Saturday, 29 December 2012

Bad pharma?

I've just finished reading Ben Goldacre's most recent book, 'Bad Pharma'. For those who are not familiar with Goldacre, he's a doctor and a journalist/writer on medicine and science. 'Bad Pharma' is subtitled 'How drug companies mislead doctors and harm patients' and presents a detailed list of issues to justify this statement.
The books main allegations surround the conduct of clinical trials. Goldacre makes a number of concerning points about trials funded by drug companies, backing up his statements with references to research findings:
  • drug companies don't systematically publish the results of all trials that are conducted. Trials that produce negative results are significantly less likely to be published than those that find positive results;
  • drug companies don't always stick to the initial trial definition. For instance, in some cases they change the duration of the trial so that it finishes earlier than planned -usually at a point when the trial results appear favourable in terms of the performance of the drug being tested;
  • drug companies sometimes change the criteria that is to be used to judge the successful outcome of a trial after the trial has started, typically the newly selected criteria will present a more favourable outcome than the originally selected one;
  • drug companies sometimes run trials that focus not on end points that really matter to patients but on proxy measures that may or may not really correlate to those 'real' end points (e.g. such as judging the success of a trial of a statin drug by looking at how it lowers blood cholesterol rather than by looking at how many heart attacks it prevents).
These problems with the conduct of trials mean that it is virtually impossible for doctors to judge whether one drug is better than another and this has a direct impact on patients. Goldacre goes so far as to say that the lack of reliable and comprehensive trial data results in preventable deaths.
In addition to the concerns on the conduct of trials, the chapter on the way in which pharmaceutical companies market their products is also very disturbing. Goldacre states that pharmaceutical companies spend twice as much money on marketing as they do on research and development. He describes how there is a great deal of research that shows that this marketing effort has a real impact on the prescribing patterns of doctors and other medical professionals - even though most doctors are confident when asked that their own decisions on prescribing are not changed by exposure to this marketing.
I found 'Bad Pharma' to be a very interesting and concerning book and it is well worth a read if you are interested in medicine or science. Even if only half of Goldacre's claims are true then there is something very wrong that must be resulting in real harm to patients. My one caveat on the book is that Goldacre seems to be something of a lone voice on this topic, he states himself that the professional medical associations, medical journals, regulators, legislators and the pharmaceutical industry itself do not see the situation in the way that he does - though the words 'they would say that, wouldn't they?' do come to mind here!
On a different topic, I received my ninth round of Trabectedin chemotherapy on 27th/28th December. As usual the infusion itself went smoothly and I wait to see how the side effects develop this cycle. I've been having increasing issues with fluid retention so that's my main concern.
Finally, to close this post, a couple of recent night shots of Bath abbey.


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