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Bad Pharma by Ben Goldacre: quick review & course connections
There’s a good chance that you’d not be here to read this without the pharmaceutical industry designing and manufacturing the vaccines and medications you’ve used during your life – but how much do we know about where they come from?
In this thoughtful, well-researched and instructive book, Ben Goldacre* (doctor, evidence-based medicine proponent and author of Bad Science) outlines how Big Pharma works, but also what the issues are and how they can be fixed. He has a TEDMED Talk on the premise of the book (below) and takes care no to write a ‘hatchet-job’ on the industry, but to shine a light on the current state of clinical research and marketing.
I recommend the book to IB Biology and IB Chemistry students and teachers – read a copy before the next teaching cycle begins – as there are many sections of direct relevance to our courses that could be used as lesson ideas or real-world contexts for what we’re learning. It would make a great addition to the reading list for students, especially those intending to pursue medical, biochemistry or pharmaceutical careers.
In each chapter, Goldacre identifies a problem and gives a clear account of why it is a problem, using systematic reviews of academic literature and specific case studies to highlight each point. He makes it clear to the reader why these problems actually are problems, but also offers concrete advice or proposals on how to solve them.
Some highlights for the IB Biology course
Chapter 1 gets stuck in with statistical analysis and why systematic reviews of literature, meta-analyses and careful work with data are so important. It introduces the work of the Cochrane Collaboration and works through a neat illustration of the importance of considering all the data as more studies are carried out. The Cochrane Collaboration’s logo is itself a fascinating story, and you could model this in class with a simple set of investigations in the early stages of the course (see some ideas on the Statistical Analysis page).This video is very useful – from the Testing Treatments page.
The ideas and issues come thick and fast for the rest of the book.
As you read it, you will see many potential connections to the course, as well as to Theory of Knowledge. Here are just a few ideas that might spark discussion in class:
- What is the problem with missing trial data and publishing only favourable results?
- What does this publication bias do the reliability of the information we use to make decisions?
- How are drugs designed and tested (this is super interesting, going from in-vitro and animal testing to stage 1, 2 and 3 human trials, and has an obvious link to the IB Animal Experimentation Policy).
- What are the ethical issues with human testing, in particular the ideal/ representative nature of the patients used and the incentives they receive?
- What is the impact of outsourcing trials to other countries that might have different ethical codes?
- What are the ethical issues of randomising and controlling trials with humans, particularly in cases where there is a known drug that helps compared to a new drug?
- What are the roles of drugs regulators on medicine and are they working?
- How should trials be designed to give more valid and reliable data (for example, comparing the ‘new’ drug against the current best alternative vs placebo)?
- How could we use nationwide health records to conduct larger, simpler trials to determine which treatments really are most effective?
- How do the many branches of pharmaceutical marketing affect decision-making and how can we recognise and mitigate for this?
- How can we fix it all to keep medical innovation going whilst generating reliable, cost-effective data and drugs?
TED Talk: What doctors don’t know about the drugs they prescribe
*Yeah, I know I’m a bit of a fanboy and have featured him on here a lot, but with this and Bad Science, he has produced a lot of useful content to connect to our classes.
Ben Goldacre: What doctors don’t know about the drugs they prescribe [TED Talk]
Here’s Dr. Ben Goldacre of Bad Science giving his TED Talk, which is an eye-opener into what happens in academic research and drug testing. A good link with TOK here:
- How do research groups and journals decide what to publish – what is publication bias?
- What are the consequences of not publishing negative results?
- To what extent does publication bias affect other academic disciplines?
This is a really interesting dilemma. Evidence-based medicine works, that’s why it is called ‘medicine’. Sometimes publication bias leads into misrepresentation of data and drugs get approved. But it’s not the same as promoting pseudoscience – ‘fake’ medicines which we know do not work and are supported by no peer-reviewed, controlled evidence.
Ben Goldacre: Battling Bad Science
One of MrT’s science blogging heroes, Dr. Ben Goldacre, runs the Bad Science blog and Guardian column. Over the last few years, he has been dedicated to highlighting the problems of bad science in the media and dodgy claims – by looking at the actual evidence. Some great sources for TOK and Biology, and now he has a TED Talk. Enjoy!
Remember: “Extraordinary claims require extraordinary evidence” [Sagan’s Standard]
A funnier version for an American audience after the jump…
Ben Goldacre: Bad Science Interview
Dr. Ben Goldacre is the author of the excellent Bad Science blog and column in the Guardian newspaper. His new book, BadScience, is out now and in it he explains how (with many, many examples), Science is misrepresented in the media and how some ‘quack’ disciplines present unscientific data as fact.
