'Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients' - By Ben Goldacre. The PDF file you selected should load here if your Web browser has a PDF reader plug-in installed (for example, a recent version of Adobe. Bad Pharma - Free download as PDF File .pdf), Text File .txt) or read online for free. Cataloguing in Publication Goldacre, Ben Bad pharma / Ben Goldacre. Dr Ben Goldacre earned his reputation for his book Bad. Science and his column in the Guardian newspaper of the same name. In both he provides an.
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Summarizes criticisms of the industry and highlights likely changes in response to the accusation that the industry undermines evidence-based medicine. Modelling Pharmaceutical R&D. Discussion: Statistics Research in Business and Industry ‐ The General Electric Experience. PDF | On May 1, , Dennis Lendrem and others published Bad pharma: how drug companies mislead doctors and harm patients Ben Goldacre Faber. Ben Goldacre. Nenhuma oferta encontrada. ISBN ISBN Ano: / Páginas: Idioma: inglês. Editora: Faber & Faber.
Some of this stuff is hard. Learn more. Ana Ramos Lopez. Forgot password? Ben Goldacre August This has all been perpetrated by ordinary people, but many of them may not even know what theyve done. In general, doctors and academics think you should always use the scientific name, because it tells you a little about the class of the molecule, and is less ambiguous; while journalists and patients will more often use brand names.
If the address matches an existing account you will receive an email with instructions to retrieve your username. Pharmaceutical Statistics Volume 12, Issue 3. First published: Read the full text. Tools Request permission Export citation Add to favorites Track citation. Share Give access Share full text access. Share full text access. Please review our Terms and Conditions of Use and check box below to share full-text version of article.
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Wiley Online Library. Related Information. Email or Customer ID. We like to imagine that regulators only let effective drugs onto the market, when in reality they approve hopeless drugs, with data on side effects casually withheld from doctors and patients.
Im going to tell you how medicine works, just over the page, in one paragraph that will seem so absurd, so ludicrously appalling, that when you read it, youll probably assume Im exaggerating.
Were going to see that the whole edifice of medicine is broken, because the evidence we use to make decisions is hopelessly and systematically distorted; and this is no small thing.
Because in medicine, doctors and patients use abstract data to make decisions in the very real world of flesh and blood. If those decisions are misguided, they can result in death, and suffering, and pain. This isnt a simple story of cartoonish evil, and there will be no conspiracy theories.
Drug companies are not withholding the secret to curing cancer, nor are they killing us all with vaccines. Those kinds of stories have, at best, a poetic truth: But most of us, doctors included, dont know exactly what. These problems have been protected from public scrutiny because theyre too complex to capture in a soundbite, or even 3, words.
This is why theyve gone unfixed by politicians, at least to some extent; but its also why youre holding a book of over four hundred pages. The people you should have been able to trust to fix these problems have failed you, and because you have to understand a problem properly in order to fix it yourself, this book contains all that you need to know.
So, to be clear, this whole book is about meticulously defending every assertion in the paragraph that follows. Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques which are flawed by design, in such a way that they exaggerate the benefits of treatments. Unsurprisingly, these trials tend to produce results that favour the manufacturer. When trials throw up results that companies dont like, they are perfectly entitled to hide them from doctors and patients, so we only ever see a distorted picture of any drugs true effects.
Regulators see most of the trial data, but only from early on in a drugs life, and even then they dont give this data to doctors or patients, or even to other parts of government. This distorted evidence is then communicated and applied in a distorted fashion.
In their forty years of practice after leaving medical school, doctors hear about what works through ad hoc oral traditions, from sales x. But those colleagues can be in the pay of drug companies often undisclosed and the journals are too. And so are the patient groups. And finally, academic papers, which everyone thinks of as objective, are often covertly planned and written by people who work directly for the companies, without disclosure.
Sometimes whole academic journals are even owned outright by one drug company. Aside from all this, for several of the most important and enduring problems in medicine, we have no idea what the best treatment is, because its not in anyones financial interest to conduct any trials at all.
These are ongoing problems, and although people have claimed to fix many of them, for the most part they have failed; so all these problems persist, but worse than ever, because now people can pretend that everything is fine after all. Thats a lot to stand up, and the details are much more horrific than that paragraph makes it sound. There are some individual stories that will make you seriously question the integrity of the individuals involved; some that will make you angry; and some, I suspect, that might make you very sad.
But I hope you will come to see that this is not just a book about bad people. In fact, its possible for good people, in perversely designed systems, to casually perpetrate acts of great harm on strangers, sometimes without ever realising it. The current regulations for companies, doctors and researchers create perverse incentives; and well have better luck fixing those broken systems than we will ever have trying to rid the world of avarice.
