{"id":575,"date":"2013-03-25T12:16:20","date_gmt":"2013-03-25T12:16:20","guid":{"rendered":"http:\/\/occamstypewriter.org\/irregulars\/?p=575"},"modified":"2013-03-25T12:16:20","modified_gmt":"2013-03-25T12:16:20","slug":"bad-pharma-good-pharma-bad-pharma","status":"publish","type":"post","link":"https:\/\/occamstypewriter.org\/irregulars\/2013\/03\/25\/bad-pharma-good-pharma-bad-pharma\/","title":{"rendered":"Bad Pharma, Good Pharma, Bad Pharma"},"content":{"rendered":"

I was surprised and saddened to hear the news <\/a>that the pharmaceutical company, AstraZeneca were closing their R and D facility at Alderley Park in the North West of the country.\u00a0 This is an iconic research site, set among lakes and parkland.\u00a0 The beta blocker, propranolol and the breast cancer drug, tamoxifen were both discovered there.\u00a0 I remember visiting the site many years ago when I was a postdoc in the US.\u00a0 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.\u00a0\u00a0\u00a0 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.<\/p>\n

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.\u00a0 I don\u2019t buy this argument in an era of internationalised science and I detect misplaced snobbery in his words.\u00a0 There are world class universities in the North and surely we should be distributing jobs and wealth around the country.\u00a0 It is certainly a blow for the North West and for the people whose lives are affected by the decision.\u00a0 One of the people affected is a former PhD student from my lab.<\/p>\n

But of course there is no room for sentiment in these commercial decisions.\u00a0 AstraZeneca has, until recently, been making vast sums of money from its blockbuster drugs.\u00a0 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.<\/p>\n

The need for the Pharmaceutical Industry to make as much money as possible pervades Ben Goldacre\u2019s second book, Bad Pharma<\/a>, which I just finished reading.\u00a0 It is a shocking indictment of the practices of this industry which is, after all, so important for the health of so many people.\u00a0 There are plenty of reviews of the book around including one by OT blogger, Stephen Curry<\/a> so I won\u2019t go in to great detail.\u00a0 Two of the many facts in Goldacre\u2019s 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\u2019 prescribing decisions are influenced by devious and dodgy marketing practices.\u00a0\u00a0 There is much more in the book about how \u201cmedicine is broken\u201d and I am surprised there has not been more outcry.\u00a0 It is not an easy read, which is a pity, but I urge you to have a go.<\/p>\n

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.\u00a0 These have been almost exclusively in collaborations with preclinical scientists.\u00a0 My first PhD student was part-sponsored by Pfizer and about half of all my other doctoral students also had industry links.\u00a0 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.\u00a0 I also enjoyed the stimulation of getting out to visit different Pharma sites.\u00a0 Students benefitted from their industry placements: they could use different techniques and they could learn first hand how it was to work in industry. \u00a0Because we didn\u2019t do research that was close to \u201cmarket\u201d there was never any conflict of interest and, apart from approval delays, we were always free to publish.<\/p>\n

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.\u00a0 I found them to be honest, intelligent and hardworking so it comes as a big surprise to read Ben Goldacre\u2019s revelations.\u00a0 Of course I was dealing with preclinical scientists and Goldacre\u2019s revelations relate to clinical aspects of drug development and to marketing practices.<\/p>\n

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.\u00a0 As an academic, I found that the clinical\/preclinical divide created some odd anomalies.\u00a0 My first academic post was in the recently established Nottingham Medical School.\u00a0 I hadn\u2019t anticipated the amour propre of some of the clinically qualified staff but I soon learnt my place.\u00a0 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.\u00a0 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.\u00a0 Some years later, I got my own back by writing a book: Brain Biochemistry and Brain Disorders<\/a>.\u00a0 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.\u00a0 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.\u00a0 The meetings I attended, in the mid 2000s were based around strong core symposia on both pre-clinical and clinical topics.\u00a0 They were held in interesting locations and we were well looked after.\u00a0 I learnt a lot and I never detected any bias in the scientific content of the main symposia.\u00a0 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.<\/p>\n

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.\u00a0 The psychopharmacology trade fairs were like nothing I had ever encountered.\u00a0 The Exhibition Hall was decked out with brightly coloured stands for each of the drug companies making psychiatric drugs.\u00a0 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.\u00a0 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.\u00a0 It reminded me of traditional food markets I had visited in Southern France or Italy, only there was an altogether more sinister intent.<\/p>\n

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.\u00a0 Occasionally, proceedings at one of the stands would be interrupted by a quiz.\u00a0 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\u2019s drug.\u00a0 The person who knew most about the drug would be declared winner and would get a slightly better freebie like a memory stick.\u00a0 If this isn\u2019t brain washing I don\u2019t know what it is; the most surprising thing to me was the readiness of clinicians to participate in these juvenile charades.\u00a0 I have to admit a conflict of interest here; I did pick up some freebies my self.\u00a0 I picked up some pens and for my research, I picked up some of the articles on drugs.\u00a0 According to Ben Goldacre the articles were probably ghost-written and worthless.\u00a0 I also acquired two shopping bags from the AstraZeneca stand.\u00a0 We still use these but what people think when they see us in Devon using a bag emblazoned with \u201cAstraZeneca Neuroscience\u201d I don\u2019t know.<\/p>\n

If any of this troubles you, please read the full story in Ben Goldacre\u2019s book<\/a>.\u00a0 Also, have a look at the AllTrials web site<\/a> which demands that all clinical trial data should be published so that a true assessment of the efficacy of drugs can be made.\u00a0 I want to emphasise the importance of this.\u00a0 There are many drugs in use around the world where published data on clinical trials are incomplete.\u00a0 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.\u00a0 If you are a patient, then you may be taking a medicine for which we have incomplete and, therefore, potentially inaccurate data on efficacy.<\/p>\n","protected":false},"excerpt":{"rendered":"

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.\u00a0 This is an iconic research site, set among lakes … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":153,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[20,122],"tags":[156,153,157,154,155],"class_list":["post-575","post","type-post","status-publish","format-standard","hentry","category-guestposts","category-science-policy","tag-astrazeneca","tag-ben-goldacre","tag-clinical-trials","tag-drugs","tag-pharmaceutical-industry"],"_links":{"self":[{"href":"https:\/\/occamstypewriter.org\/irregulars\/wp-json\/wp\/v2\/posts\/575","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/occamstypewriter.org\/irregulars\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/occamstypewriter.org\/irregulars\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/occamstypewriter.org\/irregulars\/wp-json\/wp\/v2\/users\/153"}],"replies":[{"embeddable":true,"href":"https:\/\/occamstypewriter.org\/irregulars\/wp-json\/wp\/v2\/comments?post=575"}],"version-history":[{"count":0,"href":"https:\/\/occamstypewriter.org\/irregulars\/wp-json\/wp\/v2\/posts\/575\/revisions"}],"wp:attachment":[{"href":"https:\/\/occamstypewriter.org\/irregulars\/wp-json\/wp\/v2\/media?parent=575"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/occamstypewriter.org\/irregulars\/wp-json\/wp\/v2\/categories?post=575"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/occamstypewriter.org\/irregulars\/wp-json\/wp\/v2\/tags?post=575"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}