Last night I finished reading Bad Pharma by Ben Goldachre. At over 400 pages, it took me three days to read because I simply could not put it down. To those of you who have read Bad Pharma you probably won’t be surprised at the following words which I’m going to use to describe my feelings right now: anger, disbelief, disillusionment, sadness, confusion…regret. It’s an excellent book, but it’s an excellent book that breeds a lot of negative thoughts.
The cover of the latest edition.
Basically (and very basically at that) it’s a non-fiction book about the systematic corruption, bad ethics and downright dishonesty within medicine, scientific academia and the pharmaceutical industry. As a young, budding scientist, it was difficult for me to read. It wasn’t difficult because of me being made aware that these perversions exist in science. I wasn’t completely naive – I knew that science wasn’t a pure, wholly ethical, perfect institution. But to realise the extent to which these perversions occur…that was what was difficult.
So now I’ve been undesirably tossed into a state of career crisis, if you want to call it that. It may seem extreme, but again, to those of you who have read the book it might not seem unreasonable that my general good faith in science as a whole has been quite tarnished. Up until now, my plan was to complete my BSc degree in Biochemistry, do a PhD and then go into the pharmaceutical industry. But now, the last part is very undesirable to me.
I think the most upsetting thing about me having read this book is that I feel like the wool has been pulled over my eyes…by everyone – my school teachers who taught me science, my university lecturers who currently teach me science, the people who write the textbooks I use, my GP, the media…literally everyone who’s ever fed me information or given me ideas to do with science as a whole. Imagine this – being a wide-eyed student fresh out of school, or in their first year of university studying science, or as a fresh graduate from science, and thinking that the scientific working world which they’re about to enter is amazing, ethical, innovative and ‘pure’. Having so much enthusiasm for being a proper scientist about to help change the world and help people. And then you realise that actually, you’re in for a very different ride. You’re in for a ride that includes bribery, distorting data, hiding data, years of work that turns out to be unsuccessful and subsequently hidden…the list goes on.
But of course, that’s being completely pessimistic about it. Of course there are loads of people in medicine, scientific academia and the pharmaceutical industry who really are good and who really are doing proper, ethical work. I know good people exist…the problem is that a lot of bad people exist, and those bad people are often at the top of the chain and therefore have a lot more influence than the good people. The problem is that science as a whole is still corrupt and unethical, and is hurting and killing real people.
So the first question I asked myself was this: “I know that I am a good, ethical person, but can I willingly work for a company or an industry that actively chooses to favour profit over patients, therefore causing unnecessary suffering and death to real people?”
The answer is no. Then I asked myself: “Could I work for a company or industry that does this, but make a positive difference by doing good, ethical work myself and make things better from the inside out?” But then I realised that being one person trying to good in a global industry that’s systematically bad is not very encouraging. Of course, I wouldn’t be alone – I wouldn’t be the only good scientist in the world. But it would certainly feel like that a lot of the time.
So, what is it that Bad Pharma actually says? How is science corrupt? Obviously I can’t give every example that a 400+ page book gave, but I’ll try and summarise very briefly.
Firstly, the book covers missing data – data procured from trials that isn’t publicised. One example the book gives is of the drug TGN1412, which was trialled on twelve patients in London in 2006. Rapidly (within a day) each patient deteriorated until one had respiratory failure, one stopped breathing properly after their blood pressure dropped dramatically…other symptoms were kidney failure and white blood cells disappearing. The researchers who carried out this trial had no idea these effects would happen because basically, a very similar drug was tested during 1996 which produced similar outcomes in the single patient it was trialled on. However, because the results were obviously negative, the research was never published and because scientists therefore couldn’t possibly know that a similar drug would have these disastrous side-effects, the 2006 trial happened and patients were harmed.
Another example (the one that had the largest effect on me) was the story of how GlaxoSmithKline (GSK) withheld data about whether a drug called paroxetine is an effective antidepressant. GSK also withheld data about its harmful side-effects (including increased risk of suicide). The fact that this was so troubling to me was that the people most likely to be affected by this withholding of information were children. If paroxetine was prescribed for depression for children, there was a much higher risk of said children committing suicide, because of the drug’s side effects. The fact that it was children’s lives at stake was what was so upsetting. GSK continued to withhold data about paroxetine while children died.
So that was the first chapter (which included many more examples of pharmaceutical companies and researchers withholding negative data). The next few chapters looked at where drugs come from (including a basic overview of how a drug is developed, from first conceptions to being brought onto the market), how some trials are unethical and inaccurately presented, how some regulators are unethical, and how drugs marketing is often unethical and biased. It described how what doctors and GPs prescribe is influenced by the drugs reps they see, how that oftentimes your GP doesn’t actually know which treatment is best for you because there’s simply been no systematic reviews and evidence comparing various drugs, and how marketing in certain countries affects not only what doctors prescribe, but what patients demand (often incorrectly).
For example, in the USA direct-to-consumer marketing is legal, which is basically when you see drug adverts on TV. In the UK this isn’t legal, and as a Brit, when I visited Orlando in Florida in 2012, I was very surprised to see so many drugs adverts on TV, because you simply don’t get that in the UK (apart from of course the standard Nurofen adverts and stuff). There were so many pills being advertised on American TV and I was most astounded about all the side-effects that were reeled off very quickly at the end of each advert. To me they always seemed worse than death, like “may cause nausea, drowsiness, vomiting, depression, suicidal thoughts…” the side-effects just seemed to get worse and worse until there seemed like there being absolutely no point in taking the drug in the first place.
Bad Pharma was describing how these advertised drugs are usually new and expensive and are hardly better than the same, old drug, but because they’re being advertised, that’s what patients ask for. And that’s what they get. Also, obviously the drug company that makes the drug is going to make the adverts, so who knows what data they’re withholding to make their drug sound great.
So, in summary, the book describes how almost every aspect of medicine and science is polluted with bad ethics and practice. It was quite a downer. So now I’m left wondering what on earth to do. I have to apply for my PTY (Professional Training Year, which is where you take a year out of university to work in industry for 9/12 months) by November and I might be being narrow-minded, but apart from work in the pharmaceutical industry, what other options are there for a biochemist? I don’t want to go into teaching, and I can’t do very much that’s environment- or animal-related because I’m not a biologist, ecologist or zoologist. So I guess I’m just going to have to look at my options. I had planned to apply for the GSK PTY programme, but since GSK has been the subject of the biggest drug investigation in UK history, plus many other scandals about withholding data and unethical practice, I don’t particularly want to apply for that anymore.
Anyway, wish me luck in a) finding something decent to do for my PTY, and b) deciding on what to do with my future, now that I don’t particularly have much respect for the people in medicine, scientific academia and the pharmaceutical industry who make it a corrupt place to be and a non-trustworthy industry for patients. I know it’s not all bad and that science and the pharmaceutical industry as a whole has done so, so much good, but it’s still hard to ignore the bad that’s very prevalent today.