by Ben Goldacre

“I did everything a doctor is supposed to do.  I read all the papers, I critically appraised them, I understood them, I discussed them with the patient and we made a decision together, based on the evidence.  In the published data, reboxetine was a safe and effective drug.  In reality, it was no better than a sugar pill and, worse, it does more harm than good.  As a doctor, I did something that, on the balance of all the evidence, harmed my patient, simply because unflattering data was left unpublished.

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“Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques that are flawed by design, in such a way that they exaggerate the benefits of treatments.  Unsurprisingly, these trials tend to produce results that favour the manufacturer.  When trials throw up results that companies don’t like, they are perfectly entitled to hide them from doctors and patients, so we only ever see a distorted picture of any drug’s true effects.  Regulators see most of the trial data, but only from early on in a drug’s life, and even then they don’t give this data to doctors or patients, or even to other parts of government.  This distorted evidence is then communicated and applied in a distorted fashion.”