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

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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.
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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 Women’s 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.


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Additional Information

Publisher
Vintage
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Published on
Dec 10, 2008
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Pages
480
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ISBN
9780307489753
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Language
English
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Genres
Health & Fitness / Health Care Issues
Medical / Administration
Medical / Health Policy
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Content Protection
This content is DRM protected.
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Eligible for Family Library

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A New York Times bestseller/Washington Post Notable Book of 2017/NPR Best Books of 2017/Wall Street Journal Best Books of 2017 

"This book will serve as the definitive guide to the past and future of health care in America.”—Siddhartha Mukherjee, Pulitzer Prize-winning author of The Emperor of All Maladies and The Gene  

At a moment of drastic political upheaval, An American Sickness is a shocking investigation into our dysfunctional healthcare system - and offers practical solutions to its myriad problems.

In these troubled times, perhaps no institution has unraveled more quickly and more completely than American medicine. In only a few decades, the medical system has been overrun by organizations seeking to exploit for profit the trust that vulnerable and sick Americans place in their healthcare. Our politicians have proven themselves either unwilling or incapable of reining in the increasingly outrageous costs faced by patients, and market-based solutions only seem to funnel larger and larger sums of our money into the hands of corporations. Impossibly high insurance premiums and inexplicably large bills have become facts of life; fatalism has set in. Very quickly Americans have been made to accept paying more for less. How did things get so bad so fast?

Breaking down this monolithic business into the individual industries—the hospitals, doctors, insurance companies, and drug manufacturers—that together constitute our healthcare system, Rosenthal exposes the recent evolution of American medicine as never before. How did healthcare, the caring endeavor, become healthcare, the highly profitable industry? Hospital systems, which are managed by business executives, behave like predatory lenders, hounding patients and seizing their homes. Research charities are in bed with big pharmaceutical companies, which surreptitiously profit from the donations made by working people. Patients receive bills in code, from entrepreneurial doctors they never even saw. 

The system is in tatters, but we can fight back. Dr. Elisabeth Rosenthal doesn't just explain the symptoms, she diagnoses and treats the disease itself. In clear and practical terms, she spells out exactly how to decode medical doublespeak, avoid the pitfalls of the pharmaceuticals racket, and get the care you and your family deserve. She takes you inside the doctor-patient relationship and to hospital C-suites, explaining step-by-step the workings of a system badly lacking transparency. This is about what we can do, as individual patients, both to navigate the maze that is American healthcare and also to demand far-reaching reform. An American Sickness is the frontline defense against a healthcare system that no longer has our well-being at heart.
In Baltimore's inner-city neighborhood of Upton/Druid Heights, a man's life expectancy is sixty-three; not far away, in the Greater Roland Park/Poplar neighborhood, life expectancy is eighty-three. The same twenty-year avoidable disparity exists in the Calton and Lenzie neighborhoods of Glasgow, and in other cities around the world.

In Sierra Leone, one in 21 fifteen-year-old women will die in her fertile years of a maternal-related cause; in Italy, the figure is one in 17,100; but in the United States, which spends more on healthcare than any other country in the world, it is one in 1,800 (and now, with the new administration chipping away at Obamacare, the statistics stand to grow even more devastating). Why?

Dramatic differences in health are not a simple matter of rich and poor; poverty alone doesn't drive ill health, but inequality does. Indeed, suicide, heart disease, lung disease, obesity, and diabetes, for example, are all linked to social disadvantage. In every country, people at relative social disadvantage suffer health disadvantage and shorter lives. Within countries, the higher the social status of individuals, the better their health. These health inequalities defy the usual explanations. Conventional approaches to improving health have emphasized access to technical solutions and changes in the behavior of individuals, but these methods only go so far. What really makes a difference is creating the conditions for people to have control over their lives, to have the power to live as they want. Empowerment is the key to reducing health inequality and thereby improving the health of everyone. Marmot emphasizes that the rate of illness of a society as a whole determines how well it functions; the greater the health inequity, the greater the dysfunction.

Marmot underscores that we have the tools and resources materially to improve levels of health for individuals and societies around the world, and that to not do so would be a form of injustice. Citing powerful examples and startling statistics (“young men in the U.S. have less chance of surviving to sixty than young men in forty-nine other countries”), The Health Gap presents compelling evidence for a radical change in the way we think about health and indeed society, and inspires us to address the societal imbalances in power, money, and resources that work against health equity.
The acclaimed author of Carved in Sand—a veteran investigative journalist who endured persistent back pain for decades—delivers the definitive book on the subject: an essential examination of all facets of the back pain industry, exploring what works, what doesn't, what may cause harm, and how to get on the road to recovery.

In her effort to manage her chronic back pain, investigative reporter Cathryn Jakobson Ramin spent years and a small fortune on a panoply of treatments. But her discomfort only intensified, leaving her feeling frustrated and perplexed. As she searched for better solutions, she exposed a much bigger problem. Costing roughly $100 billion a year, spine medicine—often ineffective and sometimes harmful —exemplified the worst aspects of the U.S. health care system.

The result of six years of intensive investigation, Crooked offers a startling look at the poorly identified risks of spine medicine, and provides practical advice and solutions. Ramin interviewed scores of spine surgeons, pain management doctors, physical medicine and rehabilitation physicians, exercise physiologists, physical therapists, chiropractors, specialized bodywork practitioners. She met with many patients whose pain and desperation led them to make life-altering decisions, and with others who triumphed over their limitations.

The result is a brilliant and comprehensive book that is not only important but essential to millions of back pain sufferers, and all types of health care professionals. Ramin shatters assumptions about surgery, chiropractic methods, physical therapy, spinal injections and painkillers, and addresses evidence-based rehabilitation options—showing, in detail, how to avoid therapeutic dead ends, while saving money, time, and considerable anguish. With Crooked, she reveals what it takes to outwit the back pain industry and get on the road to recovery.

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