On the issue of efficiency of Prozac or similar drugs, sometimes the explanation is that they simply work and you know it if you have taken them. I found the effects of SSRIs very noticeable, and every doctor prescribing them knows of patients who suddenly were able to leave the bed, or deeply depressive patients switching into a manic episode. The latter might not sound like an improvement, but for the patients, quality of life improves immensely. This can explain why doctors and regulators look favourably on drugs with a long history of clinical use.
I'd also criticize the conclusion that there's nothing better than Aspirin on the market. Which hasn't been known since ancient times by the way. The original salicylic acid was much worse on the stomach. Both Ibuprofene and Diclofenac have better analgesic properties, again very noticeable, and metamizole has different properties, again much more useful than asparin. There's really nothing to argue with that, except some hand-waving "placebo" talk, which often isn't so scientific either.
I'm more familiar with the veterinary side of things, and there the situation is that there are both independant trials, and a sort of "grapevine" where veterinarians compare notes on different drugs.
You can't really argue with anesthesia drugs. Either they work or they don't. Either they have a high incidence of accidents in a particular species, or they don't. Antibiotics much the same, especially when performing individual lab tests. Sure there is a lot of hyperbole or bad advertising, but it's not just "bad pharma".
The argument that painkillers haven't progressed in efficacy since Aspirin seems like it'd be thwarted simply by comparing Advil, Aspirin, and Tylenol, which seem to have noticeably different anti-inflammatory properties (acetaminophen being better for headaches and ibuprofen better for toothaches, for instance).
A zeroth-order argument for the utility of modern painkillers: you can take acetaminophen and ibuprofen at the same time for "twice" the effect, without either risking deadly liver poisoning from acetaminophen overdose, or stressing out the stomach lining from high-dosage ibuprofen or aspirin.
Those of us who occasionally get migraines know all about this, as do people in palliative care.
I wasn't referring to any comment about "medication" or "drugs" in general, but to a comment about Prozac and similar drugs. When you study them, they absolutely don't work better than the pre-SSRI antidepressants, and neither of them work much better than placebo. When you don't study them and just know that they work because you have taken them, they work just as well as prayer and Reiki.
> On the issue of efficiency of Prozac or similar drugs, sometimes the explanation is that they simply work and you know it if you have taken them.
This is what people who take homeopathy say. It's what doctors and patients said about knee arthroscopy for rheumatoid arthritus until they did a trial involving sham operations.
When Prozac was introduced in the UK we were told that it made people "better than well", and that everyone should have it and that the UK prescription laws were seriously flawed because this drug was restricted to people who had a diagnosed illness and was not available to everyone.
It's that kind of behaviour which is sleazy. The deliberate hyping of medications.
The brutal cynicism of using dying cancer patients to campaign for your ineffective very expensive cancer medication is really disgusting.
I'm not sure whether you're critiquing the book or what you've read in the review.
>It's what doctors and patients said about knee arthroscopy for rheumatoid arthritus until they did a trial involving sham operations.
small correction; The NEJM studies (below), to which your comment was probably referring, were actually for arthroscopic surgery in osteoarthritis patients, not rheumatoid.
It's quite common to think these conditions are similar, but are really rather different, with diverse etiologies. RA is considered an autoimmune disease, whereas OA is not.
Pain medication does work for quite a large number of conditions. Much of this has been demonstrated against a placebo or different treatments. If you give these drugs to animals in pain, they cease showing pain behavior.
Just defining all effects of pain medication as placebo just isn't scientific at all. Placebos often don't work reliably and repeatable either...
You still haven't said whether you are responding to the book or this review of the book. This review is, as several people have said, lousy. It's pointless for us to discuss this review because I disagree with the review. I do agree with a lot of the book.
