Good or Bad Pharma?

Reading Bad Pharma was something I saw as a necessary but nasty task.  Admittedly, I had formed an opinion from the cover and hyperbole surrounding it.

After finishing the biography of Steve Jobs and intending to read one of Job’s favorite reads ‘Autobiography of a Yogi’ Goldacres weighty tome, a ‘turgid 400 pages of vitriolic anti-pharma rant’ (my book review, admittedly before reading it) seemed to be a very anti-zen like interruption.

Goldacre’s central premise is that ‘Pharma companies should release all unpublished clinical data, as we currently have an incomplete picture of evidence based medicine, which in turn does harm to patients.’

As an ex pharma marketer I had encountered much anti-pharma sentiment but at least Goldacre’s book is informative, well referenced, constructive and not from the pseudo-science mould.

The thoughts of ‘bias’ I had embarking on this book did weave their way around me as I completed it, however ultimately, in a Jujutsu style manouevre, I felt, I myself was wearing a woven cloak of bias.

I believe the bias I recognized in myself as a pharma marketer did come from a good place.  I had a belief that the medicines I was working with had a great potential to help patients, this was reinforced by the data I had access to and the direct feedback I had from patients.  Patients and their carers, frequently remarked what a difference these medications had made to their lives.  This is all very nice stuff but these heartening anecdotes are of course not data and a seemingly obvious learning emerged, it is important to have the full set of data available as a pharma marketer or medic and to be as objective as possible.

I then watched the Pharma Times debate between Goldacre and Stephen Whitehead, an interesting spectacle to behold.  They started off trying to capture the ‘faux’ nice guy ground, which went along the lines of:

Goldacre: ‘I have come here for a constructive open debate and not for bickering, and I hope Stephen has too, although the fact he has not bothered to engage thus far, attempted to smear me and has been dismissive of all the points in my book makes me think he is not such a constructive guy etc etc….’

Whitehead: ‘Ben is a lovely guy, I have met him on a number of occasions, of course we should not forget he has his own agenda and this is purely driven out of him wanting to sell more copies of his book, and for this own personal PR etc etc…’

Disclaimer these are my summarized recollections from the speakers, in summary I did not find either of their pugilistic styles constructive but entertaining yes.

Neither of them would have recognized common ground if it opened up and swallowed them whole.

Common ground there was, as most of the panelists and audience seemed to agree on ‘If’ and ‘Why’ when it came to Pharma releasing its unpublished trial data.  The resulting focus of the debate was on ‘How’ this could be made to happen.

I did raise a point to the audience suggesting that for those that had not, they should read Bad Pharma and make their own informed decisions, and that it was indeed a worthwhile read.  I did make a quip that if this seemed like a plug, and if Goldacre wanted to give me an envelope stuffed with cash, then in the interests of transparency I would happily declare this on my blog.  Next time I will leave the jokes to the GP comic chair Dr Phil Hammond 


Bad Pharma
What will the title for Ben Goldacre’s sequel be? #evilpharma #worsepharma #jollynicepharma #notsobadpharma ….


So from the feedback in the debating room, Pharma seemed to be moving on the data transparency subject and making the right noises, albeit too slowly for Goldacre who no doubt fears another ‘false fix’ and all this being brushed under the  ‘dirty pharma carpet’

I actually think Pharma has no choice but to be on this accelerated journey towards ensuring the complete use of all data available, particularly in the ‘real world setting’ i.e. from patients who actually use their medicines in the community.  As we move to the much vaunted era of personalized medicine and self reported patient measures of effectiveness and side effects, there is a big opportunity for Pharma to use this complex data as a force for better patient outcomes.  There will be ‘many eyes’ on this ‘real world’ data and it will become apparent quickly, if it represents a ‘distorted picture’

Clinical trial data, in its idealistic setting, will become  increasingly meaningless and irrelevant.  If Pharma does not release this data soon then they might as well shred it, recycle the pulp and donate it to Goldacre’s publishers to print copies of his next book.

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