Synopses & Reviews
If you believe that the latest blockbuster medication is worth a premium price over your generic brand, or that doctors have access to all the information they need about a drugs safety and effectiveness each time they write a prescription, Dr. Jerry Avorn has some sobering news. Drawing on more than twenty-five years of patient care, teaching, and research at Harvard Medical School, he shares his firsthand experience of the wide gap in our knowledge of the effectiveness of one medication as compared to another. In Powerful Medicines,
he reminds us that every pill we take represents a delicate compromise between the promise of healing, the risk of side effects, and an increasingly daunting price. The stakes on each front grow higher every year as new drugs with impressive power, worrisome side effects, and troubling costs are introduced.
This is a comprehensive behind-the-scenes look at issues that affect everyone: our shortage of data comparing the worth of similar drugs for the same condition; alarming lapses in the detection of lethal side effects; the underuse of life-saving medications; lavish marketing campaigns that influence what doctors prescribe; and the resulting upward spiral of costs that places vital drugs beyond the reach of many Americans.
In this engagingly written book, Dr. Avorn asks questions that will interest every consumer: How can a product judged safe by the Food and Drug Administration turn out to have unexpectedly lethal side effects? Why has the nations drug bill been growing at nearly 20 percent per year? How can physicians and patients pick the best medication in its class? How do doctors actually make their prescribing decisions, and why do those decisions sometimes go wrong? Why do so many Americans suffer preventable illnesses and deaths that proper drug use could have averted? How can the nation gain control over its escalating drug budget without resorting to rationing or draconian governmental controls?
Using clinical case histories taken from his own work as a practitioner, researcher, and advocate, Dr. Avorn demonstrates the impressive power of the well-conceived prescription as well as the debacles that can result when medications are misused. He describes an innovative program that employs the pharmaceutical industrys own marketing techniques to reduce use of some of the most overprescribed and overpriced products. Powerful Medicines offers timely and practical advice on how the nation can improve its drug-approval process, and how patients can work with doctors to make sure their prescriptions are safe, effective, and as affordable as possible.
This is a passionate and provocative call for action as well as a compelling work of clear-headed science.
From the Hardcover edition.
About the Author
Jerry Avorn, M.D., is an associate professor of medicine at Harvard Medical School and chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Womens Hospital in Boston. An internist, geriatrician, and drug researcher, he is the author of more than two hundred papers in the medical literature on medication use and its outcomes, and one of the most frequently cited researchers in the fields of social science and medicine.
Table of Contents
PROLOGUE: DIFFERENT STROKES
PART ONE: BENEFITS
1: THE PREGNANT MARES LESSON
2: LEAVING THE DARK AGES BEHIND, MOSTLY
PART TWO: RISKS
3: THE FAT IS IN THE FIRE
4: TOO SWEET TO BE TRUE
5: COLD COMFORT
6: GETTING RISKS RIGHT
7: THE MOST VULNERABLE PATIENTS
8: ENTER DOCTOR FAUSTUS
9: IMPERFECT MEASURES
10: WHOSE RISK IS IT, ANYWAY?
11: A BALANCING ACT
PART THREE: COSTS
12: LIVE CHEAP OR DIE
13: FILLING THE PIPELINE
14: WHAT THE TRAFFIC WILL BEAR
15: NAVIGATING THE THIRD DIMENSION
PART FOUR: INFORMATION
16: SIGNALS, NOISE, AND THE BIG VOID
17: INFORMATIONAL KUDZU
18: DEVISING AN ANTIDOTE
19: THE EMPERORS FASHION CRITICS
20: SAME LANGUAGE, DIFFERENT ACCENTS
PART FIVE: POLICY
21: PULLING THE FACTS TOGETHER
22: TURNING KNOWLEDGE INTO ACTION
23: MARKETS AND MEDICINES
EPILOGUE: THE TRIPLE-EDGED SWORD