When Goldacre talks about placebo he tends to talk about the pricing differences between differently packaged but identical medication. Thus, a brand name paracetamol is the same as an own-brand paracetamol and they're the same as a budget paracetamol. Yet one can be five or six times more expensive than the other. (Personally I don't see this as particularly bad behaviour.) I agree that he tends to place too much emphasis on placebo, but then I haven't read the studies. There are strong psychological aspects to pain; pain in cancer patients can be helped with cognitive behaviour therapy; some people (40% in one (not very good) report) with long term pain reported relief when they took a placebo.
But also look at coproxamol. This is an old med. we used to think that mixing meds meant you could use smaller quanties of active ingredients. Coproxamol is a sub-therapeutic dose of paracetamol and a dangerous toxic opiod (opiate?) dextropropoxyphene. (Paracetamol in acute overdose is very dangerous so for the dextropropoxyphene to be the more worrying ingredient tells us something). We've known since at least the 1980s that this med is not particularly effective and is very risky, yet it has only just been withdrawn from general use in the UK. We knew that it was less effective than paracetamol alone (because you'd take that at an effective dose) but that it was far more dangerous and that evidence got stronger through the 1990s and 2000s. (An overdose of paracetamol is treatable if caught in time, although paracetamol overdose does kill many people each year. An overdose of coproxamol is usually fatal before help arrives. For a time coproxamol was the leading medication in fatal overdoses.) Removal of this med was fiercely fought for years by pharmaceutical companies and by patient advocacy groups (sometimes funded by those same companies).
> On the issue of efficiency of Prozac or similar drugs, sometimes the explanation is that they simply work and you know it if you have taken them.
This can often be down to the placebo effect. Chris Kresser talks about this [1], saying that even when given a placebo people will report feeling better.
That's a review? There's almost no criticism, or even considered discussion, of the book at all. He's just copied and pasted sections that he thinks are important or interesting, and called it a day.
Not that there's anything wrong with quoting sections of a work that you think are worthy of spreading to a wider audience (assuming proper attribution), but IMNSHO it's a bit disingenuous to call QFTing a "review".
(FWIW, I thought the book was both excellent and terrifying, and that you should read it. That's also not a review, just an opinion. :-p )
Edit: downvotes? Am I really being unfair? Can you explain what it is you think the author of the review has added here?
Greenspun did a good job of characterizing (even summarizing) the information that you can find in the book. I learned new things from reading his review. Since I didn't read the book, this was more valuable to me than a "discussion".
I don't think the purpose was really to review it. I think he was using this as an opportunity to publicize the book and the issues it raises. People generally do that when they agree with the contents.
No, he writes what he thinks; as a longtime reader of PG's blog I've not noticed any agenda. He's also been reading Piketty's Capital and tearing P's thesis to bits.
Piketty's argument - the one he puts forward over 700 pages in the book - as distinct from Piketty himself.
Saying Piketty is jealous may or may not be true, but it says nothing about whether what he says in his book is correct or not (and if not in what way he is incorrect).
If someone disagrees with what he says then saying things about Piketty himself is really rather by-the-by as it's his analysis that needs to be critiqued. He may be an idiot speaking truth or a genius speaking nonsense, but the truth or nonsense (rather than the idiot or genius) is the significant matter.
EDIT: I've not read either Piketty (life is too short - at least mine is) or Greenspun's analysis of it (would be rather pointless as I've not read what he's talking about).
I'm only saying that if something can be genuinely summarised as "Piketty is jealous" then that sounds like an attack on the author rather than the work.
Try reading his blog then. He's not rebutting it word for word, of course, but he makes it fairly obvious there are some rather large and often fundamental holes in Piketty's arguments:
No I am good thanks. I will just discount it. I don't consider a blog post a suitable way to analyse the magnum opus of an economist of the stature of Piketty.
EDIT : Curiousity got the better of me. I read the review of Capital.
I stopped at this line -
"Here are some ideas, some taken from my 2009 economic recovery plan for the U.S."
The author is a supremely talented electrical engineer. Stick to that instead of whining "No one listened to my economics ideas."
Last time I checked, economists don't post blogs claiming no one is listening to their ideas about microprocessors or front end development.
