Friday, November 30, 2012

Tyler Cowen v. Ben Goldacre

Tyler Cowen reviews Ben Goldacre:
Goldacre’s policy recommendations would in general raise the costs of research and development, although they would  likely improve the accuracy of research results and reduce over-prescription and overuse of drugs.  It is quite possible they would lower the rate of return to pharmaceutical innovation, likely I would say.  These trade-offs are neglected, and, much as I admire many features of this book, I cannot help but, alas with trepidation, call some of its central features “Bad Science.”  Bad Economic Science.  The morality of the narrative and the Platonism of his vision distracts him from presenting the policy trade-offs clearly.

And Goldacre responds (in the comments):

The key argument of the book is that the results of clinical trials should not be withheld from doctors and patients. Industry spokespeople continue to deny that this happens at all, in the face of overwhelming evidence, in a testament to how easy they have found it to evade serious public discussion.
Sharing all trial results would not cost any more money, since the cost in a trial is in conducting it, rather than dissemination. The risk to industry is that doctors and providers of healthcare services would have a clearer picture of the absolute benefits of drugs, and of which is best, or most cost effective. So the downside would perhaps be that drugs might become more like commodities, as purchasers got better information.

I haven't read the book yet (though it's on my shortlist), but, for once, I think Goldacre has a stronger argument than Tyler here.  I'm sure that Goldacre probably could have moderated his tone a little bit, but if his book is, as he says, mostly about calling for greater transparency in pharmaceutical studies, then Tyler's response seems a bit weak.  Tyler basically seems to be saying that pharma companies should not have to publish their studies because they make a lot of money selling mediocre (but often unnecessary) drugs and the profits from these drugs allow them to create more drugs.  This seems akin to saying that it's okay for pharma companies to defraud the public because it's in the greater good.  It also seems to skew the incentives.  If a pharma company can turn a profit with either a mediocre product or a good one, there's not a whole lot of incentive to work extra hard to produce a good product. 

And as for Tyler's criticisms about tone, if your goal is to stir up public sentiment to push for reform, I'm not sure that moderation is the goal.  There is a place for moderate criticism and a place for outrage, and this book may fit the latter.  

1 comment:

  1. I think you ignore TC's point completely. Whereas you characterize pharma as "they make a lot of money selling mediocre (but probably unnecessary) drugs and the profits from these drugs allow them to create more drugs," TC's claim is that they only charge $13,000 to add a year to your life. That's amazingly cheap and effective! And certainly worth defending.