
Book review: Bad Pharma - dpatru
http://blogs.law.harvard.edu/philg/2014/07/08/book-review-bad-pharma/
======
aaron695
Having read the book, this review I would say is very misrepresentative.

The actual book is very good and a definite read.

But this article seems to have spun it into a conspiracy theory.

This is the opposite of why I liked the book in the first place, it explains
how bad(For consumers) things happen due to systems not conspiracies. Also how
things are not bad, just could be much better. Many examples are how mistakes
are made but then found and how people are working to stoping them happening
again.

"With all of the trillions of dollars spent on drug development and drugs
themselves, have you ever wondered why people don’t seem to feel better than
they did back in the 1970s?"

The book for instance would NOT agree with this statement. Seriously would you
want to have 70's medicine or 2014 medicine? This is crazy.

~~~
angersock
People could actually _afford_ 1970s medicine, so it's rather a moot point,
no?

~~~
PM_Tech
People in my country, and almost every Western nation in the world can afford
medicine.

The problem you speak of is unique to the USA's backwards healthcare system
that costs more for worse healthcare.

------
Karellen
That's a review? There's almost no criticism, or even considered discussion,
of the book _at all_. He's just copied and pasted sections that he thinks are
important or interesting, and called it a day.

Not that there's anything wrong with quoting sections of a work that you think
are worthy of spreading to a wider audience (assuming proper attribution), but
IMNSHO it's a bit disingenuous to call QFTing a "review".

(FWIW, I thought the book was both excellent and terrifying, and that you
should read it. That's also not a review, just an opinion. :-p )

Edit: downvotes? Am I really being unfair? Can you explain what it is you
think the author of the review has added here?

~~~
dpatru
Greenspun did a good job of characterizing (even summarizing) the information
that you can find in the book. I learned new things from reading his review.
Since I didn't read the book, this was more valuable to me than a
"discussion".

~~~
Alex3917
How do you know he did a good job if you didn't read the book?

~~~
PM_Tech
You know better than to bring logic to HN. Someone is having a rant; don't
cloud the issue with facts.

------
driverdan
This is the kind of content we want on the front page of HN? A "review" that
is nothing more than content copied out of the book with a few paragraphs
introducing each copied section, for a book that has been out for almost a
year and a half?

If you want to read some real reviews of Bad Pharma a quick search will find
you these:

[http://davidhealy.org/not-so-bad-pharma/](http://davidhealy.org/not-so-bad-
pharma/)

[http://www.theguardian.com/books/2012/oct/17/bad-pharma-
ben-...](http://www.theguardian.com/books/2012/oct/17/bad-pharma-ben-goldacre-
review)

[http://www.sciencebasedmedicine.org/bad-pharma-a-
manifesto-t...](http://www.sciencebasedmedicine.org/bad-pharma-a-manifesto-to-
fix-the-pharmaceutical-industry/)

Goldacre's blog, Bad Science, also talks a lot about the book and the topic:
[http://www.badscience.net/category/big-
pharma/](http://www.badscience.net/category/big-pharma/)

------
pinaceae
a bit of a weird review. mixes trial design, which is international, with
inherent US issues like the ok to advertise prescription drugs.

i postulate that pharma is actually working, better than a lot of other
industries. pharma has a working patent system that balances the need for
profit and expiration dates (see the recent patent cliff that wreaked havoc,
in a good way, on the entire industry). it has to scientifically prove that
their products actually work and don't kill people in obvious ways.

you think trials are easy? look at how many products fail in phase 2 and 3
studies. you think the industry _likes_ pissing away all that money? you have
the FDA, but then also the various EU country hurdles - where they might
approve your product, but not cover it due to insignificant benefits over
older products.

HIV is under control, Hep C is cured. Certain cancer survival rates are way
better than 25 years ago. Your chances of survival into old age are going up
all the time. You can bone your wife at 70, any time you want.

While big bad pharma attempts to cure cancer, for massive profits, other
industries create sugar drinks and chat apps. BioTechs are the ultimate start
ups, try creating a complex molecule/protein and prove it does something
significant. I'll take Genentech over Facebook, anytime.

~~~
shas3
"you think X is easy?" is a pointless statement. Everything is easy or
difficult to different extents to different people. Also, the difficulty of
solving a problem is not the primary criterion for choosing whether to attempt
or expect to solve the problem. More importantly, there are no excuses for
unethical behavior and fraudulent research.

I haven't read the book but I have read a lot of Ben Goldacre's articles
([http://www.badscience.net/](http://www.badscience.net/)). His arguments are
typically about how quacks, kooks, and pharmas practice 'bad' and fraudulent
'science' and are dishonest in presenting the results of their 'research'.