The first half says "this is why Piketty is (probably) wrong about there being a problem" and the second half saying "and he's wrong about what we should do about it, here's what we should do instead".
Surely if there is no problem, the there is nothing which needs to be done about it?
Is a review the same as a critique? I'm not so sure, but I do kind of agree with you, it did feel a little thin on the ground. That said, I'm now going to read this book, so it "reviewed" it enough to help me the reader make a decision.
The AllTrials campaign was launched in January 2013 and calls for all past and present clinical trials to be registered and their results reported. It is an initiative of Bad Science, BMJ, Centre for Evidence-based Medicine, Cochrane Collaboration, James Lind Initiative, PLOS and Sense About Science and is being led in the US by Dartmouth’s Geisel School of Medicine and the Dartmouth Institute for Health Policy & Clinical Practice. Since then, the AllTrials petition has been signed by 79138 people and 489 organisations."
"When a new drug gets tested, the results of the trials should be published for the rest of the medical world — except much of the time, negative or inconclusive findings go unreported, leaving doctors and researchers in the dark. In this impassioned talk, Ben Goldacre explains why these unreported instances of negative data are especially misleading and dangerous."
"
...
Now you might say, well, that's an extremely unusual example, and I wouldn't want to be guilty of the same kind of cherry-picking and selective referencing that I'm accusing other people of. But it turns out that this phenomenon of publication bias has actually been very, very well studied. So here is one example of how you approach it. The classic model is, you get a bunch of studies where you know that they've been conducted and completed, and then you go and see if they've been published anywhere in the academic literature. So this took all of the trials that had ever been conducted on antidepressants that were approved over a 15-year period by the FDA. They took all of the trials which were submitted to the FDA as part of the approval package. So that's not all of the trials that were ever conducted on these drugs, because we can never know if we have those, but it is the ones that were conducted in order to get the marketing authorization. And then they went to see if these trials had been published in the peer-reviewed academic literature. And this is what they found. It was pretty much a 50-50 split. Half of these trials were positive, half of them were negative, in reality. But when they went to look for these trials in the peer-reviewed academic literature, what they found was a very different picture. Only three of the negative trials were published, but all but one of the positive trials were published. Now if we just flick back and forth between those two, you can see what a staggering difference there was between reality and what doctors, patients, commissioners of health services, and academics were able to see in the peer-reviewed academic literature. We were misled, and this is a systematic flaw in the core of medicine.
8:18
In fact, there have been so many studies conducted on publication bias now, over a hundred, that they've been collected in a systematic review, published in 2010, that took every single study on publication bias that they could find. Publication bias affects every field of medicine. About half of all trials, on average, go missing in action, and we know that positive findings are around twice as likely to be published as negative findings.
8:45
This is a cancer at the core of evidence-based medicine. If I flipped a c...
Having read the book, this review I would say is very misrepresentative.
The actual book is very good and a definite read.
But this article seems to have spun it into a conspiracy theory.
This is the opposite of why I liked the book in the first place, it explains how bad(For consumers) things happen due to systems not conspiracies. Also how things are not bad, just could be much better. Many examples are how mistakes are made but then found and how people are working to stoping them happening again.
"With all of the trillions of dollars spent on drug development and drugs themselves, have you ever wondered why people don’t seem to feel better than they did back in the 1970s?"
The book for instance would NOT agree with this statement. Seriously would you want to have 70's medicine or 2014 medicine? This is crazy.
Agreed. This kind of spin sometimes does more harm than good. Not that there's any doubt that greed and corruption play a big role too -- but there are many, many more factors.
Hell, I wish it were simply a matter of one big "pharma conspiracy". That would be an easy problem to solve.
The reality is paralyzing in its complexity, as with all issues that plague large political systems. And as our technology and means of communication advance at a faster and faster rate, it only becomes more evident how far being we are in understanding "social tech", and how intractable some of these problems are currently. We are nowhere near close to being able to tackle problems in the domain of complex social systems.
> it explains how bad(For consumers) things happen due to systems not conspiracies
That's one of the things I like most about Goldacre - he's very calm and measured compared to many people involved in these debates.
