Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients

Evidence based medicine is a term held near and dear, but evidence based research, studies etc. are not based on anything positive- all the so-called evidence is distorted in dozens of crucial stages including drug regulation and laws supposed to protect people. 1) New drugs are not needed, just more expensive and/ or replacements of less new dangerous drugs, or don't work well. 2) Data is purposely skewed to favor benefits. Bad trial data is lost or unreported. 3) Tests on humans are done in third world countries with less than ideal patients for the purpose of the drug 4) Regulators do not do their job as there is a big financial conflict of interest. 5) Doctors are either fooled or paid to push these drugs 6) Most doctors don't even know the difference between Relative Risk and Absolute Risk- big problem as this is the main way that drug's benefits are falsely increased and risks reduced- but it is all just distortion or statistics. The big problem is that nobody in the industry wants to do anything about it. And if they try then they will be lambasted and thrown out of their medical society. We see the same thing happening with politics today- speak up and you are finished. There are many more 'tricks of the trade' that are either deliberately used or become convenient loopholes in every stage of a drug's production and marketing that get used by scientists, regulators, academics and doctors either knowingly, knowingly with the acceptance of money or increased job status to further their interests. Medical journals, for example are not published or edited by the serious scientific minds that we are led to believe- these magazines are either literally owned by the pharma companies themselves or bought with different forms of bribery. The process from a drug's invention (usually a "me too" copy of a molecule) to it's marketing is filled with loopholes that have zero concern for the health or well being of the patient. In fact most drugs since the 1970s are only "invented" as a means to make more profit. This book more than confirms my fears, doubts, and criticisms of medicine I've had my whole life, experienced and studied. And it is a very good reference for all the claims. As the author states, the main reason why people are so impressed and willing to be herded like cattle to slaughter when it comes to trusting medicine, is due to the fact that most people hate effort, especially when it comes to dry material and understanding statistics and systematic review. If it can't be explained in one sentence then most people are not interested. The bottom line is that health is your main concern and drugs will never ultimately save you- only your diet and lifestyle can do that. Yet I am all too convinced that most people do not want to be helped- they just want to remain either helpless victims or they are just too stubborn to put the change and effort in to at least help their own situation, but becoming more aware of their own body and health,. Just like alternative medicine-another group of dubious individuals- people love to swallow a miracle pill and just let their faith guide them without ever gaining any genuine awareness of reality. That is fine with me- this is a free society to so what you please- just that the drug and supplement industry are not transparent, so that the majority of effortless people will unfortunately be misled and as a result suffer much harm, as we see with this health crisis. At best we can look forward to the missing data becoming published in the public domain so that people can at least look at it. But few will do this. And, sadly, even IF the pharma system corrects the dozens of problems that mislead doctors and harm patients, most of the drugs that people take are based on the old system anyway. I have little faith is any system, and am committed to helping people yes, but as Jesus said, "You have to save yourself". 2000 years later George Carlin added, "Ya gotta wanna"

Bad Pharma highlights serious issues with the way the pharmaceutical industry works today. In the book Ben highlights the problems with the industry from several angles, how the tests can be tweaked, how negative tests are not published, how you can make a neutral test appear positive by sub-dividing the goals and then emphasize the fluke positive one. He also shows how the medical journals are part of the problem and the issue with ghost written articles. He shows the problems with the regulatory side as well, for example the European Medicines Agency, their lack of transparency, and how they have effectively blocked access to critical data for researchers. All through the book Ben makes use of well documented examples, and all the issues highlighted are well documented and exemplified. The book is written in an easy to access language, and so it reads well. He does repeat himself a bit, so one more round of editing and cleanup before release would probably have been a good idea. Some readers on amazon.co.uk have criticised this, but I don't see it as an issue. You don't need to have a degree in medicine or a higher degree in general to understand the issues Ben highlights. Ben Goldacre runs the Bad Science website (badscience dot net) and has previously written the book Bad Science. Where Bad Science was an attack on quackery and pseudo science, and his website to a large degree has dealt with the same topics, this book is a critical look at the pharmaceutical industry. As such it ought to silence those that have attacked Ben Goldacre for being in the pockets of the Pharmaceutical industry over time. Ben Goldacre has done society a big favour by writing this book. I definitely recommend reading it if you want to understand more about how US and European health care works and what can be done to improve it in the future.

