|Year : 2013 | Volume
| Issue : 2 | Page : 339-340
Bad Pharma: How drug companies mislead doctors and harm patients
Nuvis Analytics Pvt. Ltd, India
|Date of Web Publication||13-Jun-2013|
C R Sridhar
Nuvis Analytics Pvt. Ltd
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sridhar C R. Bad Pharma: How drug companies mislead doctors and harm patients. J Can Res Ther 2013;9:339-40
Author: Dr. Ben Goldacre
Publisher: Fourth Estate, London.
Price: INR 499.00
This is the second book by Dr. Ben Goldacre in his 'Bad' series. The first one, 'Bad Science' dealt with how science has been used to peddle doubtful therapies and dud products. In this book 'Bad Pharma' he takes on the poor practices of pharmaceutical companies.
Doctors need effective drugs to manage the health care of their patients. To take a decision on drugs doctors need information. However, pharmaceutical companies quite often do not give accurate information on the drugs they peddle. They provide biased data, influence prescriptions through various means, and routinely bypass regulators. The net effect of these practices is: Poor quality of life or death.The author discusses the details of what the pharmaceutical companies are doing to increase their bottom lines at the cost of patients. The story starts with data and ends with data.
The entire book is summarized neatly inside the jacket of the book. 'Doctors and patients need good scientific evidence to make informed decisions. But companies run biased trials on their own drugs, which distort and exaggerate results. Unflattering data is simply buried. Government regulators withhold vitally important information. Seemingly independent doctor and patient groups are funded by the industry, in a world so cracked that medics and nurses are now educated by the industry. The result of all this is inevitable: Patients are harmed, unnecessarily, in huge numbers'. To say the least: 'Medicine in broken'.
The author gets into great detail on what is happening in the world of pharmaceutical marketing, in the United Kingdom and United States, which is undesirable and dangerous. He maintains that doctors are unwittingly or wittingly compromising their profession for persuasion and pelf.
The marketing of drugs starts with trial data and ends with the observed results in practice. The final proof of the effectiveness of a drug lies in the observed results in practice. The time between trial data and reliable observed results can be five years or ten years or till the patent runs out. It is in between these years that the marketing machinery of the pharmaceutical companies goes into an overdrive.
Missing data is a routine problem. In company-sponsored trials the negative trial data is suppressed and the drugs are released for marketing based on the positive results. It is now well known that research sponsored by a pharmaceutical company on its drugs, by and large, show very positive results compared to the same drug tested by independent bodies. This problem of 'missing data' seems to be endemic in pharmaceutical research. This problem is tackled by the meta-analysis of trial data. However, this synthesis of data is time consuming because of accessibility problems of the negative results. Many researchers do not report the negative results because these results do not help the researchers push their academic standing. A formalized and structured meta-analysis of drugs is now managed by the Cochrane Collaboration. However, this is a partial solution.
The story of Vioxx is now well known. How did this drug pass the regulators? Why did it stay in the market for such a long time? There is no single answer to this question. Biased trial data, lobbying, friendship, socializing, and the like – it could be anything. It is not unusual for pharmaceutical company executives to sit as regulators and for regulators to join pharmaceutical companies. The phenomenon of 'Regulator Capture' is normal in this industry.
What about the medical profession. On what basis do they prescribe the drugs to their patients? Obviously it is based on the information that they get from their peers, media, and sales persons. Questionable positive data on drugs travels to medical professionals in various forms. They are: Peer-reviewed journals, conferences, word-of-mouth, advertising, and the sales representatives. Almost all these sources have company-sponsored biases. Dr. Goldacre quotes a number of instances where the academic journals' independence is compromised because of the support they receive from pharmaceutical companies. Many key note speakers in conferences are 'paid' by the pharmaceutical companies to speak positively about the company's drug. The influence a sales person has on doctors is well-documented. The net result is: Doctors prescribe drugs without an accurate or a complete knowledge of the drugs they are prescribing and exposing their patients to serious side effects.
Ben Goldacre raises a number of issues of great importance on the introduction and marketing of drugs. He does suggest a number of solutions covering data, regulators, academics, journals, and sales persons. Not all the solutions he suggests seem practical or implementable. Many of them will be on the wish list, as the industry has structural issues. In most markets a consumer buys a product based on his judgment, but in this industry the patient has to buy what his doctor prescribes. The interdependency of the pharmaceutical company and the medical profession, and the dependency of the patient on his doctor form a very strange structural imbalance. Then the society has no option but to live with it.
The book offers a looking glass into the medical profession and pharmaceutical industry and is a great help to the medical profession to identify and understand the forces that play in pushing biased information to their profession.The book may not be very helpful to completely solve the problems a doctor faces in trying new protocols, but has enough information to make them wary of accepting drug efficacy. However, how many doctors have the skill sets or the time to analyze the data? Very few have the necessary skills. They have to depend on the regulators' recommendation. It is here that the onus should lie.
Pharmaceutical companies launch ineffective or drugs that have serious side effects and make huge amounts of money, while the patients suffer. The decision to hoodwink doctors and patients is done by the management of the pharmaceutical companies. What should happen to the top echelon that perpetrated this crime? The author is silent on this issue.
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