To anyone that liked Bad Pharma: I can really recommend "Bad Science" as well, which is similar but broader. In particular it has some very interesting information about "alternative" medicine and its relationship to "big pharma". He also has a great blog: http://www.badscience.net/ and occasionally gives talks - do go, if you ever get a chance to hear him speak.
Personally I see an intersect with many of the issues in pharmaceuticals and software patents. My particular interest is in so-called 'Low Dose Naltrexone' which I take for Crohn's Disease. The current system seems to neglect drugs which have multiple uses, particularly when said drug has gone out of patent, i.e. is cheap, as there is less of an incentive to do these hugely expensive trials in comparison to doing them for a newly patented, more profitable drug. This is not a 'big pharma' conspiracy, it's captialism + patents that is a big issue here and, as someone earlier said, it'd be a lot easier to address if it were just a conspiracy. As Goldacre shows, it's a flawed system that needs to be reformed to focus on patient health as much as, if not more than profits.
a bit of a weird review. mixes trial design, which is international, with inherent US issues like the ok to advertise prescription drugs.
i postulate that pharma is actually working, better than a lot of other industries. pharma has a working patent system that balances the need for profit and expiration dates (see the recent patent cliff that wreaked havoc, in a good way, on the entire industry). it has to scientifically prove that their products actually work and don't kill people in obvious ways.
you think trials are easy? look at how many products fail in phase 2 and 3 studies. you think the industry likes pissing away all that money? you have the FDA, but then also the various EU country hurdles - where they might approve your product, but not cover it due to insignificant benefits over older products.
HIV is under control, Hep C is cured. Certain cancer survival rates are way better than 25 years ago. Your chances of survival into old age are going up all the time. You can bone your wife at 70, any time you want.
While big bad pharma attempts to cure cancer, for massive profits, other industries create sugar drinks and chat apps. BioTechs are the ultimate start ups, try creating a complex molecule/protein and prove it does something significant. I'll take Genentech over Facebook, anytime.
"you think X is easy?" is a pointless statement. Everything is easy or difficult to different extents to different people. Also, the difficulty of solving a problem is not the primary criterion for choosing whether to attempt or expect to solve the problem. More importantly, there are no excuses for unethical behavior and fraudulent research.
I haven't read the book but I have read a lot of Ben Goldacre's articles (http://www.badscience.net/). His arguments are typically about how quacks, kooks, and pharmas practice 'bad' and fraudulent 'science' and are dishonest in presenting the results of their 'research'.
A vast majority of the population is inept at understanding the kind of statistical language in which drug companies misrepresent results. In addition to innate human propensity for logical fallacies (e.g. Type 1 thinking- Kahneman, Tversky, etc.), our perception is tainted by the personal dimensions of issues related to health and suffering.
Ben Goldacre is a darn good science 'popularizer' and does a great job of explaining these things to a general audience.
No one is arguing that good things don't come out of big pharma.
The complaint is that trying to figure out if a drug is effective & safe (or not) is near impossible. The trial data you have access to is incomplete because drug companies selectively release results. Doctors are also financially motivated to prescribe the drugs, tainting the decision making process.
This is the kind of content we want on the front page of HN? A "review" that is nothing more than content copied out of the book with a few paragraphs introducing each copied section, for a book that has been out for almost a year and a half?
If you want to read some real reviews of Bad Pharma a quick search will find you these:
46 comments
[ 4.1 ms ] story [ 100 ms ] threadI'd also criticize the conclusion that there's nothing better than Aspirin on the market. Which hasn't been known since ancient times by the way. The original salicylic acid was much worse on the stomach. Both Ibuprofene and Diclofenac have better analgesic properties, again very noticeable, and metamizole has different properties, again much more useful than asparin. There's really nothing to argue with that, except some hand-waving "placebo" talk, which often isn't so scientific either.
I'm more familiar with the veterinary side of things, and there the situation is that there are both independant trials, and a sort of "grapevine" where veterinarians compare notes on different drugs.