A vast majority of the population is inept at understanding the kind of
statistical language in which drug companies misrepresent results. In addition
to innate human propensity for logical fallacies (e.g. Type 1 thinking-
Kahneman, Tversky, etc.), our perception is tainted by the personal dimensions
of issues related to health and suffering.

Ben Goldacre is a darn good science 'popularizer' and does a great job of
explaining these things to a general audience.

------
bayesianhorse
On the issue of efficiency of Prozac or similar drugs, sometimes the
explanation is that they simply work and you know it if you have taken them. I
found the effects of SSRIs very noticeable, and every doctor prescribing them
knows of patients who suddenly were able to leave the bed, or deeply
depressive patients switching into a manic episode. The latter might not sound
like an improvement, but for the patients, quality of life improves immensely.
This can explain why doctors and regulators look favourably on drugs with a
long history of clinical use.

I'd also criticize the conclusion that there's nothing better than Aspirin on
the market. Which hasn't been known since ancient times by the way. The
original salicylic acid was much worse on the stomach. Both Ibuprofene and
Diclofenac have better analgesic properties, again very noticeable, and
metamizole has different properties, again much more useful than asparin.
There's really nothing to argue with that, except some hand-waving "placebo"
talk, which often isn't so scientific either.

I'm more familiar with the veterinary side of things, and there the situation
is that there are both independant trials, and a sort of "grapevine" where
veterinarians compare notes on different drugs.

You can't really argue with anesthesia drugs. Either they work or they don't.
Either they have a high incidence of accidents in a particular species, or
they don't. Antibiotics much the same, especially when performing individual
lab tests. Sure there is a lot of hyperbole or bad advertising, but it's not
just "bad pharma".

~~~
DanBC
> On the issue of efficiency of Prozac or similar drugs, sometimes the
> explanation is that they simply work and you know it if you have taken them.

This is what people who take homeopathy say. It's what doctors and patients
said about knee arthroscopy for rheumatoid arthritus until they did a trial
involving sham operations.

When Prozac was introduced in the UK we were told that it made people "better
than well", and that everyone should have it and that the UK prescription laws
were seriously flawed because this drug was restricted to people who had a
diagnosed illness and was not available to everyone.

It's that kind of behaviour which is sleazy. The deliberate hyping of
medications.

The brutal cynicism of using dying cancer patients to campaign for your
ineffective very expensive cancer medication is really disgusting.

I'm not sure whether you're critiquing the book or what you've read in the
review.

~~~
bayesianhorse
Pain medication does work for quite a large number of conditions. Much of this
has been demonstrated against a placebo or different treatments. If you give
these drugs to animals in pain, they cease showing pain behavior.

