Bad Pharma by Ben Goldacre

Ben Goldacre’s previous book, Bad Science, was effectively an adaptation of his Guardian columns of the same name, and although it wasn’t a straightforward compilation, it had something of the same character: a bit of a grab-bag of subjects, held together by the broad theme of bad science and bad science journalism, with a emphasis on trying to entertain as well as inform.

This is a more focussed book. And a drier one, which you may or may not think is a good thing, depending on your tolerance for the occasionally clunky attempts at wackiness and humour that characterise a lot of popular science writing.

Personally I thought Bad Pharma did a good job of taking a potentially tough subject and presenting it in a clear, engaging way. It’s not, btw, a tough subject because it is full of difficult science or complicated statistics, but because it’s a book about institutional and bureaucratic failings within the healthcare industry. Institutional structures, bureaucracy, regulation, professional standards: this is not the sexiest subject matter. But Goldacre did a good job of convincing me that it was important enough that I should keep reading, and making it readable enough that I was able to do so.

The book follows all aspects of the life of a drug — the way it is developed, tested, licensed, marketed, prescribed — and talks through all the ways that biases get into the system and distort medical practice. There is plenty of evidence that these distortions make healthcare worse and more expensive; the only question is how badly. But the same processes that distort the science make it impossible to accurately judge the damage.

The pharmaceutical companies are the major villains of the piece, unsurprisingly; they are the ones doing badly designed trials, hiding the results of trials with flattering outcomes, paying academics to put their names to ghostwritten articles, and spending twice as much on marketing as they do on R&D. But as Goldacre points out, they are only able to get away with it because of repeated failures by everyone else involved: regulators, governments, journals, professional bodies, patient groups, and so on. All of whom have been at the very least complacent, and often suffer from deep conflicts of interest, since the drug companies seem to be the only people in the whole system who actually have a lot of money to throw around. So they spend a lot of money advertising in the medical journals, they donate money to patient groups, they sponsor conferences and training for doctors.

It’s a worrying book, which deserves to be widely read.

» Doctor Themed Cupcakes is © Clever Cupcakes and used under a CC attribution licence.


Say aaah.

I went to the doctor today about a sore throat; he took a quick look down my throat, made me go aah, asked me where it hurt, and recommended that I just wait for it to get better.

Which is both reassuring — I’m glad he didn’t take one look down my throat and gasp in horror Oh my God, what is that thing? —  and curiously disappointing. Because, you know, you want your doctor to do some doctoring.

He obviously understood this, because he offered to write me a prescription for antibiotics if I really wanted, while making it very clear that he didn’t think I should use it.

Ridiculous though it is, I almost would have been happier to be given some pills which I knew were a placebo and told to take them three times a day.


The Checklist Manifesto by Atul Gawande

This book is a paean to the power of checklists and specifically a call for their use in medicine — Gawande is a surgeon. I bought it after reading a couple of fascinating articles he wrote for the New Yorker, and to be honest if you’ve read those articles (and watched his TED talk) you have a pretty good idea of what’s in the book.

But I still found it absolutely fascinating reading it again. It’s that thing Malcolm Gladwell is so good at: an idea simple enough that it can be explained in a paragraph but with far-reaching implications. The difference is that while Gladwell’s ideas give people a lot of pleasure they don’t actually seem very useful, whereas this idea has specific, practical [cheap!] applications which can be tested. It really could change the way medicine is practiced.

At its simplest, the idea is that when performing a complicated task like surgery, it is not enough to know what the best practices are, because people are fallible. And so a simple checklist to make sure that the basics are done properly can significantly reduce the rate of complications like infection. And it really is the basics: making sure that everyone knows what they’re doing, that they have the right patient, that pre-operative antibiotics have been given at the right time, that everyone is sterile, that they have an ample supply of blood on hand and so on.

Apparently the idea is most well-developed in aviation; ever since planes became complicated enough that missing a pre-flight check might mean a fiery death, pilots have formalised the process. And not just pre-flight checks, or the obvious things like take off and landing procedure. Apparently pilots have whole collections of checklists for use in specific situations like particular warning lights coming on.

As yet, in medicine they have apparently only tested a simple checklist for surgery, which did successfully improve outcomes, and they have come up against resistance because, I guess, doctors feel it undermines their expertise and knowledge. This book makes a convincing case that medicine would be better if it was a lot more like aviation. Being methodical and disciplined may not be the most glamorous or heroic sounding qualities, but they can be life savers.

It’s hard to do the book justice — checklists just don’t sound very interesting — but I found it completely gripping as well as persuasive.

» 757/767 Mechanical Checklist – Landing is © Kent Wien and used under a CC by-nc licence.

Daily Links


Daily Links



Wolf flu

The swine flu outbreak had me thinking: presumably the very nature of infectious diseases means that, if you want to beat them, you have to act fast and take large-scale measures. You have to act, every time, as though this one is The Big One because if it is, then time is of the essence.

But of course it means the authorities are open to accusations of needless alarmism and crying wolf. This is the third ‘pandemic’ this decade, after SARS and bird flu; how many times can we have these alerts before people stop taking them seriously?

Although as long as governments keep taking them seriously, perhaps it would be no bad thing if the media treated them more as routine news stories and less like the first horseman of the apocalypse had just appeared.

I’m assuming, btw, that the swine flu is not going to be the pandemic that kills us all. I hope I’m not tempting fate.

» The photo is ‘Padrecito Posero’, © Eneas De Troya and used under a CC attribution licence.