Some people will say that this book is an attack on the pharmaceutical industry, and of course it is. But its not only that, and its not unbounded.
I suspect that most of the people who work in this industry are fundamentally good-hearted, and there is no medicine without medicines. Drug companies around the world have produced some of the most amazing innovations of the past fifty years, saving lives on an epic scale. But that does not allow them to hide data, mislead doctors and harm patients. Today, when an academic or doctor tells you that they are working for the pharmaceutical industry, they often do so with a look of quiet embarrassment.
I want to work towards a world where doctors and academics can feel actively optimistic about collaborating with industry, to make better treatments and better patients. This will require big changes, and some of them have been a very long time coming. To that end, because the stories I am telling you are so worrying, Ive tried to go beyond simply documenting the problems.
Where there are obvious fixes, Ive set out what they are. But Ive also included, at the end of each chapter, some suggestions on what you can do to improve things.
These are tailored to whoever you might be: More than anything, though, I dont want you to lose sight of one thing: The tricks and distortions documented in these pages are beautiful, and intricate, and fascinating in their details.
The true scale of this murderous disaster only fully reveals itself when the details are untangled. Good science has been perverted on an industrial scale, but this has happened slowly, and evolved naturally, over time. This has all been perpetrated by ordinary people, but many of them may not even know what theyve done. I want you to find them, and tell them. Whats coming The book follows a simple trajectory. We start by defending our central claim: In this section we also encounter the idea of a systematic review for the first time.
A systematic review is an unbiased survey of all the evidence on a given question. It is the best-quality evidence that can be used, and where they exist, systematic reviews are used for evidence throughout this book, with individual studies described only to give you a flavour of how the research has been done, or how mischief has been made. Then we look at how the pharmaceutical industry manages to create all these positive trials for its drugs. Our first stop is to review the evidence showing that unflattering trial data can simply be withheld from doctors and patients.
Companies are perfectly entitled to conduct seven studies, but only publish the two positive ones, and this behaviour is commonplace. Whats more, it happens in every field of science and medicine: Because so much trial data is withheld from doctors and patients, we can have no clear idea of the true effects of the treatments that we use every day in medicine.
The stories in this section go from antidepressants, through statins, cancer drugs, diet pills, and right up to Tamiflu.
Governments around the world have spent billions of dollars to stockpile this flu drug, in fear of a pandemic, and yet the evidence on whether it reduces the rate of pneumonia and death is being withheld right now, to this day.
Next, we take a step back, to look at where drugs come from. We cover the drug development process, from the moment someone dreams up a new molecule, through tests in labs, on animals, the first tests in humans, and then the early trials necessary to show that a drug works on patients.
Here you will find, I suspect, some surprises. Risky first-in-man drug tests xiii. This raises serious ethical problems, because trial participants in developing countries are often unlikely to benefit from expensive new drugs; but it also raises interesting new problems for trusting the data. Then we look at regulation, and the hoops you must go through to get a drug onto the market.
We will see that the bar is very low: This means that real patients are given dummy placebo pills for no good reason, but also that drugs appear on the market which are worse than the treatments we already have.
We will see that companies break their promises over follow-up studies, and that regulators let them do this.
We will also see how data on side effects and effectiveness can be withheld from regulators, and that regulators, in turn, are obsessively secretive, withholding the data they do have from doctors and patients.
Lastly, we will see the harm done by this secrecy: Then we take a tour through bad trials. It is tempting to believe that a simple clinical trial is always a fair test of a treatment: But several tricks have been introduced, over the course of many years, which allow researchers to overstate and exaggerate the benefits of the treatments they are testing.
When you get here, you might think that some of these are innocent mistakes; in all seriousness, while I doubt that, Im more interested in how clever they are. More importantly, we will see how obvious these tricks are, and how people who should know better at every step of the chain, from xiv. After a brief detour to discuss how some of the problems around bad evidence, and missing evidence, could be addressed, we move on to marketing, which is where most previous books on drug companies have focused their attention.
Here we will see that pharmaceutical companies spend tens of billions of pounds every year trying to change the treatment decisions of doctors: Since we all want doctors to prescribe medicine based on evidence, and evidence is universal, there is only one possible reason for such huge spends: All of this money comes directly from patients and governments, so we ourselves are paying for this privilege.
Doctors spend forty years practising medicine, with very little formal education after their initial training. Medicine changes completely in four decades, and as they try to keep up, doctors are bombarded with information: Finally, we will see what can be done.
While the deceit of a marketing drive can be ignored by an ethical doctor, the problems caused by distorted evidence affect everybody, without exception.