I recently finished the horrifying yet necessary read, Bad Pharma, by Ben Goldacre. It’s impossible to sum up the book in one blog item, but I did a little more research of my own and have written the following to try to bring out some of the main issues that we in the UK, the US, and the rest of the world are facing when it comes to BIG problems with the healthcare industry and, of course, with pharmaceutical companies. I’m echoing a lot of Goldacre’s messages, but the additional research I have done leads me to agree with a lot of what is in his book, which is frightening stuff. I particularly enjoyed the way that Bad Pharma's afterword preempts any critics by finding aspects in the book that Goldacre knew would get backlash and explaining why those accusations wouldn't be correct. It was pretty comical to see big pharma reps accusing him of exactly what he said they would, even though their accusations were completely unfounded. Now, onto the 'Big Issues'!
The Big Issues
It is too simple to make the typical statement that “pharmaceutical companies are evil and profit-seeking” because the issues are much more dangerous and complex. We know it is a pharmaceutical company’s priority to sell products, and the uneasy relationship between pharmas and the public and health sector is the first big problem to be aware of. Secondly, there are issues worldwide with the way drug research is conducted in the first place, and in the way it is (or is not) published, as well as corruption in the regulatory systems used (or not used) to approve and monitor drugs on the market. This leaves a lot of room for improvement, which means that there are opportunities to alert others about the issues and to hold parties accountable.
Marketing & Conflict of Interest
When drug companies are called out for keeping prices of medicine unaffordable in developing countries, their typical response is that they need to earn back the amount it cost to make the drugs and that they need to put the rest into research and development (R&D). But if they spend twice as much on marketing and promotion as on R&D this response just does not calculate. The pharmaceutical industry also spends half a billion US dollars a year on advertising, and often drugs are advertised based on a number of potential patients instead of existing ones. Not to mention, companies lead doctors to newer, more expensive drugs, which are often no better than current, less expensive alternatives. It would be difficult to find a more indicative example of disease mongering.
Certain patient groups are also funded by pharmaceuticals, with some groups tending not to disclose this, which is obviously dangerous. Many groups are used as voices for various pharmaceutical interests without patients even realizing, as we have seen with groups campaigning against the release of patient information from the NHS database. A leaked memo revealed that this was an industry strategy to continue its track record of secrecy around unpublished trial results.
Doctors are influenced as well, despite continued claims that drug reps and gifts from industry do not influence their decision-making. One systemic review showed that 58% of doctors who take visits from drug reps are more likely to prescribe the promoted drug; not to mention the countless cases which expose companies of using the guise of “continuing education” for doctors to push their products. These problems are outrageous, and the corruption needs to be exposed.
58% of doctors who take visits from drug reps are more likely to prescribe the promoted drug
Questionable & Unpublished Drug Trials
To save drug companies money, trails are now being outsourced at an extremely quick rate to the rest of the globe where lax regulations, poor trial ethics, and corruption are often tolerated. This will not only harm trial participants, but will skew the results of the trials in numerous ways. Not to mention the fact that in the US, for example, many people who sign up for drug trials are doing so because they have no other choice; often it is their primary source of income. The Declaration of Helsinki, which is widely known as the cornerstone for research ethics, says that research should help the population which is being studied. If most Americans taking part in trials (and some pretty dangerous ones, at that) do not have health insurance, they would never be able to benefit from the possible new medicines they are testing anyway. Something is very, very wrong with that.
Not only are drug trials conducted in fraudulent ways, but ample research reveals that the majority of trials (54.8%) have no evidence of a publication, with only 26.6% of trials found to have deposited basic summary results within a registry. Negative results are also twice as likely to go unpublished, with non-publication more common among trials receiving industry funding. Journals need to represent data more accurately. If doctors and patients making decisions about health treatment cannot see over half of the results of conducted trials, no one can make informed choices about what the best medicines are. This is scary stuff.
Shockingly, due to frequent regulatory capture, drugs are also approved by regulators with weak evidence and are often worse than existing ones. This increases spending unnecessarily and can endanger patients. There definitely needs to be more pressure to make trial data completely transparent, and the regulatory process for deciding which drugs go to market needs to be assessed—with all known information about medicines open to the public.
What do we do?
Clearly, there are issues here which are imperative to the welfare of us all. Drug company marketing has been a known subject of contention for some time, but the problem has deep roots which need to be unearthed and addressed. Research trials, publications, and regulatory systems should be scrutinized by the general public and by organizations which will hold these processes accountable. A review of pharmaceutical and healthcare conflict-of-interest policies in the UK and others parts of the world needs to be held, and a central register where drug companies must declare payments to doctors (giving specific information) is also something we should push for.
Despite the ample data showing these dangers and exposing these alarming facts, people in positions of power are turning a blind eye instead of taking a stand. Public awareness is also still low. If you haven’t, please read Bad Pharma to get further information and a more in-depth understanding of what we are up against. As Goldacre notes, the problems are not just with the drug companies. There are issues with governments, regulators, healthcare teams, etc. This all might be hard to hear, but we NEED to know about it. We need to push for transparency around healthcare and the pharmaceutical industry because health is a priority for all of us!