Tim,
CAM is clearly not without fault. There are plenty within the skeptic movement to remind the community of that (including Ben Goldacre). But the fact is, as Ben points out in his book, you would save more lives, prevent more suffering and save much more public and private money by encouraging medicine and the industries that support it to clean up its own backyard. IMO Ben makes a mockery of these skeptic associations, including the likes of Friends of Science in Medicine, who consistently criticise CAM and remain silent on matters of medicine.

Jerry, I think you will find that Ben is a member of the skeptic movement. He is a regular contributor to their projects and information campaigns. I think you will also find that skeptics are just as critical of big pharma, you just hear less about it due to the court actions.

Sorry, I've just seen Ben's comments on skepticism, he doesn't self identify as a skeptic. It mainly seems to be because he doesn't care about other charlatans, just the medical ones. He does still involve himself with their work though.

Tim

I just noticed that the Australian skeptics are holding their national convention shortly. They have a panel discussing An Evidence-Based approach to medical treatment. I wonder how much time they will spend discussing Ben's book and getting stuck into Big Pharma.

Sue,
I am not sure a link to a blog from a Canadian Pharmacist constitutes a 'chapter' of the Australian Skeptics. Regardless, I think the amount of comments/debate on this topic and the conspicuous absence of the regulars who are quick to jump on the CAM threads, speaks volumes.

Thanks for the link Ken.

Sean Lamb - how would one go about doing drug development without doing clinical trials?

The normal way, Dr Ieraci,
Find a target, use a combination of rational design and/or high through-put screening of a library to find possible compounds for that target, investigate interactions in a cell culture model, then move into an animal model. Once they feel they have a promising candidate, they put it out to tender to the clinical trial companies, who work with the regulators to design appropriate clinical trials.
The clinical trial company hand the complete data to the regulators to determine approval and to the drug development company who can decide if they want to go ahead with production.

The idea of a "split" reminds me of the reform agenda (bit.ly/Wnr4Vc) suggested by Healthy Skepticism (a fine organisation). The agenda is detailed but I will quote the section on splitting the functions of the pharmaceutical industry:

"Pharmaceutical companies currently have four main functions: manufacturing, research, promotion, and education. Performance of those functions is currently distorted by incentive systems that reward only activities that increase sales of more expensive drugs regardless of the impact on health care. We recommend that the four functions be paid for separately by government agencies via competitive tender. This would allow the relevant divisions and subcontractors of pharmaceutical companies to compete with universities and non-profit non-governmental organisations for funding to provide each function separately. Incentives can then to be aligned to reward quality performance at each function separately. If a company performed poorly-for example, through research fraud or misleading promotion-then it would not get funding for that function in the next tender round. Drug prices would no longer include a premium for research, promotion, and education. Consequently, drug companies would no longer fund those functions from drug sales. Lower prices would make drugs more cost effective for larger numbers of people."

Replying to Mr Lamb's "the normal way"below:

That "normal way"would only operate for entirely new compounds, which are occurring in diminishing numbers these days. The majority of new pharmaceuticals entering the market are refinements of previous compounds, whose advantages are generally seen in incremental improvements in outcome and/or decreases in complications - not the sort of stuff that can be tested in the lab.

I am no fan of multinational companies - whether they be mining companies, pharmaceutical manufacturers, or cigarette companies. I do recognise, however, the mix of incentives that drive research and development of potentially new pharmaeuticals.

To me, the challenge is for prescribers to use as evidence-based approach as possible, recognising the wide variation in human beings and the mix of other factors determining their health. I have just been a a national scientific meeting of my specialty - a conference which does not accept drug company sponsorship and discusses futile care as well as drug efficacy critically. In that conference, we again discussed the latest research results in the use of "clot-busters"for stroke, which are much less effective than many would have you believe. This debate is occurring within medicine every day.

I have also recently been in a developing country, where one buys pharmaceuticals from the drug-seller in the local town market.

Ultimately, the way pharmaceuticals are used in any individual society depends much more on the behaviour of its health professions, its regulators and its community members than on how the manufacturers behave.

Stephen, I think that you have that the wrong way around.

The pharmaceutical companies have a tremendous profit motive for fixing the symptom, but not curing the disease. It is much better for them for someone to have to buy a drug every week, rather than take one expensive drug and be cured for life. (for example, diabetes)

Whereas the public service, with its conservative decision making, will probably not be encouraged to release a drug which has harmful side effects on people. The other point to remember is that the public service is subject to Freedom of Information laws, and reporting to parliament.
There needs to be a middle way where companies are encouraged to release drugs to fix the system and also to find cures for the diseases. We have a sort of system for that now.

John Wright I agree with the need for healthy scepticism, but, if one rejects the opinion of experts, should the opinion of the inexpert be preferred?

I can't follow the logic of rejecting the opinion of people who are educated and experienced in a particular profession. IF they have to make decisions with that knowledge and experience, and be held accountable for them, then their understanding of both the evidence and the practice are highly likely to be more valid than the opinions of the untrained and inexperienced. Don't you agree?

"You will I am sure have been around long enough to remember the consultant whom if you challenged would inevitably mean a poor reference."

John, I may have been around long enough, but that has not been my experience. In particular, as a consultant and teacher myself, I have always found that being challenged by trainees keeps me on my toes. I don't know about your friend, but my training was far from military and I have no inclination to enter the military. Could it be the company you keep?

Medicine is one of those professions that require continuous education, as new evidence arises all the time. We are not all practising with the knowledge - or even attitudes, we held as medical students. That is the nature of science - it continually updates itself and adapts to new evidence.

The reason the opinion of an expert should hold weight is not because of some appeal to authority, but because of that person's accumulated knowledge and experience - including both the underlying body of knowledge of their profession and also the practical experience of its application.

I don't know what your area of expertise is, or what you are the director of, but, if your opinion on it is no more valid than mine, I would worry about anyone paying you to exercise it.