These are excerpts from the forward of Ben Goldacre’s new book Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients
I think it’s safe to say that his book explains clearly why I do what I do.
Ben Goldacre for those of you who might not know is a practicing physician in the UK. “He is a British science writer, doctor and psychiatrist. He is the author of The Guardian newspaper’s Bad Science column.”
From Bad Pharma:
Medicine is broken. And I genuinely believe that if patients and the public ever fully understand what has been done to them – what doctors, academics and regulators have permitted – they will be angry. On this, only you can judge.
Yes, some of us already understand and we are angry. We are also disbelieved and thought to be exaggerating and histrionic and just downright not right in the head.
We like to imagine that medicine is based on evidence, and the results of fair tests. In reality, those tests are often profoundly flawed. We like to imagine that doctors are familiar with the research literature, when in reality much of it is hidden from them by drug companies. We like to imagine that doctors are well-educated, when in reality much of their education is funded by industry. We like to imagine that regulators only let effective drugs onto the market, when in reality they approve hopeless drugs, with data on side effects casually withheld from doctors and patients.
I’m going to tell you how medicine works, just over the page, in one paragraph[1] that will seem so absurd – so ludicrously appalling – that when you read it, you’ll probably assume I’m exaggerating. We’re going to see that the whole edifice of medicine is broken, because the evidence we use to make decisions is hopelessly and systematically distorted; and this is no small thing. Because in medicine, we doctors and patients use abstract data to make decisions in the very real world of flesh and blood. If those decisions are misguided, they can result in death, and suffering, and pain.
Indeed, death and suffering and pain. I’ve witnessed all among my clients and friends and myself. It was perhaps the iatrogenic drug deaths of several (far too young) clients that brought home the deep deep tragedy of our circumstances.
This isn’t a simple story of cartoonish evil, and there will be no conspiracy theories. Drug companies are not withholding the secret to curing cancer, nor are they killing us all with vaccines. Those kinds of stories have, at best, a poetic truth: we all know, intuitively, from the fragments we’ve picked up, that something is wrong in medicine. But most of us, doctors included, don’t know exactly what.
I’d hasten to say we’ve forgotten who we are. Our bodies will tell us almost everything we need to know to stay healthy. We have forgotten how to listen. Learning how to listen is joy.
So to be clear, this whole book is about meticulously defending every assertion in the paragraph that follows.
Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques which are flawed by design, in such a way that they exaggerate the benefits of treatments. Unsurprisingly, these trials tend to produce results that favour the manufacturer. When trials throw up results that companies don’t like, they are perfectly entitled to hide them from doctors and patients, so we only ever see a distorted picture of any drug’s true effects. Regulators see most of the trial data, but only from early on in its life, and even then they don’t give this data to doctors or patients, or even to other parts of government. 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. But those colleagues can be in the pay of drug companies – often undisclosed – and the journals are too. And so are the patient groups. And finally, academic papers, which everyone thinks of as objective, are often covertly planned and written by people who work directly for the companies, without disclosure. Sometimes whole academic journals are even owned outright by one drug company. Aside from all this, for several of the most important and enduring problems in medicine, we have no idea what the best treatment is, because it’s not in anyone’s financial interest to conduct any trials at all. These are ongoing problems, and although people have claimed to fix many of them, for the most part, they have failed; so all these problems persist, but worse than ever, because now people can pretend that everything is fine after all.
That’s a lot to stand up, and the details are much more horrific than this paragraph makes it sound. (continue reading Ben Goldacre’s post)
Okay, so now you have the next book for your library. You can get it in the US come January: Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients
Get it in the UK here now.
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