Bad Pharma, Ben Goldacre

One of my resolutions for the New Year was to read more nonfiction, and I have happily gotten off to an excellent start. As far as personal development goes, this is splendid, but often not so good for writing reviews. For all the extra time it takes to get through a nonfiction book, I never know what to say about them in the end. If you are a frequent nonfiction reviewer (hi, Kim!), I would be interested to know how you conceptualize and structure your reviews.

Bad Pharma is my first book for Long-Awaited Reads Month, hosted by the very lovely Ana and Iris. I thought it would be fitting to start off with a Long-Awaited book recommended me by Ana. In fact I am fudging a little bit: the book has only been out for a year or so, so the Long-Awaited part is actually the author, Ben Goldacre, whom I’ve been interested in since Ana reviewed his first book, Bad Science, in 2009. It counts, though, right? My library doesn’t have Bad Science! I SAY IT COUNTS.

This button defies you to say it doesn't count.
Long-Awaited Reads Month

Ana described this book as “a book with a relatively simple thesis and a very detailed elaboration.” Excellent way of putting it. Nobody will be surprised to hear that Big Pharma has been engaging in shady practices. What Ben Goldacre does in Bad Pharma (affiliate links: Amazon, B&N, Book Depository) is to detail all the genres of shady practice engaged in by the pharmaceutical industry and the people it pays, and why each of these practices, individually and in concert with one another, harms patients and medical outcomes.

Bad Pharma holds no surprises from an ethical perspective — you know that pharmaceutical companies have too much power in the high-stakes business of researching medicines and getting them out to patients. The devil, as so often, is in the details, and the details aren’t always what you’d expect. Goldacre isn’t shy about calling out industries and individuals by name when necessary, but he’s more interested in systemic issues that affect the medical industry broadly. For instance, the great majority of clinical trial data remains unpublished in major medical journals, and in fact unfindable. The fault in this cannot be attributed to any one source (people at all levels of the medical trials procedure contribute to it), but altogether it creates a gaping hole in our knowledge about the medicines we use every day.

I loved–and was, you know, appropriately appalled at–learning what the lacunae in our medical knowledge are. Missing trial data is one. Another is the substitution in drug trials of “surrogate outcomes” such as cholesterol numbers for the truly important outcomes like heart attack and death. When a new drug for lowering cholesterol goes on the market, the trial data that got it approved by the FDA doesn’t actually show whether the drug decreases your chance of having a heart attack or dying. This isn’t out of malice, necessarily, so much as it’s out of rush. But there’s no system of running follow-up studies to find out whether this drug, in addition to lowering your cholesterol, ultimately lowers your risk of heart attack. Sometimes it turns out a drug that lowers your cholesterol greatly increases your risk of dying of a heart attack; but studies testing for this don’t get performed systematically on drugs that already have FDA approval, so it’s a crap-shoot whether you will ever find out this information.

Another area of missing information: Most everyday drugs need not prove they are better than existing drugs in order to receive FDA approval, just that they are better than placebo. All well and good, but Goldacre says that tests comparing long-term outcomes between drugs that treat the same condition are — like trials checking on the real outcomes rather than surrogate outcomes, above — rare and spotty. Doctors — and Goldacre admits that he does this too — make decisions about prescriptions based often on folk wisdom and marketing, rather than on true knowledge of which drug works the best. They aren’t doing it out of negligence. They truly have no way of knowing which drug is best.

If you’re at all interested in medicine and failing systems, I highly recommend Bad Pharma. Goldacre occasionally strays into this tone of “we’re-all-jolly-good-sorts-in-this-together”, which is annoying, but apart from that the book is engaging and well-written, and Goldacre proposes solutions — some that seem very very workable, others less so — to all of the problems he brings up.

Cover report: Britain and America both have the same sort of idea, but I think the American cover manages it better. It’s also more readable, with the important information front and center.

American cover
American cover
British cover
British cover
  • yay! I say it counts too 😀 It makes me very happy that you read this and liked it as much as I did and went on to write such an excellent post about it.

    • Gin Jenny

      Thanks as ever for the recommendations — you are a fount of wisdom and books! 🙂

  • Athira

    It scares me when I read books like these. So many people I know take medicines for this or that and it’s terrifying because who knows what some of the nastier side-effects are and how it could affect you. In our rush to find a better cure for everything, we do tend to kludge a few ethics here and there.

    • I have a pharmacist friend and it’s sort of scary to listen to her end of work phone calls sometimes: “Hmmmm ….. I don’t know …… maybe try X?” Maybe?! Yikes.

    • Gin Jenny

      Yep, absolutely. There was a Twitter thing a while ago where researchers were telling secrets about the problematic research methods they’d employed or seen their coworkers employ — it wasn’t great. A terrifying/fascinating read if you’re interested is David Freedman’s essay “Lies, Damned Lies, and Medical Science” —

  • This sounds scary and wonderful and like a good start for an increase in reading non-fiction. And I hadn’t even heard of it, so thanks for sharing!

    • Gin Jenny

      You’re welcome! As a caveat, though, he’s a British author, and I’ve historically had a hard time finding his books in American libraries. It’s well worth the trouble though.

  • I don’t have this or I would probably read it… Guess is should start making a lit of books to buy at the end of the year. 🙂 Great post!

    • Gin Jenny

      Thanks! Your list by the end of the year will probably be quite a sight to see!