NewScientist has a review of his book here, and there is a short interview with Ben on their channel:
He has helped produce some teaching materials for schools, which are available here.
Top posts for IB Bio students to read:
2. The Media’s MMR Hoax (Wakefield trial, autism and vaccines non-link)
3. The Man Behind the Mop of Death (false-positive MRSA results from a garden-shed phony)
4. The Huff (statistics)
5. Anything to do with dodgy fish-oil trials, quack homeopaths (especially evil AIDS-denialists), BrainGym and nutritionists.
It’s all good.
Summer holidays are here!
Here are some suggestions for a productive summer.
With eight weeks off, there’s a lot you can do to make next year more successful.
1. Unbroken rest.
Block out at least two full weeks with no school work. Let your mind wander, your health recover and your sleep be deep. Reset your balance, get active and maybe even try something new – and non-academic. You will feel better and be better able to focus on the challenges of next year. If you try to do a little work each day, it will always be in the back of your mind, causing stress.
2. Focused Extended Essay work
The Extended Essay is supposed to take around 40 hours of effort. That’s one full Monday-Friday working week. Set aside some time, with peace and the resources you need, to write the best draft you can. If your EE is causing you stress, get it done sooner in the break – you will be better able to enjoy the rest of your vacation.
3. Review this year’s learning
Once you have rested and recovered, set aside a full day or two to focus on Biology. Go through your notes, work on vocabulary, make connections across topics, practice questions from the book, re-read the chapters or presentations, watch (or re-watch) the CrashCourse videos, use the sortable syllabus to practice the assessment statements, practice drawing, labeling and annotating. There is a strong positive impact of spaced practice on learning, so taking the time to review will help make your foundation stronger for next year.
4. Read about science for fun
Science is far more than the list of assessment statements we study in class. It is a fast-moving pursuit of knowledge that connects ideas from around the world and across the disciplines. And there is a lot written about science every week. Dip into the science news, read longer articles or pick up a science book. You’ll enjoy it and it will help you make more connections.
As you read science, think about the following questions:
- How does this connect to what I already know?
- What vocabulary is important in this text? How much is known or unknown to me?
- What are the implications of this information for science or the wider world?
- What Theory of Knowledge questions does this connect to? What questions does it raise?
Some suggestions for summer reading:
- National Geographic’s Phenomena salon, with blogs by Ed Yong, Virginia Hughes, Carl Zimmer, Nadia Drake and Brian Switek. These are all excellent writers, bringing research to life in informative, current, mid-length articles. Ed Yong even posts a weekly ‘missing links’ collection of loads of collected articles, news items and funny bits from around the internet.
- Dip into the #IBBio stream on Twitter once in a while – teachers are posting links, resources and articles there all the time.
- TED’s Science stream has stacks of great talks that connect to our course.
- You can also hear lots of useful podcasts: The Guardian Science Weekly, Naked Scientists, Science Magazine Podcast, RadioLab and lots more listed at PopSci.com.
- For some great books you might want to check out Adam Rutherford’s Creation, Rebecca Skloot’s brilliant The Immortal Life of Henrietta Lacks, Ben Goldacre’s Bad Science and Bad Pharma, Richard Dawkins’s Selfish Gene, or The Oxford Book of Modern Science Writing for a great compendium of lots of writers.
Have a great summer.
And keep that brain Fresh…
World AIDS Day 2010: Universal Access and Human Rights
WorldAIDS day is recognised each year on the 1st December. Although in some parts of the world real progress is being made against the epidemic, it doesn’t mean that we can relax and forget about it.
There are some really interesting datasets on the WHO website related to this theme, including global trends to the present and the current state of HIV infections in the world.
Millenium Development Goal 6 is “Combat HIV and AIDS“. Over past years, World AIDS Campaign slogans have included Keep the Promise and this year they focus on this MDG with their theme of “Universal Access and Human Rights.”
Universal Access means access to prevention, education, treatment and care. The message is spreading, the technologies and medicines are developing and the will is there to change. Now we need to make sure that it gets to the people who really need it.
