This is not a review (yet) – I’ve not read it all. But before I get on to the criticisms I should start by saying it is a good book– good enough for me to have read the first two chapters (122 pages) on a three hour flight and to recommend you read it.
Some of it is shocking – though the author’s demands that we should be shocked get a bit wearing after a while, especially as not all of what you read is quite as startling and surprising as he seems to think it is.
I admit to starting with some bias though – of the very sort that is highlighted in the book – I find Mr Goldacre quite annoying. His columns in the Guardian and writings online tend towards the Metropolitan smugness when it comes to politics – he might find politicians rather more likely to act on his views if he did not start from the premiss (and this is more or less verbatim from past online discussions) that politicians are venal idiots. A lot of people who have never tried politics seem to think it is easy – ask Esther Rantzen about where that ends up.
Indeed this recent exchange amused me, even if I lean to his side of the argument:
But I should not let that detract from my appreciation of the book and the systematic pillage of science that it outlines.
Some things struck me as particularly bizarre – here’s two:
Firstly, the Labour government established the National Institute of Health and Clinical Excellence (NICE) – precisely to decide what drugs and therapies were most cost effective in the NHS (yes, American readers, this is where Sarah Palin et al imagine the “death panels” live) – yet did not give NICE any powers to demand access to the clinical data pharma companies may have amassed on treatments they offer.
Secondly, the European Medicines Agency established a compulsory register of clinical trials – EduraCT – supposedly as a transparency measure and yet refuses to release the details of trials to the public (or even to scientific researchers).
The reality is that developed states, especially in single-payer health systems as in most of Europe, have enormous regulatory potential when it comes to dealing with pharma – as the companies (righty) say they have to spend billions on research but the only way they can hope to recover that money is by selling their products in the most expensive markets, and that requires permission from the state.
This does bring me on to what seems to be the biggest hole in Goldacre’s argument (so far, perhaps he addresses it later). Pharma advances have helped millions live better lives and that is a system driven by profit – and some of that profit comes from selling drugs which are no more effective (or even less effective) than others which may even be cheaper. If we expose the more expensive drugs for not being so good, how much baby will we throw out with the dirty bathwater? (A genuine question, as I don’t know enough about the economics to answer myself.)