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? Groundbreaking research has given us many remarkable new medicines, but America’s drug evaluation process, once the envy of the world, is being seriously compromised. Under pressure from drugmakers, the FDA has been lowering its approval standards and has let poorly effective or risky products enter the market—while our prescription prices, the highest in the world, put crucial treatments beyond the reach of many. In Rethinking Medications, Dr. Jerry Avorn explains how we got here and what we can do to ensure that our medicines are dependably effective, safe, and affordable. Part of the problem is the power of pharma’s biggest-in-Washington lobbying clout, which influences members of Congress from both parties. That leverage is extended by the FDA’s growing dependence on fees the industry pays to get its drugs approved. The increasingly revenue-driven US healthcare system shapes the way doctors prescribe medications—sometimes to the detriment of their clinical decisions. Based on his decades of practice and research at Harvard Medical School and his role at the very center of many of these controversies, Dr. Avorn presents compelling clinical illustrations of these issues across the medical spectrum: from cancer drugs to opioids, from treatments for rare diseases to psychedelics. Throughout, he offers practical steps that consumers, policymakers, and practitioners can take to address these problems—at a moment when our assumptions about scientific evidence, regulation, pricing, and the role of government are being contested as never before.

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.