Drugs companies publish only a fraction of their results and keep much of the information to themselves. Drug companies are ‘debasing’ drug trials whose publication in journals can apparently confer scientific approval. Merck had fought for years to cover up evidence linking its painkiller Vioxx to heart attacks and strokes. Some treatments on the market have been linked to fatal side effects. Companies run bad trials on their own drugs, which distort and exaggerate the benefits by design. When these trials produce unflattering results, the data is simply buried. Patient groups who are in the pay of the pharmaceutical industry will go into battle for them. There's a hidden agenda here.

Not my words, I hasten to add. All the sentences in the above paragraph are taken from articles in just one UK newspaper (the Guardian, in case you were wondering). These are just a few examples of how it's become quite fashionable to believe that Evil Big Pharma are one of the most dangerous bad guys in the modern world.

Medical Writing is grateful to Kim Goldin and the International Society for Medical Publication Professionals (ISMPP) for working with us to produce this issue. More about ISMPP can be found on page 272. We hope that this issue marks the beginning of a mutually beneficial collaboration between our two associations.

The reality, of course, is rather more complicated.

Sure, there have been times when pharmaceutical companies have done bad things. I don't think any sensible person would attempt to defend, for example, Pfizer's behaviour in marketing Neurontin for off-label uses, which resulted in them being fined $430 million. But in the same way that we don't conclude that all doctors are evil because of Harold Shipman, it would be very shoddy thinking to conclude that a few tales of bad practice show the pharma industry in general to be a force for evil.

The fact is that the pharmaceutical industry has been responsible for amazing advances in healthcare for many decades. When I was at primary school, one of my classmates died of leukaemia. Today, a primary school child with leukaemia has an excellent chance of survival thanks to modern chemotherapy.¹ The 10-year survival rates for many adult cancers have doubled since I was at primary school;² again, thanks in no small part to advances made by the pharmaceutical industry.

And it's not just cancer treatment that has improved: many EMWA members are probably too young to remember just how serious gastric ulcers could be before the era of modern acid-suppressive drugs, but for people of my parents’ generation, a gastric ulcer was a serious illness with dramatic effects on quality of life, for which the only effective treatment was often surgery. Nowadays, most gastric ulcers can be successfully treated just by taking a few pills for a few weeks.

Nonetheless, there is undoubtedly great sport to be had in criticising the pharma industry, or ‘pharmaism’, as Wendy Kingdom explains on page 262. Wendy suggests that one possible reason for this may be that pharma companies make money out of treating disease, which some people find distasteful. Nonetheless, any economist will tell you that desirable activities need to be profitable; otherwise, why would anyone bother to do them in the first place? An alternative, state-run model of drug development was of course tried in the Soviet Union, which resulted in a list of therapeutic advances that would fit ‘on the back of a stamp’.³

Because it is so fashio