I’d always known, from disquieting reports that appear in the mainstream media from time to time, that all is not well with modern medicine, but I recently read a book that’s not so much a book as an expert demolition job: Bad Pharma by Ben Goldacre (HarperCollins, 2012). I could almost hear the crash as the proud edifice of modern medicine came tumbling down. I’m aware that it’s possible to go overboard with criticism — the giant pharmaceutical companies, Big Pharma, are an especially easy target — but Ben Goldacre is not a journalist but a doctor, and his criticisms do seem to be based on solid evidence. If modern medicine is evidence-based medicine — which is the claim — then this book is evidence-based criticism. And it’s not just Big Pharma that Ben targets: academia, the regulatory authorities, medical journal editors … all come under his critical microscope.
I will just touch upon the most serious criticism in the book, which is so incredible as to be almost unbelievable, but it’s apparently true. I refer to the problem of missing data. It seems published medical research is weighted in favor of positive results for drugs being tested — negative results are merrily swept under the carpet. As the first chapter states:
Evidence is the only way we can possibly know if something works — or doesn’t work — in medicine. We proceed by testing things, as cautiously as we can, in head-to-head trials, and gathering together all of the evidence. The last step is crucial: if I withhold half the data from you, it’s very easy for me to convince you of something that isn’t true. If I toss a coin a hundred times, for example, but only tell you about the results when it lands heads-up, I can convince you that this is a two-headed coin. But that doesn’t mean I have a two-headed coin: it means I’m misleading you, and you’re a fool for letting me get away with it. This is exactly the situation we tolerate in medicine, and always have. Researchers are free to do as many trials as they wish, and then choose which ones to publish.
The repercussions of this go way beyond simply misleading doctors about the benefits and harms of interventions for patients, and way beyond trials. Medical research isn’t an abstract academic pursuit: it’s about people, so every time we fail to publish a piece of research we expose real, living people to unnecessary, avoidable suffering.
Plenty of examples are given in the chapter to back up this claim; it all makes for sickening reading (believe it or not, pun unintended). Here are two reviews of the book:
My one criticism of the book is the overuse of the colon; for example, the last two colons in the above excerpt (“two-headed coin:” and “academic pursuit:”) should be semicolons, and there are numerous such examples throughout the book. It’s fair to say that the book is a veritable colon feast, but then it is a medical book and the author is a doctor, so I suppose I shouldn’t complain about body parts masquerading as punctuation. But, yes, the book is a proctologist’s delight. 🙂
Also see: Whither Modern Medicine?