Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs

This volume is heavy, but it is not ponderous. The author, Jerry Avorn, is one of the nation's premier epidemiologists, who takes a special interest in the elderly. For more than 30 years he's been researching issues in pharmacology and has published prolifically (about an article every other month) in the staid medical journals that our doctors should be reading to keep abreast of current events in their field. Avorn knows his stuff. In this book, however, he has been freed from the constraints of the dry language of peer-review journals. Sure, this book may tell you what's wrong with the prescription drug development and delivery systems. Sure, it may save you (or whoever pays for your drugs) some money. Sure, it may even save your life. But what it will certainly do is to kill you: you'll die laughing. Here are some examples of the type of humor that appears once or twice on each page, for almost 500 pages: "Using the crude benchmark of $50,000 per QALY as the approximate threshold for a good buy, the analysis made Viagra look like an excellent deal. If we accept these results, any objection to the drug's cost, even at ten bucks a pill, goes limp. The difficulty arises in believing the inputs. The authors were astute enough to realize that cost-effectiveness analysis can rarely yield a single rigid number for such a complex issue, especially in the face of all those slippery assumptions. So they came upon an a posteriori list of plausible ranges for all the digits inserted into the model, to see if their output was sensitive to any of its members. This analysis shows that the findings stood up handsomely over a wide range of assumptions. It was, as the statisticians say, robust. But whether or not it was real is another matter; in the end, the flimsiness of the basic data used makes it difficult to consider this a hard number." (p. 257) "How very...twentieth century. Case after case of multimillion-dollar adverse-event settlements involving withdrawn drugs have demonstrated that this just isn't good enough anymore. Ignorance of the flaw is no excuse." (p. 94) "This is akin to asking your child how his day went at school and being told that he had a squabble with the teacher, when in fact he had hacked her to death with a machete. A fair report of the event would have mentioned something about stab wounds and not merely categorized it under the rubric `squabble.'" (p. 88) As the above quotes suggest, Avorn doesn't mince words. The book's conclusion, supported throughout, is that "We waste billions of dollars a year on prescription drugs that are excessively priced, poorly prescribed, or improperly taken." (p 418) He doesn't just describe the problem-and the political, economic and administrative systems that have reared it; he presents a road-map for an overhaul so that "...for a sum no greater than our current drug budget, medications could provide every American with the most productive and cost-effective intervent

Dr. Jerry Avorn does a masterful job of evaluating the benefits, risks, and costs of prescription drugs. There have been almost ten books in recent time delving into the issues of good drugs, dangerous drugs, ineffective drugs and the corrosive effects of commercial influence over medical research. This book goes into more detail and is more sophisticated than any of the others on this topic that I have seen. The list of problems that the consumer faces when taking many of these prescription drugs seems to be almost without limit. You will read about incomplete testing of drugs. You will also learn about testing in age groups that are different than the ultimate or target age groups. You will learn of drugs given to children without any non-adult testing. There are approved drugs such as Accutane that can have devastating results if the directions are not followed exactly. This book addresses the out-of-control drug advertising on TV, online and in print media. The costs of drugs are often based on whatever the market can bear, even when the key discoveries are not made by the drug company. The author explains that the real scientific evidence shows that many of the things that you can do to protect and maintain your own health are far more effective than what the drug companies products can do for you. Many of these things that you can do to stay healthy are more difficult to do than just popping a few pills - things like exercise, weight lose, stop smoking and eating a low-fat and low-carb diet.

Few people besides Jerry Avorn would have the courage and authority to write a book like this. An associate professor of medicine at Harvard Medical School and pharmaceutical researcher, he knows drugs and drug side effects more than any author I've read. If you are considering another book about medicine or drug companies, think again. This book will be the most important you read for a long time. It's easy to read and Avorn's wit and conversational writing style make it a joy for anyone. Cliches be damned, I could not put this down, reading about drug company scandal after scandal and what to do about it.

The book is gilded with so many metaphors, anecdotes and literary allusions, and it is written in such an engaging style, that it is a delightful read. Avorn is a wonderful teacher. This is also a mind-expanding book. I learned so much about a field that I thought I already understood pretty well. It felt like the biblical scales fell away from my eyes and I was able to see so much better: the history of the FDA's role in protecting the public (or is it the drug manufacturers?) from medications that are unsafe, ineffective or too expensive. The tradeoffs between risk, effectiveness and cost of drugs, and doctors' astonishing lack of information about these is a major theme of the book. But he taught me about many other areas as well. For example, the differences between prospective, controlled and observational studies and the ego-personalities behind each type--and why we need both types. These are just a couple examples. I might add that Dr. Avorn is really not out to bash Pharma or doctors or anybody. He's just describing reality as it is. He does have some terrific ideas for solutions. I wonder how many billions of dollars we would save annually, and how much better U.S. health care would be if Jerry Avorn was head of the FDA. Hmmm... This book must have been a labor of love for Avorn-a gift to his readers. My friends have thanked me for giving them copies. I should caution that if you haven't been to college, this isn't for you. This book is for doctors, clinicians, legislators, health care policy professionals, and for people who care about the decisions that doctors make about their health. Tom Doerr, M.D.

Dr. Avorn's book is unique: it summarizes complex issues concerning modern medicines and related policies in a way that makes the field accessible to everyone and yet each chapter reflects the author's depth of knowledge and wisdom based on 25 years of patient care and active research at Harvard. He brings all relevant issues concerning modern drugs on the table, including effectiveness, safety, and costs, and draws connections that are not obvious to most of us but are essential to fully understand the interactions between patients, physicians, insurance companies, and drug manufacturers. Unless we understand this system and are willing to act accordingly, we will continue to pay too much for too little improvement in medicine and will further stretch our health care system to the limit. Dr. Avorn's book provides such an understanding accessible for everyone and is reason for hope.