Bad Pharma summary

As we saw in the last blink, if medical trials are funded by the industry, it’s a safe bet that the results will be positive. But how exactly do industry-sponsored trials nearly always manage to achieve positive results?

One way is to simply not publish medical trials that produce unflattering results. We can see this quite evidently in an investigation published in 2010, whereby researchers compiled the results of all the trials that had ever been conducted on the drug reboxetine, an antidepressant by Pfizer.

We like to think of scientific research as being objective and free from commercial bias. However, business and research are only becoming more intertwined, as an increasing number of medical trials are conducted by clinical research organizations (CROs) on behalf of the pharmaceutical industry.

Trials conducted by CROs bring down the cost of testing drugs, since CROs outsource to poorer countries, but this commercialization of research raises some ethical dilemmas.

Medications don’t go straight from the lab to the stores. First, pharmaceutical companies have to send their drugs to regulators for approval.

Regulators are tasked with monitoring a drug’s safety, but unfortunately, the regulatory environment is beset with problems.

Medical trials aren’t perfect. Sometimes they’re conducted in unrepresentative patients, or sometimes they’re too brief. They can measure the wrong data, be incorrectly analyzed and sometimes the results simply disappear entirely.

On occasion, trial results are outright fraudulent.

With all the available medicines out there today, how do doctors decide which to prescribe? They don’t have the time to read every single peer-reviewed article relevant to their work. This presents a great opportunity for the pharmaceutical industry, which spends billions on marketing (about twice as much as it does on research and development) to convince doctors that their medicine is the real deal.

One way to do this is to appeal to doctors directly. In fact, the overwhelming majority of the industry’s promotional budget goes to marketing directed at doctors. About half of that is spent on drug reps, people who visit doctors in their offices and try to convince them in person of the superiority of their company’s drugs over the competition.

Because the pharmaceutical industry puts so little effort into running effective trials, we really have no idea which treatments are actually the best for many of the most important diseases.

One way to counteract this problem is by establishing randomized trials in routine medical practice.