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Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises Hardcover – January 15, 2005

4.8 out of 5 stars 10 customer reviews

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Editorial Reviews

From The New England Journal of Medicine

Armed with support from the Robert Wood Johnson Foundation, Deyo and Patrick make a well-documented -- if depressing -- argument that doctors, scientists, and laypersons alike are far too easily seduced by industry hype for merely new (as opposed to truly better) drugs and medical devices. Deyo and Patrick are appropriately tough on the Food and Drug Administration's (FDA's) drug approval process, in part because the agency's mission does not include weighing one drug against another but, rather, merely approving a new drug if it works at all, even if it has no advantages over cheaper drugs already on the market. The authors are even tougher on the FDA's process for approving medical devices, deftly hanging the agency by its own quotes, such as this gem: "New devices are less likely than drugs to have their safety established clinically before they are marketed." And, of course, they note that it is not part of the FDA's mission to regulate surgical procedures. But the basic message from Deyo and Patrick, both professors at the University of Washington, is that we are all too ready to believe that new, expensive, or aggressive care must be better than older, cheaper, or milder treatments. It is a cultural thing, they argue, citing one study that showed that whereas 34 percent of Americans believe that modern medicine can cure almost anything, only 27 percent of Canadians and 11 percent of Germans do. There is little that is new in this book for anyone who has followed the medical journals and the mainstream press over the past decade. But it is an excellent reference for the reader who wants details of the horror stories that have grabbed headlines: the rise and fall of the fenfluramine-phentermine diet pill (sometimes referred to as "fen-phen"); the high failure rate associated with some cardiac pacemakers; the widespread use of bone marrow transplantation for advanced breast cancer before studies finally showed that it was no more effective, and could be more dangerous, than standard chemotherapy; the appalling suppression or delayed publication of "negative" results in studies funded by drug makers. Citing example after example, Deyo and Patrick are at their most successful when they detail the degree to which the pharmaceutical industry, the most profitable industry in the United States, sometimes abuses its enormous power. Happily, just when you are about to move on to something, anything, else, Deyo and Patrick come up with a comparatively upbeat ending, exploring some remedies for America's ills. They like the idea of having insurers pay provisionally for some new treatments so that the insurers could easily stop payment if a treatment proved worthless or dangerous. They like the idea, endorsed last September by a coalition of editors of medical journals, including this one, of a national registry for clinical trials in order to make it harder for the manufacturers of drugs and devices to suppress negative findings. They want to stop drug companies from claiming marketing expenses as tax deductions -- a no-brainer, in my mind. And they want a better post-marketing surveillance system for drugs and devices. None of this will be easy. Fixing the mess, the authors conclude, will "require action by doctors, hospitals, the media, and the government." Judy Foreman, Ed.M.
Copyright © 2005 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

From Booklist

The authors, medical research academics, present their analysis of a phenomenon in American culture, which seeks state-of-the-art medicine regardless of the price. Avoiding controversial issues such as stem-cell research and abortion, theirs is an indictment of our health-care players, including the drug industry, device manufacturers, the media, the government, advocacy groups, hospitals, doctors, and patients. Deyo and Patrick recommend all parties change their behavior. Their concerns include aggressive marketing of new and costly products that contain only modest or no advantage over older alternatives, and doctors performing unnecessary operations. They focus upon whether and how new treatments sometimes become popular. They conclude that while fewer people in the U.S. can get insurance, people with insurance are getting a richer package of treatments although some of the technology they are buying is worthless. This is an important topic, and although many may argue with the authors' views, they present an excellent framework for debate and discussion. Mary Whaley
Copyright © American Library Association. All rights reserved
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Product Details

  • Hardcover: 336 pages
  • Publisher: AMACOM; 1 edition (January 15, 2005)
  • Language: English
  • ISBN-10: 0814408451
  • ISBN-13: 978-0814408452
  • Product Dimensions: 9.3 x 6.3 x 1.3 inches
  • Shipping Weight: 1.4 pounds
  • Average Customer Review: 4.8 out of 5 stars  See all reviews (10 customer reviews)
  • Amazon Best Sellers Rank: #972,437 in Books (See Top 100 in Books)

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Customer Reviews

Top Customer Reviews

Format: Hardcover Verified Purchase
This book is as good as Nortin Hadler's The Last Well Person: How to Stay Well Despite the Health-Care System and Worried Sick: A Prescription for Health in an Overtreated America (H. Eugene and Lillian Youngs Lehman). They all cover the same subject of how ineffective are numerous invasive and expensive medical treatments and how overpriced new drugs are no better than old ones costing far less.

The authors of this book are focused on the introduction of new treatment and remedies. Their analysis of the quality control (or lack of it) within the health care industry is concerning.

Drug testing is the most rigorous; yet it still fails in approving safe and effective drugs. Big Pharma just has to demonstrate to the FDA through randomized clinical trials that a drug is better than taking a placebo. Yet, many drugs deemed safe in clinical trials have to be recalled later when their side effects are observed over a broader patient population. And, their efficacy over placebo can be demonstrated by two statistically conclusive clinical trials without disclosing the ones that were not conclusive. The FDA never tests whether a new expensive drug is really any better than the cheaper older one or whether it is better than aspirin or other OTC drug. Thus, even the "rigorous" FDA drug approval process fails in assessing both the efficacy and safety of a new drug. The prescription of drugs for different purpose than its original use is not even regulated (off label use).
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Format: Hardcover
Hope or Hype is a fascinating look at how we approach new medical technologies and interventions in our medical system. It is extremely well-written and readable, both for medical professionals and the general public. He raises significant ethical issues that we must confront given the current and impending health-care expenditure crisis in this country. He also provides extensive historical examples of how we have introduced "innovative" healthcare treatments (in an uncontrolled way) that have proven to be unhelpful and often harmful. This is an important book for people within the health care service industry as well as for all consumers of health care in the United States.
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Format: Hardcover
A thoughtful and thorough gathering of medical practice information as driven by the prescription drug industry. How to read the glowing advertising with careful scrutiny is just one benefit. The authors write clearly about complex subjects. While not racy reading, it should be read by any of us who have or will have medical needs.
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Format: Hardcover
Hope or Hype illustrates how a market based healthcare sans proper checks and balances can perversely incentivize the system (physicians, drug makers, device makers, surgical technique innovators, insurance companies, hospitals, and even the good old FDA), endangering the public's health and raising costs.

Insufficient research, dangerous marketing techniques to consumers and physicians alike, poor government oversight, and the lure of money make for dangerous, ineffective, and sometimes unecessary intervetions (prescription drugs, medical devices, techniques, and diagnostic testing). Of course all of this is basically driven by greed and complacency with consequences for quality of care and healthcare costs.

Valuable for demystifying (1) the FDA process for vetting new drugs and (2)drug marketing alone, this is a fine contribution to the national discussion on healthcare reform and an excellent advocacy resource for consumers. Only 4 stars because the writing is a bit loose and the first half of the book is too redundant and relies too heavily on anecdote. After reading this, some readers may want to read Food Politics - after all, prevention is worth its weight in gold!
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Format: Hardcover
Why are Americans obsessed with medical miracles? In Hope Or Hype: The Obsession With Medical Advances And The High Cost Of False Promises, two doctors who are experts on ethical and policy issues in the medical world examine the false premises and promises the medical community makes to consumers, from pharmaceutical and equipment companies eager to promote new technologies and cures to physicians and hospitals too quick to prescribe costly medicines or surgeries. The hazards of such unnecessary treatments are provided within an overview of the drug and medical industries as a whole.
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