Ben Goldacre is the British physician and “nerd cheerleader” who has done important, debunking work about everything from homeopathy to vaccine scares in his book Bad Science and in his Guardian newspaper-column of the same name. Now, Goldacre has turned his gaze to the pharmaceutical industry. With Bad Pharma, his new book, he painstakingly documents how “good science has been perverted on an industrial scale.”

Pharmaceutical companies frequently hide unflattering studies and selectively publish positive ones, which means a lot of science never sees the light of day and the medical community has a skewed view of the evidence base for treatments. As well, trials are sometimes flawed by design and done on unrepresentative patients so that outcomes are more favourable. Drugs are then marketed to doctors in ways that reflect a distorted reality. Meanwhile, regulators are asleep at the switch and the medical establishment is failing to address these well-documented problems. Medicine is, indeed, broken.

While the book is called Bad Pharma, it could have easily been called Bad Doctors, Bad Academics, Bad Health Regulators, or just Bad Medicine. “The book describes a huge interlocking ecosystem of problems that reinforce each other and it’s not just about drug companies being bad,” Goldacre told Science-ish. “It’s also about regulators lacking ambition, doctors being thoughtless and lazy, lots of people being quite reasonably self-interested in systems that have perverse incentives, and patients not getting sufficiently involved in evidence.”

At a time when celebrity doctors peddle junk science, Goldacre talks with Science-ish about why real science matters, the next revolution in medicine, and the paramount importance of fair tests and trials.

Q: You’ve popularized nerdy things like clinical trial design at a time when it’s been more fashionable, among pop-science writers, to cover astronomy or particle physics. Why has study design been such a big focus?

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