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Ben Goldacre v the Association of the British Pharmaceutical Industry

The ABPI responds to Ben Goldacre's book Bad Pharma.

In Helen Lewis' review of Ben Goldacre's Bad Pharma, she quoted his damning indictment of the pharmaceutical industry:

“Drugs are tested by the people who manufacture them, in poorly designed trials, on hoplessly small numbers of weird, unrepresentative patients, and analysed using techniques that are flawed by design, in such a way that they exaggerate the benefits of treatments,” he writes. “When trials throw up results that companies don’t like, they are perfectly entitled to hide them from doctors and patients . . . academic papers, which everyone thinks of as objective, are often covertly planned and written by people who work directly for the companies, without disclosure.”

The Association of the British Pharmaceutical Industry's CEO, Stephen Whitehead, got in touch to give his response to Goldacre's accusations; his letter is printed below. Goldacre provided a reply to Whitehead's letter, which is also reproduced.

Letter from the ABPI


The points raised in Helen Lewis’ review of Ben Goldacre’s book Bad Pharma ("Lies, damn lies and drug trials") do not present an accurate picture of the pharmaceutical industry in the UK as it is today.

Mr Goldacre, as a health-care professional, no doubt understands the industry but seems to be stuck in a bygone era where pharmaceutical companies wine and dine doctors in exchange for signing on the dotted line. Similarly, references to companies (GSK, Lilly, Pfizer) being fined are all examples from the US and simply not relevant to the UK market.

Let us not forget that the pharmaceutical industry has been responsible for the development of 90 per cent of medicines in the world and through incremental innovation, has helped the management of many illnesses (some previously terminal) to improve no end.

Goldacre claims that “drugs are tested . . . using techniques that are flawed by design”, when in fact medicines are tested against the most effective comparator where possible unless there is no current standard of care. In these instances placebo studies must be undertaken.

The undertaking of clinical trials is tightly regulated in the UK by the MHRA and the EMA across Europe, who scrutinise clinical trial data relating to the quality, efficacy and safety of new medicines – everything is done to ensure that ineffective treatments do not reach patients.

Contrary to Goldacre’s musings, we do not seek to “hide” trial data – it is already best practice within industry to publish all data, positive and negative. We recognise that there still work to be done in ensuring the publication of negative trial data within journals, and in ensuring greater transparency all round within the industry, but we are working collaboratively with the wider health-care sector to achieve this and will continue to do so to bring about improved outcomes in patient care.

Stephen Whitehead

CEO of the Association of the British Pharmaceutical Industry


Reply from Ben Goldacre

Dear New Statesman,

I see that Stephen Whitehead from the Association of the British Pharmaceutical Industry has written in response to your review of my book Bad Pharma. He makes a series of false claims, on important matters of patient safety.

He says that the $3bn criminal fine levied against GSK in the US is irrelevant to the UK. This is untrue. As I explain in the book: GSK is a UK company. The US court gave examples of media stories generated by GSK to promote drugs illegally: these came from the Sun, the Guardian, the Times, and the Mail, which are all UK newspapers. GSK staff named in the US ruling continued to work at GSK; two now head major European drug companies. Richard Sykes was the chair of GSK during the period covered by the criminal fraud findings: he is now chair of Imperial College NHS Trust and also chair of the Royal Institution. 

It is, therefore, bizarre to claim that GSK’s acts of criminal and civil fraud are not relevant to the UK market. Hidden trial data and illegal promotion of drugs is an international problem and these fines very clearly relate to activity in the UK. 

Mr Whitehead goes on to make further false claims about how new drugs are tested, saying “medicines are tested against the most effective comparator where possible unless there is no current standard of care”.

This, again, is very simply untrue. As I explain in the book, a 2011 study looked at all drugs approved by the FDA between 2000 and 2010 and found that a third had been tested only against placebo, even when there was a currently available effective treatment, which they could and should have been compared against. As a result of this practice, doctors and patients are deprived of valuable information. The study was published in JAMA, one of the top three medical journals in the world, and can be read for free online.

