Goldacre is a medical doctor and a science researcher. His weekly column Bad Science takes up cudgels against dubious research, exposes fishy practices in pharma majors and takes us to the seamy areas of science policy.
His latest book Bad Pharma has its origin in an incident when even the evangelist against bad science was tricked by the claims of a pharma major. He describes how he ended up prescribing the anti-depressant reboxetine, which research had shown as ineffective against certain kinds of depression. The drug has not been approved in the US because laws there require all clinical trials to be registered with the government. Europe does not have such a law. So the pharma firm hid negative data.
Bad Pharma is as much about the predicament of doctors as it is about fraudulent practices of the industry. Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small number of 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,” Goldacre writes. In 2010, researchers from Harvard and Toronto analysed 500 trials of anti-depressants and ulcer drugs and found 85 per cent of the industry-funded studies were positive, but only 50 per cent of the government-funded trials were positive.
Goldacre also describes how drug companies hide data about medication risks that affect children, how they intimidate employers of researchers who produce results they do not like, and how they routinely withhold safety data in many ways, harming patients. It is not unusual for drugs tested on adults to be prescribed for children.
Drug regulators who do get access to hidden results often guard them from academic researchers to serve the interests of the firms whose products they are supposed to police. Medical journals frequently fail to perform basic checks on the papers they print, so many shady practices go uncorrected. In fact, some medical journals are owned by drug companies. Many published studies are not written by the academics whose names they bear, but by ghostwriters paid by drug firms. It is unfortunate that very few doctors have the acumen, or training, to exercise discretion when bombarded with advertisements encouraging them to prescribe certain drugs.
T K Sengupta is a doctor based in Birmingham, UK