty much all of the time. Many solutions were suggested for this problem, but most of these were largely concerned with the movement of small green pieces of paper, which was odd because on the whole it wasn't the small green pieces of paper that were unhappy.
The Hitchhiker's Guide to the Galaxy (1979), Introduction)

Sometimes the balance is wrong. The signs are that in this case, the situation is being corrected, as Ben Goldacre discusses in a new final chapter.  Proponents of capitalism would say it is in the process of self-correcting, and they may have a point. The book mentions in passing that evidence-based medicine has only really been around since the sixties, which makes it a very young discipline really - a generation or two old. Real change in society takes a number of generations. Just look at how long it's taking politicians to catch up with the internet, which has only been with us for about twenty years. By the time my kids are my age, this may have been sorted out. Let's hope so.

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