Name: Bad Pharma
ISBN: 9780865478060

Ben Goldacre

Argues that doctors are deliberately misinformed by profit-seeking pharmaceutical companies that casually withhold information about drug efficacy and side effects, explaining the process of pharmaceutical data manipulation and its global consequences. By the best-selling author of Bad Science.

How Drug Companies Mislead Doctors and Harm Patients

Bad Pharma

We like to imagine that medicine is based on evidence and the results of fair testing and clinical trials. In reality, those tests and trials are often profoundly flawed. We like to imagine that doctors who write prescriptions for everything from antidepressants to cancer drugs to heart medication are familiar with the research literature about a drug, when in reality much of the research is hidden from them by drug companies. We like to imagine that doctors are impartially educated, when in reality much of their education is funded by the pharmaceutical industry. We like to imagine that regulators have some code of ethics and let only effective drugs onto the market, when in reality they approve useless drugs, with data on side effects casually withheld from doctors and patients. All these problems have been shielded from public scrutiny because they're too complex to capture in a sound bite. But Ben Goldacre shows that the true scale of this murderous disaster fully reveals itself only when the details are untangled. He believes we should all be able to understand precisely how data manipulation works and how research misconduct in the medical industry affects us on a global scale. With Goldacre's characteristic flair and a forensic attention to detail, Bad Pharma reveals a shockingly broken system and calls for regulation. This is the pharmaceutical industry as it has never been seen before.

Gavin

Or - his preferred book title - The Information Architecture of Medicine has Several Interesting Flaws, Many of Which Inflict Avoidable Harm on Patients, But All of Which are Amenable to Cost-Effective Change, Were There to be Adequate Public and Political Will. An empirically rigorous angry manifesto! 

Here are all of the book's theses in one paragraph, which is another thing I love nonfiction writers doing:
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 that 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 a drug’s 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 ad hoc, from sales reps, colleagues and 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 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 of these programs persist, but worse than ever, because now people can pretend that everything is fine after all.

[Low external validity] can make a trial completely irrelevant to real-world populations, yet it is absolutely routine in research, which is conducted on tight budgets, to tight schedules, for fast results, by people who don’t mind if their results are irrelevant to real-world clinical questions. This is a quiet, dismal scandal. There’s no dramatic newspaper headline, and no single killer drug: just a slow and unnecessary pollution of almost the entire evidence base in medicine. 

Exactly as fair to pharma as it deserves and no more ("there is no medicine without medicines"). Business gimps sometimes use the term "thought leader", meaning powerful, original thinker (they usually use it spuriously). Goldacre actually is one. Please at least join AllTrials.

Luca Conti

You will look at your pills in a different way

Sara Sunshine

Daniel Kilby

Sarah Schumacher

"Medicine is broken. While patients trust that their drugs are safe and regulated, and doctors attempt to prescribe the most effective cures, the global pharmaceutical industry is a 600 million dollar business rife with corruption and greed" -- Blurb.

Bad Pharma How Drug Companies Mislead Doctors and Harm Patients

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