Bad Pharma by Ben Goldacre: review - Telegraph
When Stephen Hawking wrote A Brief History of Time, his editor warned that for each equation he included, the readership would be halved. After much resistance from Hawking, all of them were dropped except E=mc². This is one of the central problems with books that aim to popularise complex science; all too often, to grasp their ideas a level of skill is required that the average reader doesn’t possess. The quandary is how much an author should explain and risk alienating those without any scientific background, and how much they should gloss over and risk accusations of presenting an anaemic account that misses the beauty of the science.
Ben Goldacre got the compromise spot on with his first book, Bad Science, which proved a runaway success and launched him as a poster-boy for geek-chic science writing. It told the story of how science is misrepresented and misused. Its scope was wide-ranging and it used big, bold brush strokes to colour the landscape of bad science.
Bad Pharma is an entirely different beast. It’s a finely tuned drilling down into what I suspect many will consider a niche subject – the way the pharmaceutical industry undermines the scientific process in favour of profit. Although this affects us all, it risks being of interest to only a small number because to understand the drama relies on a degree of statistical knowledge many of us don’t possess.
The raw materials for a book like Goldacre’s are deathly dull. They are tiny streams of numbers and calculations; they are complex, obtuse statistical terminology; data and tables and graphs. But Goldacre has managed to achieve something marvellous here, turning them into a story everyone can get excited about. He has humanised the numbers so they become relevant. More than that, this is a book to make you enraged – properly, bone-shakingly furious – because it’s about how big business puts profits over patient welfare, allows people to die because they don’t want to disclose damning research evidence, and the tricks they play to make sure doctors do not have all the evidence when it comes to appraising whether a drug really works or not.
Goldacre sets out the book’s claims in the introduction: “Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques which are flawed by design, in such a way that they exaggerate the benefits of treatments.” He goes on to explain that when trials produce results the industry doesn’t like, they suppress this data, distort evidence and make it near-impossible for people to properly evaluate their claims. The rot runs from the “education” that is provided for doctors but quietly sponsored by drug companies through to articles published in academic journals that are ghost-written by industry insiders, without acknowledgement. It’s more than just an attack on the pharmaceutical industry, but on the whole process by which scientific experimentation in medicine is reported and evaluated.
My only criticism of the book is that while Goldacre has produced a wondrous tale of deception and cheating, at nearly 450 pages it’s far too long. Many of his fascinating nuggets – such as his argument that the widespread theory that depression is caused by low serotonin levels is a story perpetuated to sell antidepressants which has little support in academia – risk being lost. The same book, but at a hundred or so pages less, would have opened up the readership further.
Goldacre and I went to the same medical school (although he was leaving as I began) and I can see the influence of UCL’s formidable clinical pharmacology department in his writing. Indeed, he thanks the distinguished David Colquhoun, professor of pharmacology and a passionate advocate for good, rigorous science, in the acknowledgements. He and his colleagues are renowned for their critique of the pharmaceutical industry as well as being great showmen and communicators. The lectures from this department form the bedrock of medical education at UCL and as a result, graduates have a sound standing in statistics, critical appraisal and epidemiology, as well as a healthy scepticism about the claims of industry, in a way other medical graduates do not always.
But what Goldacre has achieved is to transform the subject matter of many of those lectures given with passion but, nevertheless, a degree of academic dustiness into proper stories. More often than not the book reads like a whodunit rather than a work of pop-pharmacology. This is a book that desperately needed to be written and I’m so pleased that Goldacre took up the challenge. More brevity would have helped, but it is none the less a work of brilliance.
Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients
by Ben Goldacre
448pp, Fourth Estate, t £11.99 (PLUS £1.35 p&p) Buy now from Telegraph Books (RRP £13.99, ebook £8.99)