This reverse-timelapse video of a patient who has access to anti-retroviral medications shows the impact that access can have on a person’s life:
Despite the great advances being made in treatment, however, prevention must be the number one focus for efforts and money spent on HIV/AIDS. Programmes such as intervention mapping and education with realistic, achievable and workable methods for each community has to be a real focus for the spending of money raised. Otherwise, infection rates will increase and there’s no way we can afford to treat more and more people each year.
In this enlightening TED Talk, Elisabeth Pisani pays Indonesia a visit and highlights that sometimes there are rational reasons behind the poor decisions that people make, leading eventually to HIV infection. If people are well enough educated to be aware of the risks of HIV and blood-borne infections, then are the systems in place that allow them to make the decisions that are most sensible for them?
So what you can you do about it?
1. Keep yourself safe. Never forget the simple messages of HIV prevention and take care in your activities. Stay healthy, use condoms (or don’t have sex), avoid drug use and insist on new, sterilised needles for tattoos and blood transfusions.
2. Stay aware. Revisit HIV/AIDS education resources and don’t let yourself think that just because some advances are being made, it is OK to forget about the risks.
3. Spread the message. Discuss the risks, find out about the prevalence and risk factors of HIV in your area. Wear a ribbon and use it to start conversations with others.
4. Use reliable, evidence-based health information in your decision-making and encourage others to do the same. Real medicine is based on the scientific method and is rigorous. ‘Alternatives’, quite simply, are not.
Other posts on this site about HIV/AIDS:
Great documentary following the lives of some HIV patients in the UK.
Defense Against Infectious Disease
Resources for 6.3 and 11.1 of the IB Biology course.
TOK-related resources based on denialist views against the – very well established – link between HIV and AIDS, fuelled by the ‘documentary’ House of Numbers. You really must read Ben Goldacre’s chapter on this topic from his Bad Science book (free link here).
Gene Patent Overturned: Bioethics in Action
This week a federal judge in the USA overturned patents on the BRCA1 and 2 genes, which are held by biotechnology company Myriad.The genes are implicated in breast and cervical cancer in women, specifically those who have a hereditary risk of developing cancer. Myriad’s gene sequence test is good at detecting sequences that indicate risk in these women, and they have patented this sequence of genes. The American Civil Liberties Union, among others, have been campaigning against the patenting of genes – products of nature.
Here is a really good video (45 mins) from Duke University. Prof Robert Cook-Deegan, the director of the Center for Genome Ethics, Law & Policy at Duke’s Institute for Genome Sciences and Policy, discusses issues surrounding the patenting of genes, including the case of Myriad Genetics:
The news story from Science magazine is here, and makes for good reading.
Also, read this neat article from BadScience: “I patent your ass. And your leg…”
Since the Human Genome Project, up to 20% of human genes have been patented by their discoverers. By patenting the genes – which are present in all of us – the companies responsible have control over what can be done with regards to research, diagnostic testing and treatment.
Here is a short video on the BRCA1 gene (critical in women), from OvarianCancerDr:
1. What was the effect of the patent on research and medicine?
2. What is the effect of the patent being overturned now likely to be?
3. Explain the significance of the clause that states “…[patent #5,747,282] makes claim to any sequence of 15 nucleotides, the “letters” of the genetic code, coding for any part of the protein made by the BRCA1 gene.”
4. Who are the major stakeholders in gene patenting and the current Myriad case?
5. What would you do to balance the needs of the biotech industry with freedom to research science without fear of litigation or being blocked?
6. What are the strengths and weaknesses of genetic testing services?
7. What would you do if you knew you had a family history of a type of cancer and knew there was a test you could take to assess your risk?
8. If you could have a full genome-scan done, would you? Why or why not?
9. From a TOK perspective, how does this higlight the issues of ‘knowledge’? Who ‘owns’ knowledge if it is discovered? Would the case be different if Myriad were patenting a gene that they had created rather than one which already exists?
BRCA1 and 2 genes, from the National Cancer Institute
Gene Patents, from the American Civil Liberties Union
Duke Institute for Genome Sciences and Policy
Bad Science article, from Ben Goldacre
E5 (HL) The Human Brain
Check out the excellent resources from the NewScientist: The Human Brain
PBS has a great site called The Secret Life of the Brain (with 3D animation), and there’s Slate’s special issue on The Brain. Here’s a nice podcast from the Guardian, too.
Essential Biology E5: The Human Brain
Regions of the brain:
PBS: 3D brain animation
If you have an iPod Touch, iPhone or iPad, get this cool free app: 3dBrain.
Try this out as a class or review activity: using showercaps to teach neuroanatomy.
