‘Medicine’, begins Bad Pharma, ‘is broken.’ It’s a false and pompous opening. Medicine has never been better. Less than a century ago, we doctors were as we always had been: trusted by our patients, trusted by ourselves and entirely untrustworthy. Up until close to the Second World War, medical care did more harm than good – most therapies and treatments were frauds and poisons. In the third decade of the 20th century it was still considered good practice to use leeches for pneumonia, or to take people who were frail and drug them into a deeply harmful blend of vomiting, sweating and diarrhoea. We thought that it was helpful. It wasn’t.

It was no evil conspiracy that kept medicine back, rather a deadly failure of technique. Clinical intuition was too frail to reliably pick out the effects of an intervention from reality’s crooked timber. Epistemologically, clinicians had scarcely budged since Hippocrates. Our technology had improved, as had underlying disciplines such as