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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.

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Drugs Without The Hot Air by David Nutt

David Nutt became somewhat famous in the UK when he was chairman of the Advisory Council on the Misuse of Drugs [ACMD], the statutory body which is responsible for advising the government on drug policy, and specifically on the appropriate legal classification of different drugs.

He was criticised and eventually fired for being rather too vocal about the fact that the government consistently ignored the advice of the ACMD and allowed political considerations to trump politics, and for pointing out some inconvenient truths about relative harms; that alcohol and tobacco are both more dangerous than many illegal drugs, and that horse-riding is considerably more dangerous than taking ecstasy.

This became a bit of a cause celèbre in the geekosphere. Because we all know that  politicians will ignore the evidence if it’s politically inconvenient, but it’s rarely quite so blatant as firing someone for saying what the evidence is.

This book covers various aspects of drug use: how drugs work, how harmful they are, what addiction is, what treatments are available and so on. It covers alcohol, tobacco and prescription drugs as well as the illegal ones.

It’s interesting to read because it simultaneously seems radical and rather obvious. Radical because if all the evidence in the book was taken seriously it would involve a top-to-bottom rewriting of UK drug laws; and obvious because actually not much of this stuff should come as a surprise.

For example, however much politicians may splutter about the comparison, can anyone who lives in this country seriously doubt that alcohol causes far more social harm than ecstasy or cannabis? Or that, purely pragmatically, treating addiction as a medical problem is likely to be more successful than treating it as a moral failing? And even if you think cannabis should be illegal, surely it makes intuitive sense that it is counterproductive to imprison users: both because being in prison is in itself more damaging to the individual’s future prospects than the actual drug use, and because it is very expensive to lock people up.

It’s interesting though, and very readable. It helps that, although the book takes a ‘liberal’ stance compared to the current law, it’s not derived from a naive libertarianism. Nutt is not arguing for loosening the drug laws on the basis of increased personal liberty; he wants the law to be better at managing harms and risks. So he supports the ban on smoking in public places and would tighten some of the rules on alcohol sales. And although treating addiction to heroin and cocaine as a primarily medical problem could be seen as ‘soft on drugs’, he’s arguing for it on the basis that it is the best way to minimise harm.

A few random interesting points from the book: he points out that coca leaves, cocaine and crack are all pharmacologically the same substance, and that the method of delivery makes a huge difference not just to the experience but also the addictiveness. I was startled to learn that about 500 people a year die of heroin overdoses after coming out of prison because, having stopped or reduced their use while inside, they have lost the tolerance they used to have.

And I was struck by his suggestion that the duty on alcoholic drinks should be proportional to actual alcohol content, rather than by category with one rate for beer and one for wine and so on. That would be a direct incentive for drinkers to switch to weaker drinks and for manufacturers to reverse the trend of beers and wines getting stronger. Which seems sensible. There a general argument for making alcohol more expensive anyway, but it seems like a good start to make Special Brew considerably more expensive than lagers with less than half the alcohol.

» The Pink Elephants on Parade LSD blotter is from the Blotter Art website. The bottle of Papine is from Wellcome Images and used under a CC by-nc-nd licence.

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Nature

Dazzled and Deceived by Peter Forbes

This is a book about mimicry and camouflage; principally in nature but also in human use — i.e. the military. I heard about it because it won the Warwick Prize for Writing 2011, and the subject sounded interesting, so I thought I’d give it a go.

It’s certainly pretty good, but I wasn’t blown away by it. It didn’t help that I was familiar with many of the examples already.

My other slight gripe is that it spends a lot of time using examples of mimicry and camouflage as a way to shed light on deeper ideas about evolution. Which is, obviously, a valuable exercise, and not in itself a Bad Thing. But I’ve read loads of stuff about evolution already, thank you, and so reading yet another explanation of evo-devo is not enormously exciting. I would much rather have been reading about extra examples of strange and curious animal mimicry.

So, you know, a good book; but I am not its perfect audience. Still, if nothing else it introduced me to the jaw-dropping amazon leaf fish pictured above.

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Scary research

Genuinely terrifying:

Researchers [in Israel] looked at 1,112 rulings involving requests for parole (or for changes of incarceration terms) presented to eight judges. They heard cases daily, interrupting for a morning snack and lunch.

The odds of an inmate receiving a favorable decision started at 65%, first thing in the morning, then steadily dropped until the snack break. If the judge heard eight cases in the morning, the average success rate for the last one was 25%. If the judge heard 12 cases, the average success rate for the final one was 0%. Favorable rulings popped back up to 65% when the judge returned, then slid again until lunchtime. The same pattern appeared post-lunch.

The authors could find no other factors that might explain the pattern beyond the hearing’s timing, relative to the food breaks. They had no direct measure of the judges’ mood.

From the Proceedings of the National Academy of Sciences, via the WSJ, via bookofjoe.

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Nature

Life Ascending by Nick Lane

Full title: Life Ascending: The Ten Great Inventions of Evolution. The ten ‘inventions’ are: The origin of life, DNA, photosynthesis, the complex cell, sex, movement, sight, hot blood, consciousness and death. Lane explains how each of these work and how they evolved, at least as far as current knowledge can take us — which in some cases, like the origin of life, is apparently rather further than I had realised. The consciousness chapter, if you’re wondering, was rather less persuasive.

What sets this book apart from most popular accounts of evolution is that Nick Lane is a biochemist rather than, say, a palaeontologist or an ethologist. So this is a book which focuses on evolution at the micro level: it’s all biochemical pathways and enzymes and the genes which code for them. This is the real nitty gritty of how evolution works, how it actually achieves things; but it’s also the stuff which I generally find is a complete headfuck. No matter how many times I have read accounts of the inner workings of a cell over the years, it just doesn’t stick.

So it is not a small compliment to say I found this book was not just full of new and interesting information, but also managed to be clear, engaging and enjoyable. I still ending up having a long pause halfway through, and I’ve already forgotten a lot of it, but I enjoyed it as I read it.

» The picture is Cytoplasm to vacuole targeting from the Journal of Cell Biology, used under a CC by-nc-sa licence. Picked because it’s a striking image rather than because it’s relevant in any way beyond basic thematic appropriateness.

‘The cytoplasm to vacuole targeting (Cvt) pathway uses Atg11 to direct Atg9-containing membrane from mitochondria (top right) to forming autophagosomes (center) before eventual fusion with the vacuole (bottom right). Original painting by David S. Goodsell, based on the scientific design of Daniel J. Klionsky. (JCB 175(6) TOC1)’

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A passing thought on the Nutt business

Politicians are always quick enough to invoke ‘scientific advice’ when they want to deflect responsibility for an unpopular policy decision, like the availability of different treatments on the NHS, or the mass slaughter of animals during a foot and mouth outbreak. And as long as they actually are acting on good scientific advice, fair enough.

But if you’re going to hide behind scientists when it’s convenient… well, the flip side of that is that if you later choose to ignore the advice of your carefully chosen independent scientific advisors, you should have the guts to stand up and explain why.

» If you don’t know what I’m talking about: a government minister sacked an (unpaid) senior drugs advisor, a professor of psychopharmacology called David Nutt, for giving a lecture saying that the government’s drug policy ignored the scientific evidence. You can download the lecture as a PDF here; it is worth reading.