Perhaps the most important things to say at the start of a review of Bad Pharma is that I think that Goldacre argues convincingly for a sound central thesis. I accept the argument that there are serious flaws in the pharmaceutical industry’s approach to the research, discovery, production and marketing of drugs, and in the pharmaceutical industry’s relationship with doctors (and vice versa). Goldacre’s clear elucidation of many of the issues deserves praise, and makes this a worthy book.
I also, for the most part, enjoyed the conversational tone which Goldacre employs throughout. Normally, I’m irritated by excessive informality in tone, but Goldcare seems to strike a well-judged balance between formality and informality which worked well for me.
I hope, then, that it’s clear that I think this is an excellent book which is well worth reading, for both a general and specialist audience. This is an unambiguous recommendation. But there were a few niggles within that I felt I couldn’t ignore in the context of a review.
Firstly, there are occasions when Goldacre uses slightly sensationalist language without a clear explanation as to why. For example, he repeatedly refers to things – particularly emails – as “secret”, which he seems to use as a synonym for “unpublished”. To me, there is an important difference between something being unpublished, and something being secret. The latter refers to something that has been deliberately hidden and guarded, whereas the former is something that has merely not been conducted in the public sphere. Perhaps Goldcare has a justification for calling things “secret” which isn’t made explicit on every occasion, or perhaps he doesn’t. I don’t know, but I think that use of the term should be openly justified. There are other similar examples where I’d quibble over the use of particular words, too. But these are minor, minor points.
Goldacre argues that the drive for private profits lies behind much of the wrongdoing in the pharmaceutical industry. I think this is probably fair, but there were two points here that I don’t think he discussed in quite the detail I would have liked.
Firstly, the fact that drug companies pursue profits is not really the fault of the drug companies: it is the way we have chosen to structure our society. It could be argued that the pharmaceutical industry should be brought into the public sector, which could serve to remove the drive for profit. I think this is probably unworkable, and could’ve been demolished as a suggestion in a couple of paragraphs, but to me, omitting this discussion meant that there was a bit of a mismatch between saying that profit is the root of all evil within the industry, and a bunch of solutions that don’t address that central point.
Secondly, that motivation doesn’t (presumably) apply to the public sector. I think there are issues in public sector research that are not dissimilar to those seen in the pharmaceutical industry. In particular, there seems to be a frequent problem of publicly funded studies being underpowered. Granted, Goldacre talks a lot about public bodies like the MHRA, but I think that exploring the problems specifically with publicly funded research would have been an interesting exercise, and might have helped reduce criticism that Goldacre is unfairly singling out the pharmaceutical industry.
I also have slight concerns about Goldacre’s demand that every study should be published. In principle, I agree with this completely, and can see the argument for it. But I worry that there are probably oodles of really bad quality trials that are unpublished. So firstly, where do these get published? No journal is going to want to publish a terrible study. And secondly, given that Goldacre also describes a paucity of the skills required to critically appraise studies, is there not at least some risk that bad trials will not be recognised as such? I’m not sure how we navigate around this problem. I suspect Goldacre would argue that if all trials are brought out into the open, then the wheat will separate itself from the chaff, but I’m not entirely convinced.
Overall, I should emphasise again, this is a great read, and an important book. I think it is well worth reading, and I think the niggles I have with it are testament to the fact that the book was engaging and made me consider its arguments. It comes highly recommended.