Ben Goldacre: Bad Science

BenGoldacre is a British physician and journalist, and the author of the The Guardian newspaper's weekly Bad Science column. He describes himself as"a junior doctor in London and a shameless geek". You can read past columns here at his website. His first book, Bad Science, is published today in the UK (London: Fourth Estate).

Don't miss today's column which discusses the medicalization of everyday life. Although Goldacre doesn't mention the topic of intellectual property, at least not here, it seems to me that pharmaceutical patents have played a crucial role in this process. In any event, read the article and don't miss his account of how the golden age of medicine has creaked to a halt (see below).

"Before 1935 doctors were basically useless. We had insulin, morphine for pain relief - a drug with superficial charm, at least - and we could do operations fairly cleanly, although with huge doses of anaesthetics, because we hadn't yet sorted out well-targeted muscle-relaxant drugs. Then suddenly, between the 1930s and the 1970s, science poured out an almost constant stream of miracle cures.

"Everything we associate with modern medicine happened in that time: antibiotics, dialysis, transplants, intensive-care units, heart surgery, every drug you've ever heard of, and more. For people who were ill, the difference was spectacular. If you got TB in the 1920s you died, pale and emaciated, in the style of a romantic poet. If you got TB in the 1970s, then in all likelihood you would live to a ripe old age. You might have to take rifampicin and isoniazid for months on end - they're not nice drugs, and the side-effects make your eyeballs and urine turn pink - but if all goes well you will live to see inventions unimaginable in your childhood.

"Times have changed. The pharmaceutical industry is in trouble: the golden age of medicine has creaked to a halt, the low-hanging fruit of medical research has all been harvested, and the industry is rapidly running out of new drugs. Fifty "novel molecular entities" a year were registered in the 1990s, but now it's down to 20, and many of those are just copies of other companies' products, changed only enough to justify a new patent. So the story of "disease mongering" goes like this: because they cannot find new treatments for the diseases we already have, the pill companies have instead had to invent new diseases for the treatments they already have.

"Recent favourites include social anxiety disorder (a new use for SSRI antidepressant drugs), female sexual dysfunction (a new use for Viagra in women), the widening diagnostic boundaries of "restless leg syndrome", and of course "night eating syndrome" (another attempt to sell SSRI medication, bordering on self-parody) to name just a few: all problems, in a very real sense, but perhaps not necessarily the stuff of pills, and perhaps not all best viewed in reductionist biomedical terms. In fact, you might consider that reframing intelligence, loss of libido, shyness and tiredness as medical pill problems is a crass, exploitative, and frankly disempowering act."