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4.09 AVERAGE
4.09 AVERAGE
Not much unfamiliar here- but then, this is the sort of debunkery I enjoy, so it stands to reason that I've come across most of the examples here. Goldacre's got a whimsical tone that I enjoyed, a matter-of-fact "you're not stupid, your brain just isn't trained to deal with this sort of obfuscation and complexity" attitude. Recommended, especially if you have ever believed anything presented in the media as a staggeringly important, health-affecting statistic.
Abandoned because while I think he is correct in the arguments I didn't feel I was learning anything (other than how frustrated the author is made by both the continuing existence of bad science and that people continue to get taken by charlatans spouting nonsense pretending to be science)
Entertaining. If you read Goldacre's columns in the Guardian, then much of the material will be familiar, but good stuff nonetheless.
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.
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.
Really interesting book.
Good to get an insight into pharma from the opposing view.
Good to get an insight into pharma from the opposing view.
This was good. The star rating looks kind of low, but that's because (a) I'm a hard marker, and (b) I assign stars based on my subjective enjoyment of reading the book more than anything else. The UK-centric nature of some of the examples Goldacre dissects made it harder to stay engaged than (I imagine) it would have been had I been more familiar with them, and my capacity for reading at length about everything being terrible is not very high.
But the chapters where I was mainly just learning about why particular ways of thinking about health-related science are wrong, and also why people often don't understand that they're wrong, were top-notch. I learned interesting facts about cosmetics, started to understand the nature and depth of my lack of understanding of unintuitive statistics, and devoured more information about placebo effects and regression to the mean (rapidly becoming some of my favourite concepts to think about).
Very much worth reading, for both people invested in various kinds of 'woo' and pseudoscience … and people who struggle to argue against such things effectively.
But the chapters where I was mainly just learning about why particular ways of thinking about health-related science are wrong, and also why people often don't understand that they're wrong, were top-notch. I learned interesting facts about cosmetics, started to understand the nature and depth of my lack of understanding of unintuitive statistics, and devoured more information about placebo effects and regression to the mean (rapidly becoming some of my favourite concepts to think about).
Very much worth reading, for both people invested in various kinds of 'woo' and pseudoscience … and people who struggle to argue against such things effectively.
An engaging and humourous look at bad science and how it has been perpetuated by quacks and the media. A sober and logical read that should be avoided by those easily influenced by media hype and email health warnings as it will give them less to obsess over.
Goldacre has a way of making complex science subjects accessible to the wider public. His first book, Bad Science, highlighted the way that the media dealt with reporting science, and in this book he concentrates his ire onto the $600 billion global pharmacy industry, now dominated by a handful of behemoths.
And what he reveals is frankly terrifying. He details the way that the industry hides a large majority of the trial data, the way that the legislation requiring data to be published is ignored by companies, and in the EU it is still secret in some cases. There is loads of detail on the way that the data is cherry picked to demonstrate that a particular drug is so much better than the competition. There is lots of detail on the appalling way that the industry is regulated, even though it is very heavily regulated, most of it is ineffective and not enforced, and where the regulation could be improved to help patients and save lives these are not enforced or are not enacted on after lobbying from the industry.
The biggest chapter though is on the marketing that these companies employ. Their budgets for marketing are normally twice the R&D budgets, which gives you some idea of where their priorities lie. He explains how they sponsor various ‘conferences’ and provided sweeteners to medical professionals at all levels, from lunches to flights to what most people would consider bribes. The nefarious dealings of the drugs rep are dealt with too, from the pressure that they put onto doctors to use their medicines and the way that they collect data directly from surgeries and pharmacies. A lot of academic papers are ghost written, and a leading figure puts their name to it, shocking really.
There is some details on NICE, but not a huge amount. He looks at the way that they select the drugs for use in treatment, noting that even they do not have access to all the trail data for each medicine that they consider.
