When I saw recently that Simon Singh, energetic “quack buster “ and scourge of homoeopaths, chiropractors and their ilk, had established an award called the Golden Duck to be presented to the person who had “supported or practised pseudoscience in the most dangerous or irresponsible manner” , my first thought was: How unfair!
What about all those major league pseudoscience practitioners promoting dangerous and/or ineffective drugs, supported by dodgy or invisible data? Shouldn’t we also have the chance to point the finger at them too?
Having read Ben Goldacre’s excellent new book Bad Pharma – not to mention written two of my own – that set out exactly how pharmaceutical companies can, and do, accentuate the positive and eliminate the negative results in drug trials, I was well aware of just how many candidates there were in need of recognition.
The obvious thing to do was to set up a rival award, a sort of Oscars to Singh’s BAFTAs, but first I had to make sure the playing field was level. Since the duck denotes quackery, I checked that the definition of quackery – restricted by Singh and his allies to CAM (complementary and alternative medicine) – also applied to drugs and other medical products. Here’s a definition from the mainstream medical site – Medicinenet.com : “Deliberate misrepresentation of the ability of a substance device ….to prevent or treat disease.”
Aggressive promotion and quackery
That’s a pretty clear description of such common practices as hiding unfavourable drug results or continuing to prescribe them even though trials have shown them to be dangerous or ineffective. And here is Wikipedia’s explanation, which also seems right on the button: “… quackery’s salient characteristic is aggressive promotion (“quacks quack!”).” Promotion doesn’t get much more aggressive than the multimillion dollar marketing budgets available to drug companies.
The Silver Bullet seemed a good name – sense of fantasy from its use on werewolves and from the implied promise that this will hit the target and sort out the problem. To be awarded to the company, product or medical device demonstrating the most blatant “aggressive promotion” or “deliberate misrepresentation”.
The Golden Duck is officially awarded by a self-congratulatory sounding group set up by Singh called “The Good Thinking Society”, which has proved remarkably unimaginative in its choices. Winner was Andrew Wakefield who was found guilty of serious professional misconduct by the GMC (General Medical Council) two years ago, while runner-up Prince Charles has been out of the CAM picture even longer.
Busy confiscating water pistols
If CAM quackery is so widespread and harmful, it’s curious that another of Singh’s groups – The Nightingale Collaboration, whose members have been enthusiastically reporting CAM practitioners to the Advertising Standards Authority for making unjustified claims – have been unable to come up with anyone more active or up to date. The great thing about the Silver Bullet is that there is no shortage of candidates who are both.
The Golden Duck is a distraction from real and deadly quackery that is all too common. If Singh were put in charge of cutting the high school death toll from America’s gun laws, he would be busy confiscating water pistols while ignoring the loners wandering the corridors with high velocity assault rifles.
So please let me know which of these you’d like to see given the bullet and do send in your own suggestions with supporting details because I plan to have another awards round soon – I’ve got at least another half dozen already.
1) Aggressively promoting drugs
Companies can greatly increase sales by illegally promoting drugs to treat conditions for which they don’t have a licence i.e. without proper evidence that they are effective for that disorder. Last year alone in America Abbott Laboratories agreed to pay $1.6 billion for illegal marketing of its anti-seizure drug Depokote, GlaxoSmithKline paid a, so far, record $3 billion for illegal marketing of the diabetes drug Avandia along with several others, while Johnson & Johnson was ordered to pay $1.2 billion for violating consumer protection laws in the way it promoted its anti-psychotic drug Risperdal. This would have to be a joint award.
2) Misrepresentation of patented memory pill.
Aricept is the only drug licensed to treat Alzheimer’s but the patent on this two billion-a year seller ran out in 2010. Pfizer and the Japanese company Eisai persuaded the FDA to grant them a valuable 3-year patent extension with a so –called “new” version – Aricept 23. The only thing new was the dose – 23 mgs per pill rather than the 5 or 10 mgs in the old version. A BMJ investigation found the benefits were minimal but the side-effects were significantly increased.
3) Sleeping pill scandal surfaces – again
For at least twenty years the doctors have known you can easily become addicted to benzodiazepines – tranquilizers and sleeping pill with names like temazepam, valium and Sonata. Guidelines say they should only be taken for a week and only in cases of serious trauma. Yet 18 million and rising prescription are written for them every year and an estimated 1.5 million people are addicted. It is almost impossible to get any help withdrawing. Recently angry campaigners met with the British Medical Association to try yet again to put an end to this dangerous and evidence-free prescribing.
4) Claims backed by invisible evidence
This is probably the best known scandal but is such a blatant case of hiding data it is worth including. Back in 2009 the NHS spent £500m on Tamiflu (oseltamivir) a drug that was supposed to reduce your risk of getting swine flu and if you did catch, to reduce its severity. But when scientists from the Cochrane Collaboration (a charity that assesses whether a drug is worth taking) asked the manufacturer to see all the trial data, Roche refused and is still refusing three years later. There have been at least 123 trials of Tamiflu yet over half the data about how patients actually responded still hasn’t been published. The Cochrane scientist suspect effectiveness has been exaggerated and serious side-effects downplayed.
5) Licensed antidepressant no better than placebo
Reboxetine is an antidepressant, whose manufacturer Pfizer has also been playing hide-and-seek with the evidence. In England alone the NHS spent a million pounds on this drug in 2004 and a bit less – £740 thousand in 2011. The drop may have had something to do with the fact that in 2010 a German equivalent of the Cochrane Collaboration (the IQWIG) eventually managed to get to see all the trial data and found that out of seven trials comparing it with a placebo only one had found it was more effective. The positive one that got the licence was the only one published, the rest had remained hidden. ( Bad Pharma – Ben Goldacre. 4th Estate.) This was also the one reporting the fewest side effects, the hidden ones showed the drug to be more harmful. Remarkably in 2011 the UK drugs watchdog – the MHRA – declared it was OK to continue prescribing Reboxetine because the “benefits outweighed the risk”.
The cumulative effect of distortions like these are huge and make it impossible to make sensible decisions about treatment as well as damaging hundreds of thousands of patients. Do vote, putting your votes in the comment box below. The choices are as follows:
1) Aggressive promotion: GSK and Abbots and Johnson & Johnson.
2) Misrepresentation Aricept 23 (Pfizer and Eisai)
3) Sleeping pill scandal – BMA
4) Invisible evidence – Tamiflu (Roche)
5) Selling a Placebo – Reboxetine (Pfizer and MHRA)