Putting the drug companies' research to the test

Millions of drugs are being prescribed every day on faulty evidence, claims a new book on the pharmaceutical industry

THE FIRST medical test recorded is recounted in the Bible, when Daniel, imprisoned by Nebuchadnezzar in Babylon, refused orders to eat the food and wine from the king’s table. Instead, he demanded that the Jews brought from Jerusalem should eat only fresh vegetables and drink fresh water and then be compared with those who ate the king’s offerings. “At the end of the 10 days they looked healthier and better nourished than any of the young men who ate the royal food,” Daniel 1:12 records. Two thousand years on, the writer, doctor and journalist Ben Goldacre believes the example has much to recommend it.

Following his success with Bad Science, a book that sold 400,000 copies, Goldacre has turned his attentions to the world’s pharmaceutical industry in Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients. The public believes that drugs are tested over years in carefully-run trials before being prescribed by doctors familiar with the research that led to their creation. Much of that image is a fiction; drugs are often tested against placebos filled with sugar, or against drugs that have been shown repeatedly not to work, while results are often manipulated, says Goldacre.

However, Goldacre moves to dispel myths of “cartoonish evil”, or conspiracy theories of the “they have the cure for cancer, but they won’t tell us” variety. “This is not just a book about bad people. In fact, it is possible for good people, in perversely designed systems, to casually perpetrate acts of great harm on strangers, sometimes without even realising it.

“Drugs are tested by the people who manufacture them, in poorly-designed trials, on hopelessly small numbers of weird, unrepresentative patients,” he writes.

Academic papers “are often covertly planned and written by people who work for the companies without disclosure”, while many diseases are ignored because the potential rewards of developing a treatment for them are insufficient.

Regulators have failed miserably, with the European Medicines Agency worst of all, refusing, as it does, to publish information gathered, it says, in the interests of transparency.

Pressured by lack of money, governments could be about to make the situation even worse by giving pharmaceutical companies a greater role in deciding on patients’ treatment, he warns.

“Companies are perfectly entitled to conduct seven studies, but only publish the two positive ones, and this behaviour is common-place,” he writes.

“Because so much trial data is withheld from patients and doctors, we can have no clear idea of the true effects of the treatment that we use every day in medicine.”

Some of the problems are created by the ties of friendship. “If you are a regulator, who can you talk to about your work at the home, or in the pub? Nobody will understand it.

“So you end up having more in common with people you know who are working for pharmaceutical companies’ regulatory departments,” he tells The Irish Times, sitting in the lobby of a London hotel. “If you are a young doctor, you go to the drugs company’s dance in the hospital. Your colleagues are going, so you want to fit in. And there’ll be nurses there.”