Thoughts on finally reading Bad Pharma

I finally got round to reading Ben Goldacre’s book Bad Pharma. I’m not going to go into too much detail about the book, but if you have even a passing interest in medicine, public health and the costs of providing it, or your own health, I would highly recommend that you read it too. These are some of the random thoughts it raised in me.

First, you only had to know medical students at university, and see what freebies they got from drug companies, to know that something was up. And I’ve long been interested in publication bias. So I was already at least aware of most of the issues, but the book is still quite a catalogue of all kinds of rogue behaviours by many actors. Pharma companies misbehave of course, but so do drugs regulators around the world (I was probably most surprised by just how useless – and even worse – they are), professional bodies, journals and their editors, patient groups, doctors and academics. There is a lot of money going around, and therefore corruption both big and small, explicit and implicit. Nobody comes out too well in this story.

Second, since my backgroud is in banking, I couldn’t help making comparisons. Bankers misbehave too, no doubt about it. Both industries are heavily regulated, but the regulators have in both instances been fairly comprehensively captured by industry interests. In bankers’ defense, when they fiddle LIBOR rates, some other financial company may lose a few million dollars, but when drug developers intentionally hide adverse data about their products, thousands of people will die. So why is there so much less outcry about pharma? It is probably more complex to understand publication bias than lying about benchmark rates. And the deaths are isolated and hidden from view, whereas the financial crisis was very much visible on every high street.

And finally. In passing, Goldacre says something along the lines of “just because there are issues with medicine, it doesn’t mean that alternative medicine works”. Sure. But the opposite works as well: just because homeopathy doesn’t work, it doesn’t mean that (“traditional” or whatever you want to call it) medicine necessarily works any better. To be clear, I don’t think there’s any physical way that homeopathy works. But you can also be prescribed medicines by your GP that are not much better than placebo, if at all. So when a lazy skeptic rants about homeopathy and “the scientific method”, they should always be reminded that there is science and then there’s cargo cult science. Medicine is beginning to look more and more like a cargo cult than the real thing – there are journals, trials, complex statistics etc, but if it’s all based on smoke and mirrors then what do you really have that you can rely on? My attitude is to pay more attention to studies of how science is actually done: its history and sociology, and not just what scientists say in after-dinner speeches. The reality is always much more messy than “hypothesis, test, replication”.

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