In March 2013 I published a review I’d written of Bad Pharma. The review itself was originally published in the newsletter of a translators’ network. Below is my book review only, not the entire blog post, which was a little longer. I think you can see that I was very troubled by what I’d read. AllTrials is still running at http://www.alltrials.net. I no longer translate anything to do with clinical trials.
Let me be honest about how I approached this book. I had bought, read and enjoyed Bad Science a couple of years ago, and bought Bad Pharma looking forward to a similar experience: a well-written book by someone who’s intelligent and obviously has a sense of humour. Not only that, but, joy of joys, the spelling and punctuation are British, a relatively rare find in non-fiction books if you live outside the UK. I bought Bad Pharma thinking I’d enjoy reading the book and then be able to write a reasonably light-hearted review for this Newsletter.
Well, this is not that review. Bad Science, despite its sombre moments, was essentially a book I found it enjoyable to read. In my arrogant way, I felt vindicated: I was right not to buy expensive face creams; right not to trust in the MMR scare; right not to believe in the medicalisation of unpleasant aspects of normal human experience. I say “arrogant” because I have been taken in by other, equally spurious claims. Bad Pharma, though, is different, and not enjoyable at all. This is a book you read with your chin bouncing off the floor. I read it in disbelief at the things that go on and shock at the high-up people who let it continue, and with a growing realisation that one of my clients and one of my CPD providers might be playing a part in it. If your work involves the pharmaceutical industry, read this book. If you don’t have time to read it, find time. If you really, really don’t have time, read pages 1 to 29 (the beginning of chapter 1) and pages 240 to 259 (the beginning of chapter 6).
There is no substitute for reading the book itself, but the bare bones are that very often trials are not published if they don’t support the sponsor’s line (leading to publication bias and “a slow and unnecessary pollution of almost the entire evidence base in medicine”); patients’ rights are violated all the time; CROs can allow trials to seem independent of drug companies but drug companies are their customers (the “commercialisation of trials”); research articles are often ghostwritten by drug company employees or professional writers, not written by the doctors listed as their authors in journals; doctors are manipulated by drug company employees to make them prescribe their drugs; and the regulations that are supposed to govern these things are not enforced, and would be hopelessly inadequate even if they were.
Did you know that in 2008, for clinical trials conducted outside the US, the FDA switched from the Declaration of Helsinki to the less rigorous ICH GCP? I didn’t. Do you feel confident when translating an informed consent form that trial participants’ rights are being protected? I used to. Have you heard the figure of £550 million cited as the cost of bringing a new drug to market? I have. Did you believe it when you heard it? I did. Did you know that it has spawned “a vast critical literature, and even a popular book”? I didn’t. Are your source languages spoken in countries “where regulatory oversight is poorer, as is the normal standard of clinical care”? Have you translated contracts that assign the rights to data to a trial sponsor? Has it occurred to you that a placebo-controlled trial doesn’t necessarily investigate a meaningful clinical question? Did you know that most CPD for doctors is funded by the pharmaceutical industry? Did you know that time and time again people have claimed that certain measures have solved these problems when in fact they’ve done nothing of the kind? Did you know that 66% of fraud cases in the US involve the pharmaceutical industry?
Goldacre says repeatedly that all this is not because people are evil. He describes problems created in situations in which “no individual doctor or academic has done anything they would regard as unethical” and in which, for example, a journal editor might face a choice between “[p]ublish[ing] a trial…or meet[ing] the end-of-year budget by firing an editor”. He also describes a very human reaction, on the part of doctors asked to advocate specific companies’ drugs, to the people they get to rub shoulders with as a result: “I’m thirty-six, and I’m getting drunk with the people who write the clinical guidelines!” I expect a number of us can identify with that feeling of being professionally star-struck – I know I can.
Bad Pharma is not just a description of problems: it also contains proposals for how to address them, in a list at the end of each section. Goldacre makes specific suggestions for each key group: doctors, patients, drug company employees, etc. Translators are not one of those key groups (and I wouldn’t expect us to be), but there is, for example, a list of guarantees for patients to ask for, which we might perhaps consider adapting for our clients. I’ve hinted above at some of the ways in which our work might be abetting the bad practices described in Bad Pharma. In chapter 6, Goldacre says that “good people participate in projects which overall do great harm, without necessarily ever knowing. I strongly encourage you to familiarise yourself with the activities of your company”. He’s addressing employees of pharmaceutical companies; I think this advice could apply equally well to those of us who have pharmaceutical companies or CROs among our clients.
So much for content. What about Bad Pharma as a book, and in particular from a translator’s point of view? Well, as I said above, this is a well-written book by an intelligent author with a sense of humour. The arguments made in the main body of the book are made well, and the notes section at the end provides a great deal of extra detail and sources for further reading. One small gripe I have is that I find the chapter lengths unbalanced. Chapters 1 and 6 are each 100 pages long; the other four chapters are 141 pages long combined. The length of chapter 6 isn’t really a problem, because by that time you know you’re on the home stretch, but when you’re halfway through chapter 1 you do sometimes wonder if you’ll ever get as far as chapter 2. Nevertheless, for a book that contains so much information Bad Pharma is an easy read. As for translators specifically, Goldacre has inadvertently created a useful resource for us (even though many of us are humanities graduates, a group he’s not too keen on if Bad Science is anything to go by): Bad Pharma contains plenty of authentic usage and terminology and has an excellent, comprehensive index. I generally think I’m quite well up on terminology in this area, but ‘regulatory capture’, ‘me-again drug’ (not to be confused with a me-too drug) and ‘seeding trial’ were new to me.
Ultimately, though, the structure and layout of Bad Pharma are far less important than its content. It’s what Goldacre says that has made such waves since this book was published (his blog at http://www.badscience.net will keep you abreast). So yes, as a translator, fillet this book for terminology, definitions and collocations; if you’re British, revel in every -ise, every anaesthetist and every dash with a space on either side (also, surely only a Brit would ever write “slightly amazed”?); but, also as a translator, take a long, hard look at your work and your client list and ask yourself if, like me, you might be contributing to this problem by working for the clients you work for.