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.


A Woman in the Crossfire: Diaries of the Syrian Revolution by Samar Yazbek

A Woman in the Crossfire is, as the subtitle suggests, an account of the Arab Spring-inspired uprisings in Syria; or at least the first few months of them.

This is my book from Syria for the Read The World challenge. Because of the rules I’ve set myself, that the books should be written by people from the countries in question, I often find it frustratingly difficult to find books which are up to date, and which engage with life in those countries as it is now: usually if a book is only twenty years old I’m doing quite well.

This book is certainly up to date. Or at least, as a piece of journalism I suppose it’s already slightly out of date; it covers the period from March to July last year, and the situation in Syria has moved on since then. But it still feels very fresh and raw.

Like A Poet and Bin Laden, this is journalism (in a broad sense) written by a novelist. And although it is much less ‘literary’ in form — it’s written in a pretty straightforward diary form, plus interviews she did with other Syrians — there are certainly bits that don’t quite read like standard journalism. Most obvious is the amount of emphasis on her own emotional and psychological experience. It rubs against the normal assumption of journalism that keeping the journalist out of the story is evidence of objectivity.

But actually, the psychological pressures on a dissident living in a police state which is cracking down violently on protests is a fascinating subject in its own right. The sleeplessness, the panic and uncertainty, the fear that the regime will take revenge, not just on her but on her daughter: this is an important part of the story of what it means to live in a dictatorship. And it makes it all the more admirable that she kept on putting herself in danger by going out to observe protests and conduct interviews; and completely unsurprising that after a few months she chose to leave the country, taking her daughter with her.

At times it starts to feel a bit repetitive because, well, events were repetitive: there are an awful lot of protests and massacres. Generally, though, the quality of the writing is enough to keep up the interest. The book does a particularly good job of providing a sense of life as it happened; it’s not just the facts, it’s the texture of experience.

» The photo Banyas Demos – / Syria سورية مظاهرات /صور بانياس, from 6th May 2011, is © Syria-Frames-Of-Freedom and used under a CC attribution licence.


A Poet and Bin-Laden by Hamid Ismailov

This book tells the true story of Belgi, an Uzbek poet who fled the brutal regime in Uzbekistan and ended up in an Islamic militant/terrorist/dissident organisation up in the mountains of Tajikistan, just at the end of the 90s: in other words, as part of the same broad cultural movement as the Taliban and Osama Bin Laden, just before 9/11.

The value of the novel is that it provides a more intimate perspective on that movement. Not that Hamid Ismailov was part of it himself — it’s not an insider’s view — but he’s an Uzbek poet and novelist who fled the country and ended up working for the BBC World Service, writing about an Uzbek poet who fled the country and ended up fighting with Islamic militants. There’s a cultural empathy there which is quite different to reading a book written by, say, an American diplomat or academic.

It’s more nuanced, more human, messier. The militants are not a faceless mass, they are a group of individuals. The religious cause is the primary motivation for some; but others are mainly concerned with opposing a particular Uzbek regime, or with personal ambition. And those who got caught up by accident and know that they are likely to be shot if they try to leave.

Belgi is well suited to being the human face of islamism, because his poetry offers the most direct possible contradiction of the stereotype. Most of the chapters start with an extract of his poetry, and it is modern, elusive/allusive… it is not the poetry of zealotry or violence. For example, picking one essentially at random:

Has summer come?
In your life you’ll still write another
Twenty-five books in the little square
among the mass of stone, ugly memorials.
Some concrete piece, the existence of a memorial
left by the builders,
turns into the absurd
as though, yes, say as though, in as far as
even if the thought ends
the yearning to continue it
does not end.
Shall I go into the dining room
and soak my hardened
brains in tea
so as to pour into my thought?
Here no one needs you,
but this is just the width and the length
of the fact that you need no one.

The poetry is not contemporary with him being a militant, it’s a different phase of his life; but still, the two things seem strikingly at odds.

So there’s a lot which is interesting about the book. But I do have some issues, mainly to do with form rather than content. The publisher’s blurb refers to it as a ‘reality novel’ and says that ‘in this book Hamid Ismailov masterfully intertwines fiction with documentary’. I don’t have a principled objection to mixing fiction and non-fiction, but in practice I found it confusing: I just wanted to have some idea of what was definitely true, what might be true, and what, if anything, was pure invention. No doubt the people who tried to teach me literary theory at university would despair at my naivety, but there you go.

What I found particularly confusing was that the book is an odd mixture of what reads like fiction with documents reproduced verbatim: press releases, transcripts of radio interviews and so on. And I was reading it thinking, well, the ‘documentary’ stuff must be genuine because anyone inventing it as fiction would make it a bit livelier; but the ‘fictional’ bits include events where the author wasn’t present, told as though from direct experience.

I ended up trying to google Belgi to find out whether or not he even existed; and to add to my confusion, couldn’t initially find any trace of him (I did eventually, once I worked out what to search for).

