A review of the book Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients by Ben Goldacre.

I was skeptical about many things involved in the pharmaceutical industry before I read this book but now I am fully horrified. I actually work in a pharmacology lab in a major university and we are regularly involved in projects analyzing drug safety (unfunded by that industry). I am familiar with many products that were/are heavily marketed by drug companies which our analyses show to be clearly much worse than nothing. This book did much for me in explaining how this can and does happen.

Being in academia, I see a lot of nonsense with journal publishing and authorship. It is clearly less of a means of scientific communication than a currency of career advancement for scientists. What is therefore contained in this ostensibly scientific record is definitely suspect. I, however, did not fully appreciate the degree of abject corruption of this scientific record by pharmaceutical companies.

The problem with this that I don’t think the book really emphasized quite enough is that if the official scientific record is so thoroughly subverted, it is therefore hopelessly flawed. To be clear, science, as it is practiced in our civilization, is flawed. As a science enthusiast, I’m pretty horrified to see science, as a concept, left only with a theoretical defense against woo and superstition. Why should a faith healer be impressed by our so-called "science" when clearly everything that makes it scientific has been distorted? When people tell me that I need to have faith in their mystical book of miraculous supernatural superstition because it was written by Someone Very Important, I tell them that is not good enough. I need to know the details. Currently, as far as I can tell, the details of academic publishing that I do know about (from my own sources and Bad Pharma) prevent me from giving any more credibility to what we think of as "science".

For example, if someone does something that turns out to be ineffective, is it scientific to keep repeating that? In my opinion no. But in our so-called scientific culture, negative results are almost never published leaving pointless situations to recur at enormous expense over and over. This book just showed me how this theme extends beyond my most cynical doubts into territory that is clearly harming people. Normally it’s a special kind of larceny when you kill your victim while stealing from them, but this seems to be another day at the office for drug companies.

I was shocked to learn that all of the information to really make drugs much safer exist. I thought that because of drug company lobbying and chicanery that it was impossible to find out certain obvious pieces of the puzzle necessary to clean up this mess. But no, this book tipped me off (and I verified it) to the fact that drug companies do know exactly how things are going. They have information that would be very interesting for patients. For example, the fact that they buy prescribing histories from doctors, hospitals, etc, is fascinating since that information could be used to greatly improve pharmaceutical safety. Were this data available for open scrutiny, bad drugs would be spotted very quickly as I’m sure they are in the only area of the entire pharmaceutical enterprise that is scrupulously scientific: the marketing departments. I know a lot of people make a comfortable living in drug marketing, but it horrifies me to imagine them being so naive as to think that kind of biased meddling leads to better patient outcomes.

If after reading this book you don’t have serious doubts about regulatory agencies, "scientific" publishing/journals, peer review, doctors' expertise, and drug marketing that is literally unhealthy, then you’re probably the kind of person who will respond especially well to a placebo effect. If you don’t die from (known but suppressed) side effects.

UPDATE 2019-04-02

These pharma companies are definitely venal and feckless to some extent but I am sympathetic to the fact that the reality is truly quite complex. Here is a very insightful (and long) article that covers many interesting facets of pharma economics. Four Reasons Drugs Are Expensive, Of Which Two Are Wrong