Countering the drug industry's marketing machine

Patients, not drug companies, should give feedback on medicines for a true picture of their effectiveness

Your new book is called Pharmageddon. What does the title mean?

"Pharmageddon" refers to a change in healthcare that's rather like climate change. When we hop in our cars to go to work, this seems to be a good thing. But we don't connect it to the fact that we may be pushing the climate towards the brink. In the same way, the climate of healthcare is being pushed towards the brink by doctors giving patients expensive and risky drugs - and failing to notice when things go wrong. Medicine as we had it will cease to exist. It will become Healthcare Inc.

Why has this happened?

Worldwide product patents give companies such extraordinary returns that they have got a tremendous incentive to hype the benefits of drugs and hide any possible risks. Then we made these drugs prescription-only, so the true consumers of a drug are not you and me. The consumer, from the industry's point of view, is the doctor who prescribes the drug. Companies offer free gifts for doctors, trips to the Caribbean to meetings, and so on. But most doctors, while they probably are influenced by these things, are even more influenced by the evidence.

So hasn't evidence-based medicine helped?

I'm an advocate of controlled trials but we have an overblown estimate of how useful they can be. Clinical trials are done mostly by the industry. Only half of the trials are published and of those that are, ghostwriters for the industry polish a negative trial so that it's glowingly positive.

Couldn't these problems with clinical trials be fixed?

If we had the capability to do 100 times more trials than we're doing, if the trials were independent and we had access to all the data, then we would be much further forward. But you have to wonder how realistic that is. Controlled trials are hugely useful but they shouldn't be the only club that you take to the golf course. We need to restore people's ability to make judgement calls based on the evidence in front of their own eyes.

How will your new website, RxISK.org, help?

The idea is to encourage people to produce the best possible descriptions of things that happened to them on treatment and to take the descriptions to their doctor, with a view to engaging him or her in the process. If we get a bunch of people who have the same issue, we'll be able to tease things apart. We'll be giving people feedback in real time, saying: "We've got 200 people who have reported the same problem." It's going to make lots of patients and doctors much happier to speak up.

Some parents sincerely but wrongly believe vaccines caused their children's autism. Won't you find similar problems with false leads?

Yes, of course the data is going to be dirty. It's trying to get a process of teamwork going, as opposed to people coming up with observations and facing an industry that is in control of a body of evidence that seems to say there is no link. The more people we can pull in, the better the chance that we're going to get it right.

Profile

David Healy is director of the North Wales School of Psychological Medicine, Bangor, UK. A long-standing critic of the pharmaceutical industry, his latest book is Pharmageddon (University of California Press)

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