A published and an unpublished review of ‘Bad Pharma’

Professor Ian Reid, who died tragically early at the age of 53 on 15 June 2014, played a leading role in British, especially Scottish academic psychiatry for over two decades. He is a doctor who I admired immensely and his early death was a terrible loss.

Ian was a Senior Registrar in Psychiatry when I began training in 1993 at Royal Cornhill Hospital. He had a brilliant mind, was a distinguished researcher and was unparalleled in his generation as a lecturer, speaker and influencer. Ian went on to become Professor of Mental Health and Head of Department at the University of Aberdeen. A few years after his appointment I left Aberdeen to take up a Consultant post in Stirling and it was at this time my interest in ethics developed. It was most helpful to me to be able to e-mail Ian about a range of issues but particularly in relation to antidepressant prescribing. It is fair to say that we had quite different views on what “appropriate” prescribing of antidepressants might constitute. We also discussed the role of the pharmaceutical industry in Medicine.

In this post I will share Ian’s published review of ‘Bad Pharma’ by Ben Goldacre followed by his unpublished version. I do so with nothing but full respect for Ian alongside the appreciation that science must always be open to the subjective view (which may not make it into publication):

In September 2013 I e-mailed Ian to say "I read your review of Bad Pharma. Your review did not contain the views that I long heard from you in Aberdeen!"

Ian kindly replied to share with me this original but unpublished version:

“It’s all different now, Angus (I’ve changed the names). They hid so much… harm”.

 “Like what, m ‘boy?” my companion asked, settling back into his leather-bound, BMW-flavoured, fat-cat NHS pension.

“Who would have thought that Pharma Hospitality could cause excessive weight gain and type II diabetes? They kept that quiet”, I replied, ruefully patting my stomach.

“Och (for he is Scottish) no harm in it – didn’t affect me – or my prescribing” he said, waving his walking stick.

I arched an eyebrow. Such lack of insight from a distinguished colleague, retired early with a gammy leg after falling off the Hilton balcony at an APA symposium in San Francisco in 2001.  His collection of post-it sticky notes, stuffed into his pockets at the exhibition hall earlier that day, had mitigated the damage – but a hastily hushed-up Hospitality-Related Movement Disorder had been the outcome, nonetheless. I remembered arriving at the airport earlier with my fellow Key Opinion Leaders.  The US immigration officer had asked, given that so many UK psychiatrists were passing in front of him, just who was left looking after all the patients back home. Looking around the arrivals hall, I couldn’t be sure.

I was trying to read the new Goldacre book about Bad Pharma. Angus poked at the book with his stick: “Aha! That geek chick with naturally curly hair? Pretty young thing.”

I sighed. “It’s ‘geek chic’ – it rhymes – and he’s a smart bloke,” I corrected. His brain had become so addicted to Strawberry Daiquiris by past unregulated off-label administration of free drinks that he couldn’t quite see properly the Telegraph review of Goldacre’s book that I planned to crib later. If you can’t afford a ghost writer – plagiarise! He fell asleep, sodden with memories of the days when they used to launch new CNS drugs: flare-lit dinners on a Miami beach – conjurers moving from table to table, delighting with hand-magic. We never guessed it could end with so many needlessly injured delegates. Because it was hidden. Unreported. Statistically massaged, probably. I vaguely recalled something about massage…

But of course, Goldacre is concerned with patient harm: doctors get off lightly, and are simply misled.

So this was what doctors needed to know! It didn’t seem to match curricula around the country, with students doing elective modules on Psycho-Geography, Conversational Swedish and Existentialism in Film. There is no room in the course now for the traditional hard-core subjects like ‘Messing Around with the Nursing Staff’ or ‘Pharmacology’. In our day, critical appraisal was reserved for the purchase of fine art; statistical skills for the stock market. And now Pharma is up in front of the beak! It seems dissonant or ironic, somehow, I mused, what with the damn NHS managers parroting airport-bookstore grade business-wisdom and trying to dress like they were running a corporate bank.

Angus woke with a start: “I’ve always been curious…”

“Yes Angus?”

“Well – way things are, nowadays – you’ve flown economy, I suppose?”

I conceded that I had.

“What’s it like?”

Conflict of Interest: I used to do Pharma sponsored talks and accept corporate hospitality (Eli Lilly, AstraZeneca, Sanofi and others). However, my last Pharma sponsored lecture was cancelled by the company legal team following sight of the proposed materials, and an entire CNS marketing division promptly folded. This latter is just an association, not proof of causality, you understand.

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