Drug Companies Hide Unfavorable Evidence

Ben Goldacre, a British epidemiologist and newspaper columnist (“Bad Science”), who used to attack homeopathy (trivial), has now written about something important: drug companies hide vast amounts of unfavorable evidence.  I already knew this but many details were new to me.

I liked some of the comments:

We live in France and used a traditional GP for five years. Every time one of us went [to see him] he or she would come back with prescriptions for three or four medicines. Over that time he prescribed our family of five an estimated 60-80 medicines. We only ever took one, and everyone always got better without using these medicines. . . .This same GP also would refer us to thoroughly incompetent specialists. A few years ago I had a frozen shoulder. I went to see a ‘specialist’ who yanked my arm and shoulder about, clearly having no idea how an arm actually moves, and he then suggested operating. . . . Instead I looked on the Internet for info and found some exercises I could do and also underwent some Bowen technique treatment. A year later I was fine.

As a business consultant, I was approached many many years ago by a company who wanted help to set up an independent research institute evaluating farm pesticides. They’d found the doses prescribed for actual application were many times the amount actually needed (for obvious profit reasons), sometimes efficacy was in doubt, and loads of hideous ecological side effects were buried.

Speaking of “many times the amount actually needed”, I attended a talk about lighting standards in office buildings in which the speaker said the standards were too high (e.g., desks were better lit than necessary). His explanation was that the more lighting there is, the more air conditioning you need. The more air conditioning, the more cost, and architects are paid a fixed percentage of the cost. One of his slides showed that someone in the industry wrote down this rationale.

My GP often says the pharmaceutical industry wants to see everybody on prescription. He does prescribe tests, a lot of them, but drugs very rarely, and most of his recommendations are targeted at patients’ lifestyle: diet, exercise, work, relationships. When he does prescribe drugs, if it is an antibiotic or an antifungal, you have to come back after 1 week so that he can see if the treatment has worked/is working. If you need longer term treatment, for example physiotherapy and painkillers for back pains, or if you have a long term condition such as diabetes, he insists on seeing every month, to check that you are treatment compliant. . . .  I have to thank him for a lot. Until fairly recently, I was stuck in a really unhealthy work environment, and could not find another job. I had done a Psychology course which had nothing but praise about antidepressants, so I asked him if he would prescribe me one of the newest tricyclic ones. He was extremely angry, told me I needed a new job, not tablets, and that if I ever got that drug elsewhere and he found out, he did not want to see me again (he would probably have found a blood test to check up I was ‘clean’). So I did not go down the tablet route, and he was right: all I needed was to change job.

Two or three years ago, I was working in Germany and went to see a German doctor. He looked at the list of daily medications my British doctor had prescribed (5 different drugs), ostensibly to help me survive middle age. He looked shocked, and told me that the British medical profession is dominated by the pharmaceutical industry, and he advised I stop taking three of the drugs prescribed. Now, having come back to the UK, every time I visit my GP, I am bullied once again to take this or that. If I try to resist, I receive very patronizing lectures about this or that risk.

Thirty years of bi-polar disorder taking virtually every possible anti-depressant over time, and at times when hospitalized, forced to take them under the duress of threatened sectioning under the Mental Health Act. Throughout those years I told the psychiatrists that the drugs didn’t work beyond an initial “placebo effect” lasting about 2 weeks, and that the side effects were often awful. Now it seems I may have been right all along. . . . Big Pharma, [you] made a difficult life a lot worse.

Maybe Goldacre will someday grasp that “evidence-based medicine”, which he often praises, also hides a vast amount of unfavorable evidence.