Listening to this audio book helped me understand better how pharma companies use data and statistics to make products seem better than they are, and/or to hide harms. Sadly, I could immediately see how several of these strategies have been used thus far regarding the promotion of certain well publicised injections. An essential listen.

Ce livre permet d'avoir une idée juste du fonctionnement de l'industrie pharmaceutique au sens large du terme. En effet, il est question ici de la totalité de la chaine du médicament : du chimiste au consommateur, en passant par les instances de régulations. C'est un cadeau que nous fait ici Ben Goldacre en permettant avec un livre simple, bien écrit et clair de connaitre les raisons des scandales qui entourent cette industrie. Il réussit l'exploit d'éviter les faiblesses habituelles du genre, à savoir un discourt moralisateur où l'ont porte un acteur en pâture sans voire la totalité du problème. Si vous êtes un minimum intéressé par cette problématique, et vous l'êtes assurément en lisant ceci, ce livre est à lire absolument. Le seul petit défaut, il n'est pas encore traduit en français mais il vaut très largement l'effort.

I rarely give five stars but this book deserved it. While criticism can be ideological and philosophical, in this book it's based on scientific evidence. Drugs are all about science and decisions have to be made purely based on evidence. The author has tried to highlight the usual but hidden practices used by drugmakers to game the system. On the top of that, he tried to bring home the point that ignoring this directly affects people and poses threat to people's lives; even leading to death. He also focuses both on U.S. and Europe, thus improving our understanding of worldwide practices. The author's solution is clear: TRANSPARENCY. Regulators can't completely be relied upon on matters of life and death and we need more independent eyes to call out the fake data. This book is a must for every journalist as well as a doctor who rely on pharma companies to treat their patients.

Ya había leído 'Bad Science', así que tenía especial interés en leer este volumen. Lo que no me esperaba es tal cantidad de de información sobre estos desmadres. A cada página que pasas te enteras de algo horrible sobre lo que las empresas farmacéuticas tienen montado y parece que no va a acabar nunca. Desde ocultar información hasta negarse a hacer los ensayos como se debería, por no hablar de la cantidad de dinero que reciben de productos que hay en la calle y no sirven para nada. No lo digo por decir, porque yo entiendo del tema, de hecho, soy sanitario. No se trata de una obra sensacionalista, al contrario, todo está debidamente documentado haciendo referencia a los artículos correspondientes. Que ojalá lo lean muchos médicos y lo tengan en cuenta a la hora de recetar fármacos a sus pacientes, porque hoy en día no sabemos a qué atenernos. Me pregunto si todo este entramado tiene solución. Bueno, sí que la tiene, lo que más bien me pregunto es si seremos capaces de unir fuerzas y luchar contra los que abusan del poder. Gracias Ben Goldacre por contarnos todo esto, cada vez te admiro más.

