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.
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 For instance, the great majority of clinical trial data remains unpublished in major medical journals, and in fact unfindable.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.
