Powerful Medicines
The Benefits, Risks, and Costs of Prescription Drugs
2004
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.
What they're saying
“[The author] brings considerable skills as a clinician and epidemiological researcher to bear on this task, along with a broad knowledge of the history of science and delightful writing style. Avorn uses an engaging combination of clinicial case histories, data, and evidence-based explanation to provide both lay and professional audiences with the benefit of more than twenty-five years of work in the field....In compelling language that is both witty and clear, Avorn describes the realities that underlie our current crises of drug usage, safety, and cost.”
Health Affairs
“Provides insight into one of the central medical debates of our time: how to ensure that prescription drugs are affordable, effective and safe.”
American Scientist
“Expressive [and] well-documented….Dr. Jerry Avorn brings convincing data and sharp analysis to Powerful Medicines, his timely, challenging appraisal of health policy.”
The Boston Globe
“Passionate and well-informed….[Avorn] goes beyond articulating the problems and makes many creative suggestions about how we can do better.”
Annals of Internal Medicine
“Deepens a reader’s understanding of the complex cost-benefit analysis involved with prescription drugs.”
The New York Post
“Engaging….Holds significant promise to improve the U.S. health care system.”
Science
“Entertaining….Goes a long way in explaining how our medicine, once so vaunted, has become so bitter.”
The New York Times Book Review
“Avorn is equal parts teacher and reformer....He proposes solid ideas about how to build a more rational system of drug evaluation.”
The American Prospect
“Often funny, always educational, with a bedrock of science, vision, and skepticism, Powerful Medicines provides a solid foundation for understanding and implementing the best aspects of evidence-based medicine today.”
Journal of the American Medical Association
In Powerful Medicines, Dr. Avorn 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.
Profiteering pharmaceutical companies and the FDA have met their match in Dr. Jerry Avorn, a Harvard Medical School researcher and clinician. In Powerful Medicines, he brilliantly combines patient vignettes, scientific critique, and statistics to create a risk/benefit balance for prescription drugs. His premise: "Every drug is a triangle with three faces--representing the healing it can bring, the hazards it can inflict, and the economic impact of each." Avorn's gifts as a writer are apparent in the prologue, an edgy account of the mismanagement of medications for several stroke patients. He then details the intellectual history of drug assessment and benefits, including the biblical food police in the Book of Daniel, the deer-in-the-headlights Estrogen debacle, and the current infatuation with Ginseng and other alternative medicines. Turning from benefits to risks, Avorn examines diet pills, Viagra, cold medicines, and diabetes drugs, comparing them to the decisions of Dr. Fautus--who makes life-changing bargains between safety and effectiveness. Other insightful chapters offer views of prescription drug economies and comparative healthcare around the globe. The final chapters create an insightful template for emerging public policy. Throughout, Avorn pulls at common threads: the line between personal and public responsibility, the perils of drug promotion, and the marketplace that usurps the role of scientific evidence in selecting treatments. Anyone looking for a quick muckraking read will be disappointed. But Avorn's views, literate and complex, will frame the debate on prescription drugs for years to come.”
Comments on Powerful Medicines
“This is an authoritative, stunningly comprehensive, and beautifully written work about a subject that ought to interest every American. At last: a smart Harvard doctor who knows drugs, understands FDA and regulatory policy, and has a sense of humor. Unbelievable!”
– Donald Kennedy, Ph.D., Editor-in-chief, Science; President emeritus, Stanford University; Former Commissioner of the FDA
“Powerful Medicines is a must-read for anyone interested in the use, abuse, and economics of prescription drugs. The issues it addresses are central to the ongoing debate about how to reduce the cost and improve the quality of health care in America."
– Senator Edward M. Kennedy
“In Powerful Medicines, Dr. Avorn brilliantly demonstrates the corrosive effects of commercial influence over medical research, education, and clinical care. This compelling book spells out the adverse effects such privatization can have on the health care system and ultimately on patients.”
– Bernard Lown, M.D., Winner of the Nobel Peace Prize
“Only Jerry Avorn, with his insider's penetrating vision, could show us the triumphs and travesties, promises and perils of today's prescription drugs. Refreshingly, he not only diagnoses the ills of our current system but proposes novel remedies that we are well advised to heed.”
– Jerome Groopman, M.D.Author, The Anatomy of Hope; Recanati Professor of Medicine, Harvard Medical School
"In this pragmatic volume, Avorn sets out an impressive plan for the American health care system to get helpful drugs to those who need them, protect patients from dangerous side effects and keep costs within reasonable limits… Informative and witty… makes a compelling case for prescription sanity and shows how constructive change can realistically be achieved."
– Publisher’s Weekly
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