  • It sounds like it covers some similar ground to his earlier book Bad Science, which I thought was great. A real eye-opener. But I’d be interested to read Bad Pharma too.

    • Gin Jenny

      Yeah, I hear very good things about Bad Science. My library doesn’t have it, alas, alas!

  • Eva

    Oh, oh, oh! You need to read Body Hunters by Sonia Shah too! About all the super shady nonsense the drug companies pull during trials in the Global South.

    This sounds fabulous but also terrifying. I’ve been meaning to read Bad Science for ages too. Luckily my library does have it! I think I’ll start there but pop bad pharma on my tbr list.

    I also wish we lived in the same town. Are you still in NYC? If so, at least with luck we’ll be in the same state later this year! (My planned move, assuming the universe cooperates with me, is to upstate NY. Then I’d just be a train ride away!)

    • Gin Jenny

      I moooooved! Back to Louisiana! I got a really good job here and moved back at the end of November! Arrrrgh. When do you find out about NYC?

      Thanks for the recommendation of Sonia Shah! Body Hunters sounds interesting, and my library has it. I will definitely be checking it out. It’s published by the New Press, evidently, which is one of my favorite nonfiction presses!

      • Eva

        Oh I didn’t realise that! Well, my mom wants us to go to New Orleans in the next year or two so maybe we can manage a side trip. 🙂

        I won’t be moving to NYC, but I’ll be apartment hunting in upstate NY in April/May and as long as I find a place I’m hoping to be moved in by early June.

  • I love Ben Goldacre! As an aspiring science writer, I kind of want to be him when I grow up, but I actually haven’t read either of his books. What was I thinking? I’ll have to put them on my list right now. I also like your tag “it’s more fun to read about gaps in knowledge that occur because of flawed systems.” In fact that’s pretty much my favorite. Why, do you think? I think maybe corruption depresses me, whereas flawed systems fill me with hope that a better system is possible.

    • Gin Jenny

      Do you read his column? He writes a column, yeah?

      I agree with you about why the flawed systems are better than corruption. Where systems are flawed, there’s no reason not to fix them (apart from, I suppose, inertia). Where there’s corruption, it’s harder to hope that things will get better.

  • ‘Bad Science’ was a revelation, fascinating and horrifying in equal measure. There’s no doubting that we need books like this, but I did find that Goldacre came across as a little smug.

    • Gin Jenny

      Oh yes. I agree with that. A teeny bit smug and a teeny bit condescending at times. I still enjoyed the book though!

  • I think you did an excellent job reviewing this work of nonfiction. Just tell what it tells and your reactions to it. That should do it.
    AND… I know a pharmacist. When convos turn to topics of what’s wrong with health care etc etc, I found it most telling that the only thing this guy says he will ever take himself is aspirin.

    • Gin Jenny

      Hahahaha, that is telling!

  • This sounds interesting. And scary. At times I wonder if I wouldn’t rather stick my head in the sand than know about these things. At the same time, it is probably better to know, right?

    • Gin Jenny

      Eh, your mileage may vary. This is a brand of scary information that I like knowing, but there are lots of brands of scary information that I stick my head completely in the sand about.

  • aartichapati

    Ben Goldacre was just on the On the Media podcast talking about bad news reporting and they mentioned Bad Pharma and I remembered Ana’s review of the book. I’ll have to check this one out as well! Great review. Also frightening.

    • Gin Jenny

      Was he? I must have missed it, I listen to that podcast every week! I’ll have to go investigate. (Might have heard it and just not registered who the guest was.)

  • I have the same problem with reviewing nonfiction. If it’s something that arouses strong feelings or questions then I can write about those AT LENGTH (see: Jenna Jameson’s autobiography), but I just finished a huge history of Opium and I have no idea where to start the reviewing shenanigans… Usually I just start writing and see what happens. 🙂

    I have Bad Pharma on my TBR shelves… somewhere… and as someone who has to take a LOT of medication for various health problems I think it’s going to be a veeeeery interesting read. I haven’t read Bad Science yet either, that’s been languishing on my shelves for YEARS, but I will. Eventually. Maybe not scare myself ALL at once??

    • Gin Jenny

      I think it’s hardest with history books, sometimes! I often end up telling a couple of stories that interested me and leaving it at that. I’m reading a fascinating book right now about Victorian pornography, and although it’s intriguing, I’m not sure yet what I’ll have to say about it on the blog.

      Hahahaha, yeah, Bad Pharma luckily didn’t have anything to say about either of the two medications I take, so I choose to believe that those two are fine. :p

  • Ela

    Goldacre has a column in the Guardian (which may or may not be available to you in the US – it’s certainly free to view in the UK) called ‘Bad Science’. I’d recommend his book, ‘Bad Science’, though, if you can ever get hold of it – it’s a lot more wide ranging than ‘Bad Pharma’, particularly in showing how badly science is reported in the media.

    • Gin Jenny

      I expect I can find it! I read lots of articles on The Guardian, so presumably they are available. Lovely Guardian!

  • I thought this was a really good review! Agree that reviewing non-fiction is difficult, unless I suppose it’s your area of expertise… Like everyone else, I keep meaning to read Ben Goldacre’s books, I used to read his column in the Guardian.

    Re the smugness someone further up mentioned: I think that’s probably an occupational hazard if you spend your life looking at what other people and systems are doing wrong. 🙂

    • Gin Jenny

      Hahahaha, you are quite right about the smugness, which is why I didn’t highlight it in my review. At least he’s being smug about things we can all agree on.

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