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Book review: Bad Pharma

blogs.law.harvard.edu

11–20 of 47 posts

Re: Book review: Bad Pharma

#11

On the issue of efficiency of Prozac or similar drugs, sometimes the explanation is that they simply work and you know it if you have taken them. I found the effects of SSRIs very noticeable, and every doctor prescribing them knows of patients who suddenly were able to leave the bed, or deeply depressive patients switching into a manic episode. The latter might not sound like an improvement, but for the patients, qua…

Of course, the mention of painkillers is a throwaway line in the review, not from the book.

Re: Book review: Bad Pharma

#12
check http://www.alltrials.net/ campaign

"About AllTrials:

The AllTrials campaign was launched in January 2013 and calls for all past and present clinical trials to be registered and their results reported. It is an initiative of Bad Science, BMJ, Centre for Evidence-based Medicine, Cochrane Collaboration, James Lind Initiative, PLOS and Sense About Science and is being led in the US by Dartmouth’s Geisel School of Medicine and the Dartmouth Institute for Health Policy & Clinical Practice. Since then, the AllTrials petition has been signed by 79138 people and 489 organisations."

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What you can do today:

http://www.alltrials.net/get-involved/individuals/

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All Trials News:

http://www.alltrials.net/news/

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TEDMED 2012:"Ben Goldacre: What doctors don't know about the drugs they prescribe" ( video 13:29 )

https://www.ted.com/talks/ben_goldacre_what_doctors_don_t_kn...

"When a new drug gets tested, the results of the trials should be published for the rest of the medical world — except much of the time, negative or inconclusive findings go unreported, leaving doctors and researchers in the dark. In this impassioned talk, Ben Goldacre explains why these unreported instances of negative data are especially misleading and dangerous."

"

...

Now you might say, well, that's an extremely unusual example, and I wouldn't want to be guilty of the same kind of cherry-picking and selective referencing that I'm accusing other people of. But it turns out that this phenomenon of publication bias has actually been very, very well studied. So here is one example of how you approach it. The classic model is, you get a bunch of studies where you know that they've been conducted and completed, and then you go and see if they've been published anywhere in the academic literature. So this took all of the trials that had ever been conducted on antidepressants that were approved over a 15-year period by the FDA. They took all of the trials which were submitted to the FDA as part of the approval package. So that's not all of the trials that were ever conducted on these drugs, because we can never know if we have those, but it is the ones that were conducted in order to get the marketing authorization. And then they went to see if these trials had been published in the peer-reviewed academic literature. And this is what they found. It was pretty much a 50-50 split. Half of these trials were positive, half of them were negative, in reality. But when they went to look for these trials in the peer-reviewed academic literature, what they found was a very different picture. Only three of the negative trials were published, but all but one of the positive trials were published. Now if we just flick back and forth between those two, you can see what a staggering difference there was between reality and what doctors, patients, commissioners of health services, and academics were able to see in the peer-reviewed academic literature. We were misled, and this is a systematic flaw in the core of medicine.

8:18

In fact, there have been so many studies conducted on publication bias now, over a hundred, that they've been collected in a systematic review, published in 2010, that took every single study on publication bias that they could find. Publication bias affects every field of medicine. About half of all trials, on average, go missing in action, and we know that positive findings are around twice as likely to be published as negative findings.

8:45

This is a cancer at the core of evidence-based medicine. If I flipped a coin 100 times but then withheld the results from you from half of those tosses, I could make it look as if I had a coin that always came up heads. But that wouldn't mean that I had a two-headed coin. That would mean that I was a chancer and you were an idiot for letting me get away with it. (Laughter) But this is exactly what we blindly tolerate in the whole of evidence-based medicine. And to me, this is research misconduct. If I conducted one study and I withheld half of the data points from that one study, you would rightly accuse me, essentially, of research fraud. And yet, for some reason, if somebody conducts 10 studies but only publishes the five that give the result that they want, we don't consider that to be research misconduct. And when that responsibility is diffused between a whole network of researchers, academics, industry sponsors, journal editors, for some reason we find it more acceptable, but the effect on patients is damning.

...

"

Re: Book review: Bad Pharma

#13
Having read the book, this review I would say is very misrepresentative.

The actual book is very good and a definite read.

But this article seems to have spun it into a conspiracy theory.

This is the opposite of why I liked the book in the first place, it explains how bad(For consumers) things happen due to systems not conspiracies. Also how things are not bad, just could be much better. Many examples are how mistakes are made but then found and how people are working to stoping them happening again.

"With all of the trillions of dollars spent on drug development and drugs themselves, have you ever wondered why people don’t seem to feel better than they did back in the 1970s?"

The book for instance would NOT agree with this statement. Seriously would you want to have 70's medicine or 2014 medicine? This is crazy.

