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Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs Hardcover – Deckle Edge, August 17, 2004

4.4 out of 5 stars 20 customer reviews

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Editorial Reviews

Amazon.com Review

Profiteeering 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 mismanaged medications of 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 with comparisons 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. --Barbara Mackoff

From Publishers Weekly

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. Avorn, chief of the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women's Hospital in Boston, argues, "[F]or a sum no greater than our current drug budget, medications could provide all Americans with the most productive and cost-effective interventions in all of health care." Avorn claims, "[W]e waste billions of dollars a year on prescription drugs that are excessively priced, poorly prescribed, or improperly taken." To remedy this situation, reform is needed in how new drugs are approved and marketed. In addition, practicing physicians need access to state-of-the-art information about new medications, including how well they compare to established (and often cheaper) products. Computer technology, Avorn shows, can bring together the latest information on treatment options and drug contraindications. But changes in the pharmaceutical industry itself—of which Avorn does not hold a flattering view—may be necessary to eliminate pressure to prescribe the most heavily advertised and costly new product when old standbys are equally effective. Though this informative and witty book is overly long, it makes a compelling case for prescription sanity and shows how constructive change can realistically be achieved.
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

This Book Is Bound with "Deckle Edge" Paper
You may have noticed that some of our books are identified as "deckle edge" in the title. Deckle edge books are bound with pages that are made to resemble handmade paper by applying a frayed texture to the edges. Deckle edge is an ornamental feature designed to set certain titles apart from books with machine-cut pages. See a larger image.

Product Details

  • Hardcover: 464 pages
  • Publisher: Knopf; 1 edition (August 17, 2004)
  • Language: English
  • ISBN-10: 0375414835
  • ISBN-13: 978-0375414831
  • Product Dimensions: 6.6 x 1.6 x 9.6 inches
  • Shipping Weight: 2 pounds (View shipping rates and policies)
  • Average Customer Review: 4.4 out of 5 stars  See all reviews (20 customer reviews)
  • Amazon Best Sellers Rank: #1,872,063 in Books (See Top 100 in Books)

Customer Reviews

Top Customer Reviews

By M. Agelasto on March 8, 2005
Format: Hardcover
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.
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Format: Hardcover
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.
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Format: Hardcover
Easy to read and follow, wide-ranging in scope, dripping with insight from a real medical insider, and very humorous besides, this book is a tour-de-force in many aspects. Problems with HMOs, the FDA, Big Pharma, and out-of-control drug advertising are all addressed.

The benefits of drugs are addressed by giving examples of the launching of some that were later risky enough to be banned. The most detailed illustration of the benefits and limitations of the randomized clinical trial (RCT) I have ever read are in this book. Dr. Avorn also gave the best illustration of the advantages of the observational study on large numbers of subjects as a better way to find the risks of drugs.

The risks of drugs have many causes besides thier inherent toxicity. Dr. Avorn shows how the subjects in an RCT may be healthier or younger or too male compared with the likely drug target group, how dosages may be too high for children or the elderly, how adverse effects are hard to predict and under-reported and that RCTs are not run for enough time. He notes how too many drugs are approved by the FDA based on handy measurements such as blood pressure or cholesterol levels, not real clinical endpoints, like death.

The costs of drugs are noted to be whatever the markets will bear, even when the key discoveries are made in government or academic labs, as is usually the case.

He writes about the drug information overload for physicians from ads or "detail women" from Big Pharma, and of "education" courses put on by Big Pharma, all biased of course.

Dr. Avorn has, for >25 years, been involved in studies on how to use computerized data on filled prescriptions and later medical histories of each patient to correlate drug use with well-being.
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