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London Thinks – I Think you’ll Find its a bit More Complicated Than That!

Author, doctor and extremely fast speaker, Ben Goldacre, spoke to a sold out audience in the Main Hall of Conway Hall for the third London Thinks event on 1 December 2014.

The talk centered on Goldacre’s view that we need to be better at measuring risks and benefits when it comes to administering drugs with modest benefits across large populations. His main example for this was the use of statins — which are prescribed on a regular basis and yet we don’t know which one of the many statins is the best course of treatment. It could be the very expensive version or the very cheap, generic variety. Knowing which one would save more lives than we currently do and could potentially save the NHS millions of pounds a year.

One of the ways Goldacre suggests would be a useful way of finding out the answer is doing massive trials, where an algorithm would decide which one would be prescribed. If a doctor wanted to prescribe a statin, they’d have the option randomising which statin they’d prescribe. It would have the real world benefits of a massive control trial with real patients but also would pit different statins against each other. Right now, most trials are with ideal patients and only have to do better than a placebo.

However, the current ethics procedures aren’t really set up to deal with these types of trials. Instead, they will remain very expensive and not of a large enough cohort to demonstrate relative effectiveness between the different drugs. It was a very 20th century way of doing drug trials, it was said, but we need a 21st century way of doing things instead.

The Structure of Patents

Another main point Goldacre made was that wherever there is uncertainty in treatment, these sorts of mass randomised trials would be a good way of reducing that uncertainty. However, against this ideal is the entire structure of patents which incentivise drug companies to sell the most drugs at the time where there is the least certainty about their effectiveness. By the time we have data, the patents have expired and no company is interested in running trials using now genericised drugs.

Ben’s new book, I think you’ll find it’s a bit more complicated than that, a collection of his many writings on medicine and other subjects is now available. As well, you can find out about many of the ideas from his talk in his previous book, Bad Pharma.


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