You can't really argue with anesthesia drugs. Either they work or they don't. Either they have a high incidence of accidents in a particular species, or they don't. Antibiotics much the same, especially when performing individual lab tests. Sure there is a lot of hyperbole or bad advertising, but it's not just "bad pharma".
Those of us who occasionally get migraines know all about this, as do people in palliative care.
I hear the same thing about the power of prayer and Reiki.
Drugs seem to work much more reliably.
It is exactly this kind of thinking that pharmaceutical companies are exploiting when they hide results from trials.
This is what people who take homeopathy say. It's what doctors and patients said about knee arthroscopy for rheumatoid arthritus until they did a trial involving sham operations.
When Prozac was introduced in the UK we were told that it made people "better than well", and that everyone should have it and that the UK prescription laws were seriously flawed because this drug was restricted to people who had a diagnosed illness and was not available to everyone.
It's that kind of behaviour which is sleazy. The deliberate hyping of medications.
The brutal cynicism of using dying cancer patients to campaign for your ineffective very expensive cancer medication is really disgusting.
I'm not sure whether you're critiquing the book or what you've read in the review.
small correction; The NEJM studies (below), to which your comment was probably referring, were actually for arthroscopic surgery in osteoarthritis patients, not rheumatoid.
It's quite common to think these conditions are similar, but are really rather different, with diverse etiologies. RA is considered an autoimmune disease, whereas OA is not.
update: included subsequent years
(2002) http://www.nejm.org/doi/full/10.1056/NEJMoa013259
(2008) http://www.nejm.org/doi/full/10.1056/NEJMoa0708333
(2013) http://www.nejm.org/doi/full/10.1056/NEJMoa1301408
Just defining all effects of pain medication as placebo just isn't scientific at all. Placebos often don't work reliably and repeatable either...
When Goldacre talks about placebo he tends to talk about the pricing differences between differently packaged but identical medication. Thus, a brand name paracetamol is the same as an own-brand paracetamol and they're the same as a budget paracetamol. Yet one can be five or six times more expensive than the other. (Personally I don't see this as particularly bad behaviour.) I agree that he tends to place too much emphasis on placebo, but then I haven't read the studies. There are strong psychological aspects to pain; pain in cancer patients can be helped with cognitive behaviour therapy; some people (40% in one (not very good) report) with long term pain reported relief when they took a placebo.
But also look at coproxamol. This is an old med. we used to think that mixing meds meant you could use smaller quanties of active ingredients. Coproxamol is a sub-therapeutic dose of paracetamol and a dangerous toxic opiod (opiate?) dextropropoxyphene. (Paracetamol in acute overdose is very dangerous so for the dextropropoxyphene to be the more worrying ingredient tells us something). We've known since at least the 1980s that this med is not particularly effective and is very risky, yet it has only just been withdrawn from general use in the UK. We knew that it was less effective than paracetamol alone (because you'd take that at an effective dose) but that it was far more dangerous and that evidence got stronger through the 1990s and 2000s. (An overdose of paracetamol is treatable if caught in time, although paracetamol overdose does kill many people each year. An overdose of coproxamol is usually fatal before help arrives. For a time coproxamol was the leading medication in fatal overdoses.) Removal of this med was fiercely fought for years by pharmaceutical companies and by patient advocacy groups (sometimes funded by those same companies).
That is sleazy behaviour.
He talked about Prozac and about homeopathy.
This can often be down to the placebo effect. Chris Kresser talks about this [1], saying that even when given a placebo people will report feeling better.
[1] http://chriskresser.com/placebos-as-effective-as-antidepress...
Not that there's anything wrong with quoting sections of a work that you think are worthy of spreading to a wider audience (assuming proper attribution), but IMNSHO it's a bit disingenuous to call QFTing a "review".
