Rethinking Medications

Suddenly, everything seems up for grabs about the medicines we take: Do they really work as advertised? Do some of them have dangerous, undisclosed side effects? Why are they so expensive, even unaffordable? A leading medical expert provides a clear-headed, dispassionate understanding of life-and-death questions that have suddenly become so contentious. Groundbreaking research has given us many remarkable new drugs to treat conditions that have plagued patients for generations. But at the same time America’s drug evaluation process, once the envy of the world, is being seriously undermined. Under pressure from the pharmaceutical industry and politicians, the Food and Drug Administration has lowered its approval standards to allow new medicines onto the market without the rigorous assessment that once made it the global gold standard for medication regulation. Instead of carefully reviewed scientific evidence, government officials now make alarming public statements about effectiveness and risks, unmoored from scientific evidence. All this while out-of-control drug prices—far higher in the US than anywhere else in the world—put badly needed treatments beyond the reach of many patients. Dr. Jerry Avorn, a physician and professor of medicine at Harvard, has been studying these issues for decades. In Rethinking Medications, he engagingly explains how we got here and provides concrete solutions to ensure that all our medicines are effective, safe, and affordable. The book takes on the most fundamental aspects of the medicines we take: - Does it work? Who says? How do we know? - Is it safe? What’s the evidence? How can we be sure? - Why is my prescription so expensive? Is it worth what it costs? Who determines that price? Why does the US pay twice as much as other countries for the same medicines? - With new leadership at FDA, CDC, NIH, and the whole Department of Health and Human Services, who decides these life-and-death questions for the nation, and how well are they doing their jobs? - …and finally: how do all these issues affect the choices that patients and doctors make every day? Rethinking Medications draws on Dr. Avorn’s long experience as a clinician, outspoken patient advocate, and the founder of an internationally respected research group at Harvard. He illustrates this accessible and entertaining account with examples from cancer drugs to opioids, from treatments for rare diseases to psychedelics. Throughout, Dr. Avorn proposes practical advice for consumers, policymakers, and practitioners to address these problems. At a time when all our assumptions about scientific evidence, regulation, pricing, and the role of government are under assault as never before, this book points to actionable solutions within reach and a way out of the current confusion, beyond all the noise.

Jerry Avorn, MD, is a professor of medicine at Harvard Medical School and a senior internist in the Mass General Brigham health-care system. He built a leading research center at Harvard to study medication use, outcomes, costs, and policies and developed the educational outreach approach known as "academic detailing," providing evidence-based information about medications to prescribers. One of the nation’s most highly cited researchers, Dr. Avorn is the author of Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs, and he has written or cowritten over six hundred papers in the medical literature as well as opinion pieces in The New York Times, The Washington Post, JAMA, and The New England Journal of Medicine.