*Bad Pharma*, by Ben Goldacre

Here is a simple sentence from Frank Lichtenberg, an economist who studies pharmaceuticals and a highly reputable researcher in the area:

This implies that the incremental cost-effectiveness ratio (cost per life-year gained) of pharmaceutical innovation was about $12,900.

Read the whole paper, and if you wish to go further, you can peruse his entire body of work.

I am thus a little nervous when Ben Goldacre entitles his recent book Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients.  (I have a UK copy, and it is due out in the U.S. this February.)  I do in fact agree with Goldacre’s portrait of a sector wracked with massive corruption and shoddy scientific standards.  And I see many aspects of this book as deserving an “A” or “A+” rating, which I would not hand out lightly.  But I won’t continue down that track, because I suspect the book will receive many very positive reviews, as indeed it did in the UK.

Could he not have called the book Not Nearly as Good as it Could be Pharma: How Corruption is Diminishing One of Our Great Benefactors?  Admittedly that does not roll off the tongue as nicely.

Or how about Slow Pharma: How to Get the New Drug Pipeline Up and Running Again?

Goldacre’s policy recommendations would in general raise the costs of research and development, although they would  likely improve the accuracy of research results and reduce over-prescription and overuse of drugs.  It is quite possible they would lower the rate of return to pharmaceutical innovation, likely I would say.  These trade-offs are neglected, and, much as I admire many features of this book, I cannot help but, alas with trepidation, call some of its central features “Bad Science.”  Bad Economic Science.  The morality of the narrative and the Platonism of his vision distracts him from presenting the policy trade-offs clearly.

Lichtenberg’s name does not appear in Goldacre’s index.  Nor does the word “innovation.”

Recommended, with or without prescription, but use with extreme caution.  And you should “compound” this with other books.

Addendum: I bought this book myself, which included Amazon shipping charges from the UK, and was not sent a free sample or visited by an attractive sales representative.

Second Addendum: There is some back and forth between Goldacre and me in the comments section.


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