I could go on. There are serious ongoing problems in the pharmaceutical industry, which rushed journalists have sadly neglected. Doctors and patients need the results of all clinical trials, to make informed decisions about the risks and benefits of treatments. Companies continue to withhold this information, with the complicity of medicines regulators and NICE, as I document in my book. This is a global scandal that puts patients at risk.

There are many people working in the pharmaceutical industry with high moral standards, who recognise that this kind of ongoing unethical activity must be urgently addressed, and who are keen to engage constructively with doctors and academics. The industry as a whole may wish to consider whether the outright denials and demonstrably false claims of Stephen Whitehead are going to serve them well. 

Dr Ben Goldacre

Photo: Getty Images
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What's to be done about racial inequality?

David Cameron's words on equal opportunities are to be welcomed - now for some action, says Sunder Katwala.

David Cameron made the strongest, clearest and most high profile statement about ethnic inequalities and the need to tackle discrimination ever yet offered by a British Prime Minister in his leader’s speech to the Conservative Party conference in Manchester.
“Picture this. You’ve graduated with a good degree. You send out your CV far and wide. But you get rejection after rejection. What’s wrong? It’s not the qualifications or the previous experience. It’s just two words at the top: first name, surname. Do you know that in our country today: even if they have exactly the same qualifications, people with white-sounding names are nearly twice as likely to get call backs for jobs than people with ethnic-sounding names? … That, in 21st century Britain, is disgraceful. We can talk all we want about opportunity, but it’s meaningless unless people are really judged equally”, said Cameron.
While the proof of the pudding will be in the eating, this was a powerfully argued Prime Ministerial intervention – and a particularly well-timed one, for three reasons.

Firstly, the Prime Minister was able to root his case in an all-but-universally accepted appeal for equal opportunities. It will always prove more difficult in practice to put political energy and resources behind efforts to remedy discrimination against a minority of the population unless a convincing fairness case is made that values cherished across our whole society are at stake. Cameron’s argument, that any party which tells itself that it is the party of the ‘fair chance’ and ‘the equal shot’ must have a response when there is such clear evidence of discrimination, should prove persuasive to a Conservative Party that has not seen race inequalities as its natural territory. Cameron argued that the same principles should animate responses to discrimination when it comes to race, gender and social class. Put like that, wanting job interviews to be fair – by eradicating conscious and unconscious patterns of bias wherever possible – would strike most Britons as offering as clear a case of the values of fair play as wanting the best baker to win the Great British Bake-Off on television.
Secondly, Cameron’s intervention comes at a potential "tipping point" moment for fair opportunities across ethnic groups. Traditionally, ethnic discrimination has been discussed primarily through the lens of its impact on the most marginalised. Certainly, persistent gaps in the criminal justice system, mental health provision and unemployment rates remain stark for some minority groups. What has been less noticed is the emergence of a much more complex pattern of opportunity and disadvantage – not least as a consequence of significant ethnic minority progress.

Most strikingly of all, in educational outcomes, historic attainment gaps between ethnic minorities and their white British peers have disappeared over the last decade. In the aggregate, ethnic minorities get better GCSE results on average. Ethnic minority Britons are more likely, not less likely, to be university graduates than their fellow citizens. 

As a result of that progress, Cameron’s intervention comes at a moment of significant potential – but significant risk too. Britain’s ethnic minorities are the youngest and fastest-growing sections of British society. If that educational progress translates into economic success, it will make a significant contribution to the "Great British Take-Off" that the Prime Minister envisions. But if that does not happen, with educational convergence combined with current ‘ethnic penalties’ in employment and income persisting, then that potential could well curdle into frustration that the British promise of equal opportunities is not being kept.  Cameron also mirrored his own language in committing himself to both a ‘fight against extremism’ and a ‘fight against discrimination’: while those are distinct challenges and causes, actively pursuing both tracks simultaneously has the potential, at least, depolarise some debates about responses to extremism  - and so to help deepen the broad social coalitions we need for a more cohesive society too.

