Bad Pharma - Ben Goldacre

While reading this book I had a nagging doubt - I shouldn't be reading this. Not because it isn't an excellent book, but because of two other reasons. Firstly I shouldn't need to read it, and secondly because the people who need to read this does not include myself. The book is an extensive critique of the shortcomings and problems with the pharmaceutical industry. These problems shouldn't exist and the people who need to read this book are those who can fix it, that is the people who work in and around the pharmaceutical industry.

Having said that, this book is essential reading because it demonstrates convincingly that problems do exist within the pharmaceutical industry and they are not being fixed despite claims to the contrary.

The book can be split into two parts. The first part deals with issues with the evidence which is used for any decision relating to the drugs produced by the pharmaceutical industry, and the second part with the marketing activities of the pharmaceutical companies. The overall theme of the book is Goldacre's case that the system allows these issues to distort the decision making of doctors when prescribing drugs to the benefit of the pharmaceutical industry and detriment of patient care.

The second part of the book about marketing struck me as the less scandalous of the two. Why? Because I got the impression that the pharmaceutical companies are doing very similar things to what happens in other industries. To give an example, I work in IT, developing software primarily for IBM based systems. IBM run developer forums, have customer groups, sponsor conferences and run education courses for developers (amongst many things). This is very similar to the activities that the big pharmaceutical companies are accused of using to influence doctors which is why I struggled to be shocked by this activity.

However, where there is a big difference is how much these activities benefit everyone. Within IT there is the possibility that it leads to a virtuous circle where everyone benefits (it doesn't always work that way, but it often does). That is, IBM run an educational course I go on, I develop better software, which benefits the customers who use the software. Even though the information I get from IBM will be biased it doesn't really matter in this case as all have a vested interest in the outcome. In medicine though, biased information may not be in the interests of one party in the circle, the patients.

Where I was most shocked by this book was in the first section. Goldacre builds a powerful case that the information base for modern medicine is both incomplete and systematically biased, with the result that the decision making of doctors is seriously impaired. And both of these issues need not be there. This to me is a shocking state of affairs and makes this one of the most important books I've read. There are real life and death decisions being made every day and there is evidence in this book that these are being made without the knowledge needed. Hopefully this book can lead to change and if it does, lives may be saved by this book.