Dr Goldacre is a writer on matters of medical science for The Guardian newspaper, but I came to know him from an earlier book, Bad Science. In that book Dr Goldacre told how science is used badly by a wide range of vested interests, the newspapers included and how we, the public, are badly served because of it. It was an extremely interesting book and I have since recommended it to others, If you haven’t read it then I now recommend it to you.
Bad Pharma, on the other hand, has none of the qualities of readability that made the earlier work so accessible.
I think we are all aware that pharmaceutical companies are somewhat less than lily-white in the way they test and market their drugs. What we may not be aware of, and I certainly wasn’t, was how complicit doctors, medical journals, professional journals, academics, the wider science community and regulatory agencies are in their bad practice. Some of the very people that we rely on to protect us from the big bad pharmaceutical companies are inadvertently helping them to do what they do.
To point a finger at the pharmaceutical companies alone is to do them a minor injustice. Note the use of the word ‘minor’. They are still as guilty as hell, as Dr Goldacre explains.
I am of an age where I need to take drugs for a range of minor ailments. My doctor is able to tell me what each one is for and how it helps me. He can even tell me what the side effects are likely to be, in most cases. However, he may not be able to tell me about some side effects, because these have been concealed by the pharmaceutical companies and this is just a part of the scandal. I am not going to mention any of the drugs or drug trials to which Dr Goldacre refers in the book; it might cause you to worry unnecessarily, but if you have any concerns then please consult your own doctor.
What is very questionable is whether my doctor understands how my cocktail of drugs interact with each other and may, consequently, be doing me harm. This is information I would expect my doctor to have at his fingertips, but because of the way drugs trials are run, documented and the results shared this may not be the case. Dr Goldacre explains why this is so. He explains it at length. He explains it so much that I could read no further.
This is the problem with this book and the reason I have given it only one star.
I regard myself as being well educated but I’m not a scientist, I’m not a mathematician and I’m not a statistician. After starting off with a fairly easy to read introduction Dr Goldacre soon drifts into the level of all those subjects that leaves me yawning and looking round the room trying to find something to read that I can understand a bit more easily. Instead of wanting to turn the page to find out what other horrors Dr Goldacre is going to expose, I found myself going to the home page of my Kindle to find out what other books I have on it that I can read – even ones I didn’t enjoy first time round.
To give you an idea of the depth and complexity that the book reaches, by the time I had reached 20% of the way through, that’s almost one fifth (joke) the author had referenced 82 different documents, journals and studies. References such as this are the way authors credit the work of others and are essential to prevent accusations of plagiarism, however, this is also an author’s way of saying “If you don’t believe me, here, go and look it up for yourself”. But to tell me, the reader, about all this work is so laborious that it sent me to sleep (several times). At least the only side effect of this sedative is a stiff neck!
Was it all necessary? I don’t know, I’m not a scientist or a doctor. All I can say is that a reader that loses interest in a book is going to close it and certainly isn’t going to recommend it.
I would like my MP to read this book and start a political campaign based on its contents, but I can’t be sure he will be any more successful in reading it than I was. I would like the Secretary of State for Health to read this book, or at least have someone read it for him (that’s not a slight, he’s just a very busy man), and then get the law changed, but the same problems exist. In writing the book the way he did Dr Goldacre has probably defeated his own purpose. Instead of exposing a scandal I suspect he has buried it.
I will still recommend this book. I may even go back and have another crack at it myself sometime in the future when I’m stuck in an airport departures lounge with no other reading matter. The subject is important and deserves to be more fully debated, but on this showing I doubt most people will get any further than I did. It will be one of those books that lots of people have heard of, but very few have ever finished reading.
Last week I made reference to the government’s new legislation to prevent the raising of taxes. This week our beloved Chancellor has revealed new plans, this time to legislate against governments running perpetual fiscal deficits.
I approve of the idea in principle. I don’t think it’s right for governments to build up debt which our children and grandchildren will have to pay off. The level of debt is now so high it could end up placing an unbearable tax burden on future generations. They won’t thank us for it and the fact that we probably won’t be around to see it happen doesn’t make it any more morally acceptable. In fact it makes it even more immoral. However, we’re dealing with politicians here so morality seldom takes precedence in decision making, hence the need for this law.
Is this also a trap for future Labour governments? In part it probably is. A Labour government that plans to run a fiscal deficit will have to account to Parliament for their plans and if they don’t pass certain supposedly stringent tests Parliament will be able to use the law to block them. I see this being the basis for many a bun flight on the floor of the House.
However, this proposed new law may actually work. It will certainly prevent some of the abuses we have seen in the past and I’m not singling out any party for that, both Labour and the Tories have been guilty at various times.
The first abuse is the one we see just before general elections. It is the abuse of bribing us with our own money. You know the sort of thing, the money that is suddenly found to fund tax breaks or public spending which, it is hoped, will persuade voters to vote for the party in government. Future governments will have to operate a fiscal surplus if they wish to do this because if their promises threaten to create a deficit they would be breaking the law. If the government is truly running a surplus they will effectively be giving us some of our money back; paying us a dividend if you like and there would be nothing immoral about that.
At the last election all the parties trotted out their ‘fully costed’ manifestoes. Fully costed, as I pointed out at the time, is the not the same as fully funded. The parties were very cagey about telling us how they would pay for their election promises. Now these parties will be forced to say how they will pay for their promises because this law will call them to account. If they can’t prove how they will fund their promises without going into deficit they will be exposed.
This will tie the hands of future Chancellors and prospective Chancellors. Not George Osborne in particular because he has a hefty deficit to deal with and until he has restored the fiscal balance he won’t be hampered by the new legislation. By that time the next election will be on the horizon and he may not even be the Chancellor as it’s likely we will have a new Prime Minister who may have chosen his own Chancellor.
Of course this won’t put an end to government borrowing. Governments borrow for two reasons. The first is the most common. Government spending has to be paid for as it occurs, but the tax revenue used to pay the bills is collected in arrears, so there is always a need for short term borrowing to close the gap. It's the fiscal equivalent of taking out a payday loan to cover the gas bill until you get paid at the end of the month.
The second reason is a bit more arcane. Imagine that you have a car and you know that in about three years’ time you will have to replace it. You have a choice. You can borrow the money and buy a new car now, or you can save up the money over the next three years and then buy it. There are a number of things that have to be taken into account: The cost of maintenance for the old car over three years, the rate of interest you will be charged on a loan, the rate of interest you might earn on your savings, what inflation will do to the price of the car over three years, etc. Governments also have to consider this when they are planning their spending.
Take the new Queen Elizabeth class aircraft carriers that are being built for the Royal Navy. With interest rates being so low it would have made sense to borrow the money up front, then spend it as it's needed. However, inflation is at an all-time low so perhaps it would have made sense to save the money up until it needs to be spent because inflation would have little effect on price. However, at the time the decisions were being made the world was going mad, in financial terms, and no-one had any idea what would happen to either interest rates or inflation. It’s a bit of a conundrum but it was a decision that had to be made, so I doubt that the new legislation will affect borrowing for investment of that sort.
Will this new legislation actually work, or will its ‘exceptional circumstances’ clause provide too many loop holes and allow future governments to continue the fiscal bad practices of the past? Who knows, but it will be interesting to see what happens.
Next week another book review: Anti-Social Media, by Kate-Beth Heywood.