“All that glisters…” 'Bad Pharma' by Ben Goldacre. 4th Estate

Book Review

I thought it about time I started reviewing a few health related books and articles, so enjoy… Benjamin Franklin once wrote ‘in this world nothing can be said to be certain except death and taxes’. Having read Bad Pharma I would add ‘…and anything published by Ben Goldacre’. Why such certainty? Well it would be impossible to publish such a damning book critical of the pharmaceutical industry without either robust evidence or the world’s best team of lawyers. For those unfamiliar with this author, Ben is a GP whose first bestseller Bad Science, took us on an hilarious journey through ‘quack’ medicine (aka homeopathy), placebo effects, medical statistics, health scares and the MMR hoax. Research is never an easy subject to fathom, but that book achieved it, opening up the world of medical data to a wider audience. Bad Pharma has opened up another world, but one far murkier and, quite frankly, appalling. From the opening chapter Ben reveals how the pharmaceutical industry goes out of its way to hide trial data which in turn lead to unnecessary patient deaths, use techniques to ensure prescribing of expensive branded medication over generic equivalents, directs funding and finance towards targeted patient groups, prevents governmental organisations providing realistic data and guidance on the drugs we prescribe daily, and interferes with media reporting. Ben has a fair and balanced approach throughout the book. By fair and balanced I mean that nearly all of the major pharma companies do not escape criticism of their actions over the last decade, including those best known to the travel health industry. So far many of the critics of this book suggest this is in fact ‘old news’ and pharma’s act has been cleaned up, most of us being savvy to the infamous ‘tricks of the trade’. However, one only needs to review recent press releases about Tamiflu and it becomes clear there is far more cleaning up to do, as this institutionalised ethical cancer has metastasised to an almost untreatable level. After reading this book I found myself in a slight quandary. The travel medicine community is a large benefactor of the generosity of big pharma. Many of us, myself included, have benefited from corporate sponsorship and employment through consultancy and teaching. It is without doubt pharma input has provided practice nurses and GP’s with continuing and comprehensive continuing professional development. Their support of study days is incomparable and, unfortunately, currently necessary as the NHS often fails to deliver appropriate training for its staff, and to that end we are grateful. Globally, vaccines have measurably improved human population health and conquered diseases that have caused suffering for millennia. However, as Ben quite clearly describes in his book, this cannot and does not excuse the pharmaceutical industry from their moral obligations to behave responsibly. This could include behaviour such as releasing all drug trial data so we as clinicians can have a better chance of doing what’s right for our patient and not what the latest shiny advert suggests is right, or perhaps being less involved in study days. If the world in which we work has any chance of changing, I would suggest this book be mandatory reading for any student in healthcare. For those of you old and wise enough to be aware of pharma industry issues, I challenge you to read this book and try firstly, not to be surprised at the level to which big pharma has sunk, and secondly, consider it in relation to your daily practice. For those of you who are newer to this arena, just remember the next time you are enjoying a wonderful study day, laid on in a plush hotel, having just had a second helping of deep fried prawns in a hoisin sauce, all that glisters certainly isn’t gold. James Moore Declaration of Interests James has received Pharma money for lecturing, consultancy work and sponsored conference places (but following this review suspects those times are past)