(FWIW, I thought the book was both excellent and terrifying, and that you should read it. That's also not a review, just an opinion. :-p )
Edit: downvotes? Am I really being unfair? Can you explain what it is you think the author of the review has added here?
http://en.wikipedia.org/wiki/Bad_Pharma
Not without a book of comparable size and research time invested.
Saying Piketty is jealous may or may not be true, but it says nothing about whether what he says in his book is correct or not (and if not in what way he is incorrect).
If someone disagrees with what he says then saying things about Piketty himself is really rather by-the-by as it's his analysis that needs to be critiqued. He may be an idiot speaking truth or a genius speaking nonsense, but the truth or nonsense (rather than the idiot or genius) is the significant matter.
EDIT: I've not read either Piketty (life is too short - at least mine is) or Greenspun's analysis of it (would be rather pointless as I've not read what he's talking about).
I'm only saying that if something can be genuinely summarised as "Piketty is jealous" then that sounds like an attack on the author rather than the work.
RSJW is right on the money with his TL;DR
http://blogs.law.harvard.edu/philg/2014/06/17/book-review-pi...
EDIT : Curiousity got the better of me. I read the review of Capital.
I stopped at this line -
"Here are some ideas, some taken from my 2009 economic recovery plan for the U.S."
The author is a supremely talented electrical engineer. Stick to that instead of whining "No one listened to my economics ideas."
Last time I checked, economists don't post blogs claiming no one is listening to their ideas about microprocessors or front end development.
The first half says "this is why Piketty is (probably) wrong about there being a problem" and the second half saying "and he's wrong about what we should do about it, here's what we should do instead".
Surely if there is no problem, the there is nothing which needs to be done about it?
"About AllTrials:
The AllTrials campaign was launched in January 2013 and calls for all past and present clinical trials to be registered and their results reported. It is an initiative of Bad Science, BMJ, Centre for Evidence-based Medicine, Cochrane Collaboration, James Lind Initiative, PLOS and Sense About Science and is being led in the US by Dartmouth’s Geisel School of Medicine and the Dartmouth Institute for Health Policy & Clinical Practice. Since then, the AllTrials petition has been signed by 79138 people and 489 organisations."
---
What you can do today:
http://www.alltrials.net/get-involved/individuals/
---
All Trials News:
http://www.alltrials.net/news/
---
TEDMED 2012:"Ben Goldacre: What doctors don't know about the drugs they prescribe" ( video 13:29 )
https://www.ted.com/talks/ben_goldacre_what_doctors_don_t_kn...
"When a new drug gets tested, the results of the trials should be published for the rest of the medical world — except much of the time, negative or inconclusive findings go unreported, leaving doctors and researchers in the dark. In this impassioned talk, Ben Goldacre explains why these unreported instances of negative data are especially misleading and dangerous."
"
...
Now you might say, well, that's an extremely unusual example, and I wouldn't want to be guilty of the same kind of cherry-picking and selective referencing that I'm accusing other people of. But it turns out that this phenomenon of publication bias has actually been very, very well studied. So here is one example of how you approach it. The classic model is, you get a bunch of studies where you know that they've been conducted and completed, and then you go and see if they've been published anywhere in the academic literature. So this took all of the trials that had ever been conducted on antidepressants that were approved over a 15-year period by the FDA. They took all of the trials which were submitted to the FDA as part of the approval package. So that's not all of the trials that were ever conducted on these drugs, because we can never know if we have those, but it is the ones that were conducted in order to get the marketing authorization. And then they went to see if these trials had been published in the peer-reviewed academic literature. And this is what they found. It was pretty much a 50-50 split. Half of these trials were positive, half of them were negative, in reality. But when they went to look for these trials in the peer-reviewed academic literature, what they found was a very different picture. Only three of the negative trials were published, but all but one of the positive trials were published. Now if we just flick back and forth between those two, you can see what a staggering difference there was between reality and what doctors, patients, commissioners of health services, and academics were able to see in the peer-reviewed academic literature. We were misled, and this is a systematic flaw in the core of medicine.
