The Book

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

Click & Go

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.