POWERFUL MEDICINES

Cogent analysis of how pharmaceutical drugs are approved, promoted, and prescribed in this country, with some well-considered recommendations for improving the present system.

According to Avorn (Medicine/Harvard Medical School), Americans waste billions of dollars on prescription drugs that are overpriced, poorly prescribed, and improperly taken. He draws on his extensive experience as researcher and physician to explore the relationships between benefits, risks, and the economic impact of prescription drugs. While the FDA comes under scrutiny for its failure to properly assess the risks of such medications as the diet drug Redux and the diabetes drug Rezulin, this is not another FDA-bashing book. Avorn’s picture is bigger. Through case studies, he examines decisions made by the regulatory agencies, pharmaceutical companies, health policymakers, and physicians that reveal faults in the entire system. After examining how benefits and risks are discovered and measured, he turns to the difficult question of how these are balanced against each other when making decisions about a drug’s use. Avorn finds that in the real world, the major source of information about drugs is the promotion departments of pharmaceutical companies. Surrounded by “an almost suffocating plethora of information of very uneven quality,” physicians have not been prepared by their medical education to deal with it. He proposes an educational outreach program based in medical schools that would send academic “detail men” to doctors’ offices just as drug companies do. They would provide neutral, evidence-based assessment of drug choices so that physicians would know which treatments were more better, safer, and more cost-effective. Avorn points to Canada, Australia, and Great Britain as countries whose drug-assessment procedures we can learn from. His final chapters offer concrete, practical ideas for improving the ways in which drugs are evaluated and pertinent information about them is disseminated.

Marked by solid scholarship, measured criticism, and pithy comments: an informative and highly readable study that makes a significant contribution to the ongoing discussion of an important health care issue.