Just defining all effects of pain medication as placebo just isn't scientific
at all. Placebos often don't work reliably and repeatable either...

~~~
DanBC
You still haven't said whether you are responding to the book or this review
of the book. This review is, as several people have said, lousy. It's
pointless for us to discuss this review because I disagree with the review. I
do agree with a lot of the book.

When Goldacre talks about placebo he tends to talk about the pricing
differences between differently packaged but identical medication. Thus, a
brand name paracetamol is the same as an own-brand paracetamol and they're the
same as a budget paracetamol. Yet one can be five or six times more expensive
than the other. (Personally I don't see this as particularly bad behaviour.) I
agree that he tends to place too much emphasis on placebo, but then I haven't
read the studies. There are strong psychological aspects to pain; pain in
cancer patients can be helped with cognitive behaviour therapy; some people
(40% in one (not very good) report) with long term pain reported relief when
they took a placebo.

But also look at coproxamol. This is an old med. we used to think that mixing
meds meant you could use smaller quanties of active ingredients. Coproxamol is
a sub-therapeutic dose of paracetamol and a dangerous toxic opiod (opiate?)
dextropropoxyphene. (Paracetamol in acute overdose is very dangerous so for
the dextropropoxyphene to be the more worrying ingredient tells us something).
We've known since at least the 1980s that this med is not particularly
effective and is very risky, yet it has only just been withdrawn from general
use in the UK. We knew that it was less effective than paracetamol alone
(because you'd take that at an effective dose) but that it was far more
dangerous and that evidence got stronger through the 1990s and 2000s. (An
overdose of paracetamol is treatable if caught in time, although paracetamol
overdose does kill many people each year. An overdose of coproxamol is usually
fatal before help arrives. For a time coproxamol was the leading medication in
fatal overdoses.) Removal of this med was fiercely fought for years by
pharmaceutical companies and by patient advocacy groups (sometimes funded by
those same companies).

That is sleazy behaviour.

------
rollthehard6
Personally I see an intersect with many of the issues in pharmaceuticals and
software patents. My particular interest is in so-called 'Low Dose Naltrexone'
which I take for Crohn's Disease. The current system seems to neglect drugs
which have multiple uses, particularly when said drug has gone out of patent,
i.e. is cheap, as there is less of an incentive to do these hugely expensive
trials in comparison to doing them for a newly patented, more profitable drug.
This is not a 'big pharma' conspiracy, it's captialism + patents that is a big
issue here and, as someone earlier said, it'd be a lot easier to address if it
were just a conspiracy. As Goldacre shows, it's a flawed system that needs to
be reformed to focus on patient health as much as, if not more than profits.

------
mazimi
I found this to be a much more objective review of the book:
[http://www.sciencebasedmedicine.org/bad-pharma-a-
manifesto-t...](http://www.sciencebasedmedicine.org/bad-pharma-a-manifesto-to-
fix-the-pharmaceutical-industry/)

------
teekert
"We’re nearly 30 years into Prozac Nation. The pills are cheap and published
research shows that they work well. Is everyone cheerful?"

What a dumb argument, this makes me not want to read this book.

------
pella
check [http://www.alltrials.net/](http://www.alltrials.net/) campaign

 _" About AllTrials:

The AllTrials campaign was launched in January 2013 and calls for all past and
present clinical trials to be registered and their results reported. It is an
initiative of Bad Science, BMJ, Centre for Evidence-based Medicine, Cochrane
Collaboration, James Lind Initiative, PLOS and Sense About Science and is
being led in the US by Dartmouth’s Geisel School of Medicine and the Dartmouth
Institute for Health Policy & Clinical Practice. Since then, the AllTrials
petition has been signed by 79138 people and 489 organisations."_

\---

What you can do today:

[http://www.alltrials.net/get-
involved/individuals/](http://www.alltrials.net/get-involved/individuals/)

\---

All Trials News:

[http://www.alltrials.net/news/](http://www.alltrials.net/news/)

\---

TEDMED 2012:"Ben Goldacre: What doctors don't know about the drugs they
prescribe" ( video 13:29 )

[https://www.ted.com/talks/ben_goldacre_what_doctors_don_t_kn...](https://www.ted.com/talks/ben_goldacre_what_doctors_don_t_know_about_the_drugs_they_prescribe)

 _" When a new drug gets tested, the results of the trials should be published
for the rest of the medical world — except much of the time, negative or
inconclusive findings go unreported, leaving doctors and researchers in the
dark. In this impassioned talk, Ben Goldacre explains why these unreported
instances of negative data are especially misleading and dangerous."_

 _"

...

Now you might say, well, that's an extremely unusual example, and I wouldn't
want to be guilty of the same kind of cherry-picking and selective referencing
that I'm accusing other people of. But it turns out that this phenomenon of
publication bias has actually been very, very well studied. So here is one
example of how you approach it. The classic model is, you get a bunch of
studies where you know that they've been conducted and completed, and then you
go and see if they've been published anywhere in the academic literature. So
this took all of the trials that had ever been conducted on antidepressants
that were approved over a 15-year period by the FDA. They took all of the
trials which were submitted to the FDA as part of the approval package. So
that's not all of the trials that were ever conducted on these drugs, because
we can never know if we have those, but it is the ones that were conducted in
order to get the marketing authorization. And then they went to see if these
trials had been published in the peer-reviewed academic literature. And this
is what they found. It was pretty much a 50-50 split. Half of these trials
were positive, half of them were negative, in reality. But when they went to
look for these trials in the peer-reviewed academic literature, what they
found was a very different picture. Only three of the negative trials were
published, but all but one of the positive trials were published. Now if we
just flick back and forth between those two, you can see what a staggering
difference there was between reality and what doctors, patients, commissioners
of health services, and academics were able to see in the peer-reviewed
academic literature. We were misled, and this is a systematic flaw in the core
of medicine.

8:18

In fact, there have been so many studies conducted on publication bias now,
over a hundred, that they've been collected in a systematic review, published
in 2010, that took every single study on publication bias that they could
find. Publication bias affects every field of medicine. About half of all
trials, on average, go missing in action, and we know that positive findings
are around twice as likely to be published as negative findings.

8:45

This is a cancer at the core of evidence-based medicine. If I flipped a coin
100 times but then withheld the results from you from half of those tosses, I
could make it look as if I had a coin that always came up heads. But that
wouldn't mean that I had a two-headed coin. That would mean that I was a
chancer and you were an idiot for letting me get away with it. (Laughter) But
this is exactly what we blindly tolerate in the whole of evidence-based
medicine. And to me, this is research misconduct. If I conducted one study and
I withheld half of the data points from that one study, you would rightly
accuse me, essentially, of research fraud. And yet, for some reason, if
somebody conducts 10 studies but only publishes the five that give the result
that they want, we don't consider that to be research misconduct. And when
that responsibility is diffused between a whole network of researchers,
academics, industry sponsors, journal editors, for some reason we find it more
acceptable, but the effect on patients is damning.

...

"_

