Bad Pharma, Good Pharma, Bad Pharma

I was surprised and saddened to hear the news that the pharmaceutical company, AstraZeneca were closing their R and D facility at Alderley Park in the North West of the country.  This is an iconic research site, set among lakes and parkland.  The beta blocker, propranolol and the breast cancer drug, tamoxifen were both discovered there.  I remember visiting the site many years ago when I was a postdoc in the US.  I had come back to the UK to look for a job and went to Alderley Park for an interview but in the end there was no suitable position.    Much more recently I gave a talk there and was impressed by the beauty of the local countryside and by the opulence of the new research buildings.

Some of the R and D will be relocated to an enlarged Cambridge site and the head of AstraZeneca believes that drug discovery will be stimulated by proximity to Cambridge University.  I don’t buy this argument in an era of internationalised science and I detect misplaced snobbery in his words.  There are world class universities in the North and surely we should be distributing jobs and wealth around the country.  It is certainly a blow for the North West and for the people whose lives are affected by the decision.  One of the people affected is a former PhD student from my lab.

But of course there is no room for sentiment in these commercial decisions.  AstraZeneca has, until recently, been making vast sums of money from its blockbuster drugs.  Several of these are due to come off patent and the company has a poor pipeline of new drugs so something had to be done to get those billions flowing again.

The need for the Pharmaceutical Industry to make as much money as possible pervades Ben Goldacre’s second book, Bad Pharma, which I just finished reading.  It is a shocking indictment of the practices of this industry which is, after all, so important for the health of so many people.  There are plenty of reviews of the book around including one by OT blogger, Stephen Curry so I won’t go in to great detail.  Two of the many facts in Goldacre’s book that shocked me include: how clinical trial data on many drugs are incomplete with data being suppressed when the result is inconvenient; how doctors’ prescribing decisions are influenced by devious and dodgy marketing practices.   There is much more in the book about how “medicine is broken” and I am surprised there has not been more outcry.  It is not an easy read, which is a pity, but I urge you to have a go.

The book made me feel very uneasy, not only because I am a user of a medical system that appears to be seriously flawed but also because I have myself had a lot of dealings with the pharmaceutical industry.  These have been almost exclusively in collaborations with preclinical scientists.  My first PhD student was part-sponsored by Pfizer and about half of all my other doctoral students also had industry links.  This was a deliberate decision on my behalf; I wanted our work in basic science to have important potential applications and drug action fitted well.  I also enjoyed the stimulation of getting out to visit different Pharma sites.  Students benefitted from their industry placements: they could use different techniques and they could learn first hand how it was to work in industry.  Because we didn’t do research that was close to “market” there was never any conflict of interest and, apart from approval delays, we were always free to publish.

On my visits to different companies, we discussed science but there was always a social aspect and I got to know the Pharma scientists as people.  I found them to be honest, intelligent and hardworking so it comes as a big surprise to read Ben Goldacre’s revelations.  Of course I was dealing with preclinical scientists and Goldacre’s revelations relate to clinical aspects of drug development and to marketing practices.

At some stage, however, the preclinical teams must liaise with clinicians as they pass candidate drugs on for testing and I have no idea how the preclinical/clinical boundary is managed in the pharmaceutical industry.  As an academic, I found that the clinical/preclinical divide created some odd anomalies.  My first academic post was in the recently established Nottingham Medical School.  I hadn’t anticipated the amour propre of some of the clinically qualified staff but I soon learnt my place.  On one occasion, I had been teaching a course on brain disorders (schizophrenia, depression etc) to medical students and when it came to exam time I duly submitted my questions.  The Professor of Psychiatry vetoed my questions as they included references to drug therapy and, as a non-clinician and a non-prescriber, I lacked the ability to ask such questions.  Some years later, I got my own back by writing a book: Brain Biochemistry and Brain Disorders.  Following on from this I wrote a series of reviews on the drugs used to treat schizophrenia, including speculation on how they worked and the basis of their side effects.  As a result I began to be invited to speak at meetings in the area of psychopharmacology and this is where I had my first experience of the murkier side of Pharma marketing.  The meetings I attended, in the mid 2000s were based around strong core symposia on both pre-clinical and clinical topics.  They were held in interesting locations and we were well looked after.  I learnt a lot and I never detected any bias in the scientific content of the main symposia.  There was also a programme of Satellite symposia, each sponsored by a drug company, and on at least one occasion I detected what seemed to me to be company-driven content.

Attached to the main meeting was the Exhibition Hall which is basically a trade fair. Trade fairs attached to meetings of the Biochemical Society or the British Pharmacological Society are, in my recollection, rather grey affairs.  The psychopharmacology trade fairs were like nothing I had ever encountered.  The Exhibition Hall was decked out with brightly coloured stands for each of the drug companies making psychiatric drugs.  Attractive staff dressed in colour-coordinated business suits were on hand to speak to you and take you through the posters detailing the virtues of their drugs.  The hall was full and noisy and people, many of whom were clinicians, walked purposefully from stand to stand with carrier bags bulging with the freebies on offer.  It reminded me of traditional food markets I had visited in Southern France or Italy, only there was an altogether more sinister intent.

The psychopharmacology trade fairs are basically marketing exercises providing literature on the drugs, some freebies like pens and balloons all emblazoned with drug names, also free food and drink.  Occasionally, proceedings at one of the stands would be interrupted by a quiz.  Here one of the staff would take a microphone and ask questions to a group of people who had apparently read all the literature on the stand about that company’s drug.  The person who knew most about the drug would be declared winner and would get a slightly better freebie like a memory stick.  If this isn’t brain washing I don’t know what it is; the most surprising thing to me was the readiness of clinicians to participate in these juvenile charades.  I have to admit a conflict of interest here; I did pick up some freebies my self.  I picked up some pens and for my research, I picked up some of the articles on drugs.  According to Ben Goldacre the articles were probably ghost-written and worthless.  I also acquired two shopping bags from the AstraZeneca stand.  We still use these but what people think when they see us in Devon using a bag emblazoned with “AstraZeneca Neuroscience” I don’t know.

If any of this troubles you, please read the full story in Ben Goldacre’s book.  Also, have a look at the AllTrials web site which demands that all clinical trial data should be published so that a true assessment of the efficacy of drugs can be made.  I want to emphasise the importance of this.  There are many drugs in use around the world where published data on clinical trials are incomplete.  If you are a biomedical researcher interested, as I am, in the basis of drug action then you may be drawing incorrect conclusions because you have access to incomplete and misleading trial data.  If you are a patient, then you may be taking a medicine for which we have incomplete and, therefore, potentially inaccurate data on efficacy.