Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients by Ben Goldacre (3 stars)

I knew from the first few pages of this book that Goldacre had done his homework and would back his arguments with facts and plenty of references. In fact, he tells us right up front:

So, to be clear, this whole book is about meticulously defending every assertion in the paragraph that follows.

Which is great, I wanted the facts, I wanted references, I wanted solid arguments, and this book definitely delivers. But it isn't particularly entertaining, and finishing it took quite a lot of determination. Honestly I'm not sure what Goldacre could have done to improve this: it's an incredibly important message that needs to be heard by, well, preferably everyone, but especially all members of the medical and pharmaceutical industry. Judging by the contents of the afterword and the success of the alltrials campaign this has happened to some extent, which is great. But my 3 star ranking here reflects the view that just not that many lay people will be willing to trudge through this book.

Having said that, I'm incredibly glad that Ben Goldacre has written the book and launched the campaign, since it's a tragedy that (among many other problems) data from trials conducted in humans can be cherry-picked by companies to publish only favourable results. Everyone reading this should go sign the alltrials petition to help fix that.

In places I found the tone a little shrill and the recommendations, such as this one, somewhat impractical. What would patients think when confronted with such information stuck to the wall of a clinic without a 450-page accompanying novel to explain it?

All doctors should declare all payments, gifts, hospitality, free teaching and so on, to their patients, to colleagues, and to a central register. The conventional cut-off is for everything within the past three years, but we could consider making it longer. We should display the contents in our clinics, to our patients, and let them decide if such activities are acceptable.

More sensible than displaying it in clinics would be making that central register data available online. And I'm sure Goldacre is betting that sunlight shone on it like this will basically kill the entire practice of semi-bribes. Many people already shop for doctors on recommendation sites like yelp, having this data available to the patient as part of that interface when choosing a physician would be valuable.

For the most part though, the recommendations are sensible and practical. Since Goldacre basically wrote an abstract for the entire book in the first few pages I thought I'd just include it here, rather than summarising the problems and arguments further:

Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques which are flawed by design, in such a way that they exaggerate the benefits of treatments. Unsurprisingly, these trials tend to produce results that favour the manufacturer. When trials throw up results that companies don’t like, they are perfectly entitled to hide them from doctors and patients, so we only ever see a distorted picture of any drug’s true effects. Regulators see most of the trial data, but only from early on in a drug’s life, and even then they don’t give this data to doctors or patients, or even to other parts of government. This distorted evidence is then communicated and applied in a distorted fashion. In their forty years of practice after leaving medical school, doctors hear about what works through ad hoc oral traditions, from sales reps, colleagues or journals. But those colleagues can be in the pay of drug companies – often undisclosed – and the journals are too. And so are the patient groups. And finally, academic papers, which everyone thinks of as objective, are often covertly planned and written by people who work directly for the companies, without disclosure. Sometimes whole academic journals are even owned outright by one drug company. Aside from all this, for several of the most important and enduring problems in medicine, we have no idea what the best treatment is, because it’s not in anyone’s financial interest to conduct any trials at all. These are ongoing problems, and although people have claimed to fix many of them, for the most part they have failed; so all these problems persist, but worse than ever, because now people can pretend that everything is fine after all.

3 stars.

Jupiter - Illusions of Faith by Kynan Waterford (3.5 stars)

Fans of Matthew Reilly will find a lot to like in this book. It's packed with intricate action scenes featuring "the most dangerous man in the solar system" Garen Maertikye deploying a dizzying array of body enhancement technology to move stealthily, outsmart, and when forced to, destroy his enemies. In fact, the body enhancement tech was one of my favourite aspects of the novel, with the highlight being the "type-seven augmented plantim" (i.e. plant matter) body. The description of the surgical implantation of a new occupant into this body and subsequent adaptation to the user was fantastic, as was seeing its capabilities tested through a number of violent encounters.

For me the piece that was missing here was a back-story on how Maertikye came by all of his amazing tech, especially since it is far more advanced than that available to the well-funded Coalition soldier elite. Presumably there's a thriving and dangerous black market for body enhancements, an exploration of which would make a great novel on its own. But we're given little insight into how Garen has survived all of these years - how is he funded? Being an emotionless badass might be a tactical advantage, but it doesn't fuel and repair a spacecraft, or make a stormsuit.

The body tech and fight scenes sit more towards the science end of the science-fantasy spectrum, but there are also elements of the story that are much more solidly at the fantasy end: energy transfer between heavangels and humans, direct manipulation of human emotions by heavangels, and a spontaneous complete body transformation. I found these aspects hard to reconcile with the preturnatural body tech and fight scenes that were full of much more realistic physics - I've never read the term "angular momentum" so many times in fight scenes before!

I'm not against science-fantasy, but my personal preference would have been for these aspects to have a pseudo-science grounding: like the heavangels are nano particles that move through the atmosphere in clouds but can inhabit humans as brain parasites. There's a great potential twist here if the humans try to stop killing them, only to be overtaken as hosts for an alien parasite. Garen's stormsuit could have been specially designed to harvest energy from a cooperative cloud of nano particles.

While I'm on my high-horse writing my wishlist, I also wished there was more ship slang, which is bound to develop on a closed ecosystem like the Golgotha, and less use of the word terrorist, which is cringe-worthy in a couple of cases. Like when a soldier is supposed to be verbally abusing a captured Maertikye, and the best he can muster is "You're in more trouble than you know, terrorist".

While the action has a Matthew Reilly flavour, it is far from being mindlessly dumb like those novels. A lot of thought has gone into the Coalition's economic stranglehold on the population and life on board the Golgotha. Character development isn't spectacularly deep, and having a main character with deliberately suppressed emotions doesn't help in this regard, but it isn't completely absent. To its credit, things don't get tied up in a neat bow at the end, it's suitably complicated, and suitably open for plenty of sequels.

Looking forward to the next one.

3.5 stars