This is a magnificent and brave book. It demands full support, and I am bold enough to express this. It brings together knowledge which many of us in medicine have known for some time, but it makes clear that the problem is worse than we have realised. This book strikes a fundamental blow to medical epistemology. We used to joke that "Half of what you learn in medical school will be of no use to you in practice- the problem is just that we don't yet know which half; After reading this book you realise the problem is deeper- too much medical knowledge is suppressed from the start- and so as doctors we do not even know what we don't know. It just never crosses our consciousness. We don't even know the half of it. The flaws in medical knowledge Goldacre describes run wide and deep. Too much medicine is simply never published or recorded. Negative results "This does not work" are just as important to medical practice as "this does work." Yet routinely negative studies are ignored, filed away, unpublished, maybe never even written up. There is no journal of failed treatments and other false starts. Authors and researchers don't get promoted for showing such results. Share prices don't rise on such news. Too much pre-selection and pre-editing goes on so that what reaches large journals and is then available to be incorporated into guidelines is rather over-optimistic, and based on a biased sample. (Most of the times a drug hasn't worked in a clinical trial the information simply vanishes into "internal company files") Goldacre points out how unethical this is- patients have been taking part in clinical trials to advance medical knowledge- and then the trial goes unpublished so no one can learn from it. Worse still some patients are at risk of harm as a result of this omission. The way information is presented to and by journals is biased. Large positive results are welcomed by drugs companies and journals alike- good for sales of both of them. Good for authors too. (Kudos/promotions) Some doctors put their names to articles they have barely even reviewed. Many trials are stopped too soon- so long term treatments are assessed over unrealistically short time scales. Many trials stop too soon so that later complications are missed out of the analysis. Many trials are set up against false or misleading comparators, rather than against best current treatments. Many journals are not robust in their peer review processes, and the possibility of obviously misleading flawed papers reaching publication (and so the credibility that goes with that) is huge. Peer review is touted as a gold standard of academic accuracy yet in reality it shows that fools seldom differ, and that great minds think alike. The misuse of reviewing by some competitive scientists to advance their own views, and to do down competition, rather than quality assure scientific results, is a blot on science's copy book. (I do peer review for some journals and sign my name to reviews- and try to be fair about a paper's merits) National Regulators are not given the full information about candidate drugs, and have no means to compel its production. So they make their assessments of a drug's merit on partial and positively skewed information. Bodies like NICE then have incomplete information on which to base their recommendations. All the way through the deletion and distortion of the published record of medicine is weakening our ability as doctors to make good treatment recommendations to our patients. We do not know either the positive results or the negative results properly, and so no one can get a proper overall view of which drug is good for which patients. The potential for harm by ignorance is huge here- whether by missed benefits or unrecognised side effects. All this means that the medical information data base is skewed, distorted and misleading. As a doctor I try to practice evidence based medicine, and act in accordance with current assessments of best practice. What this book confirms is that my efforts are undermined before I start- all the information I need is not available at any stage of the process. I could be superbly read and up to date- and yet because of the flaws in the medical evidence base simply be moving deeper into misleading myself, and consequently my patients. This is not a comfortable realisation. The medical information base, that can then be consolidated into reviews, guidelines, the BNF, and text books is utterly flawed. The prevalence of deletions (missing information) and distortions (spin, misleading presentations of data) mean that my personal and our collective knowledge is inaccurate right from the start. And that's before my own prejudices and misunderstandings can even get going. Some years ago a post graduate tutor asked me to lead an EBM workshop and describe the process whereby we as doctors come to understand the evidence and then digest it and present it fairly to patients. I said I very much doubted that doctors do understand evidence very well themselves- we are easily misled by presentation effects- just as everyone else is. Ultimately the analysis of medical evidence is largely by means of detailed statistics, and few doctors understand these well. A patient of mine who was a statistician told me that his first question to a client was , "what do you want these statistics to show?" He could then work to their wish. Numbers do not speak for themselves, but can be made to sing sweetly if played right. This book shows that the current systems of discovering new medical knowledge, and of using existing knowledge well, are severely flawed. This is not a good state for my profession to find itself in. We have grand edifices of knowledge, and this book shows that many of them are built on sand. For a profession that prides itself on being based on accurate, well defined and described knowledge this is a very poor performance. Goldacre's book is important and raises significant questions about what we are doing as doctors, and about how we get the information we need to practice medicine well. This book shows that there are currently very widespread deep problems at every stage in the generation and distribution of medical knowledge. His book is well written, well exampled and accurate. It should compel action by many people in medicine, the pharmaceutical industry and by those around medicine who regulate knowledge generation. This is an important book, and it is vital for doctors to read it, no matter how uncomfortable its implications are for us.