Like any good scientist, Ben Goldacre starts with his hypothesis:
Medicine is broken: the plane flies but it crashes much more often than it needs to.
The rest of the book is a meticulously researched and eloquently argued support of the hypothesis, which certainly convinced me. I should add that 15 years of medical research, albeit with little contact with the pharmaceutical industry, brought me most of the way to agreeing with Goldacre before I started reading.
Goldacre devotes a lot of pages to laying out his arguments, but his central thesis can be boiled down to one sentence: the pharmaceutical industry has the resources to aggressively pursue a vested interest in what medicines are prescribed, while the bodies that should be keeping them in check, such as regulators and academic researchers, are all too often apathetic or complicit.
In short, we have exactly the situation we’d expect from outsourcing healthcare to organisations that sink or swim by their profit margins rather than by the quality of healthcare they provide.
What Bad Pharma isn’t is a polemic against the pharmaceutical industry. The fundamental problem with any easy solution is that, to quote the opening sentence, the plane flies – most of the time. There can’t be many of us who don’t have a good reason to be glad of modern medicine, either on our own behalf or that of someone close to us. Goldacre doesn’t want to smash the system but to make it work better. He pursues his goal through various routes including the AllTrials campaign, which pushes for trials of medicine to be to be registered in a way that makes it impossible for sponsors to pick and choose what to make public.
It’s more difficult to work for improvement than to call for a structure to be torn down, so Bad Pharma is a harder and less humorous read than Goldacre’s attack on quackery, Bad Science. Medicine is not as soft a target for the simple reason that unlike quackery, it actually works. There is a baby that we wouldn’t want to throw out with the bathwater.
Bad Pharma asks regulators, professional bodies, patient organisations and you and me to step up and make the system better. I’m bound to agree because it’s in line with my oft-droned opinion, that medicine will only prioritise the public good if it’s publicly led.
That’s not to say that there’s no place for the pharmaceutical industry; even if there was a public body competent to take over the process of developing, manufacturing and distributing medicines, we’d only replace the problems associated with profit-orientated corporations with the problems associated with any organisation that has a monopoly on an essential service.
It does mean that if we expect medicine to go on for us as patients, we have a responsibility to engage with making it work. Which is, after all, the way democracy works.
The essentials of the book are summarised in Goldacre’s 2012 TED talk: