Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs
Format: PDF / Kindle (mobi) / ePub
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 drug’s 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 nation’s 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 industry’s 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.
He was struck with the soldiers’ capacity to tolerate these severe injuries even before they received any painkiller. The observation led to Beecher’s lifelong study of the body’s ability to control the sensation of pain. Years later, neuroscientists discovered that the brain can synthesize its own endogenous versions of morphine, which were named endorphins. Some wondered whether these substances might be related to the capacity for self-analgesia that Beecher observed, or the relief so commonly
industry got itself placed outside FDA’s regulatory control. In Senator Orrin Hatch thwarted Kessler by championing passage Avor_0375414835_4p_all_r1.ps 6/18/04 1:35 PM Page 65 LEAVING THE DARK AGES BEHIND, MOSTLY of the Dietary Supplement and Health Education Act, over the opposition of most professional and consumer groups. Written with heavy input from the supplement industry lobby and propelled by generous campaign contributions, the bill was nicknamed “the Snake-Oil Protection
Rezulin disaster occurred in a novel class of drug brand new to the marketplace. A similar problem could never arise in a drug that had been in use for nearly a century and held a trusted place in tens of millions of American medicine cabinets. Or so we’d expect. For decades, phenylpropanolamine, or PPA, was one of the most widely ingested drug products in the United States. Related to the amphetamine class of drugs, it had long been known to have some of the properties of “speed” but in milder
observational studies each have their own strengths and weaknesses, a major agenda for drug research and policy in Avor_0375414835_4p_all_r1.ps 6/18/04 1:35 PM Page 124 POWERFUL MEDICINES the coming years will be to figure out how the two approaches can be reconciled. At least since Descartes, Western science has earned its living by dividing up opposites like these, a way of thinking that has served us well but that has its own limitations. If it’s reconciliation we want, we’ll have to
addictive, making it difficult to stop treatment once it is started. The second was that long-term users were found to have sharply increased susceptibility to developing several kinds of cancer. The product’s manufacturer disputes the latter effect, arguing that the data “merely show an association, but do not prove a causal relationship.” Would you recommend approval of this drug? If so, would you allow it to be sold over the counter, as the manufacturer requests? The second product being