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Bad Pharma Book Review.Indd WEMJ Volume 114 No. 3 Article 2 September 2015 Bad Pharma by Ben Goldacre Publishers: Faber and Faber Book Review drug reps provide a fancy lunch as a Andrew Jones pretext to deliver a suspiciously one-sided Medical Student, Bristol University presentation. Having finished Bad Pharma If you are not furious by the time you have the day before I was ready to scrutinise finished reading Dr Ben Goldacre’s Bad every detail for any sign of bias. I didn’t Pharma, you have not read it correctly. have to: it was obvious and Bad Pharma This book systematically breaks down made it that way. everything that is wrong with the pharmaceutical industry and its interface Goldacre’s fiery rhetoric may put off some with regulators, journals, clinicians and readers. However, I believe the strength patients. Evidence-based medicine is of his condemnations are in proportion to a key part of the medical curriculum; it the issues outlined. These are dangerous guides our clinical decisions and informs practices being discussed. our national guidelines. However, there are flaws in the system that are not openly After all, the text is not all fire and discussed and in this book, Goldacre brimstone. Each chapter concludes with a tears the lid from the Pandora’s box of “what can be done?” section, serving as Big Pharma with shocking clarity. What’s downplay the negative consequences of a concise list of ways to move forward. more, the facts are delivered with wit, drugs. It is widely taught that randomised Despite Big Pharma’s assertions, these as opposed to the soporific sermon that controlled trials provide the most problems are present even now and medical students may be used to in the substantial evidence but strategies such as change must happen. Medical students lecture theatre. stopping trials early or the use of surrogate and doctors can form part of this change outcomes are less well known. and I strongly recommend looking up A brief introduction familiarises us with alltrials.org to see what you can do. how drug development is supposed to You may think “how is this relevant to work, framing our expectations against me? I’m not interested in academia or Overall, Bad Pharma, despite its clear the reality that he will later discuss. This industry”. In spite of this, academia and agenda, is a rigorous and balanced piece section makes it clear from the start: industry are interested in you and what of work. With true epidemiological this book can be read by anyone and is you prescribe. The very fact that Bad poise, Goldacre uses the best evidence relevant to everyone. Pharma’s longest chapter is devoted to available to decry the worst aspects marketing techniques used by industry is of drug development. Meanwhile, he We then take an in-depth look at the a testament to the severity of its influence. maintains that the collaboration between murky world of missing data. With From the clandestine behaviour of drug clinicians and industry is valuable sardonic lucidity, Goldacre sheds light reps to the widespread use of ghostwriters, and necessary. This book provides a on the tendency of unflattering trial data we see that the pharmaceutical industry’s comprehensive analysis of the current to go unpublished and distort the picture marketing schemes are inherently corrupt. state of the pharmaceutical industry and presented in the available academic Recently, I witnessed my first “drug evidence-based medicine, forming a vital literature. Here, the mechanisms put in lunch”, where attractive and charismatic part of the doctor’s toolkit. place to prevent this problem are shown to have failed, signalling a strong need for change. As the author argues, missing data leads to misinformed clinical decisions and “avoidable suffering and death”. Regulators – the presumed guardians of healthcare - are then put to shame by a discussion of their dodgy practices and suspicious opacity. Much that should be in the public domain is sequestered away. For medics, this section overviews how drugs should be regulated – from trial to widespread clinical use –and what policies ought to be in place to ensure this. The chapter Bad Trials could accompany any undergraduate epidemiology course, outlining the dubious tactics employed to exaggerate the positive effects and 1.
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