Evidence for functions of brain structures
Reader on brain technologies, from Nature
PhET Lab: Simplified MRI shows you how MRI works (allow Java to run)
How does fMRI work? Video from 60 minutes:
Investigating Broca’s area:
Ferrier’s animal experiments reader (from 1881)
Guardian article: Your Lying Brain – the quest for perfect lie detector.
The strange past and promising future for the lobotomy, from Wired Science
Although fMRI is a great tool, there is the danger of believing too much of the hype. Ben Goldacre explains that some brain imaging studies report more positive findings then their numbers can support.
Sympathetic vs Parasympathetic control
Simple animation from GFisk
Heart rate control animation, from McGraw Hill
Put some ACh into it, music video:
Pathways of the pupil reflex animation from Utah Medicine
How to test the pupil response:
Perception of Pain
Pain pathways animation, from Bay Area Pain Medical
Effect of endorphins on pain, from Wadsworth Psychology
Do fish feel pain? Reader from Science Daily
Optogenetics: Shedding Light on Brain Regions.
This is a great video, and Ed Yong has a really good post on optogenetics at his site.
TED Talk: Aditi Shankardass on A Second Opinion on Learning Disorders
With an estimated 1 in 6 children suffering from a developmental disorder, Aditi Shankardass asks if we can afford to ignore brain imaging and diagnostic technology when making decisions about brain-related difficulties. Another great short talk from TED, which links to the use of technology in determining brain function.
TOK link: how might the use of brain scanning technology represent a potential paradigm shift in diagnosis? Where we have relied on symptomatic diagnosis in the past, could the use of new neuroscience give a new way of knowing that replaces what we already know?
Now protect that brain that you’ve been cramming full of knowledge!
This is a funny story from Wired.com. Read the experimental protocol in the image here, then click on it to read about the results. Ooh, the dangers of false-positives!
And Carl Zimmer has a great piece on the teenage brain at Discover Magazine.
A similar piece at Wall Street Journal.
And a lot of teen brain resources at PBS Frontline, including a full documentary.
Key terms: brain, regions, broca,
The Memory of Water: Science or Pseudoscience?
“Can you tell the difference between science and pseudoscience”
“What separates effective medicine from alternative medicine?”
This is an activity from the ToK and Biology section.
As you grow through Biology and ToK, you should develop your critical thinking skills and become more of a skeptic. Being able to answer these two questions is a skill that you can carry through life, helping you to make sensible decisions when faced with a range of seemingly convincing alternatives.
Medicine is a system of rigourous testing, evidence collection, statistical analysis and controls to ensure that a treatment is effective when recommended to patients. If it works and it is strongly corroborated, we call it medicine – it is available to professionally-trained medical doctors to use or prescribe for their patients.
Alternative medicine is simply that – alternative to medicine. It is not rigorously tested, double-blind controlled or statistically analysed. It is built on belief without true empirical evidence. One might believe it’s efficacy based only on anecdotal or circumstantial evidence, but this is not enough.
This activity links with unit 3.1 – Chemical Elements and Water.
Richard Dawkins’ recent series Enemies of Reason tackles these issues brilliantly, as does Dr Ben Goldacre’s Bad Science blog. Start with this short clip of Dawkins explaining the idea behind homeopathy, a bastion of alternative medicine:
- So why is it that people buy into homeopathy and alt med?
- Have you heard of the placebo effect or the powers of suggestion and how they affect feeling?
- Watch the whole episode (below) and think of reasons why a patient might feel better after visiting a homeopath than after a consultation with the doctor.
- What is the difference between complementary and alternative medicine? Which might a doctor recommend as part of a treatment? Why?
To find out more about homeopathy and it central ideas:
Homeopathy from the Skeptics Dictionary
The End of Homeopathy? From BadScience
And lots of great information from Evidence Based Medicine First
Watch the full series of Enemies of Reason on GoogleVideo:
Part 1: Slaves to Superstition
Part 2: The Irrational Health Service (includes the homeopaths)
And it’s not only homeopathy that abuses our sacred water. The oxygen-water companies are it too.
More than Water? From BadScience (download reading activity here)
Unless you have gills, it’s an expensive burp! from Chem1.com
So, when you read the magazines, watch TV or wonder about a miracle cure, anti-ageing cream, magical treatment or anything else related to unusual claims and you health, think: “Where’s the evidence?”
Now here’s a funny sketch from Webb and Mitchell: