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| title | chunk | source | category | tags | date_saved | instance |
|---|---|---|---|---|---|---|
| Bad Pharma | 1/4 | https://en.wikipedia.org/wiki/Bad_Pharma | reference | science, encyclopedia | 2026-05-05T08:47:31.497683+00:00 | kb-cron |
Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients is a book by the British physician and academic Ben Goldacre about the pharmaceutical industry, its relationship with the medical profession, and the extent to which it controls academic research into its own products. It was published in the UK in September 2012 by the Fourth Estate imprint of HarperCollins, and in the United States in February 2013 by Faber and Faber. Goldacre argues in the book that "the whole edifice of medicine is broken", because the evidence on which it is based is systematically distorted by the pharmaceutical industry. He writes that the industry finances most of the clinical trials into its own products and much of doctors' continuing education, that clinical trials are often conducted on small groups of unrepresentative subjects and negative data is routinely withheld, and that apparently independent academic papers may be planned and even ghostwritten by pharmaceutical companies or their contractors, without disclosure. Describing the situation as a "murderous disaster", he makes suggestions for action by patients' groups, physicians, academics and the industry itself. Responding to the book's publication, the Association of the British Pharmaceutical Industry issued a statement in 2012 arguing that the examples the book offers were historical, that the concerns had been addressed, that the industry is among the most regulated in the world, and that it discloses all data in accordance with international standards. In January 2013 Goldacre joined the Cochrane Collaboration, British Medical Journal and others in setting up AllTrials, a campaign calling for the results of all past and current clinical trials to be reported. The British House of Commons Public Accounts Committee expressed concern in January 2014 that drug companies were still only publishing around 50 percent of clinical-trial results.
== Synopsis ==
=== Introduction === Goldacre writes in the introduction of Bad Pharma that he aims to defend the following:
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 which 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 through ad hoc oral traditions, from sales reps, colleagues or 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 even 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.
=== Chapter 1: "Missing Data" === In "Missing Data," Goldacre argues that the clinical trials undertaken by drug companies routinely reach conclusions favourable to the company. For example, in a 2007 journal article published in PLOS Medicine, researchers studied every published trial on statins, drugs prescribed to reduce cholesterol levels. In the 192 trials they looked at, industry-funded trials were 20 times more likely to produce results that favoured the drug. He writes that these positive results are achieved in a number of ways. Sometimes the industry-sponsored studies are flawed by design (for example by comparing the new drug to an existing drug at an inadequate dose), and sometimes patients are selected to make a positive result more likely. In addition, the data are analysed as the trial progresses. If the trial seems to be producing negative data it is stopped prematurely and the results are not published, or if it is producing positive data it may be stopped early so that longer-term effects are not examined. He writes that this publication bias, where negative results remain unpublished, is endemic within medicine and academia. As a consequence, he argues, doctors may have no idea what the effects are of the drugs they prescribe. An example he gives of the difficulty of obtaining missing data from drug companies is that of oseltamivir (Tamiflu), manufactured by Roche to reduce the complications of bird flu. Governments spent billions of pounds stockpiling this, based in large part on a meta-analysis that was funded by the industry. Bad Pharma charts the efforts of independent researchers, particularly Tom Jefferson of the Cochrane Collaboration Respiratory Group, to gain access to information about the drug.