Re: Book review: Bad Pharma

#15
post #3

That's a review? There's almost no criticism, or even considered discussion, of the book at all . He's just copied and pasted sections that he thinks are important or interesting, and called it a day. Not that there's anything wrong with quoting sections of a work that you think are worthy of spreading to a wider audience (assuming proper attribution), but IMNSHO it's a bit disingenuous to call QFTing a "review". (FW…

I don't think the purpose was really to review it. I think he was using this as an opportunity to publicize the book and the issues it raises. People generally do that when they agree with the contents.

Re: Book review: Bad Pharma

#16
post #6
post #3

That's a review? There's almost no criticism, or even considered discussion, of the book at all . He's just copied and pasted sections that he thinks are important or interesting, and called it a day. Not that there's anything wrong with quoting sections of a work that you think are worthy of spreading to a wider audience (assuming proper attribution), but IMNSHO it's a bit disingenuous to call QFTing a "review". (FW…

Greenspun did a good job of characterizing (even summarizing) the information that you can find in the book. I learned new things from reading his review. Since I didn't read the book, this was more valuable to me than a "discussion".

How do you know he did a good job if you didn't read the book?

Re: Book review: Bad Pharma

#17

Having read the book, this review I would say is very misrepresentative. The actual book is very good and a definite read. But this article seems to have spun it into a conspiracy theory. This is the opposite of why I liked the book in the first place, it explains how bad(For consumers) things happen due to systems not conspiracies. Also how things are not bad, just could be much better. Many examples are how mistake…

Agreed. This kind of spin sometimes does more harm than good. Not that there's any doubt that greed and corruption play a big role too -- but there are many, many more factors.

Hell, I wish it were simply a matter of one big "pharma conspiracy". That would be an easy problem to solve.

The reality is paralyzing in its complexity, as with all issues that plague large political systems. And as our technology and means of communication advance at a faster and faster rate, it only becomes more evident how far being we are in understanding "social tech", and how intractable some of these problems are currently. We are nowhere near close to being able to tackle problems in the domain of complex social systems.

Re: Book review: Bad Pharma

#18
post #4

On the issue of efficiency of Prozac or similar drugs, sometimes the explanation is that they simply work and you know it if you have taken them. I found the effects of SSRIs very noticeable, and every doctor prescribing them knows of patients who suddenly were able to leave the bed, or deeply depressive patients switching into a manic episode. The latter might not sound like an improvement, but for the patients, qua…

The argument that painkillers haven't progressed in efficacy since Aspirin seems like it'd be thwarted simply by comparing Advil, Aspirin, and Tylenol, which seem to have noticeably different anti-inflammatory properties (acetaminophen being better for headaches and ibuprofen better for toothaches, for instance).

A zeroth-order argument for the utility of modern painkillers: you can take acetaminophen and ibuprofen at the same time for "twice" the effect, without either risking deadly liver poisoning from acetaminophen overdose, or stressing out the stomach lining from high-dosage ibuprofen or aspirin.

Those of us who occasionally get migraines know all about this, as do people in palliative care.

Re: Book review: Bad Pharma

#19
post #9

On the issue of efficiency of Prozac or similar drugs, sometimes the explanation is that they simply work and you know it if you have taken them. I found the effects of SSRIs very noticeable, and every doctor prescribing them knows of patients who suddenly were able to leave the bed, or deeply depressive patients switching into a manic episode. The latter might not sound like an improvement, but for the patients, qua…

> On the issue of efficiency of Prozac or similar drugs, sometimes the explanation is that they simply work and you know it if you have taken them. This is what people who take homeopathy say. It's what doctors and patients said about knee arthroscopy for rheumatoid arthritus until they did a trial involving sham operations. When Prozac was introduced in the UK we were told that it made people "better than well", and…

Pain medication does work for quite a large number of conditions. Much of this has been demonstrated against a placebo or different treatments. If you give these drugs to animals in pain, they cease showing pain behavior.

Just defining all effects of pain medication as placebo just isn't scientific at all. Placebos often don't work reliably and repeatable either...

Re: Book review: Bad Pharma

#20

On the issue of efficiency of Prozac or similar drugs, sometimes the explanation is that they simply work and you know it if you have taken them. I found the effects of SSRIs very noticeable, and every doctor prescribing them knows of patients who suddenly were able to leave the bed, or deeply depressive patients switching into a manic episode. The latter might not sound like an improvement, but for the patients, qua…

>On the issue of efficiency of Prozac or similar drugs, sometimes the explanation is that they simply work and you know it if you have taken them. I hear the same thing about the power of prayer and Reiki.

Turns out, medication tends to work with much more people than prayer or Reiki...

Drugs seem to work much more reliably.

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