Thirdly, Cameron’s challenge could mark an important deepening in the political competition between the major parties on race issues. Many have been struck by the increase in political attention on the centre-right to race issues over the last five to ten years. The focus has been on the politics of representation. By increasing the number of non-white Conservative MPs from two to seventeen since 2005, Cameron has sent a powerful signal that Labour’s traditional claim to be ‘the party of ethnic minorities’ would now be contested. Cameron was again able to celebrate in Manchester several ways in which his Cabinet and Parliamentary benches demonstrate many successful journeys of migrant and minority integration in British society. That might perhaps help to ease the fears, about integration being impossible in an era of higher immigration, which the Home Secretary had articulated the previous day.

So symbolism can matter. But facial diversity is not enough. The politics of ethnic minority opportunity needs to be about more than visits to gurdwaras, diversity nights at the party conference fringes and unveiling statues of Mahatma Gandhi in Parliament Square. Jeremy Corbyn’s first speech as Labour leader did include one brief celebratory reference to Britain’s ethnic diversity – “as I travelled the country during the leadership campaign it was wonderful to see the diversity of all the people in our country” – and to Labour bringing in more black, Asian and ethnic minority members - but it did not include any substantial content on discrimination. Tim Farron acknowledged during his leadership campaign that the Liberal Democrats have struggled to get to the starting-line on race and diversity at all. The opposition parties too will no doubt now be challenged to match not just the Prime Minister’s rhetorical commitment to challenging inequalities but also to propose how it could be done in practice.

Non-white Britons expect substance, not just symbolism from all of the parties on race inequalites.  Survation’s large survey of ethnic minority voters for British Future showed the Conservatives winning more ethnic minority support than ever before – but just 29 per cent of non-white respondents were confident that the Conservatives are committed to treating people of every ethnic background equally, while 54 per cent said this of Labour. Respondents were twice as likely to say that the Conservatives needto do more to reach out – and the Prime Minister would seem to be committed to showing that he has got that message.  Moreover, there is evidence that ethnic inclusion could be important in broadening a party’s appeal to other younger, urban and more liberal white voters too – which is why it made sense for this issue to form part of a broader attempt by David Cameron to colonise the broad centre of British politics in his Manchester speech.

But the case for caution is that there has been limited policy attention to ethnic inequalities under the last two governments. Restaurateur Iqbal Wahhab decided to give up his role chairing an ethnic minority taskforce for successive governments, unconvinced there was a political commitment to do much more than convene a talking shop. Lib Dem equalities minister Lynne Featherstone did push the CV discrimination issue – but many Conservatives were sceptical. Cameron’s new commitment may face similar challenges from those whose instinct is to worry that more attention to discrimination or bias in the jobs market will mean more red tape for business.

Labour had a separate race inequalities manifesto in 2015, outside of its main election manifesto, while the Conservative manifesto did not contain significant commitments to racial inequality. The mid-campaign launch in Croydon of a series of race equality pledges showed an increasing awareness of the growing importance of ethnic minority votes - though the fact that they all involved aiming for increases of 20 per cent by 2020 gave them a slightly back-of-the-envelope feel. 

Prime Ministerial commitments have an important agenda-setting function. A generation ago the Stephen Lawrence case opened the eyes of middle England to racist violence and police failures, particularly through the Daily Mail’s persistent challenging of those injustices. A Conservative Prime Minister’s words could similarly make a big difference in the mainstreaming of the issue of inequalities of opportunity. What action should follow words? Between now and next year’s party conference season, that must will now be the test for this Conservative government – and for their political opponents too. 

Sunder Katwala is director of British Future and former general secretary of the Fabian Society.