It’s not until chapter 32, halfway through the book, that Ismailov writes:

I think the time has arrived for me to interrupt my story and put in at least a brief word of clarification. Everything that I have written so far is documentary, and not only in those sections where I cite documents or eyewitness accounts, but also – even more importantly – in the parts where I tell the story of Belgi-Yosir, or rather, where I reproduce reality as seen through his eyes.

This is the point at which I must say that I have not made anything up, and while I am open to the reproach that I have not seen it all with my own eyes, nonetheless I have made it a rule in every case to rely on the words of those who did see things for themselves. Many of these people will never admit what happened to them: for instance Alisher, or Umar, who told me himself how he and Belgi came to be in Hoit, now works in a foreign cultural delegation.

If that explanation had appeared in the first few chapters it would have saved me a lot of fretting.

In fact I personally would have liked a generally simpler narrative. Inevitably there are a lot of unfamiliar names to keep track of — people, places, organisations — but it seemed to be made harder than necessary by the way it kept shifting around; not only the stylistic shifts between the documentary, ‘fiction’, and Ismailov’s first-person accounts of his own experiences, but also it felt like it kept hopping around in time and place.

So in various ways I found the model of a ‘reality novel’ awkward; it felt like the two impulses were fighting each other a bit, and I would have preferred either one thing or the other: a novelistic narrative or straight non-fiction.

But it’s an interesting and valuable book, despite that.

[Just in the spirit of full disclosure: the publishers, Glagoslav, sent me a review copy because I previously wrote a review of Ismailov’s novel, The Railway. Which was a first. So thanks to them for that.]


Londoners by Craig Taylor

To give it its full, ludicrously long title: Londoners: The Days and Nights of London as Told by Those Who Love It, Hate It, Live It, Long for It, Have Left It and Everything Inbetween.

This makes a good pair with Daily Life in Victorian London. It’s a compilation of interviews with Londoners of all sorts. Some of them are the obvious London clichés — black cab driver, yeoman warder, hedge fund manager , refugee — and some are more exotic: beekeeper, dominatrix, Wiccan priestess. And most are are just, well, ordinary: teacher, street cleaner, personal trainer, estate agent, student.

But of course the key to books like this is that ‘ordinary’ people often turn to be unexpectedly interesting when you scratch the surface. Either because they have led unexpectedly interesting lives, or because they are charming or funny or insightful in telling their own stories. And those who don’t have great back-stories and who aren’t great storytellers: even they are always good for a couple of paragraphs to help build up the mosaic.

There’s obviously no shortage of material in a place the size of London, so a book like this is entirely dependent on the skill of the person who conducts the interviews and then edits and curates them. Craig Taylor has done a cracking job and it’s well worth reading.

» the Big Issue seller’s licence is from the Museum of London collection.


Nothing to Envy by Barbara Demick

Full title: Nothing to Envy: Real Lives in North Korea. I’ve had this book since February and was finally spurred to pick it out of the pile by the death of Kim Jong-il.

It’s based on interviews with refugees from North Korea which were conducted over several years by Barbara Demick, an American journalist. She interweaves their stories into a chronological narrative to create a picture of everyday life in North Korea over the past few decades.

Obviously there are limitations created by her almost complete lack of access to the country itself, but she focussed on people from a particular city, Chongjin, near the Chinese border, and did her best to cross-check as many details as possible. The result is a very solid and convincing picture. It’s a fascinating and horribly grim picture of a personality cult, rigid bureaucratic social control, and constant fear that saying the wrong thing could get you sent to the gulags… and then the famine kicks in and it gets even worse.

It seems bizarre that a Stalinist system like this can still survive into the twenty-first century, decades after Communism collapsed elsewhere and even as South Korea and China become rapidly more prosperous. But I guess the really extraordinary thing is that it lasted as long as it did in Russia, China and Eastern Europe.

Anyway, it’s a good book, well worth reading.

» The photo Arirang (DPRK) is © Gilad Rom and used under a CC attribution licence.


Life in the Republic of the Marshall Islands, ed. Anono Lieom Loeak, Veronica C. Kiluwe, Linda Crowl

Life in the Republic of the Marshall Islands is my book from the Marshall Islands for the Read The World challenge. It’s a compilation of short pieces published for the 25th anniversary of the Marshall Islands constitution. It includes a variety of subjects, including personal memoirs, accounts of traditional crafts, and more political pieces.

The two chapters I found most interesting were both political: one was an account of the way that, thanks to lax adoption laws in the Marshall Islands and an immigration compact with the US, the islands became a popular target for Americans looking for babies to adopt.

The other was survivor accounts of radioactive fallout from American nuclear testing. The Americans seem to have treated the survivors badly, but they also failed to warn or evacuate the islanders on some of the atolls which they must have known were at risk of exposure. Usually I believe that cock-up is a better explanation than conspiracy, but given the darker corners of Pentagon’s history, you have to wonder whether they knowingly allowed people to be exposed so that they could serve as test subjects.

I found other chapters rather less interesting — there was a description of the techniques for building outrigger canoes, for example, which was just too technical for me — but to be fair I really wasn’t the intended audience for the book.

» The image is, obviously I guess, a screengrab of Google Earth centred on the Marshall Islands. Blue, innit.