8:18
In fact, there have been so many studies conducted on publication bias now, over a hundred, that they've been collected in a systematic review, published in 2010, that took every single study on publication bias that they could find. Publication bias affects every field of medicine. About half of all trials, on average, go missing in action, and we know that positive findings are around twice as likely to be published as negative findings.
8:45
This is a cancer at the core of evidence-based medicine. If I flipped a c...
The actual book is very good and a definite read.
But this article seems to have spun it into a conspiracy theory.
This is the opposite of why I liked the book in the first place, it explains how bad(For consumers) things happen due to systems not conspiracies. Also how things are not bad, just could be much better. Many examples are how mistakes are made but then found and how people are working to stoping them happening again.
"With all of the trillions of dollars spent on drug development and drugs themselves, have you ever wondered why people don’t seem to feel better than they did back in the 1970s?"
The book for instance would NOT agree with this statement. Seriously would you want to have 70's medicine or 2014 medicine? This is crazy.
Hell, I wish it were simply a matter of one big "pharma conspiracy". That would be an easy problem to solve.
The reality is paralyzing in its complexity, as with all issues that plague large political systems. And as our technology and means of communication advance at a faster and faster rate, it only becomes more evident how far being we are in understanding "social tech", and how intractable some of these problems are currently. We are nowhere near close to being able to tackle problems in the domain of complex social systems.
The problem you speak of is unique to the USA's backwards healthcare system that costs more for worse healthcare.
That's one of the things I like most about Goldacre - he's very calm and measured compared to many people involved in these debates.
To anyone that liked Bad Pharma: I can really recommend "Bad Science" as well, which is similar but broader. In particular it has some very interesting information about "alternative" medicine and its relationship to "big pharma". He also has a great blog: http://www.badscience.net/ and occasionally gives talks - do go, if you ever get a chance to hear him speak.
What a dumb argument, this makes me not want to read this book.
i postulate that pharma is actually working, better than a lot of other industries. pharma has a working patent system that balances the need for profit and expiration dates (see the recent patent cliff that wreaked havoc, in a good way, on the entire industry). it has to scientifically prove that their products actually work and don't kill people in obvious ways.
you think trials are easy? look at how many products fail in phase 2 and 3 studies. you think the industry likes pissing away all that money? you have the FDA, but then also the various EU country hurdles - where they might approve your product, but not cover it due to insignificant benefits over older products.
HIV is under control, Hep C is cured. Certain cancer survival rates are way better than 25 years ago. Your chances of survival into old age are going up all the time. You can bone your wife at 70, any time you want.
While big bad pharma attempts to cure cancer, for massive profits, other industries create sugar drinks and chat apps. BioTechs are the ultimate start ups, try creating a complex molecule/protein and prove it does something significant. I'll take Genentech over Facebook, anytime.
I haven't read the book but I have read a lot of Ben Goldacre's articles (http://www.badscience.net/). His arguments are typically about how quacks, kooks, and pharmas practice 'bad' and fraudulent 'science' and are dishonest in presenting the results of their 'research'.
A vast majority of the population is inept at understanding the kind of statistical language in which drug companies misrepresent results. In addition to innate human propensity for logical fallacies (e.g. Type 1 thinking- Kahneman, Tversky, etc.), our perception is tainted by the personal dimensions of issues related to health and suffering.
Ben Goldacre is a darn good science 'popularizer' and does a great job of explaining these things to a general audience.
The complaint is that trying to figure out if a drug is effective & safe (or not) is near impossible. The trial data you have access to is incomplete because drug companies selectively release results. Doctors are also financially motivated to prescribe the drugs, tainting the decision making process.
Those are major complaints.
If you want to read some real reviews of Bad Pharma a quick search will find you these:
http://davidhealy.org/not-so-bad-pharma/
http://www.theguardian.com/books/2012/oct/17/bad-pharma-ben-...
http://www.sciencebasedmedicine.org/bad-pharma-a-manifesto-t...
Goldacre's blog, Bad Science, also talks a lot about the book and the topic: http://www.badscience.net/category/big-pharma/