He also writes about how a lot of the drug companies fund patient groups either overtly with cash donations or covertly by funding particular conferences and so on. They have been proven to use them to exert pressure on national agencies (FDA and NICE) to supply the latest drugs regardless of the cost; i.e. £50K spent with a group means that they get their £21k per patient drug treatment approved, even though the trial evidence is not there or is at best not proven to be any more effective than the current items on the market. A real scandal.
Throughout the book he does give suggestions on how the situation can be improved but he does realise that they is an endemic problem and powerful vested interests do hold sway. Even just enforcing the current rules would make a difference, but it seems unlikely at the moment.
The phrase for illegal drugs used to be: Just Say No. Perhaps it should apply to legal drugs too...
And what he reveals is frankly terrifying. He details the way that the industry hides a large majority of the trial data, the way that the legislation requiring data to be published is ignored by companies, and in the EU it is still secret in some cases. There is loads of detail on the way that the data is cherry picked to demonstrate that a particular drug is so much better than the competition. There is lots of detail on the appalling way that the industry is regulated, even though it is very heavily regulated, most of it is ineffective and not enforced, and where the regulation could be improved to help patients and save lives these are not enforced or are not enacted on after lobbying from the industry.
The biggest chapter though is on the marketing that these companies employ. Their budgets for marketing are normally twice the R&D budgets, which gives you some idea of where their priorities lie. He explains how they sponsor various ‘conferences’ and provided sweeteners to medical professionals at all levels, from lunches to flights to what most people would consider bribes. The nefarious dealings of the drugs rep are dealt with too, from the pressure that they put onto doctors to use their medicines and the way that they collect data directly from surgeries and pharmacies. A lot of academic papers are ghost written, and a leading figure puts their name to it, shocking really.
There is some details on NICE, but not a huge amount. He looks at the way that they select the drugs for use in treatment, noting that even they do not have access to all the trail data for each medicine that they consider.
He also writes about how a lot of the drug companies fund patient groups either overtly with cash donations or covertly by funding particular conferences and so on. They have been proven to use them to exert pressure on national agencies (FDA and NICE) to supply the latest drugs regardless of the cost; i.e. £50K spent with a group means that they get their £21k per patient drug treatment approved, even though the trial evidence is not there or is at best not proven to be any more effective than the current items on the market. A real scandal.
Throughout the book he does give suggestions on how the situation can be improved but he does realise that they is an endemic problem and powerful vested interests do hold sway. Even just enforcing the current rules would make a difference, but it seems unlikely at the moment.
The phrase for illegal drugs used to be: Just Say No. Perhaps it should apply to legal drugs too...
I don't know how anyone can follow this book. I was really intrigued by the topic and hoped for a few ah-ha moments but after the brief digression about Kellog's theories on "self-abuse" I had to put it down. It was liked reading the first draft of a blog post: meandering, rant-filled and with unfinished thoughts (bringing up Vitamin C and claims of assisting the the immune system, then promptly dropping the topic). Unless you've completely forgotten everything from Psych 101 and biology, move on.
The official Kindle edition is riddled with poor typographical errors: words running intoeachother or sometimes having oddly appear-ing hy-phens; and inconsistent formatting. Most irritating.
This starts off as a fascinating read; parts needed rather more concentration than I had available, but it's certainly an eye-opening book. Goldacre comes across as genuinely annoyed at much that he tells us; and while it's fun to watch him debunk the personalities in the alternative medicine business, for example, the main benefit comes from his oft-repeated mantra "it's a little more complicated than that".
You'll never read reports about science in the media in the same way...
This starts off as a fascinating read; parts needed rather more concentration than I had available, but it's certainly an eye-opening book. Goldacre comes across as genuinely annoyed at much that he tells us; and while it's fun to watch him debunk the personalities in the alternative medicine business, for example, the main benefit comes from his oft-repeated mantra "it's a little more complicated than that".
You'll never read reports about science in the media in the same way...